Are You a Noncompliant Diabetic?

Please share how you got off 140 units of insulin AND are not on dialysis.

What is your exact protocol?

The day I went off Insulin was dramatic. My Dr started me on Byetta and said to reduce my insulin by one half. When I got home my Blood Glucose was so low that to take a shot of insulin would have put me into Hypoglciemic condition. I have never taken a drop of insulin since that day. Byetta made the difference. I should have said this in response to the article by David Mendosa. I was in to much of a hurry. Thanks for the request.

Dear Rob,

What a devastating comment on the state of modern medicine!

David

Dear Anne,

Thank you for sharing your story. I have known that people with diabetes have to take responsibility for their own treatment. But I didn't really realize that people with other conditions also had to.

Best regards,

David

Sadly, you are hardly the only one with a story like that. But what really concerns me is your calf pain on the statins. If you still have it, maybe you need to be more firm with your doctors about it. This could be serious.

Best regards,

David

As a doctor and a diabetic I see both sides of the dilemma.  It is actually impossible for diabetics to follow the current  "Standard Of Care" (the ADA recommendations) , and maintain normal blood sugars without dangerous hypoglycemia. Doctors are strongly pressured to follow the ADA guidelines.  Doctors assume the patient must be doing something wrong, rather than realizing that the "Standard Of Care" does not work, cannot work, and never has worked.  I see hopelessness about diabetes in most doctors; primary care, endocrinologists and specialists.   Some blame the disease "it's progressive", some blame the patients.  The true culprit is the current recommendations. 

It is impossible to have normal blood sugar without deadly hypoglycemia if diabetics eat carbohydrates and try to "cover" them with insulin or medication.  Blood sugars will be too high and too low.  High blood sugar is toxic to molecules and cells throughout the body, and low blood sugars are quickly dangerous.  Medication cannot imitate the fine balancing act which a healthy pancreas can do when we eat carbohydrates. So for those of us (all diabetics) with 50-80% of our insulin-making  beta cells dead, it is best not to eat carbohydrates if we want normal blood sugar.  Eating carbs forces the few remaining beta cells to work very hard to supply the insulin needed to process the carbs.  So eating carbs burns out the remaining beta cells faster, causing diabetes to progress. 

It is very possible to avoid the highs and lows that occur when we eat carbs, and to preserve the remaining beta cells.  We can eat normal amounts of protein, get our extra calories from oil (which does not affect cholesterol or blood sugar) and get all the needed vitamins and minerals from low carb vegetables.  We do not have to eat the high carb foods like roots, fruits and grains.  Very low carb diets work very well to control diabetes and prevent the complications of uncontrolled diabetes.

Dear Dr. Helen,

Thank you so much for your knowledgeable and thoughtful comments. I couldn't agree more!

Best regards,

David

Hello Dr. Helen,

Thank you for your informed comments.  I too, feel the ADA is not only seriously outdated, but causing great harm with the information they promote, from a physical and psychological standpoint. 

For what its worth, here are my corrections to the ADA's response to "Ten Diabetic Myths..."  I'd love to get your opinion.  

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Kenneth Hampshire responds to answers to diabetes “myths” by American Diabetes Association

Myth: Diabetes is not that serious of a disease.

Fact: Diabetes causes more deaths a year than breast cancer and AIDS combined.  Two out of three people with diabetes die from heart disease or stroke.

Correction: While the ADA, to their credit, properly identified diabetes as serious, it labeled diabetes a disease rather than a disorder.

Type 2 diabetes should be more accurately called a disorder.  This is a small but important distinction.  Most people understand the definition of disease, and indeed part of the official definition is, a condition caused by an invading microbiological agent.  None of us would hold anyone at fault who is suffering from typhus, small pox, or measles.

But diabetes is different.  It isn't contagious.  You don't "catch" diabetes from your neighbor walking down the sidewalk.  Diabetes is nearly 100% caused by those who have it.  This is not meant to point a finger, but to bring about an understanding that people with diabetes are not powerless.  Far from it.  We can elect to change the path diabetes takes.

If we allow ourselves to be convinced that diabetes is not our fault, we lose the only real weapon we have to combat it.  Calling diabetes a disease excuses personal responsibility to change lifestyle.

Myth: If you are overweight or obese, you will eventually develop type 2 diabetes.

Fact:  Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role. Unfortunately, too many people disregard the other risk factors for diabetes and think that weight is the only risk factor for type 2 diabetes.  Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight. 

Correction: Again, diabetes is not a disease.  Big errors here by omission.  Inexcusable.

The #1 factor in developing diabetes is lifestyle, largely improper diet and lack of exercise.  By citing obesity, family history, ethnicity, and age as the only causes of diabetes, the ADA displays a tragic disregard to people’s health by shifting focus away from the main causes of this disorder.  All of the risk factors cited by the ADA combined, don’t account for even half of the risk factors for diabetes.  Multiple studies conclude that improper diet and lack of exercise are the predominant causes of diabetes.

This is a breach of someone in a position of trust.  People largely believe that the ADA has their best interests in mind and, therefore believe what the ADA states.  To misinform the public in this manner is the height of irresponsibility. 

Supporting Studies: Arch Intern Med 2009; 169: 798–807, N Engl J Med 2001; 344: 1343-50, http://chronicillness.suite101.com/article.cfm/lifestyle_factors_prevent_chronic_illness#ixzz0VMWj5mOc.

Myth: Eating too much sugar causes diabetes. 

Fact: No, it does not.  Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors.  Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories, whether from sugar or from fat, can contribute to weight gain.  If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.

Correction:  To plainly state that eating too much sugar does not cause diabetes, without calling out sugar’s role in an improper diet, is an immeasurable disservice. 

To state that diabetes is caused by genetics and lifestyle factors leads people to believe that genetics is the leading cause of type 2 diabetes, more influential than even lifestyle factors.  Wrong.

Between 80% and 95% of all diabetes cases are attributable to lifestyle factors, with genetics playing a minor role.  This ADA “answer” states that there are two primary causes of diabetes, with genetics playing the lead role.  How shameful.

Myth: People with diabetes should eat special diabetic foods.

Fact: A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit.  Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive, and can also have a laxative effect if they contain sugar alcohols.

Correction:  Let’s see,,, diabetes is a disorder whereby the body has lost the ability to properly metabolize glucose.  If higher than normal levels of glucose exist in the blood stream for extended periods of time, great bodily damage occurs.  So, the “recommended” diet (high in carbohydrates) for diabetics should be the same as for those people who are able to properly metabolize glucose?  What, have we collectively gone insane?  By what stretch of the imagination can this information be correct? 

This doesn’t even consider the damage caused by systemic inflammatory response precipitated by elevated levels of blood insulin.  By recommending this level of dietary carbohydrate to a diabetic, it is guaranteed that massive physiological damage will continue unabated since the body will respond by producing large amounts of insulin (excepting minor variations of diabetes like type 1.5, or end stage diabetes).

If a causative agent is present in a disorder or injury, you remove the causative agent before treating anything.  The main causative agent is a diet high in carbohydrates.  To state, “A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit.” is just wrong.

Myth: If you have diabetes, you should only eat small amounts of starchy foods, such as bread, potatoes and pasta. 

Fact: Starchy foods are part of a healthy meal plan.  What is important is the portion size.  Whole grain breads, cereals, pasta, rice and starchy vegetables like potatoes, yams, peas and corn can be included in your meals and snacks.  The key is portions.  For most people with diabetes, having 3-4 servings of carbohydrate-containing foods is about right.  Whole grain starchy foods are also a good source of fiber, which helps keep your gut healthy.

Correction: The ADA is right.  It is all about portion size, but they’re wrong on their recommended portion size.

Most people with diabetes eat far, far too many carbohydrate-containing foods, and this recommendation does nothing to correct that.  For most diabetics, a healthier recommendation would be to eliminate all simple sugars (cookies, cakes, candies, ice cream, honey, molasses, maple syrup, etc.), soda, fruit juices, and anything made from white, refined flour (many cereals/breads, most pasta, and all pastries), and severely limit all whole fruits and grains, whole or otherwise.

Myth: People with diabetes can't eat sweets or chocolate.

Fact: If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes.  They are no more “off limits” to people with diabetes than they are to people without diabetes. 

Correction:  Well, sure, anything can be eaten by people with diabetes, if they want to continue to suffer the terrible consequences of that decision.

What kind of diabetes organization tells a person with diabetes that they can eat sweets and chocolate?  Or that there are “…no more “off limits” to people with diabetes than they are to people without diabetes.”

Think about that statement for a minute.  Third grade reasoning tells you this is absurd.  Nobody is this stupid by accident.  When I encounter something like this, I ask, “Who benefits?”

Myth: You can catch diabetes from someone else.

Fact: No.  Although we don’t know exactly why some people develop diabetes, we know diabetes is not contagious.  It can’t be caught like a cold or flu.  There seems to be some genetic link in diabetes, particularly type 2 diabetes.  Lifestyle factors also play a part.

Correction: At least they got this one almost right.  Maybe we don’t know “exactly” why people get diabetes, but we’ve got some good “guesses.”  Like, duh, maybe improper diet and lack of exercise. 

Here, the ADA tells people that there is a genetic link to diabetes.  While this is technically correct, most people read this to say that genetics “causes” diabetes.  This is not correct.  Genetics never causes type 2 diabetes.  It can only pre-dispose to it.  Lifestyle is the primary causative agent.

The ADA says that, “Lifestyle factors also play a role.”  Yeah, kinda.

Myth:  People with diabetes are more likely to get colds and other illnesses. 

Fact: You are no more likely to get a cold or another illness if you have diabetes.  However, people with diabetes are advised to get flu shots. This is because any illness can make diabetes more difficult to control, and people with diabetes who do get the flu are more likely than others to go on to develop serious complications.

No correction.  Give one to the other team.

Myth: If you have type 2 diabetes and your doctor says you need to start using insulin, it means you’re failing to take care of your diabetes properly.

Fact: For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications.  But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal.  Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one. 

Correction: Oh how we love to treat symptoms, but ignore the causes.

This answer just totally misses the point.  If you have this conversation with your doctor, you have failed to take care of your diabetes.  And so has your doctor.  Unfortunately you will be the one to pay for your doctor’s ignorance and for being so gullible. 

Nearly everything done to diagnose and treat diabetes in this country is wrong.  Insulin resistance begins years, usually decades before blood glucose rises above normal ranges.  Why is it then that testing for blood insulin levels is not a routine test for everyone?  Why do most people with diabetes find out they have diabetes only when they are in stage 3 of the disorder?  This is not only shortsighted, but borders on the immoral.

People could receive proper instructions on how to change lifestyle habits years or decades earlier.  There are natural products that are safe and effective at reducing insulin resistance that could be used before pharmaceutical drugs.  That, and other lifestyle options never come into play because the crucial information of impending diabetes or other complications is rarely communicated to those with insulin resistance.

Responsibility, personal and professional, is key to good health and to reducing the healthcare costs that are bankrupting the Western world (See http://archinte.ama-assn.org/cgi/content/full/ 169/15/1355).  

The truth is that most people with type 2 diabetes can turn around their disorder by making significant changes in their diet and fitness level before any insulin or medications are needed, but this safe and proven treatment is totally ignored by organizations like the ADA.

Myth:  Fruit is a healthy food.  Therefore, it is ok to eat as much of it as you wish. 

Fact: Fruit is a healthy food.  It contains fiber and lots of vitamins and minerals.  Because fruits contain carbohydrates, they need to be included in your meal plan.  Talk to your dietitian about the amount, frequency and types of fruits you should eat.

Correction: What?  “Because fruits contain carbohydrates, they need to be included in your meal plan.”  Are you kidding me?  Consuming fruit by a diabetic will drive blood glucose levels up dramatically.  This the ADA recommends?  Carbohydrates in vegetables, rather than fruits, are much more suited to the diabetic since the amount of carbohydrate is far lower while contributing valuable nutrients and fiber.

And fruit is a healthy food?  Sure, in moderation for people without diabetes.  But for people with diabetes, consuming more than severely limited quantities will lead to elevated blood glucose levels and serious long-term complications.  For diabetics, the main source of carbohydrates should be vegetables.  Period.  Unless, you like using pharmaceutical drugs and suffering the consequences that come with their long-term use.

This information taken from the American Diabetes Association website: http://www.diabetes.org/diabetes-basics/diabetes-myths/ on November 4, 2009. 

Dear Ken,

I absolutely agree with you more than I do with the ADA. The ADA is a very conservative organization that changes its mind somewhere between 10 and 100 years after the facts are well established.

Actually, you missed a biggy, the ADA's claim that diabetes is progressive. While it does progress from bad to worse if you follow the organization's dietary advice, it doesn't if you control your diabetes. Please see http://www.healthcentral.com/diabetes/c/17/14868/diabetes-myths and http://www.healthcentral.com/diabetes/c/17/14273/diabetes/

I also think the ADA should be ashamed of its collective self for recommending that an adequate level of blood glucose control is an A1C of 7.0. This is far about the normal level, which is even further above the optimal level. Please see http://www.healthcentral.com/diabetes/c/17/59130/normal-a1c-level

The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent. Even this is above the normal level of 4.5 to 6 percent.

As to whether diabetes is a disease or a disorder, well, you may be right. For a long time I resisted calling diabetes a disease, but lately I have labeled it one so that my readers would take it more seriously. A quick web search of definitions of "disease" does not tend to support your position. I don't think this is something worth arguing about considering the seriousness of the other issues you raise.

The question of weight and diabetes is one that is highly charged. The ADA says, as you quote, "Most overweight people never develop type 2 diabetes, and many people with type 2 diabetes are at a normal weight or only moderately overweight." The ADA is right that most overweight people never develop diabetes. That's obviously true as 2/3s of Americans are overweight but "only" 8% of us have diabetes.

But the ADA is clearly wrong that "many people with type 2 diabetes are at a normal weight or only moderately overweight." The CDC's statistics say it's more than 85 percent; see http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5345a2.htm

So weight and type 2 diabetes are clearly related. One does not cause the other, but both probably stem from the same cause. It may be inflammation; see http://www.mendosa.com/blog/?p=226

I wonder if you gave one to the other team that we should have kept. I mean the ADA's denying that people with diabetes don't get more colds. I don't have the statistics and the ADA doesn't have them either, or they would cite them. But people with diabetes that is uncontrolled have a weakened immune system and logically that seems to me that this would mean more colds.

Thanks for your analysis of the ADA's incredibly weak "myths."

Best regards,

David

Hello David,

As I re-examine my analysis, I must agree with your diabetes/illnesses assertion.  A quick search finds numerous citations and statements.  It is always a good idea to read the study, but these writers' summations of these studies suggest you are correct:

-"Individuals with diabetes are at an increased risk of developing active tuberculosis (TB), according to research published in the journal PLoS Medicine."

-"A recent study has found that diabetics may also be more prone to blood infections or sepsis which can lead to fever and septic shock. Septic shock can cause a dramatic drop in blood pressurewhich can be fatal. The Danish research involving over 1,300 subjects with bacteremia found that 17% of them had diabetes compared to 6% in the general population." -wrong diagnosis

As to my not calling the ADA on their "progressive" statement – actually their statement is correct given that most people with type 2 do not take significant actions to slow or reverse their disorder.  This goes back to my contention that most type 2's have no idea of 1) how serious their disorder is, and 2) how important their own ability to change the course of the disorder is.  By calling diabetes a disease, by calling genetics the primary cause of diabetes, by calling A1c's and fasting blood glucose levels normal that are really too high – all this misinformation works to communicate an excuse for personal responsibility that is devastating to a diabetic if they allow themselves to believe it.  I have talked with thousands of diabetics, and I can tell you that there is an overwhelming ignorance and lack of concern among them for their own health.  This may not be true for you and the people who read your posts, but it is among the general type 2 community, and I believe this is because we are all bombarded with information that says, "Diabetes is not your fault."  Until people take responsibility for their own diabetes, the tragic diabetic statistics will continue.  People will never take responsibility until they understand that it is their fault.  This is tough to say, but if we don't get real with this disorder, it will become the biggest health disaster the world has ever known.

But at the end of things, yes, I should have called the ADA on their progressive statement.  It really is just another piece of the misinformation campaign.  It is only progressive if we elect to do little or nothing to change it.

Good work my friend.

Ken Hampshire