Diabetes

[ERD50]

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.

-ERD50

 

[GregLee]

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?

 

[haha]

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

 

[rgarling]

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.

 

[TromboneAl]

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.

 

[rescueme]

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)...

 

[haha]

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.

Ha

 

[haha]

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.


Ha

 

[rgarling]

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.)

 

[FIRE'd@51]

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.

 

[haha]

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

 

[TromboneAl]

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.

 

[haha]

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?

Ha

 

[ERD50]

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.

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.

edit/add:

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).

-ERD50

 

[ERD50]

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).

-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.

-ERD50

 

[TromboneAl]

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.

 

[harley]

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.

 

[rescueme]

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.

 

[rescueme]

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.

 

[ERD50]

...

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

 

[haha]

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).

Thanks for the info, Rescue. I think that other than genetics and chance, diabetes is a mostly test of moral character and one's ability to think, be upbeat, and hew to a demanding program.

The internet is a giant help at finding information that may be helpful. I also would like to once again recommend the book The Art and Science of Low Carbohydrate Living, by Drs. Volek and Phinney. Anyone interested in or committed to the low carb approach to carbohydrate intolerance, weight loss, metabolic syndrom or T2 diabetes should benefit from this book. They say flat out that breaking the diet is a very bad idea, as you can quickly lose your adaptation to burning fat and ketones rather than carbohydrates. Also, they strongly suggest that this is not a diet- it's a new, permanent way of living and especially of eating. People hate to give up things they like, me included, but after all we give up things all the time. When you get married (in America) you are giving up all the other actual and potential partners, who of course remain attractive to you. This is likely no easier than giving up sweets or pasta or mashed potatoes, for example- so why not get on with it and kiss those formerly fun things goodbye, in the interest of keeping your eyes and kidneys and extremities?

Ha

 

[gindie]

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:

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.

I just received the following response from Jenny herself when I asked for enhancement/clarification to the above. She gave me permission to post it, along with the suggestion to read her page on the subject at http://www.phlaunt.com/diabetes/14046739.php.

"If you read the page in which I explain why people didn't eat their way to their disease you will see a long list of environmental factors that explain the huge increase in both obesity and diabetes that has taken place over the past 50 years. Pesticides, arsenic, plasticizers, PCBs, all have been shown to cause diabetes or intensify insulin resistance. So do SSRI drugs, atypical antipsychotics and even Statins.

Blood levels taken of women as part of a new NIH study of environmental impacts on infants are showing shockingly high levels of plastics like BPA, flame retardants, pesticides etc in the the blood of average people. Industry wants you to think that the increase in obesity and diabetes are due to people's bad behavior, because the costs to remove these toxins from the environment are prohibitive, and the toll industry's chemicals have taken on human life already incalculable.

I am old enough to have been born into a world without plastic, but to remember also how the the trucks came and sprayed clouds of DDT on us children as we played at night and then our mothers would fill the room up with spray before we went to sleep. No one thought anything of it. When I was a kid very few people were fat and trust me, people ate plenty of food. It is a revisionist fantasy to think everyone lived an active life and ate small portions in the past. What we are seeing around us is very similar to what happens to lab animals with chemically damaged genes. Huge babies, decreased fertility, etc. etc.

Yes, once you have damaged the genes with these various chemicals, carbs become toxic, but you need to damage the genes to end up with diabetes."

 

[rgarling]

If being insulin sensitive is considered a genetic flaw then yes these "damaged genes" cause carbohydrates to be toxic when consumed in typical western-diet sized portions.

Remember what Morgan Spurlock did to himself in only 1 month?

 

[TromboneAl]

That response from Jenny Ruhl seems a bit like crazy talk to me.

 

[rescueme]

"If you read the page in which I explain why people didn't eat their way to their disease you will see a long list of environmental factors that explain the huge increase in both obesity and diabetes that has taken place over the past 50 years. Pesticides, arsenic, plasticizers, PCBs, all have been shown to cause diabetes or intensify insulin resistance. So do SSRI drugs, atypical antipsychotics and even Statins.

I tend to agree with this statement since (as previously posted) my T2 did not come as a result of any known family member with the condition, but assumed based upon my "interaction" with PCB's (a component of Agent Orange) many years ago.

It's funny that this is mentioned, since such "contaminants" are the factors involved with many other conditions - not only T2.

In the group that I wor*ed with for close to 30 years, there were four people that served (on the ground) in Nam. Of those four, three (me included) were receiving care for our exposure to AO (including cancer, in addition to T2). As for the fourth? Who knows if any condition has yet to show itself?

The idea that T2 (and many other conditions) are a result of "poisoning ourselves" (or the government doing it, in my case) sounds logical, in my simple way of thinking.

Maybe environmental exposure is one of the primary reasons with the explosion of T2, with the management of diet (more specifically, carbs) being the "control mechanism" to keep it in check.

Heck, what do I know? All I do know is that "I have it" and "I control it" by watching my diet (with carb control), along with a bit of exercise which reduces stress - which adds to the problem, if you don't keep stress in check, IMHO.

Just my simple POV, based upon my simple life...