Retrospective #329: My FBGs have been transformed, Part 1

In early 2016 I believed a couple “tweaks” to my self-treatment of Type 2 Diabetes resulted in a blood sugar control “break through.” When originally written, it was too soon to say I had found “the secret.” Here’s what I wrote then:

1) I am now adhering with a high level of compliance to the following 5 guidelines that Andreas Eenfeldt (www.thedietdoctor.com) mentioned in a video I watched in January [2016]:  I now a) follow strictly a low carb diet, b) eat only when hungry, c) sleep 7-8 hours a night, d) weigh myself daily, and e) practice intermittent fasting. The two IF methods Dr. Eenfeldt “prescribes” are 5:2 and 16:8. I chose 16:8, seven days a week! I skip breakfast because I’m not hungry at breakfast (see #326). I also sometimes skip lunch, or eat a very light, keto lunch (e.g., one or two hard boiled eggs). As a result of the IF, I think I am in a mild form of nutritional ketosis for more hours every day.

2) For the last 10-12 years, while eating Very Low Carb (VLC), I have been taking 500mg of Metformin once a day as my only oral anti-diabetes medication. (Before that, to avoid hypos, my doctor stopped my Avandia, which I had just started, and had titrated me off a sulfonylurea (Glyburide) from 20mg to 10 to 5mg and then later from 5mg to 2½ to 0. He also had cut my Metformin from 2000mg to 1000 to 500. These changes all occurred during “week 1” of VLC.

I provide this history to explain why I had been reluctant to increase my oral anti-diabetes meds. It was PRIDE, and the fact that no one had ever suggested that I needed more Metformin or that I add another anti-diabetes med, until last year – and if they had, I’m not sure I would have agreed. But the conventional medical wisdom is that Type 2 diabetes is a “progressive” disease. That’s what drives the medical corollary to increase medications. And, my A1c had been creeping up, and it was becoming increasingly difficult for me to get fasting readings below 100mg/dl. Was I having “compliance issues” with my VLC diet or was the disease actually progressing? This question was unanswered, so adding a new medicine was an existential question, and it was a matter of pride for me. But my health (the risk of all the microvascular and macrovascular complications) was at stake. This is the crossroads: – more medication or better compliance with diet – that every Type 2 or “Pre-diabetic” faces every day, or on every doctor’s visit, for a lifetime.

I decided that for me the first step for was more vigilant self-management of my diet. After all, TYPE 2 DIABETES IS A DIETARY DISEASE. That’s why I began the steps described in 1) above.  But that still left the question: If my disease was in fact progressing (not a case entirely of my “compliance” slipping), should I consider increasing my medication from just 500mg of Metformin once a day or adding another class of meds? I pondered this question for months.

Scene 2: For years I have attended classes offered by a Certified Diabetes Educator (CDE), both to support her as well as try to persuade her to subscribe to and teach a Low Carb Way of Eating for diabetics. So far, I’ve failed! Last year she suggested I try the new SGLT2 inhibitors. SLGT2s block the re-absorption of glucose in the kidney, increase glucose excretion, and thus lower blood glucose levels. I read all the latest research and decided I was not ready to go there. So instead, last December, I asked my doctor to increase my Metformin to 500mg TWICE a day, and he said, “okay.”

Scene 3: In January I attended a conference on Metabolic Therapeutics and learned that a sub-set of attendees, all of whom were very healthy athletes/body builders, were taking supplemental ketones to help lose weight and stay in ketosis. Some of them, including the conference organizer and a major presenter, were also maxed out on Metformin, which increases insulin sensitivity and suppresses gluconeogenesis to minimize body fat by promoting breakdown and burning of body fat for energy. This was an eye-opener for me. Metformin is a wonder drug for many reasons. It’s mechanism of action is not completely understood, but in a recent JAMA article, it was seriously advocated for everyone. And, unlike the SLGT2s, is has been around for well over 50 years, is demonstrably safe, and really cheap. So, after the conference, in February I decided to ask my doctor to increase my Metformin dose to 1500mg/day.

In the weeks following implementation of that decision, my fasting blood sugars slowly began to transition. And by the second half of March (2016), after a long hiatus, I was routinely getting fasting readings (FBG) below 100mg/dl again, mostly in the 90s. What happened next, however, was quite remarkable. See Part 2 of this story tomorrow.