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What if You Already Have Diabetes?

This entry is cross-posted at Your Health is on Your Plate.

Last summer, after my patient Mrs. Price heard me say that her blood sugar was 204, a single tear ran down her cheek as she said,  “My eldest granddaughter is getting married next year.”  A blood sugar measurement over 200 is one way to confirm a diagnosis of diabetes.  Her parents had both died in their 60’s from complications of chronically elevated high blood sugars.  Here is what I told her.

“The most important difference between your situation and mine right now is that your body is no longer able to keep its blood sugars in the normal range by itself.  But that doesn’t mean you are going to suffer the terrible complications that your parents did.  Kidney failure, blindness, heart attacks and amputations are not inevitable complications of diabetes.  It’s not diabetes itself that’s the problem; it’s uncontrolled diabetes.”

“There’s good news here: First, we found out about this before it turned into a serious problem.  Secondly, as long as you learn to keep your blood sugars in the normal range, your risk of developing complications will be pretty close to mine, which is to say, low.  A diagnosis of diabetes doesn’t mean that you’re going to have trouble.  It just means that your body can’t control its sugars automatically anymore, and it’s going to need your help.  But as long as you give your body the help it needs, and you learn how to conserve your insulin, the payoff will be huge.  I have no doubt that we will be able to get your sugars in the normal range.  You’re just going to need to involve your brain in the process.”

“You’re not going to be able to keep your blood sugars in the normal range automatically anymore, because if you could, your blood sugars wouldn’t be over 200.  And I can’t keep your blood sugars in the normal range all by myself either.  But if we work together, we can and we will.  So let’s figure out what we need to do to get your sugars under good control.  And then let’s do it.”

When I take care of patients with diabetes, I have lots of goals.  I want to get their average blood sugars under 125.  I have goals for total cholesterol, triglycerides, HDL and LDL.  I want blood pressures below 135/85, and I want kidney function in the normal range.  I want strong peripheral pulses and I want my patients’ feet cared for expertly, at home and by the podiatrist.  I want my patients’ eyes checked at least once a year.  And so on.

“But you, Mrs. Price,” I continued, “have only one goal.  Your goal is to dance at your grandchildren’s weddings.  Not just attend them, but dance at them.  All of them.  Starting next summer.”  She smiled a little.

“Did you know that one hundred years ago, before we had medicine for diabetes, the only treatment for diabetes was a high fat diet?,” I asked.  She did not know that.

I taught Mrs. Price how to conserve her insulin using the “Four Recommendations.”  She stopped buying the cereal and orange juice she’d been eating at 11:30 a.m. for years.  I prescribed a medication “to make my insulin more efficient,” as she put it.  We made an agreement that she would begin to walk 5 minutes every day, and that she would begin to increase that number by 1 minute a month.  I reminded her that “Slow but steady wins the race,” because I certainly didn’t want her to sprain an ankle or get shin splints, two complications that would prevent her from getting much exercise at all for months.  She also made a rainy-day plan — to walk in the nearby mall in bad weather.  This is Cleveland, after all. 

We got Mrs. Price a glucometer, and I showed her that she could actually figure out which foods were causing blood sugar spikes by testing before she ate and then an hour afterward.  As time went by, she got better and better at predicting which foods were going to cause unacceptable spikes, and which foods kept her blood sugars in the normal range, more or less.  She stopped buying foods that spiked her blood sugar, except once in a while “special for the grandkids,” as she put it.  She started eating a protein-rich breakfast at 8 a.m., and noticed, to her surprise, that it resulted in significantly less after-dinner snacking.  As the year went by, we watched her 3-month blood sugar averages drop from 190 to 150 to 120.

Last weekend, I am pleased to report, Mrs. Price danced at her granddaughter’s wedding.

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5 Responses to “What if You Already Have Diabetes?”

  1. Bryan T. Says:

    My dad died from complications of high blood sugars. I remember him having to give himself injections in the abdomen. I also remember as a kid having to use his horrible tasting liquid sweetener on our breakfast cereal because he didn’t want sugar in the house. My father was a very lean individual and very active which is one reason I don’t fully understand how he even became diabetic to begin with. For some reason I’ve always associated diabetes with being overweight or obese. I guess my question is can diabetes be averted by simply eating healthy and in moderation? Also, if diabetes is in your family does that mean you’ll have eventually?

  2. Dr Sukol Says:

    MOST diabetes can be averted by eating well in moderation, but not all. Some people become diabetic because their overweight status makes them resistant to insulin and no matter how much insulin they make, it ends up not being enough. Other people are predisposed to diabetes because they have fewer islet cells, the cell that makes insulin. But even these people will be helped by getting adequate exercise and eating a diet that puts less of a burden on those cells and doesn’t force them to maximize production for years on end. You can’t guarantee that you’ll never become diabetic, but you certainly can tip the odds strongly in your favor.

    Remember that your dad likely had no reliable way of monitoring his sugars like we do now. They may not have been able to get his sugars under control without the tools we have available today. Take heart in that, and conserve your insulin as you have learned. The odds are on your side.

  3. Richard Says:

    Virtually ALL diabetes can be averted by eating correctly. This means low carbohydrate and high fat consumption, avoiding wheat products and vegetable oils. It’s not difficult at all once you get started and you’ll feel much better. Unfortunately, the standard American diet (SAD) along with recommendations from the keepers of the conventional wisdom (ADA, AHA, etc.) will encourage all the wrong eating habits. Is it a wonder that 2/3 of the population is overweight and half of these are obese and that Type II diabetes and hypertension are common? My suggestion to anyone who is interested or concerned about preventing or treating diabetes is to go to and start reading (ignore his politics) and specifically to this post: Also, reading Gary Taubes, Good Calories, Bad Calories is a good place to start.

  4. Roberta Schiff Says:

    A vegan dIet is excellent for controlling diabetes. Complex carbohydrates, those found in whole, unprocessed foods (grains, vegetables,nuts, small amount of whole fruit) can be safely eaten by people with diabetes. Unlike refined,processed foods, the whole foods break down slowly and don’t cause blood sugar spikes. Vegetables contain many of the same substances used in drugs used for type 2 diabetes.

  5. Dr Sukol Says:

    I would be hesitant to claim that diabetics and individuals who are markedly insulin-resistant will be able to maintain their blood sugars in the normal range on a diet that features large amounts of grains, even whole grains. As we continue to see, humans seem to have the ability to thrive on many different kinds of diets, as long as they are based on whole foods and not refined and processed food-like products. Perhaps the vegan diet is best for those individuals who remain insulin sensitive.

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