January 24, 2010

Keeping it Simple

After years of tracking diabetes news, we old-timers can become jaded. We've seen hundreds of mouse "cures" that go nowhere, hundreds of poorly designed studies meant to promote some product or scientific-religious belief, and very few new ideas that are worth the time it takes to find them. When we turn to a blog like this, we want to read something new, and when we write a blog like this, we may think that if we don't have something exciting to report, we probably should shut up.

But when I look at my blog and web site stats to see what people are reading here, and when I reflect on the many emails I get from site visitors, it's crystal clear that what excites the majority of the visitors to my blog and the main Blood Sugar 101 web site is not the fascinating new tidbits I occasionally dig up--the ones that interest the devoted core of readers who are likely to post comments on the blog.

What attracts and generates responses from those visitors is the simple stuff that is so obvious to us old-timers we find it boring--the stuff that, sadly, 98% of all people with Diabetes world wide don't yet know.

Based on my mail and stats, here's the information that amazes people about the blog and site:

1. Normal blood sugars are much lower than the targets doctors tell patients to shoot for.

2. Diabetic blood sugars can be improved dramatically and even, for some people normalized, by cutting back on the carbs we eat.

3. Some diabetes drugs are safer and more effective than others but doctor often do not understand how to use diabetes drugs appropriately. With both metformin and insulin they often prescribes doses that are too low to do any good. By the same token, most if not all supplements sold as being "good for diabetics" are a complete waste of money.

4. Testing after meals is the best way to find out what foods are a good diabetes diet for you. Each person's diabetes is different, and without testing your favorite meals you won't know what foods are raising your blood sugar to levels that damage your body.

5. The so-called glycemic index doesn't work for most people with diabetes. Grains, whole or not, raise blood sugar dramatically.

6. Many people with Type 2 diabetes can drop their blood sugars surprisingly quickly without having to lose a single pound just by cutting down on carbs. Conversely, contrary to what doctors tell us, people with diabetes can lose a lot of weight and not see underlying blood sugar control improve. This is because most people with Type 2 have defects in insulin secretion that will not go away no matter what they weigh.

7. If you are thin and over 30 and diagnosed with "Type 2 Diabetes" and don't respond to pills there is good a chance you have either a slow form of autoimmune diabetes or, far more rarely, one of the genetic syndromes lumped together under the label "MODY." If so, you need to see a competent endocrinologist who is aware of these newer diagnoses. Unfortunately, not all practicing endocrinologists keep up-to-date.

There's nothing dramatically new here. It's all things I'd learned by 2003 after reading the diabetes newsgroup every day for a year. The new research that has trickled in since then has added very little that is new. Mostly it has confirmed that it's safe to cut carbs, a bad idea to eat low fat diets, and that there are more people with oddball forms of diabetes in the population than used to be thought.

So it strikes me that we in the blogosphere need to keep in mind, that yes, it's fascinating to read about obscure research that points to this or that possibly useful micro-finding. It's good there are bloggers out there tracking it, and I'm going to keep scanning the journals myself.

But when we are writing for a Googling world audience, it's far more important to keep the focus on the simple, boring facts about how blood sugar works that most people with diabetes still don't know. That knowledge is what can keep people from going blind, losing kidneys, or ended up with amputations.

I love my highly knowledgeable fans who read every post and keep up with the research cites. But I love even more the people who write to me that they've had diabetes for five years, but only brought their A1c down from 9% to 5.6% this past month after trying out the technique they found HERE. Even more, I love the people who write me two years later that they're still using that technique and still getting A1cs in the 5% range.

That's what matters. So if you've become bored with hearing about the "same old, same old" stuff, remind yourself it's not old stuff to the majority of people diagnosed with Type 2 diabetes whose average A1c is up near 9% and whose doctors have little to suggest even when their fasting blood sugar is up near 200 mg/dl.

 

22 comments:

khurtwilliams said...

Jenny,

This was excellent. I forwarded the link onto my father-in-law who has T2.

Nigel Kinbrum said...

"98% of all people with Diabetes world wide don't yet know." That figure is rather sad. Where did it come from?

Matt Stone said...

Jenny-

What percentage of type 2 diabetics secrete less than normal amounts of insulin? I gathered from Julian Whitaker and others that most type 2's secrete far more insulin than a normal person that is not insulin resistant? Just curious as to your thoughts.

Jenny said...

Julian Whittaker is a very bad source for information about diabetes. He's a self-promoter who uses a bogus medical certification. He makes his money promoting scientifically discredited vitamin cures and other discredited fringe treatments. He has no credibility at among those who study the science of diabetes.

He's parroting a belief that was current maybe 15 years ago.

More recent research has found that almost all the genes associated with diabetes cause some form of insulin secretory defect. People with Type 2 may be very insulin resistant (as are maybe 2/3rds of all people over 40), but by the time they have developed diabetes their insulin levels are usually dropping.

And most of the people who are insulin resistant and pumping out a lot of insulin NEVER develop diabetes.

Nigel,

Just start talking to local people with diabetes about what they've been told about their condition, and you'll understand where that statistic comes from. The NHANES data points to 10% as the typical A1c of American diabetics and I read a while back that it has been going up, not down, because the drug company pushing of new oral drugs has got doctors avoiding insulin for people with terrible A1cs.

Boz said...

Very wise word. My two cents? We all different for case to case. That's something most of the medical community fails to recognize. The more enlightened ask questions, like my endo. He's always interested on how I keep my numbers low, or if they are up, what has changed to cause it.
It's hard to find good help. But not impossible.

Matt Stone said...

Thanks Jenny.
Not endorsing Whitaker. What Whitaker does is rely upon starvation to work, which it may for some, but not for all.

What I believe I have created is a method for reversing insulin resistance. Something that's obviously very useful for prediabetics, and perhaps a handful of full-blown type 2's as well.

It would be very inappropriate for anyone with insulin deficiency though.

Jenny said...

Matt,

Insulin resistance isn't one condition. It can be caused genetic problems with mitochondria or accumulations of intracellular liver fat (much harder to budge with diet than some authors make people think), and many other things.

The kind that can be reversed by diet is "secondary insulin resistance" caused by blood sugars going over some limit between 160-200. But other kinds don't respond to dietary interventions, including religious low carb dieting.

rachel421 said...

I'll just have to repeat what you just said because it's true, true, true.

I've learned an encredible amount over the last few days reading your site. Out of all my readings this site is most user friendly and to the point. Thank you for your direct, simple, but very detailed approach.

My father is currently chasing grains with insulin, and I have postpradial b.g. of 250ish when I eat carbs. Yet no doctor would diagose me with diabetes yet.

This knowledge is helping me in the nick of time!

John said...

Diagnosed in '93; indifferently controlled by glyburide, & eventually (!) metformin - in '04 after several
very scary infections I started insulin
& Lantus.

Been in the low 5% ever since.

Read Dr. Bernstein's books, then ran across Jenny...

It's taken awhile, but such low-carbing
as I can manage enables me to stay in
the low 5% and cut my Insulin intake by
1/3.

Thanks Dr. Bernstein and Jenny.

Jack

jacque k said...

Jenny,

You so often write on just the topic I've been thinking about ...

Lately I've been wondering about low-carbing and OGTTs. I've read that a person should eat what most Americans would consider a "normal" amount of carbs for about 3 days before an OGTT--the implication being that for a Bernstein low-carber, the OGTT numbers would be skewed.

But which way? Higher or lower? And why?

Rosemarie said...

Jenny, thank you for the work you do. I am one of the few who are SKINNY and never had a weight problem in my life (67), but became concerned as my fasting BG had been around 115- 125 for many years with spikes to 180+ (after eating carbs/fruit, etc.)

I spent over a year as a McDougall vegan (because I actually like all those foods) to see what effect it would have. My cholesterol came down to 155 from 250+ and my BG came down some but still above 100. A1C 5.8.

I am now reading all I can about low(er) carbs, more fat, etc. (never been a junkfood/soda consumer anyway).

I have one burning question which has never been answered to my satisfaction - maybe YOU can.

Why are doctors like McDougall, Fuhrmann, Barnard, etc. discredited - considering the success they have with their followers? And they all show solid documented proof that their way works.

Dr. McDougall has one of the most informative websites. He has articles/newsletters always with documented sources for his information. His forum is staffed and monitored with accredited and knowledgeable people. All for FREE without obligation!

There are posters (Star McDougallers) who were in bad shape who came back to health by going starch-based vegan. HOW CAN THIS BE???? How can opponents say "it doesn't work?"

So why did I stop? I lost too much weight even though I ate all day long and was still hungry. When I tried to add more fat into my diet I was told fat clogs up the insulin receptors and will make insulin resistance worse.

That's when I turned my attention to the low carb community and found you as well. Your common sense approach appealed to me and I'm following your directions...testing often. I'm starting to get a much better picture of what works for me.

villaneweva said...

Excellent post. It can be very difficult to sift through loads of information and it definitely helps to have a concise foundation to build upon.


That being said... do you know if cooking food with "soluble fiber" will turn that fiber into digestible carbs?

-Jeff

Jenny said...

Lots of good questions here, but they deserve posts of their own, so I won't attempt to answer in a comment.

Steve Parker, M.D. said...

You mention physicians prescribing insulin doses too low to be effective.

I just finished Bernstein's "diabetes solution" book. He uses Lantus 3 units twice daily (plus mealtime rapid-acting insulin) for himself.

I rarely see such low doses in my hospital practice, probably because most people eat many more carbs than Bernstein and his patients.

And he commonly adjusts insulin in 1/4 to 1/2 unit increments. I rarely see that either.

-Steve

Jenny said...

Dr. Parker,

Dr. Bernstein is a Type 1 who is physically tiny and eats almost no carbs. His Lantus dose is very low even for a Type 1 following his program.

Your hospital may be better than most. My local one still uses sliding scale and the nurses have such a terror of hypos they wanted to raise my blood sugar when my meter showed 110.

The problem I refer to is the huge number of people with Type 2 who don't have access to endocrinologists. Family doctors don't have the time to teach people who to use meal time insulin, and out of fear of hypo give patients only Lantus, usually in doses that leave their meal time numbers soaring into the 200s.

Lantus only lowers basal blood sugar so in a person eating carbs it can have ittle impact on the post-meal sugars that are what cause complications. It is too slow.

Many people diagnosed with long-term Type 2 diabetes who need insulin would do best on the same kind of basal/bolus regimen given Type 1s.

Harold said...

The diet provided to hospitalized diabetics is modeled after the ADA's ridiculous high carb diet for diabetics. The last hospital dietician I talked to thought a blood sugar of 180 was quite acceptable. I am a diabetic and a physician and do not want to ever have a blood sugar that high and do not using it information in Dr Bernstein's or Jenny's book. My A1c is under 5. I use small doses of long acting and regular insulin with a very low carbohydrate diet. It can be done!

Matt Stone said...

Thanks Jenny. I think my program does work in part because of a tremendous increase in mitochondrial activity (raised metabolism, higher body temperature, etc.).

I have experienced low-carb diets making insulin resistance far worse, not better. The very presence of ketones and a diet extremely high in fat in general intensifies insulin resistance.

John said...

I'm T2, theoretically, diagnosed in '93 at age 44 - In retrospect realize I've been symptomatic since my early 20s...

Bolus/basal insulin works for me, with the additional spin that I have some gastroparesis, complicating figuring
out what's going on a bit.

I worked out appropriate dosages from "Using Insulin",Walsh,Roberts,Varma,&
Baily",and "Pumping Insulin",Walsh & Roberts - What real endos do for a living, I presume. I've never seen one,
AFAIK.

In the aftermath of getting hit on my
bicycle by a car, I had the
semi-comical experience of causing a
Nursing panic when, post-op, they realized my BG averaged around 100.

My records clearly show that, but who reads?

They discontinued Insulin & tried to
force me to take oral glucose. Without
Insulin my fasting BG soon was 200;
perfect,they said...

I quit eating till I could manage a wheelchair, & checked myself out.

Book recommendations disclaimer - No
personal interest, other than satisfied
customer. I'm not a pumper, BTW. The
pump book helped me decide I could do
without it, at least for now; a
non-trivial financial decision.

Jack

John said...

> The last hospital dietician I talked to thought a blood sugar of 180 was quite acceptable...

Yep, got the same story from the VA dietician while hospitalized.

I told her if I did what she said my A1C would be 9, just like most of their older diabetics. She did'nt have an answer for that.

BTW, some of the bogus "studies" purporting to show
that tight control is "dangerous" come from the older VA patient population,
which like me were diagnosed decades after the onset of the disease, treated
ineffectively for more decades, and now
are suffering the consequences.

Self-fulfilling prophecies, if I remember my logical fallacies...

Jack

Jim Purdy said...

I still have a lot to learn about my Type 2 diabetes, but the most important simple lesson I've learned so far can be summarized in 3 short words-

"Carbs are evil!"

(But of course, YMMV.)

The 50 Best Health Blogs

Nicky said...

My sister recently got her T2 dx - making 100% of our generation. She stole my copy of 101 at Christmas; bg now down to normal levels everywhere except fasting. She - and I - think you rock :) My A1c has now been sub-6 for 5 years, thanks to you, Jennifer and some of the asd stalwarts.

Jenny said...

Nicky,

I'm so glad to hear you are still doing so well. Sorry your sister had to be diagnosed, but at least she's got the information she needs to preserve her health.

You were certainly one of the best of the asd stalwarts. I miss the old newsgroup and wonder how some of the regulars have fared.