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Old 07-16-2011, 12:22 PM   #101
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I would like to comment on the issue of "balance". IMO it is bogus. Do you attempt to balance your virtuous acts with evil ones? The nice things you say to your wife with nasty things?

There may be reasons to eat carbohydrates, but if so they should be positive attributes of carbohydrates, not just some contrived and abstract issue of "balance".
I only meant 'balanced' in the traditional sense. Didn't mean to imply it was good/bad, just more along the lines of what one would eat if they were not specifically trying to emulate a low-carb diet. I was curious what that 'mix' (better term?) would do in terms of blood sugar profiles.

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Old 07-16-2011, 12:56 PM   #102
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I would like to comment on the issue of "balance". IMO it is bogus. Do you attempt to balance your virtuous acts with evil ones? The nice things you say to your wife with nasty things?
I believe I was first in this thread to mention the term "balanced diet". I did not appeal to some yin-yang principle of "balance" and I gave a reference saying what is meant (though of course everyone knows this already) and giving a number of scientific references in support of balanced diets. The article I referred to does not even hint at this reasoning you're criticizing -- balanced diets are good because it is good to have balance. So what in the world are you on about?
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Old 07-16-2011, 01:07 PM   #103
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I believe I was first in this thread to mention the term "balanced diet". I did not appeal to some yin-yang principle of "balance" and I gave a reference saying what is meant (though of course everyone knows this already) and giving a number of scientific references in support of balanced diets. The article I referred to does not even hint at this reasoning you're criticizing -- balanced diets are good because it is good to have balance. So what in the world are you on about?
IF it is not useful, please ignore!

To me it is very clear what I mean, but I am not a proselytizer.

Ha
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Old 07-16-2011, 02:43 PM   #104
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I've had a problem with measuring your blood glucose and making conclusions: Those meters are very unreliable and/or other circumstances can effect the readings.
...
As far as blood glucose readings are concerned, those meals would be expected to have a similar affect on blood glucose (as ERD50 & Fired@51 have pointed out). Two other variables, the size of the meal and the amount of exercise you engaged in just prior or just after could alter the result. A short experiment here might be useful, but I don't think you need more than the 1 hour & 2 hour samples.

Getting matching readings from meters made by different manufacturers is hoping for too much. I would strive for a procedure that yields consistent results from the same meter.

The idea of testing your blood sugar is not for the low carb choir, because they are already doing what can be easily done, but rather for the 'balanced diet' people who are eating 'healthy grains' and 'limiting fat' intake, while shooting for 50% to 60% total carbohydrates. For people not doing manual labor, this will likely drive their blood glucose quite high, and it is currently believed that ANY blood glucose excursion above 140 does permanent damage.
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Old 07-17-2011, 10:36 AM   #105
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The one thing that I don't understand about Jenny Ruhl, is that she feels that eating too much carbohydrate-containing food cannot cause you to develop diabetes:

You Did NOT Eat Your Way to Diabetes!

I agree that genetics plays a big role, but if diabetes is caused only by one's genetic makeup, I would expect no increase in the incidence of diabetes since, say, 1980 -- 30 years isn't enough time for a shift in the gene pool.



IOW, I'll bet that few people on a low-carb diet from an early age would develop type 2 diabetes.
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Old 07-17-2011, 10:57 AM   #106
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IOW, I'll bet that few people on a low-carb diet from an early age would develop type 2 diabetes.
Probably, but being low-carb is not a guarantee of not being a diabetic (see my previous post).

High carb "may" (along with family history), "doom" you to T2; just not always ...

OK, I'm the "exception to the rule", but it still requires me to make the "life decisions" as other T2's....

BTW, 124 on my Freestyle meter this morning. Not great, but not doing bad (being a T2 for 10+ years, with no meds - just diet/exercise)...
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Old 07-17-2011, 11:29 AM   #107
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The one thing that I don't understand about Jenny Ruhl, is that she feels that eating too much carbohydrate-containing food cannot cause you to develop diabetes:

You Did NOT Eat Your Way to Diabetes!

I agree that genetics plays a big role, but if diabetes is caused only by one's genetic makeup, I would expect no increase in the incidence of diabetes since, say, 1980 -- 30 years isn't enough time for a shift in the gene pool.



IOW, I'll bet that few people on a low-carb diet from an early age would develop type 2 diabetes.
Yes, that makes no real sense. I believe what she means is that without the genes for it, you can eat ice cream all day and weigh 400 pounds and still not become diabetic. However, the genes for it are pretty common.

The book I mentioned earlier in this thread, The Art and Science of Low Carbohydrate Living makes this very clear, either you are carb intolerant, or you are not. If you are, you may become diabetic or prediabetic (metabolic syndrome.) They also say that carbohydrate tolerance tends to decrease with age, so people can age into it.

Also, with the genes, you can eat what would have been considered a very reasonable diet and still get it. I tend to agree with your idea, that if you go low enough on carbs from early childhood, T2 DM is likely not in your future.

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Old 07-17-2011, 11:32 AM   #108
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BTW, 124 on my Freestyle meter this morning. Not great, but not doing bad (being a T2 for 10+ years, with no meds - just diet/exercise)...
Have you been able to use your meter to understand how exercise of different types and durations affects your readings?

I have the genes for sure, and for years I ate a diet of "healthy complex carbs" and just counted on divine providence to see me through. Then one day I had a check-up and sure enough my FBS was high. At that time, my number was not diabetic but would be now. I got as serious as I knew how, but this was 15 years ago and I couldn't find a lot. I thought of Atkins as a controversial diet doctor, and I thought that all those academics that recommended "healthy complex carbs" couldn't have been evil or crazy or stupid- so I spent a lot of time sitting on the fence. But I did gradually listen more and more closely to my meter, and to the online low carb groups. Also, I always exercised heavily.

But whatever I am doing now is the best yet. I am squeezing more carbs out so that my vegetable intake is mostly just huge salads and giant bowls of spinach or other greens, radish, celery, etc. And I aim to exercise 6 days/week, for at least an hour. I haven't yet settled on whether I will do 2 or 3 weight sessions/week, but I am doing multiple sets. I am going to a good gym with mostly hard exercising men and women, and lots of very good equipment, free weights, Hammer Strength, Free Motion, so the social environment supports getting down to work. There is some aerobic stuff, but much less than a typical 24 HR Fitness or similar.

All week long I have not had one FBS over 100. Today, it was 91. The key for me seems to be going to bed absolutely physically destroyed. It's a demanding program, but I have seen too much of what diabetes can do, so as long as I can stay with the fact that it takes a somewhat focused life to stay ahead of this beast I should be OK. Also, it takes cooperative people around you. Too many people are diet sabateurs. My family, and my girlfriend are wonderful in this, and when I am out with other people they let me alone with my food and drink choices too.


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Old 07-17-2011, 11:52 AM   #109
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The one thing that I don't understand about Jenny Ruhl, is that she feels that eating too much carbohydrate-containing food cannot cause you to develop diabetes...
Most of the information on Jenny's site is excellent. I think this is a bit of apologetics on her part to support her readership who are probably feeling pretty bad when they first arrive.

Her argument here boils down to: you did not eat your way to diabetes, but you can eat your way out. (That is by eating 'correctly': lowering carbohydrate intake until blood sugar drops.)
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Old 07-17-2011, 12:05 PM   #110
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The one thing that I don't understand about Jenny Ruhl, is that she feels that eating too much carbohydrate-containing food cannot cause you to develop diabetes:

You Did NOT Eat Your Way to Diabetes!

I agree that genetics plays a big role, but if diabetes is caused only by one's genetic makeup, I would expect no increase in the incidence of diabetes since, say, 1980 -- 30 years isn't enough time for a shift in the gene pool.


The threshold fasting reading for a diabetic diagnosis was lowered from 140 to 126 in the late 1990's, which is where the slope of the curve in the above graph undergoes a large change. Presumably there were a lot more diabetics back then than we think (they just weren't diagnosed), so a lot of folks are likely carrying the gene today whose parents weren't classified as diabetics.
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Old 07-17-2011, 12:25 PM   #111
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The threshold fasting reading for a diabetic diagnosis was lowered from 140 to 126 in the late 1990's, which is where the slope of the curve in the above graph undergoes a large change. Presumably there were a lot more diabetics back then than we think (they just weren't diagnosed), so a lot of folks are likely carrying the gene today whose parents weren't classified as diabetics.
Good point. How about harder targets, like diabetic renal disease, or amputations?

Ha
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Old 07-17-2011, 12:37 PM   #112
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The threshold fasting reading for a diabetic diagnosis was lowered from 140 to 126 in the late 1990's, which is where the slope of the curve in the above graph undergoes a large change.
I'd be surprised if someone would fail to correct for that -- that would be a real misinterpretation of the data (not correcting for the redefinition of the term "diabetes"). But maybe.
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Old 07-17-2011, 12:50 PM   #113
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I'd be surprised if someone would fail to correct for that -- that would be a real misinterpretation of the data (not correcting for the redefinition of the term "diabetes"). But maybe.
How would they correct for it? They look at the diabetes statistics, not at what blood sugar level the diagnosis was made. How could they?

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Old 07-17-2011, 01:04 PM   #114
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The threshold fasting reading for a diabetic diagnosis was lowered from 140 to 126 in the late 1990's, which is where the slope of the curve in the above graph undergoes a large change. ...
I also noticed the word "diagnosed" in there, and was wondering that same thing.

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I'd be surprised if someone would fail to correct for that ...
I wouldn't be surprised at all. I see it all the time. I would not assume it was corrected until I saw something that said it was corrected. Esp since it is pretty well known that the definition has changed, I might actually expect an asterisk on that graph with the explanation right there in a footnote on the graph. Just takes a couple words, the details can be in the backup. Lacking that, "diagnosed" is "diagnosed", no more, no less.


Another question(s) on these meters and strips (for anyone). I read up a bit, and from what I gather, there is a chemical reaction on the strip when exposed to glucose, and then the meter reads some effect on the strip that correlates to this reaction (the chemical reaction has some measurable electrical response?).

The strips have a manufacturing tolerance, and a code to indicate their offset (IOW, it is hard/expensive to manufacture these strips to tight tolerances, but easy to characterize them by measuring something). So you've got test strip tolerances, and then meter tolerances in reading the effect of the reaction. So my questions:

Can you read a single prepared strip multiple times (with diff meters or the same meter), or does reading it alter the effect, so subsequent readings of that strip are not meaningful?

Can you buy/make a reference solution of glucose, to validate the strip/meter? Maybe this is complicated by all the other stuff in blood, but it isn't that hard to make up dilutions to achieve any ppm you want.

Home brewers often do that with their hydrometers. They are down to single digit concentration levels, but dilutions are easy (768 tsp per gallon). Two dilutions gets you to 1.65ppm.

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How would they correct for it? They look at the diabetes statistics, not at what blood sugar level the diagnosis was made. How could they?

Ha
Easy if they had the raw data. Tricky, but not impossible to be reasonably accurate through other means (i.e, if they knew the distribution of people between 126 and 140 prior to the change, it seems they could detect a deviation from this).

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Old 07-17-2011, 02:03 PM   #115
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How would they correct for it? They look at the diabetes statistics, not at what blood sugar level the diagnosis was made. How could they?

Ha
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Easy if they had the raw data. Tricky, but not impossible to be reasonably accurate through other means (i.e, if they knew the distribution of people between 126 and 140 prior to the change, it seems they could detect a deviation from this).

-ERD50
Let me add to that previous post, I might have left too much out.

You can get a good idea of the distribution of the population from a pretty small sample. You don't need to know the specifics of the individuals that were diagnosed.

So let's say that for each of those years 1980-2007, they have enough raw data on the general population to characterize the curve (I'd expect this to be true). They can look at the curve, and estimate that based on the number reported that are above above 126, how many would be above 140. Or work it the other way.

Putting made up sample numbers to it, let's say the curve of a good sized sample shows that 1% of the population is above 140, and an added 2% are between 126 and 140. It follows that if you tell me X people were diagnosed with the 126 definition, that I can tell you with reasonable certainty that 1/3 of them are above 140. Conversely, if you tell me that X are diagnosed with the 140 definition, I can tell you that I expect an added 2X to be between 126-140. So I could adjust a graph for that pretty easily.

A much tougher nut is to estimate how aggressively people are being looked at for this issue. You generally don't detect what you don't look for. If more screening is occurring, diagnoses obviously will go up. If it can be quantified, it can be accounted for, but I'd bet there is some subjectivity there. I imagine if a Doctor is more sensitized to the issue, he/she would order more tests and may not even be aware of this effect.

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Old 07-17-2011, 02:23 PM   #116
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I would do it by using the distributions of blood sugar levels found in the population, and using it to adjust the stats for number of diabetics. Eg if x% have BG above 140, you can predict that y% have BG over 126. And you add a note describing your correction.

Of course it would be better to work with absolute BG values, which certainly would be a available.

They'd be bad for not adjusting, but people rarely adjust for inflation, so who knows.
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Old 07-17-2011, 10:35 PM   #117
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Most of the information on Jenny's site is excellent. I think this is a bit of apologetics on her part to support her readership who are probably feeling pretty bad when they first arrive.

Her argument here boils down to: you did not eat your way to diabetes, but you can eat your way out. (That is by eating 'correctly': lowering carbohydrate intake until blood sugar drops.)
I tend to agree. I think this part of the website is a bit of misdirection to allow people who are feeling crushed by guilt and shame to get past it a bit and get to work on controlling their disease. I read this when I was first diagnosed and it helped. But as I became more educated I realized that, assuming any of the science of diabetes is valid, I did do a lot of it to myself. But by then I was aware that there was a lot I could do to control it too, and so it wasn't as important to think I was blameless.
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Old 07-18-2011, 07:53 AM   #118
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Have you been able to use your meter to understand how exercise of different types and durations affects your readings?
Absolutely!

It's the only tool I have to use on a daily (or in my case, weekly) basis to monitor my current "condition" between BT's (Overnight/A1C).

When I was first diagnosed (July, 2001), my fasting glucose was at 207 and A1C at 9.5. Also since I was a "newbe" at T2 management, I would test four times a day for the first couple of years, to understand how diet/exercise was affecting my current level. Since those early years of management, and with a bit more understanding of how T2 "works" in my situation, I've dropped back on the testing to weekly.

My last test (in April '11) had an overnight of 105 and an A1C of 6.5. BTW, that 6.5 is the highest reading since my original test, 10 years ago.

Over the period, I've ranged in A1C readings of 4.7 (April '02, after losing a lot of weight - folks said I looked like a skeleton at that time, in addition to a lot of exercise) to my last test of 6.5 (with a more normal body weight, and just moderate exercise). My lowest overnight glucose reading was 84 (Nov '03), but that dosen't count since the A1C is the "gold standard" in T2 testing, IMHO.

I approached my personal challenge with knowledge, obtained by a lot of reading, along with instructions of my diabetes management team (as I mentioned before, about going to classes - which is usually paid for by your health insurance).

I know that diabetes control is up to me, but I also realize the progressive nature of the condition. After 10 years (and not one med), I realize that in the future I'll have to take a med to help control my numbers. However, that will just help me keep on track - not replace what I have attempted to do in the diet/exercise areas.

As one who has had the condition for the last 10 years (and actually for the last 20, since the condition usually is present a decade or longer before diagnosis), I feel I'm on the right track.

It won't kill you, assuming you manage the condition with lifestyle changes, along with personal testing, in addition to those BT's ordered by your doctor. In fact, it may extend your life (as I feel it did in my case) since you are aware of it and hopefully modify your "bad habits" to manage the disease.

IMHO, the worst thing you can do is take a med (or insulin) and continue your lifestyle, if it indeed added to your failure to manage the condition. Now if you do try to actively manage the condition (through diet/exercise) and you still can't manage it on your own, then sure - take the med. However, I've met more than a few folks who just pop a pill (or take a shot) and continue their lifestyle, without taking any responsibility for their health.
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Old 07-18-2011, 08:08 AM   #119
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Can you read a single prepared strip multiple times (with diff meters or the same meter), or does reading it alter the effect, so subsequent readings of that strip are not meaningful?

Can you buy/make a reference solution of glucose, to validate the strip/meter? Maybe this is complicated by all the other stuff in blood, but it isn't that hard to make up dilutions to achieve any ppm you want.
The strips are one-use, and are designed for the specific brand/type meter you are using.

For instance, I use the Freestyle brand meter. However, over the last 10 years they have made advances in meter design/usage (smaller, faster test results with a smaller blood sample) and you can't mix the strips for the old/new meters and expect consistant results.

And yes, they do supply a vial of "test blood" (testing solution) to be used with the meter to check its accuracy. You insert a strip, place a drop of "blood" on the strip, and check the results vs. what the test "blood" says on the label. Usually it is around a 20 point variance, but as long as you get within the range, your meter is operating correctly.

The biggest improvement over the last decade is that you no longer have to "code" your meter, when you get a new vial of test strips. I won't go into the details, since for most meters, they no longer apply. I'll just say that in many cases, the results (good or bad) were due to "mis-coding" of strips.
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Old 07-18-2011, 10:55 AM   #120
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...

And yes, they do supply a vial of "test blood" (testing solution) to be used with the meter to check its accuracy. You insert a strip, place a drop of "blood" on the strip, and check the results vs. what the test "blood" says on the label. Usually it is around a 20 point variance, but as long as you get within the range, your meter is operating correctly.
Thanks rescueme, that's very helpful. -ERD50
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