What do people do when the doctor tells them they are prediabetic or diabetic? What should YOU do?
I have followed literally hundreds of diabetics over the years, seeing what they expected and what they actually got. My experience is that these unfortunate folks fall into three categories of diagnosis.
Getting an annual blood test?
Lots of people don’t go to a doctor or get an annual blood test. These folks generally discover they are diabetic when their feet hurt, vision deteriorates, or they have a heart attack. In other words, they have “symptoms”. Unfortunately some even find our they are diabetic when they get really sick and go to the emergency room with a screamingly high blood sugar requiring extreme measures to reduce. Some die.
These are folks who actually have an annual blood test and the blood test shows glucose levels that aren’t “normal” but aren’t quite bad enough to diagnose as diabetic. Generally a doctor will call this prediabetic and suggest patients “watch” their diet without any specific direction.
One exception! If you happen to be among the huge percentage of Americans who are overweight and potentially obese, the doctor will surely tell you to lose weight. This is actually very good advice because many diabetics who manage to lose and keep off extra weight make great progress. On the other hand, some don’t. It can be a genetic thing.
But the doctor sometimes isn’t very helpful with losing weight either, perhaps saying to cut your calories or exercise more. Very few people are successful in losing and keeping off weight using the calorie counting or exercise strategy. You know those people.
Most people diagnosed as “prediabetic” ignore it. Why? Perhaps because they have no true notion of the danger. But some of those people know instinctively that they will have to change their way of eating and they are VERY fond of their current diet. What I don’t know won’t hurt me. You know those people too.
Technically prediabetes is actually already diabetes. That is, sugar metabolism in your body is already out of line and some symptoms may already be showing up. Two important early symptoms are frequently neuropathy (nerve damage in feet and possibly hands causing tingling or pain) and retinopathy (blood vessel and nerve damage in the eyes). Note that it is easy to miss the cause of these symptoms.
The progression of diabetes is attached to the amount and effectiveness of insulin produced by your pancreas. A condition called “insulin resistance” prevents the insulin from working very well. But sometimes genetic variations can reduce the amount of insulin available in the first place. Both of these situations are complicated. Type 1 diabetics make no insulin at all.
Genetics related to environmental toxins discussed in my recent cancer post on this website also can contribute to diabetes. In any case, the pancreas first tries to compensate for insulin resistance by producing more insulin. This can go on for a very long time. But at some point the pancreas doesn’t keep up and insulin production goes from high to low.
Most doctors don’t test insulin levels; instead they depend on blood sugar readings. When the amount of insulin is sufficiently diminished that your fasting blood sugar reaches a high level, THEN your doctor will see you are diabetic. Now the doctor has something to treat.
If you ignore it, prediabetes will usually move right along into blood sugars that the doctor will call “diabetic.”
Now the usual doctor abandons the diet watching and goes straight for medication. In some cases the doctor may refer you to a nutritionist or diabetic dietician, largely because the average doctor knows very little about nutrition. The doctor is also likely to tell you that diabetes is progressive and will only get worse. Medication is a delay tactic.
Those who go to the nutritionist or diabetic dietician get the recommendations of the ADA (American Diabetes Association). Those recommendations allow, perhaps even insist on, consuming a lot of carbohydrates (sugar). Any need to lose weight is supposed to be met by cutting calories, which we already know isn’t likely to be successful all by itself.
If weight loss does not occur, the average doctor will be sure you just aren’t trying. Meanwhile the carbohydrates (sugar) in your diet will cause your blood sugar to steadily rise and the doctor will prescribe more of or additional medications. If those medications are insulin, you will gain even more weight.
What happens during the “progression”?
As that happens, you pancreas’ ability to keep pumping out excessive amounts of insulin goes further downhill. The amount of sugar hanging around in your blood stream exceeds the insulin supply. Potential panic city.
Certain other conditions like heart disease, kidney disease, certain autoimmune diseases, etc. have been slowly developing during this period. Now they start showing up. In fact, it isn’t uncommon for those folks who don’t have an annual blood test to find out they are diabetic when they have a heart attack. There are studies showing the direct relationship between high insulin and heart disease.
So while your pancreas was still pumping out extreme levels of insulin, that excessive insulin was doing damage in other parts of the body.
What does a diabetic do now?
Two groups here: Some accept whatever happens in the interest of maintaining the dietary status quo. Others are not so willing and start looking for help.
You may get lucky and have a doctor who understands the nuances of truly managing diabetes. And there are actually certain specialty doctors out there who can guide a patient. They are not, however, usually covered by Medicare or most standard insurance plan. People without lots of discretionary cash are in trouble. Soooo they start asking for the opinions of others. Opinions are cheap.
The opinions of others
These are not all bad. I long ago figured out how to deal with my diabetes with the help of Jenny Ruhl, owner of a website called Blood Sugar 101. She did the research and built that site because doctors couldn’t help her. I found her on a Google search.
But it kinda depends on whose opinion you seek and your willingness to follow the advice. Your dilemma is this – not being able to depend on your doctor or a nutritionist means you have to depend on yourself. You have to be able or willing to seek and assess the value of information and advice you receive.
Start with this thought. You need to understand your condition and how to make decisions about how to improve your situation. You do not need someone to tell you what to do because what works for somebody else may not work for you. Trust me; one size does not necessarily fit all. Diabetes is a complicated disease.
Books, the internet and Facebook
Those who can’t or won’t read are going to struggle.
First learn about your disease through books and the internet. I can confidently recommend starting with Blood Sugar 101 written by Jenny Ruhl. Jenny provided for my early education in handling my own diabetes. I can also recommend Dr. Bernstein’s Diabetes Solution although it’s a tougher read. Dr. Bernstein’s book is particularly focused on type 1 diabetes.
Jenny Ruhl also has a website, also called Blood Sugar 101. There is excellent information here on every aspect of diabetes, including how genetics can play a role. Both Blood Sugar 101 and Dr. Bernstein have websites and Facebook pages.
Once you have educated yourself and made some decisions, you now arrive at the support community requirement. Diabetes Facebook pages are a good support source. Type “diabetes” on the Facebook search line and they will appear.
Warning: Any group that advocates “anything is okay in moderation” should be avoided. Moderation only works for people who aren’t already sick. Diabetics are sick.
Most groups are focused on a specific and sometimes rigid diet structure. That may be reducing carbohydrates to a very low level, say 20 or 30 carbs per day. That might be going LCHF (low carb/high fat.) That might be high protein. That might be a “ketogenic” diet or even “fasting.” The possibilities are endless and all have merit for some people. The question is, are you among those people?
I have never seen a program that was right for everyone. None the less, some of these groups were created by and contain very knowledgeable members and administrators who can often add value.
Now as to your friends, family, and neighbors. If these happen to be poorly controlled diabetics their ideas are apparently flawed. If they aren’t diabetic, they aren’t likely to know much about it. Diabetes is not a well understood disease. This could be the blind leading the blind.
The ADA also has a Facebook page. You may want to avoid it unless you just enjoy reading nasty comments by people who have failed using their advice.
One concern about Facebook support groups is a lack of concern about nutrition. They really do get snared up in the business of cutting carbs. Unfortunately an emphasis on an extremely low carbohydrate diet can result in low carb “junk” which tends to be tasty but is absent the vitamins, minerals, etc. that should be eaten in plant food.
The optimum operation of your genes in keeping you healthy is totally dependent on your nutritional status. Consequently just counting carbs doesn’t get it. Consider, instead, selecting your carbs carefully with the emphasis on nutrition.
One thing the Facebook pages do have in common is this – advocating elimination of all processed food, particularly those made from or including ground up grain and sugar. This elimination would include vegetables oil made from grain.
I have outlined that diet in some detail in my book, It’s All About the Food. Processed food is sadly absent the natural nutrition found in whole food AND contains the actual bulk of the calories in a typical diet. So this step alone is likely to cause weight loss and has, for many, been enough to bring blood sugar under control.
If eliminating processed food isn’t enough, then you may have to cut out all or most whole food starches like potatoes, whole grains like quinoa, rice, even traditional or steel cut oats, all nutritious but significant sources of sugar. Eliminating them narrows your carbohydrate intake to an equally nutritious variety of green, leafy and cruciferous vegetables and the lowest carbohydrate fruits like blueberries.
Diabetic medications (including insulin) might be required during the period of adjustment to a new diet. I have seen many eliminate medication on a good diet. But here is the most important thing; medication is not a fix allowing for a bad diet. There are many medications that have ugly, health affecting side effects. Research your medications carefully with the goal of eliminating or at least reducing them to the lowest possible level.
There is nothing like insulin to cause weight gain. Insulin is just moving the excess sugar out of your blood and into your fat cells. Insulin makes you hungry. That is why most people get fat as they progress into diabetes.
This is where a Facebook group is handy, sharing their experiences with medications, offering ideas on how to overcome the cravings that could nag at you when starch and sugar are eliminated from your diet, and providing recipes for food that your diet hasn’t always contained. They provide a shoulder to cry on.
In summary, learn about the causes and implications of diabetes by reading. Determine a dietary course of action and then just do it consistently. Track your blood sugar and symptomatic responses to the diet for at least a month. If the first course of action doesn’t work, then modify it. Find a support group to help you.
Diabetes doesn’t have to be a progressive disease. Keep the faith.