I'm not familiar with Biotin but Chromium Piccolate is something most type 2 diabetics have tried over the last 20 years or so, with the same discouraging results. Apparently the original marketing of that supplement was based on a study of people living in an area of Africa where the diet was deficient in the mineral chromium. However, anyone eating a regular western diet will get more than enough chromium to meet their daily needs, so taking the supplement will be a waste of time and money. Another recommendation that has been around for some years and apparently has worked for some people is adding cinnamon to your foods, e.g. sprinkling it over cereals or taking it outright by the teaspoon swallowed down by water. As a relatively inexpensive spice it probably can't hurt to try, though at best I've heard of some people being able to lower their Hba1c by half to one point after increasing their cinnamon intake regularly for several months, e.g. going down from 9 to 8 or 8.5.
Interesting. I had heard about the cinnamon.
My issue is a fluctuation throughout the day. I may be 123 now and on the 30 minute drive home I'll drop to 80 and have to grab a couple of glucose tabs. Then before dinner I'll be 118 and afterwards 140, then by bed I could be 70 or 170.
A few years back people would have suggested that you have 'brittle diabetes', a diagnosis that has since been discarded by medical professionals. I still think that your best chance is to work this out with a reputable endocrinologist, who should presumably have experience with other patients with the same issues.
Tor
My dear vancouversailor. You are doing an excellent job of providing supportive, accurate info and I do not wish to inhibit that. But I have been giving some thought to why you got my "hackles" up with your original post.
It is actually fairly simple now that I tracked it back in my long association with this home site for many of us (I joined when there were about 800 members or so): There is not a single person here who is NOT engaged in self-management. That's all.
Self-management is the path we all need to figure out because for most (if not all) our healthcare providers are not always as knowledgeable about The D as we are. Of course there are some basics that are covered, but the amount of wrong info we can get from our healthcare providers, especially for T2s, is difficult.
So I would simply underline the excellent info you are providing, but please remember that everyone here is engaged in some level of self-management. It's what we have to do!
Blessings, as ever.....Judith in Portland.....
Hi Judith
Thanks for sharing your perspective on these issues.
My comments about people with diabetes not wanting to manage it themselves but just wanting a prescription from their doctor were directed at a large proportion of the approximately 300 million people worldwide, whereof close to 30 million in the US, currently diagnosed with diabetes type 2. The members of this online forum called tudiabetes are only a tiny percentage of those numbers, and are likely to be among those most motivated to manage their own health, as witnessed by their efforts to find and join a resource place like tudiabetes.
My comments were also somewhat inspired by my initial experiences more than 10 years ago when I first started exploring online resources about diabetes. At the time there was an active group at msn.com called Diabetes, where I had to keep changing my nickname because every time I posted something about self management I got banned for 'harassing behavior'. I am aware of course that is a far cry from the views that dominate among users of this here forum.
Cheers,
Tor
Oh yes---I get it, my dear. A few years ago I kind of put a tentative "toe in the water" at an ADA discussion board. I posted something that I thought quite mild about how some level of carb restriction was probably necessary---not advocating anything extreme----well, I was flamed fiercely and with a kindergarten level of bullying...At least here at TuD we are sure that one can have a civilized discussion!
As to the getting flamed for posting about self-management---I can only imagine. It really is an essential part of dealing with this scourge. As I have said before---If you want to treat diabetes by the book, you need to write a new book for every diabetic.....
Be well....We are having an endless "wind event" with freezing temps---very unusual this time of the year. We're all going stir crazy---that's 8 kitties and 2 mostly adult humans bouncing off the walls--I just keep telling myself that Hey--bouncing off the walls and being silly with my kitties is, after all, just another kind of exercise--Teehee!....Blessings
I totally agree with your approach. I thought my one hour daily was good till I had read your comment.
1 hour per day is good especially if it is somewhat intensive, say brisk walking or bicycling. I've read that the improvements to circulation and fitness are measureable even down to 15 minutes a day. But more is better and as I am retired and have time on my hands, the two hours a day works pretty well.
Tor
Thanks for sharing your story & routines. I have recently had an increase in my H1C--my doctor wants to put me on Januvia. But I want to try and be mindful/intentional in my healthy habits first . . . Your post gives me alot of good ideas.
My doctor wanted to put me on insulin cause my levels were 9 and sometimes go to 13.My last HlC was 9.6 I refused my doctors offer of insulin and like vancouversailors approach. Incidentally I changed doctors and now starting Dr. Hyman’s Bloodsugarsolutions book . I treadmill 1 hour daily at 3mph. I am still trying to find the best approach. Please be encouraged and continue to be supported.
Brava Sugar2. But just remember, as a T2, you have a lot of options and 9.6 is pretty high. Insulin is not to fear if it is what your body needs. And what it can do is buy you some safe space while you make other adjustments--preserving Beta cells, etc. For T2s, it is entirely possible to use insulin as a breathing space and then taper it off as you make other adjustments.
I'm not familiar with Dr. Hyman. I will look him up. I have found Bernstein's lo-carb approach helpful to me, but we are all different. The best advice, always, is Eat To Your Meter!....Blessings.....
Sugar2 I read somewhere (I believe it was in an annual report from the Clinical Endocrinologist Association in the U.S.) that at a specific time a study showed that the average hba1c of type 2 diabetics was 9.2. Not to say that's a good thing but it does mean you are in ample company.
I have found, and these are things that I believe apply to many people with type 2 diabetes, that there are a number of things we can do to bring our blood sugar levels down in the course of a relatively short period of time (say over six months or so) without the use of meds or insulin,
Number one is managing the carbs we eat. The typical low carb or no-carb diets that we often hear people praising are very rarely sustainable over time, partly because they are, for the most part, the essence of culinary boredom, and partly because many people find that these low carb diets are fraught with problems like constipation, smelly urine and elevated cholesterol. A very good alternative is to study the glycemic index and aim at a mealplan where the carbs are in the lower part of the scale, which will allow for many types of pasta, Uncle Bens converted rice, bread made from rye or oats, all types of squash to mention some examples.
Number two is weight management. It is a fact that the vast majority, probably more than 90 percent, of type 2 diabetics are overweight or even obese at the time of diagnosis. As body weight is reduced through increased activity and decreased calorie intake, there is usually a corresponding reduction in average blood sugars as insulin resistance in the body decreases proportionately with weight loss.
Number three is timing of the exercise, with the greatest benefits being reaped from activity immediately after eating. (Forget the 'old wives' tales about exercise right after eating being harmful; as the Irish say, that's a load of malarkey.) On the same note exercise doesn't need to involve driving to a gym somewhere or investing in expensive equipment, for most people the best activity is simply going for a brisk walk in your own neighbourhood.
Number four, which some people find easier than others, is time management in order to reduce blood sugar hoisting stress and allow for ample time to plan and prepare meals and do the activity that we have decided to do. Some people are equally quick to scream that their schedule is SO busy that they couldn't possibly fit in any activity, as they are to tell you the current plots in half a dozen sitcoms and other tv shows. At some point one does have to think seriously about priorities in life. And it's a fact that if you want to go for a half hour walk after breakfast and before driving or bussing to work, you may have to go to bed half an hour earlier and sacrifice that late night show you're used to watching.
Last but not least, the more information we have about our health situation the better we are able to cope with it. There are many excellent books written about managing diabetes type 2, in addition to the online resources available at sites like Tudiabetes and the Joslin Diabetes Center at Harvard University. And then there is what we could call macro-information, i.e. knowledge gained from our weight scale, regular blood sugar tests, routine checkups with health professionals and consultations with dieticians, nurses and other support people in the diabetes community.
In other words, it's not a question of 'My hba1c is up, I have to have insulin', it's a question of 'self management or reliance on prescription meds and insulin'. That choice is, in most cases, ours to make.
I am very familiar with Dr. Hyman. He basically advocates a low carb high fat diet. He is a bit of a "celebrity" doctor catering to high profile clients and writing books. He guided former President Clinton away from the vegan diet he was following onto a LCHF diet. He claims to practice "functional medicine" so of his recommendations involve alternative medicine and include dealing with the mind body connection and things like gut health.
For many of us with T2, truly changing from the standard diet to a LCHF diet can result in outstanding improvements in our HbA1cs. A LCHF is easy to do, sustainable in the long term and has been found for people with T2 to be superior in weight loss and health markers (including cholesterol). So it really should be the first type of diet recommended. But in the end, as Judith advises, we must check our blood sugars and do what we have to do. If we do everything with diet and exercise and we still have difficultly controlling our blood sugars, we need to just increase treatment. It isn't a failure. A failure is when we don't act when we should.
Brian offers very sensible advice here.
My initial mildly negative reaction to Tor's post has been -- mildly -- born out as this discussion has progressed. While everyone's been polite and respectful, that old, invalid idea that taking insulin is somehow "bad", represents failure, etc. has reared its head.
The idea that T2 diabetes can be managed effectively with diet and exercise for most T2s, and if you take medication (especially insulin, my God!!) represents failure, or "not doing what you should do" is what I object to.
T2 is not a simple disease. Life is not a simple process to implement and follow. Those of us T2s who need insulin as a tool to achieve excellent BG control are not somehow bastard stepchildren to those others of you who -- some of you -- see yourselves as superstars because you can pound your chest and brag about managing this without medication.
We are no less than you. No less successful. We are, like you, struggling to manage this condition so that we can live and be happy, and if we're succeeding at it with medication and/or insulin, we're "just as good".
In terms of whether or not to go on an insulin regime there appears to be some dissent about whether or not there are any disadvantages to injecting insulin.
I've never had to inject insulin myself so I cannot speak from personal experience. Based on the testimonies of other diabetics on the board injecting insulin certainly can be a lifesaver, not just for type 1 diabetics but also for type 2s that are unable to manage through diet, exercise and medications. However, from what I've read there is one major downside to injecting insulin as compared to burning off excess blood sugars with activity, reducing the intake of carbohydrates and/or using medications to stimulate the body's own insulin production. And that is the physiology and purpose of insulin: To remove excess blood sugars from the blood stream by converting them to stored body fat. Given that the majority of type 2 diabetics are overweight from day one, and that excess weight, particularly in the abdominal area, is closely tied to insulin resistance and elevated blood sugars, then there appears to be the potential for a perpetual cycle when injecting insulin. I.e. increased weight = increased blood sugars = need for even more insulin = even more increased weight and so on and so forth. This may not apply to everyone and I might have misunderstood something here, but if so I'd appreciate any information correcting the above.
The fault in your logic is - "... the physiology and purpose of insulin: To remove excess blood sugars from the blood stream by converting them to stored body fat."
Insulin removes excess blood sugars by providing a means for glucose to enter your body's cells and used as "fuel".
IOW, it is not a foregone conclusion that exogenous insulin = conversion of glucose to fat.For some T2s, exogenous insulin is just a tool, just as exercise, diet, sleep, etc are.
Not quite sure whether your logic is stereotyped, over-generalized, or just wishful thinking. Many of us on insulin are NOT on insulin because we “are unable to manage through diet, exercise and medications.” Nor are many of us overweight, obese, or sofa spuds. It is because our beta cells no longer produce sufficient insulin to meet our metabolic needs that we require insulin and yes, I am officially a T2. In my own personal case, I was self-diagnosed when my A1c only measured 6.1 (it’s the highest I have ever tested)! However, I had all of the symptoms common to diabetics including frequent urination, neuropathy, even a pretty severe case of foot drop. Finger prick tests confirmed my post prandial BG surges were well above normal (compared to non-diabetics). My BMI at the time was 22.5 and my daily activities included a 6 mile walk every morning after breakfast. My endocrinologist confirmed my self-diagnosis and accompanying neuropathy through a battery of tests. I was put on various oral meds; all of which did squat to lower by BG levels. Finally, more than 4 months later, when my neuropathy continued to worsen but the endo refused to prescribe insulin for me, that I decided to start using it on my own (it can be purchased OTC in my state).
Net bottom line: 30 days after going on insulin, my foot drop symptoms began to fade; 90 days later, it was virtually gone (neuropathy took much longer to heal); my A1c dropped quickly to 5.6; then more slowly into the lower 5’s. The last three years, it has been 5.0 or lower with 2.5 years at 4.8. I am in my 70’s and joined a local support group to assist others who were struggling with their BG control. NONE of the seniors (age 65+) who had been diabetic for at least ten years and had A1c’s above 5.9 were complications-free. Only those of us in the under 5.6 range were 100% complications-free as determined by detectable symptoms and lab tests. Your own HbA1c value of “under 7.0” would be toxic to me personally. It could come back to haunt you as you age based on the experiences of the seniors in the local support group but I do wish you well and hope that you continue to enjoy good health. However, your formula definitely doesn’t hold true for me or any of the other well-controlled seniors in my group.
Seconding Mike, your understanding of insulin and its physiological effects is basic and incomplete in the extreme. It is the common understanding by most people, and sadly, far too many diabetics that really should understand their disease better.
Insulin is a big topic, so I'm not going to try and cover it here in any sort of completeness. To make the point, however, I'll educate on one aspect of the hormone: Tissues sensitive to it, and what it actually does.
There are many tissue types in the human body. There are only 3 that respond meaningfully to insulin: Skeletal Muscle, liver, and adipose (fat) tissue.
One function insulin stimulates is the uptake of glucose from the blood by these tissues. By far the biggest, and fastest-reacting "sponge" is the liver. Second in line is skeletal (large) muscle, and last fat tissue.
When insulin is elevated, glucose is removed from the blood primarily by the liver and large muscle, then converted into glycogen complexes ("human starch"). This stored fuel is then either burned at a later time (muscles), or converted back to glucose as necessary to maintain BG levels and provide ready energy on the spot as demanded.
Fat tissue will take up glucose and convert it to fatty acids in response to insulin too. However, this is a much slower process. If activity/demand by the body consumes stored hepatic glucose before it is turned into fat, it won't be.
Insulin doesn't make you fat -- high carb intake, without activity, results in fat accumulation (as you've said). However, the mechanism isn't simply insulin+carbs means fat stores. Rather, the dynamic is more complex than that: Liver soaks up most of it after a meal, muscles some. Over the next 24 hours or so (very approximate) the liver gradually unloads the "excess" glucose, which is then immediately taken up by muscles, etc., if there is activity. If sedentary, BG rises a little, pancreas injects a little insulin, and adipose tissue slowly converts the glucose to fat.
The greater complexity of this dynamic is important. It is true that if you just sit on your ■■■ all the time and eat, you'll get fat. However, knowing what you know now from above, it informs various strategies for better managing BG -- things that might not be obvious otherwise. Like taking a walk BEFORE a meal rather than after. Makes little difference for a "normal"; for a T2 diabetic, it makes a huge difference between gaining weight or not for eating exactly the same food.
There's much, much more about insulin. And about a half dozen other hormones involved in digestion, glucose counter-regulatory control, etc.
As I said from the very start, I'm impressed with what you've accomplished. I have absolutely no criticism for the approach, and wish I could manage my BG -- to the extent I want, which is "tight tight control" -- with diet and exercise.
It is not possible, and that's true for many others. Also, it simply is not "possible" for some others because it impacts their quality of life and happiness, not wanting to follow the kind of program you are.
What gets people riled is the criticism, the idea that people managing their diabetes with meds and/or insulin are somehow doing something wrong, and they could be doing it "better".
That's purely a matter of opinion, personal values, and circumstance. To use argumentum ad absurdum, a T2 that finds it perfectly acceptable to be clinically obese, sedentary, and eat all sorts of carb-rich, fatty, delicious food and considers themselves a "gourmand", but is a T2 diabetic, managing their diabetes very successfully with a basal/bolus insulin regime is doing great in my book.
They're managing their diabetes. It's not my place to be Parris Island USMC Drill Instructor and yell at them "Get moving, Maggot!". That's their decision, and as a fellow diabetic, if they're doing good with the BG, I say only, "Good Job!"
No problem, my favorite fairy-tale was the one about the kid that shouted that the emperor was naked when everyone else pretended not to see that. He didn't win any popularity contest or gain a flock of supporters but had the satisfaction of having said what others had been avoiding.
And yes I am aware that insulin is instrumental in bringing fuel for energy i.e. blood glucose to muscle cells, the problem is what happens when those muscle cells remain dormant and unused, as they do for most of the time with most of the population, the result is an increase in stored body fat, which was my point.