Diabetes – A Disease of Glucose Intolerance

I am an inquisitive person. You may often find me asking “why?” I question the way things are being done and wonder if it is the right way, or if there is a better way. Even when I find the best way (for me), and prove it to myself, I sometimes periodically have to re-prove it to myself.

After a few years with an A1c at around 5.0, my doctor told me he was removing diabetes from my diagnosis list (that was a few years ago). He said “you’re just not diabetic.” I know that is not true (as you will soon see), but it’s just that I live within my carbohydrate tolerance, and that makes it APPEAR that I am not. However, I told him that I was fine with that but I still wanted an A1c twice a year.

So, things have been going along as usual.

Recently, I’ve gotten the opportunity to wear a continuous glucose monitor. As a diabetes educator, I sometimes have access to cool gadgets. For those of you who don’t know how a CGM works, here’s how.  The CGM tests your glucose every 5 minutes and plots it on a line graph.  You can then get a realistic picture of what is happening to your blood glucose, 24, hours per day.

So, I happened to have at my disposal an insulin pump with an integrated CGM, and I was given some sensors and a transmitter. So after about 7 years from diagnosis, and many years on a low carb way of living, I decided to do some experimentation on myself. I was thinking, “how diabetic am I, still, after many years of low carb?”

I began wearing the continuous glucose monitor (with the insulin pump turned off.) Here is what my CGM graph looks like pretty much most of the time. Nice and level, with normal blood sugar (my low alarm is set at 70, high alarm at 120). I stay in that range pretty much all of the time, typically staying between 75-85 at fasting and 90-105 post meal. I was super happy to see this especially after such a stressful year, that my blood sugar is doing well. You will notice a small increase (at around 4:30), that was a low carb meal (meat and salad, which was about 15g of carbs from non-starchy veggies).

Then I decided to experiment what it would be like if I ate how it was recommended for people with diabetes to eat.  I was going to start slow…

This photo was a meal that included meat, salad and ONLY 1 SERVING (15g) of carbs that came from whole grains. As you may know, I am grain free first and foremost. Grains are my biggest blood sugar dis-regulators, even more than sugar.

My blood glucose was nearly double normal for me. This tells me a few things. First, the “heart healthy whole grains” mantra is a lie (at least for me). And second, the mantra “everything in moderation” is a lie (at least for me). This was only 1/3 cup of whole grains. I would guess that most people would say 1/3 cup of ANYTHING would be considered moderation. So, everything in moderation is no good for me.

Ok, so here is where things get crazy.

I decided to do a meal that follows typical diabetes advice, yes, 60g of carbs in one meal. I decided to eat no other carbs that day so I would still end the day eating very low carb, but I ate the entire 60g in one sitting. In addition, I ate processed and refined grains and about 3 bites of something sweet (“moderation,” lol).

Hold on to your seats folks.

This meal included meat, salad, and refined grain products. Here we are.

If you don’t know this, any random blood sugar over 200 is a diagnosis of diabetes, regardless of what/when you ate. It took me three hours to get back into normal range and even 24 hours later, I was still elevated about 25 points above baseline. I can’t even tell you how I felt! Literally could not keep my eyes open at 5:30 at night. (Kinda wonder how many kidney, eye and brain cells I damaged with this experiment.)

And here’s the thing folks. The reason those 60g of carbs per meal recommendations were made, is because it is not unusual for the average American to eat 150g to nearly 200g of carbs in a meal.

This is a very graphic reminder for me that the way I have chosen to manage my diabetes with a sugar-free, grain-free, very low carbohydrate way of eating, is truly best for me. I am a person who is extremely sensitive to starchy / sugary carbs. It also reminds me that whether or not I have the label on my medical chart, I am fully aware that I have diabetes. However, as long as I maintain my low carb lifestyle, I have no evidence of it. I can live free from the worry of diabetes related issues. In contrast, if I live by the standard “diabetes diet” or by the “standard American diet,” I would need medication and would fully expose myself to diabetes related complications.

If you think about it, one of the tests we use to diagnose diabetes is called an oral GLUCOSE TOLERANCE test. That’s right, diabetes is a disease of GLUCOSE INTOLERANCE. So, what is the best solution to GLUCOSE INTOLERANCE? Eat all the glucose you want and rely on pills or shots to minimize the effects? Or, just take in less glucose to begin with…? The latter solution has helped me, a person with diabetes, to live the life of a person without it.

I am not in question of whether a low carb lifestyle is best for diabetes, or at least best for me. I have proven it to myself time and again. Of course, your body may react differently to these foods. The only way you are going to know, is to test frequently before and after meals. Sadly, we don’t all have access to tech-y gadgets. But access to a BG meter is easy for most folks. It will tell you everything you need to know.

On a side note, I have learned a few other things about my blood glucose with wearing a continual monitor. Protein is my friend. I know that many people out there feel the need to limit protein strictly. This is not true for me.  Protein lowers my blood glucose post meal.  Now, I know there are some folks out there who will say that is because protein raises insulin.  That is true.  But I’m not trying to live a life of NO insulin, I’m trying to live a life of LOW insulin.  I’m not going to fret over the amount of insulin needed to cover a blood glucose of 85-95.  With decent amounts of protein, I feel better, can workout physically hard, and see better results with my weight.  Once again, your response to protein my differ, but for me, it is my friend.

Next, my blood glucose will raise, not at any particular time in the morning, but particularly when my feet first hit the floor, no matter what time it is. Someone once said that this is your body’s way of making breakfast for you, lol. This confirms to me that my first meal of the day, while it is my biggest meal, it also needs to be my lowest in carbohydrates.

My final food related experiment was to eat a low carb meal, but have a large portion to see if just the portion size itself would make my blood sugar spike, even if the meal was low carb.  I did this because many people think they need to starve themselves or eat like a bird to manage their blood glucose.  So, I ate a meal to satisfaction, generous in protein and the fat that came with it, and a healthy sized handful of leafy greens.  It resulted in about a 10 point rise in blood glucose.  This confirms to me that I can listen to my body and eat to satisfaction.  Of course there is no need to overeat, but neither do I need to starve myself to be healthy.

On a final interesting note, I have discovered that my blood glucose elevates more for stress than for my low carb meal choices. I have seen my blood glucose raise 20-30 points on my ride to work, when no food was involved. My blood glucose will also average 20-30 points higher on mornings where I have not gotten at least 7 hours of sleep. This helps me know that I am on the right track with delving into my research about stress and diabetes management. Working so hard to keep blood glucose controlled with diet, only to have it go haywire with stress, is defeating my goals.

So I am working on that content for this page. And trying not to stress myself about getting it done, lol!!!

And I almost forgot one thing…I had to come back and add this to my article.  EXERCISE!  Exercise is CRUCIAL for my blood sugar management.  If I skip exercise for a few days, my blood sugar will creep up to 20-30 points higher in the morning.  I have noticed that DURING exercise, my blood sugar goes up slightly, within 10 points.  But afterwards, it lowers it and it stays down until the next day.  So folks, please don’t overlook exercise in your health regimen.

Hope these insights will be of help to you.

As always, wishing you continued health and happiness!

Happy low carbing to you!!

Addendum to article:  Some folks have asked if I “carbed up” before this experiment to get my body used to more carbs.  It is common advice given to low carbers before an oral glucose tolerance test to eat lots of carbs (150-200g) for three days prior to the test, so as not to falsely fail.  This experiment was not to see whether I could pass an oral glucose tolerance test.  It was an experiment to prove to myself that the only way personally for me to maintain normal NON DIABETIC blood sugars, is to maintain a low carbohydrate way of living.

An oral glucose tolerance test is 75g of liquid sugar carbs that has to be consumed in 5 minutes, with no other food.  My first experiment meal was a standard meal for me with only 15g more of added carbs from starchy food, and my blood glucose was nearly double my normal pre-meal numbers.  The second experiment meal was 60g of food carbs, 15g of which was non-starchy as usual, and 45g of which was starchy, eaten over about 45 minutes, along with protein and fat.  Neither one of these meals mimics an oral glucose tolerance test.  So it’s not the same.  Now, if I ate lots of carbs all the time, it is true that my response may have been slightly less.  On the other hand, if I ate lots of carbs all the time, I would have been high to begin with (and living with diabetic blood sugar all the time!) So, I probably would have ended up with similar post-meal numbers, but I would NOT have been starting from normal numbers.  I would have been starting with high numbers.  Either way, there is NO WAY, even if I “carbed up” beforehand, that I would have maintained normal, non diabetic numbers eating 60g of carbs in one sitting.

My response is a also good reminder for those that are low carb, that it really needs to be a way of life, not an on and off “diet.” And there are those out there who wonder whether they should plan “cheat” meals on low carb. Well, if you do, this is what you might see, so be careful.  Once again, “moderation” might be a bigger problem than you think 🙂

There is no way that I would have put my body through three days of eating 150-200g of carbs just to see if I’d end up at 183 instead of 203.  Just this one meal took me two full days to really get back to complete normal.  My experiment simply served to reiterate the point that the standard dietary advice for diabetes DOES NOT result in normal NON DIABETIC blood sugars, which is my goal.

***

Today is a few days past my experiment and I’m about to go to sleep.  (I stay up late only one night per week, this is my long day.)  Here is my bedtime reading.  In the second photo, I have scrolled back 6 hours on my graph.  You are viewing 7 pm to 1 am.  I ate my low carb dinner during this time represented on the graph.  (Anyone see it?  😉