Sunday, February 2, 2020

Retrospective #351: Am I still a Type 2 Diabetic?

Note: If you are asking the question, “Am I a type 2 diabetic,” look at “How Diabetic Do You Want to Be? Part 1” (#344 and “…Part 2” (#345). But read on if you are interested in a short essay on the subject “Am I still a Type 2 Diabetic?” The answer depends on whom you ask.
First, you need some “history.” I was diagnosed a Type 2 in 1986, before the A1c test was developed and the standard test was fasting blood glucose on two consecutive office visits of ≥140mg/dl. That standard changed to ≥126mg/dl in 1997, and the ADA adopted the hemoglobin A1c test to replace the FBG in 2002.
In 1986 my doctor started me out on the only anti-diabetic oral medication then available in the U.S. at the time, a sulfonylurea (SU), Micronase (generic: Glyburide). No doubt he advised me to lose weight (I was obese), but instead I gained. I do not recall if he gave me any dietary advice, but if he did, it would have been to follow the ADA, AMA and AHA Standard of Care: The Dietary Guidelines for Americans, issued every 5 years 1980, latest edition 2015.
When Metformin (in use in Europe since the mid ‘50s) was permitted in the U.S. in 1995, and I was maxed out on the SU, my doctor started me on that too. And when in a few years I was maxed out on Met, he started me on a 3rd class of oral drugs, the TZDs. I was then at my heaviest weight, and in yet another effort to get me to lose, my new doctor suggested I try a Very Low Carb diet he had read about in The New York Times. It was 20g of carbohydrates a day) as described by award-winning science writer Gary Taubes in the NYT Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie?” It created quite a stir. He tried it and it worked. I tried it and, over time, lost 170 pounds.
Strictly eating no more that 20g of carbs a day, from the first day, to prevent hypoglycemia (low blood sugars) I had to give up first the Avandia (the TZD), then cut the other two meds in half, and then cut them in half again. A while later, I gave up the SU (glyburide) altogether and continued on 500mg Metformin once a day for the next 14 years.
In addition, in no time at all my lipids (cholesterol) improved dramatically. My HDL average more than doubled (39 to 81), my triglyceride average plummeted by 2/3rds (from 137 to 49), and even my LDL came down! And with all the weight lost my blood pressure improved substantially (on the same and then fewer meds). All these changes were from diet alone. NO EXERCISE.
So, am I still a Type 2 Diabetic? A clinician who looked at my fasting blood glucose (90mg/dl) would say, “Consistent with the absence of diabetes.” Yet, 30 years ago I was diagnosed a Type 2. Was it a mistake? Am I still a Type 2 Diabetic? Or, has my Type 2 Diabetes been “cured” because my “symptom” (high blood sugar) has gone away.
A clinician who looked at my hemoglobin A1c would see 5.7% and say, “Consistent with an increased risk for diabetes (prediabetes).” They would have no basis to conclude otherwise. They’d say, “We’ll continue to monitor that” (until it gets worse), and then maybe they’d write a script for a minimum dose of Metformin.
An endocrinologist would order a 2-hr Oral Glucose Tolerance Test (OGTT) in a hospital outpatient setting. It would reveal the underlying Impaired Glucose Tolerance (IGT). Result: Definitely, Type 2 Diabetic.
The truth: Starting probably 40 years ago, I gradually developed Insulin Resistance. I became Carbohydrate Intolerant. Insulin receptors on the surface of muscle, that are supposed to “open the door” to allow glucose to be taken up, started to gradually fail. My pancreas made more insulin. With overuse, its capacity to make beta cells began to wear out. That loss of function is not going to change. It’s not reversible, but my Type 2 Diabetes is TREATABLE, by making my insulin receptors work better. The only treatment that works for that underlying metabolic dysfunction (Insulin Resistance) is a low carbohydrate diet. THIS TREATMENT WORKS!
Eating Low Carb or Very Low Carb not as hard as you might think. After a few days, you lose your sense of hunger because your body has started to access and break down body fat for energy. It’s good energy. You feel alert. Pumped, actually. You don’t get sleepy after lunch. Your energy level is constant – no peaks and crashes – and you feel lean. You’re ready to hunt.

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