Frequently Asked Questions (FAQ)

Basic information

Type 2 diabetes is a condition in which the body is unable to produce enough insulin in order to maintain blood sugar in a normal range after a meal.

In a person with Type 2 diabetes, for each gram of carbohydate eaten, blood sugar will increase about 4 mg/dl (depending on body weight – less impact on a heavier individual) about 1 hour after a meal. The more progressed an individual’s diabetes, the longer blood sugar will remain high, sometimes for several hours. Generally, blood sugar will start to come down after 2 or 3 hours.

Blood sugar results above 140 mg/dl are bad and may reduce the number of insulin-producing beta cells. This creates a feedback effect: the fewer the number of beta-cells alive, the more blood sugar increases and the more beta cells that die. This is why, if left untreated, diabetes gets progressively worse.

In addition, blood sugars above around 160 will make you sleepy because the brain does not function well on high blood sugars.

Type 2 diabetes is diagnosed when you have a fasting blood sugar >= 125mg/dl and an HbA1c>=6.5 on two separate tests. Unfortunately, this is a terrible way to diagnose people. Most diabetics will show abnormally high post-meal blood sugars (above 140 mg/dl) many years before their fasting blood sugar starts to rise. By the time your fasting blood sugar has risen to 126, your diabetes is going to be very difficult, if not impossible, to reverse.

If your blood sugar ever goes over 140 mg/dl (blood sugar typically peaks about 1 hour after a meal), you are likely diabetic or on your way to becoming diabetic. The sooner you take action to keep your blood sugar under control, the greater your chance of getting better.

To be absolutely sure you are properly diagnosed with Type 2 diabetes (and not Type 1 or MODY), you should have an antibody test.

Diabetes is caused eating lots of sugar/refined carbs that raise your blood sugar to high levels. Having a genetic predisposition puts you at a higher risk of getting diabetes.

In every country that has switched to the typical Western diet, diabetes rates skyrocket. Eliminate the sugar and diabetes rates become non-existent. There is no doubt of the cause and effect. See pp. 298-299 of Big Fat Surprise.

That is why diabetes is so out of control in the US: despite the strong recommendations from the AHA and WHO to limit sugar to less than 5% of calories, we do absolutely nothing to limit sugar in the US, especially highly refined carbs that raise your blood sugar very quickly.

So our dietary advice is causing the problem. We limit fat, and tell people sugar is just fine and to be sure at eat 60% of your calories from carbs. If we told people to go low-carb instead of low-fat, we would save hundreds of billions in healthcare costs in America.

There is some evidence of environmental effects, but these are much smaller. The major cause of diabetes is diet.

The single best thing you can do to prevent getting diabetes is to reduce as much as possible sugar/refined carbs from your diet: sugar, bread, pasta, etc.

Refined carbs cause blood sugar to skyrocket putting a huge burden on your pancreas. This starts a vicious cycle: inflamation leading to insulin resistance and higher blood sugar levels. So it spirals out of control getting worse and worse until your pancreas is burned out and no longer produces insulin. And what little it does produce isn’t consumed very well due to the extensive damage.

In every country that has switched to the typical Western diet (which is high in refined carbs), diabetes rates skyrocket.

In the early 1900’s, sugar consumption was 10 lbs per person per year. Now it is 150 lbs per person per year.

There are no examples of a healthy society eating a diet as high in sugar and processed carbs as the diet we eat.

In Japan, the traditional Asian diet is 70% complex carbs and diabetes rates are around 1.5%. simple carbs is the main culprit.

Eat “real foods” (foods that have legs and/or grown in the ground), rather than manufactured foods (like ice cream, potato chips, fruit juices, etc) is a great guildeine for healthy eating.. If you want even more benefits, eliminate/reduce the carbs and try a ketogenic diet.

Changing behavior is very hard, even if the consequences are losing a limb! There are a lot of people who ignore their diagnosis and continue to eat what they please. Ignoring diabetes and letting your blood sugar rise to levels above 140 mg/dl can lead to serious complications such as peripheral neuropathy, loss of limbs, organ function, vision, and brain function. Once you are diagnosed with diabetes, unless you want to get worse and worse over time, you should eat less than about 30g of carbs per day. So the high carb foods you love like popcorn, breakfast cereals, oatmeal, fruit juices, ice cream, pancakes, cereal, fruit, bread, bagels, muffins, etc. should be avoided. Diabetes means you will not be able to eat these foods,except in small quantities, ever again until there is a cure; or you caught it early enough and reversed the damage. When you are a diabetic, eating even a single banana can increase blood sugar to unhealthy levels.
You want to keep your post-meal blood sugar under 140 mg/dl to minimize death of your remaining insulin-producing beta cells. Eating a ketogenic diet (a diet high in fat and low in carbs)  has been shown in random-controlled trials to do the best job in keeping your numbers under control than eating a diet high in carbs (simple or complex).

When starting, measure your blood glucose several times a day to make sure you understand how food impacts you. Keeping your blood sugar under 140 mg/dl at all times will minimize progression.

If you can keep your blood sugar low, even though you produce little insulin, the reduced load on your pancreas allows you to store excess insulin which will improve your ability to tolerate eating carbs (for that rare occasion when you cannot resist that apple strudel dessert).

Follow the tips in the next column (Taking Action). The single most important item is diet.

In certain cases, diabetes is reversible:

  1. If you have gestational diabetes, giving birth will cure you.
  2. Bariatric surgery can often cure diabetes for most people almost instantly, however, it is unknown how or why.
  3. You caught it early and made lifestyle changes to lower your blood sugar and improve your insulin sensitivity.

Most people who have diabetes are believed to have impaired beta cell function, which is either a lot of dead beta cells or defective signaling that inhibits  insulin production. That’s why in many people, diabetes can be impossible to reverse: the beta cells are dead and they cannot be brought back to life.

However, the success of bariatric surgery shows that there are a lot of people who could reverse diabetes by hormone manipulation. We just do not know how yet because the hormone signalling is not well studied and/or understood.

Individual results will vary, but I have severe diabetes because the doctors did not notice it until 7 years after I had exhibited very high non-fasting blood glucose levels (over 140).

I no longer have a phase 1 insulin response, meaning I do not store excess insulin that can be released immediately  after a meal. The very highest insulin concentrations that I ever achieve are 25 uIU/mL which is well inside the normal “fasting” range and a far cry from normal people who can sustain levels 6 times higher after a meal.

Despite my severe Type 2 diabetes, I have been able to achieve fasting glucose levels as low as 78 by following the advice I have published on this website. That is truly remarkable since it is lower than most normal people. My blood sugar rarely goes over 130 mg/dl because I’m careful about what I eat. But you have to be diligent to stay in the high 70’s. If you eat more normally while avoiding simple/refined carbs, you should be able to sustain a fasting blood sugar of around 105 without using insulin.

Here is a list:

  1. Seung Kim at Stanford University is looking at signaling and producing beta cells from skin cells (your pancreas is super sensitive so is “off limits” for harvesting beta cells).
  2. Ron Evans at Salk Institute is working on FGF1. One injection a week and you can eat like you did before you became diabetic!
  3. Justin Annes at Stanford is working on a drug that is 10 times more effective than Dipyridamole in growing new beta cells.

Taking action

There are 3 ways to keep your blood sugar under control:

  1. Decrease the amount of glucose produced by your stomach, liver, and pancreas
  2. Increase the amount of insulin you secrete
  3. Increase your insulin sensitivity.

The techniques in the sections below address each of these in detail:

To accomplish #1, minimize eating carbs and take metformin, which keeps your liver from dumping glucose. You can also exercise which depletes glucose and makes it harder for your liver to dump glucose into your blood.

For #2, there is a drug, Dipyridamole (150 mg/day is typical dose) that can marginally accelerate the growth of new beta cells in your pancreas.

For #3, doing exercise (HIIT, muscle building), taking Metformin (requires a prescription) and/or Berberine (which activates AMPK), can increase your insulin sensitivity.  Exogenous ketones (such as KetoForce can lower your blood sugar, but it tastes really awful: mix with lemon juice). I suggest you wait until beta-hydroxybutyrate (BHB) salts are available in powder form since these taste much better. Brain Octane is a good substitute to raise your ketone levels, but it’s a bit pricey compared to regular MCT oil.

Cinnamon was once thought to improve insulin sensitivity but it is now problematic. The common cassia cinnamon that improves insulin sensitivity  is unhealthy to take in large doses because it damages the liver, and ceylon cinnamon is safe in large doses but does not impact post-meal blood sugar in diabetics. See “Ceylon cinnamon does not affect postprandial plasma glucose or insulin in subjects with impaired glucose tolerance”.

For lancing, Genteel is the only painless way to draw blood from almost anywhere in your body. I highly recommend Genteel for everyone,especially for kids.

For glucose meters, I recommend the Abbott Freestyle Lite, Freestyle Freedom Lite, or InsuLinx meter because they are the most accurate meters available. They also require far less blood (0.3uL) than most any other meters so you never have to void a test strip. I prefer the InsuLinx meter because I can enter in before/after meal or fasting and hours after a meal. The other Abbott meters are smaller in size. You can get the meter for free (see suppliers section).

The best diet for diabetics is a low-carb diet such as Atkins, Bernstein, and ketogenic. While you can achieve good results with a diet of complex carbs (avoid simple carbs), the results are not as good. In this study, the ketogenic diet beat the low-glycemic index diet handily in all 5 biomarkers tested.

You actually don not need to eat carbs at all. The very best diet is a ketogenic diet where you eat 20% of calories from protein and 75% of calories from fat and under 5% from carbs (see Books). Believe it or not, the best way to lose fat is to eat a diet of 80% fat and 20% protein and avoid all carbs. You cannot avoid carbs entirely, but you want to keep your carb intake to less than about 30g per day (under 10g/meal). I personally eat <5g of carbs per meal and eat around 20g of protein at each meal.

For the past 35 years, society has been taught to avoid fat, especially saturated fat. While it sounds logical, it is not true at all. It is the single biggest health blunder in American history. It was caused by the misguided efforts of one man: Ancel Keys. Keys blasted anyone who disagreed with him and buried all data that disagreed with his theory that fat is bad for our health.

If you want to avoid diabetes, heart disease, and obesity, you should eat a diet of primarily fat: 20% protein and 75% fat, keeping carbs to 5% or less. Saturated fat is perfectly healthy and does not cause clogged arteries or heart disease. Carbs do.

The only fat you should avoid are the trans-fats in processed foods. All other  fats are fine.

When out and about, void foods labelled “fat free” and “low fat.” These foods are typically low fiber and high carb with added sugar. Your supermarket is filled with these unhealthy foods. Since 1980, we have been told to choose these foods. Big mistake. That is why obesity, heart disease, and diabetes have dramatically increased since then.

For more info on the controversies surrounding fat and carbs, check out

  • Ending the War on Fat at Time.com – a free five minute video
  • Fed Up – a movie, available on iTunes.
  • You can also see a portion of the political debate when establishing the first U. S. Nutritional Guidelines in 1977, called the McGovern Report
  • Big Fat Surprise, a fantastic book by Nina Teicholz which tells the whole story of why the government food recommendations are so nutty
  • ead Death by Food Pyramid by Denise Minger or Good Calories Bad Calories by Gary Taubes

The best diet books are in the Books section.

Exercise works for most diabetics, but not all (see Exercise regimens offer little benefit for one in five people with type 2 diabetes).

High Intensity Interval Training (HIIT) such as Tabata training  is a great way to increase insulin sensitivity for 24 hours. Tabata training (named after the head Japanese scientist who discovered its effectiveness) consists of eight intervals lasting 20 seconds of intense movement with 10 seconds of rest. I do it on an exercise bike: 20 seconds at full intensity, 10 seconds rest for a total of 8 sets which takes just four minutes.

Doing low-intensity exercise can lower your blood sugar immediately by up to 2 points per minute.

Weight training is excellent for building muscles which also increases insulin sensitivity for as long as you maintain your muscle mass. The more muscle mass, the higher your insulin sensitivity will be.

A 30 minute workout of deadlift/pushups and pullups/situps is a simple but effective way to work most all of your key muscle groups. Note the pairings: do 10 reps of each and then do the other while the other set of muscles recover. That way you do not waste time and keep your heart rate up. Work fast because the key is to work muscles to exhaustion after about 10 reps.

Vary your workout with different exercises. There is no one best way to build six pack abs, etc.

To build muscle, make sure you eat at least 20% protein, ideally from an animal source; stay clear of veggie proteins, eat at least 20g of protein at each meal, and strength train with heavy weights (12 reps to exhaustion) twice a week (to allow time for your muscles to recover)..

To lose weight, do not try to lose weight quickly or you will lose muscle, not fat. Rapid weight loss will likely cause your body to use its muscle for energy instead of your fat.

You never want to lose muscle: muscle is what you want to build to become more insulin sensitive and muscle is extremely hard to re-build. Losing fat is trivially easy compared to building muscle. For most people, there is no good way to lose more than about 1 lb a week,unless you are really overweight in which case you can lose 100 lbs in a year.

If try to lose at a faster rate than this, your body will turn catabolic on you and eat your muscle and preserve your fat.

The average 150 lbs. male should eat no less than 80% of maintenance caloric intake per day and keep protein intake at about 20g of protein for each meal.

For example, if you maintain your weight at 2,000 calories/day, you can eat 1600 calories/day which will decrease your weight by almost 1 lb a week, depending on the amount of exercise and its intensity.

The only safe prescription drug for diabetes is Metformin. Take 2g per day if you can tolerate it. A 500mg/day dose will not do very much. I take four 500mg XR Metformin and I spread out the dosing over the day so I avoid stomach upset and keep the drug stable in my blood. There can be differences in generic Metformin vs. branded Metformin so if you have a problem,like getting sick from it, try switching them.

All of the other drugs you hear and see about have very dangerous side effects. See Blood Sugar 101 for more info.

I take a 500 mg Berberine tablet twice a day. Supplier is Thorne Research.
At the time of my diagnosis, I had diabetes for 7 years and my fasting blood sugar was over 126. I’ve been able to lower my fasting blood sugar to 76 mg/dl which is astonishing! The lower your fasting blood sugar the better.

The tricks I used to lower my fasting blood sugar include:

  • eat very few net carbs (Net Carbs = Total carbs – fiber) during the day
  • Dinner is going to be the most important meal for determining your fasting glucose the next morning. A high carb dinner can easily raise your fasting glucose 10 points or more.
  • 4 minute HIIT exercise every day,
  • build muscle workout twice a week,
  • take 2g of Metformin (500 mg XR 4 times a day),
  • 1 g Berberine (500mg twice a day)
  • adequate sleep

I also take omega-3 fish oil (with vitamin D and no omega-6), a multi-vitamin, alpha lipoic acid, resveratrol, and one ultra-delicious (zero net carb) vitafusion fiber gummy. It’s not clear how effective these things are compared with the list above.

There are three tricks you can use to blunt the impact of carbs in the food you eat:

  • Do 20 deep knee bends before a meal or some other exercise. This will make you somewhat more insulin sensitive by the time the sugar from your food enters your blood.
  • Eat fat and protein with your carbs. Eating carbs alone will cause the carbs to spike more than if you ate the carbs with a meal with lots of protein and fat.
  • Do low-intensity exercise 1 hour after you eat
Meters: You can get a free meter and up to 100 test strips per month for as low as $15 per month (up to around $0 per month depending on your insurance) by joining the Abbott FreeStyle Promise Program. I am a data wonk, so I chose the InsuLinx meter, but the other meters are equally accurate (but they do not allow you to key in stuff like exercise, fasting, time after a meal, etc).

Test strips: The Abbott FreeStyle Lite, FreeStyle Freedom Lite, and InsuLinx are interchangable (despite what Abbott will claim on their website) so just look for the best price. You can get 100 test strips each month for 15 cents to 40 cents each (depending on insurance) by joining the Abbott FreeStyle Promise Program. You can also get test strips on eBay. The little secret that most people do not know is that most all brands of test strips are usually accurate for 1 year after expiration, so you can get a great deal on eBay by bidding on expired strips if you need >100 strips a month because most people (including the sellers) do not know that secret!

Low-carb foods: My #1 favorite food supplier of diabetic-friendly low-carb foods is LC Foods. Everything they sell is safe for diabetics and most everything is delicious, especially the hot cocoa, pancakes and the flavored milk and smoothies. You get your protein and fiber easily from their foods. Mix with heavy cream to get your daily fat needs. It was life-changing when I found out about them. Caution: All of the pasta and bread products I’ve ordered from suppliers are lousy (this may change over time), but everything else at LC Foods is great.

Just because they say diabetic friendly, does not mean it is true. Here are some examples:

  • Diabetic Lifestyles Bread: Claims to have a super low glycemic index. But glycemic index is defined by how normal people respond, not diabetics. It raised my blood sugar just like normal bread. Your best clue is reading the label. If it is high in net carbs, stay clear.
  • Quest Bars:  Half of the fiber they use (IMO) is digestible… So instead of just a carb or two per bar, most people find that eating a Quest bar is like eating 12 gm (or more) of carbs. See Are Quest Bars Really as Nutritious as they Claim? The bottom line is look for net-carbs, but even net carbs is not definitive for some foods (such as these). For most all other foods, net carbs is a reliable indicator. If you are in Europe, just look for the carb content because they don’t allow fiber to be included in the Carb content on the label.
  • Dreamfields pasta: Study Finds Dreamfields Pasta Produces Identical Glucose Curves as Regular Dry Pasta.

In general, stick with trusted suppliers like LC Foods and you will not go wrong.

Finally, avoid pasta and bread products from low carb companies. I am not aware of any low carb versions of these that taste good.

Powdered,  artificial sweeteners are sub-optimum, but both Truvia, xylitol and Stevia are the vastly superior choices.

Misc

I highly recommend the following books:

  • Keto Clarity: The best “how to” book on eating a ketogenic diet. A ketogenic diet is an extremely healthy low carb diet similar to the Atkins diet. If we all ate like this, we’d eliminate obesity, heart disease, and diabetes in America.
  • Art and Science of Low-Carbohydrate Living: Explains the medical justification for why eating fat is awesome and eating carbs is horrible
  • Blood Sugar 101: The second best book overall on understanding diabetes including phase 1 insulin response, dangerous drugs, etc. Short and to the point.
  • Dr. Bernstein’s Diabetes Solution: The best book on Type 2 diabetes. Filled with information from a lifetime of experience with diabetes.

If you read all these, you will have a great understanding of why everything I’ve written here works.

Best diabetes info website: Blood Sugar 101.

These websites are also great sources of information because they provide uniformly excellent advice: Authority Nutrition, Diet Doctor, and The Eating Academy.

Sadly no. Doctors know most people will not change their behavior, so they prescribe dangerous drugs. Very few doctors will tell you to eat a ketogenic diet unless they have a specific interest in nutrition and ketogenic diets.

The American Diabetes Association (ADA) is funded by the drug companies. Even though low carb diets have proven time and time again in decades of random controlled trials to be better for diabetics, the ADA refuses to acknowledge this on their website. Even when great studies show ketogenic diets are superior to the ADA diet (such as this study of ketogenic vs. ADA diet by Laura Saslow), they refuse to publish this information. They put out magazines that tell people it is okay to eat lots of carbs. How can it be okay to ingest carbs if you have a disease that says you do not tolerate carbs?! They have done nothing to change the way diabetes is diagnosed so we can catch it years before it gets to the stage it is incurable.

The Joslin Diabetes Center at Harvard Medical School may not be a lot better than the ADA. George King, director of research, says that the ideal diabetes prevention diet should consist of 70% carbs. Ouch. His statement was taken out of context. There is ample evidence that this will turn you into a diabetic (whenever countries adopt the typical Western diet, diabetes rates skyrocket). The article should have said “avoid simple/refined carbs because these cause dramatic rises in blood sugar”. King’s study showed the traditional Asian diet (TAD) is vastly superior to the typical Western diet (TWD). The Asian diet is high in complex carbs, the American diet is high in refined carbs.”  

I found out 7 years after I became diabetic that I was a diabetic. Had any of my doctors looked at my random glucose measurement and knew that any time you have a random blood sugar over 140 mg/dl, it is abnormal, I could have taken action much earlier to avoid damage to my beta cells. I could have cut my refined carbs 7 years ago and likely avoided becoming a diabetic.

I think the simplest way to diagnose diabetes is for doctors to actually pay serious attention to non-fasting blood glucose on every blood test, rather than ignoring it. Any value over 140 mg/dl is a red flag that merits further investigation. But because the test only has a “normal range” for the “fasting” case, doctors think non-fasting glucose is immaterial. It isn’t. It is one of the best indicators we have that something is wrong. It is a huge oversight that costs us billions of dollars. If we just interpreted the data on the CBC test alone, we would find a lot of diabetes and we would find it years earlier than we find it now – early enough to help people avoid becoming a diabetic.

They are not doing squat as far as I can tell despite the fact that diabetes costs us hundreds of billions of dollars per year in healthcare costs.

Both the World Health Organization (WHO) and American Heart Association say limit sugar to 5% of calories, but the Dietary Guidelines for Americans Advisory Committee (DGAC) is completely ignoring this advice. That is infuriating and insane. There is no scientific justification for ignoring these guidelines. The more we limit refined carbohydrate intake, the lower our rate of diabetes will be. It is the single biggest lever we have, but we are notdoing anything to change this because people on these committees are afraid of speaking out. They do not want to be criticized in the press by their peers for going against “the conventional thinking” even when the conventional thinking lacks scientific basis.

Foods in grocery stores and restaurants should be highlighting how low they are in carbs, not how low they are in fat. Our irrational fear of fat is counter productive and leads to increasing diabetes, obesity, and heart disease.  The day our government says “fat is good” and “carbs are bad” will be the beginning of a new era. All the scientific evidence is there to support it.

At the very least, we should be telling people, “eat real foods” and “avoid foods with refined carbs.” We are not even close to doing that.

I get the same promos you do. There are tons of them. I have also been to the chiropractor seminars advertised in newspapers. These are only worth the free meal they give you and not much more. In general, they are all junk. There is no proprietary supplement or other methods for treating Type 2 diabetes. These are scams to get your money. I have seen plenty of these and none of them work. The stuff that really works is simple and is in this FAQ. There are no magical cures or supplement(s) that are proprietary, much as we would like to believe there are.