Wednesday, March 25, 2020

Retrospective #403: Denial is not a river…

Someone (a relative) told me recently that their A1c was 6.1%, and they’re not doing anything about it – not even taking Metformin. What are they thinking, I’m thinking! Are they waiting until their doctor tells them, as Tom Hanks was, “You’ve ‘graduated’ to full-blown, Type 2 diabetes.” After observing “high-normal” blood sugars for 20 years, his doctor congratulated him! What is his doctor thinking? I mean, folks, DENIAL IS NOT A RIVER. I know, it’s an old joke, but that Standard of Care is just bizarre…unless, that is, MEDICINE DOESN’T HAVE A BETTER SOLUTION.
That’s what it amounts to, though. Metformin is not generally prescribed to pre-diabetics, although in my opinion it should be. Currently, it’s occasionally prescribed “off-label,” meaning “used in a manner not specified by the FDA.”
But, putting pharmacotherapy aside, what else can a pre-diabetic (and their doctor) do to “delay,” as the medical establishment might say, or totally avert, the onset of frank Type 2 diabetes? The latter as demonstrated in many recent trials, REVERSING incipient type 2 diabetes and putting this modern lifestyle scourge into total remission?
Well, the first thing you have to do is ACKNOWLEDGE THAT YOU ARE PRE-DIABETIC. That means that 1) you had a genetic predisposition and 2) in order to avoid eating saturated fat and cholesterol, you’ve eaten, as you’ve been told, a diet unnaturally low in fat and high in refined carbs and sugars. As a consequence, your body has “expressed” an intolerance for so many carbohydrates. “Pre-diabetic” means YOU ARE NOW CARBOHYDRATE INTOLERANT. The medical condition you have is Insulin Resistance (IR), and the sooner you face it, the easier it will be to manage.
Insulin Resistance is part of Metabolic Syndrome, a constellation of symptoms that put you at much higher risk of heart disease (CVD and CHD) as well as most other chronic diseases of Western Civilization, including Alzheimer’s disease (also known as “Type 3” diabetes) and many types of cancer. But Insulin Resistance can be managed by “lifestyle” (dietary) changes. Resistance is the body’s natural response to too much of something. Carbs, converted to glucose, require insulin to transport it in the bloodstream to destination cells. When you eat fewer carbs, your body will make less insulin and will naturally become more insulin sensitive (the opposite of insulin resistant).
So, the object of self-management of your Insulin Resistance, then, is to keep your blood insulin level low. There is not a common lab test to measure blood insulin, though, but a good surrogate is your blood sugar level, either fasting (FBG) or A1c. Unfortunately, there is no drug to lower blood insulin level, although anaerobic exercise also helps. 
But, if you’re Insulin Resistant, the natural way to lower your blood insulin is to restrict carbohydrates. It is not a “therapy” that will enrich Big Pharma, or Agribusiness, so you’re not likely to hear about it from them. And to avoid financial penalties and sanctions, your doctor is not likely to go against the current Standards of Medical Care either.
So, self-management of your pre-diabetes is something you’re just gonna have to do all by yourself. Perhaps that’s why you’re surfing the web right now and how you came across this site. If so, we hope you’ll come back. We encourage you to try carbohydrate restriction on your own. Test your blood before and after a meal and see how much it improves when you eat fewer carbs. Do it for 3 months, and see your A1c improve and your weight plummet!
Or…here’s an idea. Forget about how much carbohydrate restriction will help your pre-diabetes or Type 2 diabetes. Don’t even think about asking your doctor for “permission” to go on a carbohydrate restricted diet to help control your pre-diabetes or Type 2 diabetes. As my relative does, just ignore the fact that Type 2 diabetes is a dietary disease.
Instead, if you would like to lose a few pounds, and you think your doctor would like that as well, ask your doctor: Would a carbohydrate-restricted diet be a good way to lose weight? I’ll bet you that you’ll get a big “YES.”
Or, don’t even ask your doctor. Help your doctor avoid the risk of financial penalties and sanctions from Medicare and other insurers. Then, when you next have blood work done, ask for a copy and remember your weight and cholesterol – especially triglycerides and HDL-C, and blood pressure and inflammation. Then, when you get your next lab report, bathe in the praise when your doctor sees that all of them have improved. It’ll just be our little secret how you did it.

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