Friday, November 22, 2019

Retrospective #279: My fasting blood glucose is 85mg/dl

My Fasting Blood Glucose (FBG) was 85mg/dl (4.22mmol/l) this morning. That’s not “normal” for me. I have a “broken glucose metabolism.” It has been broken for more than half my life. I am Carbohydrate Intolerant. I was diagnosed a Type 2 diabetic over 33 years ago (1986) and was certainly “pre-diabetic” for years before that with Impaired Glucose Tolerance (IGT) and then Impaired Fasting Glucose (IFG). That’s how my Type 2 diabetes was discovered. On my first office visit, an observant GP saw that I was obese and ordered a fasting plasma (blood) glucose test.
In those days the threshold for a diagnosis of Type 2 diabetes was two consecutive lab tests of 140mg/dl or more. (Today it’s 126mg/dl or an A1c test.) That doctor, whom I only saw once (I moved), did the usual thing in those days: he prescribed a sulfonylurea, micronase (generic: glyburide), and probably told me to lose weight by “eating less and exercising more.” The “medically advised” diet in those days hewed to the newly formulated Dietary Guidelines for Americans, first published in 1980 and updated every 5 years thereafter. The 2020 version is being drafted now.
Of course, as everybody knows, it’s virtually impossible to lose weight and keep it off on a calorie-restricted, balanced diet. Your body “craves” more. It doesn’t want you to “starve.” So, it’s constantly signaling  you that you’re “hungry.” I put all these words in quotes because they have become part of the lexicon of dieting by this failed meme. You know it. I know it. You would think that our clinicians would know it too, but the medical profession today is more a business that is governed by the “Standards of Practice” they must follow in order to be paid for the medical codes they submit, and the “bottom line.” Too bad for us that the government has intervened in the patient-doctor relationship.
So, how did my blood sugar get to be 85mg/dl this morning?  A brief history: on the restricted-calorie, balanced diet I probably followed, my weight continued to rise from 300 in 1986 until I weighed 375 pounds in 2002. And my anti-diabetic medications increased as well until I was maxed out on two drug classes and starting a third. I knew that before long, I would become an insulin-dependent Type 2 (or would be dead), if I didn’t change my Way of Eating.
Then, one day in 2002, on a regular office visit, my doctor said to me, “Have I got a diet for you!” A few months earlier he had read Gary Taubes’ “What If It’s All Been a Big Fat Lie,” the New York Times Sunday Magazine cover story. He tried the diet himself, lost 17 pounds, liked his lab tests, and decided to “prescribe” the diet for me. I was ready. I was motivated and willing to try something different. The diet was Very Low Carb (20g/day). I lost 60 pounds in the next 9 months. That was a major “lifestyle change,” but I was able to stick to strictly eating Very Low Carb because it worked!
But even before I lost that weight – the first day I started to eat Very Low Carb, actually – I had a hypo, a dangerously low blood sugar. I called the doctor, and he told me to stop taking the 3rd oral med. The next day, when I had another hypo, he told me to cut the other two classes of meds in half. A few days later he ordered me to cut them in half again. Eventually, I titrated off the Micronase (an SU) altogether, and today I just take a small dose of Metformin with supper. Over time, my A1c’s drop to the mid 5s, my HDL-Cs double (from 39 to 84), my triglycerides dropped 2/3rds from 137 to 49, and my inflammation marker (hsCRP) dropped from “high risk” to “low risk” of cardiovascular disease.
I kept the 60 pounds off for several years and then, over the summer of 2006, I regained 12 pounds. (It could have been the ice cream.) I recommitted to Very Low Carb and switched to “Bernstein” – Richard K. Bernstein’s Diabetes Solution 6-12-12 program” for diabetics. I lost 100 pounds in 50 weeks. Altogether I lost 170 pounds.
Along the way, until I learned (from my meter) what I could eat and what I couldn’t, my total calories dropped, eventually to 1,200 calories/day. My carbs of course have always been VERY low (about 5% today). My diet is mostly moderate protein (20%) and high (75%) “good” fats: saturated and monounsaturated. I try hard to completely avoid polyunsaturated fats (PUFAs). PUFAs are the so-called “vegetable” oils, like soybean, corn, sunflower and Canola oil.
I eat 1-2 small meals a day, with no snacks. If I were snacking, it would only be before supper, with sliced radishes with salt and ghee and diet tonic (vodka optional). I am not ever hungry. I have great energy levels and (at age 78) no health complaints. And when I eat like this for just a few days, my FBG drops from the low 100s to the 70s and 80s. 

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