Monday, March 23, 2020

Retrospective #401: “Improve your A1c with a non-insulin option”

This advertising copy is effective. People who have been diagnosed with Type 2 diabetes, or Pre-diabetes, are afraid of insulin – having to inject insulin to manage their high blood sugar. And if you are the type of person who relies on your doctor to manage your blood sugar, then you’ll be interested in a way to “improve your A1c with a non-insulin option.” But if you have any common sense, you’d realize that the best way to manage your blood sugar is not to eat those foods that become “sugar” (glucose) in your blood. You’d realize that “those foods” are carbohydrates.
Of course, the TV ad had a different “fix” in mind for you; their drug therapy. They’re playing on the dread people have for the drudgery (and cost) of daily insulin injections. Insulin-dependent Type 2s start with a slow-acting basal dose of insulin injected once a day. When that fails to produce a “satisfactory” A1c, many (most?) eventually inject a fast-acting bolus with each meal. And, with 4 or more injections a day, and constant testing, if you are very careful to avoid hypos, you can achieve “good” blood glucose control, by their Standard of Care guidelines. It’s an onerous path.
But t doesn’t have to be this way. In 1986 I weighed 300 pounds when an internist, based on a hunch (my weight) took a blood sample and diagnosed me a Type 2 diabetic. He started me on an oral anti-diabetic drug of the only class then available in the U.S., a sulfonylurea. Seven years later, when the A1c test first came on the market, an endo discovered my A1c was 8.9%. My dose was increased and I few years later, when it was introduced in the U. S., he started me on Glucophage (metformin). Nine years later (2002) I was maxed out on both the sulfonylurea and met, and I had started on a 3rd oral med, Avandia. Type 2 diabetes is a progressive disease, the medical establishment says, and both my doctor and I knew that when the 3rd class of drugs was no longer effective, I would “graduate” to insulin.
My doctor then turned his attention to my weight. He had tried before. I had seen his staff dietician who advocated a “restricted-calorie, balanced diet and exercise.” It didn’t work. I lost weight but promptly regained it. Then, one day in 2002 my doc read the New York Times Sunday Magazine cover story, “What If It's All Been a Big Fat Lie,” by Gary Taubes. He tried the diet himself, and he lost weight. So, he asked me to try it too, and he monitored me closely.
The diet was Atkins INDUCTION, which is VERY low carb, just 20 grams of carbs a day. On the first day I had a hypo. I called him, and he told me to stop taking Avandia. The next day I had another hypo and he told me to cut the other two drugs in half.  Later that week, when I had a 3rd hypo, he told me to cut the two drugs in half again. So, in just one week, by strictly following a VERY LOW CARB diet, before losing more than a few pounds of water weight, I virtually eliminated all my diabetes meds. My Type 2 diabetes had gone into remission, and I was no longer drug dependent.
A year later, in August 2003, I had lost 60 pounds and my A1c was 5.4%. Four years after that, over a summer I regained 12 pounds, so I started on Richard K. Bernstein’s 6-12-12 program for diabetics (30 carb grams a day). Over the course of a little over a year, I lost that 12 and another 110 pounds, reaching 205 pounds at the end of 2008. That was my early teenage weight. And my weight after I completed 8 weeks of PT in Army Basic Training in 1960!
In 2018, 16 years after beginning to eat Very Low Carb, and plenty of “misadventures” (cheating) along the way, I celebrated by dropping below 200 pounds (186 last week) for the first time since I was in my early teens. And although when he started me on it in 2002, my doctor’s motivation was to get me to lose weight, NOT to treat my so-called “progressive” Type 2 diabetes, I have “IMPROVED MY A1c WITH A NON-INSULIN OPTION.” FURTHERMORE, I HAVE FOREVER AVOIDED PROGRESSING TO BECOMING AN INSULIN-DEPENDENT TYPE 2, and MY LATEST A1C WAS 5.2%.
To his credit, although he suggested it to help me lose weight back in 2002, my doctor did have an inkling that eating VERY LOW CARB might help my type 2 diabetes. As he walked me down the hall that fateful day (to schedule my next appointment), he said, “Dan, this diet might help your diabetes too.” Boy, was that an understatement!
Would that more doctors had a similar understanding of the basic relationship between dietary carbohydrates and blood sugar regulation. TYPE 2 DIABETES IS A DIETARY DISEASE, and the best treatment is SELF-MANAGEMENT by CARBOHYDRATE RESTRICTION. Your doctor can’t write a prescription for that, but YOU can!

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