I’m active in diabetes matters locally. I attend several meetings per year, where I meet medical personnel and other diabetics. Always the conversation gets to numbers. Most of the medics [and all dietitians] warn me of the dangers of my strategy to keep my numbers well into the non-diabetic range. I’ve asked them to give me the details of any studies proving that I’m in danger. also I ask what I’m likely to suffer and how much longer I should expect to wait for it to happen. No-one has yet answereed those questions. A dietitian did tell me my brain needs carbs, but I told her mine seems to function adequately on ketones.
Fellow diabetics often ask me what they can do to improve their numbers and also in some cases T2s wish to avoid being put onto insulin. I’ve been told by some people that it’s too difficult for them and I watch them make the choice NOT to try. When It’s a matter of informed choice,I suppose it’s OK, but too many patients are not given the choice by their care team.
We have a culture of “a prescription for medication for all conditions” here in England.
I don’t find my methods budensome. I’ve got used to it. I’m far from 100% on compliance. I do give in to temptation and pay the price, but I keep my target in sight at all times and if I fall off the path, I climb back up as fast as I can.
My current meter average is 4.9 [88] on admittedly only 1 or 2 tests per day. I have a heavy cold and it’s crept up the last couple of days.[AND I put a little honey in my tea, when my throat was feeling raw.]Still I have kept below 6[108] even through this. Since I kept in the 4s[72 - 88} for most of this last month and I’ve hardly touched 6[108] in the last 6 months, I expect my next HbA1c to be as good as my last[ in February] of 5.1% and I’d be happy to be lower.
I find some fellow diabetics are so sure the medics have it right, that they cannot understand where I, a mere retired scienist, could teach them anything.
At the meeting I attended yesterday, of local volunteers involved in the management of health care provision, We were reminded that the medical profession should be serving us and not dominating our choices.
Hana
I have followed Dr. B for some time and I quickly came to the conclusion that I had no interest in saving the world. I will, if asked, disclose my regime to my medical team. I will initially simply state that I follow a low carb/carb restricted diet. If pressed, I will come clean and let them know the diet that I eat. I am currently following keeping below 30 g/day, although in general I have been about 50-75g/day.
I have also been active locally, I lead a diabetes support group and am constantly interacting with the staff at the diabetes center. I am frank with them about my diet. But I have had to accept that in the US dieticians are told what to recommend, a high carb diet. Many of them believe in low carb, but are convinced that most people will not comply.
I will talk about my experience, but I won’t try to change other people. If they ask me questions I will answer.
But I have not been as successful as you. I am maxed on three oral medications and am diligent about exercise, but I am unable to get my HbA1c below 6%. My numbers are basically always above 100 mg/dl. My challenge has been that my doctors think I am doing “ok,” when I know in my heart I am not.
I also exercise regularly. 5 sessions per week at the gym plus dog walking daily. This week I have a heavy cold and can’t breathe well enough for that much exercise and my levels have crept up a bit. I even hit 5.6 once!
I got my levels down into the 4s by eating less in total and I’ve pretty much kept that going.
I’m sure most of the dietitians I meet truly think that low carb is harmful. I’ve just been reading about the long term effects of low carb/ketogenic diets over the long term in epilepsy. There certainly appear to be few side effects that don’t resolve with time. Most wouldn’t be a problem with adults.
Hana
It never ceases to amaze me that a number that is considered unhealthy or dangerous for non-diabetics is regarded as normal or even good for diabetics. Did you all see the Bernstein interview on Diabetes Daily?
He mentions that if you wind up blind or with a limb amputation, well that’s just diabetes for you. But if you die in your sleep from an extreme hypo, your doctor will get sued. Thus it’s ‘good’ to keep your patients unhealthy.
I gave up on endos a while ago, I just a see a generalist now for my scripts. I finally realized that the only ‘medical professional’ that can help me, is me.
I have spent a lot of time on this question and I will try to be succinct in my response. In 2006 when I discovered Dr. B and starting managing my D with his system and saw my A1C drop to 5.0 I started a website with an MD out of the UK called D-solve (http://www.dsolve.com) to aggregate, promote, and disseminate info on using low carb and low insulin as a form of achieving normal blood sugars. Dr. Katherine Morrison (whose son is type 1) out of the UK has written an entire online “how to” course and she is a real fighter in this cause where she is at (including influencing the most recent UK standards to include low carb diet as a treatment option). As part of the website I have spent a lot of time with Dr. Morrison collecting research for those I run into that actually care about what the science says (this often includes combatting the cholesterol hypothesis)–here are a few examples (one is a collection of studies Dr. Morrison put together to justify low carb with her peers):
~ http://www.dsolve.com/news-aamp-info-othermenu-60/1-latest/227-meta…
~http://www.dsolve.com/additional-resources/downloads/doc_download/1…
~http://www.dsolve.com/additional-resources/downloads/cat_view/17-do…
As a related aside, I had kind of lost touch with my endo and wanted to find a new one and the first one I went to we were literally arguing about whether it was OK for a diabetic to have normal blood sugars–our voices were quite raised (mind you this is our first meeting) and then after that she wanted to measure my blood pressure (my face was still red at this point). Anyways, I have found a great MD who is open minded and has a much better understanding of lipid metabolism. I try to educate those that are interested or open minded and avoid wasting my time on those that do not want to invest the time to see what science, logic, and reason has to say on the matter.
I hope the resources at d-solve are helpful for folks.
P.S. on the topic of quick low-carb fast food–has anyone tried the double down at KFC? I have tried both the fried and grilled (fried has 11g carbs and I think the grilled has 2g). Anyways, I do a fair bit of weights in my exercise (currently doing P90X) and I like the amount of protein in the double down 
I wish there was a good green salad offered there. The TAG (total available glucose) group here on TuD is about what I was doing based on Dr. B by covering my meals with a combo of novolog (for carbs) and regular (for protein/fat)–I just started on the pump and have found the TAG info on calculating a dual bolus to do the same as my novo/reg regimen works good with the double down (although I have adjusted the ratios a bit for myself).
The most heated discussions on Tu have been about diet. It’s a sacred cow. I was quite shocked the first time I encountered such disdain, defensiveness & anger, though I now know better. Numerous people have contacted me about low carb diets for better control. I don’t think one followed it.
All we can do is arm ourselves with the facts & keep chipping away at the high carb paradigm. One day, hopefully soon, people will look back in shock at what diabetics were told to eat. I challenge my doctors. I’ve switched endos several times (aren’t many where I live) until I found one who accepts what I do. Actually, I don’t believe he accepts it completely & is probably taking the stance of least resistance:) He knows I’m not going to change. With some doctors I never even bring it up. My PCP is most supportive, but he’s unusual. I’ll never go back to a CDE.
The gatekeeping of info is a disgrace & what angers me. People should be given options. Patients aren’t children, though that’s the philosophy behind the medical model. The most frustrating discussion I participated in here was one started by a CDE. I think I may have run her off. When I questioned her about her approach, she admitted that she didn’t present low carb because she believed it would scare patients off. She didn’t believe they would adhere to it, so it was better to have them follow the ADA way. I argued with her, said withholding info was a disservice & condescending & got grief from other members.
Truly diet is the sacred cow. People will always get more dogmatic about diet than any other subject. But I’m with bsc, not going to try to save the world. As long as there are delicious, easily mass-produced foods out there that stimulate serotonin production no less, people will go to any length do defend them. And this is especially easy to do with epidemiology. If we were somehow able to get it into the public consciousness that fat isn’t going to kill you, new studies would immediately come to light, linking protein to brain cancer or some other malady. It all boils down to the fact that people love their cookies and candies and cakes and pies. I’ll certainly talk to anyone that will listen about diet, but approaching folks about it just seems futile.
Diet is indeed a very sensitive issue and I am not one to force my way of thinking on anyone–but I do try to provide an alternative perspective to anyone that is interested. I also agree that there are those that manage to make a higher carb diet work, but for me personally it was impossible to achieve the numbers I have now eating that way.
I do see the tide turning on the low-fat cholesterol hypothesis–this most recent study (see below), the emerging popularity of all things “paleolithic” , the outrageous health care costs (and the pressure to find cheap ways to reduce those costs), are encouraging:
http://www.dsolve.com/news-aamp-info-othermenu-60/1-latest/226-revi…
http://www.scientificamerican.com/article.cfm?id=carbs-against-cardio
Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease - http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1
The conclusion of the study of above was as follows: “Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”
I think the tide is turning and will probably take a new generation of researchers and doctors (to question their elders–I associate with many researchers that are questioning the status quo such as those listed in this rebuttal: http://www.dsolve.com/additional-resources/downloads/doc_download/4…), but in the end I am positive that while science may stray for a short time on a bad hypothesis we are ultimately rationale and reason based and we will correct our course. I also know that people will make bad choices, but there are a lot of people (like my mother-in-law) who are heavily reducing fats because they think it is healthy and would do otherwise if instructed to do so from an MD.
“The great tragedy of Science-the slaying of a beautiful hypothesis by an ugly fact.”
Thomas Huxley
I have been asking for a basal insulin for over two years. Doctors are “insulin resistant.” The two reasons that they don’t want me to go on insulin, that I will gain weight and I will kill myself with a hypo. I already inject my Byetta, I was over the whole needle thing a long time ago. Personally, I find it a bit insulting to have a paunchy doctor sit there and tell me I should not use insulin cause I am fat and stupid. I have found it quite hard to find medical care that wants me on a road to normal health, they all want me to be an ADA like patient with poor blood sugar control and lots of complications to fret over.
Have you thought about trying NPH? It’s surely the worst of the long-acting insulins but you can just walk into a pharmacy and pick up a vial. Also, it might help to find a general practitioner that doesn’t know anything about Diabetes but will write a script for whatever you tell him you need.
I used to use two doses of NPH as my basal when my script for lantus ran out. I didn’t really see a big difference in my BG using the two regimens and each has their own basal peak (neither is perfectly flat). Here is a review of clinical studies for Type 2s between using NPH and Lantus:
Comparison of insulin detemir and insulin glargine in subjects with Type 1 diabetes using intensive insulin therapy
http://www.ncbi.nlm.nih.gov/pubmed/17493554
Alan, were you using Dr. B when you were taking the NPH (i.e. taking very small doses in line with the Law of Small Numbers) or was this pre-Dr. B? Just curious about the difference in our experiences. On Lantus I would get a 8-9 hour peak that pretty consistently caused hypos if I didn’t eat something–it definetely wasn’t flat, but was quite predictable.
Phishery,
Interesting about NPH & Lantus. I experienced consistent afternoon lows from Lantus. Different doses at different times didn’t make a difference. Another topic for an argument with my endo, who insisted Lantus didn’t peak & that it lasted 24 hours.
That title was copy/pasted incorrectly the title of the study is:
Comparison of insulin glargine and NPH insulin in the treatment of type 2 diabetes: a review of clinical studies
My lows were at that exact time as well. I messed around with two doses and one dose but either way I had a peak at that time pretty consistently. I have had educators tell me there is an 8 or 9 hour peak–in the AM that may have gone unnoticed when I was dosing at 10 PM it would have occured during the dawn phenomenon (I have a fairly pronounced one), but in the PM I really felt it.
I’ve also heard it called Not Particularly Helpful. I have to admit that it seems to behave a little differently each night, though during the day it seems pretty steady. Thing is, you can pick it up at walmart for about 20 bucks and it doesn’t require a prescription. That carries alot of weight in my book.
I believe the ADA now set 7% A1c as diagnostic for diabetes. How can they reconcile that with their setting 7% as a target for diagnosed diabetics under treatment?
I sincerely hope you’re right. I’m not sure I have that much faith, every few years going back at least 2 centuries someone from the medical community will come forward and ask “hey why aren’t we eating right?”. They’ll realize the health benefits of eating a high-fat, low-carb diet and try to tell the world, but inevitably we’ll all revert back to our carb-swilling ways.
Hey by the way I love your site
Yep, NPH is mixed insulin.
I have a simple diet philosophy. I believe cooking evolved long after we did, so I think I should eat that which is digestible raw. whether or not I choose to cook it. I don’t really fancy steak tartare , but I know I can’t digest raw grains. So beef I cook and eat and grains I don’t. This equates pretty closely to the paleo diet.
to the shock and horror of many of my aquaintances, I put cream in my coffee and eat cheeses freely. These valuable foods have been villified here in Britian to the extent that I’m a pqariah.
I also don’t believe in the “Healthy Balanced Diet”, which dominates all food/nutrition discussions here. It’s led to “lite” yogurt containing 20g of sugar per pot, which is seen as “Healthy” and cheese being rejected.
We now have children suffering from malnutrition, because their mothers restrict their essential fats. Semi skimmed milk[about 1.5% fat outsells the whole stuff and many people use that abomination “Skimmed milk” which doesn’t taste like milk at all. I admit to the semi-skimmed, because I prefer the reduced cream in my tea, but I add cream to my coffee.
Hana
I pretty much agree that the restricted died helps… but sometimes I get confused. Especially after reading this article…http://articles.mercola.com/sites/articles/archive/2001/07/14/insulin-part-one.aspx Now I wonder if I was better off without all the meds I take for heart, seizures, and Diabetes… Also why do we give respect to the word of diabetes… and Capitalize it… It deserves NO respect.