Achieving the “Impossible”: from injecting insulin to achieving target HbA1C

A few weeks after requesting that her endocrinologist take her off insulin so that she could begin a low carbohydrate diet with his and her GP’s oversight (article here), this young woman was told she needed to get her HbA1C to ≤7.0%, which is the therapeutic target for adults with type 2 diabetes. She was told that it was unrealistic for her to think that she could do so following a low carbohydrate diet, and that she should go back on insulin.  She replied that she wanted to continue to eat a low carbohydrate diet for a total of 12 weeks, and her endocrinologist replied that more than likely he would need to put her back on insulin then, because it was not realistic for her to accomplish those goals using diet, even with Metformin support.

*Metformin doesn’t 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.

Well, she achieved the “impossible”!

She had her blood tests yesterday and when she checked her results on-line last night she could not believe it!! Her results were below the 7.0% therapeutic target. . . and this was (1) despite me starting her on a moderate low carbohydrate diet for the first several weeks and only gradually lowering carbohydrate content in order to meet clinical outcomes*, and (2) despite her having two weeks of weddings in mid-July where she ate a little ‘off-track’, which caused her blood sugar levels to rise).

In spite of these, she did it!!

Note: weight loss was only ~5% of her original weight, so would not account for her significant improvement in HbA1C results.

Here are her results:

from injecting insulin to HbA1c within target

*I was asked on social media after the previous update on her progress 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.

After this young woman picked up her blood test results last night, she sent me this short email which I have her permission to share here;


Such overwhelming feelings right now. We will talk tomorrow but I took my blood test today and have attached the results! Please tell me I am seeing the number I am seeing because it is hard to believe! Also, for the graph this week, I had to change the minimum limit from 5 to 4 to account for my TWO readings of 4.7!! “

As relayed in the second article about her progress (posted here), in 10 weeks this young woman went from a fasting blood glucose of 16.8 mmol/L (303 mg/dl) to 4.7 mmol/L (85 mg/dl). . . and this past week she had her second fasting blood glucose reading of 4.7 mmol/L! Twice in one week, she achieved normal fasting blood glucose numbers; the first time since being diagnosed as having type 2 diabetes in 2017.

As she said in the previous article, she is “invested” in her health and that investment translated to her own determination and hard work to follow her Meal Plan, to speak to her endocrinologist about adding an extra dose of Metformin at bed-time, and to determine when was the best timing to take her before bedtime dose and her early morning dose, in order to prevent her blood sugar from spiking in the morning due to Dawn Phenomena. Yes, I helped but she did the work! 

I asked her to write in her own words what it was like to get her blood test results last night, and this is what she wrote:

“I feel so happy and proud of myself. Patience and consistency has paid off.

Typically, if I were doing this on my own or changing how I was eating, I never stuck with it long enough to see changes.  The number on the scale or one bad meal would take me further back than when I started.  However, keeping track of my blood sugars and being accountable to someone have kept me going, and I feel like nothing can hold me back now.

I am so motivated to keep going and giving myself time to progress. I know I can do this!”

I am so proud of her hard work and accomplishments!

I look forward a day when Diabetes Canada updates its Clinical Practice Guidelines to enable clinicians to recommend a low carb or ketogenic diet as a therapeutic option for those with diabetes ⁠— just like the American Diabetes Association (ADA) did last year.

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.

UPDATE (Sept 6, 2019): During our weekly call, this young woman told me that she is meeting her endocrinologist this week and is looking forward to his reaction to her accomplishments, as well as that of his diabetes nurses.  She said during her last visit 8 weeks ago (4 weeks after coming off insulin and beginning a low carbohydrate diet) her doctor told her that she is ‘not eating rice and needs to be eating that’ and reminded her that the ‘insulin will cover that’.  The diabetes nurse also told her ‘she should be eating 60 g of carbohydrate per meal plus snacks’ (which is still the recommendations for those with diabetes in Canada). She assured them that she is carefully monitoring her blood sugar multiple times per day and that they are coming down, and she feels great.

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To your good health!


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Copyright ©2019 The Low Carb Healthy Fat Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

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