Ten weeks ago, with her endocrinologist’s knowledge, this young woman discontinued insulin to begin a low carb diet. She has been gradually achieving normalized blood sugar, but this morning she had her first totally normal fasting blood sugar level since being diagnosed as type 2 diabetic! How cool is that?
As relayed in the first part of this account (posted here), at this young woman’s insistence her doctor gave her 12 weeks to ‘try a low carb diet’ and then he would put her back on insulin. Needless to say, he was not optimistic that changing her diet would ‘work’.
When she saw him a few weeks after beginning a low carbohydrate diet, and after lowering her fasting blood blood sugar from 16.8 mmol/L (303 mg/dl) to approximately 7.5 mmol/l, he told her that that the only way she could get her blood sugar below 7.0 mmol/L was to begin injecting insulin again. She responded by saying that she was not even half-way through her 12-week “trial period” and that she wanted to continue. As a result of her on-going “dawn phenomenon” (and upon my recommendation) she asked her endocrinologist to add an extra dose of Metformin* at bed-time to prevent her liver from making so much glucose in the morning (via gluconeogensis) and while he agreed, he said that if her HbA1C was not below 7.0 mmol/L (126 mg/dl) the next time she has it checked, he was putting her back on insulin.
*Metformin does not lower blood sugar, but helps the body become more insulin sensitive and to keep it from manufacturing glucose from stored fat or protein which is what underlies high morning blood sugar.
This coming week she is having her 3 month blood work and she and I both realize that it is unlikely her HbA1C will be below 7.0 mmol/L because there was a two week period this summer where she had several friend’s weddings, and got off-plan a bit. While she was quite disciplined, a few things she ate that were low glycemic index complex carbs still caused her blood sugar to rise above the levels she had been achieving. She got right back on plan after the weddings, and has been doing absolutely amazing! I am so very proud of her!
Here is a graph of her blood work over the past 10 weeks, including the ‘blip’ in the middle from the weddings;
She is not “there” yet, but this week she began having much less variation in blood sugar and the graph continues to be shifted downward. She is doing so well.
She has begun delaying the first meal of the day to noon because she doesn’t feel hungry in the morning, and is making extra effort to try different timing for taking her late-night and early-morning Metformin, so as to maximize the reduction in fasting blood sugar from dawn-phenomena (gluconeogenesis). This morning, while we were on our weekly Skype call, she took her blood glucose. 4.7 mmol/L (85 mg/dl)! This was her first normal early morning glucose since being diagnosed as being Type 2 diabetic in 2017!! I asked her to hold the meter up to the screen and took a picture of it!
Note: I’ve edited out her name and made the numbers a bit more readable.
In just 10 weeks, this young woman has gone from a 2 hour post-meal glucose reading of 18.7 mmol/L (337 mg/dl) to between 6.5 mmol/L (117 mg/dl) and 7.9 mmol/L (142 mg/dl).
The normal “goal” for 2 hour post-prandial glucose for someone with type 2 diabetes is ≤ 7.8 mmol/L (141 mg/dl) and in just 10 weeks, she is already doing considerably better than that!
As I did in the first post about her progress, I asked her to write in her own words what it has been like and how she feels. This is what she wrote today;
“I have been working together with Joy for close to 3 months now and I am amazed at the progress being made. Monitoring my blood glucose levels consistently has given me more insight into how and when I should be eating and taking my medication. This is key to the progress that I have made. There have been highs and lows, with life and weddings getting in the way, but getting back on track from any deviation is crucial. Knowing that I was accountable to Joy and my blood glucose monitor motivated me to get back to those lower numbers.
With the guidance of Joy, I have adjusted the timing of my Metformin and made tweaks to my diet which will help lower my numbers and prevent spikes. I found that I was not hungry in the mornings and all I needed was my coffee, so I pushed my first meal to lunch and my second meal has been dinner. My cravings have been close to eliminated and I don’t feel the need to snack between meals.
The biggest issue has been my increased fasting glucose due to the dawn phenomenon. To avoid a nightly prescription of insulin (which I never want to take again), I have been invested in figuring out when the nighttime spike is occurring and how I can adjust the timing of my Metformin to minimize it. For the past couple of nights, I have been checking my blood glucose levels every 1-2 hours, and have narrowed down the time at which the spike occurs. This investigation has lead me to my lowest ever fasting glucose reading today of 4.7!!! This is a number I never thought I would see. I couldn’t believe it. I still can’t believe it. I keep checking to see if I read the number wrong but there it is every time!
This has been a slow and steady road, but being consistent and invested in my health is starting to pay off. It has all been worth it and I cannot wait to see what the next 3 months bring!.”
Note: This is what only one person has been able to achieve following a well-designed low carbohydrate diet the last 10 weeks, but these results are quite consistent with Virta Health‘s 10-week results from their outpatient study with 238 subjects published in October 2017 and outlined in this post.
Post-publication addendum (August 23, 2019): I was asked on social media yesterday why I didn’t start this young woman on a very low carbohydrate, ketogenic diet from the outset. This is what I replied; “Diabetes Canada has not (yet?) deemed a LC or very LC diet as safe and effective medical nutrition therapy. I start people at 130 g of carbs, then reduce carbs as necessary to achieve clinical outcomes as a prudent approach. Hence why I conclude the article w/ hope of future policy change.“
I partner with people’s GPs and Endocrinologists to enable them to oversee reduction and de-prescription of injected insulin (or other medications that may result in low blood sugar when following a low carbohydrate diet) while their patients follow a well-designed low carbohydrate diet to effectively manage their blood sugar. It is fantastic to see people such as this very determined young woman replicate what hundreds have done under the care of knowledgeable clinicians and as published in an ever increasing number of peer-reviewed studies.
It was so exciting to recently witness hundreds of CDEs in the United States being taught how to use a low-carbohydrate diet and a very low carbohydrate (ketogenic) diet as medical nutrition therapy with people with both type 1 and type 2 diabetes and how to manage the many medications prescribed for people with diabetes (you can read about these two presentation in this post and this one)!
I long for the day that Diabetes Canada releases an update to Clinical Practice Guidelines similar to what the American Diabetes Association (ADA) did last year, which enables clinicians to recommend a low carb or ketogenic diet as a therapeutic option for those with diabetes.
For more information about the clinical changes at the ADA, you can read any one of several articles from April 2019 that are posted under the Science Made Simple tab above, including this one.
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