My neighbor, a man in his 50's, was recently diagnosed as diabetic. Prior to his diagnosis, he had a rapid weight LOSS. He was never fat. He is really rather lean, whereas before he was rather robust. He has also complained of pain in his feet. He now takes a pill to control his blood sugar, and is following his doctor's recommendations about diet. He says that the pill has too strong of an effect on his blood sugar levels. And he is still eating whole grains.

I don't know much about this topic, but I do care about this man and I would like to point him toward research about diet that may help him. Do you have any suggestions about reading material/methods that might help him control his blood sugar levels without meds?

Thanks in advance for your input.

The best advice to the newly diagnosed is this simple page:
http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

For a whole site full of information on the current state of research, I recommend Jenny's site highly: http://www.phlaunt.com/diabetes/

If the pill your thin friend is on is a sulfonylurea pill (amaryl, glypizide, etc) please point him to my MODY page, because intense response to a sulf drug from a thin "type 2" is diagnostic for MODY diabetes.

MODY It's Not Type 1 and Not Type 2 but Something New
http://www.phlaunt.com/diabetes/14047009.php

If that's what he has, he might do a lot better on either a) Byetta or b) insulin.
I found the sulf drug unbearable when I tried it. It lowered my blood sugar far too much and resulted in raging hunger. I got to eat a couple bakery scones and not go over 110 but it wasn't worth it!

MODY was just in the news yesterday, coincidentally.

I agree with all of the above.

I also say for education and further insight read Dr. Bernstein's Diabetes Solution and to get him on to this site.

I really encourage him to become proactive and self manage his disease.

This is the true secret in conquering this disease. It is very individual and each individual must learn enough and adapt enough to control his own situation.

Ralph

I really want to reiterate one point: The idea that controlling blood sugar "without meds" is superior to using meds is ONLY true for certain kinds of Type 2 which are mostly characterized by insulin resistance.

A slim person diagnosed with Type 2 almost certainly has an insulin secretory defect and going without meds is a great way to burn out the remaining beta cells.

I really wish I had started on insulin in 1998 when I was first discovered to be diabetic. I controlled very well for years with diet, but the strain of compensating for my lack of post-meal insulin release wore away at my fasting blood sugar control. I know now that I would have been far better off starting immediately on insulin which would have been the appropriate treatment for the kind of diabetes I have.

People who have mild, slow-onset autoimmune diabetes (LADA) also do much better if they are put on insulin very fast as it can prevent the immune attack from destroying the rest of their beta cells.

Bottom line: diabetes in a thin person is often a sign of a secretory failure that DOES require a med--insulin, as fast as possible to prevent further deterioration!

Thank you all for your responses. I will review this information.

A medium carb diet and glipizide ER works great
for me.Not one study shows anything wrong with
glipizide ER.There is, of course,throwdown
criticism by self appointed experts on sulphys.
Sulphys,like insulin,require a bit of balancing
between med intake and carb intake.
Eddie

Eddie,

If the sulfs work for you and don't make you hungry, then go for it. The older generation of sulfonylurea drugs were shown to cause higher than expected amounts of heart attack. The claims for the newer ones are that since they don't stimulate a recepter on the heart like the older ones did, they won't. This hasn't actually been tested by looking at a large population to see if it is true.

The big problem with them for a lot of people is that they cause relentless hunger. They actually normalize my blood sugar, but at the cost of making me so hungry it is like a form of insanity, so I can't use sulfs. I have heard from other people who have had this experience, too.

Typically, people who use them do eventually find that their beta cells seem to "burn out" and their blood sugars get worse. It is not known if this is caused by the sulfs of the fact that in all the studies that saw this effect people were keeping their blood sugars high enough to kill the beta cells. Beta cells will die if exposed to blood sugars over 150 mg/dl for many hours at a time.

If Sulf works well for you, you might do very well on Byetta. The mechanisms by which they lower blood sugar is similar, but Byetta often helps people lose weight, too.

Jenny, I have found this thread to be very interesting and informative, thanks for contributing. I do have a question, though.

In another thread recently (now I forget where it is) you said that I don't have a lot of weight to lose, and that I was probably a 'thin diabetic'. But I don't think you knew that I am only 5' tall, so the amount of weight I was carrying a few months ago was far too much for my height. In fact, on pretty much all the charts, I am well into the overweight zone, and on some I am right on the line between overweight and obese (or was - before I lost the 13 pounds so far!) Trust me, I looked fat and still do to some extent.

Now, does that change your opinion of what my catagory might be? The diagnosis on my labwork results was given as hyperinsulinemia (however you spell that) which I take to mean insulin resistant. And what, if that were so, would be my chances of controlling my sugar through diet alone? Just that I value your expertise and wonder what your take is now that you know my height.

Rose,

Actually, it is MUCH easier to control with diet alone if you really are insulin resistant and producing a lot of insulin.

Did you get a fasting insulin or C-peptide test? Without such a test showing higher than normal levels, I would still not jump to conclusions about your insulin sensitivity.

I'm very insulin sensitive but I was overweight at diagnosis thanks to the months of raging hunger caused by very high blood sugars. When I lost the weight, my blood sugar response did NOT change, and when they put me on insulin I turned out to be insulin sensitive, not resistant. But I was told for 8 years that I was a "Typical Type 2."

So you really won't know whether you are IR or not until you lose the weight and see what happens to your blood sugar. If you can't get truly normal blood sugars with diet and metformin--i.e. fasting values in mid 80 mg/dl range, as I couldn't, then you should start questioning the diagnosis. If you can, it might be right. Or you might have lost too many beta cells to get complete control with diet.

It is SO much more complex than the family doctors realize. But the good news is that armed with your trusty blood sugar meter, you can figure out what you need to figure out, and then if diet alone doesn't work, you can prod your doctor to help you take the next steps you might need to regain control.

Thank GOODNESS we have a disease where they give us the tools we need to take charge. Few other chronic diseases are like that. If you only rely on lab tests done every six months, as is the case with most, you are completely at the mercy of the doctor's knowledge level which you have little way of evaluating!

I think if serum insulin is tested and is very high, you can assume insulin resistance (IR).

If there's IR and diet alone does NOT control bg, I'd suggest trying metformin, which works very well for most IR folks.

You know what, I get more information from you folks here than I EVER get from my doctor. I am going to have to get an endo, and even that will be hard considering that a lot of them are not that well informed either. My doctor's total 'diabetes education' with me was a few phrases like 'watch the carbs' and 'don't obcess about the meter, once or twice a day is enough' (didn't tell me what numbers to shoot for, even) - and on the way out of the room he said 'ok, see ya in 3 months!' The only reason I go to these guys (it's a family practice) is because we are in a very small town and they are the only truly close place to go to if we need to go fast. However, it's getting to be time to drive into 'the big city' I guess! Thanks again for all the info and advice for myself and for ImOnMyWay!

Rose -

The key to your success is YOU!

You must manage your own diabetes.

You are doing great.

Get educated.

Try things.

See what works for you.

If you have a small town Doctor, OK. What is important is whether or not he will support your endeavors.

My Doctor supports what I do. He sees that I have taken charge, became educated and learning still.

He likes the results so he supports what I do. He is open to whatever works for me.

The proof to him is results; the A1C was 5.4 last time.

The A1C will be lower this time.

I have set a goal for "normal" A1C and that is under 5.0 certainly and perhaps 4.2-4.6 as Dr. B suggests is the normal range for non-diabetics.

Everything I have read says complications go up quickly as the A1C goes up. Conversely, the best protection from complications is a lower A1C.

The corollary to this is a tighter control of your BG swings during the day.

I have set a goal of no higher than 140 1 hour after eating. If I low carb properly this is simple.

If I decide to have more carbs, then I do use a fast acting Novolog insulin to keep my upper goal to 140. I probably will zero in on 120 as I get better with my control.

My other goal is to have a fasting BG reading under 100 preferably as close to 85 as possible, but certainly anything under 100 is good.

So take charge of your program.

You are doing great, read, ask questions, see other people's experience and if your local Doctor will equip you with the tools you need, be it metformin ER or basal insulin or a fast acting insulin (all of this is your decision) then you really don't need to go to the big city.

BTW if you do go to the big city you are likely to find a high priced endo guy who will preach the ADA version of diabetes control and you will have taken a step backward. My opinion.

Best wishes to you,

Ralph

Thanks Ralph, nice of you to post that for me. I will try and keep a level head and continue to learn. Haven't been doing this for very long and it is not exactly hard to absorb everything, but it is a process, I think, takes time.

My doctor in this little town is nice enough and in fact I always thought everyone in that practice was up to date - but I soon found that they truly do not know much about the newer protocols for diabetics. For instance, he thinks my A1c of 5.9 is wonderful. He thinks I can eat way more carbs than I do. Etc etc. So I doubt that I can go very far with him, frankly.

By the way, I figured out why I was feeling those cravings and an empty feeling - I think my gallbladder had something to do with that, because last night I had a mild attack, nothing terrible, just what I call 'colic'. And my sugars are higher than I would like, even though I'm not cheating. Gonna give it a day or two to level off and go from there. Sometimes you have to just wait things out.

Stick with your Doctor.

The ADA has taught Doctors that an A1C under 6.0 is good.

In fact, if I recall correctly an A1C under 7.0 is the breakpoint for diagnosing diabetes or a fasting blood sugar over 125; I could be wrong.

But, having read a lot, listened to folks here, having an A1C as close to 5.0 or less is the ideal.

I suppose many people can live with an A1C under 6.0 and not see complications.

But, what I have seen of many diabetics is they follow their Doctors advice and lower their carbs to 100-200 a day and still wonder why their BG is in the 200s or higher.

I just gave a man at my mother-in-laws assisted living facility my copy of Dr. B's Diabetes Solution. He was telling my wife he couldn't control his blood sugars, etc., etc.,

I told him take it, read it once, twice, three times, buy his own copy and take charge of his disease and he will see results.

So we all have to learn and figure out what works for us.

You are on the right track.

Best wishes,

Ralph