Retrospective #311: How Can I Manage My Type 2 Diabetes?

Type 2 Diabetes is a Dietary Disease. Your blood sugar (glucose) rises and falls depending on what you eat. When you eat carbohydrates, there is a direct and simple relationship to your blood sugar level. It goes up. And when you eat more protein than your body needs, there is, to a lesser extent, a secondary and delayed rise in blood sugar. Fat, the “other” (third) macronutrient, has virtually no effect on blood sugar.

Carbohydrates – including simple sugars and more “complex” carbs, especially those in packaged foods that have been processed and refined to the point where they are virtually simple glucose – will have the most impact on your blood sugar. In contrast, unprocessed, whole vegetables – “real food” -- although also carbohydrates, will digest at a slower pace. However, all carbohydrates – simple, processed or “whole” – will become glucose “under the curve” (in your blood) within an hour or two of eating them. That’s better than a few minutes, but it’s still an elevated blood sugar.

So, to manage your type 2 diabetes yourself, by what you eat, you’ll need to educate yourself about what carbs are and what foods contain them. You will need to study the Nutrition Facts panel on processed foods, paying attention to the carbohydrate grams. And don’t forget to check the portion size. It is usually much smaller than you will eat.

You will also need to learn what effect carbs have on your blood sugar. That depends on your degree of Insulin Resistance (IR).  As a frame of reference though, if you fasting blood glucose is not between 70 and 100mg/dl, you have a degree of Insulin Resistance. If it is between 100 and 126mg/dl, you are considered Pre-Diabetic. If your fasting blood glucose is 126mg/dl or greater, you are, frankly, a Type 2 Diabetic. Do you know your fasting blood sugar?

You’re thinking that your doctor will test your fasting blood sugar (or A1c) if he or she suspects you have IR or are Pre-diabetic or Diabetic. True, but he/she can only monitor your Type 2 Diabetes at the time of your office visit. Type 2 Diabetes is a Dietary Disease, so it’s up to you to manage your blood sugar. And to do that you’ll need a meter.

In addition to testing your blood after an overnight fast, you’ll want to know how your blood sugar responds to the foods you usually eat. You do this by testing both before and after “test” meals. To find out how high your blood sugar spikes, test before and then 1 hour after starting to eat. To find out how close to “normal” it returns, test again 2 hours after that meal. If your blood sugar doesn’t drop to near where you began by 2 hours postprandial (after eating), you are Pre-Diabetic. If it isn’t below 140mg/dl, you have Type 2 Diabetes and you have eaten way too many carbs in that meal. Blood sugar in a “healthy” person never goes above 140mg/dl, even 1 hour after a big carb load.

You will learn quickly what you should eat and what you shouldn’t. Carbs are hidden everywhere, especially in plain sight. Fruit, for example, is just a simple carbohydrate: sugar and water. At least whole fruit contains some fiber, so it’s better than juice, but otherwise it’s not much different from a candy bar. Fruit juice will send your blood glucose through the roof, and put a load on your liver, and if your liver is already full of glycogen, it will make fat from sugar!

Bread has a glycemic index of 100, meaning it is the definition of a high carb food. The ingredients list of virtually all breads begin with flour (a highly processed, 100% carbohydrate), then water, and then always some form of sugar.

Proteins digest slowly, and the component amino acids not taken up by your cells will be stored in the liver. By a process called gluconeogenesis, the liver can make glucose from some of them, which is a good thing. It can also make glucose from the glycerol backbone of a triglyceride (fat) molecule. Small amounts of glucose are essential, whereas the body has ZERO requirements for CARBOHYDRATES. But the liver of Type 2s makes glucose even when the body doesn’t need it. That’s why clinicians prescribe Metformin to suppress this unwanted glucose production.

So, take charge of your Pre-Diabetes or Type 2 Diabetes. Manage what you eat. Monitor your blood sugar. And eat to your meter. It’ll take time to learn what affects your blood sugar level and by how much. How strictly you eat low carb will determine how your blood sugar responds. Just remember: Type 2 Diabetes is a Dietary Disease and YOU are in charge of managing it. Your doctor is there just to monitor your improved blood sugar control and your weight loss.