Holiday Eating: a harsh reminder that I am not ‘cured’- a Dietitian’s Journey

I was eating low carb for a year and following that, eating keto for 1.5 years, and for the past 6 months I’ve been in partial remission of my type 2 diabetes (with HbA1C significantly ≤ 6.5%). Two weeks ago my fasting blood sugar (FBG) was assessed at the lab as being 5.2 mmol/L (94 mg/dl), so for all intents and purposes, it is though I am not diabetic (normal HbA1C and normal FBG). My blood pressure too is totally normal (120/70) — which is a huge drop from the hypertensive emergency level that started me on my “journey” March 5, 2017.  I feel well and I look well and provided I continue to eat a very low carbohydrate diet, I am well. But this past weekend, I had conclusive evidence that I am NOT cured of my type 2 diabetes!

Sunday I was invited over to a friend’s house for a holiday party and I decided for the first time in as many years to eat “off plan”; not that I haven’t had the odd taste of something , but I’ve not had an off-plan meal in two and a half years. This past Sunday, I did.  I didn’t go crazy — certainly not as when compared with all of the goodies I would eat at special events in the past. I had a few homemade falafel balls, 1/2 a potato pancake and 1/2 a freshly made donut, and the rest of what I ate was baked salmon, low carb veggies and club soda. 

Naturally, I expected my blood sugar to be elevated afterwards, but an hour later it was 11.3 mmol/L (204 mg/dl)!! That is the above the 10.0 mmol/L (180 mg/dl) blood sugar level cutoff where the body excretes the excess sugar in the urine (called glucosuria). I was clearly still very diabetic (i.e. not cured).

I had some Metformin in the house and took one tablet and also did 20 slow squats in order to coax my muscles to accepting the excess blood sugar. An hour later my blood glucose was 8.6 mmol/L (155 mg/dl); still very much above the so-called “ideal” of 7.8 mmol/L upper cut-off for someone with type 2 diabetes. An hour later my blood sugar was 6.8 mmol/L (123 mg/dl).  Dejected, I went to bed.

I woke up 3 hours later to use the washroom (not surprising given my body was trying to get rid of so much excess sugar!!) and I decided to test my blood sugar one more time to see what it went down to. It was 4.1 mmol/L (74 mg/dl)) — which is usually what it is after a day-long fast. To be sure, I checked the result 3 times. Surprisingly, I was still producing small amounts of ketones 0.3 mmol. It was evident was that my muscle (as a bi-product of my significant weight loss (50 pounds) and encouraged by the squats) and my liver (also a bi-product of my significant weight loss and encouraged by the Metformin*) accepted the excessively high sugar load and the rest left via my urine. This is certainly a MUCH better response than I had to eating carbs 2 – 1/2 years ago, but by no means am I “cured”. I am still a person with type 2 diabetes, just in remission.

*the Metformin helped suppress the breakdown of fat from my fat cells (lipolysis) and the resulting release of glycerol, since I had all that sugar to use. I also helped promote glycogen storage.

Despite having had type 2 diabetes for 8 years prior to adopting a low carb lifestyle, I did have a first-phase insulin response to eating all those carbs, but it was clearly inadequate. I did have a second phase insulin response, but having been eating only low carb, my pancreas was not used to such a huge sugar load. It was ill-prepared. As a result, my blood sugar hit glucosuria levels (above 10 mmol/L), resulting in my body dumping excess sugar in my urine. 

It’s hard to know what my first phase and second phase insulin response would have been had a eaten 100 or so grams of carbs for 3 sequential days before eating this huge carb load, in order to prepare my pancreas (i.e. this is what is encouraged for those eating low carb before having an oral glucose tolerance (OGTT) test).

It’s also hard to know how much of the improved insulin sensitivity was due to my significant weight loss and resistance exercise that I am doing and how much was due to the Metformin I took, but I have NO desire to repeat this experiment without the Metformin, in the interest of science!  In fact, I am VERY content to go back to eating “on-plan” and letting my body recover from the excessively high carb load I gave it. The harsh reality is I am not cured. I still have type 2 diabetes. I am just in remission, provided I continue to eat a very low carb diet.

I’ve been in partial remission of type 2 diabetes for about 6 months now, but I have clearly not reversed (cured) it.  For an explanation of the difference between partial-, complete- or prolonged-remission and reversal / cured, please click here). As discussed in that article, remission of type 2 diabetes can occur with weight loss of ≥ 15 kg (33 pounds) which either results in restoration of β-cell function by either (a) β-cells being reactivated or (b) by existing β-cells functioning better and this is what I’m experiencing. I am in partial remission (using Virta Health’s definition) as my HbA1C < 6.5% using only occasional Metformin, and my fasting blood glucose ≤ 5.5 mmol/l (100 mg/dl).

Diabetes reversal (i.e. being “cured”) is where a person no longer has the symptoms of type 2 diabetes (which has been documented to occur), but is clearly not my case! I am still very much diabetic. But I don’t have any symptoms, provided I continue to eat a very low carbohydrate diet.

Some final thoughts…

Critics of a very low carb / ketogenic diet say that it is “not sustainable”, but when the option for me of not eating this way is to have responses as above, eating real, whole food (instead of refined, prepared foods) is very sustainable! Have a look at some of my articles about what I eat, my posts on Instagram and my recipe tab, you’ll see that I am not suffering!

Those who have been following my “journey” from the beginning know that I had two girlfriends who worked in healthcare die (one of a heart attack and one of a stroke) before I faced my own health crisis in March 2017. I changed March 5th of that year and have not looked back. I do it for me. I do it for my young adult sons. I do it for Kim and Jane who didn’t get the opportunity to change their lifestyle before dying prematurely.

We’ll hear people who advise others to do something “as if their life depended on it” and for me, eating this way is just that. My life (via cardiovascular health) and my quality of life (having my vision, all my toes, etc.) depends on it.  It’s all a matter of motivation and that is mine.

What’s yours?

Perhaps you want to lose weight for health reasons, or for aesthetic reasons or to eat less carbs to bring down high blood sugar or lower a risk that you know runs in your family. Whatever your reasons are, I can support you in accomplishing your goals.

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To your good health!

Joy

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