Sunday, January 31, 2010

Diabetes

I have been having high fasting blood glucose readings. It looks like I have diabetes. I am not surprised. I am obviously in a risk group, and I have had hypoglycemia at least since my teen years and more likely my whole life. Although on the surface hypoglycemia looks like the opposite of diabetes, the truth is that it is actually a risk factor for diabetes. It works like this. Your body has an over active insulin response so every time you eat, any glucose released into your blood stream is immediately stored as fat. The first result is that you are more likely to put on fat than the average person. The second result is that you have the typical symptoms of hypoglycemia: anxiety, hunger way too fast after eating, heart palpitations, feeling faint, and shaky hands.

Well if this keeps happening for years and years, when you hit your 40's or 50's your pancreas, which has been producing insulin when it isn't needed causing the hypoglycemia, starts to basically wear out and not work so well anymore. Suddenly you don't have enough insulin, and you have high blood sugar, hence diabetes. There are some preventative measures you can take (basically eating a low carb diet and choosing carbs that have a low hypoglycemic load), but I think that now that is too late for me. The truth is that I only really understood how this all works quite recently.

It is not too late for me to be healthy though, and even to eat in a way that will cause me to no longer have diabetes. (Although they say there is no cure for diabetes, technically if you have fasting blood glucose levels under 100, and you are not taking any medications to control your blood glucose, you do not have diabetes anymore. This happens in a lot of cases when people lose a lot of weight or switch to a very low carb diet.) I do have decisions to make, and that is what this entry is for.

When I first found out that I had diabetes, my initial reaction was shock! You may find this odd considering that I suspected. For the last two weeks, I have been having odd symptoms: lack of hunger and hunger at weird times for me, weird food cravings, excess thirst, excess urination. At the same time, I thought it must all be in my head and that being tested was just a precaution. Well I am so glad that I took that precaution because now I have choices. What are my choices? Here is how I see it.

Choice #1: Doing Nothing

Yep! Technically I could do nothing. I could keep eating and exercising and living the way that I have been with little thought towards my blood glucose readings.

Pros - This is an easy option. Maybe this diabetes thing really is a fluke that will correct itself. I already try to make healthy eating choices and to exercise on a regular basis. (I love being active!) Why should I do anything differently?

Cons - There is a strong correlation between regularly elevated blood glucose levels and heart disease, kidney disease, neuropathy, and retinopathy. In some cases (particularly kidney disease), the exact cause and effect have even been determined. In the long term, this will definitely affect my quality of life. Of course, I could die tomorrow, but the truth is that even in the short term it is affecting my quality of life. (The headaches, thirst, hunger, excessive urination etc. are things that I would rather not have to deal with daily!)

Choice #2: Make Better Choices

This may sound simple, but in reality, simply making better choices can be one of the difficult changes to make. I know the right way to eat: more whole grains, more veggies, more fruits, more lean proteins, more healthy fats, less refined carbs, less saturated fats. That about sums it up! If I just increase the right foods and decrease the worse foods and increase my exercise, there is a good chance at this point that I will be able to lower and stabilize my blood glucose levels.

Pros - This is really simple in theory. It doesn't require any complicated plan or equipment. I can for the most part eat what my family does with a few occasional substitutions.

Cons - In reality, I would need to set up a support system to increase the likelihood of actually making better choices. If it was so easy, I would be doing it already. I would need to keep track of what I eat and how I exercise, and I would need some sort of markers to show that I was doing better than I was before.

Choice #3: Diet Recommended by the ADA

The American Diabetic Association recommends that those with diabetes follow a diet based on their popular exchange program. For me, this would mean limiting calories to 1500 a day and carefully keeping track of how many servings of what types of foods I eat at each meal.

Pros - Following this diet, I would be sure to lose some weight. It would be easy to know that I was doing the right thing with out thinking about it a lot as long as I bought the right foods and put some effort into pre-meal planning.

Cons - It would be very difficult to stick to the exact exchange program recommended by the ADA while doing normal activities like eating out, attending family functions, and going to potlucks. I would be eating differently from the rest of my family a lot. Most people diagnosed with type 2 diabetes as adults have extreme difficulty sticking to this diet.

Also, the diet is not based on most recent findings of good nutrition (for example it makes no distinction between whole grains and refined carbs.) There is some question if this diet which focuses on mainstream American foods has really been developed as the best diet for those with diabetes or if it is actually, designed as a minimum effort to be combined with insulin or drugs to survive. I don't want mere survival with dialysis by 55 an inevitable and vision loss and possible limb loss not far behind. I want better health.

Choice #4: Low Carb

Diabetes can be thought of as an allergy to carbs. Your body can't process them properly. Therefore eating a diet very low in carbs just might be a good solution for someone with diabetes. A lot of research has shown that pretty much all type 2 diabetes can be cured by following a very low carb diet. (How low varies from person to person, but in general, it tends to be somewhere between 30 and 60 grams of carbs a day, carefully divided between regular meals in the pattern that works best for the individual diabetic.)

Pros - At this point, this choice seems to be the best for my partner Diana, and it would be nice if we were eating the same things. Following this diet would get my blood glucose under control.

Cons - I do not think that a low carb diet is the healthiest diet for everyone, and I do not think that this option is necessary for me at this point. In the past, I have been very unsuccessful at sticking to very low carb diets.

Option 5 - Low Fat

Believe it or not, very low fat diets have also been found to cure type two diabetes. When I say very low fat, I mean a diet with only 10-15% of the calories coming from fat. This type of diet would most likely be vegetarian and dairy products would be limited to those of the skim variety.

Pros - You can eat a lot of food on a low fat diet and still lose weight. I really like fruits and vegetables. I have eaten various forms of low fat diets during much of my life so it seems almost comforting to me to eat this way.

Cons - The most obvious one is that I have eaten various forms of low fat diets for most of my life, and I am extremely overweight. I have doubts that this is an effective way for me to lose weight which may be necessary to stabilize my blood glucose. Also, although I like low carb diets, I am hungry all the time while following them, and therefore am grazing continuously.

Another con, is that low fat diets for diabetes feel wrong to me. That could be something that I could get past with more research on my part, but for now, it feels odd and contradictory.

In conclusion, I think that for now I am going to try choice 2: making better choices. I am going to keep track of my food intake for the month of February with dual goals of getting my weight under 300 lbs. and my fasting blood glucose under 120. Those are very modest goals. I am going to discuss investing in a couple of tools to help me on this journey with my partner. I am not going to obsess about my weight although weight is an easy thing to monitor to enable me to see progress. I am not going to obsess about my blood glucose either. I will refrain from testing it until the last week in February at which point I will decide whether I will continue on with this choice or attempt another path that may be more effective.

Stay tuned for more updates as the month progresses.