Tips for Managing Your Type 2 Diabetes

If your post meal blood sugar ever goes over 140, you are a diabetic and you need to take it seriously or you’ll get a lot worse. Unfortunately, few doctors are taught this. It’s the first sign of diabetes…any random blood glucose test over 140 means you are in trouble. Take it seriously immediately or you will regret it for the rest of your life because if you catch it too late (once most of your beta cells are dead), it isn’t reversible.

Are you a type 2 diabetic? I am. I was finally diagnosed 7 years after having super high post meal blood sugars. I had a fasting blood sugar of 130. Now my fasting is 80 and that’s without insulin. That’s an incredible reversal. To do it, you have to ignore your doctor’s advice and pay attention to the early insulin advice in Dr. Bernstein’s book Diabetes Solution (which is what I did).

In a nutshell, here’s how to reverse it:

  1. Use insulin early, not late. You should immediately start basal insulin (Levemir pen) and fast-acting insulin (I use the Novolog penfill cartridges with NovoPen Echo). Your objective is to keep your blood sugar under control (like always between 70 and 140 and ideally close to 80). It’s MUCH safer and more effective than ANY drug you see advertised. And if you use the BD Nano 4mm needles, there is zero pain when you stick yourself. Zero. No joke.
  2. So why don’t the drug companies tell you this? Insulin is generic so they don’t make money on it. So they advertise the meds that they make the most money on, not the meds (and treatment regimen) that are the most effective to reverse your disease.
  3. Get yourself a Genteel. This is a blood testing instrument that causes zero pain and allows you to test anywhere on your body (I test on my legs).
  4. Get yourself a Freestyle Lite meter. I use the InsuLinx meter myself so I can record my insulin. You can get expired test strips cheap on ebay. Most people don’t know that they are still good for years after the expiration date.
  5. If you are rich and can afford $300/month, get some Freestyle Libre sensors on eBay (and get the Libre meter). Not sold in the US. I got a German one. Lasts 14 days and gives you insight into your blood sugar. Beware, often the reading are not accurate so double check with your meter.
  6. Inhaled insulin is awesome. Acts in 1 hour (compared to injections which take 2 hours). Afrezza. I buy the 4 unit packs.
  7. Keeping your blood sugar in check with insulin for 4 months or more will allow you to reduce your insulin dosing.
  8. I’ve found that even though I don’t need to use basal insulin anymore (i’m 85 without any basal insulin), when I do use it, I can recover much faster from sugary foods if I use 5 units of Levemir in the morning. And I have a feeling it helps me to recover more beta cells.
  9. Stay away from fast acting carbs. If you can’t resist, then pre-dose 1 hour before with NovoLog or use Afrezza 20 minutes before you eat it (ideally).

If you aren’t a diabetic, here’s my advice for healthy living. The core messages (first three points) are exactly the same as described in Dr. Sarah Hallberg’s excellent TED talk “Reversing Type 2 Diabetes.” I didn’t copy her advice. I found out exactly the same things she did soon after I was diagnosed with type 2 diabetes.

  1. Cut your intake of refined carbs (e.g., sugar) as much as possible. It is much easier to do this early to avoid diabetes than to become a diabetic and deal with it later.
  2. Fat is good. Eat more fat. Look for the full fat alternatives of products and avoid like the plague anything labelled non-fat or low-fat. Since most of your calories need to come from fat, you are always looking for foods rich in fat. All fat is equally good as far as we know. There are people with belief systems that will tell you otherwise, but they can’t back up their beliefs with credible data. You can live with zero carbs. Carbs are unnecessary for human life. But you cannot live without fat. Increasing your fat intake will make you less fat. That’s why fat people have such a hard time losing weight…they cut the fat and that makes them even fatter because they substitute carbs for the fat they cut. Since 80% of my calories come from fat, I’m always looking for fat in foods.
  3. Eat more real foods (stuff that is not “man made”)
  4. Assess your diabetic risk at least once a year:
    1. Test your blood sugar 1 hour after eating a meal of 50g of carbs (e.g., drink 2 cups of Apple Juice)
    2. Test your A1c.
  5. If your post meal blood sugar is over 140 or your A1c is > 5.5, it means you’ve already lost a lot of beta cells and are probably also insulin resistant and if you don’t cut back your carbs, you will likely lose more and end up like me: a diabetic who may have to take insulin for the rest of my life (or give up eating lots of foods). Most doctors diagnose you with diabetes after it is too late to reverse it. The above tests catch it early and should be done once a year. Normal people never go above 140 and rarely go above 120. I regularly had random blood sugars at 140 and above for 7 years and none of my hematologists said anything. Had they warned me then to reduce my refined carbs, they could have saved me from being a diabetic for life.
  6. Stop looking at LDL-C as a predictor of heart disease and look at LDL-P and look at CRP, HDL, and Triglycerides instead. See this article by Jimmy Moore on cholesterol.

If you are not a diabetic, see  Dietary Guidelines for America for why limiting refined carbs will help you avoid heart disease, diabetes, and obesity. Most people don’t find this out until they have open heart surgery or become a diabetic. They learn this from their heart surgeon. Most overweight people never figure it out. And it’s really unfortunate that this advice (to limit refined carbs) isn’t a front-and-center campaign focus for the ADA.

If you are a type 2 diabetic here is a quick summary of what I learned in my first year as a diabetic:

  1. Get a Genteel lancing device. Blood sugar testing is critical. If it’s painful, people won’t do it. The Genteel is the only device that lets you test anywhere on your body with absolutely zero pain. I test on my leg, below the knee. I never ever have any pain at all. It is simply unbelievable. Use with the the J&J Lifescan OneTouch FinePoint Lancets.
  2. Get an Abbott Freestyle or Freestyle Lite or Insulinx meter. These meters all use the same test strips. They are the most accurate and use the least amount of blood. If you are in Europe, try to get on the Abbott Libre system. It rocks.
  3. You can buy Abbott test strips for as little as 15 cents each. Contact me if you want to know how.
  4. To minimize further damage, keep your blood under 140 at all times. Patients with tight blood sugar control do the best and can even reduce their meds because they reduce their insulin resistance. High blood sugars will make your insulin resistance worse, kill or deactivate more beta cells, and lead to complications that are really nasty like losing your vision, your limbs, or diabetic nerve pain.
  5. Diet is key; you must limit your carbs or take a lot of insulin to keep your blood sugar from spiking after a meal. Either is fine, but reducing your carbs is easier of the two (reduces the uncertainty of the amount of insulin to inject). I do both.
  6. There are only two known safe diabetes drugs: Metformin and insulin. Generally speaking, you should avoid the others (see why on the Blood Sugar 101 website). Also, insulin is not really a drug. It is simply replacing the natural hormone your body is no longer producing.
  7. Don’t be afraid to use as much insulin as required to keep your blood sugars in your target zone; high insulin will not make you more insulin resistant. It is the high blood sugars that cause insulin resistance, not high insulin levels.
  8. Contrary to what most people believe, the earlier you start on insulin, the faster you will get better and the less risk you will have of losing an organ. I didn’t figure this one out until 6 months into it when I read the section of of Dr. Bernstein’s book about how people who start early on insulin improve. So I started on insulin both basal and fast acting. What happened was that for the same dosages, I saw my fasting blood sugars decline every month so now instead of 125 they are 75 every morning. I now have to reduce my dosage. This happens because controlling bloood sugars reduces insulin resistance. So the more you control your blood sugar, the less insulin you have to take. So the big advice that most diabetic doctors don’t tell you is: do not be afraid of insulin and to start insulin use if you cannot keep your fasting blood sugar and blood sugars normally under 100 and well under 140 after meals. I use insulin pens (including the new cool Echo pen) and nano needles. The needles nowadays are virtually painless. Do not fear insulin. You are simply replacing what your body used to naturally produce. I use basal insulin to keep me around 90 between meals and use fast-acting insulin before meals as required to keep my blood sugar under 140 after a meal. By setting basal at 90, I give myself some leeway in case I overestimate the carb content/glucose timing of your meal (i.e., you have safety margin to protect against going under a blood sugar of 60). I split my basal dose: 2 shots of 5 units at bedtime, 2 shots of 5 units when I get up. I typically shoot around 6U of fast acting insulin before each meal.
  9. There are three ways to control your blood sugar: diet, exercise, and the two drugs. The lower carb your diet is, the better. Weightlifting is the most time efficient way to lower blood glucose.
  10. The two best books are Blood Sugar 101 and Dr. Bernstein’s Diabetic Solution
  11. It’s counter-intuitive, but the sooner you start on insulin, the sooner you’ll get off insulin. Most diabetics wait until they have severe damage until they start insulin. Then it is way too late. My biggest regret is that even after being diagnosed, that my doctor never explained this to me and instead tried to get me to go on drugs like Januvia instead. I feared the needles. I feared injecting insulin would increase my insulin resistance and start me down a slippery slope into total drug dependence. Both fears were totally wrong and unjustified. And it’s a shame that this information is not better known. The ADA is doing nothing to educate patients about it. And the Novo Nordisk pamphlet they give newly diagnosed patients is terrible. So I did this and after about 6 months of insulin, I’m now completely off the basal insulin and my fasting blood sugar is 80. No doctor ever told me to do this. This is why diabetes is a problem. Doctors avoid the effective treatment.
  12. Afrezza, the new inhalable insulin, rocks. Unlike fast acting insulin which kicks in starting around 2 hours after injection, inhaled insulin works its magic in less than 1 hour, and is also unlikely to cause hypos. So it is awesome if you decide to eat something you shouldn’t that is a refined carb. Afrezza can keep your blood sugar in check…fast acting insulin is way too slow.
  13. If you can find a doctor that agrees with the above, you are really lucky. If you can’t, you’ll need to decide whose advice to take.
  14. Food labeling often misleading. For example I’ve never found a bread or pasta in the supermarket that won’t raise blood sugar by a lot despite what the labels say. Black bean spaghetti is awesome and only available on Amazon.
  15. All of the Quest protein bars that have Isomalto-Oligosaccharides (Prebiotic Fiber) aka IMO in them (all of the old bars) are terrible as far as raising your blood sugar. The “net carbs” value (carbs-fiber) is misleading; it is much much higher because the IMO is digestible. However, the new Quest bars which use “Soluble Corn Fiber” instead of IMO don’t raise blood sugar at all. They are absolutely fantastic. I can eat a double chocolate bar and my blood sugar goes down (slightly). That’s amazing! I’m thrilled that Quest is making all their bars now with the new formula.
  16. The coolest new gadget for diabetics is the Freestyle Libre. I have to buy mine on eBay from overseas. Game changing. Amazing technology. Be sure to use the USB cable with the meter or it won’t work on your PC. This is the coolest device ever for diabetics.
  17. The coolest thing in development is the smart insulin patch.

Diabetes is reversible if you catch it early enough and take one simple action: cut way down on your refined carbs. for example, I never realized dry cereal, bagel, and orange juice were awful for me. I thought they were “healthy.”

A good tip off that you are diabetic is if you feel tired or sleepy about 45 minutes after eating a high dose of a sugary food (like ice cream or a decadent dessert).  Have a diabetic friend test your blood sugar about an hour after you eat a meal with 50g carbs (apple juice and other fruit juices are an easy way to get 50g of fast acting carbs). If you blood sugar is over 140 at that time, it is time to seriously back off the refined carbs. If you don’t, your glucose control will get worse and worse over time. It is the blood sugar spikes caused by eating massive amounts of refined carbs that has caused us to be so diabetic. This kills beta cells and makes us more insulin resistant. The cycle repeats, getting slightly worse with each meal. Then your doctor realizes your fasting blood sugar is 125 and refers you to a specialist.  It’s a real shame the American Diabetes Association doesn’t warn people of this. Most people catch this way too late, when it isn’t reversible.

Lastly any random blood sugar test over 140 is cause for serious investigation. How doctors can ignore this huge warning sign is inexplicable. Normal people rarely if ever get above 140 and if they do, it is only for a very small amount of time. One hour and 15 minutes after a meal, you should be back under 100. My kids for example can eat huge amounts of carbs and never break 100. My doctors ignored these early warning signs for 7 years (I had random blood sugars as high as 200 on my blood tests). Today, I have virtually no beta cells left and I rely on insulin, a low carb diet, and exercise for keeping my blood sugars in a safe level. Had my physicians been educated on recognizing that any random glucose of 120 or more is cause for concern, they could have warned me six years ago and could have saved me from becoming a diabetic.

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