Type 2 diabetes and victory

[Shawn Baker]

JAG- just to clarify I'm not a diabetic, but I am a board certified orthopedic surgeon who has taken care of thousands of diabetics over the years to include unfortunately having to do their amputations- There are clearly many diabetics (including some type 1 diabetics), that have gotten off medications, lost weight, improved many facets of their overall health via low carbohydrate diets (sometimes it is a ketogenic diet, sometimes it's not). I don't believe I was trying to imply that you advocated consuming unlimited junk as clearly you don't, however much of the world does do that and it is the primary reason for all the chronic disease in my view. I think Grant can make up his own mind as to what he will do and let the results speak for themselves. I know if I were in the same situation (fortunately I'm not) I would definitely look into a very restricted carbohydrate diet. I've spent many years doing my own personal research about this stuff, have applied it in my own life and to many patients with good results. The standard treatment for type 2 diabetics as practiced by most physicians leads to life time disease management (generally with ever increasing medications) with an almost inevitable worsening of disease and quality of life. I think there is clearly a better way.

[left coaster]

Jag... you seem angry, I'm not intending to upset you. Did you watch the video's Shawn posted? I'm also not diabetic, even though I have 2 immediate relatives who are. I don't use a ketogenic diet, but I do generally restrict carbs etc (if you read the thread you'd understand this) and my blood glucose is very stable. My comments about brain metabolic function are not directed at you as an insult. Rather, they are based on some intensive research I have been doing recently as part of a wrap-up for a doctorate in cognitive neuroscience, I've worked in acquired brain injury rehab for the last 15-20 years and decided to put a 'bow' on it. Emotional regulation is a cognitive function.

I could stand to lose about 15lbs, but I have no interest in being below 220... orthopedic and related peripheral neurological injury rehab has been a long road for me.

[Carl Watts]

Hi Guys, with all your experience and people you have seen with diabetes, weight seems to be a primary factor.

With this in mind, could you put a scale on the body fat vs risk of diabetes ?

my blood sugar level is at the upper limit of being considered "Pre-Diabetic" however I simply cannot do much more exercise and my body fat is 21% so in reality where does this sit in terms of "Risk" when compared to say someone at 30% or even 35% which is not that uncommon these days, in fact I think we have a figure of 1 in 4 people that are overweight in this country and the USA must be even worse.

[hjs]

Hi Guys, with all your experience and people you have seen with diabetes, weight seems to be a primary factor.

With this in mind, could you put a scale on the body fat vs risk of diabetes ?

my blood sugar level is at the upper limit of being considered "Pre-Diabetic" however I simply cannot do much more exercise and my body fat is 21% so in reality where does this sit in terms of "Risk" when compared to say someone at 30% or even 35% which is not that uncommon these days, in fact I think we have a figure of 1 in 4 people that are overweight in this country and the USA must be even worse.

Carl, I wonder why you think 21% bodyfat is not high. Compared to other people your age maybe. You proberly gave the answer yourself. You now work out, lets say you get an injury and you keep on eating like you do now? ..
You should get control over your insuline production. Limit the times the times you eat carbs.

[GrantM]

Grant,

This disease is no fun, and I wish you continued success. You are in the unusual condition of having T2 and wanting to GAIN weight; for most T2 like Shawn and Left Coaster it is the opposite. Next time you talk to your doctor you might suggest you get tested for LADA (a form of slow onset T1 diabetes that hits later in life) because about 10% of people diagnosed with T2 have been found to actually have LADA T1. There are blood tests he can order: http://www.diabetesforecast.org/2010/ma ... e-1-5.html
If you do have LADA T1, then tapering off insulin isn't going to happen, so if that is a goal of yours then you might want to be tested simply to know whether that is a realistic possibility.

Hi Jag
Thank you very much for the information. It really is greatly appreciated!
I plan to visit my physician in the new year. If I go now the Hba1c will not be worthwhile as I know my management of the disease of late has not been up to scratch. So getting some stability now and data together and will probably go in mid to late Feb '16.
I normally pick up a bloods sheet a day or 2 before with the required tests on and I will certainly ask him to include LADA testing in the mix. Thx!

Re weight: I have always been skinny my whole life, never overweight and always active. The doctors I have seen have all been shocked when I tell them I am diabetic. Thinking back, the food and loads of sugar I used to eat growing up makes me cringe now. This is my own doing

Currently 45yrs old, weight 77kg @ 185cm or thereabouts.
I have been heavier but that was most notably muscle mass a number of years ago and 1 goal is to try get 'some' back in time and bulk up a bit.
My main goal, forsaking everything else for now without any doubt, is to take absolute control and manage my BGL's effectively. Even on prescribed diet from dietician its not doable on current meds.
There is absolutely no way I will ever get off insulin jabs, that's a given and I accept it fully, but by drastically reducing the carbs lately I have been able to back off the dose a bit and have more consistent bgl's which is great.
My T2 was diagnosed and managed for years orally with increasing doses of Glucophage, gradually this became impossible and then I went onto insulins. (at a 'stab' maybe 5 years now, not sure).

Its worth 3 months of my life to give it a crack, and if the Physician is happy with eating regime when I go in then fine, if he wants me to eat more carbs then he needs to tell me how the hell I get them in, and the calories needed just to maintain let alone with bulk, without spiking my bgl's. Probably more insulin. I don't know, time will tell.
For reference my prescribed doses are
'Humalog 100 Kwikpen' - 24 per day (split into doses before meals)
'Lantus - 21', (prescribed in the evening before bed)

I have reduced the Humalog by about 4-6units total per day with good control, while packing in just over 2500 Calories a day.
Before, on a std diet or foods I was eating, I was using full doses, and a bit extra and probably only getting in around 1500-1700 calories with poor bgl's consistently. Hungry and tired the whole time.
Its seems quite apparent, it is either a 'very very' low carb lifestyle (bordering on keto) or more insulin for me.

So far no adverse affects, just that I picked up my t-shirt lying on the floor this morning that I used while rowing a 3km last night (and its hot and humid here) and it smelt like a badly maintained public toilet.
Woke up with an 8.4bgl, a bit high but had some carbs at dinner.
8 units of Humalog (2 less than normal) + 1100 calorie breakfast of champions (76f:3c:21p) and as I write now 2 hours after eating bgl below 7. If I had eaten weetbix + 10 units of Humalog prior as normal @ only 300 calories I would be in the 10-12bgl by now.

[Shawn Baker]

Grant you may want to look at some videos from Dr. Eric Westman from Duke university as he has had many, many patients come of all insulin, to include people using 100s of units daily

Carl- look up Dr. Tim Noakes as his story is a bit similar to yours

[jag]

Shawn,

You're mistaken in your belief that a Type 1 can ever go off of insulin. If Westman says that, then he is mistaken too. Type 1 diabetes is an autoimmune disease that destroys the Beta cells in your pancreas that produce insulin. Once Type 1 is fully established, your insulin producing cells are dead, and you are unable to produce more than a trace of insulin (often not even that), so insulin either injected or from a pump is always needed. Also, Eric Westman and Tim Noakes are diet book authors, who will say absolutely anything if it will sell them a few more books. Diet book authors have a special place in hell reserved for them. I would recommend never listening to anything they have to say.

Carl,

Different people have different body fat levels at which they are at increased risk of developing Type 2 diabetes. One interesting finding is that Asian people (e.g. Japan, Phillipines, India) are at risk of developing Type 2 diabetes at body fat levels significantly lower than that for Europeans - so they are at increased risk even at the high range of what is considered "normal" BMI for Europeans. Also, the risk is much more dependent on liver fat than it is on body fat - which is why waist measurement is a better measure of risk than BMI. The best ways to reduce liver fat are to reduce body weight, to eat no trans fat and less saturated fat, and to eat less refined sugar. (Let me know if you're interested in reading a paper that describes this). In short, there is no one "safe" level of body fat for everyone, since it is highly personal. But if you're seeing symptoms, then bringing down body weight and making those dietary changes until the symptoms lessen would be wise.

Grant,

The more I hear, the more it sounds like you have Type 1 diabetes to me. Your total daily dose of insulin per Kg of body weight is exactly the same as mine (.58), and that's in the expected range for a relatively insulin-sensitive Type 1 diabetic. Also, you shouldn't beat yourself up about eating sugar in your youth; diabetes is not caused by eating sugar or carbohydrate. There is no correlation at all with Type 1 diabetes, so if, as I suspect, you have LADA T1, then your early diet had nothing to do with it. Even if you do have Type 2, the only correlation with Type 2 diabetes is that excess liver and body fat, which can be caused by eating excess sugar, will increase your chances of getting Type 2 diabetes. Since you were never overweight, you can rest your conscience on that score too.

Maintaining consistent blood sugar is the important thing, so if you're achieving that with your current diet, then by all means you should keep it up. Although I have said a lot of negative things about ultra-low-carb diets here, I am not a believer in ultra-high-carb diets either. I eat a moderate amount of carb every day, and try to get as much as I can from vegetables, fruits and whole grains. I believe that diabetics need to get rid of as many empty calories as they can, so never drink sugar soda or juice, sugar cereal, big desserts, etc. Besides diet, the other things that I consider of critical importance for a T1 to achieve consistent blood sugar are to regularize their lifestyle as much as possible (so that meal consistency of whatever carb/protein/fat ratio you prefer is predictable which makes insulin requirement predictable), and to test BG a LOT (I test many times a day so that I know where my blood sugar is and where it is heading so I can make micro-corrections as needed).

[left coaster]

It's interesting how Tim Noakes has done an about face on high carb intake for athletes.

This recent publication of his is interesting:

Volek, J. S., Noakes, T., & Phinney, S. D. (2015). Rethinking fat as a fuel for endurance exercise. European Journal of Sport Science, 15(1), 13–20. doi:10.1080/17461391.2014.959564

I'm with you Jag, some carbs are likely necessary. Just look at a beet for example, a veggie that has lots of health properties, it also contains carbs. Do we need to eat wheat flour, white rice etc., I'm not so sure... You also made a good observation about the 10% of folks who have an autoimmune component to their type 2 diabetes.

[Carl Watts]

A bit of Google and my body fat appears to be in the "Ideal" green range here.

http://www.builtlean.com/2010/08/03/ide ... age-chart/

Waist is 38 inches.

[Shawn Baker]

JAG, While admittedly extremely rare, there have been a few documented cases of type 1 diabetics managed by diet alone (low carb), many type 1 diabetics that choose a low carb diets are often able to reduce their insulin requirements. I am often amazed at the extremely high dosages of insulin type 2 diabetics are on these day (I routinely see well over 100 units per day, in my type 2 patients)- they just become increasingly more insulin resistant due to all the extra insulin and then their dosage continues to go up (a vicious cycle). Your recommendations are fairly well aligned with what the ADA recommends, unfortunately for a significant percentage of those patients the carb content is still too high. Of course you can always just add meds and increase dosages to keep the blood glucose in check!!- I am squarely in agreement with Dr. Fung (videos I posted earlier) that for type 2s the more pressing problem is too much insulin production. Also, I routinely utilize carbohydrates depending upon the type of training I'm doing and don't think for many people they are a problem- I also severely restrict them much of the time as well. I think if you have issues with insulin resistance than you should taper down the carbohydrates until it is no longer a significant issue and then add them back in as tolerated. Expirement and see what works for the individual.

[hjs]

A bit of Google and my body fat appears to be in the "Ideal" green range here.

http://www.builtlean.com/2010/08/03/ide ... age-chart/

Waist is 38 inches.

If you think so, why bother to ask?

Btw. Your bmi is just above the obese border, 30 plus, severly overweight.

[left coaster]

The BMI calculations have always confused me.

At 235lbs, I wear either a 34 or 36" waist pant, depending on the make, so I'll say it's 35. at 220 my waist is 32" or less. I was about 185 once and my waist was 29", skinny b***h I was. By BMI standards, I'm clearly obese, but I'm not 100% sure if it's a bad thing. Evan at 220 I show as 'severely over weight. I've never been lean, but at 220 I actually have abs, I got 4 now lol, some work to do, no doubt.

I was in a physical anthropology class once and we did bone size measurements. My wrist and skull measurements put me in the top 10% of men, so I'm not sure how accurate these tools are for me. My neck is also rather thick and I usually need a size or two up in dress shirts so I can actually button it up for a tie. Like a tall short person...

I used this calculator http://www.webmd.com/diet/body-bmi-calculator

[Carl Watts]

BMI is total rubbish.

Our entire All Black rugby team has a BMI of over 30 and they are considered our "Elite Athletes" over here.If you have ever done any weight training or have the body type that just puts on muscle without even taking drugs your going to be over 30.

I think you just need to get down to actual body fat percentage, thats what everyone tends to try and avoid like the plague. I'm not seeing anyone post any number here for starters.

There is no way I'm obese at a BMI of over 30, its a joke, seriously do you want me to post a picture ? Again it also comes down to body type as well. My neck measurement is 43cm or 17inches for starters. Your waist size is not your pants size, you need to measure it. some 36" Levis pants that I bought in the USA need a belt or they literally fall off me. Pants are actually a bit of a problem in getting the right cut or they simply will not go over my thighs which are 25 inches which is typically associated with much bigger waist sizes.

[Edward4492]

Carl,
100% correct. BMI is bullshit. It makes zero allowance for muscle mass. Most NFL running backs, guys that are chisiled with very low bodyfat would have BMI's in the obese range. The only real indicator is bodyfat.

[hjs]

BMI is total rubbish.

Our entire All Black rugby team has a BMI of over 30 and they are considered our "Elite Athletes" over here.If you have ever done any weight training or have the body type that just puts on muscle without even taking drugs your going to be over 30.

I think you just need to get down to actual body fat percentage, thats what everyone tends to try and avoid like the plague. I'm not seeing anyone post any number here for starters.

There is no way I'm obese at a BMI of over 30, its a joke, seriously do you want me to post a picture ? Again it also comes down to body type as well. My neck measurement is 43cm or 17inches for starters. Your waist size is not your pants size, you need to measure it. some 36" Levis pants that I bought in the USA need a belt or they literally fall off me. Pants are actually a bit of a problem in getting the right cut or they simply will not go over my thighs which are 25 inches which is typically associated with much bigger waist sizes.

new this would, that you get when start posting numbers. Normal bf% is 11/22 in your table, so there you are also close to overweight.

Rugbyers are often overweight, even the all blacks, and I fear they are not that healthy. A top rugby player gas a tough lifestyle.

That said you are in no way a strenght athlete Carl, be real. Erging is an endurance sport, so you should compare to rowers/ergers. If you pulled a sub 1.20 500 at your age, maybe you where.
And waist size, don,t think thats rocket science.

Back to the point... You asked my bsugar is high, should your weight/ eating be a factor. if you really give a rats ass, give it a try and see for yourself. If you don,t why bother to get in in this thread?