Retrospective #235: Self- vs. medical management of T2DM

A Google search on self-management of Type 2 diabetes got 1.75 million “hits” in 2014. That’s a lot of advice, the vast majority of which, in my opinion, was really bad. So, in this sea of flotsam and jetsam, there wouldn’t be much chance that you’ll find this little rubber ducky (#235). But my post is going to show you how almost any well-designed Type 2 diabetes self-management program is far superior to any ADA/AHA/AMA/USDA designed protocol.

To show superiority, we will need a basis for comparison. For Type 2 diabetes, that would be the Standard of Care as set by the American Diabetes Association (ADA).  They, in turn, will be tied into the U.S. government’s standards for insurance reimbursement for Medicare and Medicaid patients, to which both supplemental and private insurers also generally conform. And since Type 2 diabetes is a medical condition that is commonly associated with a raft of co-morbidities, including obesity, metabolic syndrome, dyslipidemia, hypertension, and cardiovascular disease, the Standards of Care and insurance reimbursements for these conditions must also be factored in.

So, when you “present” as an overweight middle-aged person, with elevated fasting glucose (>100 but <126mg/dL) or an A1c that is “increased risk of diabetes” (5.7-6.0%) or “higher risk of diabetes” (6.1-6.4%), if you’re lucky, you’ll get Metformin and be told to “lose weight.” Not so lucky? You’re told, “Your glucose is a little high” and “We’ll watch it.”

You’re probably already on a cocktail of blood pressure meds for your overweight-related hypertension, and if you’ve been eating a low-fat, high-carb diet, as recommended since 1980 by the Dietary Guidelines for Americans, you probably also have high triglycerides, low HDL, and high LDL, with a total cholesterol over 200mg/dL (i.e., “High Cholesterol”). So, you’re on a statin too, to lower your Total and LDL Cholesterol, because that’s what statins do.

Your doctor must treat you for this complex of conditions. For example, an endocrinologist (a hormone specialist!) that I went to recently (without a referral), wanted to prescribe a statin for me because my total cholesterol was over 200. It did not matter to him that my total cholesterol (207mg/dL) was over 200 BECAUSE MY HDL WAS 90. (Friedewald formula: TC = HDL + LDL + TG/5). My LDL was 110 and my triglycerides 34. All that mattered to him was, that, to conform to the NCEP Standard, I be on a statin. I refused. He probably wrote in my chart, “Noncompliant.”

The Dietary Guidelines for Americans (DGA) are similarly one-size-fits-all. The DGA guides to this day that everyone, regardless of metabolic status, should eat the same low-fat, high carb diet. But the pendulum is beginning to swing.

We’re now told to eat less sugar and highly processed carbs (that’s good advice). We’re also told it’s the quality, not the quantity, of fat that matters. They say shun trans fats (very good advice) and eat more vegetable and seed oils and less saturated fat (that’s very bad advice). The government’s one-size-fits-all standards are still way behind the curve.

The American Diabetes Association Standard of Care, to achieve an A1c ≤7.0%, is hopelessly lax. The reason for this catastrophic Standard of Care is that it is a function of a failed treatment protocol. And it is a failed treatment protocol because of the government’s insistence on a LOW-FAT, HIGH CARB ONE-SIZE-FITS-ALL DIET for all Americans.

Never mind that this dietary is what has made us fat. Never mind that all carbohydrates raise your blood glucose. When you “present” as an overweight middle-aged person, with elevated fasting glucose, or A1c, your doctor should tell you to drastically curtail your intake of carbohydrates. Mine did. He started me on 20 grams of carbohydrate a day to lose weight. I did. I lost lots of weight (170 pounds in the first few years). I also had to stop taking virtually all my oral diabetes meds in the first week! Over time my blood pressure went from 130/90 to 110/70 on fewer meds. My HDL more than doubled, and my triglycerides dropped by two-thirds. And I am no longer, of course, taking a statin.

I self-monitor my T2DM by carefully watching what I eat, weighing myself daily, and monitoring my fasting blood sugar daily, and A1c’s, to a much higher standard than prescribed by the American Diabetes Association and my doctor.

What’s your HDL level?  Or does your doctor even care? You see, there’s no ‘magic pill’ to get your HDL up above the 40mg/dL range (50 for women), considered “borderline.” Only a low-carb diet does that…and lowers triglycerides too.