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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

The Normal A1C Level

February 11th, 2009 · 500 Comments

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You want to control your diabetes as much as possible. You wouldn’t be reading this if you didn’t.

So you regularly check your A1C level. This is the best measurement of our blood glucose control that we have now. It tells us what percentage of our hemoglobin — the protein in our red blood cells that carry oxygen — has glucose sticking to it. The less glucose that remains in our bloodstream rather than going to work in the cells that need it the better we feel now and the better our health will continue to be.

As we are able to control our diabetes better and better, the reasonable goal is to bring our A1C levels down to normal — the A1C level that people who don’t have diabetes have. But before we can even set that goal, we have to know what the target is.

The trouble with setting that target is that different experts tell us that quite different A1C levels are “normal.” They tell us that different levels are normal — but I have never heard of actual studies of normal A1C levels among people without diabetes — until now.

The major laboratories that test our levels often say that the normal range is 4.0 to 6.0. They base that range on an old standard chemistry text, Tietz Fundamentals of Clinical Chemistry.

The Diabetes Control and Complications Trial or DCCT, one of the two largest and most important studies of people with diabetes, said that 6.0 was a normal level. But the other key study, the United Kingdom Prospective Diabetes Study or UKPDS, which compared conventional and intensive therapy in more than 5,000 newly diagnosed people with type 2 diabetes, said that 6.2 is the normal level.

Those levels, while unsubstantiated, are close. But they comes along one of my heroes, Dr. Richard K. Bernstein, the author of the key text of very low-carb eating for people with diabetes, Dr. Bernstein’s Diabetes Solution. Dr. Bernstein himself developed type 1 diabetes in 1946 at the age of 12.

“For my patients…a truly normal HgbA1C ranges from 4.2 percent to 4.6 percent,” he writes on page 54 of the third edition of that book. “Mine is consistently 4.5 percent.” Then in his July 30, 2008, telecast he reiterated that as far as he has been able to determine, a normal A1C is 4.2 to 4.6.

What Dr. Bernstein says is normal is so at odds with the other experts that at least a year ago I determined to find scientific proof of what a normal A1C level actually is. It turned out to be a lot more difficult to find than I ever imagined.

My personal quest for a normal A1C level and that of my favorite Certified Diabetes Educator drove that search.

When I learned in 1994 that I had diabetes and that my A1C level was 14.4, I was gradually able to bring it way down. Lately I have been doing everything I can think of to try to get my A1C down to normal. But in 2008 my level in nine separate A1C tests always ranged from 5.2 to 5.6. That’s far from normal, according to Dr. Bernstein.

My favorite Certified Diabetes Educator is also doing everything she can to get a normal A1C level. And she doesn’t even have diabetes — which she double-checked by taking a glucose tolerance test — but her most recent A1C was 5.4.

What could we be doing that is so wrong? Each of us is thin, eat a very healthy diet, exercise a lot, take care of our teeth and gums, which is a major source of infection. Could we have other infections or stresses that prevent us from getting our A1C levels down to “normal”?

It turns out that my favorite Certified Diabetes Educator and I have normal A1C levels after all. I learned this just yesterday when I finally tracked down actual research determining what normal levels are.

A friend suggested that I contact the people who run the standardization program for A1C testing. This organization affiliated with the University of Missouri is the NGSP. Those initial used to stand for the National Glycohemoglobin Standardization Program. But now that the NGSP is international, they changed the name.

So I called Curt Rohlfing, the NGSP data manager and technical writer/research analyst at the University of Missouri. And finally hit pay dirt in my quest for learning what a normal A1C is.

Curt told me that every three or four years his lab at the university studies a group of people who don’t have diabetes to scientifically determine what a normal A1C level is. The results from one study to the next are always close, Curt told me. In their most recent study they tested 29 people who lived nearby in central Missouri.

I asked how they knew if the people they tested didn’t have diabetes. “Because we did fasting glucose tests on them, they had no prior history of diabetes, and none of them were obese,” Curt replied.

So what were their levels? They ranged from 4.5 to 6, Curt replied. That’s at plus or minus 3 standard deviations.

I am certainly no statistician. But Curt tells me that it includes about 99 percent of the values.

The range is narrower — 4.7 to 5.7 — at plus or minus 2 standard deviations. This includes about 95 percent of the values.

“The upper limit is the more important one,” Curt explained further. “The lower limit doesn’t convey as much meaning.”

They also see “a little skew toward the high end of the range, a bit of tailing at the high side,” Curt continued. In fact, levels below 4.5 are “quite unusual,” and usually are only when people have anemia or other abnormalities of the red blood cells.

Remember these are the ranges obtained by the people who set the standards for A1C tests. Sadly, however, not every laboratory or home test kit meets those standards. Maybe the lab that Dr. Bernstein uses doesn’t. Does yours? Curt suggests that you ask your doctor if the lab running the test uses a method that is certified by the NGSP.

The first conclusion of the research for me is that we need to shoot for a normal A1C level of no more than 6.0 instead of trying what may be impossible, a level of 4.2 to 4.6.

However, an A1C level of 6.0 can cause people who take insulin injections or one of the sulfonylureas to go hypo. That’s why the American Diabetes Associations sets the goal conservatively at 7.0.

Still, a lower A1C level among people who take those medications is possible without hypos. Dr. Bernstein has amply shown that both in his own life and that of thousands of his patients.

And certainly, for those of us who don’t take insulin injections or one of the sulfonylureas we can set our goal even lower.

That’s because we have to understand the different between normal and optimal. For example, two-thirds of all American adults are overweight. Thus it has become normal in our culture to be overweight. Likewise, the average American gets little exercise, and that is also normal. We know that being a chubby couch potato isn’t optimal.

“I’m going to aim to be in the lower end of the normal A1C range,” my favorite CDE tells me, “because that is what I believe is optimal for human health.” And now that I know my A1C is in the normal range I am still going to do my best to bring it down as much as possible. Are you?

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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500 responses so far ↓

  • 1 Christina Jones // Mar 12, 2009 at 5:36 am

    I don’t know if you will get this comment, or answer it, but I’m asking anyway. How long does it take to drop your A1C? In early January, I had an A1C of 10, and blood sugars averaging in the 300 range. I immediately grasped control, began daily exercise and cut out all sugar and most of the carbs, and my average sugars now are below 120. I have been chomping at the bit to go to the doc and get another A1C, but I don’t want to be horribly disappointed. How long will it take before all of these major lifestyle changes (and believe me, they are major!) will show up on the test?

  • 2 David Mendosa // Mar 12, 2009 at 8:20 am

    Dear Christina,

    Your A1C level is probably already much lower. The key fact is that the A1C measures your average blood glucose level over the past two or three months and it is weighed heavily toward the more recent levels.

    Best regards,

    David

  • 3 alice // Apr 14, 2009 at 6:42 am

    Hi , I had my A1C checked my Dr said that it is 6.8 It never goes higher Thank Goodness. I check my sugar s at home and . at times it is low 70 sometimes or 100. He took mine 2 hrs after eating and it was 130 , but because my A1C is 6.8 he wanted to put me on Metformin, im scared because i was put on Avandia and januvia, and my sugars dropped low and landed me in hospital , also metformin 500 and I got dry mouth. can you tell me what I can take to help me naturally ? my Husbands A1C is 7.7 he is on junamet 50/500. now he also gave him glumetza 500. is that to much meds ? your help would be greatly appreciated
    Thank you
    Alice

  • 4 David Mendosa // Apr 14, 2009 at 7:45 am

    Dear Alice,

    Thanks for asking. As you read in the article above, your A1C is higher than normal and will probably in time lead to complications that you can avoid if you take action now. Your doctor’s recommendation of metformin is an excellent one, and it will not make your blood glucose level go too low. However, you do have one natural choice that will work, and that is a very low-carbohydrate diet as I have written about here.

    As to your husband, the three medicines he’s taking for diabetes is a lot (three because Janumet is Januvia and metformin). It’s about the maximum, and doctors try not to prescribe a lot of different medications because of the many unknown complications when we take many drugs.

    Best regards,

    David

  • 5 Serena // May 11, 2009 at 8:24 am

    Hi, David,
    I’m also wondering about what is normal A1C levels. I have a hx of diabetes on my father’s side (he passed due to a major heart attack), and his mother (my paternal grandmother) also had diabetes. Imagine my surprise last year when I learned that my A1C was 6.2%. My fasting glucose was good, however. The dr. started me with post-prandial testing, and I found that I was insultin resistent. I have had additional A1C testing every 3 months, and it’s gone down to 6.0% and has stayed there. I know it can go lower if I just cut out the sugar and junk (guilty as charged).

    But I’m just wonderning, considering my family history of diabetes, could 6.0% be good enough??

    My dr. encourages me to get my 2-hr post-prandial level down to under 100. However, I went to a dietician recently and she said, considered I had a hx of diabetes, that under 140 should be what I aim for.

    So who’s right???

    Thanks!

  • 6 David Mendosa // May 11, 2009 at 4:16 pm

    Dear Serena,

    Compared with most of your doctor’s patients, you are fine. What your doctor and dietician say is the conventional wisdom.

    But your chances of any number of the awful complications of diabetes do go up when your A1C is higher than normal, i.e. higher than what people who don’t have diabetes have. Please for the sake of your health do everything in your power to get your level below 5.0.

    Best regards,

    David

  • 7 Janeen // Jun 8, 2009 at 9:18 pm

    I was just diagnosed type 2. My oral glucose test went over 200 at the 1 hour and 2.My a1c is 6.1.I am over weight and have been trying to lose the lbs. I tried for many months to lose the weight before I went to the doctor about my blood sugar. I have been tracking my glucose for years and ordered my own test. Before she ordered my a1c as the reslut of my ogt I brought in, she looked at me like my eating must be out of control. My results speak for themselves. She said she wants to put me on metformin for the weight not the diabetes, she said it is under control. However, even small amounts of carbs can send my blood sugar over 200 an hour after meals.Are there any other things I could do? I try to really read all labels and avoid rice,bread,pasta.Thanks for your time.

  • 8 David Mendosa // Jun 8, 2009 at 9:29 pm

    Dear Janeen,

    We have two great ways to control our weight, and I have successfully use them both. First, I lost well over 100 pounds by taking Byetta. Then, when I wanted to stop using any drugs, I began to follow a very low-carb diet instead, and lost even more weight and have kept it off. Both strategies together may work even better, as Dr. Bernstein’s patients will tell you. I have written many articles about both Byetta and low-carbing.

    Best regards,

    David

  • 9 Tariq Siddiqui // Jul 29, 2009 at 5:45 am

    Excellent research. Very helpful in understanding the normal Levels.

  • 10 Jill // Oct 15, 2009 at 7:51 pm

    Hi David,

    I had the 2 hour glucose test. After an hour I was at 250. I had the A1C test and it came back normal. I don’t know what the numbers are yet. I will be seeing my doc on Wednesday. Does this mean I have diabetes? I am not over weight. I am nervous about this. I am so thristy all the time and urinate 15-20 times a day. I am very tired and hungry all the time.

    Thanks for your help!

  • 11 David Mendosa // Oct 15, 2009 at 8:41 pm

    Dear Jill,

    Generally, an A1C test cannot diagnose diabetes or not. But the fact that you are thirsty and have to urinate a lot are classic signs of diabetes. It could be something else. I can’t say.

    Best regards,

    David

  • 12 Jill // Oct 16, 2009 at 9:12 pm

    What about the 2 hour fasting test that I had? At the half hour mark my glucose level was 193, at 1 hour it was 250, then it went down to 146. Does this mean I have diabetes?

    Thanks for your help.

  • 13 Kevin Leahy // Oct 16, 2009 at 10:01 pm

    Hi Jill,
    I have to start by saying I am not a health professional, but I am studying to be one. I also am a type I diabetic. Your doctor would be the person to diagnose you with diabetes, but certainly the blood glucose values you describe are abnormal. I would schedule an appointment if possible and talk to you doctor about treatment options. The first thing they will say, and I agree, is to focus on lifestyle changes. It is incredibly difficult for some people, but it is worth the fight. Even healthy individuals should be striving to eat their fruits, vegetables, and whole grains, but we must be extra vigilant. That may not be enough for you, so metformin is a good starter medicine to help you keep your sugar levels under control. Good luck and good health.

  • 14 Jill // Oct 17, 2009 at 8:02 am

    Thanks David. I do have an appointment with my doc on Wednesday. I am 51 years old and NOT over weight. That’s the strange thing. I am a pretty healthy eater and exercise 4-5 days a week. Now I will just have become a healthier eater. I will be following the doctors orders.

    Thanks again for all your help!

  • 15 Jill // Oct 17, 2009 at 8:03 am

    Oh! I mean Kevin. Thanks for your help. Sorry.

  • 16 Kevin // Oct 17, 2009 at 8:27 am

    Jill, you unfortunately may fall into that category of people who develop this metabolic disease without having any of the common risk factors. In your case diet and exercise sounds like it will not be enough if the doctor diagnoses you. Definitely speak with the doctor about the different classes of medications that can help with diabetes, but also those to help the heart, arteries and kidneys. I am encouraged by some of the preventative medications that doctors are prescribing for people like me. Good luck.

  • 17 Jean Thomason // Oct 19, 2009 at 12:28 pm

    Hey David,
    I am facing the Dr. on Nov. 4th. Last year at this time I was not diabetic but I am afraid that this year I will be. Is this site a current site or have you quit working with it. I noticed that some of the articles are from 2001

  • 18 David Mendosa // Oct 19, 2009 at 1:20 pm

    Dear Jean,

    Good question. I have been writing about diabetes for more than 13 years. So some of my articles date back to 1996. I hope that every one of the more than 1000 articles that I have written about diabetes show the date. I keep writing at least two articles EVERY WEEK about diabetes, so the site certainly is current, while parts of it are not; therefore the dates on my articles.

    Best regards,

    David

  • 19 Ellen // Nov 2, 2009 at 9:34 am

    David-

    I’m type 2- diagnosed at 6.8, and lost 44 pounds on a strict low carb diet (I am doing very little carbs- just veggies, seldom even eat fruit) and my weight is now fine. Not taking meds. A1C went to 5.9. I have been monitoring my BS very carefully the past few months and with the meter that Dr. Bernstein recomments. My numbers range from 69-89 random, and from 94-104 two hours after meals. (In the past 3 months- seldom hit 120 two hours after meals). And yet I just had an A1C test of 5.9 again. That is an average of 133. How can that be?

  • 20 David Mendosa // Nov 2, 2009 at 9:45 am

    Dear Ellen,

    First, an A1C of 5.9 is equivalent of an average glucose level of 123, not 133. Second, which of the various meters that Dr. Bernstein has recommended from time to time are you using? Then, perhaps the particular meter that you are using isn’t accurate enough. I do know that the WaveSense meters, like the Jazz, always test higher than most other meters. When I approached company representatives about this, the acknowledged the fact and showed me that their meters test right in the middle of Clarke error grids and that some other meters regularly test lower.

    Best regards,

    David

  • 21 Ellen // Nov 2, 2009 at 10:09 am

    I’m using the Accu Chek Aviva. I called his office and that’s what they told me. Also have used the Accu-chek Compact Plus and the Freedom Lite. Have used all three at the same time to compare and sometimes they were close and sometimes not. Once, meter A was 117, meter B was 94. Immediately after tested again, and meter A was 100 and meter B was 104. Go figure.

  • 22 Ellen // Nov 2, 2009 at 10:12 am

    BTW- I was using a scale that Dr. Bernstein used for A1C averages. He says 5.9 is 133 but maybe he is off. Thanks

  • 23 David Mendosa // Nov 2, 2009 at 10:15 am

    Dear Ellen,

    Yes, the Aviva is Dr. Bernstein’s current recommendation. But you do have to remember that NONE of our blood glucose meters are accurate enough.

    Best regards,

    David

  • 24 Ellen // Nov 2, 2009 at 10:37 am

    How frustrating. Makes me wonder why I bother testing and spending all that money on strips.

    But thanks for your site and newsletter and your responses.

  • 25 David Mendosa // Nov 2, 2009 at 10:51 am

    Dear Ellen,

    Good point. Considering how much you already know about how different foods effect your blood glucose levels and how well you are controlling your diabetes, maybe you need to test only in exceptional circumstances — while of course you continue to get regular A1C tests.

    Best regards,

    David

  • 26 Ellen // Nov 2, 2009 at 11:00 am

    Can I trouble you with one more question? Since you are also on a low carb diet, have you ever had any kidney problems? My blood tests always show a slightly high BUN, BUN Creatinine Ratio, and now a slightly low eGFR and slightly high hematocrit. Everything I’ve read points toward dehydration. (That could even cause a slight rise in A1C I think). I also have extremely dry eyes. But I urinate a lot because of the protein I eat. Can just drinking more water help? Dr. Bernstein swears eating more protein doesn’t hurt the kidneys.

  • 27 David Mendosa // Nov 2, 2009 at 12:24 pm

    Dear Ellen,

    I have not had kidney problems. And do remember that we need either fat or carbohydrate for energy. Not protein. How much protein we need is still an open question. Dr. Hamdy, whom I wrote about at http://www.healthcentral.com/diabetes/c/17/41992/protein-carbs , probably represents a view at the upper limit. However, you may not need more than the 46 grams/day that most women need, according to the Institute of Medicine, as I wrote at http://www.healthcentral.com/diabetes/c/17/63252/protein-muscles

    You might try drinking more water. Of course, it could just result in your peeing even more!

    Best regards,

    David

  • 28 Tina // Nov 5, 2009 at 2:48 pm

    Diagnosed with Type 2 after a 6.5 A1C and GTT with over 250 at 1 hour and 300 at 2 hours. That was 3 months ago. A new A1C report today shows 5.8 which is within the normal range for this lab. Is it possible to be diabetic and have normal A1C? I am so confused. My main problem is the post prandial sugars as my fasting is usually okay ranging from 105 – 124, but occasionally higher like in the 130 or 140. I can always tell if my sugar is higher because my vision blurs. Also, I have had several hypo spells recently, but didn’t check sugar, I just know that is what it was, because my mother is insulin dependent and I have seen her hypo episodes.
    Appreciate any comments.

  • 29 David Mendosa // Nov 6, 2009 at 2:23 pm

    Dear Tina,

    Good for you! Your A1C is in the normal range, which is about 4.5 to 6.0. So you are in the high end of normal. Remember that the medical profession uses the term “normal” as being the equivalent of what we generally think of as “average.” And average is not where we want to be, when perhaps half of all Americans are insulin resistant and therefore pre-diabetic. We want to be optimal — a different concept entirely.

    Yes, it is not only possible but always true that we can have diabetes and have a normal — even an optimal — A1C. Good blood control doesn’t cure diabetes, because when we stop controlling it with diet, exercise (and drugs if necessary), our blood glucose levels will go sky high again. You and I have pushed our diabetes INTO REMISSION. That’s wonderful. But we always have to watch it so it doesn’t bounce back.

    Always check your blood glucose when you go hypo! Otherwise, you don’t know how to get it back into normal range. The best way to do that is something I wrote about at http://www.healthcentral.com/diabetes/c/17/74755/glucose-tabs

    I can understand if taking insulin made you go hypo. Taking the right amount of the right kind of insulin at the right time is really tricky at first. The only other drug that is likely to make you go hypo is one of the sulfonylureas, an old diabetes drug that most people think should be retired in place of newer and better drugs.

    Best regards,

    David

  • 30 Ellen // Nov 6, 2009 at 2:30 pm

    I had numbers similar to yours and didn’t think of myself as a “diabetic” for almost a year although I did stick to my low-carb diet. Then I started testing my normal husband after we ate meals. He could eat french fries and a milkshake. I could have a few of his fries and a tiny taste of his milk shake. My BS one hour later was 158. His was 104. That will remind you that you have diabetes.

    I’m a newbie here, so I don’t pretend to be an expert, but wondering if you are on medication? If not, I don’t think you don’t need to worry as much about hypos. Let me just tell you my experience. When your body is used to your blood sugar being a little high- and then you bring it down, you may experience the feelings of hypo, e.g., hunger, the shakes etc. That’s adrenalin kicking in and signaling your brain to eat carbohydrates because your body wants you to get your BS back up a little. This is just an adjustment. I felt that way when my BS first went to 74 which I now realize is not really low. So after your body adjusts to having normal blood sugars you shouldn’t experience that “low” feeling. But like I said, if you’re on medication, that’s a completely different story.

  • 31 David Mendosa // Nov 6, 2009 at 3:27 pm

    Dear Ellen,

    Two excellent points. I hope that Tina sees your message. Your second point was one that I would have made if I had remembered to write it!

    Best regards,

    David

  • 32 Carol // Nov 10, 2009 at 8:26 am

    I had and A1C level of 5.8 the first week of June 2009. I began Dr. Neil Benard’ program for reversing diabetes at the end of June. It is a vegan diet with very low fat and low glycemic index food. My A1C level yesterday, Nov. 9 was 5.1. It appears that fat is a problem in the control of diabetes. My results are inline with what Dr. Benard has to offer in his program and explained in his book. Yes, A1C of 6 or 7 is not acceptable for me, because I was having to increase my level of medication after 3 years of knowing I have diabetes. And yes I have been exercising too. This is just one example. It is working for me. Thanks for listening.

  • 33 Ellen // Nov 13, 2009 at 10:13 am

    David- I would love to see you comment on Carol’s comments above. I have been doing high protein/fat- low carb and getting good results. However I try to be open-minded to any possibility. However I can’t understand how eating less fat and more carbs (even the so-called good carbs) could do anything but raise my blood sugar (plus leave me hungry all the time). I have read Barnhard’s (Sp?) articles and I know he has a book- I think it’s called “Rerversing Diabetes” and he advocates a vegetarian diet. Everything I’ve read just contradicts that so I’ve just dismissed that as dangerous. But as I said, I want to keep an open mind. In fact, fat is supposed to be the one type of food that doesn’t cause a reaction from insulin. So would love to hear from you on that. Thanks

  • 34 David Mendosa // Nov 13, 2009 at 12:28 pm

    Dear Ellen,

    I have read Dr. Barnard’s book and several of his articles. His vegan diet may work for some people, but, like you, I don’t see how it could because it is necessarily high in carbohydrates.

    Best regards,

    David

  • 35 Carol // Nov 13, 2009 at 4:01 pm

    Presumably, fat in the cells interfers with the action of insulin. I think we are all familiar with the observation, that as a person looses weight, they are better able to control their blood glucose level. And again, I am only one example and it is working for me.
    Regarding the high carb diet, it involves eating food that is low on the glycemic index along with low fat. Both parts are important.

  • 36 Ellen // Nov 13, 2009 at 5:29 pm

    I don’t want to seem argumentative because I do believe everyone can learn different points of view from these forums. But fat in your cells is totally different from dietary fat. In fact, if you eat more fat and less carbs, you are more likely to burn fat, and not store fat in your cells. It’s when you eat a lot of fat and a lot of carbs that you will store the fat. Gary Taubes has some wonderful articles on fat and carbs. As for the GI, only some of the foods lowest on the index can be tolerated by diabetics. It recommends a lot of food that is very bad for diabetics (generally). For example, whole grains can raise BS levels by 4 or 5 times what they should be. The ADA continues to recommend oatmeal. The tiniest amount of steel cut oatmeal will send my BS up to 300. Pasta will act more slowly but over several hours will raise BS. I’ve seen some information on the glycemic index that I can try to dig up.

  • 37 Carol // Nov 13, 2009 at 6:57 pm

    Yes, every change in diet does not work for everyone, that is why there are so many different ones out there. All I am saying is that I read Dr. Barnard’s Book, studied which vegan foods would give me appropriate protein, looked at the GI and what foods were high and low and found food I like that fits the progam. I have been doing this since June and my A1C went from 5.8 to 5.1 so far and my glucose levels have been very near normal. I have also reduced my medication to one Avandamet pill per day. I had been following the ADA recomendations and they took me only so far. I did not read the book with the intention of doing anything different. But by the time I finished it, I had decided to try it. It works for me, lost weight, blood glucose under control, healthy and feeling great. I am making good wishes for you to find what works for you.

  • 38 Ellen // Nov 14, 2009 at 1:07 pm

    I didn’t realize you were taking medication. That makes a difference. You can tolerate more carbs with medication. But 5.1 is fabulous in any case!

  • 39 Sally Ann Lycke // Nov 17, 2009 at 7:32 am

    Boy! Am I ever glad to have found this site… I’ve been a diabetic since 1987 and find myself on more and more medication. Right now I’m taking Tolazamide, Metformin, Lisinopril, Lovostatin, and am now on 13 units of Lantus insulin each night. My last blood work resulted in a NORMAL glucose fasting but a high A1C of 9.5; my doctor wants me to retake the tests “because there must be some mistake.” My biggest problem is: what to eat for breakfast. The American Diabetes Association says I should be eating a small bagel with low-fat cream cheese; however, eating that would shoot my blood sugar levels up to almost 300! I usually eat brussel sprouts or butternut squash with a dab of I Can’t Believe It’s Not Butter…but I’m getting really tired of THAT. Any suggestions? The highest my blood sugar levels have ever been is 330, usually right around 100 (but Kaiser Permanente doctors always spout that blood sugar levels need to be under 100). Mine are–most of the time.

  • 40 David Mendosa // Nov 17, 2009 at 8:33 am

    Dear Sally,

    I am likewise glad that you found this site! Unfortunately, to be taking more and more medicine seems to be the rule when you follow the ADA’s diet advice (I wrote about that at http://www.mendosa.com/blog/?p=211 ).

    You understand, I’m sure, because of your comment on the bagel. Eggs in any form make a much better breakfast. Personally, I like mine poached in a little microwave poacher. Sometimes it’s just egg whites, sometimes whole eggs. Many people, of course, enjoy their eggs with bacon, ham, or sausage. All of these are very low carb and won’t raise your blood glucose levels much if at all. The British often like kippers and perhaps other fish for breakfast; another excellent choice.

    Sometimes instead of eggs or in addition to them I have a very low carb (5 grams) drink of greens powder. Now, I know from my own experience, that most greens drinks taste terrible, but the one I drink is delicious. Please see http://www.mendosa.com/blog/?p=382

    Best regards,

    David

  • 41 Tyra Somers // Nov 19, 2009 at 11:14 am

    Hello,
    What should I be shooting for as far as post prandial rise in blood sugar? When is the best time to measure?
    Also, how do you tell if you are insulin resistant? And what happens to the extra insulin you produce?

    Thanks,
    Tyra

  • 42 David Mendosa // Nov 19, 2009 at 2:21 pm

    Dear Tyra,

    Most (but not all) organizations say that a post prandial level of 140 mg/dl or less should be our goal two hours after the first bite of the meal.

    Doctors can test to see if you are insulin resistant or not or if your pancreas doesn’t produce any insulin. If you are insulin resistant, your pancreas is pumping out too much insulin and it makes the glucose stay in your blood rather than being uses by the cells that need it. It is precisely this that causes all of the dire consequences of diabetes.

    Best regards,

    David

  • 43 SAMMY G DAILY // Nov 29, 2009 at 11:34 am

    DAVID, I HAVE BEEN READING YOUR BLOGS FOR A COUPLE OF MONTHS NOW AND FIND THEM VERY HELPFUL. I AM A 76 YEAR OLD MALE DIAGNOISED WITH TYPE 2 SOME ONE YEAR AGO. I HAVE MANAGED TO GET MY AIC DOWN FROM 7.25 TO 6.6 AND I AM STILL WORKING THE PROBLEM, BUT I AM HAVING SOME SYMTOMS MY DOC CANNOT EXPLAIN. IF I EAT A MEAL WITH HIGH FAT OR HIGH CARBS, SOME 2-3 HOURS LATER, MY HEART BEAT GOES TO MAX, AND ALSO BOUNDING OCCURS. HAVE YOU EVER HEARD OF THIS AS RELATED TO DIABETES. I UNDERSTAND YOU ARE NOT A DOC, JUST HAVE YOU ENCOUNTERED THIS BEFORE. THANKS-SAM DAILY

  • 44 David Mendosa // Nov 29, 2009 at 1:15 pm

    Dear Sammy,

    I haven’t encountered that before. Sorry. All I can suggest is testing your blood glucose level when your heart beat goes up and see if you can find any pattern.

    Best regards,

    David

  • 45 angus mcphail // Dec 6, 2009 at 10:07 pm

    My story was recently written up in “GI News:
    here in Australia.
    a 23 yr vet of type 2 i was constantly told by
    medico’s including endocrinologist that i was
    in the non diabetic range of A1c.
    having been on a 5year research for diabetics
    on a chol .lowering drug, i recently obtained my
    data and found although my fasting bgls average
    was in10mmol/s my /a1c ranged from 3.8-4.4!
    this yr I was at last told that I had a suspected
    hemoglobinopathy!
    i,m a 68 yr old scot with irish ancestry and i,m at
    a loss as to why the pathology labs and Drs did
    not question these low A1c’s
    It would have saved me years of frustration and
    heartbreak.

  • 46 Amina // Dec 9, 2009 at 12:06 am

    when i eat in the morning my blood comes 230.when when i walk in the evening it is 160,so iwant your advice

  • 47 David Mendosa // Dec 9, 2009 at 10:31 am

    Dear Amina,

    Both your evening and morning blood glucose levels are too high. Since you are already exercising, you have only two other courses of action to bring down your levels. They are a better diet and more or different diabetes medications. With a better diet you will also lose weight if it is too high, and for most people with diabetes it is. A better diet basically means eating less but particularly less starchy and sugary foods — cut way back on wheat and wheat products, including bread as well as corn, rice, and potatoes to reduce the starch in your diet and cut out the table sugar (sucrose) and high-fructose corn syrup entirely. That is the best first step with diet, but eventually you may want to go further and follow a very low-carb diet. For the diabetes medication you will need to discuss this with your doctor.

    Best regards,

    David

  • 48 Carol // Dec 9, 2009 at 11:40 am

    Amina, I would also like to say that, following Dr. Neil Barnard’s Program for Diabetes has brought my A1C level to 5.1(within the range for non-diabetics) and my twice daily check of blood glucose in the normal range. The program is in a Book form and has recipes with it. It is another alternative. There are many choices, because one theory or diet does not work for everyone. you might want to read it and see what you think and if you want to try it. Good wishes, Carol

  • 49 Anne // Dec 10, 2009 at 10:42 am

    I have lost the weight, and lowered the cholesterol levels (under 100) and raised the good! I weigh 103 pounds (5′2″), walk daily and my A1C is 5.6. Down from 8.8 (August 2008) I take 2.5 metformin per day and wondering if I should try to get my A1C lower. I do subscribe to a low-carb diet, under 100 carbs per day. I am a very active 56 year old and teach yoga and pilates. Any suggestions for doing more? I am a bit of a perfectionist. My post prandial numbers after meals run from 90-120 (occasionally higher).

  • 50 David Mendosa // Dec 10, 2009 at 12:06 pm

    Dear Anne,

    You don’t want to lose any more weight, because it’s now at the very low end of a normal BMI. That’s wonderful!

    Your A1C could, however, be a bit better. Normally, I would say that an A1C of 5.6 is fine — it is indeed in the normal range — but since you say that you are a perfectionist (like me!), you might consider just a little fewer grams of carbs per day. That’s basically because as A1C levels go up from about 5.2 the long-term risks of complications increase.

    Best regards,

    David

  • 51 Elaine // Dec 17, 2009 at 2:53 pm

    I am currently taking Glipizide ER 2.5mg. I am having trouble with my morning levels being high, sometimes 185, but my bedtime levels are between 100/130. I have tried eating fruit, cheese, peanut butter for a bedtime snack but sometimes it’s high and sometimes it’s normal. What should I do? This is driving me crazy. I talked to my MD, but he gave me no advise. Please help

  • 52 David Mendosa // Dec 17, 2009 at 3:08 pm

    Dear Elaine,

    By far the most important number for those of us with diabetes is our A1C level. What is yours?

    Meainwhile, please see “Good Drugs, Bad Drugs” at http://www.healthcentral.com/diabetes/c/17/98218/good-drugs-drugs-bad

    Best regards,

    David

  • 53 Mike // Dec 23, 2009 at 6:14 pm

    Hi David,

    I have never been diagnosed as diabetic or pre-diabetic. I have been monitoring my fasting BS during my annual physical for the past 20 years, and it usually comes back to around 90. But the results from 2 years ago and last year went up to mid-90’s. That caught my attention, and I immediately did a baseline A1C test with a result of 5.9.

    Since then I have been following a low carb diet (60 to 70 gm a day) for about a year, and I have been monitoring my BS everyday. I can see my BS drops over time, both fasting and after meals. A few days ago I had my annual physical again, and my fasting BG dropped to 87, which is in line with my measurements at home. But what is surprising is that my A1C shot up to 6.1.

    A 6.1 A1C translates to an average BS of 129. In a typical day, my BS does not go up beyond 125 at ANY time, including 1 and 2 hour after meal measurements. Every 2 to 3 weeks I will do continuous measurements for a day, where I check my BS every hour during the 16 waking hours. The average usually comes out to between 100 and 105. That puts my A1C betwen 5.1 and 5.3. If I include the 8 hours during sleep, I expect the average will be even lower.

    So far I have only one data point in calibrating my meter. A few days ago I used my meter at my doctor’s office to check my BS right after the nurse drew blood for the fasting BS test. My meter came out to be 7 points higher than the lab test.

    I have read that certain people have A1C higher or lower than their measured average BS value. Is it possible they could be off by as much as 0.8 to 1.0%?

    At this stage I am not sure whether I should rely on my measurement values or the A1C result to determine the next course of action. If my measurement values are correct and I am one of those less common individuals who have inflated A1C results, I can just stick with my current approach of BS management. On the other hand, if the A1C results trumps my daily measurements, I may have to consider medication since I already exercise 5 days a week and I am very thin.

    Appreciate any comments. Thanks.

  • 54 David Mendosa // Dec 23, 2009 at 6:37 pm

    Dear Mike,

    I wouldn’t be too concerned. Yet it would be wise to watch your diet (fewer carbs), lose weight if necessary, and get enough exercise. Similar to what President Reagan once said, “Trust, but verify.”

    Your A1C levels — whether 5.9 or 6.1 — are right on the cusp of normal, as I point out in the article above. My guess is that your most recent level of 6.1 is within the range of normal variation. All tests have some inaccuracy built in to them.

    But to get a “second opinion” and perhaps set your mind at ease, why not buy a home A1C test like I wrote about at http://www.mendosa.com/blog/?p=400 and http://www.mendosa.com/blog/?p=339 ?

    Best regards,

    David

  • 55 Karen // Dec 30, 2009 at 12:41 pm

    In June of 2006 I got diagnosed with Impaired Glucose Tolerance. My 2 hr. GTT #’s were.
    Fasting – 84
    1 hour – 218
    2 hour – 178
    A1c – 5.4

    My A1c’s have been 5.5, 5.7, 5.5, 5.7.

    I had anothe r 2hr GGT a few weeks ago and #’s were as follows:

    Fasting – 88
    1 hr – 115
    2 hr – 97
    A1c 5.7

    I have no idea what I am now. How can I go from one extreme to another. Dr. said I must have changed my lifestyle and I did get rid of a lot of carbs. This has me stumped.

    Any insight is appreciated.

  • 56 David Mendosa // Dec 30, 2009 at 12:49 pm

    Dear Karen,

    Yes, it does seem strange that your A1C went up a bit (although within a normal margin of error) while your GGT went down at the 1 and 2 hour marks. But I certainly agree with you and your doctor that going on a low-carb diet really helped. You are on the right track.

    Best regards,

    David

  • 57 madhavi // Jan 28, 2010 at 3:45 pm

    Hi David,

    I just found your site, and wow – it’s so informative! I feel like I’ve come to the right place for my question!

    I am not diabetic – was never diagnosed as such before, but I have family (mom’s side) history full of diabetes.

    I just came home all sullen today, because I was given my blood test results (without consultation with the doc yet). I couldn’t wait to find out what the results indicated, hence the anxiety now.
    My A1C had been in the upper 5.0 range, then it jumped to low 6, and now, today, it’s at the highest – 6.6!! My fasting sugar is 109, but it’s been in that range before too.

    I’m really scared.. really!! My appointment with the doc is not until next week, and I am dreading to be told what I fearfully think I may have. Do you think it’s diabetes?? Or would it be considered pre-diabetes? Either way, I’m going on a diet with low carbs – and absolutely NO sugar whatsoever!

  • 58 David Mendosa // Jan 28, 2010 at 5:28 pm

    Dear Madhavi,

    I am sorry to say that you probably have diabetes. But it’s a close call based on your A1C level of 6.6%. Your doctor — or you — might want to have to take a fasting blood glucose test, which until now has been the standard. But now the A1C is accepted, as this article says:

    TUESDAY, Dec. 29 (HealthDay News) — In its latest set of clinical guidelines, the American Diabetes Association is promoting a more prominent role for the hemoglobin A1C blood test in the diagnosis of type 2 diabetes and prediabetes.
    Long used in the management of diabetes, the A1C blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of type 2 diabetes at A1C levels above 6.5 percent, and prediabetes if the A1C levels are between 5.7 and 6.4 percent.
    “We’ve added another test that can make it easier to find out if you have diabetes,” said Dr. Richard Bergenstal, president-elect of medicine and science for the American Diabetes Association (ADA).
    The new guidelines will be published in the January issue of Diabetes Care.

    In ANY case your low-carb diet makes great sense!

    Best regards,

    David

  • 59 madhavi // Jan 28, 2010 at 7:27 pm

    Dear David,

    Thank you so much for the quick response!!!

    Yes, I think I did remember an article like that last year. I was wondering why 6.5 seemed like the “magic” number.

    I just got home from the gym – trying to ease my nerves.. the swimming/water exercises did help. but..still.. was worried..so the next best thing I did was speak to my doctor at home right after that! And.. the good news was that…while the A1C was quite high, he kept repeating that I do not have diabetes. He strongly advised me to continue to lose weight (low carb diet with exercise). I’m sure there’s more to it, and so he told me so too – until the appointment next week.

    It is still scary – no doubt. My mom told me if you can prevent it, you must in every way – as unfortunately, there’s no cure. =( My heart goes out to all the people with this condition. Interestingly enough, I’m def. not out of the woods – as I read somewhere recently that people that are in the border line for diabetes.. are at same high risk for diabetes related diseases & ailments (i.e. kidney, heart disease, retina, neuropathy, etc.) as full blown diabetes patients. It’s something that I am now reminding myself.

    Thank you again for being there!

  • 60 Amanda // Feb 3, 2010 at 7:57 am

    I have a fasting bs level of around 115-120. I’m usually 225 1 hour after a regular carb meal. 150’s around 2 hours after meal. It takes about 4 hours for me to drop to 130’s. My doctor says this is normal. I don’t thing so. Looking for a second opinion from anyone.

  • 61 David Mendosa // Feb 3, 2010 at 9:06 am

    Dear Amanda,

    You are right, your levels are absolutely not normal. They are, however, typical for people with diabetes. For example, the American Diabetes Association says that a level of up to 180 at two hours after a meal is OK. However, the other major organizations set the max at 140. But those are not “normal” levels, i.e. the levels that people who DON’T have diabetes would reach. They don’t go above about 120 even with a lot of carbs. We people with diabetes cannot handle a heavy carb load, as your numbers show. This is not a technical question — it is a question of life and death, specifically one of complications. High levels like you experience will lead to complications sooner or later.

    Best regards,

    David

  • 62 Ellen // Feb 3, 2010 at 10:24 am

    Amanda-

    Are you taking any medication for blood sugar control? If not, why don’t you try a low carb
    diet. I have controlled my diabetes for over 18 months now with a diet of no grains, and a cup of vegetables and one cup or one piece of fruit daily. I eat a lot of meat and fat. I am so much healthier and my post meal numbers are never above 120. Also lost 45 pounds. I put my non diabetic husband on a similar diet and he has lost 50 pounds and his cholesterol improved so
    much that his doctor asked him if he had put him on cholesterol medication.

  • 63 Amanda // Feb 3, 2010 at 10:39 am

    Thank you so much for you information. My husband is type 2. (6.2 barely weighing in at 185) My daughter is type 1 (diagnosed at age 3). I’m well educated on diabetes. My doctor knows I’m not on meds. I actually just randomly checked my blood sugar to show my youngest of three children that it’s not that bad to get pricked by the lancet, and low and behold I was above 200. I’ve been self monitoring to see what increases my levels the most. I am fine with low carbs which makes since. I guess I just wanted to see for myself if I do fit in the Type 2 category. I feel that my Dr. was going by the normal levels for a “diabetic” and not a person with normal insulin function. Thanks again! I’ll eat low carbs. I need to lose about 20 lbs.

  • 64 Mike Harris // Feb 11, 2010 at 10:22 am

    I just had my A1C and it registred @ 6.7. My dr said that it was fine as I am insulin dependent (lantus). However, I take about 15 units each night and if I do not have something sweet right after that I drop to the 50’s sometimes even 40’s. I feel the effects around 2am – 5am. I usually always awaken with coldsweats and light headed. He will not adjust my lantus and states it is the appropriate dose. Should I be worried.

  • 65 David Mendosa // Feb 11, 2010 at 12:05 pm

    Dear Mike,

    Covering insulin with carbohydrates is not the best of strategies! If I were in your shoes, I would be worried — about your doctor. Maybe it’s time to get a second opinion from another doctor?

    Best regards,

    David

  • 66 Amanda // Feb 11, 2010 at 12:26 pm

    I have a daughter that is type 1. We have supplies in the home to test. I’ve monitored my own blood sugar and had noticed some highs. I’m in an above post. A week ago my 14 year (non-diabetic) old randomly checked her blood levels and was 170 an hour after a normal carb meal. I didn’t worry until I had her check her ketones and she tested “large”. I monitored her over the weekend and she did not go over 140 one hour post meals. However, she did experience some odd lows such as 59.. 69.. Her A1C at Dr. office was 5.5. What is going on? Dr. once again says this is normal. Could we be in the early stages of type 1? She does carry the antibodies that attack the pancreas.

  • 67 David Mendosa // Feb 11, 2010 at 12:57 pm

    Dear Amanda,

    Unfortunately, your 14-year-old daughter’s normal A1C level won’t tell if she had diabetes or not. That’s because her levels vary so much with the lows canceling out the highs. I would recommend that you get her tested for diabetes with one of the two standard tests.

    While the A1C has now been approved as a possible test for diabetes, please note these recommendations of the American Association of Clinical Endocrinologists/American College of Endocrinology. These are the first three:

    AACE/ACE support the ADA recommendations for use of a confirmed A1c as an available option to

    diagnose diabetes, with the following recommendations:

    1. A1c should be considered as an additional optional criterion, not as the primary criterion.
    2. AACE/ACE suggest using traditional glucose criteria for diagnosis when feasible.
    3. A1c is not recommended for diagnosing type 1 diabetes.

    Best regards,

    David

  • 68 Amanda // Feb 11, 2010 at 1:24 pm

    Thanks for responding. I wish all doctors would update their information about diabetes. It was suggested to me by a friend that if her A1C is “normal” but, she’s shown large and traces of ketones that she may be anorexic. I honestly don’t think this is the case. I have thought about it and have kept a very close eye on behaviors at meals and after. I don’t think the few episodes of above normal range is coincidence. Could it be that her pancreas is still trying to work? Have I caught something early and the evidence is not totally there? I’m very concerned. I’ve adjusted to one type 1 diabetic. Two in the family would be a bit of a mind challenge for me.

  • 69 David Mendosa // Feb 11, 2010 at 1:32 pm

    Dear Amanda,

    Like you, I sincerely hope that your second daughter doesn’t have diabetes. But it is, of course, better to be prepared.

    Yes, her pancreas may still be working to some extent. People with type 1 often have what’s called “the honeymoon period.”

    Best regards,

    David

  • 70 Jeanne // Feb 20, 2010 at 12:12 pm

    Dear David,

    Thank you so much for the good work you do on this site–since I was first alerted to my own levels three years ago, I have been following your directions and Dr. Bernstein’s books very carefully.

    I just went to my latest test–and I was 126 and 5.4 A1c. The doctor told me I am fine and not to worry –to continue what I am doing (low carb, no sugar) and should be fine. Somehow this does not seem right to me. I lost 30 pounds, but have gained back 12 (inactive at a computer job) and went a bit wayward with the low- carb diet.

    Does it seem like it is correct to say I am not diabetic?

    J

  • 71 David Mendosa // Feb 20, 2010 at 5:49 pm

    Dear Jeanne,

    If your doctor ever diagnosed you as having diabetes on the basis of a standard test, I would think that your diabetes is “in remission” now. Please keep it that way by keeping the weight off and following your excellent diet.

    Best regards,

    David

  • 72 Ron // Apr 5, 2010 at 5:41 pm

    Dear David,
    I was diagnosed with type 2 several months ago.
    A1c was 7.5. Since that time I’ve lost 21 pounds, walk 2.1 miles a day. My glucose in the morning is average less than 108 and my average after meals (2 hours) is 104? That doesn’t seem to make sense but thats what the meter tells me.
    I’ve just checked my A1c using the bayer A1cnow and it was 6.0. Thats after only 2 months so I would hope it would drop a bit after another month under my belt.
    Now I’m told I have diffuse fatty liver (Insulin resistance I assume).
    Is there a test to test insulin resistance. I fear that now that I’m wathching carbs that the fat is now becoming a problem

  • 73 David Mendosa // Apr 10, 2010 at 4:51 am

    Dear Ron,

    Yes, your doctor can test your insulin resistance — which would determine whether your have diabetes or not. There are now three tests including the A1C. Your A1C level would not indicate that you have diabetes, but it would be wise to confirm with your doctor.

    Best regards,

    David

  • 74 Ellen // Apr 10, 2010 at 5:17 am

    Re fatty liver. Eating low carb should improve that. Eating fat and protein doesn’t cause fatty liver. In fact if you read about how fois gras, they force feed corn mush to geese. My fatty liver went away as soon as I went low carb. (I eat no grains at all).

  • 75 Ellen // Apr 10, 2010 at 5:19 am

    Sorry- meant to say “how fois gras is made.” And by the way- I believe it means “fat liver” in French.

  • 76 Steve // May 3, 2010 at 8:21 am

    My A1C is 5.9%, however I have had very normal fasting and after meal BS (in the 70’s, 80’s and low 90’s). I haven’t been diagnosed as diabetic; at least not yet. I read that a 5.9% A1C corresponds to an averge glucose reading of 133. My issue is this, how can this be when my readings on different glucose monitors have been what I stated above? There is no way that my average BS is 133. What’s wrong here?

  • 77 David Mendosa // May 3, 2010 at 10:36 am

    Dear Steve,

    Here is exactly the same answer I gave Ellen here last year:

    First, an A1C of 5.9 is equivalent of an average glucose level of 123, not 133. Second, which of the various meters that Dr. Bernstein has recommended from time to time are you using? Then, perhaps the particular meter that you are using isn’t accurate enough. I do know that the WaveSense meters, like the Jazz, always test higher than most other meters. When I approached company representatives about this, the acknowledged the fact and showed me that their meters test right in the middle of Clarke error grids and that some other meters regularly test lower.

    Best regards,

    David

  • 78 jennifer // May 21, 2010 at 12:34 pm

    David, do you have opinions regarding T1 versus T2s and their uses of insulin pumps + CGMs?

    I just started using a CGM (T1 for 35 years), and it’s so awesome, and the missing link, in my mind, for soooo long.

    Now that I finally understand better what insulin pumps do, I’m [finally] looking into that as well.

    Along that path, I met a T2 woman using a pump, and some T2s who are way out of control.

    I have come to see that combination as the best answer for both types, given the benefits of the CGM and the capabilities of the pumps. And you are right on, it’s all SO much easier to control if using a low-carb diet (carbs make me whack out, as much as I love a good cheeto). Salads and protein are pretty reliable re my insulin reuirements. ;)

    What is your opinion of T2s using a pump + CGM to get more even control, also?

  • 79 David Mendosa // May 22, 2010 at 10:02 am

    Dear Jennifer,

    I absolutely agree with you. Even people who have type 2 that is not in good control can benefit greatly from using a pump and continuous glucose monitor to get them in control. Sadly, however, few type 2s do.

    Best regards,

    David

  • 80 Schelia Watkins // May 23, 2010 at 11:43 am

    Dear David,
    I was diagnosed with type 2 diabetes 7 years ago. I finally decided to change my eating habits and joined a fitness club since May 2009 I have loss 80lbs and 46 inches. My A1C has gone from 6.5(2009) to 5.9(2010). would love to be diabetes free but, even with the results that I have my doctor stated to continue with routine and Rx. My goal is to lose 65lbs by December 2010. What should my A1C be in order to be completely off my Rx.
    Schelia

  • 81 jackie // May 29, 2010 at 8:13 am

    Hello to David and any others who might know about things below!
    I have been eating a super-low carb diet ( no grains or starches or fruit or dairy) with about 900 calories. It has been 30 days since I switched to almost no carbs, but I have never eaten a lot of calories.
    I have always done heavy aerobic exercise 4-6 days a week for one hour (it is getting harder as I run out of gas partway through now).
    I need to lose about 50 lb.
    I am barely losing weight- maybe a pound a week.
    My endo says that low ketotic diets DO have a big risk- something about how they shut off the production of a compound produced in the bone marrow that removes the plaques or lipids in the arteries.I cannot locate this study. Has anyone ever heard of this?
    I also have slightly high BP (140/95) now – I am shocked.
    I am also hypothyroid- endo is raising my doses of T4 now. If that does not work, we will have to work with insulin-resistance.
    How can I be doing all this and have high BP and not lose much weight???

  • 82 Saddaf Sultana // May 29, 2010 at 11:18 am

    dear david

    finally, i have started loosing weight, 2 kgs in 25 days, following a low carb diet, yet fat is not high. i am hungry all the time and yet my weight loss is not really significant. correct me if i am wrong, calories do not count on low carb? 1200 cal/day is my allowed limit. and i try to make it even less by eating less fat.

    regards

  • 83 David Mendosa // May 29, 2010 at 6:10 pm

    Dear Saddaf,

    Sadly, in my experience calories do count even on a very low-carb diet. Yes, I have read that all calories aren’t equal, and that may well be so. But when I increase my calorie intake, I increase my weight at the same time. So sorry!

    David

  • 84 David Mendosa // May 29, 2010 at 6:12 pm

    Dear Jackie,

    I think that you put your finger on the problem — your thyroid. Take care of it and you will solve your weight problem at the same time.

    Davi

  • 85 David Mendosa // May 29, 2010 at 6:20 pm

    Dear Schelia,

    Your question is essentially what is a normal A1C level, because only at that level can you be reasonably confident of not getting one of the complications of diabetes. A normal level is 6.0 or below. Some people who I respect very much say that it is 5.0 or below. When you get down to that level, you can probably go out your diabetes medication safely.

    David

  • 86 Ellen // May 29, 2010 at 6:57 pm

    Saddaf-

    I would add that even if you can get your A1C numbers down to a better number ( and most charts say that with every .1 increment over 5 you raise your risk of doing damage) that doesn’t mean you’re “diabetes free.” I control my blood sugar through diet but if I cheat, I’m reminded of my diabetes when I test my BS 2 hours later and see that it is much higher than my husband’s who probably ate a lot more carbs than I did.

  • 87 Ellen // May 29, 2010 at 7:08 pm

    Saddaf-

    Re diets. I would like to tell you about the diet my endo put me on two years ago and I lost all the weight I needed to and am never hungry and my A1C is good . This is extreme but it works for me. You could talk to your Dr. and see what s/he thinks. I eat two meals a day- no snacking. I eat 8 oz. of meat with each meal and am allowed 1/2 cup vegetables, 1/2 cup salad and 1/2 cup or 1/2 piece of fruit. I avoid all grains and starches.

    If I want to lose a little more weight the only way to do it is to cut back a little on the meat- maybe to 5-6 oz. per meal. But if I go lower than that I will get a little hungry. But it passes and I’ve learned to live with it. My weight is really fine now but I’d just like to lose a few more pounds for vanity reasons!! So calories do count somewhat although I think they’re secondary to the type of calories you eat. And I never worry about fat. I believe that fat is not bad for you as long as you’re eating very low carb. Read Gary Taubes and Dr. Richard Bernstein for great information.

  • 88 David Mendosa // May 31, 2010 at 9:14 am

    Dear Ellen,

    I couldn’t agree with you more!

    I especially like your comment that you can live with a little hunger. In fact, I will go further — whenever I have a little hunger I know that it means I will be losing weight, and I like that feeling!

    Best regards,

    David

  • 89 saddaf sultana // Jun 1, 2010 at 12:33 pm

    dear Ellen & dear David

    yes, you are right. infact, i knew about the right portion size as told by my doctor three years ago.. i was just hoping to find a way to eat more. ..i know it is me vs. me.. if i want to stay healthy.

  • 90 saddaf sultana // Jun 1, 2010 at 10:11 pm

    …. and to do that i am embarking on a strict menu control regime:
    tea with full cream milk at 7.am
    breakfast: one full egg omelete + tea at 9am
    midmorning: 1/2 cup melon or apricot at 11am
    lunch:1 cup vegatable/meat curry+ 1/2 cup yogurt
    tea: 1cup tea with milk + 1/2 regular buiscuit
    dinner: 1 cup meat/vegetable curry + 1/2 cup yogurt
    after dinner: green tea with lemon

    30 miute daily on elliptical treadmill.

    bhindi water as medication in the morning.

    do advise if it can be improved upon.
    thanks

  • 91 David Mendosa // Jun 2, 2010 at 6:31 pm

    Dear Saddaf,

    Sounds very good! Two questions: do you have rice with your curry? If so, how many grams of carbohydrate in it and in your biscuit? (Or is that 3 questions?)

    David

  • 92 saddaf sultana // Jun 3, 2010 at 12:20 am

    dear david
    1. i generally donot take any rice or roti with meals. below mentioned quanities are one full day’s consumption on those days ( maybe twice a week) when temptation takes over me ( i loath myself later on). also, i take no more than 2 tablespoons of curry with 2-4 ounces of cooked meat or vegetables per meal. some chutney and green salad without dressing( we call it kachumer salad). so my not so often rendezvouz with no no food in a whole day is quantified below:

    1). 1,2 tablespoon cooked white rice (carbs -15 gm) or
    1/2 whole wheat roti(carbs-10gm, calories-40)

    2). 1 little buicuit (carbs-3gm,calories-10)

  • 93 Ron // Jun 3, 2010 at 12:37 pm

    Dear David,
    I started a really low carb diet myself.
    To my dismay the glucose levels have been rising.
    I’m not really sure whats going on or how to change it.
    My BS seems to be around 100-110 in the morning and then rises to mid 120’s during the day. This occurs even without food, only water.
    I’ve limited my carbs so that I very rarely rise above 140 after 1 hour.
    Is there something I can do to get this level down. I’m stuck at an A1c of 6.0 and can;t seem to get any lower.
    It does go lower after I exercise, it can drop into the 70’s. But it quickly rises even without eating.
    I have not tried any medication up until this point, just diet.
    Is something I should reconsider? Is there any harm in taking meds. My only real objection is getting too comfortable with the lower levels using meds and getting back into bad habits.

  • 94 David Mendosa // Jun 3, 2010 at 1:40 pm

    Dear Mike,

    It is possible that you no longer have enough beta cells and need to start taking insulin. If I were you, I would discuss your situation with an endocrinologist.

    Best regards,

    David

  • 95 sysy morales // Jul 2, 2010 at 10:39 am

    This is a very interesting post. Personally, my lowest A1c was 4.5% and coincided with me getting pregnant with twins (after being told before that I couldn’t get pregnant). Not easy, but possible. Low carb is what does it for me.

  • 96 chris // Jul 24, 2010 at 8:51 pm

    I have had high a1c’s for about 10 years (avg around 10-11) I am 25 and have been diabetic since 7. I haven’t really taken that great of care of it since about 13 years old or so.. I was wondering if I started taking good care of it now, what are the chances of a good (or bad if that calculates better) outcome for my case?

  • 97 David Mendosa // Jul 25, 2010 at 3:58 pm

    Dear Chris,

    Great question. If you don’t already have any of the many complications of uncontrolled diabetes, you can prevent them if you keep your blood glucose levels down to normal. Even if you already have complications, you may be able to reverse most of them with a normal A1C. The chances of a good outcome in either case remain high. Dr. Bernstein has proven this in his own life and that of his many patients, most of whom, like you, have type 1 diabetes. Please read his book, Dr. Bernstein’s Diabetes Solution, and follow his recommendations.

    Best regards,

    David

  • 98 sysy morales // Jul 26, 2010 at 8:50 am

    Chris, I second what David says. I had 10-11 years of high A1c’s myself! Then I began turning everything around following Dr. Bernstein’s recommendations of eating low carb and not using the pump. I ended up getting my A1c’s way down AND I reversed nerve damage in my feet :) It is not too late for you! You can definitely turn things around. Now is the best time to start.

  • 99 Jennifer // Jul 26, 2010 at 8:59 am

    What is this about the pump?

    I have been trying to get a pump. Outrageously, because me getting devices is like continually jumping through hoops, my 30-day-glucose-average before seeing the nutritionist was 129, or approx a 5.7 A1C, I believe. I was eccstatic!

    Upon following the nutritionist’s daft advice to never correct within 4 hours of administering a correction for a high, after only 2 weeks of this my 30-day average is 163. I am outraged.

    And, it’s left me almost all-high, all the time, even eating almost no carbs, as before. It’s left me all unstable, I feel.

    But, because I’d wanted to get even more even than in my sometimes-low 129-average days, I had begun the pump process.

    What is negative about pump usage? I just naturally eat low carbs mostly but don’t know about the badness of using a pump — what is it?

  • 100 sysy morales // Jul 26, 2010 at 9:48 am

    Since a pump is a tool and not a cure or anything close to a cure, I would say that it all depends on how a person uses the pump whether it works or doesn’t work for them. Just like 2 people on injections can have 2 very different results. If you are on the pump and have been consistently high you should speak to your doctor because perhaps your insulin requirements need to be adjusted. For me personally, the pump gave me hurdles to better control because sometimes the infusion site wasn’t good due to scar tissue, or sometimes the tubing would have air bubbles and thus give me higher numbers, I had to deal with keeping batteries with me for it, and also was too temped to not only snack too much, but also go out without my testing meter because my insulin was already with me. I also sometimes need just a half of a unit and with the pump, never knew if I was really getting that tiny amount. For me a syringe is more fail-proof. BUT, I know for a fact you can have better control than your average of 129 per 30 days with the pump and without the pump. I had a very good A1c with the pump and now maintain around a 5 % A1c without it. It is all about getting the dosing of your insulin just right and learning about all the things that affect your blood sugars. The pump is a great invention but, doesn’t click with everyone. Doctors will tell you the best thing to do is use the pump but this is narrowminded. I recomend working with your doctor to stabalize your glucose while on the pump and then choose whichever option suits you most. The point is you can do well with either. I have proven this and so have many others. Good luck to you :)

  • 101 Jennifer // Jul 26, 2010 at 10:13 am

    Thanks. Yes, I know I can get good, using low-carb, results using MDI.

    I was hoping to be able to even out a bit more, when I do eat some carbs, potatoes particularly seem to really staaaaay with me, using a pump. Hence my hoop-jumping, and now way out of stable control due to the [dumb] nutritionist. And now that doc fired me bc, he said, I was rude to his receptionist (when neither the doc nor the nutritionist would call me back).

    As such, however, I am exhasperated with this hoop-process, and am hence really, really curious to know the specifics of the Mendosa anti-pump theory, since I can easily give up these hoops if it really is bad somehow. ??

  • 102 David Mendosa // Jul 26, 2010 at 10:28 am

    Dear Jennifer,

    What is “the Mendosa anti-pump theory”? I don’t remember ever hearing about it before.

    Best regards,

    David

  • 103 Jennifer // Jul 26, 2010 at 10:30 am

    Sorry, Bernstein! I just read this on a post 2-3 up from here, “Then I began turning everything around following Dr. Bernstein’s recommendations of eating low carb and not using the pump.”

    I am wondering what this “not using the pump” theory is all about, the particulars, etc. Sorry I mis-stated!

  • 104 David Mendosa // Jul 26, 2010 at 10:31 am

    Dear Jennifer,

    Thanks for clarifying your comment. For a moment I thought that my memory was failing!

    Best regards,

    David

  • 105 Cindy // Aug 15, 2010 at 2:02 pm

    If I have an A1C of 6.8 and my Doctor has me on Metformin, do I really need Lisinopril 2.5mg? I do not have high blood pressure.

  • 106 David Mendosa // Aug 15, 2010 at 2:43 pm

    Dear Cindy,

    Many doctors routinely prescribe Lisinopril not only for high blood pressure but also to protect the kidneys of people with diabetes, since we are particularly at risk of kidney disease. So I can’t say whether or not you need it. But I do know that your A1C level is above normal, which does make you a good candidate for kidney failure.

    David

  • 107 AL-THAWADI // Aug 19, 2010 at 4:22 am

    Is potatos and brown rice good for insulin resistent people

  • 108 David Mendosa // Aug 19, 2010 at 10:07 am

    Dear Al-Thawadi,

    Unfortunately, not. potatoes and brown rice are both full of starch, which raises our blood glucose levels more than just about anything!

    David

  • 109 Mary // Aug 23, 2010 at 12:39 pm

    Hi AL-THAWADI,

    Sometimes we have a cultural thing about foods and certain foods are “comfort” foods to us. (Cornbread is mine)

    If you absolutely must have rice, use brown INSTANT (precooked or parboiled) Rice, then only eat 1/2 serving.

    It is a strange thing that usually we try to avoid processed foods but rice is an exception as the INSTANT (like minute rice) has a lower glycemic index. It will not raise your BG as fast as regular rice. Still it is something you need to have only once and a while and only a 1/2 serving. Then you should test your blood sugar 2 hours after you have eaten it and see if your BG (blood Glucose) is 170 or less (some say 140-180, but go by what your health professional told you).

    When I first was diagnosed as a Diabetic I could not understand why SOMEONE wouldn’t just tell me what I could or could not eat! Well, I found out it is because every diabetic is a little different. I can eat a small serving of cornbread without a problem, but 1 bite of white bread drives my BG crazy. So we must test our blood exactly 2 hours after eating a new thing to see how it affects us. Good luck to you!

    Mary

  • 110 Don // Aug 24, 2010 at 7:56 am

    David, THANKS so much for answering each person’s questions. You’ve given me a good education reading all of your answers. THANK YOU and thanks for a great website.

  • 111 Paul // Sep 15, 2010 at 2:04 am

    I lost a toe in 2005 due to diabetes infection,then in 2006 I lost half a bone in the other foot. I became a dibetic in 98 with a level
    over 200 my A1c was about 8.5,now I am down to 5.9 I lost about 93 lbs feel better and I also believe in a more natural way to combat diabetes
    vitamins,cinnamin,chromium,holy basil,gymnea sylvestre,and others look up natural ways to combat diabetes it helps ask questions don’t let the doctor make all the decisions fight back and keep working at it or you might lose parts like I did unneccissarily

  • 112 Dave D // Sep 15, 2010 at 12:25 pm

    I found this website by accident, which was a good thing!
    I wasnt sure how I was going to make out when I first got the news that I was T2. There are many things that I still dont uderstand about it and may never actually get a grip on, however, I did learn there are numbers better than others when it comes down to the A1C. 200 days ago I was at 7.1 and just a week ago I showed 4.9. I did pretty much (drastically) change my diet but I still have something to comfort me here and there.
    Going from 7.1 to 4.9 seems very drastic to me given some of the entries make by other folks in relation to how long some have waited for a change in their own numbers. Is it common for this kind of change in the A1C or am I just lucky that my body is responding well to my lifestyle changes? (diet and excercise)
    I can honestly say that I was a soda junkie and I havnet touched it in these past 200 days and I found I really dont even miss it.
    Thanks for having such a great site available! Best wishes to everyone!

    Dave

  • 113 David Mendosa // Sep 15, 2010 at 2:11 pm

    Dear Dave,

    Good going! You must be doing everything right. Keep it up!

    Best regards,

    David

  • 114 Satya // Sep 16, 2010 at 8:56 pm

    Hi David,
    I am 34/m. I was diagnosed with T2 in Oct 2009 with a fasting of 146 and 2 hr pp of 246. At 210 lbs, I was borderline obese. I was started on 5 mg Metformin and immediately started taking contgrol of my diet and exercised daily. By Dec 09, my A1C was 6.2. Due to working hard on healthy food, and exercise, I eventually lost 40 lbs and weighed 160 lbs by Feb 2010. My A1C was 5.3 and my doctor immediately stopped my Metformin and Lisinopril. I continued on my diet and exercise and last week, i weighed 153 lbs and my A1C stood at 5.2.
    I continue to stay away from rice(there was a time i couldnt imagine food without rice), refineds flour, sugar and starchy foods. Though not daily, I exercise 2 times a week.
    I have seen no dramatic rise in my sugar levels in occasional splurge on food at parties. I would dare to ask, and it may sound cliche, can i ever consider myself “cured”?

  • 115 David Mendosa // Sep 17, 2010 at 6:44 am

    Dear Satya,

    You are doing great! Your A1C is down just where mine is with diet, exercise — and weight loss — alone. No drugs. But I had to lose 150 pounds to get there!

    I don’t consider myself cured of diabetes. That’s because with controlling what I eat, which like you includes no grains, potatoes, sugar, or fructose, I know that my diabetes would get out of control again.

    Actually, I prefer it this way! I have a wonderful incentive to follow a healthy diet and get a whole lot of wonderful exercise outdoors in nature.

    Best regards,

    David

  • 116 Jason // Sep 30, 2010 at 6:37 am

    David,

    Great site – lots of good info here. I was diagnosed as T2 in March if this year, with an A1C of 8.9. I immediately cut out most carbs, and have maintained this diet since then. I have lost 30 lbs, and my A1c is now 5.5. I feel great! My question is this – is it harmful to occasionally have a high-carb meal (the food I still love to eat)? Still no sugar, but pasta and bread. I am very careful to limit it to about once a month, but having that outlet allows me to maintain my control the rest of the time.

    Thanks,

    Jason

  • 117 David Mendosa // Sep 30, 2010 at 10:50 am

    Dear Jason,

    Thank you. I think that you can gradually cut out grains, but is is sure hard at first. As an interim step you might look into Dreamfields pasta, which I have written about here.

    David

  • 118 John // Oct 9, 2010 at 12:01 am

    I am type 2, averaging about 90 BS daily, and a 5.9 at the latest.I take glipazide and metformin 500 x2. Dr wants to take me off the glip but my BS goes up to 115. Could I now increas metformin dosage to bring my BS down again?

    Another point: As a general principal, and in light of Dr Bernstein’s Chinese Resteurant Effect, why not heed grandma’s advice to chew our food a much longer.?

  • 119 David Mendosa // Oct 9, 2010 at 8:45 am

    John,

    Grandma’s advice is the best and latest! I agree with your doctor and with your desire to up the metformin dose. He can prescribe a doubling of your dose.

    David

  • 120 Fran // Oct 27, 2010 at 11:49 am

    i was diagnosed in March of this year as pre-diabetic – fasting blood glucose of 82 and A1C 6.2. I was stunned. I have always been an exerciser, eat healthy, not overweight in any fashion,form or manner and bicycle 4 days a week(spinning) and walk the other two days. I am watching my carbs (was not getting enough) and trying to be even more aware. get retested in November. Anything else I can do? Met with a Dietian about 4 months ago and she helped me with carbs. I am horrily frustrated at my diagnosis.

  • 121 Ellen // Oct 27, 2010 at 7:54 pm

    What do you mean by “not getting enough carbs?”Most people are eating too many. And unfortunately most dietitians are very old fashioned in their advice. You should probably try to eat less than 50 grams a day, maybe less. Avoid grains and eat mostly vegetables with just a little fruit.

  • 122 Fran // Oct 28, 2010 at 9:05 am

    If I only eat 50 grams I will starve -I am a high level exerciser (burn 500-600 calaroies in one exercise) and am eating 190-215 grams of carbs a day. this is the recommendation from my dietitian. – they are very healthy carbs – whole grain/multi grains, dark green leafy, crunchy vegetables, fresh fruit , oatmeal, walnuts, almonds, etc. 45-60 carbs per meal and 30 per snack (2 per day). I can’t sustain on 50 carbs a day. The dietitian is very young and very up to date along with being a certified diabetic educator. where did you get 50 carbs per day guideline?

  • 123 Fran // Oct 28, 2010 at 9:09 am

    Maybe you mean 50-55% of daily calories in carbs – found this “many dieticians actually adivse that carbohydrates should not represent more than 50 – 55% of a pre-diabetic diet. This means that for a 1,600 daily caloric intake, 220 grams of carbohydrates should be present.”

  • 124 Ellen // Oct 28, 2010 at 9:43 am

    I actually eat 30 grams of carbs a day. I eats lots if meat and fat and have plenty of energy, low cholesterol, extremely low triglycerides, and blood glucose now within range without medication. Have you been diagnosed with diabetes? Maybe you can tolerate more carbs but that is a lot. You might want to read Dr. Bernsteins book The Diabetes Solution. There is also a great website -www.phlaunt.com/diabetes. Also Gary Taubes work- Good Calories/Bad Calories.

    My endocrinologist will not allow me to eat any grains. I have been doing this for over two years now and I’ve put my husband on a similar diet. It works for us.

  • 125 Ellen // Oct 28, 2010 at 9:48 am

    Sorry- I see above you said “pre-diabetic.” Dont trust that. You could be losing beta cells (insulin producing cells) and you won’t get them back. That’s what happened to me. That website I gave you above is a fabulous education. Also- be aware that your fasting blood sugar can be the last to go. By the time that goes up, you’ve killed a lot of beta cells no would recommend buying a meter and testing your BS one and/or 2 hours after you eat. 2 hours after you eat it should be back in the 80s. Or at least low 90s. If it’s not- you need to be more careful with the carbs.

  • 126 Ellen // Oct 28, 2010 at 10:00 am

    I’m sorry- keep forgetting things. As far as your fasting number being in the 80s which is normal but your A1c being 6.2 a recent study showed that ( and I hope I can explain this well- I’m a non-scientic layman!) the A1C tends to reflect your after meal numbers heavily. So e.g., even if your fasting or random numbers are low- if your after meal numbers are high (which to my layman’s way of thinking is the true test) it will show up in your A1C. So I would highly recommend you test 1 and 2 hours after a meal. I would eat oatmeal for breakfast when I was supposedly pre-diabetic and two hours later my BS was 198. That should have been a warning to me. So as I said- if your BS after a meal doesn’t go back to the 90s or even 80s you might be insulin resistant and heading for diabetes .

  • 127 Fran // Oct 28, 2010 at 12:45 pm

    Ellen,than you so much for the information. WOW, I can’t believe that is all of the carbs you eat – my cholesterol is fabulous and always has been. However, now you give me food for thought. Why do you not eat grains? Do you eat fruit and complex carbs veggies? what do you mean by “killing a lot of beta cells.” I am very frustrated because this has happened – I feel like mybody has betrayed me in spite of my very healthy lifestyle. Carbs give me energy and I need them but try to make outstanding choices regularly. I hear you on the A1C and understand the measurement – it is about the spikes and not my fasting blood glucose.

  • 128 Ellen // Oct 28, 2010 at 2:11 pm

    I am probably the wrong person to ask about grains. I think that grains (wheat, rice, oats, corn, barley, corn, and sugar) are responsible for the obesity and diabetes epidemic in this country. I don’t think there is an overweight person in the world who wouldn’t lose weight and be healthier if they gave up (or at least drastically reduced) their intake of grains and starches. Having said that I know people are different and some people can eat all the grains they want and not gain weight. However for diabetics, grains, even whole grains will raise your blood sugar the most. I eat two meals a day- 8oz of meat at each meal, non starchy vegetables and usually some berries

  • 129 Ellen // Oct 28, 2010 at 2:15 pm

    Beta cells are the cells that produce insulin. If your blood sugar goes too high it can damage beta cells in a couple of different ways. If they’re required to produce more and more insulin because of carb overload they can burn out. The website I gave you has good information on this. But just remember, carbs raise blood sugar the most, protein less, and fat only very little.

  • 130 Fran // Oct 29, 2010 at 5:35 am

    thanks. I did go to the website you gave me and good information. I agree with you in that I think we are all different in how our bodies process food. My carbs are extremely healthy and high in fiber. I don’t do sugar, sweets, pasta (rarely)I am not overweight and have never been. I am very fit – just finished a 200 mile bike trek over 5 days on in TN and ALA at age 63. It was fabulous. I continue to pursue information as I don’t want my pre-diabetes to go full blown. My mother was a diabetic and did not care for her diabetes. I am not that person. I feel certain is genetic but hard to digest. Thank yo so much for all that you have shared with me.

  • 131 Wendy // Nov 1, 2010 at 10:11 pm

    I am a 56 year old woman who has had digestive problems my whole life. Three years ago I began having episodes of horrible nausea and vomiting. Before I got sick I would suddenly become very tired and chilled, then get extremely nauseous, vomit uncontrollably for several hours, and finally shake and gasp for breath for a couple of hours. I have been taken by ambulance to the hospital twice, where all bloodwork, including blood sugar, is completely normal. Have had just about every diagnostic test there is (CT scans, mri, endoscopy, etc.). My local GI doc finally sent me to a major medical center where a HIDA scan with small bowel transit showed very slow transit time. Stizmarker studies showed very slow colon transit. My doctor said this is due to nerve or muscle damage, possibly caused by diabetes, lupus, or scleroderma, and had me do bloodwork. Everything came back normal, except my A1c test which was 5.9 (glucose was 88). After my last attack in July (3 months ago) I went on a strict elimination diet and as a result have lost almost 15 pounds. I am not hungry and due to the digestive problems must eat small, easily-digestible foods. I have to remind myself to eat, and can’t tolerate wheat, dairy, and anything fatty or rich. I have given up all sugar except an occasional 1/2 cup serving of sorbet. I do eat apples a lot.
    Would that reading of 5.9 indicate a problem that would result in this significant amount of nerve or muscle damage to my intestines? Every time I have had a fasting blood test in the past, my glucose levels are always normal. Thanks!

  • 132 David Mendosa // Nov 2, 2010 at 7:37 am

    Dear Wendy,

    Why would you think that your A1C of 5.9 would indicate a problem? It is, after all, the upper range of normal.

    David

  • 133 Wendy // Nov 2, 2010 at 8:08 am

    Hi David, thanks for the prompt reply. On my test results it says “indicates above average risk for diabetes”. I’m shooting in the dark here, just looking for answers as to why I have nerve damage to my digestive system. I have read so many different ranges online, it’s hard to sort it all out. So I assume from your answer that it should not have caused the problem. Thanks again for your answer!

  • 134 Rob // Nov 4, 2010 at 6:03 pm

    I was diagnosed with Type 2 about 2 years ago. I have since dropped 80 pounds and I am now at a healthy weight. I have dradtically lowered my carbs and my A1c scores have been 5.1. Here is my question. Almost all of my meals are healthy low carb meals, but I allow myself to eat 2 unhealthy meals a week with lots of carbs (pizza with ice cream for example). If my A1C is 5.1, does that mean having the 2 bad meals a week is ok or am I endangering myself by having 2 bad meals a week? Thanks.

  • 135 Ellen // Nov 6, 2010 at 11:48 am

    Here’s my opinion. You might be overdoing the high carb meals twice a week. You should test your BS two hours after the meal. If it isn’t below 120 ( at the highest -preferably under 100) that means that you need your beta cells to produce more insulin to handle the carb load. So that means you’re overworking your beta cells and that could cause them to burn out. It might happen slowly over time. Also having high BS coursing through your blood vessels could be slightly damaging to them over time. And lastly- a little cheating is necessary to stick to a strict low carb diet- but if you cheat too much- you might start to slide.

  • 136 Steve // Nov 6, 2010 at 2:55 pm

    I am not a diabetic, but I do have a question about post prandial glucose ranges. Most if not all of the literature that I have read states that a PP reading under 140 is normal, but some of your remarks suggest that you should be under 120 2 hrs after a meal. Which is it? My A1C is 5.4, but once in a while, I will get a post prandial reading that is around 120 if I consume a high carb meal. My doctor said that is normal and can happen. Why is the literature not consistent?

  • 137 Phyllis // Nov 12, 2010 at 11:31 am

    I am type 2 and would like to know what a correct reading for aic should be. Mine started out at 5.8, now 7.4..I need to bring this down..please help…

  • 138 David Mendosa // Nov 12, 2010 at 11:49 am

    Dear Phyllis,

    To avoid complications as much as possible, you need to keep your A1C level below 6.0, as my article here emphasizes. So you are going in the wrong direction. You might want to start by reading my article at http://www.mendosa.com/advice.htm

    Best regards,

    David

  • 139 Phyllis // Nov 12, 2010 at 1:28 pm

    How many carbs a day is good? My doctor told me 45 per meal…how does that sound?

  • 140 David Mendosa // Nov 12, 2010 at 1:49 pm

    Dear Phyllis,

    What your doctor told you is, sadly, the standard medical line. But please read the book “Dr. Bernstein’s Diabetes Solution.” His recommendation works out to 42 grams per DAY.

    David

  • 141 Angela // Nov 16, 2010 at 10:46 am

    My 12year old son was just diagnosed with diabetes…Drs still trying to determine if it is type 1 or 11. His A1C a few days ago was 12.6 with glucose at 251. We have been told to admitt him into the hospital for insulin treatment over the next couple of days to bring his A1C under control. Saying no to him will be very hard for me to do but as a mother, I need to do whatever it takes to keep my son healthy. Is it not possible to avoid the hospital and just immediately change his diet and start a rigorous exercise routine?

  • 142 David Mendosa // Nov 16, 2010 at 10:57 am

    Dear Angela,

    My recommendation would be to do both. While I have now finally been able to control my diabetes and my weight with diet and exercise alone, that does take a long time. Initial and immediate use of insulin has become the best strategy of many health professionals for a very good reason. This is because insulin shots will very quickly bring down blood glucose levels. And you absolutely need to bring down the level very quickly to avoid the terrible complications of uncontrolled diabetes. The longer levels are high the greater the risk of complications later.

    Best regards,

    David

  • 143 Patricia // Nov 29, 2010 at 3:22 pm

    My 9 year old was diagnose with type 1 before her 8th birthday. I have read lots of times doctor Bernstein book and a book from a Swedish doctor Ragnar. I live in the UK and she is in Lantus as basal and Novorapid per each meal. I count every carbs she eats. Try not give them much and her A1C has been 8.2, 8.2,8.8 and 7.9. I do test her at least 6 times a day and correct any high reading with extra novorapid. She usually does not have more than 4o carbs per meal. I can not go as far as Dr. Bernstein propose and some timer her BG are high for no particular reason (no related to food). I need to bear in mind she is a child and becoming a small person. She swims and is going to do it at a competitive level and she eats lots of raw food; tomatoes, peppers, cucumber, etc. What else can I do ?

  • 144 David Mendosa // Nov 29, 2010 at 3:28 pm

    Dear Patricia,

    I am sorry that your daughter has diabetes. It is difficult to control. I am not a doctor and can’t give medical advice. But I wonder why you say that you can not go as far as Dr. Bernstein recommends in terms of carbs per meal (6 grams for breakfast and 12 for lunch, dinner, and possibly one snack if far enough apart from the main meals).

    Best regards,

    David

  • 145 Patricia // Nov 30, 2010 at 2:35 pm

    Hi David. Thanks for your response. The difficulty of Dr. Bernstein Diet is the drastic restriction in carbs. If it was me I would do it but is very difficult to force a child to eat like that without having other conflicts at this age. Puberty is another variable in the equation and “force” is not easy at this age and I do not think I should be totally open about the risks at this early age taking into account she is very cooperative

  • 146 Joy // Dec 3, 2010 at 6:03 pm

    Hi David, I’ve learned so much here! I am 36/f, overweight, and a huge family history of diabetes. I have been hypoglycemic for years. Recently had an A1C of 7.0, which I now understand is wayyyy too high, even if it isn’t as high as my two brothers, 10.5 and 13.2. I’m going to be talking to a dietitian soon to discuss what exactly I should be eating. My doctor prescribed 1000mg of Metformin, and I’m scared to take it. My 2-hour post meal bs was 304 after a carb-heavy meal, but was 85 and I was getting shaky 3 hours later. There is nothing worse than having low bs, and I don’t want to have to drink juice or eat candy to get it back up because my medicine made it too low. Am I on the wrong track here? Thanks so much for any advice you can give me.

  • 147 David Mendosa // Dec 5, 2010 at 10:16 am

    Dear Joy,

    Metformin won’t make your levels go low. Only insulin or a secretagogue like a sulfonylurea will. You do need to bring your A1C level down substantially and you have only 4 ways to do that: 1) medicine, like metformin (which is a great choice — as is Byetta), 2) a very low-carb diet, 3) exercise, and 4) stress reduction. Try to practice all of the above!

    David

  • 148 Ellen // Dec 5, 2010 at 11:21 am

    Joy- one thing I’d like to add to David’s excellent advice is that a BS of 85 is actually excellent – it’s not low. The reason you might feel bad and get the shakes is that your body will need to get used to having normal blood sugar. It’s used to it being high. There are chemical reasons that I can’t explain well, but it’s basically if your blood sugar starts to go down, until you adjust to that, you will produce adrenalin, which tends to give you the shakes and make you crave carbs. Once you adjust to normal BS that will stop and you will welcome a reading of 85!!

  • 149 Ron // Dec 21, 2010 at 11:11 am

    David,
    My A1c was recently @5.8 and my fasting was 98 at the docs. I asked the doc to put me on metformin, since I virtually eat no carbs, and still can’t get my A1C any lower.
    Heres my question:
    Will metformin bring my A1c lower? I’m trying to achieve 5.2 or lower. I’m thin about 152 and 5′9″ tall. I’ve read that metformin typically works for Overweight but not necessarily thin Type2.

  • 150 David Mendosa // Dec 21, 2010 at 1:49 pm

    Dear Ron,

    I have never heard that metformin works only on people who are overweight.

    Best regards,

    David

  • 151 Ellen // Dec 21, 2010 at 4:43 pm

    Sometimes I read that Doctors prefer Metformin (or even more- the brand name- Glucophage) when their patients need to lose weight. That it is helpful in losing weight, and lowering BS, while other drugs don’t contribute as much to weight loss. Maybe that’s what you’re hearing. So if you don’t need to lose weight, there are other drugs that you might consider for lowering your A1C. My numbers are about the same as yours, and my doctor isn’t anxious to put me on medication. He says my risk of heart disease and other complications is only minimally raised with a 5.7 A1C. So I’m going to try to get it a little lower without meds.

  • 152 Ron // Dec 22, 2010 at 11:11 am

    Really not sure where I heard or read it, just that it sticks in my mind about the Metformin.. I’ve been on it for a week and no sideaffects yet. I don’t really see any down side except weight loss, and I’ll monitor that closely. The Doctor said that my numbers where good, but I just want it a little lower if I can get it..
    Seems like from what I read it can only help.
    I’ll keep you all posted.

    Thanks Ron

  • 153 Ann // Apr 9, 2011 at 9:15 pm

    In February, my fasting glucose level was 109, and my doctor expressed concern. Now, in April, my fasting glucose level is 105, my A1C is 5.8, and my doctor says I’m pre-diabetic and need diabetes counseling. Everything I’ve read points to this not being the case. Is my doctor over-reacting? Should I be concerned about this? I’ve been focused on lowering my cholesterol, which I’ve been successful at…it’s dropped 45 points since February. Just wondering if now I need to focus on glucose? Thanks.

  • 154 David Mendosa // Apr 10, 2011 at 8:41 am

    Some experts, like Dr. Richard K. Bernstein, say that a normal A1C level is 4.5 or less. Do yourself a favor and bring your level down by avoiding starches and grains.

  • 155 Ann // Apr 10, 2011 at 9:40 am

    Any suggestions on what to do then? I’m trying to keep my cholesterol down by cutting back on meat, dairy, etc…..and then if I cut way back on starches and grains and limit fruit, the only thing left is vegetables! Are whole grain carbs better or OK…like whole grain pasta and bread?

  • 156 Ellen // Apr 10, 2011 at 12:49 pm

    Please read Dr. Bernstein, and also Gary Taubes. You should be eating meat, other forms of protein and fat, and lowering your carbs drastically. Meat and fat do no cause high cholesterol. I put my husband on a strict low carb diet (no grains or starches) and his VLDL went from 44 to 11. His trigylcerides dropped from close to 300 to 93. It’s the grains that are bad for you. If you eat more meat and less grains, you won’t be hungry and your numbers (cholesterol and blood sugar, should improve. If you’re just one of those people who have the genes for high cholesterol, you might need to take medication for that. You don’t want to mess around with an A1C of 5.8. Once you destroy your insulin producing cells, you can’t get them back. I wish m doctor had been more aggressive in treating me when I still had a chance to reverse things. Good luck.

  • 157 Ellen // Apr 14, 2011 at 11:06 am

    Would appreciate your advice on something (acknowledging that you’re not a doctor!). I’m a Type 2 treating it with diet only for 3 years. Steady 5.6-5.7 A1C. Recently a lot of stress (I believe) caused my A1C (I also noticed my after meal numbers) to go up. I was also diagnosed with Lobular Carcinoma in situ (not technically breast cancer despite the word carcinoma- but my risk is now greatly increased). So my endocrinologist recommended I go on Metformin ER, 500 mg twice a day with meals (I only eat two large but low-carb meals a day on the diet he put me on). He says there is some indication that Metformin might be helpful in reducing breast cancer risk as well as the fact that it would probably help get my numbers down a little better. So my question is- I’m going on a cruise to the Mediterranean soon and am thinking there may be days when I will be eating three meals a day. Should I take a 3rd pill if I do eat a 3rd meal? The doctor’s assistant said I should and I didn’t want to insult her by arguing, but I’m wondering if it would hurt if I just stick with the 2 pills a day for those two weeks even if I do eat 3 meals. I will try to stick to my low-carb diet- and it’s not like my BG is outrageously high. Is increasing to 3 a day more likely to cause gastric upset? I have been on the pills only 3 days but so far no problems. Thanks.

  • 158 David Mendosa // Apr 14, 2011 at 11:15 am

    Dear Ellen,

    That’s a new one on me. I haven’t heard that three meals call for three tablets of metformin. But it could make sense. You are right, however, that taking more metformin could lead to gastric upset. But the usual way to deal with that is to then just back off.

    David

  • 159 Carol // Apr 14, 2011 at 11:58 am

    Ellen,
    I also have type II diabetes and am taking Metformin. I do take 3 tablets a day. If you take it as prescribed with meals, you should not have stomach upset. I would only take the additional dose if my glucose values go up, not just because you are on a cruise. Get some exercise while on the cruise, eat lots of veggies, don’t go to the midnight buffet or desert spread. I went on a cruise to Alaska and lost 3 lbs, so you can have fun and enjoy it all without over dosing on food. Best Wishes!

  • 160 Ellen // Apr 14, 2011 at 12:08 pm

    Thanks David and Carol.

  • 161 Anne // Apr 17, 2011 at 7:02 am

    I take 3 metformin per day (500mg) and haven’t had any gastric upsets so its worked for me. I always take with a meal. I am working hard to keep me A1C down, last was 6.2 although my numbers which I take religiously at least 4-6 times per day didn’t jive with the lab tests. I did one at home with the Bayer Home test and came up with 5.4. So which is correct? I also at am a loss at what else to do to lower my numbers. My weight is 103 (5′2″) and I exercise a lot including teaching yoga, pilates, hiking, biking and walking after dinner. I can’t afford to loose more weight and I eat low-carb, under 60 carbs per day. So, what else can I do? Any suggestions?

  • 162 Ellen // Apr 17, 2011 at 8:37 am

    I use the home A1C test a lot and it always comes up .3-.5 points lower than the official lab A1C. Also I read that even if your fasting and random finger sticks are nice and low that your after meal numbers weigh more heavily in an A1C test for some reason. So that explains to me why it seemed like for most hours in the day my BG was low- yet my A1C was still a little high. It’s that 2 hours after a meal that you want to keep those numbers as low as possible – and they only way to do that is to eat really low carb. (other than using insulin).

    I’m on my 5th day of Metformin and I am noticing headache, fatigue, some gastric upset although none severe. I’m going to stick with it and hope I adjust to it. It’s just a little annoying because for 3 years on low carb I never had any gastric upset at all and had so much energy so I’m not used to nit feeling well.

  • 163 Ellen // Apr 17, 2011 at 8:40 am

    Ps. I try to keep my carbs to no more than 30 per day. 60 is a little high. Also- I eat no grains and only a little fruit. Dr. Bernstein says that he had a patient who insisted on eating one apple per day and she went from I think a 5.2 to 5.7.

  • 164 David Mendosa // Apr 18, 2011 at 12:06 pm

    Dear Ellen,

    Please don’t assume that your “official” lab results are correct and the A1CNow is off. The A1CNow is certified to be standardized, as I wrote at http://www.mendosa.com/blog/?p=400 , and most labs are not.

    David

  • 165 Ellen // Apr 18, 2011 at 1:12 pm

    Wow. That’s good to know. I will read up on that.

  • 166 Anne // Apr 19, 2011 at 6:12 am

    Ellen, thanks for your input. I have also read Dr. Berstein’s book as well as many others on the topic. I don’t eat grains either, I use almond meal or coconut flour and stick with lots of veggies with my protein for each meal. I eat very little fruit, occasionally 1/4 cup of blueberries or 1/4 of an apple. The issue I have is keeping weight on. I did a very low carb in October and lost 7 pounds (in two weeks) which put me at 94 pounds. So I am trying to balance it all out. Perhaps I will try a bit lower carb
    again and see how it goes. I lead a very active lifestyle at 57. Have a great trip and enjoy yourself!

  • 167 Arun // Apr 28, 2011 at 5:36 am

    I am from India. It is a great relief for me to stumble upon your wonderful diabetes site. I propose to make this my Bible.

    I am 63 and I just got my first A1c done. Bad news…it was 6.8. My doc told me not to worry but to get back to diet and exercises to lower the number to 6.5 to start with. No medication prescribed. Do you really feel I can get it down below 6 to say even 5.5 without medication. If yes, what would be a reasonable time frame? Thanks

  • 168 David Mendosa // Apr 28, 2011 at 11:02 am

    Dear Arun,

    I know that you can get your A1C down to 5.5 or even less without medication, because I can do it (my most recent test was 5.3). But medication, like metformin, Byetta, or Victoza, will help the process go quicker. Of course, the quickest way is to eat very few carbs, particularly by eliminating all starch and fructose. The starch comes from grains and potatoes and the fructose is in sucrose, which we eat as regular table sugar, as well as in high-fructose corn syrup. Low-carb eating works best to bring our A1C level into control.

  • 169 Arun // Apr 29, 2011 at 12:49 am

    David,

    Thanks a ton for your helpful answer. I am already on a very low carb diet. However, a meal in this part of the world is never complete without a bit of cereal, so I have very small portions of whole wheat chappattis or chakki atta chappattis as we call them here. These are flour made of whole wheat. In addition I have small portions of fruit 3-4 times daily; bananas, guavas, mangoes or watermelons. Sugar is totally cut off. I plan my next test after 2 months. Hopefully…..I may see an improvement.

  • 170 Ellen // Apr 29, 2011 at 4:38 am

    The fruits you are eating are some of the highest in sugar. My doctor forbade all melons, bananas and grapes. Also you may be having too many servings of fruit. You should get most of your carbs from non-starchy vegetables. And seriously, you should give up the grains. You should keep your carbs to no more than 30 grams a day if you want to lower your blood sugar with no meds. My A1C was 6.8 when I was diagnosed and I got it to 5.6 in 3 months eating no grains, and very little fruit.

  • 171 Arun // Apr 29, 2011 at 4:51 am

    Thanks Ellen for your response. I will keep your points in view. To start with I am substantially reducing my carb intake, say more than 60-70% reduction. I am off on potatoes totally, and only on greens. As for fruits, I thought ADA recommended 5 very small portions spread over intervals as our body does need carbs. Water melon (as per David Mendoca’s GI chart) though has high GI is very low on Glycemic load. So I presumed small portions would not harm. Thanks for your tip anyway, I am making a beginning so let me see how it goes :-) …Regards

  • 172 Ellen // Apr 29, 2011 at 6:14 am

    I would steer clear of anything the ADA has to say about diet. Really. Two of the best resources about diabetes and low carb (in addition to this site) are Dr. Richard Bernstein. He has 2 books, The Diabetes Solution and The Diabetes Diet that you should read. Also a website and he does monthly telephone conferences. Dr. Bernstein will tell you what he thinks of the ADA. The other resource on low carb-is Gary Taubes. He has a new book, Why We Get Fat” which is very readable and an older book “Good Calories, Bad Calories” which is heavier on the science. I recommend him highly.

  • 173 Satya Samantray // Apr 29, 2011 at 7:27 am

    Arun,
    I am a type 2 Diabetic, and I do have an Indian origin as well. And I am just 35.
    There was a time I could not imagine a meal without rice or chapatti (home made whole wheat tortillas). But hard fact is, we need to come out of this mentality that no meal is complete without this carb loaded grain. Have one (if you must), then spruce up your meal with green leafy vegetables and salads, curries made up of least oil and never lose the opportunity of adding loads of veggies in any item. Having said that, my wife has found a solution to this issue of adding tortillas to meal and be guilt free to some extent. To make the dough, to the whole wheat, she adds equal amout of soy flour, some flax seed powder (meal) and a bunch of spinach. and voila, the carb reduces to almost half and man, it is tough to increase your sugar with this carb, because it is high in fiber and really complex carb. I was obese when diagnosed at 32. I reduced my weight by 60 pounds, and this had an immediate impact on my sugar and hypertension. Doctors stopped my medication and today I control my sugar with diet and physical activity. I am aware diabetes cannot be cured, but can be stayed off your front door. Moment you stray, its ready to barge in, no knocking. I do not punish myself by restricting carbs completely, and yes i have read all the Bernstein books. Its hard for people from other parts of the world with diverse cultures and taste palates to follow it relegiously. Yes, you can make changes to your diet. Every person responds differently, and best way to check your sensitivity is to poke and check your blood regularly.

  • 174 Arun // Apr 29, 2011 at 7:30 am

    Thanks Ellen for your follow-up message. I have to acclimatize gradually to achieve my goal and I am doing so. I belong to that part of the world where nearly 50% of the total food comes from carbs. Eliminating all carbs in one go is difficult but not unachievable. Today I had a small bowl of whole wheat porridge, one very small banana and half a piece of guava for breakfast plus sugarless coffee. My BS two hours later was 113. Lower than the range 130-150 it used to be earlier with my regular high carb fare. Regards :-)

  • 175 Ellen // Apr 29, 2011 at 8:50 am

    Actually I wouldn’t be surprised if the typical American diet isn’t at least 50% carbs. And the breakfast you described is 100% carbs. You are fortunate that your blood sugar was only 113 two hours later. Sounds like you should be able to tolerate what you’re doing. Although some experts would say that 113 two hours later is still high and remember that the Post prandial blood sugars are heavily weighted in the A1C and some think are more likely to contribute to complications. Only time will tell if it works for you. Sounds like you’re committed and we all have to find what works best for us so I’ll leave you alone now! Best of luck.

  • 176 Arun Prabhu // May 3, 2011 at 9:29 pm

    Thanks Satya, for your valuable tip on wheat-soya combi. I propose to try that soon. You do need some carbs, though little, to make you going. If I successfully make it to a1c ~6 by diet alone, thereafter I will attempt lower numbers by eliminating carbs altogether.At age 63 this was my first a1c test. Cant guess how long i was this high(6.8). I hope I am on the right track without medications.
    Ellen, I guess you are right. The PP sugars weigh more heavily on a1c. I will be following all your posts :-)

  • 177 Anna // Jun 16, 2011 at 7:42 pm

    Dear David,
    I was diagnosed with Type 2 Diabetes about a year ago but haven’t really taken the diagnosis too seriously, until recently. My doctor doubled my metformin dose a few weeks ago when my A1c went up from a 6.2 to a 6.7. He hasn’t really explained what this means-I just figured this wasn’t good when he doubled my medication. Yet, he hasn’t given me a blood glucose meter and doesn’t have me checking my blood sugars. Everything I’ve read about diabetes talks about how important this is-yet my doctor doesn’t have me doing this. I asked him once about it and he said he’d let me know when I need to start doing it. I feel like he is giving me double messages and am very confused. Part of me is in denial about the whole diabetes issue and would like to say that since he isn’t taking it seriously than neither do I and I can eat whatever I want but then again my father had diabetes and died at an early age (just ten years older than I am now). I don’t want to die in ten years and maybe I should be taking this more seriously than I am but it’s hard to when my doctor doesn’t have me doing my blood sugars which seems to be the first thing you do in everything I read. What would you do? Is my A1c something to be concerned about? Thank you. Anna

  • 178 David Mendosa // Jun 16, 2011 at 8:06 pm

    Dear Anna,

    Fingerstick tests are important. But the A1C test is even more important. Fingerstick tests will tell you that your level is high at that moment. Generally, you can tell if it is high because it is basically just the starches — anything made from wheat and potatoes being the worst — that drive up the level. So what would I do? Well, what I DID was cut out all grains and potatoes. I follow a very low-carb diet and have brought my A1C level from 14.4 when I first learned that I have diabetes to 5.2 when I got my most recent A1C test a couple of weeks ago.

    David

  • 179 Anne // Jun 17, 2011 at 3:43 am

    David,
    Would you share your low-carb diet with us? How many carbs do you eat per meal and perhaps give us a day in the food life of David Mendosa! If you have it already posted, please direct us. I am trying to lower my A1C and it looks like you have been most successful! Thank you.

  • 180 David Mendosa // Jun 17, 2011 at 8:00 am

    Dear Anne,

    Thanks for asking about what I eat. Here is an update of my diet:

    My breakfast starts either with a bowl of kimchi or with two glasses of Greens First. I wrote about them at http://www.healthcentral.com/diabetes/c/17/67280/drink-veggies . I buy Greens First from Amazon.com.

    I absolutely love this way to start the day! Much better than the two cups of coffee I used to start the day with. I don’t drink any coffee or alcohol now. I stopped drinking both of them to help control my headaches, which are now gone. Instead, I usually drink Assam or Darjeeling tea.

    When I wrote the article about Greens First, I hadn’t experimented much with it. But now I make it with carbonated water that I make from filtered tap water and a Soda Club carbonator. I really enjoy the fizz.

    I usually drink two more big glasses of carbonated water in the morning and two more in the afternoon. Got to stay hydrated!

    Then, a half hour or so after my first breakfast I sometimes eat two egg that I poach. I spice up the eggs with a little hot sauce (my favorite is Tapatío, which doesn’t have any vinegar) , and a little summer savory.

    Lunch is a salad, which I make with olive oil and ume plum vinegar dressing in a ratio of 3:1 (with cloves of garlic and Dijon mustard). I prefer the ume plum vinegar both for taste and for the fact that it has no sucrose or fructose, which I avoid as much as possible. Lots of greens, starting with spinach and including arugula whenever I can get it at a natural foods store. Sometimes other cruciferous greens like watercress.

    BroccoSprouts are essential (see http://www.healthcentral.com/diabetes/c/17/60926/broccosprouts ). I often now eat some broccoli flowers in my salad, even though I wrote on my website that I didn’t (my diet keeps changing!). Usually artichoke hearts, onions, and cucumber too.

    Often a can of VitalChoice.com sardines or mackerel or salmon or albacore tuna — preferably packed in water, not oil. I sometimes add a few capers and powdered lemon to the fish for flavor.

    Sometimes green peppers or red ones for a dash of color (even though the red ones are a bit higher in carbs).

    Dinner is usually fish or grass-fed/grass-finished beef, especially ground beef. When I cook fish, I bake it on a wood cooking plank. Fish is the best for omega-3 fat, and it tastes wonderful with pepper, powdered lemon (see http://www.healthcentral.com/diabetes/c/17/1589/true-lemonade/ ), and capers.

    Sometimes I will have one of my favorite low-carb veggies with (or for) dinner. Like an artichoke or okra.

    My favorite snack is an avocado wrapped in toasted nori, a sea vegetable. Sometimes I will snack instead on an extra glass of Greens First.

    When I use sweetener, it is always SweetLeaf stevia from Wisdom Brands.

    When I am on a hike at lunch time, my usual lunch will be one or two cans of sardines from VitalChoice.com, a handful of almonds, or beef jerky.

    I don’t take any prescription medicine for diabetes or related conditions like blood pressure or lipids. I do closely watch my carb and calorie intake and make sure that I hike or take a walk almost every day.

    Not a lot to eat! No wonder I have been able to lose half my body weight. But I very, very seldom get hungry at all, even when I fast for up to 24 hours (see “Intermittent Fasting” at http://www.healthcentral.com/diabetes/c/17/121291/intermittent ). And all of my food is delicious and healthy (very low-carb and well balanced toward the anti-inflammatory omega-3 and away from the pro-inflammatory omega-6 fat).

    It is delicious to me. Everybody is different, but I hope this gives you some good ideas.

    David

  • 181 Ellen // Jun 17, 2011 at 8:11 am

    Anne- you might want to read Dr. Bernsteins Diabetes Solution and his diet book. He also has a conference call each month around the 23rd. He has a website with all this information. I have been successful in losing weight and keeping my Blood sugar under control on a diet of two meals a day. I eat per day about a pound of meat, one cup of vegetables, one cup of salad and on piece of fruit. I’ve modified it and usually eat less fruit. It’s the grains and starches I avoid. I aim for about 30 grams of carbs a day. Good luck.

  • 182 Arun // Jun 18, 2011 at 1:05 am

    David – I have been going through many of your posts and have noted the high importance you accord to green leafy veggies because of its low carb content and other nutritive properties. Out here is some parts of India, Colocosia leaves also called Taro leaves are considered among the best among green leafy vegetables. You may refer to this link for more details.
    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2675/2

    Arun

  • 183 Arun // Jul 3, 2011 at 9:50 am

    Here I am back with my second a1c test after a lapse of two months. It is now 5.8, down from 6.8 in April last week. I am on no medication.
    The following actions helped me.
    1. Reduced my weight by around 10 kg ( 22lb). My BMI is now 21.5
    2. Daily walk 10, 000 steps with pedometer monitoring.
    3. A piece of cinnamon in the morning
    4. Avoided altogether added sugar in tea/coffee, all bakery products including breads and biscuits. No to potatoes and root vegetables.
    4. Considerably reduced whole grain intake
    5. Sparsely ate small portions of bananas, mangoes and papayas
    6. Consumed mainly green veggies all kinds, fruits like oranges, apples and avocados. Very fresh fish particularly sardines and mackerel. Eggs and lean chicken meat. Low fat yoghurt.
    7. Topped all meals with sugarless lemon juice
    7. An ounce of nuts daily

    I guess I should be able to go lower with a little more hard work.

    Greetings to everyone.

  • 184 saddaf // Jul 3, 2011 at 11:11 pm

    dear david
    it is said that diabetes and heart ailments go together. so a diet based mainly on protiens from eggs and meat may not be good for keeping a healthy heart. i am feeling severe constricting and choking pains in my rib cage and jaws more than occasionally and they do go away after 10-20 minutes. but i am worried. yet to see a doctor about it. i have previously been advised to lower meat content to lower cholestrol.

    regards

  • 185 Ellen // Jul 4, 2011 at 6:16 am

    I’m jumping in here- but please read Gary Taubes’ article (it can be found online)” What if it’s all been a Big Fat Lie?” It will reassure you that it’s not the fat in our diet that is causing obesity and heart disease (or high cholesterol). Gary also has a website. Also read his book “Why We Get Fat.”

    High Triglyceride levels have been shown to be more indicative of heart disease and that is causes by eating too many carbs- not protein. And fat. My husband and I gave up grains and starches and our tryglycerides went from close to 300 to 53 (for me) and 90 for my husband. That also sent his VLDL (the really bad cholesterol) from 44 to 10.

  • 186 Ellen // Jul 4, 2011 at 6:38 am

    PS. Please do see a doctor about your chest pains and good luck.

  • 187 Ray // Aug 4, 2011 at 6:05 pm

    Aug 04, 2011

    Hi,
    Can you tell me:
    How many diabetics around the world have normal hemoglobin A1c (below 6.2%)?
    Is that 1% of diabetics or 2% of diabetics or more?

    Can you research this information and let me know.

    Thanks!
    Ray
    rk2005@shaw.ca
    +++++++++++++++++++++++++++++++

  • 188 David Mendosa // Aug 4, 2011 at 7:46 pm

    Dear Ray,

    Good question. I have looked for years for such data. But I’m convinced that nobody knows. Some years ago I picked up from the ADA that they think the AVERAGE level of people with diabetes in the U.S. is 9.0, but they aren’t even too sure about this. My guess is that the proportion of people with diabetes who have an A1C of less than 6.0, the usual definition nowadays of normal, is much less than 1/10 of 1 percent. I would go further and state that 6.0 is NOT normal but rather than the level that is typical of people who have not YET been diagnosed with diabetes. A truly normal level, i.e. the level that young, healthy, thin people, is probably 5.0 or less.

    David

  • 189 LeAnne // Aug 23, 2011 at 10:16 am

    I just got a call from my doctor, saying that my A1C level is 6.1. She wants me to start taking a drug called Mediforin ??? { spelling } Does this seem a little pre-mature ? I would think that she would want me to do some follow up testing of some kind. I don’t know which way to go. I have not picked up the meds yet, as I am very confused. The only person I can talk to at her office is her nurse, and she is about as informative as a book with no words. Do I get a second opinion ? I must admit that potatoes are my favorite food. I eat them at least 5 times a week. Would diet alone bring these levels down ? I am not obese, though I could stand to lost 15 pounds. I am a 50 year old female with no family history of any ailment. I however am on 40 mg of Zocor, 10 mg of Lisinopril, and prilosec for ulcers. Am I the bad egg in the family basket or what ? Any comments would be appreciated.
    Thanks for you time.

  • 190 David Mendosa // Aug 23, 2011 at 12:41 pm

    Dear LeAnne,

    The drug is metformin. It is generic and therefore quite reasonably priced. It is also extremely effective and safe. More people with diabetes use it than any other drug and it is essentially the only drug used for pre-diabetes. Your A1C is right on the borderline between pre-diabetes and full blown diabetes. Hopefully, you haven’t crossed that border. Metformin hopefully will keep you from getting it. Your doctor is absolutely right and you are fortunate. Now, please do everything to avoid getting diabetes before it’s too late. Cut out those potatoes! Cut out the bread! Cut out the other grains as soon and as much as you can! Yes, diet alone can will bring down your A1C level in the short term; metformin will give you a big boost and losing weight in the longer term will give you another boost. But don’t fool around — take the metformin until your A1C goes way down, like below 5, and diet, diet, diet (and exercise).

    David

  • 191 LeAnne // Aug 24, 2011 at 8:03 am

    Thank you david for your rapid response. I appreciate your input, and I will get the meds filled today. I guess denial is the easiest way to respond to something you don’t want to hear. I spoke with my sister last night about my test results. She is in the medical field. She really made me stop and think. Diabetics can suffer some very devestating long term effects from the disease. Having had no diabetics in my family, I am very ignorant to it’s cause and affects. Your site has opened my eyes to a very real problem. Now the good news. My sister who is a smoker has made a pact with me…….She will quit smoking, if I will knock out the potatoes, the gravy, and all the other food that has brought me to where I am today. Today I begin my new journey. Wish me luck !!!!

  • 192 angel g // Oct 11, 2011 at 7:47 pm

    I stumbled on your website. I am glucose intolerant although my FG and A1C readings are normal. I am in my late 30s and my FG readings went up to mid 80s compared to mid 70s in my early 30s.

    To take action, I went on a low carb diet coupled with intensive exercises and I lost weight which is not my intention. I now weigh 85 pounds on a 1.5 m frame. What should I do to increase my weight without carbs? Doctors asked me to increase my carb intake. I am afraid to eat yet afraid not to eat. Thank you.

  • 193 David Mendosa // Oct 12, 2011 at 6:44 pm

    Dear Angel,

    Eat fats! Use liberal amount of olive oil on your salads and when you cook. Eat plenty of nuts like almonds, walnut, pecans. And eat all the avocados you can afford!

    David

  • 194 Abdul // Nov 1, 2011 at 5:12 am

    Hi David

    Thanks for your effort. today I have seen my doctor today and checked the fasting glucose and found 73 and the A1C 5.8. The Dr said that I am at risk and need to recheck my A1C after 3 months from now. I am on diet and exercising 30min per day. My weight is 59 Kg. Are the results o.k and need to worry. Thanks

  • 195 David Mendosa // Nov 1, 2011 at 8:46 am

    Dear Abdul,

    The one thing you didn’t write is what your BMI — your body mass index — is. If you get it down into the low normal range, like below 22, you will find that you are managing your diabetes or pre-diabetes well.

    David

  • 196 Khushbu Pareek // Nov 15, 2011 at 9:33 pm

    My Daughther age-12 Year
    glucose fasting-251 mg% 20.08.11
    glucose PP-498 mg% 20.08.11
    we noticed this disease on 20.08.11, atpresent use 50-60 unit insulin per day,

    atpresent report
    glucose fasting-100 to 225 mg%
    glucose PP- 200 to 350 mg%
    suger level is fluctuation is very abnormal
    please sugges & guide me

  • 197 Candee // Nov 17, 2011 at 11:29 am

    I am not sure whether I should be worried about this or not. Here are my stats: I am 44. My BMI is 21. My A1C has been around 6.4 to 6.7 for the past four years down from 10.5 when I was diagnosed. I am not on medication. My cholesterol is normal and my BP is normal.

    However, my fasting levels are always high. 150 to 170! My doctor is not concerned because my A1C is below 7.0. Should I be concerned and how can I bring my fasting numbers down? I have tried everything from eating less at dinner and exercising after to eating a small snack before bedtime.

    Any suggestions?

  • 198 David Mendosa // Nov 17, 2011 at 11:43 am

    Your fasting levels are so high because your A1C level is still too high. It is higher than a normal level, which means that you are much more likely to suffer complications down the road. While your A1C is much better that it was when you learned that you had diabetes, you still need to bring it down to a normal level. A normal level is below 6.0, as almost everyone would agree. But you probably need to bring it down to about 5.0 or less. You can do that with medication or with a very low-carb diet.

  • 199 Anne // Nov 17, 2011 at 12:53 pm

    Reading the above comment had me reflect on my own A1C which was recently 5.5 which I thought was good. My BMI is barely 18, I eat low carb but not very low carb and good protein intake and lots of veggies avocado’s, good fats (and sometimes bad ones!). When I go lower carb I loose weight. The last time I went very low carb I lost 7 pounds in two weeks. I know this is not an issue for many people but I try to keep some weight on. I exercise every day and sometimes twice.I take metformin 500 mg x3 per day and 1.5 glimperide which lowered my A1C as the metformin was working that well and my A1C went up to 6.0! Without genetic testing it has been hard for the endocrinologist to determine if I am one of the MODY variations of diabetes. I am inclined to think I am. I was diagnosed in 2008 but I suspect it had been around for a while. I was thinking my not feeling well was due to chronic Lyme disease.
    So, how low do we go for the A1C???

  • 200 David Mendosa // Nov 17, 2011 at 1:27 pm

    Dear Anne,

    You do have one of the best A1C levels of anyone who has diabetes. Most people would say that a level of 6.0 or below is normal. Personally, my goal is to achieve the level that Dr. Bernstein himself has and many of his patients have, about 4.5. But I’m not there yet; my level this week is 5.2.

    David

  • 201 Candace P // Nov 21, 2011 at 1:37 pm

    Hello – I’m concerned about my Metformin use. My dr. has me on 1500 mg/day strictly for weight loss. My blood sugar is fine and I’ve never had any diabetes indications whatsoever. I’m also not really overweight but could stand to lose a few pounds. A couple weeks ago my urine test at my physical had trace ketones and low PH and there were some other things in my blood tests (chloride, CO2) that were bordering on also indicating ketosis.

    Here’s my question- can Metformin use in a nondiabetic alter your body permanently? I’m worried about losing beta cells or something. Thank you so much. ~Candace

  • 202 Chuck Boyer // Nov 22, 2011 at 9:01 am

    I’ve had diabetes now for approx. 20 years, nearly half of that time insulin-dependent. I keep my A1C in the range of 4.2-4.7, most of the time hovering around 4.3. I find the syndrome itself a fascinating study. Always something more to learn about it. Always something new/novel my body presents me with. Loving it. Loving life. Thank you, David, for your thoughtful (and quite accurate) takes on the condition.

  • 203 Sandi // Dec 1, 2011 at 8:56 pm

    I have heard the comment “I am confused” more then several time throughout the remarks. Well I am also confused. I was recently diognosed as having diabetes. My A1C was 6.8. My dr. said that since we are coming into the holidays she would put me on Metformin. She said I could take it daily or just when i would be tempted to eat “holiday foods”. She said she would recheck my blood in 3 months. I have started a low carb diet and exersice program but feel worse on the medication, dry mouth, tired and loss of appetite. Should I see a specialist since I am concerned about my meds. Thanks, Sandi

  • 204 David Mendosa // Dec 1, 2011 at 9:01 pm

    Dear Sandi,

    I think that you would indeed be wise to see a specialist. Your doctor’s suggestion that you take metformin just when you are tempted to eat too much is strange. And you do need to reduce your A1C to a normal level to avoid complications later.

    David

  • 205 Cathie // Dec 2, 2011 at 2:03 am

    I’m 56 years old, been obese all my life (top 325). I’ve had 2 strokes, a heart attack, and suffer from neuropathy as well as low thyroid and high blood pressure. I’m ashamed to say that I totally ignored my diabetes for 30 years and this is where it got me. I am also partially blind and have been treated for kidney problems. I am the poster child for what NOT to do when you have diabetes (type 2). Recently I started making changes and more of an effort. My 7 day avg is 139, my 14 day average is 133 and so is my 30 day average. My A1c is being tested when I see my doctor in a few days. Due to my physical limitations/disabilities Idon’t get any exercise. BTW my averages were in the 200s for a long time. I take 1000mg of metformin twice a day and 56 units of Novolin 70/30 twice a day. I guess my question is….is it too late for me to see any improvement in the complications I’ve brought on myself?

  • 206 David Mendosa // Dec 2, 2011 at 8:50 am

    Dear Cathie,

    It is never too late to manage our diabetes! In fact, we can actually reverse many complications. It requires bringing our blood glucose level down to normal — no more, no less.

    David

  • 207 Cathie // Dec 4, 2011 at 11:05 pm

    I’m working on it. Thank you for your brief but timely reply.

  • 208 Bill // Dec 30, 2011 at 10:23 am

    I am reading alot about very low carb diets as a strategy for controlling diabetes. While this is a valuable approach, I recently tried a different strategy – a low fat, good fat only diet heavy on whole grains, legumes, vegetables and soy based products. Yes I do limit carb intake to about 50 grams per meal, but I am now convinced that the cellular accumulation of fat in the body increases the insulin resistance…. and that decreasing these “mostly animal” based fats decreases cellular fat and thereby increases the ease of insulin (and sugar) penetration into the cell – which is fundamental to energy production.

    In September my A1c was 9.6; three months later it is 5.7 – this strategy has also helped me lose about 13 pounds in this period. My triglycerides, my LDL cholestorol are in the normal ranges for the first time in years…. I am off glipizide and only take metformin now.

    So my bottom line is to say that I think type 2 diabetics should look not only at “treating” the disease with a low carb diet but also try to “control” (or dare I say reverse) the disease with a low fat approach.

  • 209 Niko // Jan 16, 2012 at 3:05 pm

    David:

    First, congratulations on your HbA1C reduction. Keep up the good work and continue to be an inspiration to the rest of us!

    I just wanted to drop you a quick note thanking you for your looking into a realistic normal HbA1C. You’ve confirmed that my goal of <6 is realistic and possible.

  • 210 Ethel Undahl // Feb 8, 2012 at 5:09 am

    My aic was 5.7 about 6 or 7 months ago….now a doctor I went to found out I had gastic bypass said Your aic was normal and you may not be diabetic anymore….seriously?…not that I want to be but I am still overweight and that was from an old test….should I get a second opinion?

  • 211 Rexene El Arabi // Feb 11, 2012 at 8:02 pm

    My 13 year old type 1 diabetic is on the pump. He sees an endo dr. every 3 mths. The last couple appts have been very upsetting. Although his blood sugars are great is A1C is 12.2! His meter is linked to his pump and all data is downloaded. We are at a loss. How can your blood sugar levels be good and have a horrible A1C?

  • 212 David Mendosa // Feb 11, 2012 at 11:47 pm

    Dear Rexene,

    Yes, that sounds unusual. But not impossible. When you write that his blood sugars are great, what are they actually two hours after the start of his big meals? Particularly when he eats carbohydrates? That is what would make the A1C level so awfully high, and I would expect that a high meter level two hours after a big meal would also be high.

    David

  • 213 Rexene El Arabi // Feb 12, 2012 at 12:07 am

    Zak tests 6-10 times a day. Usually, his bg is around 150-175 2 hrs after a big meal. He boluses 15min prior to the meal. Are there any other health probs that would effect the A1C?

  • 214 Ellen // Feb 12, 2012 at 6:30 am

    I think those after meal numbers are rather high if they are two hours after a meal. You should be shooting for under 120 two hours after a meal. Even if his blood sugars are low most of the day, I have read that the numbers in the couple hours after a meal weigh more heavily in the A1C for some reason. Have you read Dr. Richard Bernstein’s book- The Diabetes Solution. It is very helpful.

  • 215 David Mendosa // Feb 12, 2012 at 8:36 am

    Dear Rexene,

    I agree with all of Ellen’s comments. Still an A1C level of 12.2 correlates to an AVERAGE fingerstick level of about 360 (see for example http://www.rajeun.net/HbA1c_glucose.html ). So something else is at work here. If I were in your shoes, I would go to your local pharmacy and buy an A1CNow Self Check kit. It’s two tests, one of which you save for a couple of months to test later and the other one test now. The kit costs $30. I would also get an inexpensive blood glucose meter and some test strips. Wal-Mart sells one called the ReliOn, which is probably accurate enough and it is the least expensive at about $9 for the meter and about $9 for a few test strips.

    Please keep me in the loop as you work this out.

    Best regards,

    David

  • 216 Rexene El Arabi // Feb 12, 2012 at 10:40 am

    We have tried a back up meter and had my son test using both for a couple of days and the numbers were still in range. There is something else very unusual going on. I will definitely pick up a A1C self check. But are there any other causes? Thank you for your help.

    Frustrated Mom

  • 217 Ellen // Feb 12, 2012 at 12:56 pm

    Dr. Bernstein says that there is often an underlying infection somewhere (often a tooth) that causes high blood sugars. I would also look at how many grams of carbs he eats. He should be eating no more than 30 grams a day and adjusting his insulin accordingly.

  • 218 David Mendosa // Feb 12, 2012 at 3:25 pm

    Dear Rexene,

    I agree with Ellen that Zak’s numbers are too high either with the A1C test or with his fingerstick tests and that a very low carb diet will help, and perhaps better insulin management (and Dr. Bernstein’s book will help that). But I simply can’t think of any other reason why the A1C and the fingerstick tests are so far apart.

    David

  • 219 Richard // Feb 15, 2012 at 4:04 pm

    Hi David,

    I’ve recently been diagnosed with type 2. My GTT gave figures of 146 fasting and 200 after two hours. :(

    I’ve been cutting back on the carbs and testing my BG at home. I’ve managed to get my glucose in the morning down from 150 for my first test to around 99 over the past few weeks. I had my first HBA1C test and it came back as 6.2%.

    I’m terrified of complications. I wondered, what should be target A1C be and do you have any data on the effect this will have on the chances of complications? Am I going to get complications no matter what or have I got a good chance to avoid the worst?

  • 220 David Mendosa // Feb 15, 2012 at 8:51 pm

    Dear Richard,

    Very good questions. I think that it is clear from the article on which you are commenting, at http://www.mendosa.com/blog/?p=366 , that your target A1C should be 4.5 to 5.0. This is the normal A1C level. At this level any complications that you get for the rest of your life would be a coincidence. I am saying that we have no guarantees in life. But when you have a level as low as someone who doesn’t have diabetes, any problems that you have would not be the result of diabetes. Let me be even more clear: Roughly half of neuropathy is caused by uncontrolled diabetes. That means you could still get neuropathy even if you never had diabetes. Some other things, known and unknown, can cause it. By the way this reminds me of another article that I wrote. Please read, “Diabetes Causes Nothing” at http://www.mendosa.com/blog/?p=1026

    David

  • 221 Richard // Feb 16, 2012 at 2:24 am

    Thanks David, I’ll give that a read. At the moment I am not on medication. I understand medication can lower the BG and HBA1C but I’m also concerned about side effects. My doctor says I don’t need medication yet and should try to get control with diet and exercise. Can you provide any advice?

  • 222 David Mendosa // Feb 16, 2012 at 7:04 am

    Dear Richard,

    You doctor is exactly right.

    David

  • 223 Richard // Feb 16, 2012 at 1:21 pm

    Thanks David :)

  • 224 ROBSCARED // Feb 22, 2012 at 1:45 pm

    Hi David,

    I was recently diagnosed with Diabetes (December). My A1C was 10.4 when diagnosed. I have another blood test scheduled in a week. Hopefully I will see that number decrease, since I have been following a low-carb diet (even during the holidays) and I don’t think I’ve cheated. My glucose levels are between 85-110 (fasting) and between 90-130 (2 hours after a meal), with a few 140s and only one 180 since I was diagnosed roughly 2 months ago. I have already lost 16 pounds and I know I have to exercise more, but I am tired all the time. I respect everyone’s opinion (or try to) but to me diabetes is frustrating, tiring, hard, depressing. I already have some vision issues. I went from 20/20 in November to +3.00 in December, back to 20/20 in January and now to -1.00. I have purchased at least 6 pairs of glasses. I also have some neuropathy-like symptoms. My question is, if I am doing everything I can, and I am already having eyesight and other issues, should I assume that the road ahead will be rocky and that I am going to end up blind, or my feet amputated, or with renal failure? I have read so much about cases in which people take good care of themselves and they still develop all these complications. I hope that my questions are not dumb. I am just so concerned and scared, and hence, stressed out (I can barely sleep). For instance, the other day my sugar level went up to 167 fasting, and 140 at lunch time without eating ANYTHING. I didn’t do anything different, and yet, I could not control my sugar levels that day. So, is it true that no matter what I do, I will have to face those awful complications? The other thing is, the endo who diagnosed me said that I was going to be okay with just diet and exercise (with an initial A1C of 10.4!!!). After reading more about the disease (or medical condition), I went to seek a second opinion, and this new endocrinologist suggested that I start taking metformin, once a day 500 mg. So, doctors don’t seem to agree on things like medication, and that confuses me even more. I have an appointment with a third endo in March… The first doctor failed to play his educator role. He just said “Yup, you are diabetic”… period! The second one explained to me that this condition is indeed progressive and no matter what I do, in 5-10-15 years, I will need insulin… I am so confused and scared because again, my question is no matter what I do, I will end up using insulin and with major complications? Sorry for the long message, but my other issue is, I am the only one who is diabetic in my family and they don’t seem to understand how concerned I am. They just say: ” calm down.. relax…” The same applies to my friends… So I am just venting, and talking to someone who might understand how frustrated and scared I am. The other issue (yes, I have a lot of issues… LOL… just a little bit of humor) is that I can’t stop thinking that I did this to myself for not taking care of myself for so long… So I feel so guilty, angry… Sorry again for the long email.

  • 225 ROBSCARED // Feb 22, 2012 at 1:49 pm

    BTW, thank you so much for your website and for this venue to ask you questions, voice our concerns. Very helpful!

  • 226 David Mendosa // Feb 22, 2012 at 6:52 pm

    Dear Rob,

    I am glad to help you as much as I can. And I do hope that I can help you get over being scared and angry at yourself. We’ve all been there. When I learned I had diabetes my A1C was 14.4, even quite a bit higher than yours. That was 19 years ago and I haven’t suffered any complications.

    Complications are not inevitable. Bill Polonsky, one of my favorite diabetes professionals says it best, “Diabetes causes nothing.” Please read my article on this at http://www.mendosa.com/blog/?p=1026

    My LEAST FAVORITE diabetes professionals are those who says that diabetes is a progressive disease. I know that they usually just say this to scare us into managing our diabetes. But as you and I both know being scared doesn’t lead anyone to positive action. Please read my article on this subject at http://www.mendosa.com/blog/?p=211

    Doctors do not agree on the best medicine for diabetes — or for that matter any other disease. Medicine is still part art and part science. I prefer to manage diabetes without drugs where possible. But first we have to get our blood glucose level down to normal. That can take a little while, even on a very low-carb diet. During that time taking metformin makes a lot of sense. Metformin is probably the safest drug for diabetes and is certainly the least expensive. When you get your A1C level below 6.0, I am sure that your doctor would be delighted to take you off metformin.

    You write that you are tired all the time. This reminds me of another article that I wrote, which I would like you to read. It’s at http://www.mendosa.com/blog/?p=314

    When you go on a very low-carb diet, which is the best treatment for diabetes — and I definitely mean less than 50 grams of carbohydrates each day –your body has to adjust from burning carbohydrates for energy to burning fat for energy. That takes a week or two. But if you also eat a low-fat diet, you will not get energy food from any source. You have to get the good fats, particularly monounsaturated fats (olive oil, olives, avocados, tree nuts, meaning no peanuts as well as no cashews), omega 3 fats, and some saturated fats, particularly from coconut oil.

    Finally, I know just how you feel that you did this to yourself. Of course. But when we indulge in the blame game, we can also blame our doctors, the whole medical establishment, and in fact our whole culture. We are part of that culture and, believe me, it is not easy to go against that grain. But we have to do that to regain our health. We can indeed regain it. Just get down to a normal A1C.

  • 227 ROBSCARED // Feb 22, 2012 at 7:39 pm

    Thank you so much for your response, David, and for your words of encouragement. I did read the articles and they are really good. Again, I belive that all this is a process and most people only refer to the “food” part of it. There are other elements involved as well, including the emotional factor, even a social element. For instance, I’ve heard people saying that diabetes is a disease of fat people and (believe me) I’ve heard one or two saying things like “ewww”…. Oh well, I have no choice now but to move forward. Again, my major concern is that I’ve had diabetis for only two-three months, and I am already having vision problems and neoropathy-like symptoms. We’ll see how everything develops from now on. Hopefully, I will start feeling better, once everything sinks in. I cannot thank you enough.

  • 228 David Mendosa // Feb 22, 2012 at 8:17 pm

    Dear Rob,

    I very much agree that food is only one part of the solution. Exercise is of course another. The third leg of diabetes management is stress reduction. That is one reason why I make sure to get out in nature almost every day and to meditate daily. I agree too that the “social element” is important. For example, that’s one reason why I stopped seeing a girlfriend who seemed to have everything go wrong with herself and her friends. I didn’t want to be sucked into that vortex. To me the “social element” is a big part of stress reduction. And stress, of course, in related to inflammation, which in turn in connected with diabetes.

    David

  • 229 ROBSCARED // Feb 22, 2012 at 9:06 pm

    Thanks again, David. I am considering a few options (yoga, meditation, a therapist, more exercise) to reduce my level of stress. Regards.
    Rob

  • 230 Richard // Feb 23, 2012 at 2:03 pm

    @ROBSCARED

    David will be able to comment more (I’m new to diabetes too). However, I’ve read many times that having high blood glucose can affect your site *temporarily*. I believe that I’ve experienced it too, where one eye becomes slightly blurred when my BG was high. Since diagnosis and taking control this has improved for me. It isn’t necesarily your retinas at fault. You should also understand that though you’ve been diagnosed for just a few months that you may have had diabeted for longer.

    I’ve read elsewhere that the neuropathy problems, if they are that, can be improved once you have your BG under control.

    It’s hard for me to say, “Don’t despair”, as I seem to despair every few days but I’m sure it gets better over time.

    @David

    You mention not eating peanuts. Is there a specific reason? I love peanuts and they don’t seem to affect my BG. I like them as a source of calories – I’m type 2, vegetarian and struggling not to lose weight too quickly.

  • 231 David Mendosa // Feb 23, 2012 at 2:28 pm

    Dear Richard,

    You make some excellent points about it being common for our sight to be temporarily affected at first. Neuropathy can take considerably more time to reverse, and this is something that I am glad that you reminded me of. Dr. Richard K. Bernstein writes about how he and his patients reverse neuropathy in his book, “Dr. Bernstein’s Diabetes Solution.”

    Your question about peanuts is important. I have always recommended nuts to people who need to gain weight. But I only recommend true nuts, the tree nuts. Peanuts are not nuts at all, they are legumes.

    The main problem that I see with peanuts is that they have far too much omega-6 fatty acids and very little of the good fats, the monounsaturated and the omega-3 fats.

    It happens that last night I was just reviewing Dr. Ron Rosedale’s great “Rosedale Diet” book as I prepared to interview him later today. He has two more reasons to avoid peanuts in addition to the one above: “they are high allergenic” and “they are prone to develop a carcinogenic mold called aflatoxin.” So stay away from all peanuts and peanut butter. Almonds, walnuts, pecans, and macadamia nuts are great.

    David

  • 232 Richard // Feb 24, 2012 at 6:56 am

    Hi David,

    luckily I’m not allergic to peanuts yet, though I am to many other things.

    I had read that the aflotoxin scare was not as big a problem as it was made out to be. Specifically, bagged peanuts are checked for this toxin and I believe it takes quite a bit of exposure to do any damage. The levels (at least in the UK) are thought to be far below that which could be damaging.

    It’s worth noting that aflotoxin appears in lots of foods, particularly grains and in the milk of dairy animals that eat those foods. It can be damaging to the liver for dogs but humans, apparently, have a much greater tolerance.

    That said, I wouldn’t recommend living on peanuts but a handful here and there shouldn’t hurt. It seems that most of our foods have some downside :)

  • 233 sitaram // Mar 7, 2012 at 12:12 pm

    David,

    I have been diabetic for 2 yrs now..My latest A1c is 6.4 and has been so in the last 2 yrs. I have a very controlled diet and I am very thin. I am vegetarian and excercise 4-5 times/week. I am on metaformin. I donot know what else to do, I want to bring it down below 6.0. what else can I do? Any recommendations…..

  • 234 David Mendosa // Mar 7, 2012 at 2:06 pm

    Dear Sitaram,

    I applaud your decision to bring your A1C level below 6.0 (and hopefully down to around 5.0). Nothing is more important for your health. The key is to reduce two types of carbohydrates that you eat. First, cut out the sugar. Do that first because it is relatively easy with the excellent sugar substitutes, particularly stevia, that we have now. Sugar comes in many forms, but the types that you have to eliminate are mainly sucrose and high-fructose corn syrup. Second, cut out the starches. These include wheat and anything made from it like bread, bagels, pasta, pizza, etc. Other grains like corn and rice are starchy and will also raise your blood glucose level a lot. Potatoes aren’t grains but they are high in starch and will actually raise your blood glucose level more than anything.

    I know that this is difficult — at first (believe me, it does get to be second nature). But it is especially difficult for people who follow a vegetarian diet. You do not need to eat a lot of protein, and in fact eating a lot of protein can actually raise your blood glucose level. But you do need to get your energy from fats. Fatty foods like avocados, olives and olive oil, nuts like almonds, pecans, walnuts, and macadamia nuts are high in fat and will provide the energy you need. For most people I would caution about eating too much of these fatty foods because they would gain weight. But from your message it sounds like you need more fats to put on a few pounds.

    Namaste,

    David

  • 235 Dena // Mar 14, 2012 at 7:22 pm

    Hello David first I want to say I thank you for this site. I was diagnosed with Type 2 Diabetes on Dec 29,2011. Of course I was very skepticle of the diagnosis and in shock because I have been keeping up with testing. Now I’m just scared. I was ill when I was dianosised I had been on 3 rounds of prednisone which has alway raised by blood glucose. No one in my family has diabetes but I currently have a lot of reasons I am diabetic I am stressed due to the death of my bestfriend and mother among other things emotional, and I am very overweight and unhealthy I was 5ft 7 and 333. I have a A1c reading of 6.7 and I have began losing weight walking 3 times a week. I have lost 48 pounds since diagnosis if I continue with my weight loss will my diabetes be more under control or will it disappear all together.

  • 236 Robscared // Mar 16, 2012 at 3:51 pm

    Dear David,

    I wrote you a few weeks ago and told you that I was diagnosed with diabetes in December 2011 with an A1C of 10.4 Since then, I’ve been n a low-carb diet (not as little as 42 gr per day, but some 60 gr and trying to reduce them even more). I do have sweet tooth and I still get frustrated, but my sacrifice paid off. I got the results last week and my AC1 is 5.4 Both the doctor and the diabetes educator said that it is amazing I could achieve this in jus three months, and to be honest, with not much exercise because my testosterone level is currently abnormaly low and I am tired all the time. My plan is to continue with my diet, and increase physical activity. I do have a few questions for you. If I continue having an A1C in the low 5s, do I prevent consequences or I will definitely develop them? My second question is that my doctor doesn’t want me to take metforming anymore (500 mg x 1 a day), but I am so scared that if I stop taking it my A1C or sugar levels will go up again. What do you think (and I know you are not a doctor, but you have far more experience than some of them). Finally, my doctor asked me not to test my sugar level as often. He said that probably three times a week. I currently test it 4 times a day. What do you think? Thank you in advance, and I cannot thank you enough for this site.

  • 237 David Mendosa // Mar 16, 2012 at 4:08 pm

    Dear Rob,

    If you keep your A1C level below 6.0, you will probably avoid all the complications that come with uncontrolled diabetes. We have no guarantees, but the odds are strongly in our favor.

    If you are tired all the time, please consider the strategy in my recent post at:
    http://www.healthcentral.com/diabetes/c/17/150821/trouble-saturated

    Your doctor’s advice to stop taking metformin is probably right no. The 500 mg that you are taking is probably not doing much for you anyway. What is making the difference is your diet!

    You can indeed test less often now that you know what different foods do to your blood glucose levels. The times to test are when your levels may be too high, mainly after big meals, particularly ones loaded with carbohydrates. If your level is too high — you decide what “too high” means, but probably about above 140 mg/dl two hours after the first bite of your meal then bring it right down the only way you can without drugs. That way is exercise.

    Best regards,

    David

  • 238 Richard // Mar 17, 2012 at 5:14 am

    Rob, I’ve recently been diagnosed and used low carb, high fat to aim for a low A1C in a similar manner. I too felt tired at first but after a few weeks of perservering I have found that that’s gone away. Furthermore, I’m sleeping better and have much more energy during the day now.

    Who knew that being diagnosed with diabetes could mean I actually feel healthier!?!

  • 239 Chuck // Mar 17, 2012 at 6:54 am

    Type 2 diabetic now for approx. 23 years, I’m happy to report my bloodwork at the beginning of this month came in with an A1c of 4.4. I think I’ve got the hang of it now. And can remain consistently at that level. Hypoglycemia’s not been a problem. The same test included an (educated) estimation of my blood sugars 24/7, week in and week out, etc., to be at 80. This morning’s number was 73. Feelin’ good. Being diagnosed with diabetes has been one of the best things to have ever happened to me. A wonderful wakeup call. And so timely.

  • 240 alice // Mar 17, 2012 at 7:02 am

    I was told by my dr, that new changes are being made. that the normal is going to 7.0 cause many people feel much better . It was said that people who’s a1c was low in 5.0 did not feel well and were feeling faint. but may I say that not every one is the same. only that individual can tell a Dr how there body feels.
    Thank you for all your help,with helping everyone with this problem without charging a cent.
    God Bless you David!

  • 241 David Mendosa // Mar 17, 2012 at 8:01 am

    Dear Chuck,

    Congratulations! Your A1C level is PERFECT! So, of course you are well and better than ever.

    Best regards,

    David

  • 242 Robscared // Mar 17, 2012 at 11:53 am

    Thank you so much for your response David and for this site.

  • 243 Allan // Mar 26, 2012 at 8:37 pm

    Hi,
    just got my lab results and they are—-
    glucose fasting (after 14 hrs) 147mg/dl
    Hba1c – 8.8% average glucose 205 mg/dl.
    i have yet to see a doctor. But i want to know if these results can be correct.
    Last 3 months have very heavy work schedules like wake up at 11 and go to work and then come home by 7, have a heavy meal and then again work till 3 or 4 in the morning. This is whats going on from last 3 months. Also late in the night if iam hungry would have a slice or two of pizza and 4-5 cups of coffee/tea with milk and sugar to keep awake.
    The day before i went for the tests had a very heavy dinnerat 8pm and then nothign after that and worked till 3am slept and went for the test at 10am . Could this be issue . Please advice.
    My father and his mother (grandmother)
    both were diabetic. iam 38 years old.
    A year back i had done my tests but they were in the neagtive.

  • 244 David Mendosa // Mar 26, 2012 at 11:06 pm

    Those tests reflect your blood glucose levels over a period of months. So, I am sorry to say, but your recent diet and workload aren’t the reason. Please make an appointment with your doctor now.

  • 245 Joe // Apr 7, 2012 at 11:35 am

    I don’t understand something. If Dr Bernstein is saying that normal A1Cs are 4.2 to 4.6, which is against the statistical normal of 4.7 to 5.7, who is telling the truth? Could Bernstein be exaggerating to sell more books? Pretty much all the doctors I’ve talked to say that 7% is the goal because the difference in complication risk is not that different at that level as compared to non-diabetics. It’s once you get over 7% that people start seeing major problems. On top of that, until recently, most diabetics could not maintain A1Cs 7% and below. I believe the most recent data has found that 50% of T2s maintain A1Cs of 7% and below. There has also been a consequent reduction in the incidence of complications.

  • 246 Joe // Apr 7, 2012 at 11:58 am

    Also, in one of your posts, you think that the average A1C of a normal, young person is 5% or better. Do we really know this? They don’t do A1C tests in normal people during physicals, and the data you found was that in normal, non-obese individuals, the A1C ranges from 4.7-5.7%, with a skew towards the higher end. That would indicate that the average normal A1C is 5.3-5.4.

    Also, I find it odd that Bernstein recommends levels less than 4.5. Isn’t this rare, and only found in anemic individuals or alcoholics? There was a good book I read called “Cheating Destiny: Living with Diabetes” by James Hirsch. He has a chapter on Dr Bernstein which isn’t totally flattering.

  • 247 Ellen // Apr 7, 2012 at 4:39 pm

    I’d like to jump in here if I may. I think that a lot of the establishment doctors and dietitians are critical of anyone who goes against their canon- like Dr. Bernstein. Having said that , I do think his goal of an A1C in the 4s is on the low side. I’ve done home A1Cs on my husband and sons (non-diabetics) and they have been in the low to mid 5s. However, my endocrinologist who is a low carb advocate and I think very good, wants me to have an A1C of no more than 5.7. He says complications start after that. So again, Dr. Bernstein I think is right when he says that a goal of 6 or even 7 is dangerous. When you say 50% of type twos have higher A1Cs- I bet they also have complications. But what you’re saying does bear a lot of consideration. I’ve given up on reaching an A1C of under 5, without taking drugs or insulin.

  • 248 Ellen // Apr 7, 2012 at 4:44 pm

    Oh and one more thing, having read Dr. Bernsteins books and listened to his seminars each month, I think he is genuinely concerned for people with diabetes and has really devoted his life to trying to help us. So I don’t think his motivation is greed. Would he like to sell his books- sure. But all our doctors charge us for their advice. Nothing is free.

  • 249 Lise // Jun 19, 2012 at 10:30 pm

    Hello. I’ve been reading with interest, but I am confused by my A1C results.

    For the past five years, my blood sugar level has been around 90-117. That’s 12 hour fasting. The doctor was never concerned.

    My father, his mother, my cousins and maternal Gma, were/are diabetics.

    I became concerned becUse I had read that over 100 was pre diabetic. The doctor disagreed. Two years ago I asked for him to order the A1C and it came back at 6.2. He said it was a bit higher than he expected but nothing to worry about. Checked it six months later and same results. Early this year we checked again and it was 6.2.

    I am 5′ 5″, and the heaviest I ever weighed was 136-138.

    I always exercise. Either at the gym or walk 3 miles almost every day. That’s been part of my life for a long time now. I am 56.

    Recently, I was diagnosed with SIBO. Was wondering why I can’t get rid of this bacterial overgrowth in my intestines, and whether it has something to do with pre diabetes?

    Since early January, SIBO has plagued me, and I found out very low carb was one way to deal with it. I am now down to 115 lbs, A1C is 5.9 and blood sugar level fasting was 84.

    Should I be concerned? I eat lots of nuts, veggies and meat, chicken, fish and shrimp. I also eat PB
    And drink unsweetened almond milk.

    Thanks for any guidance.

  • 250 David Mendosa // Jun 21, 2012 at 8:45 am

    Dear Lise,

    The A1C is now being used more and more to diagnose diabetes. But a level of around 6-6.5 is the gray area where one of the definitive tests HAVE to be used. You need to ask for it.

    Actually, the main reason why you need to know if you have diabetes or not is so your health insurance can reimburse you for the diabetes medicine you will need and for the cost of blood glucose testing and perhaps training. What you need to do is the same in any case. You need to reduce your blood sugar level down to 5.0 or 5.4 as soon as you can so you can avoid complications later. Your exercise is great; keep it up. But you have to cut way back on starches and sugars, those carbohydrates that people with diabetes and pre-diabetes cannot handle as well as other people. Starch is the worst, particularly all the grains and anything made from grains (cereal, bread, pasta, pizza, etc.) as well as root vegetables, particularly potatoes.

    Best regards,

    David

  • 251 Richard // Jun 21, 2012 at 10:55 am

    That’s good advice. I’m T2DM and cut out starch almost entirely. I eat no potatoes, rice or pasta and have maybe one slice of bread every couple of weeks (fried in a fry-up as a treat). I’m also vegetarian so I eat a lot of carbs in fresh vegetables but they are high in fibre too. I’m not on any medication and my HBA1C is now 4.8%. Morning readings are between 90 and 100 with the very occasional 105 and two-hours post prandial I always aim to stay below 120.

    Nothing’s guaranteed but the lower the numbers the better I think.

  • 252 Ellen // Jun 21, 2012 at 11:52 am

    Richard- I am intrigued by your diet. I would think it impossible for a type two to maintain an A1C of under 5 with a vegetarian diet. You are talking about eating a lot of carbs or being hungry. I have been on a diet of about 1 pound of meat a day with about one cup of non starchy vegetables and a little fruit for 4 years- kept the weight off and my A1C has been about 5.7 steadily, although a few times 5.9. I’m on Metformin now but would like to get off if I could. I avoid all grains so no wheat, rice, oats, barley, corn, and of course sugar.

    Would you mind sharing a typical day’s meals with us? I’d like to discuss with my doctor to see if I could try it. Getting a little sick of all this meat. Don’t know if it’s because of the length of time or if the Metformin is a little to blame for ruining my appetite.

  • 253 Richard // Jun 21, 2012 at 1:31 pm

    No problem. I’ve been vegetarian for 25 years+ now so I had to find a way of fitting that in with my T2DM.

    This morning wasn’t particularly typical. I started the day with a whey protein shake. I’d normally have some nuts, usually almonds, or a small portion of strawberries.

    Lunch today was a cheese omelette with salad and a bowl (50g) of flavoured but not salted peanuts.

    Dinner was a pasta dish without the pasta! Green beans instead of pasta, with a tomato, onion and garlic sauce and Quorn “meatballs”, which don’t contain meat of course. For dessert I had a small chocolate eclaire (party size, 2.9g carbohydrate).

    Exercise today was 30 minutes on the treadmill brisk walking (about 1.75 miles) and 45 minutes weight-training. This was three sets each of six arm and upper body exercises.

    I’ve followed this plan (except for weight training) since being diagnosed in January. I lost a lot of weight at first, going from 214 pounds starting weight to 157 pounds now, which is about right for my 5′9″ height. I was worried I wouldn’t be able to keep enough weight on but after three months my weight stabilised completely. I now weight myself once a week and it’s always between 156 and 158 pounds. I’ve also got far more energy, presumably because there’s less of me to carry around and I’m no longer living of carbs.

    I do occasionally take a multivitamin to make sure I get my B12, which I used to get from fortified cereals, which are now off the menu. Mostly though, the vegetables carry all of the required vitamins in a fat-soluble form. This just means that I need to add oils to salads and butter to cooked vegetables.

    I’ve never gone hungry. In fact, I’ve recently started fasting for one day per week, which should improve insulin sensitivity, and still don’t really get hungry. A lot of my problem in the past was feeling hungry all of the time and eating crisps and bread to stave off the hunger. Once the carbs went I had a few days of being grumpy before my energy levels rocketed; my wife several times worried that I was “hyper”!

    On another note, a friend of mine who was diagnosed at the same time as me with similar BG numbers followed an interesting plan. He did not eat lunch for four or five months, having protein shakes for breakfast and a normal dinner (low carb and with meat). He also did HIIT exercise three times weekly on a cross-trainer. This is 20 seconds of all-out, vomit-inducing levels of exercise, followed by a recovery period of 40 seconds or so, repeated three times. He repeated this three times a week. It was in response to some research done in the UK and shown on a BBC TV programme.

    After the five months, he went back to the doctor and had a repeat glucose-tolerance test. He hoped to have dropped out of the T2DM bracket and into impaired glucose tolerance. However, his actual results showed a 2-hour after 75g glucose tolerance test of below 130. He’s now officially no longer diabetic.

    This is my goal now. :)

  • 254 Ellen // Jun 21, 2012 at 4:55 pm

    Thanks for the information. I’m just not sure if I could eat that many grams of carbs per day and keep my blood sugar low enough. Like your friend? My doctor put me in two meals a day of 8 oz. of meat, a cup of vegetables and 1/2 cup fruit. I was never hungry. I just wonder after four years of that if I could do better. I might try the fasting since there are times when I couldn’t care less about food and I don’t need to worry about lows.

  • 255 Richard // Jun 22, 2012 at 2:07 am

    I’m not sure that fasting helps immediately with BG but have read about it improving insulin response over a period of time. I’m still experimenting with my body so I may or may not stick with it, depeding upon the results over, say, 3 months.

  • 256 Lise // Jun 22, 2012 at 7:53 am

    I jus spoke to my family doctor and he is adamant that I do nothing about the A1C results of the past two years coming back at 6.2 and is saying now that since it dropped to 5.9 I have nothing to worry
    About! I am insisting on seeing an endocronologist for testing. He wasn’t too happy. Said that he sees people with 8.8 and up and that when he worries.

    I would prefer to stop pre diabetes instead of finding out I am diabetic! There is a family history…sheesh.

    Maybe diabetes is rampant in this country because of these doctors who wait until you have
    The disease, to then say “you’re diabetic!”

  • 257 Ellen // Jun 22, 2012 at 8:13 am

    I agree. My endocrinologist has a chart that shows the results of studies indicating that diabetic complications start at an A1C of 5.7. For your doctor to say that he doesn’t worry until 8.8 is ridiculous and maybe malpractice.

  • 258 Richard // Jun 22, 2012 at 12:40 pm

    Hehe, in the UK it seems to be commonplace to tell patients to aim for an A1C of 7.5%. When mine came back at 4.8% I got a lecture saying I was punishing myself too much. Strange, as I haven’t felt punished at all, just healthier.

  • 259 Richard // Jun 22, 2012 at 12:52 pm

    @Lise. Whether your numbers are high or not, with a family history you might want to consider your carb intake anyway. Even if the endocrinologist says you are fine now, you might not be in another year.

    I’m becoming convinced that the underlying problem is the quality of foods pushed at us. In the USA it’s HFCS, here in the UK, it’s plain old glucose syrup or sugar. Either way, this stuff is added to so much food in order to add flavour after removing the fat that is commonly believed to be the cause of heart attacks. Of course, if that was true, heart attacks woul be going down, as we eat much less fat in general than we did twenty years ago. In fact, they are going up. It appears that this is very strongly linked with sugar intake and fast-acting carbs like potatoes. Repeated glucose shocks caused by these foods have been shown to increase insulin resistance.

    There’s too much power in the hands of food manufacturers and their lobby groups for this c**p food to disappear. We just have to avoid it. Doing so seems to reduce many problems, including diabetes, heart disease, cardiovascular disease, PCOS, hypothyroidism and many more.

    We just didn’t evolve to eat this type of high energy food. Even fruit has a question mark over it. We do seem to be able to eat it but not every day like governments tell us to. Fruit just isn’t supposed to be as available as we’ve made it with our various methods or storing it.

  • 260 Ellen // Jun 22, 2012 at 2:44 pm

    Great comments Richard. I couldn’t agree more. Our way of eating will not catch on easily because imagine what would happen to the food industry. 5/6ths of the grocery store aisles would disappear.

  • 261 Richard // Jun 23, 2012 at 2:32 am

    @Ellen

    I know. One benefit of having type 2 diabetes is that shopping trips are much quicker. I go up the first aisle (fresh veg), down the second for fizzy water, across the middle of the supermarket to the baking aisle (nuts), then to the end for milk (almond or soy), cheese and frozen items (quorn and frozen veg). I can do the whole shop in fifteen minutes, unless I stop at the garden section for more veg seeds or the DVD/bluray aisle for entertainment!

  • 262 Chuck Boyer // Jun 23, 2012 at 6:59 am

    Lise: “Maybe diabetes is rampant in this country because of these doctors who wait until you have
    The disease, to then say ‘you’re diabetic!’”

    Wow! do I enjoy reading the last few (or more) comments. Thanx, Lise, for bringing what’s been in my head, for now a long time, to daylight.

    And like another comment above, an endocrinologist told me my 5.0 was too low, that she wanted it higher, and of course she scolded me royally. Which, by the way, I didn’t take very well, since, among other things, I’m probably 20 years older than is she.

    I control my Type 2 quite well nowadays, keep my A1(c)s anywhere from 4.2-4.7. Last number was 4.4. Feeling great. No diabetic complications. And am convinced doctors by design, whether deliberate or not, are major cause of bringing on diabetic complications, albeit perhaps more slowly than would occur when diabetes is even further uncontrolled. Frankly, I see doctors as fundamentally aiding/supporting poor control. That is their standard of care.

    Like Richard, I’ve found that aggressive handling of a condition that continues relentlessly is required. Aggression with smarts; they work together.

    Thanx much,
    Chuck

  • 263 Ellen // Jun 23, 2012 at 7:28 am

    Doctors are too hung up on the fear of low blood sugar and diabetic coma. For people on medication, especially insulin, low blood sugar can be a concern, but mostly because the doctors still recommend a diet too high in carbs which leads to taking more insulin which leads to lows which leads to eating more carbs. Well, you get the picture. Even for people on insulin, if you keep your carbs to 30 grams a day you can keep your insulin doses low, avoid blood sugar spikes and lows, and keep your A1C down. See Dr. Bernsteins books for more information.

    But doctors and nutritionists are dinosaurs who refuse to budge. You’ll see the same problem with low-fat vs low-carb diets. They refuse to recommend a low carb diet that doesn’t restrict fat despite the proof that it helps to lose weight and improves yet glycerine and cholesterol. They are afraid of being sued. My endocrinologist told me about a recent patient of his with newly diagnosed type 2. She is a nurse practitioner who is doing well on his low carb diet with no fat restrictions but said to him “How can I recommend this to my patients when it’s the exact opposite of what I’ve been telling them for years?” Unconscionable.

  • 264 Ellen // Jun 23, 2012 at 7:42 am

    Sorry. ” glycerine ” should be “triglycerides.” Auto correct fail!

  • 265 Richard // Jun 23, 2012 at 9:08 am

    I think part of the problem is that doctors are trained over many years to treat with pills, not with food. We continue to do what we are trained to do no matter what. I do believe they want to help us but don’t have the nutritional knowledge because that is not their expertise. When you have a hammer, etc. Nutritionist are no better unless they are those involved in research. They just peddle the messages they are told to. Then again, why wouldn’t you when, as you say, the risk of not doing so is ending up in court.

    I’ve lost 70 pounds since diagnosis in January *without trying*. I’ve gone from borderline obese to a normal BMI with *no effort*. When overweight people I know ask how I did it, and I tell them low carb, mid-protein, high fat, they tell me that it’s impossible. My parents, despite seeing me being fitter and healthier than I have been in twenty years, tell me I should be eating bread and cereals because “they are good for you and high fat is bad”. The evidence is right in front of them but they are trained otherwise.

    The problem is that a lot of this training is from interested parties. When Yudkin published “Pure, White and Deadly”, the sugar industry turned on him and basically destroyed him. The alternative viewpoint that fat was to blaim wouldn’t hurt the sugar and cereals industry and, therefore, we have had 40 years (longer than I’ve been alive!) of learning that fat = bad, carbs = good. It’s very difficult to turn that around.

    Most of the rules around food seem to be marketing driven. From what I can ascertain, the “2 litres of water per day” has no basis, other than a marketing compaign by a water producing company.

    The 5-a-day fruit and vegetables claim appears to be false too. As I understand it the “research” for this was from the Fruit and Vegetable Growers of America, or some similar organisation. Vested interest?

    Much so-called research is done by food companies with the sole aim of getting a claim. It seems that if you find out that your product can kill people over a period of tens of years but that it gives you good skin for ten minutes, you can guarantee that the product will be adorned with “Get Great Skin with Carcinogen 3000(R)”!

    Yet governments continue to push the wrong messages. In the UK they’ve spent tens of millions of pounds on the five-a-day campaign despite there being little evidence that it provides any benefits for cancer / heart health and despite that is worsens glycemic control. Instead of trying to get people to eat healthily, they tell us to do more exercise, which has little to no impact on the obesity they are trying to mitigate.

    In the end, we all need to understand the limitations and vested interests of the people giving us information, do our own research and take control of our own destinies.

  • 266 Lise // Jun 23, 2012 at 10:02 pm

    Wow Richard, 70 lbs?  I have lost 24 lbs from low carb diet due to SIBO.  It also helped my AC1 go down three points from 6.2 and my cholesterol is lower, which surprised me.  I can’t afford to lose anymore weight because I was small to begin with.  

    I had noticed much bigger people in the UK over the last 5 years compared to 15-20.  Was quite shocking.  I thought we had the patent on obesity!  I am not diabetic that I know of but I had weird symptoms… Thirst that continued all day and night. My husband called me a camel. Dry eyes, rashes, strange dark discolouration on arm, under the arm to the side, some circulation issues and blurred vision.  Eye specialist could not figure out why.  Sores in the mouth also.  I had observed about three weeks into super low carbs (30 Gms carb/day) that athlete’s foot symptom, sores in mouth and rashes were clearing up.  So, lowering carbs for SIBO actually turned out for the best.  

    By the way, I love your final paragraph. Research is what led me to SIBO diagnosis, and I then told the GI what to look for! He was barking up the wrong tree for months. Said I needed to eat more carbs so I don’t lose weight. Well, carbs fed the bacterial overgrowth!!! Dang fool.

    On Saturday, June 23, 2012, Diabetes Developments wrote:
    There is a new comment on the post “The Normal A1C Level”.
    http://www.mendosa.com/blog/?p=366

    Author: Richard
    Comment:
    I think part of the problem is that doctors are trained over many years to treat with pills, not with food. We continue to do what we are trained to do no matter what. I do believe they want to help us but don’t have the nutritional knowledge because that is not their expertise. When you have a hammer, etc. Nutritionist are no better unless they are those involved in research. They just peddle the messages they are told to. Then again, why wouldn’t you when, as you say, the risk of not doing so is ending up in court.

    I’ve lost 70 pounds since diagnosis in January *without trying*. I’ve gone from borderline obese to a normal BMI with *no effort*. When overweight people I know ask how I did it, and I tell them low carb, mid-protein, high fat, they tell me that it’s impossible. My parents, despite seeing me being fitter and healthier than I have been in twenty years, tell me I should be eating bread and cereals because “they are good for you and high fat is bad”. The evidence is right in front of them but they are trained otherwise.

    The problem is that a lot of this training is from interested parties. When Yudkin published “Pure, White and Deadly”, the sugar industry turned on him and basically destroyed him. The alternative viewpoint that fat was to blaim wouldn’t hurt the sugar and cereals industry and, therefore, we have had 40 years (longer than I’ve been alive!) of learning that fat = bad, carbs = good. It’s very difficult to turn that around.

    Most of the rules around food seem to be marketing driven. From what I can ascertain, the “2 litres of water per day” has no basis, other than a marketing compaign by a water producing company.

    The 5-a-day fruit and vegetables claim appears to be false too. As I understand it the “research” for this was from the Fruit and Vegetable Growers of America, or some similar organisation. Vested interest?

    Much so-called research is done by food companies with the sole aim of getting a claim. It seems that if you find out that your product can kill people over a period of tens of years but that it gives you good skin for ten minutes, you can guarantee that the product will be adorned with “Get Great Skin with Carcinogen 3000(R)”!

    Yet governments continue to push the wrong messages. In the UK they’ve spent tens of millions of pounds on the five-a-day campaign despite there being little evidence that it provides any benefits for cancer / heart health and despite that is worsens glycemic control. Instead of trying to get people to eat healthily, they tell us to do more exercise, which has little to no impact on the obesity they are trying to mitigate.

    In the end, we all need to understand the limitations and vested interests of the people giving us information, do our own research and take control of our own destinies.

  • 267 Lise // Jun 23, 2012 at 10:18 pm

    Wow Richard, 70 lbs?  I have lost 24 lbs from low carb diet due to SIBO.  It also helped my AC1 go down three points from 6.2 and my cholesterol is lower, which surprised me.  I can’t afford to lose anymore weight because I was small to begin with.  

    I had noticed much bigger people in the UK over the last 5 years compared to 15-20.  Was quite shocking.  I thought we had the patent on obesity!  I am not diabetic that I know of but I had weird symptoms… Thirst that continued all day and night. My husband called me a camel. Dry eyes, rashes, strange dark discolouration on arm, under the arm to the side, some circulation issues and blurred vision.  Eye specialist could not figure out why.  Sores in the mouth also.  I had observed about three weeks into super low carbs (30 Gms carb/day) that athlete’s foot symptom, sores in mouth and rashes were clearing up.  So, lowering carbs for SIBO actually turned out for the best.  

    On Saturday, June 23, 2012, Diabetes Developments wrote:
    There is a new comment on the post “The Normal A1C Level”.
    http://www.mendosa.com/blog/?p=366

    Author: Richard
    Comment:
    I think part of the problem is that doctors are trained over many years to treat with pills, not with food. We continue to do what we are trained to do no matter what. I do believe they want to help us but don’t have the nutritional knowledge because that is not their expertise. When you have a hammer, etc. Nutritionist are no better unless they are those involved in research. They just peddle the messages they are told to. Then again, why wouldn’t you when, as you say, the risk of not doing so is ending up in court.

    I’ve lost 70 pounds since diagnosis in January *without trying*. I’ve gone from borderline obese to a normal BMI with *no effort*. When overweight people I know ask how I did it, and I tell them low carb, mid-protein, high fat, they tell me that it’s impossible. My parents, despite seeing me being fitter and healthier than I have been in twenty years, tell me I should be eating bread and cereals because “they are good for you and high fat is bad”. The evidence is right in front of them but they are trained otherwise.

    The problem is that a lot of this training is from interested parties. When Yudkin published “Pure, White and Deadly”, the sugar industry turned on him and basically destroyed him. The alternative viewpoint that fat was to blaim wouldn’t hurt the sugar and cereals industry and, therefore, we have had 40 years (longer than I’ve been alive!) of learning that fat = bad, carbs = good. It’s very difficult to turn that around.

    Most of the rules around food seem to be marketing driven. From what I can ascertain, the “2 litres of water per day” has no basis, other than a marketing compaign by a water producing company.

    The 5-a-day fruit and vegetables claim appears to be false too. As I understand it the “research” for this was from the Fruit and Vegetable Growers of America, or some similar organisation. Vested interest?

    Much so-called research is done by food companies with the sole aim of getting a claim. It seems that if you find out that your product can kill people over a period of tens of years but that it gives you good skin for ten minutes, you can guarantee that the product will be adorned with “Get Great Skin with Carcinogen 3000(R)”!

    Yet governments continue to push the wrong messages. In the UK they’ve spent tens of millions of pounds on the five-a-day campaign despite there being little evidence that it provides any benefits for cancer / heart health and despite that is worsens glycemic control. Instead of trying to get people to eat healthily, they tell us to do more exercise, which has little to no impact on the obesity they are trying to mitigate.

    In the end, we all need to understand the limitations and vested interests of the people giving us information, do our own research and take control of our own destinies.

  • 268 Richard // Jun 23, 2012 at 11:26 pm

    Oops, did I say 70 pounds. Typo, sorry. It’s 60 pounds I’ve lost.

  • 269 Lise // Jun 24, 2012 at 11:53 am

    Not sure why my entry posted twice :-(

    Maybe it could be deleted? Don’t know how to do
    that here.

    Richard, 60 or 70, it’s still a major accomplishment! Besides, who’s counting? Haha

  • 270 Richard // Jun 25, 2012 at 2:22 pm

    I think something’s not quite working properly on the comments. Sometimes mine don’t post at all.

    Strangely enough, after two years of failed calorie counting, I haven’t been counting the pounds lost particularly this time around. Just happy to feel fitter and be thinner :)

    Well-meaning, but ill-advised, people keep telling me I’ve lost too much weight and should eat bread and cereals again. Hahaha.

  • 271 lise // Jun 26, 2012 at 10:50 am

    Update on Endocrinologist visit yesterday.

    He said my A1C is fine at 5.9.

    I explained the diabetes history in our family on both sides, with the elderly and recent young ‘uns.

    This didn’t phase him. No further testing he said.

    Made me wonder if my doctor (family doc) had already spoken to him that I was on about my levels! Endo also said that since I’ve lost so much weight, and seeing that A1C had dropped because of bacterial infection and severely lowered carb intake, this is a good thing.

    He does NOT believe there is such a thing as “pre-diabetes”. Said you’re either diabetic or you’re not. I told him even the ADA has information on Pre-D, but he didn’t seem impressed, being a specialist and all that.

    Now what should I do? I have no choice but to stay on my rigid diet because of bacterial (was SIBO, now appears to be C Diff from antibiotics overuse to help SIBO), so I suppose in the long run this is helping that walk they say is inevitable to Diabetes…amazing how these doctors see things. Amazing.

  • 272 David Mendosa // Jun 26, 2012 at 12:45 pm

    Dear Lise,

    What should you do? Seems to me that it’s clear that you stay on your low-carb diet and keep your A1C level at least as low as it is now. I’m glad for you that it is so good.

    David

  • 273 Lise // Jun 26, 2012 at 1:04 pm

    David, I meant by question, should I seek further info from another specialist. Would the ADA have more literature about pre-diabetes which could be sent to my doctors?

    I thought that they both seemed to think that once it is under 6.5-8 there is no need to be alarmed. If this is how most doctors treat patients who might be at risk, it isn’t surprising that diabetes is so rampant then.

  • 274 David Mendosa // Jun 26, 2012 at 1:29 pm

    Dear Lise,

    Actually, I am probably less impressed with the ADA than your doctor is. And, honestly, I don’t think it’s worth your time and effort to be concerned about pre-diabetes and whether it exists or not. The point is to avoid turning whatever condition you have into diabetes! And you are doing that as long as you keep your blood sugar level low.

    David

  • 275 Ellen // Jun 26, 2012 at 1:58 pm

    I blame the ADA (in part) for my journey from pre- diabetes to diabetes. I faithfully followed their dietary guidelines and made my blood sugar worse. I think they do more harm than good.

  • 276 Richard // Jun 26, 2012 at 2:09 pm

    @Lise

    “He does NOT believe there is such a thing as “pre-diabetes”. Said you’re either diabetic or you’re not”

    I would say it’s time to find another doctor. From a diabetes / glucose intolerance point of view, you are doing the right thing with your diet. However, a doctor that doesn’t believe in diseases isn’t much use if you get something else he thinks doesn’t exist!

    @Ellen

    As I understand it, the ADA gives the same advice we get in the UK. The dietary guidelines are appalling. It worries me that these organisations seem to soften their approach to eating sugar, sweets, fizzy drinks, etc. after receiving donations from PepsiCo, Kelloggs and Jelly Belly!

  • 277 Lise // Jun 26, 2012 at 3:22 pm

    Oh wow! I didn’t know all these things about the ADA.

    Good thing I found this site. Has been very helpful. My father suffered terribly from complications. I am always shocked when I hear a diabetic saying that it is okay for him/her to eat all those high carb/sugary stuff for Christmas. I know a few who don’t worry much about their levels. They tell me that theirs is “mild!”. Won’t be that way for long.

    Also did not know that the system of detection and advice wasn’t better in the UK. Thought they’d be ahead of us! The UK is way ahead of the game with Celiac disease though.

    This has been a problem for me. Most gluten free packaged and processed goods are too high carb. Since I had to eliminate carbs because of SIBO, things improved overall with my gut. All the grains and carbs caused more problems than I realized.

    This brings me to the thought that whether one has diabetes or not, one should not consume the amount of carbs that is pushed on us daily. I’ve started preparing more veggies for my family, and talking to them about excess carbs in their diet.

    We cut out all sugary drinks (soft drinks as well/or pop/soda as some call these poisons), which was a smart move about six years ago.

    I was shocked to see that my chesterol improve on low carb diet. Hubby’s is a bit high, so we are trying to see if he eats less carbs, if it would help him.

  • 278 Ellen // Jun 26, 2012 at 5:24 pm

    @Richard. Exactly. Bought and paid for.

  • 279 Richard // Jun 27, 2012 at 10:29 am

    @Lise

    My cholesterol was borderline high when I was diagnosed. Since switching to high fat, low carb it’s got better. My blood pressure has dropped too. The low fat craze started in the 1970’s was a mistake IMHO. It caused food companies to create low fat but high sugar foods. Despite us all eating less fat than back then we have *more* heart disease, diabetes and obesity. Yet still the low fat, high carb message is pushed at us.

  • 280 Chuck // Jun 27, 2012 at 4:32 pm

    I am trying to get my A1-C down its been in the
    high 5’s. Doctor says I am one of his better patients.
    Should I be worried? Want to avoid compilcations
    ( father had all of them) Diagnosed in 2009, 52 year old male; alone & scared

  • 281 David Mendosa // Jun 27, 2012 at 5:14 pm

    Dear Chuck,

    You are less like to have complications later if you bring your A1C level down to the low 5′ or high 4’s. Don’t worry about it, but indeed eat fewer carbs.

    David

  • 282 Lise // Jun 27, 2012 at 8:47 pm

    David, is that advice mainly for diabetics?

    Would A1C levels in the high 5’s be okay for non-diabetics?

    Also, my nephew has type 1 diabetes. Was diagnosed a year ago. He’s in high school and hasn’t dealt well emotionally with this disease. He said his A1C was 6.7 which the doctor said was good. Is it?

  • 283 David Mendosa // Jun 28, 2012 at 5:59 am

    Dear Lise,

    Good question. My advice generally is just for people with diabetes, because that’s what I know. People who don’t have diabetes can have levels as high as about 6.0 and as low as about 4.5. Levels that them might have that are on the high side of this range probably are because they are overweight or have some other problem that causes an infection, so it is probably not normal to be above about 5.0. Still, I do know that the higher the A1C levels that ANYBODY has means the greater chance of complications. So I really would not say that a level in the high 5s that someone who doesn’t have diabetes has would be okay.

    David

  • 284 Richard // Jun 28, 2012 at 12:07 pm

    @David,

    one possible reason for high 5’s in non-diabetics would presumably be glucose intolerance, or pre-diabetes. I guess that some people without diabetes and high 5’s may have undiagnosed diabetes too. Especially as, at least in the UK, you won’t get a glucose tolerance test until you’ve had two fasting tests come back high. Here, with our fasting values on low carb diets, we would not get diagnosed.

  • 285 Ellen // Jun 28, 2012 at 12:19 pm

    People often ask me since my random blood sugar or fasting or even my A1C is normal, does that mean I no longer have diabetes. I just tell them a reminder that I do have diabetes is what happens to my blood sugar if I have a piece of bread or some pasta. Take my blood sugar and my husband’s two hours later and you’ll know I have diabetes.

  • 286 Richard // Jun 28, 2012 at 4:13 pm

    @Ellen

    It’s interesting that one. One of my T2DM diagnosed friends has battled it with low carbing and intensive exercise. He was convinced he could beat diabetes into remission / cure. Five or six months on, he took a glucose tolerance test at the doctor’s, monitoring the values himself in the waiting room as doctors here only check FBG and 2 hours after the glucose intake.

    His own numbers showed no effect for 30 minutes, followed by a fast rise but the BG level never went above 180. At 2 hours he was below 130.

    Technically, he is no longer diabetic. He has relaxed his control a little, eating the odd sandwich or some pasta. The other day he ate a spaghetti bolognese and two hours later his reading was 86. He does seem to be able to eat “normally” now, though he is keeping an eye on things and not going mad with carbs as he knows the diabetes will likely return if he goes back to his old ways.

    It gives me hope.

    Then again, earlier tonight I did a weight training session at home – six exercises and three sets of each for about 45 minutes. After the session my BG was 125 :( I had to follow it up with 30 minutes brisk walking, which lowered my BG to 82.

    I’ve considered doing a glucose tolerance test on myself. I’ve even got a bottle of Lucozade in the fridge ready to go but the odd elevated reading has meant that I haven’t developed the nerve to do it yet :)

  • 287 Richard // Jun 28, 2012 at 4:20 pm

    …my friend also mentioned that whilst on holiday he had a large dinner followed by three slices of cake and still kept below 90.

    I am starting to wonder if there are more positive stories like this out there that are not touted by diabetes organisations for a reason. I don’t know how true the claims in this video are but if true, they are damning. It wouldn’t surprise me if they were true though, given the power in the hands of large companies.

    http://www.youtube.com/watch?v=46_GInjBeQU

  • 288 Chuck Boyer // Jun 29, 2012 at 10:31 am

    @Richard

    I am impressed by your determination … and successes that come of it. Along with smarts, of course.

    After 23+ years of diabetes, I think I have my act relatively together. A1(c)s cluster around 4.4. Takes an enormous amount of dedication … and self-knowledge/understanding/regard/etc. to accomplish such. I too have no problem with cravings. I am constantly amazed at the lackadaisicalness of others among my peers who are diabetic … and quite relaxed about it. I suppose careless would be a better word.

    Self-love gets tossed around a bit too often for my taste. I prefer “self-respect,” for I think that’s what drives my dedication/consistency.

    Diabetes is the best thing that’s happened to me. A wonderful, poweful wakeup call.

    Please keep talking here. I think your comments are extremely helpful to readers of many stripes. Kudos.

    Chuck

  • 289 Richard // Jun 29, 2012 at 11:39 am

    @Chuck.

    I almost agree. I just wish I’d had the information available to me before I got diabetes! May I ask, at 23 years have you managed to stay free of complications?

  • 290 Chuck Boyer // Jun 29, 2012 at 11:56 am

    @Richard

    I do so wish. The journey’s been fraught with minefields aplenty along the way. And yes, I’ve no complications. Not one.

    Something I’ve failed to mention: Didn’t realize until a couple years ago (after I’d implemented to a large degree advice from Bernstein’s book), when I managed to get–and keep–my A1(c) at well below 5.0, that along with the perpetually higher A1(c)s came a cloying depressive state. It took retrospection. It was a couple weeks (as Bernstein suggests) into my consistent below-85 blood sugars that I recognized that I’d been living with longstanding depression–lifted from that point on. I’ve concluded that diabetics, probably nearly all (if not all), are in states of perpetual depression at least of a mild sort–and don’t realize it. It seems to come with high blood sugars. Comes on gradually over time, even over years, and goes unnoticed.

    Holding potential depression at bay’s become just another motivator for me. In a manner of speaking, I delight at being delighted. My new norm.

  • 291 Lise // Jun 29, 2012 at 12:48 pm

    Chuck, that’s an interesting observation regarding high blood sugar levels and depression. Though
    Supposedly, fingers crossed, I am not diabetic, my extremely low carb intake (for bacterial overgrowth problem) has changed my mood. My son had pointed out that the last couple of months, I don’t seem as depressed or down like I was before. Now I’ve never been one to be depressed, was not overweight, worked out, but being Celiac, I ate a lot of gluten free prepared/processed items which were extremely high in carbs. The result was A1C of 6.2 and lots of hypoglycaemia type episodes. Interesting. Carbohydrates in excess
    Seems to be a poison to our systems.

  • 292 Richard // Jun 30, 2012 at 2:06 am

    @Chuck,

    do you think the blood sugar itself is the cause of the depression, or is it the concern over blood sugars.

    I find when I take my morning reading that I have a number of reactions based upon a cut off point in my mind, which is 5.5 mmol/li or 99 in the other measurement. 99 or below and I’m satisfied, below 90 I’m happy 100-108 and I’m disappointed, 108+ and I’m annoyed and take a visit to the treadmill or cross-trainer to deal with it!

    I do feel much happier now than before being diagnosed though. I think that this is to do with being much fitter though – exercise is supposed to improve mood generally. Possibly removing the sugary and starchy foods and their resulting highs and crashes have helped too. Of course, straight after diagnosis, when it started to sink in what diabetes meant and can lead to, was a bad time emotionally.

  • 293 Chuck Boyer // Jun 30, 2012 at 7:18 am

    @Richard
    @Elise

    I do think that (altho disappointing readings can be stressful, as well as chronic concern over blood sugars) roller-coaster blood sugars are to blame. Most, I believe, Americans are overweight. The bulk of those exist in at least a prediabetic state and their bodies have insulin-resistance issues. Which of course (in my book) contribute to low-grade chronic depression.

    So in sum, there exists a physical cause for depression in such folks. Couple that with the state of the economy and high unemployment, and static incomes of those who do have jobs, and we have a perfect storm for depression to occur.

    Not fun.

    Elise, glad to see your comment re carbohydrates in excess seems to [poison] our systems. It helps me to consider fast-acting carbs as nonfood. As if it were cardboard or sawdust, I’m not about to place in mouth and chew. And swallow.

    And one of my rules of thumb is to totally avoid foods containing any flour at all. No matter the kind of flour.

  • 294 Ellen // Jun 30, 2012 at 8:16 am

    When people ask me if my diet is the Atkins diet I tell them what my endocrinologist called it- “beyond Atkins.” A short and sweet description for people in a hurry is that I avoid all grains and starches. That means no sugar, wheat, oats, rice, barley, rye, potatoes, peas, beans (except green beans), carrots etc.

  • 295 Richard // Jun 30, 2012 at 12:18 pm

    @Ellen

    You avoid carrots, beans and peas? I eat those readily without seeing any impact on BG.

  • 296 Chuck // Jun 30, 2012 at 1:08 pm

    I know depression, stress,anxiety, are real for
    me and it is related mostly to my diabetes & control. Was diagnosed in 2009, yet the stress
    seems to be a new issue, that may be affecting my
    sleep. I have good control according to my doctor
    but not tight control. Could it be all the info we
    read; ie mostly the internet are maybe playing a part? Of the subject; what is a good, fast preperation food for breakfast, I currently have 3/4 cup of lowfat cottage chesse. Also, just ordered Dr. Beirnsteins book? Wish there was a doctor near me in the Chicago area!

  • 297 Richard // Jun 30, 2012 at 1:14 pm

    Is that another Chuck?

    I tend to have a bowl of almonds or a protein shake for breakfast. When strawberries are in season, half a dozen serve me well.

  • 298 Chuck F // Jun 30, 2012 at 6:34 pm

    I will post with name from now on to avoid confusion

  • 299 Ellen // Jul 1, 2012 at 10:12 am

    They’re starch. High in carbs. I am allowed a little raw carrots- but don’t like them raw. I haven’t eaten peas in 4 years. Maybe I’ll try some and see what happens to the blood sugar.

  • 300 Richard // Jul 1, 2012 at 12:53 pm

    I guess it’s a case of YMMV.

  • 301 Chuck F // Jul 12, 2012 at 4:09 pm

    Just received my results; 5.6 not bad but want to get it down! Only thing strange is my glucose was
    110 high for me. My meter at home showed lower
    & meter was purchased in April! Anyone have this
    problem?

  • 302 Richard // Jul 13, 2012 at 5:16 am

    @Chuck

    5.6 is pretty good; far better than most! 110 fasting isn’t too bad either. Mine varies between 85 and 105.

    All BG meters have an acceptable margin of error. For your numbers and my meter, the meter give results within 10% of the true value. Also, your meter is checking capilliary blood but the full blood test will be from veinous blood so there is a margin of error there too.

    My last FBG at the doctor’s was 88. I tested with my meter at the same time and got 92. As long as the meters are reasonably accurate you can use them to manage your diabetes. If you are worried about large differences you might want to get hold of some test fluid so you can check your meter’s calibration.

  • 303 Arun Prabhu // Jul 13, 2012 at 8:45 am

    My one year journey to reduce A1C levels has been satisfying. I am thankful for the inputs I got from this site.
    Here are details pertaining to me.

    1.Gradual decrease of a1c from 6.8 in April last year to 5.3 this month.

    2. I am on NO MEDICATION.

    3. I religiously followed the regime outlined my be in my post dated 03 July 2011. Pl note that I still eating small portions of fruits 3 times daily and a small bowl of rice or a couple of chappitis daily too.

    I firmly believe diabetics from any part of the world can control their blood sugars by choosing from the foods available in their own country. Atkins diet may suit the western world but not ours. Even if we eat meat we are predominantly vegetarians and it is possible to achieve low blood sugar readings by choosing foods low in GI and low in glycemic loads. I have done it.

    I have stopped pricking my fingers to check BG long ago and I propose to do so only if my A1C deteriorates.

    04/11 – 6.8; 07/11 – 5.8; 11/11 – 5.6; 07/12- 5.3

    BMI- 20.5

    Total C- 170; Triglycerides- 60; LDL – 73; HDL- 85
    FBG on 08/07/12 – 88.

    My greetings to all of you.

  • 304 Satya // Jul 13, 2012 at 10:42 am

    Hi Arun, this is Satya….glad to see you back. If you remember, we had this discussion back in 2011. I assume, David has to control the size of the blog by keeping on editing/removing posts. I do not see either my post or yours related to the regimes we followed to bring down our A1Cs down from high to lower 5s using Indian subcontinent diet. As a matter of fact, neither I am on medication anymore and last two times I checked my A1C, it was 4.7 and 4.8. And I do eat tortillas and rice. Key is portion control and keeping yourself physically active so that you burn the calories and keep the metabolism going. People from different parts of the words have different metabolism. What cheese and meat may do to some people may not be that effective to some. What lentils and Indian vegetarian foods are appealing to us and are healthy may not make sense to many in the other parts of the world. I stay in US and am fortunate to have the best of both worlds.

  • 305 David Mendosa // Jul 13, 2012 at 12:14 pm

    Dear Arun,

    Thank you so much for your post. You are doing so well that you are bound to be an inspiration for many other people.

    By the way, your post was so positive it deserved to be posted three times. But I deleted the two duplicate posts.

    David

  • 306 David Mendosa // Jul 13, 2012 at 12:16 pm

    Dear Satya,

    Actually, I didn’t remove your post. Can you please try posting it again? I think you can be a big help to others.

    David

  • 307 Richard // Jul 13, 2012 at 12:42 pm

    @Arun

    Mt last A1C was 4.8 from completely vegetarian diet – no Atkins here :)

  • 308 Cathie // Jul 13, 2012 at 1:05 pm

    I’m wondering if obesity is a major contributer to developing diabetes? If so, how drastically changed can the disease be with weight loss or is diabetes with you forever once you have it? I’ve been obese (not just overweight) all my life and I struggle daily to try to lose weight. Are there many side effects to taking Byetta?

  • 309 David Mendosa // Jul 13, 2012 at 1:18 pm

    Dear Cathie,

    Diabetes and obesity are strongly related, although no one can claim that one causes the other. But all we need to do to see the relationship is consider these statistics:

    85% of all adult Americans who have diabetes are overweight or obese (based on U.S. CDC studies which I have cited in some of my articles).

    66% percent of all adult Americans are overweight or obese, according to U.S. government studies that you can read just about anywhere.

    Why the difference? It has to be something about diabetes.

    Yes, Byetta has some side effects. Not a single drug that does anything lacks them (when you read about a supplement that “has no side effects” you can be sure that the supplement has no effects period.

    The big side effect with Byetta is nausea. We do have many ways to deal with nausea, and I devoted a whole chapter of my book on Byetta to them.

    But now we have Bydureon, which is one shot a week rather than the two shots a day of Byetta. Same drug, but better coverage so it helps us even more with blood sugar and weight control. I just mentioned it in my article yesterday at http://www.healthcentral.com/diabetes/c/17/154486/choosing-weight

    David

  • 310 Ellen // Jul 13, 2012 at 1:41 pm

    As we all know there are thin people who have type two diabetes and many many overweight people who do not. Many experts conclude that certain genetic factors cause a person to become insulin resistant. Insulin resistance cause weight gain. Over time the insulin resistance cause a decrease in the production of insulin leading to full blown diabetes. One of the first thing my doctor who is a respected enocrinoligist , said to me was ” You did not do this to yourself.”

    I recommend you read articles and books by Gary Taubes (he also has a website) and Dr. Bernstein. Also my favorite site in addition to this one is http://www.phlaunt.com/diabetes.

    Also, while it seems different diets work for everyone , I can tell you that if you eat plenty of meat, eggs or fish, some non – starchy vegetables, a litle fruit such as berries, and avoid all grains (no wheat, sugar, oats, rice, barley or corn; no potatoes) you WILL lose weight without being hungry and without medication. Your triglycerides will plummet and your cholesterol and blood pressure will improve. (This diet is high in protein so people with kidney damage should consult their doctor).

  • 311 Richard // Jul 13, 2012 at 3:45 pm

    @Ellen

    I second that. I don’t eat meat or fish but I switched my diet away from carbs by cutting out sugar, starch and grains. Within two weeks I had lost over 20 pounds. After a few months I’d lost 60 pounds without feeling hungry or really trying. This was after years of calorie counting to try (unsuccessfully) to lose weight.

    I was losing weight so quickly I became worried I would end up underweight! As it is, my weight stabilised at about 155lbs, which is about right for my 5′ 9″.

    On the blood pressure, I went from a faintly stupid 215/150 to around 140/80 now. Still a little high but far better.

  • 312 Arun Prabhu // Jul 13, 2012 at 8:56 pm

    @Ellen

    I entirely agree with Richard. My triglycerides was 180 in April last year. Now it has plumetted to 60. I am on a predominantly vegetarian diet though with a very heavy reduction in carbs.

    Moreover I reduced nearly 15 lb in three months starting April last year. Now my BMI is 20.5 down from 27.

    I firmly believe wholly vegetarian food CAN control diabetes.

    Arun

  • 313 Ellen // Jul 14, 2012 at 7:53 am

    Wish I could understand how a wholly vegetarian diet could reduce blood sugar levels. It’s almost entirely carbohydrates. And carbohydrates, even the “good ones” will raise blood sugar more than protein or fat. And Dr. Bernstein won’t even attempt to treat vegetarians. I’ll need to do some research on that and talk to my doctor.

  • 314 Satya // Jul 14, 2012 at 9:47 am

    I eat vegetables that are low in carbs and high in fibers. I have done enough research in this and have pricked my fingers a lot in the past to judge which affects me and which not.
    First of all, I am not a vegetarian; I do eat chicken, fish and eggs; but i eat it just 2-3 days a week. I usually eat vegetables and low carb tortillas made out of whole wheat flour, soya flour, flax seed meal and spinach blend.
    The vegetables I eat are spinach, green beans, long beans, cauliflower, cabbage, cucumber, bottle gaurd (lauki in India), methi leaves, ridge gourd (http://www.spiceflair.com/ridge-gourd/), bitter gourd (karela in India) etc.
    I never ignore the advantages of egg and meat.But it never harms to do some basic research on the highly nutritional (low carb, low calorie, high fiber, low glycemic) vegetables available all around. Nowadays you can get all possible vegetables in every corner of US.
    And I am not talking about legumes (dals) from India which forms a major part of my diet as well. Since we are talking about low carbs, I didnt mention them here. But dals have high proteins and I exercise portion control when I consume dal. Its integral to Indian diet and difficult to eradicate it completely.

  • 315 Richard // Jul 14, 2012 at 11:37 am

    @Ellen

    Not all vegetables are entirely carbohydrate and many of the ones that are primarily carbs are a favourable mixture of usable carbohydrate and fibre. I eat large salads and see barely any change in my BG from them.

    Then there are nuts that are primarily protein and fat, many vegetable oils, cheese and eggs that are really low in carbohydrates. These are great for snacks and the protein makes you feel fuller quicker and for longer than carbs and some fats.

    As I say, my FBG is in the “normal” range, my one hour post prandial is almost always below 115 and two hour post prandial below 108 (and often quite a bit lower). I’ve been vegetarian for about 25 years now. I used to eat lots of high carb food but I’ve found it pretty easy to make the change.

    In reality there are lots of low carb alternatives to meat that don’t have the unpleasant side effects that meat can give. The biggest problems for diabetics come from processed carbohydrates and high starch or sugar (sucrose or fructose) foods such as fruits and potatoes.

  • 316 Richard // Jul 14, 2012 at 11:41 am

    @David

    Is there something wrong with the comment engine at the moment? Every comment I’ve posted in the past few weeks has cause the page to hang until I click the button again (at which point it tells me I’ve posted the same comment twice)

  • 317 Arun Prabhu // Jul 15, 2012 at 8:03 am

    @Ellen

    Myself, Sathya and Richards are excellent examples of how predominantly vegetarian food can control blood sugar levels. I will not be able to comment on why ” Dr. Bernstein won’t even attempt to treat vegetarians.” …but the results are here to see. Human beings are complex creatures and not like machines that deliver predictable outputs on quantifiable inputs. Yes, ” low carb ” is the guiding principle, but the paths to achieve this are many.

  • 318 Richard // Jul 15, 2012 at 10:42 am

    @Arun

    I’m not sure about Dr Berstein either. I’ve not read his book or followed him elsewhere. It seems a little harsh of him to say such things but hey, we are all different (YMMV etc) and all have to find our own way of dealing with what life throws at us.

  • 319 Ellen // Jul 15, 2012 at 3:26 pm

    Dr. Bernstein is an 80+- year old type 1 diabetic diagnosed at age 12 and who is partly to thank for the fact that we have the blood sugar testing meters that we have today. He has just found in his decades of treating diabetics that they can’t get their blood sugar controlled well if they are vegetarians.

    But there seem to be one or two of you that are able to control yours on a vegetarian diet.

  • 320 Ellen // Jul 15, 2012 at 3:26 pm

    Dr. Bernstein is an 80+- year old type 1 diabetic diagnosed at age 12 and who is partly to thank for the fact that we have the blood sugar testing meters that we have today. He has just found in his decades of treating diabetics that they can’t get their blood sugar controlled well if they are vegetarians.

    But there seem to be one or two of you that are able to control yours on a vegetarian diet.

  • 321 Chuck F // Jul 15, 2012 at 3:36 pm

    I am curious abut all you people with 5.0 below
    A1c. Do you follow a strict “Dr. Bernstein” diet or
    just watch carbs. Received my A1c last week; 5.6
    want to get it lower along with my dinner fasting
    score of in the 90’s. Comments? Idea’s

  • 322 Richard // Jul 16, 2012 at 10:43 am

    I just watch carbs and exercise.

  • 323 Richard // Jul 16, 2012 at 10:49 am

    @Ellen.

    Sorry, I meant I hadn’t read that he didn’t help vegetarians. Are you certain that this is true?

    From his book in the “So What’s Left to Eat Section” he seems to be endorsing his diet for vegetarians using soy and similar products. Here’s the quote I found:

    “Tofu, and Soybean Substitutes for Bacon, Sausage, Hamburger, Fish, Chicken, and Steak
    About half the calories in these products come from vegetable fat, and the balance from equal
    amounts of protein and slow-acting carbohydrate. They are easy to cook in a skillet or
    microwave. Protein and carbohydrate content should be read from the labels and counted in your meal plan. Their principal value is for people who are vegetarian or want to avoid red meat.
    Health food stores stock many of these products.”

  • 324 Ellen // Jul 16, 2012 at 12:40 pm

    Meat eaters also eat tofu and eggs etc. and other things vegetarians eat. I listen to his monthly telephone conferences which are free and he has often said that if a vegetarian asks for his advice he usually says ” Change your religion” meaning they will have to up the vegetarian lifestyle. I also heard him tell about a woman who came to see him from a distance who had not told him before hand that she was a vegetarian and he felt bad because there wasn’t much he could do for her.

  • 325 David Mendosa // Jul 16, 2012 at 1:00 pm

    In one of his books Dr. Bernstein wrote this:

    “Is it possible to eat a vegetarian diet on your program?

    First of all, if the vegetarian diet is not providing substantial amounts of protein, it is not healthy for anyone. Vegetarians who have come in to see me had a number of other problems associated with their diet. They all looked sick, and tended to be weak, and so on. But, if your religion is such that you must be vegetarian, and I can understand this because I do not want to be killing animals. There is a way around it, and that is to use supplemental protein. Whey protein, which is derived from milk, is probably the most balanced in terms of the amino acids that humans need. There are many whey protein powders on the market, in health food stores, and in weight lifter’s stores. If you get an amount of whey protein equivalent to the number of ounces of protein that someone your size would need, that’s great; you’re not getting protein malnutrition. Egg white protein is also acceptable. You should take folic acid and B12 supplements. You could do fine with a vegetarian diet.”

    Richard K. Bernstein MD (2011-11-03T04:00:00+00:00). Beating Diabetes Type 2 (Kindle Locations 5552-5560). eBookIt.com. Kindle Edition.

  • 326 Richard // Jul 16, 2012 at 2:20 pm

    @David

    That’s interesting. I happen to use whey protein shakes for breakfasts quite often as they are high protein and low carb. That said, there’s a lot of misinformation about protein and the vegetarian diet, a lot being dreamt up by the meat lobbyists in the past. From what I understand, it’s pretty difficult to be low on protein if you eat a balanced vegetarian diet. Especially if you are vegetarian, rather than vegan. Vitamin B12 is a tricky one for me. Before diabetes I’d get it from fortified cereals. Now I use a supplement.

    If anyone needs a good example of how well someone can do on a vegan diet, have a look at Rich Roll (my current inspiration for my increasing exercise). In my mind anyone who can swim 2.4 miles, cycle 112 miles and then run a 26.2 mile marathon is impressive. Someone who is vegan and can do this five times in one week is something else.

    http://www.richroll.com/

  • 327 Chuck Boyer // Jul 16, 2012 at 3:05 pm

    With a couple of exceptions, I consider myself a confirmed vegetarian. My last A1c was 4.4, which is slightly higher than it is usually (most of the time it’s 4.2-4.3). Have been diabetic for over 20 years now, Type 2.

    I do eat a bit of fish, as in Alaska-caught salmon, wild-caught sardines, at times a bit of mackerel … all from the can. As to volume of fish, I eat no more than the size equivalent of half a boiled egg in a meal. And a couple times per week maybe one boiled egg.

    If I’m short of animal proteins, I add soy protein isolate powder to a meal. A small amount, maybe as much as a level teaspoon. And in fact may combine a half-teaspoon or so with a taste of fish.

    Recently began putting a teaspoon or so of Greek yogurt, plain and nonfat, with my second (and final) meal of the day.

    As to carbs, I pay special attention to veggies that score below 10 on the glycemic index. If fresh isn’t available, I go with frozen. And if I desire (for nutrition benefits) a particular food that’s higher than 10, as, for instance, pink grapefruit, I make my portion size so small as to bring down its net glycemic effect to well within tolerable for me.

    Two meals a day, one predawn. That one allows for no carbs at all (except maybe a level teaspoon of tahini), choosing powdered fiber (dextrin, inulin) with a tablespoon of coarse psyllium husks. Add oils (extra virgin olive, grapeseed, rice bran, whatever). Don’t cook anything, except to boil an egg … and heat water for tea. And of course the fish comes already cooked.

    Among my veggies are wild edibles that come from the backyard in season, like dandelions, violets (leaves and blooms), touch-me-nots, thistles, wood sorrel (sometimes sheep sorrel).

    If I must snack in the early afternoon (happens rarely, actually), I limit it to extremely low-glycemic veggies only. No exceptions.

    I never eat till full. Usually quit my food intake by about noon. Go to bed with a wonderfully empty stomach. Make a point to exercise in the couple hours before bedtime; if I happen to experience a bit of hunger around those times I begin exercise, the exercise will dampen it usually to nothing, or close enough to nothing that there’s no discomfort.

    Feeling great. Love life. No energy problems.

    Works for me.

  • 328 Richard // Jul 16, 2012 at 3:15 pm

    @Chuck

    So much for carbs being needed for energy, eh?

    Since cutting back on carbs I’ve found my energy levels have been massively increased. I feel about ten year younger.

  • 329 sitaram // Aug 4, 2012 at 2:07 pm

    satya – is there a way we can talk/communicate, I would like to take your advise on indian sub continent food. I live in Ohio, US.

    Appreciate it.

  • 330 sitaram // Aug 5, 2012 at 4:29 am

    satya – Is there a way I contact you. I need advise with indian sub continent food choices.

    appreciate it

    I live in Ohio, US

  • 331 Satya // Aug 6, 2012 at 8:33 am

    @sitaram, you may contact me at ssamantray@gmail.com. I stay at Columbus, Ohio

  • 332 Chuck Boyer // Aug 9, 2012 at 7:09 am

    I go extralight on protein. For one, it does have noticeable impact on my blood sugar … unless I eat very little of it. Altho I do eat a modicum of boiled eggs in a month, and an amount of fish protein (wild-caught) equal to the volume of perhaps a half a boiled egg in a particular meal, I am of the belief that animal protein is totally unnecessary. In other words, going wholly vegetarian is fine, despite what Bernstein is reputed to have stated. The only caveat being that such (new use for an old word here: vegetating) vegetating must be done intelligently. And raw is almost always best. Several years back I read a real eye-opener of a book, The China Study, by T. Colin Campbell. What’s commonly considered to be proper diet for Americans, including those who are diabetic, includes consuming, in my view, far too much protein. It seems we Americans practically obsess on it as a fundamental for good health. On the contrary, as I say earlier here, I eat very small amounts of protein … and that in only two meals per day, the second generally finished by noon. I do not subscribe to the notion that three meals a day is necessary. Or even desirable. My A1(c) holds at 4.2-4.4. No problem getting there, and holding.

  • 333 Chuck Boyer // Aug 9, 2012 at 7:33 am

    I go extralight on protein. For one, it does have noticeable impact on my blood sugar … unless I eat very little of it. Altho I do eat a modicum of boiled eggs in a month, and an amount of fish protein (wild-caught) equal to the volume of perhaps a half a boiled egg in a particular meal, I am of the belief that animal protein is totally unnecessary. In other words, going wholly vegetarian is fine, despite what Bernstein is reputed to have stated. The only caveat being that such (new use for an old word here: vegetating) vegetating must be done intelligently. And raw is almost always best.

    Several years back I read a real eye-opener of a book, The China Study, by T. Colin Campbell. What’s commonly considered to be proper diet for Americans, including those who are diabetic, includes consuming, in my view post-read of that book, far too much protein. It seems we Americans practically obsess on it as a fundamental for good health.

    On the contrary, as I say earlier here, I eat very small amounts of protein … and that in only two meals per day, the second generally finished by noon.

    I do not subscribe to the notion that three meals a day is necessary. Or even desirable.

    My A1(c) holds at 4.2-4.4. No problem getting there, and holding.

  • 334 Lise // Aug 9, 2012 at 7:44 am

    What on earth do you eat??? I can’t imagine not having enough protein to keep me going. I haven’t been officially diagnosed as diabetic, but apparently they believe I’m on the walk to becoming one. Right now I’m on a no carb diet to keep bacterial overgrowth at bay, and thought A1C dropped, I’m seriously smaller than before I had babies and have very little energy to get through the day.

  • 335 David Mendosa // Aug 9, 2012 at 9:55 am

    Dear Lise,

    When we follow a very low-carb diet, we need to get our energy from fats. Protein actually provides little if any energy. For breakfast I usually have a couple of eggs and smoked salmon or some breakfast meat. For lunch I usually have salad with a dressing of coconut or olive oil and apple cider vinegar, and for dinner this summer I usually eat a big bowl of plain yogurt with stevia, blueberries, and chia seeds.

    David

  • 336 Richard // Aug 9, 2012 at 2:00 pm

    There certainly is a lot of protein consumption in western cultures. It comes to countries as their wealth increases. I think the emphasis on the “essential”-ness of protein is pushed by the meat industry and not a reality. You do need some protein of course.

    I’ve bought the Bernstein book. It’s not quite at the top of my reading list yet but I have looked up “vegetarian” in the index and found nothing anti-vegetarian.

    Different strokes…

  • 337 Ellen // Aug 10, 2012 at 7:49 am

    Dr. Bernsteins book says little about a vegetarian diet because there’s not much to say. If I recall he mainly addresses how to get enough protein through whey protein products etc. However on his on his conference calls I have heard him say that he has trouble advising vegetarians on how to control their blood sugar unless they , as he has called it, “change their religion.” He might also have jad Type 1s primarily in mind because they produce no insulin. But you are right about “different strokes. I’ve read enough about type 2 diabetes in the past 4 years to know that it is an extremely complicated disease. I think, e,g., that if you are not as strongly insulin resistant and still produce enough of your own insulin, you might be able to do vegetarian, but for those who are strongly insulin resistant and their beta cells are low, they won’t be able to control their blood sugar on a vegetarian diet. I also think a stronger lobby than the meat industry is the grain industry. If most of the people in the world ate a more “paleo” diet, 7/8s of the grocery aisles would disappear. So we have grains, grains, grains pushed on us all the time.

  • 338 Lise // Aug 10, 2012 at 8:50 am

    I don’t mean to be disrespectful, but I am a bit confused. Keeping A1C very low seems to be the focus for some.

    And based on what some of you have said about meals, it appears that there are very little options for meals. No grains, no starches, little protein?

    I just wonder what quality of life there is if one must eliminate these things from diet, or restrict them to such tiny amounts. Almost sounds like meals are the size of a toddler’s plate.

    As I said, no official diagnosis for me, but I appear to have problems handling sugars in foods (carbs), and just yesterday my eye doctor asked if I had diabetes! Appears that at my age, my eyes are looking like that of a late 60s to 70s woman. I’m in 40s.

    Anyway, my diet is like I’m a diabetic to control intestinal overgrowth and problems with c Diff recently from antibiotic overuse, but this is the second time I was asked during an eye check, and also at the dentists. However, primate care doc said when A1C was 6.2, nothing to worry about, and endocrinologist also said that now it’s 5.9 nothing to worry about.

    Am hanging out here because I feel there is much to learn from you all, and educate myself.

    Thanks for allowing me to ask questions.

  • 339 Ellen // Aug 10, 2012 at 10:02 am

    I understand how you feel. Believe me. Sometimes I feel very sorry for myself. But if I want to keep my blood sugar down, and my weight down and be healthy, then giving up grains and starches is the price I pay. A couple of things about eating no grains and starches though (and of course I cheat occasionally), they are addicting. So once you get them out of your system, you will find you dont crave them as much. Also you’ll find that just a little is a big treat. It amazes my husband that I can eat one chocolate covered almond or make a small slice of cheesecake last a week. Another thing is the hidden benefits of eating more protein and far and less carbs (grains) is that I have more muscle, a smaller waistline and clearer softer skin. I always had problems with my skin even into adulthood and it cleared up beautifully. I really think that if dermatologists would advise teenagers to give up grains their acne would go away. And I believe they would do it. I know I would have done anything as a teenager and young adult.

    Lastly on a higher protein, fat and low carb diet I am never hungry. Like Gary Taubes said – most diets fail because you can be hungry for a few months but you can’t be hungry all your life. So you have to choose and prioritize: what controls your blood sugar, what can you tolerate – being hungry or giving up grains? For me low carb keeps my blood sugar down and I’d rather give up grains than be hungry all the time.

  • 340 Ellen // Aug 10, 2012 at 10:09 am

    Oh and as for size of meals. I eat two a day and 6-8 oz of meat at each meal and small amount of mon starchy veg small salad and occasionally some berries or 1/2 small apple. So no need to eat only a little meat. I lost 45 pounds in under a year eating a pound of meat a day. Another benefits of giving up grains is your triglycerides will go down, you will not retain fluid and your blood pressure should improve.

  • 341 Richard // Aug 10, 2012 at 1:08 pm

    @Ellen – meat / grain / sugar. All in the same boat for me.

    I’ve seen stories of people with type 2 diabetes for 5-10 years turn it around with vegetarian diets. I can’t judge them against a meat-inclusive diet and I’m guessing most people who control with high protein meat diets probably haven’t tried vegetarian.

    As you say, diabetes is complicated. People get different results from different diets. In the end, I think most people getting <5.0 on the HBA1C are avoiding the same things. These being grains, pasta, bread, sugar, fruit. Whether you get your protein from meat or vegetables is essentially unimportant. The protein requirement is far lower than people imagine anyway. Most people get far too much. My protein intake on a vegatable-based diet is way more than the minimum advised because I eat nuts and seeds.

  • 342 Richard // Aug 10, 2012 at 1:22 pm

    @Lise

    When I first have up the starches and grains I really missed them. Eight months on I don’t miss them at all. I don’t get a great deal of pleasure from my food. However, in the past I don’t think I did really. I just wolfed down whatever was in front of me. When I switched to low carb, I felt a bit weary for a couple of days whilst my body adjusted to getting its energy from fat, before losing about 70 pounds without trying and without feeling hungry. I also reduced by blood pressure from the 215 range at its highest (yes, stupidly high and that isn’t a typo – they were on the verge of admitting me to hospital) to a more normal 130ish. I’ve even come off half of my blood pressure medication.

    With a good cookbook there are lots of great recipes available, whether you are veggie like me or a meat-eater. Meat-eaters get a wider variety I guess but there’s a huge range of plants, nuts and seeds, as well as soy and similar products. If you do eat a lot of veg, you just need to stick with the ones that have plenty of fibre and eat them with oils or fats, as most of the vitamins they contain are fat-soluble; without the oil, the vitamins become much less usable.

    I diverted my pleasure from food into pleasure from exercise. I started getting my endorphins from walking (I was really out of shape so couldn’t do much more) and then lifting a few weights and I’ve recently started running three times a week. As my nurse said the other day, “this has really turned your life around”.

    Food for me now is mainly fuel. Primarily my fuel is fat, followed by quite a bit of plant protein and a little carbohydrate. I probably eat in the region of 25-30g carb per day. I do eat the odd chocolate dipped strawberry (2g carb) and the odd small fresh cream eclaire (3g carb). They barely affect me now, which I think is down to the weight-loss and the exercise changing my body dramatically.

  • 343 Richard // Aug 10, 2012 at 1:31 pm

    @Lise

    BTW, although keeping BG and HBA1C is very important for me, I’m still trying to push myself out of the diabetic category altogether. A friend of mine has already done this following the same approach as me (except eating some meat). He has been retested after six months of intense work on the problem and got a completely normal glucose tolerance test result – not even glucose intolerant any more.

    I’m not sure whether I’ll manage it but I will try everything before I give up. My current almost scientific test on myself is with fasting. I’ve been fasting one day per week for about six weeks and noticed an improvement in my fasting glucose levels (every day, not just fasting days) and an apparent improvement in insulin sensitivity, though this is harder to measure. Despite the odd high (for me) carb meal, I’ve not gone over 110 on my BG for over a month. After seeing an interesting programme about intermittent fasting this week I’m going to switch to five days normal eating followed by two days of “fasting” that permits 600 calories per day (500 for ladies). I’m hoping to get my fasting glucose below 90, rather than the 99 it seems stuck at at the moment. When first diagnosed by FBG swayed between 140 and 210 ish.

    I’m not yet convinced by those that think type 2 diabetes can’t be fixed (I hesitate to say cured but I mean giving the ability to be a little more flexible with food but still being generally low carb for ever). I’ve seen one person do it myself and heard the story of many others.

  • 344 Lise // Aug 10, 2012 at 2:34 pm

    Richard, I don’t doubt you about reversing diabetes. Why not? Anything is possible with diligent dieting and exercise. Even if it’s still there, or a sort of remission if you will, that’s not a bad thing. I have inflammatory bowel disease and it sometimes goes into remission for years. I still have it but no symptoms. When I get too stressed (deaths in family), don’t sleep well for months, eat sporadically and take chances with food, it comes back at me in full force. So why not a similar situation for diabetes???

  • 345 Richard // Aug 11, 2012 at 7:38 am

    @Lise

    That’s about what I think too :)

    Also, even if I can never get to the target point, I’m living more healthily on the way.

  • 346 Chuck Boyer // Aug 13, 2012 at 8:02 am

    @Lise

    I’ve been away a few days, so haven’t kept up with the back-and-forth here.

    To respond at least somewhat to what I see recently posted:

    I want my A1C a little above 4.0, no more. Preferably 4.2-4.3. Both Bernstein and LifeExtension are quite supportive of that.

    My two-hour postmeal BG numbers are kept below 85. Morning fasting numbers fall generally between 61 and 75–just, in fact, the way I like it. (By the way, LifeExtension considers, via one of their articles, 74 to be the ideal fasting blood-sugar number.)

    I’ve got energy to spare. I’ve had diabetes nearly 25 years now, am in my 70s agewise, and routinely engage in sand volleyball at the park with 20-25-year-olds. With older ages sprinkled in, I am, 100 percent of the time, the oldest player out there. And well received by the always younger players.

    But enough bragging. You know, too demeaning.

    I love my life, I love the challenge of diabetes … and what it’s done for me.

    I have never been healthier.

  • 347 Lise // Aug 13, 2012 at 10:45 am

    Chuck, I think your story is inspiring, as are many other stories here. And at 70, to be so active, feel well and proud of your life, well, that’s an inspiration for us younger ‘uns to keep moving and taking care of our bodies

    Bravo!

    What I don’t get still, are the doctors who think watching your carb intake while on insulin, isn’t such a big deal. They had told my dad that he could eat as many fruits as he wished because he was on Meds! He died from a heart attack 6 years ago, and had many complications.

  • 348 Ellen // Aug 13, 2012 at 11:02 am

    Lise – I’d like to jump in here because I used to think the same way. Simple- eat more carbs- use more insulin. You’re fine. But it’s so much more complicated. I know Dr. Bernstein talks about keeping numbers low. Once you start getting the number of carbs higher and the number of units of insulin higher there is much more room for error. And one other thing- too much insulin in your loos stream is also damaging to your blood vessels.

    Unfortunately most doctors are not experts on diabetes control, or give up on patients, or can’t be bothered.

  • 349 Ellen // Aug 13, 2012 at 11:04 am

    Sorry. iPhone fail. Should be “too much insulin in your blood stream…”

  • 350 Lise // Aug 13, 2012 at 11:58 am

    Ellen, most doctors ought to read this board!

    I’ve never come across a more informative place to read about diabetes, its complications, risks, personal knowledge etc.

    What is the consensus on pre diabetes? I’ve been told over and over again, that there is no such thing as pre diabetes. Was also told that though my dad, his mother, his cousins, several aunts ah uncles had diabetes, that my A1C 6.2 was not cause for concern, especially since I’m not oversight and active. Then there is the maternal side with Gma dying from complications of diabetes.

    I’d rather learn from you all, try to lower A1C, than listen to the medical community and get full blown diabetes. Then again. Less money all around…how will the Meds and doctors keep sales up of they go around warning everyone of their chances of PRE anything.

    I admire everyone of you for posting here and helping others :-)

  • 351 Ellen // Aug 13, 2012 at 12:58 pm

    I think there is a “pre-diabetes” stage myself. I think if you catch your blood sugar creeping up and you exercise and drastically change your diet to low carb, it might be possible to hold off true , can’t go back diabetes. If you save enough beta cells and aren’t too insulin resistant. However you probably have to be careful with your diet all your life. Maybe not as strict as a full blown diabetic.

    I think 6.2 is pretty high myself. I try not to go over 5.7 and wish I could get to the low 5s. My dr. has a chart that shows that damage to organs etc. starts at 5.7. So if I were you I would treat myself as a diabetic (diet and exercise wise) to try to be safe.

  • 352 Lise // Aug 13, 2012 at 1:13 pm

    Thank you Ellen. I agree with you, which is why I’ve stayed here to learn. I think the wisdom and experience on this board is way more helpful than the rubbish some of those MDs pass on. Even the Endocrinologist said “no such thing exists!”

    So if I have osteopenia, and not full blown osteoporosis, why can’t there be prediabetes?

  • 353 Chuck Boyer // Aug 13, 2012 at 2:37 pm

    Yup, I agree that 6.2’s definitely too high … and needs a firm tamp-down. My belief’s that even 5.0’s too high.

    Once I got a bit under 5.0, everything–and I mean everything!–improved. And head got clearer, chronic low depressions lifted, the sun got brighter, etc.

    It’s a shame that the word carb/carbohydrate is so broad. Yes, most carbs are bad news for diabetics–and even for non–but many carbs are wonderful, healthy, and helpful to diabetics (such is my belief). Being acutely selective is key: for example, I stick to carbs with glycemic indices below ten. Usually veggies. I eat them raw.

    I go light on fruit, which has higher GIs: for example, if I include blueberries in a meal (always my second meal, never my breakfast meal (note: breakfast is always predawn (so as to avoid the dawn effect described by Bernstein))), it’d be one or two of them, no more.

    Lots of fiber. Psyllium, dextrin, inulin powders, for instance. And also psyllium husks, the coarse stuff. It all goes into a small bowl, the whole repast, the whole shebang.

    I include oils, as in extravirgin olive, oat bran (oil), grapeseed, sunflower. And always go light, so very light, on the protein.

    Then, so to further push down the blood sugar, ten to fifteen minutes postmeal I exercise–bike, walk, whatever. If terrible weather, then I can always do pushups. Run in place. Etc. (Or find an indoor venue.)

    And sometimes I may do it all; that is, bike, walk, and do pushups after a particular meal.

    Never eat till full, always exercise postmeal, keep breakfast virtually carb-free, when insulin resistance is strongest.

    There’s more. There’s always more. And it’s an evolutionary process. Each report I make’s a snapshot. A month later, three months later, six months later, I may’ve by then altered my behaviors considerably due to new discoveries encountered during my neverending quest for better info.

    And I do think prediabetes is misnamed. It’s all diabetes. And the so-called pre- needs as much effective attention as does so-called full-blown.

    In my earlier comment I mentioned LifeExtension’s assertion that 74’s the perfect fasting BG number. Coincidentally, 74 was my fasting number this morning on first rising. (Yesterday’s was 71.)

    So it goes.

  • 354 Richard // Aug 13, 2012 at 3:50 pm

    Prediabetes here gets called insulin resistance. I think of it as you’ve got the insuling resistance that causes diabetes but not yet the full diabetes with the islet damage. It’s a warning shot across the bow that you need to do something or face diabetes in a few years.

    You are doing the right thing in dealing with it now.

    My story is similar to Chuck’s. I’m younger (at 39) but since getting diabetes my diet’s better, I exercise more, I feel great and I’m full of energy.
    I can’t beat Chuck yet though – that’s one impressive story Chuck :)

  • 355 John // Aug 13, 2012 at 4:18 pm

    My A1c was 5.6 in Jan. My fasting glucose was 81. Doctors was fine with levels.

    Recently in Aug my fasting glucose was 89.

    Should I check my A1c again?.

    Am I normal or pre-diabetic?

    I do some exercise and I am relatively careful with diet.

    Would I develop diabetes in 10 years with out diet/exercise? Thanks

  • 356 Cathie // Aug 13, 2012 at 4:26 pm

    I’m pretty sure this posting will be met with some negativity, but I’m hoping for some truly constructive comments. I was diagnosed with Type 2 about 30 years ago and since I never felt or saw any changes, I totally avoided making any changes other than usually taking the oral med I was prescribed. My dr. over the years urged me to stop smoking, lose weight and start on insulin. I resisted. As a result, I now suffer from a lot of complications! I’ve had 2 strokes, a heart attack and my vision is deteriorating rapidly. Sadly, I started making minor changes only a few years ago and more substantial ones only within the past several months. I haven’t had an A1c since September of last year and it was 8.8. My 7-day, 14-day and 30-day averages are now in the low 100s and I feel that I’m doing a lot better. I know that I need to do better, but I resist because the necessary changes (as I’ve read about other people’s changes in these posts) seem too drastic for me. I’ve long been addicted to food and used it as any other addict uses their substance of choice. I think carbs are my biggest enemy. My tastes have changed, my food intake has changed somewhat and I don’t enjoy food/eating nearly as much as I used to, but it is still one of the few “pleasures” that I can enjoy in life. Some of the things that I’ve read in these posts that people are eating sounds so unpalatable to me. Do I sound like a child? Perhaps, but I’m just being totally honest. I kinda feel like I’ve already created a lot of terrible problems for myself and denying myself enjoyable sustenance seems pointless. I’m not looking for anybody to agree with me. I’ve read enough of these posts to know that’s not going to happen. I guess I’m wondering if there might be a happy medium? A healthier way of eating that isn’t so restrictive that I feel deprived. I am stroke affected on my left side and very sedentary. I know that more physical activity would be helpful and I’m looking into buying a fitness dvd for wheelchair bound people. I’m also going to ask my dr. about byetta.

  • 357 Chuck F // Aug 13, 2012 at 4:47 pm

    Working to get my A1 c down. Last one in June was 5.6. Daliy BG 70-90, mostly in 80’s. But once
    in a while like tonight, BG was 106 & 92 in morning! Anyone have an idea why this happens?
    Had a high morning reading over a week ago of 112! Ouch?

  • 358 John // Aug 13, 2012 at 8:24 pm

    Can somebody comment on this article?
    Based on this I am thinking I should get my post pandrial glucose checked.
    Thanks

    why-hemoglobin-a1c-is-not-a-reliable-marker

    http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker

  • 359 Ellen // Aug 14, 2012 at 3:26 am

    I think that article has a lot of good points in it. I know that my A1C is in what would be considered the non diabetic range. And A1C can be effected by a lot of things. I have read that fasting blood sugar can be the last to go- do relying on that number is dangerous.

    After meal tests are very important. I always test and my doctor has said one hour after should be under 140 and two hours after under 120. I aim for lower than that.

    After meal tests are a wake up call for me. Even after 4 years I’m still in denial. E.g., a few nights ago at a birthday party I had a small piece of cake and some ice cream. I tested my husbands blood two hours later (he had a larger slice and I’ve cream) and his blood sugar was 91. Mine was 128. I always think – drat! I really do have diabetes.

  • 360 Lise // Aug 14, 2012 at 7:00 am

    Cathie, I don’t think you sound like a child at all. I think you know most of the rules or warnings about diabetes and made decisions that felt right for you, but you also had to deal with the unfortunate complications. Diabetes is not fun, and I watched my dad deal with complications for a long time. I have no advice to give. Just wanted to acknowledge what you wrote. Everyone deals with chronic illnesses differently.

    The diabetic diet does not sound like fun. We have choices with illnesses; to take meds or not, to follow a diet and exercise plan, or not. I am not diabetic that I know of YET, but I struggle with the complications of Undiagnosed and misdiagnosed Celiac disease, ulcerative colitis, fructose malabsorption, and now apparently on the road to diabetes to quote my dietician. I hope the latter isn’t true. Best of luck.

  • 361 Chuck Boyer // Aug 14, 2012 at 7:17 am

    @Cathie

    Sorry to hear of your troubles. They should serve as a warning to others, both diabetic and non.

    Addictions! They take away our free will, sabotage our health. In short, killers. Our processed-food industry in this country designs their products quite well to promote, generate, and sustain addictions.

    But then I suppose you know all that.

    I’ve not felt deprived in all my relatively steady progression toward effective management of my diabetes. Though it’s often been a psychological battle with self to discover ways I could do end runs around my own susceptibility to food addictions. I’d like to turn the notion of deprivation around: In other words, feeding the body those foods that do it harm is really and truly deprivation. With a capital D, as in Deprivation.

    At times it has seemed as if every path I took dead-ended. There’s a mine field of mis-/malinformation out there with regard to diabetes.

    Which of course further discourages effective coping.

    Sweets were my weakness. I’ve been without sugars long enough at present that my taste buds have developed acute sensitivity to subtleties in natural foods. I.e., a simple boiled egg tastes sweet to me … and a bit salty, in fact. Plain raw broccoli, collard greens, cauliflower, cabbage, brussels sprouts, all taste sweet.

    When, many years ago, I ate processed foods as my eating norm, such subtleties were lost on me. And I would’ve considered vegetable greens to be insufferably bland to taste.

    I stay away from artificial sweeteners … and, in fact, sweeteners of any sort. The one exception, which I indulge in but rarely, is inulin fiber powder, which is incredibly sweet … and is quite healthy for diabetics, is healthy for the gut, does not raise blood sugar, is free of negative side effects, etc.

    For those whose sweet tooth controls them, I would recommend their switching over from sweetened foods to plain natural foods, but with a sprinkling of inulin powder atop. It’d also work with tea/coffee/plain water.

    As I am saying, I don’t need sweeteners, including inulin. However, if I find it on sale, I might bite, so to speak.

    And a note with reference to the assertion, apparently by a doctor, that blood-sugar damage to organs occurs at above 5.7 A1C: I strongly disagree.

    My very trusted source says damage occurs at <5.0. The further above that number, of course, the greater the damage.

    And so it goes.

  • 362 Richard // Aug 14, 2012 at 2:57 pm

    @Cathie,

    sorry to hear about your problems.

    I’m afraid that there probably is no middle ground. That’s not want you want to hear I’m sure but it’s better to understand that, rather than search for a middle way that doesn’t exist.

    Do you test your own blood? If not, I strongly suggest that you start testing, particularly after meals, and aim to get your blood as close to normal as possible.

    You’ve obviously got some damage to your body already and the only way to minimise any futher advancement of the complications is to normalise your sugar with diet and any exercise you can manage as soon as possible.

    The good news is that once you’ve made the change, it really isn’t that hard to stick to. You need to get beyond the food addictions and let your body adapt to a different diet. Once adapted, you should find that it’s easy to continue with and you may even find that you don’t want the bad foods any more.

  • 363 Arun Prabhu // Aug 14, 2012 at 9:27 pm

    @Chuck

    I am interested to know the source that that points that an A1C above 5.0 causes damage to organs. If a genuinely non-diabetic has an A1C < 5.0 then as per established statistics at least 70% of the populace in US,leaving aside prediabetcs ( for that matter in our India too) must have A1C in that range. Has this been ascertained?

  • 364 Ellen // Aug 15, 2012 at 4:27 am

    The “dawn effect?” Not sure of the specifics but what I think happens is throughout the night your liver will release a form of sugar to keep your blood sugar up to normal levels. The for some reason as you start to awaken the liver clears out all your insulin. So- if you are insulin challenged, your blood sugar goes up. A great site for information is: http://www.phlaunt.com/diabetes.

  • 365 Ellen // Aug 15, 2012 at 5:27 am

    Also would like to have more facts on A1C of 5 and above contributing to organ damage. I would also think a very large number of healthy people have A1Cs in the low 5 range. My doctor has a chart that incorporates information from studies showing risk of stroke, heart attacks, retina damage etc. starts to increase at 5.7. He didn’t just pull that number out of a hat.

    @David- would love to know your thoughts on that.

  • 366 Chuck Boyer // Aug 15, 2012 at 7:11 am

    @Ellen

    As to A1C of 5 and over, I think my most memorable source, assuming memory serves me well, was Life Extension, in one of their articles.

    It’s a matter of judgment where to draw the line. I believe the beginning of increase of not only risk but the occurrence of actual organ damage is at or very near 5.0.

    I do know that after I got my A1C consistently below 5.0, I experienced a marked increase in feeling well. Not least of which was amelioration of a chronic low-level depression.

    (Which I think, by the way, afflicts most if not all diabetics, though I’m almost sure very few of them are aware of it, esp. if it’s at a chronically low-enough level.)

    I do assert–and agree with the assertion–that most Americans ought to be treating themselves via right foods and exercise … the same as if they already had what doctors seem to label full-blown diabetes.

    My information also claims that Americans who are not–I emphasize not!–diabetic have typical fasting blood sugars at 89. Those people, typically found in third-world countries, who do not consume processed foods have typical fasting blood sugars at 83.

    That tells me something. It tells me plenty. It would certainly suggest that the typical American nondiabetic is already on the road to being defined as diabetic.

    Even by doctors.

    And so it goes.

  • 367 Ellen // Aug 15, 2012 at 9:21 am

    @ Chuck –

    What is this “LifeExtensions” you’ve mentioned several times? Are they they supplement sellers?

  • 368 Chuck Boyer // Aug 15, 2012 at 3:56 pm

    @ Ellen

    Life Extension does sell supplements (which, incidentally, I do not buy). They also have a magazine … and a website. And a tremendous archive of articles re various health issues, many quite critically important to a diabetic or a potential diabetic.

    There is also a book titled Life Extension.

    I think http://www.LifeExtension.com can get you to their site, tho I haven’t tried in a while.

    My mother-in-law subscribes to their magazine.

    Tho they do sell supplements, I consider them a very good authority on the nuances of diabetes. Among other points I’ve seen made by them, one, if my memory serves me, asserts the healthiest range for blood sugars is 70-85. They further assert that even a couple hours of blood sugar over 85 can damage organs.

    Again, if memory serves me.

    They do recommend A1C to be below 5.0.

    I might add here that Bernstein, in the book of his I read, claims his diabetes patients attain A1Cs ranging from 4.2-4.7. Bernstein also goes into some detail on the benefits derived from getting below A1C 5.0 … and holding there. All supported by my own experience.

    My last A1C was 4.4, a spike or two above my more usual 4.2-4.3; the lab’s estimated average blood sugars required to gain the 4.4? 80.

    Again, so it goes.

  • 369 Ellen // Aug 15, 2012 at 6:13 pm

    Most people do disagree with Bernstein on his low A1c stand and even he , I don’t think, believes its achievable for most diabetics without medication, in particular insulin.

    I know too many perfectly healthy people (including my 88.5 year old mother ) whose A1Cs are in the low 5s, to believe it is damaging.

  • 370 Lise // Aug 15, 2012 at 8:08 pm

    It sounds almost insane to try and achieve a 4 or 4.2 on A1C. At what point does quality of life over obsession with overly low numbers get to some of you? I realise keeping numbers lower is important, but if you have to keep exercising all the time, barely eat and constant check your blood, how is that a happy life?

    Surely the saying “moderation in everything, and everything in moderation” should be part of our lives. Don’t over indulge, get enough sleep, exercise and try to be happy and with those we love.

  • 371 Rob // Aug 16, 2012 at 5:17 am

    I totally agree with Lise. I’ve been getting emails with comments and gee, if anything, they just have worry me more. My current A1C is 5 and I was happy about it. Now, I read here that you need to get a bs of less than 85 to avoid organ damage. I am diabetic…. I don’t eat much (especially carbs), I do what I can when it comes to exercising and my bs almost never goes higher than 100 2 hours after eating. I do understand that the American Diabetis Association and others don’t have the right info and say that it’s okay to have an A1C of 7 or to eat a meal of 40+ carbs. I don’t believe that is healthy, but please, do not alarm us saying that if you don’t have an A1C of 4.2, organs will be damaged…. In that case even non-diabetic people would have damage in their organs…. Please understand that this is a disease and that sometimes, in the case of most of us, no matter what we do, we will have high bs crises… totally out of our hands. I wish I could get those numbers, but I can’t. Not for now, and I am focusing on the positive (from an A1C of almost 11 to 5 in 6 months….) Some of your posts are just alarming. I say this with all my due respect…

  • 372 Chuck Boyer // Aug 16, 2012 at 6:44 am

    Uh-oh.

  • 373 Chuck Boyer // Aug 16, 2012 at 6:49 am

    It appears I’ve offended. Sorry.

  • 374 Lise // Aug 16, 2012 at 6:59 am

    No you haven’t. I may have sounded alarmed. Still trying to understand How all of this constant testing leads to feeling happy and relaxed.

  • 375 John // Aug 17, 2012 at 4:06 pm

    Sometimes, actual research shows something that you don’t expect…here is one

    http://www.ajcn.org/content/87/1/1.full

    Now can I go back and eat sugary fruits if glycemic index does not matter in diabetes prevention/management-)

  • 376 Richard // Aug 18, 2012 at 8:53 am

    I think that that study is (slightly) advocating low GI.

  • 377 Chuck Boyer // Aug 18, 2012 at 10:19 am

    @Ellen

    I do think most criticisms about/disagreements with Bernstein reflect the ignorance of the utterer.

    If I may speak so boldly.

    Especially regarding his low-A1C stand.

  • 378 Lise // Aug 18, 2012 at 10:51 am

    Chuck, everyone’s body is different. How can every diabetic live to attain what Berstein says is the right level???

    Is he like the God of diabetes?

    Does everyone agree with him?
    Should people be a slave to his ideas?

    I’m still trying to understand, not putting anyone down.

  • 379 Ellen // Aug 18, 2012 at 4:26 pm

    @Chuck-

    A rather bold statement considering you don’t even know the sources who have disagreed with Bernsteins A1C goals.

    I don’t trust my memory 100% on this but I believe just ine of the sources, was David, who did some research and spoke with some experts about a more reasonable norm for A1C being in the low 5s.

    David- where are you? Haven’t heard from you lately.

    Personally, I’m getting a little of tired of the argumentative nature of some comments on this blog, in particular, the recent name calling, so I am about to unsubscribe. I don’t need the aggravation.

    @Lise. Bernstein is really worth reading and following, however, there is always room for disagreement and individual thinking and I do part ways with him on A1C level. I could be putting my life on the line but I know that there is no way I can get my A1C to 4.6 with diet alone even if I eat only 10 grams of carbs a day. And I don’t want to take insulin. Also, as I said, every healthy non-diabetic I know who has had an A1C test, (4 or 5 of them) has had results in the low 5s , including my 88 year old mother, who has no heart, kidney or other circulatory problems.

  • 380 Lise // Aug 18, 2012 at 4:37 pm

    Ellen, please don’t unsubscribe!!!

    I so much enjoy reading your posts and others as well. True enough, there is no need for name calling. We are all adults.

    It’s interesting what you added about your grandmother.

  • 381 Ellen // Aug 19, 2012 at 9:22 am

    Thanks Lise. Actually it’s my mother. Also my extremely thin 40 year old healthy son also has an A1C of 5.1. This is all anecdotal but it’s enough to make me thing that we don’t have to strive for a 4.2 to be healthy.

  • 382 Lise // Aug 19, 2012 at 9:40 am

    Eileen, my son just finished college, is 6′ 2″ and his A1C has been 4.9 and now 5.0. He’s active and healthy. I can’t imagine telling him to starve himself so he could reach whatever Bernstein thinks is an optimum A1C. My kids were raised to shun junk food, they actually watch their carbs, both go to the gym often and are slender in build. We cut out soft drinks completely about 6 years ago, though by American standards, only drank it on flights, restaurants or road trips. Learned how awful they are and now we have WATER!

    Daughter is like me with Celiac and her fasting blood sugar for physical five years ago was 102. I was alarmed and we went low carb and encouraged her to work out. I need to get her A1C checked. She does monitor carbs, does spin class at gym, yoga and runs. Takes veggies and salads to work (another recent college grad), and limits her intake of deaserts and sweets.

    If some feel better and are able to function on very little food, then that’s the right thing for them, but if it becomes a contest to see who can get A1C the lowest, me thinks that’s kinda stressful.

    Glad you are not going anywhere :-)

  • 383 Arun Prabhu // Aug 19, 2012 at 10:01 am

    A good thing about David’s website is his attempt to make it have a global audience. Especially his effort to include Asian foods in the GI and glycemic loads list. He himself discovered the ” wonder food – chana dal”. And this is as it must be. After all diabetes is a global phenomenon. Millions and even billions of diabetic people in the globe cannot afford to eat by the meter. Pricking fingers 5 times a day is out of question. Grain and dals address the world’s food security. Yes it is true diabetics must eat far less grains but I feel there surely is an answer to controlling diabetes in every land. If my doc tells me ” you must change your religion and go Atkins” then I will change my doctor. Dr. Bernstein’s analysis definitely is insightful , a feature of all brilliant westerners. But I still maintain the paths to controlling BG are many.

    What is needed is a correct and an unbiased information on what a safe A1C is, something that is achievable and something we do not get obsessed with. I have achieved 5.3 by diet alone and I will be happy if I am able to be on the low 5 zone for the rest of my life. I am 64 without any complications – as yet.

  • 384 Lise // Aug 19, 2012 at 11:04 am

    Arun, I loved your post. You made valid points about diabetics in different countries. My mother-in-law is diabetic. She does not obsess. She eats a little of everything. Is very skinny, keeps socially active, loves life and is 83. She has no idea what her cholesterol is, trusts the doctor if he says her “sugar” is fine, and goes her merry way.

    Stressing over complications, obsessing and fighting over numbers, and generally forgetting how to live probably causes negative reactions in the body. I will read Bernsteins book out of curiosity but I’m betting he’s unrealistic for the general population, and other cultures.

    Having lived my life with other auto immune diseases, I’ve learned to find the middle path and try not to obsess. It’s hard, but I’m looking for quality in life and not quantity. Who wants to be miserable and reach 100?

    By the way, isn’t Dahl made from lentils or yellow or green split peas? Wouldn’t it cause bloating and gas in people like me with inflammatory bowel disease? I’ve had to cut out all legumes, peas and beans.

  • 385 Richard // Aug 19, 2012 at 1:17 pm

    @Ellen – hope you’re still around, I enjoy swapping ideas with you and everyone else on the blog.

    @Lise – I wonder if celiac and diabetes are linked. My doctor has just asked for me to be tested for celiac and pernicious anaemia.

    From what I have read, a healthy HBA1C for non-diabetic people is between 3.5 and 5.5%. I’ve also read about complications being massively reduced once you get below 6%.

    I’d love to be able to get into the low 4’s (last one for me was 4.8%) but I don’t think I could without resorting to medication. Dr Bernstein being type 1 doesn’t have the option for control through diet and exercise alone and uses insulin to obtain his results.

  • 386 Chuck Boyer // Aug 20, 2012 at 7:11 am

    I think under 5 A1(c) is quite achievable. And that without being, as some assume, obsessive about it.

    I also think that 4.8 is quite good. Much better than, say, 5.0 or anything in the 5s. The dividing line for excellence seems to fall into play at anything below 5.0.

    I’m happy with my being the the low 4s. My life is rich. I’m healthy, etc. I love my diabetes, which has taught me so much over lo many years now. It has been a tremendously valuable wake-up call.

    @Richard

    A while back you asked if I had any diabetes complications, and I responded I have not. Which happens to be true in the present. However, two things I think need mentioning in that regard:

    1) At about three years post-diagnosis, my hands started tingling. Diabetic neuropathy. B6, taken 50 milligrams twice a day with food, totally stopped it. I still take the B6 … and no recurrence in the intervening 20+ years since.

    2) At ten years post-diagnosis, my heart started doing strange things. It’d skip beats, sometimes leaving me a bit breathless. Arrythmia. Right on schedule. (Evidently it’s at about ten years in that arrythmia can appear like clockwork.) The doctor said it was from the diabetes–and that medicine couldn’t fix it.

    I cast about for my own solution. L-taurine, an amino acid, taken as directed (tho at first I took more than as directed, then tapered off), calmed the heart … and returned it to stability.

    Three years after that, the arrythmia returned. I added supplemental magnesium. Problem solved. Since then, no symptoms of arrythmia. Heart’s fine, and I’m fairly confident the malrhythm will not reappear.

    No other complications have developed.

    I might also mention that one of my motivators was that my mother developed cataracts from her diabetes. She went in for surgery to repair; they gave her too much anesthesia … and she died a horrible death, with subsequent multiple heart attacks and strokes.

    There are other motivators, but that is a particularly strong one.

    I am sorry that some find my positions (perhaps) discouraging. Which is unintended. I happen to be a firm believer in finding out what works after personal testing … and then following through on it.

    My experience is my experience. I’d like not to feel pressured into (somehow) apologizing for it. I mean no harm, and in fact would like to be helpful.

  • 387 Lise // Aug 20, 2012 at 7:32 am

    Chuck, you mentioned a few things that have worried my other doctors. Eye specialist asked if I had been diagnosed with diabetes and I said no. Told her about my 6.2 which I was not alerted about, then dropped to 5.9 because of low carb diet. Told her Endo and regular doc said not diabetes. But, she said that I have cataracts and that my eyes are behaving as If I’m in my late 60s or 70s. I was quite alarmed. Plan to investigate further.

    Also, rapid heart beat, palpitation and as dr said, weird or odd EKG (yet he does nothing), but said probably to do with menopause. Had hysterectomy last year.

    Now I’m wondering. No tingling. What magnesium Do you take? I bought CALM and not sure if this is best.

    Also B6… Does it work only for what you mentioned or just Good overall
    For what you mentioned?

  • 388 Chuck Boyer // Aug 20, 2012 at 1:06 pm

    @Lise

    I’d suggest you research magnesium on the Internet. (Perhaps Google something like “magnesium heart benefits,” with a followup on findings to seek out the recommended best-acting for heart rhythm.)

    My wife picks up the magnesium for me; I’m presently at the library (no Internet connection from home), so don’t have the bottle in front of me.

    Both magnesium and L-taurine seem to benefit/normalize heart rhythm, according to literature. Both supplements have worked, and continue to work evidently, for me. As arrythmia has potential for being life-threatening, I’m delighted that I’ve resolved (apparently) that particular problem’s potentiating.

    As to B6, the literature supports its effectiveness re carpal tunnel syndrome as well as diabetic neuropathy. Some sources lament that too often surgery is used in instances of carpal tunnel … when B6 would have resolved the problem just fine, and with no surgical risk (which I think, by the way, is appallingly great!).

    B6 can be overdosed (too much can bring on the symptoms of neuropathy that one is trying to resolve), but 100 mg per day (50/50) seems to be fine, again according to literature, and I’ve been taking that amount for 20+ years now in my effort to stay ahead of neuropathy.

    It has not returned.

    In my early days of diabetes my A1(c) was more than 11.0. My dealing with diabetes has undergone evolution after evolution … to arrive finally at where I am presently. I’ve progressed, in that regard, steadily, albeit at times zigzaggedly.

    I continue my efforts in that respect.

    The ophthalmologist can detect no diabetes indications in my eyes. I suspect I’ve now stabilized my blood sugars such that no such indicators will appear in future. Apparently, high blood sugars, even in nondiabetics, can damage eyes over time.

    And yes, do investigate further as to eyes. Smart move, that.

    I think as a society we depend too much on our doctors for answers they do not have. (And when they say there is no answer, we accept that as gospel and abandon a possible search on our own that could prove productive.) And too often their proffered solutions, when they think they have answers, carry side-effect consequences/baggage that interfere, sometimes profoundly, with good health.

    As I’m sure you know already.

    All my best,
    Chuck

  • 389 Lise // Aug 20, 2012 at 1:21 pm

    Chuck,

    This post actually helped me to understand why you were on that quest to keep your levels low.

    You are right about doctors and not listening to everything they say. At the moment I am dealing with them about other issues and finding myself doing all the research and reading…sigh.

    Good for you! But one question…do you share what you’re doing with the doctor(s)? Do they listen? Care? I find them really condescending at times and unwilling to associate one thing with the other. Seems like it’s all black and white. You either have something or you don’t. This is the medication for it, no other alternatives.

    Thanks. I’m slowly learning and understanding, and also appreciating WHY these levels need to be watched. You helped a lot :-)

  • 390 Richard // Aug 20, 2012 at 2:47 pm

    @Chuck. Good information. I have numbness in one foot and tingling in my arm. I’m slightly low on B12 so I’m supplementing with a B-complex just now whilst waiting to be tested for pernicious anaemia. The tingling’s not so bad today after a week or so so who knows.

    I have also had arrhythmia – terrifying way to wake up, so I’ll look into magnesium.

    @Lise. I think medical practice and medical science are out of step, particularly on what normal blood sugar is. This link has probably been posted before but it’s worth a look, as is part two.

    http://chriskresser.com/when-your-normal-blood-sugar-isnt-normal-part-1

  • 391 TC // Aug 20, 2012 at 6:55 pm

    Hello,
    My A1C was 7.1 and my doc said I have diabetes, but I just had my GTT and it was 66. The doc said she doesn’t understand because I am not on meds I was just diagnosed. I have always been hypoglycemic on no meds, controlled by diet – how can I be a diabetic? She said we would check my A1C again in October. I am confused – I am not overweight and I am healthy. All research says you cannot be diabetic and hypoglycemic unless you take to much meds and I am not on meds. Can you explain since my doc cannot?

  • 392 Chuck Boyer // Aug 21, 2012 at 7:08 am

    No respect from doctors is what I’m used to, have learned to expect. The best I get is, “Keep doing what you’re doing, but don’t tell me about it.” Scoffing and mocking is more routine. And, of course, there’s the scolding, treating me as if I’m a four-year-old who needs a good talking to.

    To add to what I said in my last post, I think the critical thing in all of this is that I’ve gotten rid of blood-sugar spikes (even postmeals), and that roller-coastering blood sugars are what bring on complications long term (and sometimes even short term).

    I suspect that many cancers, cataracts, heart problems, kidney issues, etc., result from longstanding spiking blood sugars.

    Even so-called nondiabetics suffer, in my view, from such spiking from time to time, tho it goes unnoticed, by and large, by both the field of medicine and the individuals suffering (without apparent or visible) harm to health.

    @Richard

    From what I’ve seen, the B6, in effective doses, can act quite rapidly; on the other hand, it’s, I think, more likely it’ll take a few weeks to take effect. A couple of people I know who suffered from tennis elbow-type symptoms benefited from my give-it-a-try suggestion within a few days.

    But I think I can’t reiterate enough the importance of tamping blood-sugar spikes down as a regular thing.

    Regards, and my best,
    Chuck

  • 393 Chuck Boyer // Aug 21, 2012 at 7:18 am

    @Richard

    I just now clicked on your kesser link. Love it, love it. He’s very much on the right track.

    I’ve long taken much issue with the ADA and its doctor-relied-on nonsense. And I have a lot of support for my position in that regard from experts who promote health over putting out fires.

    Kudos, Richard. Kudos.

  • 394 Richard // Aug 21, 2012 at 12:27 pm

    I like this one too:

    http://diabetes-health.vrg-healthfitness.com/2012/08/19/watch-dr-fuhrman-cures-type-2-diabetes-but-drug-companies-object-4/

    If true, it says a lot about organisations like the ADA.

  • 395 Chuck Boyer // Aug 21, 2012 at 1:51 pm

    I’m familiar with Dr. Fuhrman’s claims from watching him on Public Television. He’s very good … and very knowledgeable … and I concur with him on much of what he says.

    Thanx again for pointing to such a relevant site/link.

    There are many sources for tackling diabetes in ways that promote good health all around. All we have to do is look, listen, test for ourselves, and all the while stay on a constant look-about for what might work even better.

    Exploring is fun. As I’m sure you know.

  • 396 CHUCK F // Aug 21, 2012 at 3:37 pm

    @ CHUCK BOYER
    How do you prevent “Spikes”?
    Take B-12 now. Should I maybe take B-6 also

  • 397 Richard // Aug 21, 2012 at 4:34 pm

    @Chuck Boyer

    Exploring is fun but can also be quite depressing :(

    I’ve got a two week break from work coming up. I think I may try the first two weeks of the eight week 600kcal plan. I might not manage two weeks but it will be interesting to try.

    http://www.diabetologia-journal.org/Lim.pdf

  • 398 Chuck Boyer // Aug 22, 2012 at 6:52 am

    I’ve taken B6 for many, many years, in the 100-mg-per-day amount (50 mg twice a day, with food). It’s evidently, for me, enough to be effective … without overdosing.

    The small amounts of B6 found in multiples I think tend to be too low to make the desired difference in peripheral-nerve behavior.

    As to avoiding spikes, it works for me to eat very small meals, just two per day, and be very, very selective in the foods I incorporate … and of course their quantities. I also minimize sharply my protein intake in a particular meal.

    Protein raises my blood sugar quite noticeably.

    A good bike ride for about 15 minutes postmeal makes a big difference, in my experience, in tamping down my blood sugar. As, alternatively, does a 15-20-minute brisk walk.

    An Ayurvedic physician once told me to wait about ten minutes after eating, then exercise, advice I follow.

    I also do a 15-20-minute exercise stint roughly two hours before bedtime. Total of three times of exercise each day.

    Of course on volleyball evenings I can dispense with the late-afternoon/early-evening walk or bike.

    My best to you.

  • 399 Chuck Boyer // Aug 22, 2012 at 7:00 am

    Some at this site may want to check out longevity.about.com/od/diabetesandhealthaging/a/coffee_diabetes.htm re coffee consumption.

  • 400 Lise // Aug 22, 2012 at 7:35 am

    Does anyone know whether fructose malabsorption (which is what I have as well as Celiac disease), leads to insulin resistance? Or is it IR which brings on the FM? Am so confused and as of yet, have not found a doctor in my area with any sound advice, knowledge or understanding of what is going on in my body. There is also the SIBO problem as well, and between FM and SIBO, I cut most carbs out…no starches, fruits, high carb veggies, or grains.

    My diet consist of beef, oxtail or beef bones for broth, chicken bones for broth, salmon, shrimp, chicken breast, Zuchinni, spinach, sometimes yellow squash or spaghetti squash, steamed. Olive oil and herbs (fresh) for seasoning and sea salt. Eggs boiled and unsweetened almond milk for breakfast, and as a beverage during the day.

    Have lost weight I can’t afford to lose, and suffer from fatigue, though I swim two or three times per week, and walk or stationary bike the remainder
    of days. To keep myself from jumping off a bridge, I use meditation before sleeping, I do three fun things a week that is not food related, I get a massage (therapeutic which ins covers!) twice a week.

    Any ideas? I’m at my wits end. The bloating, pains, constipation, indigestion and sometimes reflux type issues drive me nuts. Added to that, if I don’t eat something from my list above every couple of hours, I get what I think is a terrible hypoglycemic attack! Dr said he doesn’t believe this exists also.

  • 401 Chuck Boyer // Aug 22, 2012 at 2:11 pm

    I probably can’t be of help, Lise. Sorry. I’m not familiar enough with your situation, even after what you’ve explained here, to comment beyond the following.

    One thing that comes to my mind: If I were eating your described diet, from what I can discern here in your post, I’d almost surely have constipation problems.

    Are you getting enough fiber? Psyllium works well for me, as do a small variety of fiber powders … always unsweetened, by the way.

    Such fiber(s) seem to slow blood-sugar rise, at the same time allowing enough sugar through for my energy requirements.

    As to sleep needs, have you tried melatonin? The info I have indicates it’s quite ineffective up to a certain age of the consumer. As I’ve said before here, I’m in my 70s, sleep well (with the aid, of course, of my trusty melatonin taken before bedtime), and don’t have energy issues.

    At least not presently.

    Wish I had more ideas to float your way.

  • 402 Richard // Aug 23, 2012 at 3:02 pm

    @Lise – I think fructose in general may help people along the road to diabetes. Here’s a link to an interesting video that talks about fructose a lot. IIRC, there’s some bits in there that show correlation between childhood type 2 and increase fruit juice intake. It’s a long video but worth spending 90 minutes watching.

    http://www.youtube.com/watch?v=dBnniua6-oM

    @Chuck – my B Complex has B6 at 1.4mg. I could take more but I’m wary about the 100mg you mention. I’ve read that B6 toxicity is a problem when you supplement by more than 10mg per day. Apparently above this level the long term affects are bad and actually include neuropathy.

  • 403 Richard // Aug 23, 2012 at 3:11 pm

    Another interesting read, which was attacked by the sugar industry several decades ago, is “Pure, White and Deadly”. It’s now out of print but some people have scanned it to make it available through the Internet.

    https://www.dropbox.com/s/pwh18rby5dwzd51/John%20Yudkin%20-%20Pure%2C%20White%20and%20Deadly%20%28revised%201986%29.pdf

  • 404 Ellen // Aug 24, 2012 at 7:21 pm

    @Lise
    Some ramblings and musings. I had some problem with mild constipation when I first gave up grains and starches and even most fruit. It soon went away as long as I ate my approved vegetables and a little fruit. The body adjusts. Celiac disease must really complicate everything for you but I don’t eat grains, really nothing out of a box. I found that as soon as I cut grains from my diet I no longer had any bloating, gas, fluid retention etc. But it sounds like you’ve already given up most of that. I also eat a lot of meat and only two meals a day. I am never hungry because meat stays with you. And the fewer times you put food in your mouth the fewer times you have a blood sugar rise. Its a strange diet, bur has worked well for me for over 4 years. Blood sugar good and I have so much more energy. At first this diet helped me lose a lot of weight but then I leveled out. Have you tried eating a little more meat if you want to stop losing or gain weight? I don’t take any vitamins. My doctor forbids it and from a lot of things I have read I think they can be dangerous.

    As for fructose, I’ve read that one of the dangers is that it is processed through the liver. So that isn’t a good thing and I’m sure can’t be good for those of us who are insulin resistant.

    As for sleeping problems, are you by any chance, menopausal? That can just destroy a good nights sleep!

    Another thing, with your feelings of hypoglycemia, that can happen before you get full blown diabetes. My father and I both had that problem years before our blood sugar started to creep up. And when you start to being high blood sugar down you can have hypoglycemic symptoms even when your blood sugar is normal. E. g., if your blood sugar has been running at 300, most doctors will try to bring you back to normal slowly because even at 100 you could have the shakes and feel empty. This is because your body is used to the high blood sugar and you produce adrenalin as the blood sugar drops. Adrenalin causes the shakes and makes you feel hungry and crave carbs in order to raise your blood sugar. I had this happen when I first went on my diet and my blood sugar was 74. I love having 74 now!

  • 405 David Mendosa // Aug 25, 2012 at 12:08 pm

    Dear TC,

    Unfortunately, people can get diabetes for many reasons. Typically, people get type 1 diabetes as an auto-immune disease caused by many things including infections and type 2 diabetes associated by — not caused by — being overweight and inactive. But many, many other causes exist and even otherwise healthy people get diabetes. The research definitely says otherwise than the studies you found. You need to accept that you MAY have diabetes or if not then pre-diabetes. With acceptance you can control your health better than ever, particularly if you adjust your diet accordingly.

    Davi

  • 406 David Mendosa // Aug 25, 2012 at 12:34 pm

    Dear Ellen,

    Thanks for asking about me! Where am I? This month so far I have been in the highlands of Ecuador, the islands of the Galapagos, Yellowstone and Grand Teton National Parks, and the Seedskadee and Browns Park National Wildlife Refuges. I returned home for a few days last night and am finally catching up on my email.

    The article to which all these comments are appended did quote some people who report a more reasonable norm for A1C is the low 5s. Or perhaps that with Steve Freed’s excellent comment here. But personally I trust Dr. Bernstein and all the success that he has had with thousands of his patients. Dr. Bernstein aims for an A1C of no more than 4.6 and that is definitely my own goal.

    I agree that we have to keep this discussion fact based and less argumentative. Please stay here for balance!

    Best regards,

    David

  • 407 Chuck F // Aug 25, 2012 at 5:04 pm

    Is the DCCT study & findings still valid since a “good” A1c is lower now. Is this study possibly an
    answer to what a good & normal A1c is

  • 408 Chuck Boyer // Aug 27, 2012 at 6:53 am

    @Richard

    I did research B6 dosages many, many years ago … more than 20, in fact. The info I found? A consumer can take up to 300 mg/day for a short time, but then should drop back to 200 or less for long term intake.

    My 100 mg/day is, I think, very safe. I’ve been on it for over 20 years now; no problem. As I expected.

    Don’t know where you got your info that over 10 is a problem; but if that’s true, then I must be overloaded with B6 toxicity.

    I also have been, during my entire time on it, aware that toxicity with B6 would bring on neuropathy long term.

    Something’s amiss here. I do think I’ll continue with my dosage, which I cosider to be safe … as well as effective. I doubt that B6 at 10 mg/day would be effective in alleviating present neuropathy.

    Regards,
    Chuck

  • 409 Richard // Aug 27, 2012 at 7:06 am

    @Chuck

    I can’t find that reference again. I have found references to 100mg. Mayeb the 10mg was a typo.

  • 410 Chuck Boyer // Aug 27, 2012 at 2:21 pm

    @Richard

    I do find it interesting that 100-mg tablets of B6 are available over the counter. And if memory serves me, even 200.

    I take the 50-mg size, as I’ve already indicated, twice/day with food.

    Seems that as people get older, the likelihood they have too little B6 in the bloodstream rises. (Something to look forward to.)

  • 411 saddaf // Aug 31, 2012 at 4:25 am

    Dear Chuck Boyer sahab!, in our part of the world, we say sahab after the name as a mark pf respect for elders.

    i have been following yours and others post and though i am pretty worried about your statement on spikes ( even one hour of sugar spikes can damage organs), i am motivated as well as pushed to do something about it. exercise is what i hate to do but i figure it has to be a part of my life if i want to be healthy again.
    thanks for all you share with us.

  • 412 Richard // Aug 31, 2012 at 1:29 pm

    I’m starting a new experiment tomorrow whilst I’m on holiday from work. I don’t know if I’ll be able to manage it or not but I’m going to try something similar to the 600 calorie diet described at http://www.guardian.co.uk/society/2011/jun/24/low-calorie-diet-hope-cure-diabetes.

    I thought I’d blog about it. Sorry if this link shouldn’t be put here but I was hoping for a bit of moral support :) @David – if you disapprove, please delete this comment.

    http://diabetesexperiment.blogspot.co.uk/

  • 413 David Mendosa // Aug 31, 2012 at 1:33 pm

    Dear Richard,

    Go go it here!

    David

  • 414 Richard // Aug 31, 2012 at 2:39 pm

    You’re not going to try talk me out of it?

    ;-)

  • 415 David Mendosa // Aug 31, 2012 at 2:50 pm

    Dear Richard,

    I do think that there are better ways to manage our diabetes and weight. But I also know that a calorie restricted (CR) diet is good for our general health. Go for it!

    David

  • 416 Chuck F // Aug 31, 2012 at 4:51 pm

    @Richard

    Keep us informed & good luck!

  • 417 Richard // Aug 31, 2012 at 5:03 pm

    Thanks Chuck.

    I’m going to post to the blog regularly. Hopefully I’ll keep it up and not close the blog after two days :-D

    I’d love it if you would visit and leave the odd comment.

  • 418 Lise // Aug 31, 2012 at 6:03 pm

    Richard, can one subscribe to your blog? I’d love to follow your adventure :-)

  • 419 Richard // Sep 1, 2012 at 1:53 am

    @Lise,

    If you use an RSS reader there’s a feed right at the bottom of the page. I’ve also added a “Follow by email” box on the right. I’m not sure how this works so I’ve subscribed to it myself to find out. I assume it will post either a link or the text of each post to you.

    Day one, 130 calories in at the moment. :)

  • 420 CHUCK F // Sep 1, 2012 at 3:30 pm

    Any have commentnts or experience with how dairy, cottage cheese has an effect on normal blood
    gluecose?

  • 421 Richard // Sep 1, 2012 at 3:40 pm

    Don’t know about normal glucose as I don’t have that ;)

    I’ve never been a fan of cottage cheese so I can’t comment. I am a lovers of normal cheese and find that the affect on my BG is negligible. I seem to be able to eat as much as a can physically stomach and see no change in my readings.

  • 422 Richard // Sep 3, 2012 at 4:29 pm

    I’m three days into my experiment now. BG levels are down (though that’s to be expected as I’m starving myself). No loss of energy though (walked 5 miles today on a day out) and no hungriness.

    I’ve updated the blog. If you want to see where I walked (and a picture of me acting stupid) I’ve added some photos to the page. :)

  • 423 Lise // Sep 3, 2012 at 5:21 pm

    Chuck, sorry for not responding earlier. Lots of allergy testing going on.

    I agree with you about my diet and constipation. It’s unfortunate that the reflux and heart burn is so bad at times that I can’t take citrucel anymore. The orange sugar free is too acidic. There is something else in citrucel that’s bothering me also. Possibly the maltodextrin I think.

    For now I have to abstain from any fibre also because the bacteria thrives on fibre. It’s a catch 22 I live with.

    Found out I am allergic to yeast and rice, oats, peppers, and garlic. Bizarre.

  • 424 Richard // Sep 6, 2012 at 11:14 am

    I saw the nutritionist today. Bit weird. I was only there for a blood test but mentioned the 600 calorie diet. She approved! She even went as far as saying that this type of diet can cure type 2 diabetes.

    Odd eh?

  • 425 Chuck Boyer // Sep 11, 2012 at 7:05 am

    Looking forward to blood labwork results coming in a few days. I suspect my A1(c) will be in the neighborhood of 4.2-4.2. But truth’ll tell. Whatever.

    @Lise

    A number of things occur to me (as a layperson who does not manifest your particular set of symptoms, of course).

    If I were to present with something akin to what you describe, I’d be sorely tempted explore a few possible avenues:

    (1) I would assume there is a solution–or set of solutions–and proceed accordingly, if not dispassionately.

    (2) I’d suspect the bacteria colony in my gut of being strongly of the toxic kind, putting the whole neighborhood in that area out of kilter and thus conducive to poor health.

    As part of a suite of (following possible) actions, I might try (Greek) yogurt, nonfat plain, with probiotics listed somewhere on the label.

    (3) I’d research effects on gut by psyllium and inulin … and even high-fiber veggies, limiting myself to greens, for one instance, with a glycemic index of under 10. And the veggies I would eat raw. When they’re cooked, sugar content goes up … and effective fiber content drops.

    (4) I’d suspect a recent history of antibiotics, if I had one, to be part of my set of problems.

    (5) I wouldn’t overlook stressors, both from life events and from my particular health presentments, as contributing factors.

    (6) I’d investigate feasibility of a stool transplant, which seems to be cutting edge nowadays.

    Wishing you well. Hope something here rings bells … somewhere.

    Yours,
    Chuck

  • 426 Tere // Sep 16, 2012 at 12:38 am

    Hi David ..

    I was recently diagnosed as T2(last month) .. high Bp 154/92 .. glucose 10 was told by my Gp it should be below 7 .. and high cholesterol. I was told that I had to go on med’s for all the above and chose NO! and I’m not sure if that decision will come back and bite my A .
    Over the past month I have made the necessary changes to my diet(but more can be done here) .. I have always done cardio 3x a wk and trained with extremely ‘heavy’ weights twice a week. Yet I have always struggled to drop the excess kilo’s.
    I came across one of your blogs and have read most of the info shared between yourself and others. I have tried to take on-board most of the information on offer here and would like to say a big KIORA from NZ and to say thanks to you and your readers for all the shared information. Its been a great help.
    My last doctors visit(4 days ago) my Bp was 149/89 and I have lost 3.5 kilos .. my glucose self test bounces between 6-8. I hope i’m on the right track and will check in again. My doctor is monitoring me month by month and will do an A1c test at three months(2 months to go).
    I think it >sux’s< to be me at the mo! lol

    Regards
    Tere from New Zealand
    Also I read your newbie post :) thats me.

  • 427 David Mendosa // Sep 16, 2012 at 7:00 am

    Dear Tere,

    You sound like you are on the right track to managing your diabetes. But getting your blood glucose under control immediately is the key to minimizing the risks of complications later. My only concern is with you phrase, “More can be done here.” I know how hard it is to give up all grains and starch and sugar. In the short term if you can’t do that, it could be better for you to accept your doctor’s advice to use a diabetes drug. That will work fast — but a very low carb diet will work just as fast and can be safer and more satisfying.

    Best regards,

    David

  • 428 Richard // Sep 16, 2012 at 9:41 am

    @Tere

    If you keep up with low carb you should be able to control your glucose levels and may find your BP helped too. My BP used to be over 200 but now it’s a more normal 130/85 most days. The only change I made was to go low carb, high fat, high fibre vegetarian. My blood glucose normalised too (last A1C was 4.8%) and I lost about 60 pounds. I would strongly advise giving up sugar and starches (potatoes, rice, pasta, bread). I do eat a tiny amount of sugar (maybe 2g per day) and a slice of bread maybe once a fortnight but that’s all. The starches aren’t as bad as sugar but aren’t far off. I also gave up most fruit as that spikes my blood too. Strawberries don’t with me so they are my only fruit intake.

  • 429 Tere // Sep 16, 2012 at 2:13 pm

    @David & Richard

    Thank You both for the advice and quick response. The past month has been a little ‘all over the place’ but ’sugar’ I had determined to dramatically cut to ‘nil’ .. but I will switch to low carb – high fibre vegetarian as suggested and ‘toy’ around with a few of the fruit options(as I can’t imagine life without a little fruit) Also, is dried fruit a no-no? Dates or Raisins? (my fingers are crossed here until I get a response) :)

  • 430 David Mendosa // Sep 16, 2012 at 2:48 pm

    Dear Tere,

    I’m not one to say absolutely no to dried fruit. Even arsenic in small amounts doesn’t kill us! But dried fruit is concentrated carbohydrates. Test it yourself to see what effect it has on your blood sugar: first test before eating the amount you choose, then eat, then at about 75 minutes, when typically we reach the highest level, test again. Don’t eat anything else during that time (or even in the two our so hours before starting the test) and don’t exercise during the test, because those would invalidate your study. If your level goes up too much — by your own standards (which will probably evolve) — eat less next time, and test then too.

    Best regards,

    David

  • 431 Ellen // Sep 16, 2012 at 5:33 pm

    Hi Tere-

    Another point of view. I eat a very low carb diet (no grains and starches and very little fruit) but I eat a lot of meat. It keeps me from being hungry. My blood sugar improved dramatically, I lost a LOT of weight without being hungry, my blood pressure is 108/60. So if you want to do the vegetarian route, just be aware that if you like meat you can also achieve great results eating meat and low carb.

  • 432 Tere // Sep 17, 2012 at 12:09 am

    Hi Ellen ..

    thank u for your advice :) .. I have started taking notes and will follow the options offered here .. I guess it will take time to gauge the ‘diet’ that I would be able to maintain long-term .. scratch that .. for the rest of my natural life. I love that I have come across this site .. its awesome to be talking to others living the talk and not having to sit across from a doctor offering generic advice. Again thank u :)

  • 433 Lise // Sep 17, 2012 at 5:32 am

    Hi all, I am having a fructose malabsorption test done soon. Not going to enjoy drinking 12 oz Coke first thing in the morning though!

    Still battling to have glucose tolerance test and have someone really consider the thought that something isn’t right in the state of Denmark i.e. my body with regard TI diabetes or pre-diabetes. It’s just bizarre how I feel (hypoglycaemic) episodes and inability to handle carbs.

    Have to call about another A1C test. It’s three months since the last one.

  • 434 David Mendosa // Sep 17, 2012 at 6:52 am

    Dear Lise,

    I think the tests will help. But I have one comment now, and it’s about your feeling hypoglycemic. Often when people change their diet they do feel hypoglycemic when their blood sugar level isn’t really that low (65 or 70 and below). It’s very important to test with your blood glucose meter at that time. What do those tests show you?

    David

  • 435 Becky // Sep 17, 2012 at 8:22 am

    My most recent AC1 test results were 6.1. I’ve been on Metformin for at least 8 years, may be more. At what level does it have to reach for a person to usually have to start taking insulin? I want to avoid it for as long as possible. Thanks.

  • 436 David Mendosa // Sep 17, 2012 at 8:37 am

    Dear Becky,

    While your A1C level is not quite into the normal range yet, your doctors will be happy enough with it that they won’t encourage you to use insulin. I won’t encourage that either, but I will encourage you to bring it down still further to minimize the risk of complications developing later. For most people the best way is to follow a very low-carb diet and perhaps lose a few pounds.

    Best regards,

    David

  • 437 Richard // Sep 17, 2012 at 12:42 pm

    @Tere

    Just to be clear, I didn’t choose vegetarian because of my diabetes. I was vegetarian already. Ellen’s right that eating meat won’t affect your blood glucose too much. Carbs bad. fat good, protein in the middle somewhere. Protein does convert to glucose but much more slowly than carbs. Also, if you eat some carbs and eat fat, protein or high fibre at the same time, the carbohydrates are converted to glucose more slowly. They’ll still get into your blood but it takes longer.

    Best thing to do is test your blood often and for different foods until you understand how your body reacts. I tend to test about three times a day now, more when I’m eating something I’m not sure of. At first I was testing probably ten or twelve times a day (so a meter with cheap strips is a must!)

  • 438 Lise // Sep 17, 2012 at 2:26 pm

    Chuck, it’s been awhile since you wrote the list of things for me to consider with regard to my declining health. I just wanted you to know that I’ve gone after the doctors with those things in mind and have slowly been getting some ideas. They don’t like being told what to look for or what tests to do, haha

    Anyway, I’ve been through allergy testing (three separate visits), for foods and environmental allergens. This is the best clinic we have in the state so I feel like am on the right track.

    They did needle sticks and also blood work. Today I went for a series of patch testing.

    The earlier tests reveal three types of mold, rice, yeast, garlic, ginger (slight) peppers moderate, and oats. I’ve known about oats before and am already gluten intolerant, so used to being deprived. Just not as severe as I’ve been.

    The one thing my allergist asked though was whether I was having any diabetic issues because I told her anything with sugar, fruits or pies, even gluten free, leaves me so tired and sick. Even strawberries and blue berries.

    Anyway, her advice was to continue following A1C levels, suggested I get the gadget you guys use for testing when I eat (other doc said I shouldn’t since not diabetic yet, sigh), and she wants retest of fructose malabsorption and lactose intolerance.

    As for stress…just being sick all the time is a stress on me, and I’m aware of this. I go to gym at least 4 times per week, walk at park other days, get massage every week, and try to do two fun things per week which is not food related. Seems
    To be helping me stay in good mood. I also listen to meditation cd. They’re by Deepak Chopra.

    I really value the input and wisdom on this board. Btw, how do I go about buying the system for testing my blood sugar levels? Am kinda chicken about pin pricks :-(

  • 439 David Mendosa // Sep 17, 2012 at 3:28 pm

    Dear Lise,

    Blood glucose meters don’t require a prescription. And people who are diagnosed with diabetes can usually get them at little or no cost. In your case, I suggest that you get one of the least expense meters and associated test strips. That would be the ReliOn meter and strips from Wal-Mart. I don’t remember, but I think that it comes with lancets and a lancing device; if not, you can get it separately there. Actually, my favorite lancets are called tiniBoy that you can get from http://www.tiniboy.com/

    It is the lancet, not the meter that can hurt! Tiniboy lancets are the smallest and therefore hurt least.

    Tips: do not use alcohol (people used to recommend that), but do wash your hands with soap and water and dry. Warm water will make the blood flow easier. Test on the sides of your fingers, not on the pad, because that’s the part of your figure that you use to write us here!

    David

  • 440 Lise // Sep 17, 2012 at 6:33 pm

    Thank out David. I will check the links out.

    By the way, my doctor said I should fast before rechecking my A1C. Why? I thought it wouldnt matter?

  • 441 David Mendosa // Sep 17, 2012 at 8:05 pm

    Dear Lise,

    That is strange indeed! Are you sure that you heard your doctor correctly? Without question, it doesn’t matter whether you are fasting or not when you get your A1C checked.

    David

  • 442 Lise // Sep 17, 2012 at 8:40 pm

    Hello again David,

    Yes, I’m sure. It’s on the form, “fasting” test. Maybe they are mixing it up with the usual fasting test done annually?

    It doesn’t matter really then? I’ll just tell the lab what they want to hear :-)

  • 443 David Mendosa // Sep 18, 2012 at 5:27 am

    Dear Lise,

    Maybe the problem is because almost all other blood tests do require fasting. Very often we get a chloresterol test (what the medical profession calls a lipid panel) at the same time, and that does require fasting.

    David

  • 444 Tere // Sep 18, 2012 at 1:39 pm

    @Richard

    Thanks again will dedicate the weekend to ‘multiple’ testing (as my wk is hectic and I tend to let time get away from me) I really want to get this under control .. thanks everyone :)

  • 445 Richard // Sep 18, 2012 at 2:14 pm

    @Lise – I had to fast for my HBA1C too. It was only because they wanted to do two tests at once – HBA1C and FBG.

  • 446 Richard // Sep 18, 2012 at 2:15 pm

    Another shameless self-promotion – I’ve mentioned before a good friend of mine who was T2DM and now isn’t (according to his doctor and a GTT). I asked him to create a guest post on my blog and he’s done so. I thought people might find it interesting.

    http://diabetesexperiment.blogspot.co.uk/2012/09/im-really-please-to-be-able-to-bring.html

  • 447 Lise // Sep 19, 2012 at 7:36 am

    Richard, this was amazing to read.

    However, it sounds so hard to do! I can’t imagine most diabetics functioning on so little indefinitely.

    My hat off to you and your friend.

  • 448 Richard // Sep 19, 2012 at 12:24 pm

    Pete found it difficult at first but was OK after a few weeks. I barely felt hungry at all but I only did it for two weeks.

  • 449 Richard // Sep 19, 2012 at 12:25 pm

    …but it is a short term thing, not a permanent diet.

  • 450 Dirk Baeuerle // Sep 27, 2012 at 10:57 am

    David -

    I am Type 2 Diabetic, now for 3 yrs., and have worked my weight down to 294 from a high of 345 back on Jan. 1, 2012. I have problems with my morning Fasting blood sugar being high. I take Metformin 500 mg in morning, Metformin 500 ER at bedtime and also 1/2 a tablet of Januvia at bedtime. During day generally my sugar is ok, but in mornings it runs typically between 130 and 180. I am eating very low carb diet, and I walk to work most days, but cannot get morning sugar down. I also have hay fever allergies and take Claratin for them. I have slight numbness in my feet and, when sugar goes up in mornings, can feel it in finger tips. I want to get my morning sugar down but don’t know what to do.

  • 451 David Mendosa // Sep 27, 2012 at 11:40 am

    Dear Dirk,

    The easiest thing to do would be to ask your doctor to increase your metformin prescription to 1000 mg each morning and evening. Next, you could work on your weight, and the easiest way to do that would be to switch from Januvia to Bydureon or Victoza, if your doctor is familiar with either of them.

    You could take a tablespoon or two of Bragg’s apple cider vinegar after dinner diluted with a full glass of water and then followed by some more water. Lots of people have found that this helps minimize the dawn phenomenon. Of course, avoid eating anything for about three hours before you go to bed.

    The best and perhaps hardest thing would be to eat even fewer carbs. In this respect, you can start by carefully counting the grams of carbs that you eat each day, and what you need to count is total carbs not net (available) carbs. You need to shoot for 50-60 grams. If you experience is like mine, you may find that you are actually consuming more than that until you check.

    Good luck. I know that you are dedicated enough to your health to do these things.

    Best regards,

    David

  • 452 Anna Beth // Oct 3, 2012 at 4:39 am

    Dear David,

    I just did a test and here are the results. Do let me know if they are within control.

    Fasting blood sugar – 89 mg/dl

    HbAIc – 6.1%

    Urea – 15 mg/ dl

    Creatinine – 0.8 mg/dl

    Triglycerides – 121 mg/dl

    HDL – 49 mg/dl

    Thanks and regards
    Anna

  • 453 David Mendosa // Oct 3, 2012 at 7:28 am

    Dear Anna Beth,

    You are doing very well! Most physicians would say that your A1C level is within control. But since you are writing a comment to my article on what is a normal A1C level, you know that it is a little higher than normal. Sorry, but I don’t know what levels of urea and creatinine should be, but your other levels are definitely within range.

    Best regards,

    David

  • 454 Chuck Boyer // Oct 3, 2012 at 8:07 am

    @Dirk

    I avoid dawn phenomena by eating breakfast before dawn. In his book, Bernstein suggests doing just that.

    It works. At least for me. No problem here with morning BS number being high.

    Regards, Chuck

  • 455 Anna Beth // Oct 8, 2012 at 6:13 am

    Thank you David. Your feedback is important and helpful. I will try to cut down.

  • 456 Tere // Dec 9, 2012 at 9:35 pm

    Hi there David …

    Haven’t posted for awhile as I wanted to wait till I had my 2nd lot of tests since being diagnosed in aug 2012 with T2.

    2nd aug 2012

    BP 154/92
    Weight 84kg
    BMI 30 (should be below 25)

    Glucose 13.6 mmol/L
    HbA1c 86 mmol/L

    Lipids (fasting)

    Chol 6.1 mmol/L
    Tri 2.0 mmol/L
    HDL Chol 1.35 mmol/L
    LDL Chol 3.8 mmol/L

    Chol/HDL Ratio 4.5 (high)

    17th nov 2012

    BP 136/80
    Weight 77kg
    Glucose 6.3 mmol/L
    HbA1c 58 mmol/L

    Lipids (fasting)

    Chol 3.8 mmol/L
    Tri 0.6 mmol/L
    HDL Chol 0.96 mmol/L
    LDL Chol 2.6 mmol/L

    Chol/HDL Ratio 4.0

    Liver Function Test done 2nd Aug 2012
    IDEALS
    Total Bilirubin 10 umol/L (<25)
    Alk. Phosphatase 67 U/L ( 40 – 100)
    GGT 28 U/L (<50)
    ALT 26 U/L (<45)
    Total Protein 81 g/L (66 – 84)
    Albumin 46 g/L (38 – 52)

    David, although I am thrilled with my new numbers .. I am concerned about the 2 numbers that really count .. glucose and a1c . My question is ..should I now consider taking medication or should i persevere until my next block of tests? I can do further work with my diet.

    I would have posted this earlier but have been trying to process it all.

    Your advice would be highly appreciated as always.

    Regards Tere (from Nz)

  • 457 Tere // Dec 11, 2012 at 7:34 pm

    Hi David ..

    2nd Aug BMI 30
    17th Nov BMI 27

    My doctor advised that my BMI should be 25 or below. I guess more work needed here too.

    As always your advice is greatly appreciated.

    Tere from Nz

  • 458 Nurcan Keskin // Dec 25, 2012 at 9:07 pm

    Dear Mr.Mendosa,

    Thanks for the insightful website. I am not If you will answer this but I would like to get an opinion on this.

    I am 36 years old female with a history of diabetes in the family.
    In September; after regular physical check up
    my a1c came up as 5.9 and the doctor told me I am prediabetic and I need to watch my diet.
    At the time I was 129 pounds (normal BMI not overweight) I am 5” 3′.
    Well being horrified and sad for 3 days, I have made below changes;
    Increased my exercise intensity
    Take off white bread, rice, pasta,pizza,juice, soda, any dessert or any bakery products from my diet.
    I started watching G Index and G load of produce that I am buying.
    Lost 11 pounds (now 118)
    After 3 months later ; in December I had another a1c and it came up exactly as before 5.9
    I was very upset, I have done everything right and I can still have the same number (what is the probability of this?)
    This time I got another doctor’s opinion.
    He said; 5.9 was normal to begin with and this is my normal blood sugar, so it won’t go lower even If I lose weight (he said; losing weight will bring down the number if the person is overweight) but I should keep an eye on my diet because of the family history.

    I have read about bitter melon juice that it can help lower the blood sugar, I have been drinking it every morning on a empty stomach (not pleasant) for 1 week now. Also the cinnamon

    I am planning to go back in 6 months to be checked again and to see if it is any lower than 5.9

    Any input on this will be helpful

    Thanks
    Nurcan

  • 459 David Mendosa // Dec 26, 2012 at 10:23 am

    Dear Nurcan,

    The changes that you made are great. Your BMI now is 20.9 and you wouldn’t want it to go much lower (although I personally do better with mine at 19.5). And it’s good news that you have pre-diabetes not diabetes. You can prevent the complications of diabetes by what you do now.

    I don’t think that your doctor is right than an A1C of 5.9 is normal. Thin, young, healthy people without diabetes usually have an A1C level of close to 5.0. Still, 5.9 is below the level at which diabetes is diagnosed.

    I know that your doctor is wrong when he said that your level won’t go lower. I personally wouldn’t bother with supplements including biter melon or cinnamon, even though they can indeed bring down your blood sugar level. I would reduce your carbohydrates even more (the starches and sugars) and consider your stress and/or infection level. Since you are exercising, do remember that exercise right after a meal heavy in carbs would have the most affect on your level.

    A1C tests, like any lab test are not 100% accurate, so don’t be surprised that your number happens to be the same. You might also consider buying your own home A1C test at your pharmacy. It’s called the A1CNow Self-Check and is as accurate, if not more so, than any lab test. Please also see this article:

    http://www.mendosa.com/blog/?p=1411

    Hope this helps.

    Namaste,

    David

  • 460 Carol Vander Stoep, RDH, BSDH // Jan 6, 2013 at 3:08 pm

    Great article! Having written a book on the connections between oral health and general health (Mouth Matters), I was surprised and pleased to see you draw the connection between high blood sugar levels and gum disease – and 3+ years ago at that. Especially when a few weeks ago, some grossly uninformed nutritionist said on the Today Show, “What goes on in the mouth stays in the mouth.” In fact, in so many ways, inflammatory diseases like diabetes and gum disease are tightly connected. Quoting from “Mouth Matters”, “Gum disease is the first symptom to emerge in those with diabetes, often showing itself in childhood before all other complications.” I see the truth of this so often in my practice. All of your readers should get checked by well-trained hygienists who understand whole body health (maybe AAOSH members?) who can also be invaluable members of the team that helps you attain optimal oral and general health! Feel free to google my website to learn more.

    Best,
    Carol

  • 461 Mary Ann // Feb 8, 2013 at 9:51 pm

    David,

    Thank you for having this website! I was diagnosed in November 2012 with T2, with an A1C of 6.4. I was shocked and new nothing about Diabetes. After shock, fear, anger and grief, I researched and found many helpful websites and blogs that provided the information that my doctor did not (everything!). I had to be the one to take control of it.

    I immediately went to low carb Atkins diet because I had success many years ago in losing weight, but eventually quit because my doctor didn’t approve. Of course over the years I gained excessive weight, had mild hypertension, was chronically fatigued, depressed, and barely able to function with increased rheumatoid arthritis and fibromyalgia, and extremely unhappy. I had no quality of life and consumed a high carb diet to self-medicate. I didn’t realize I was in a “coma.” I am actually grateful for the T2 diagnosis! It inspired me to take control of my health.

    After I met with the diabetes educator who basically gave me the meter and the ADA food pyramid and plate info and said no meds for now, but if no change in 3 months them start Metmorfin. I had to learn everything on sites like yours and others. I read Dr. Bernstein’s book and also other low carb authors. Incredibly the two topics were intertwined and I knew that I had to throw put the ADA info or I would never be able to lower my A1C.

    I had been on 2 months of Atkins Induction and gradually modified toward the Nutritional Ketogenic diet, to continue weight loss and lower blood glucose readings. In the 3 months on the diet I lost 32 lbs, from 278 to 246. I took myself off blood pressure medication 3 weeks ago since one of the drugs is Hydrchlorothiazide (HCT), is known to raise blood glucose levels. Hmm, I was on it for 15 years. I bought a home monitor and my readings are 120s/60s. I don’t advocate anyone taking themselves off medication, but my blood pressure was getting too low, 100/55 and I just knew the HCT was elevating my BG. AND my BG levels dropped by 15 points.

    Just got my lab results online today and my new A1C is 5.0. I was amazed, but more so am relieved that what I did was right for me regardless of what conventional medicine advises. Waiting for a call from the doctor as she usually calls to talk about lab work. My lipid panel improved overall as well too. Not perfect yet, but better. I’m scared to tell her that my very low carb, high fat diet is the reason for my lower A1C! Not sure if this is considered normal or not.

    I have about 80 lbs to lose and will continue my journey. Thank you for sharing your experience and wisdom for others to learn from. Sorry for the long post!

    Mary Ann

  • 462 Chuck Boyer // Feb 9, 2013 at 8:06 am

    Congratulations, Mary Ann. And by the way, you inspire. And thanx for that.

  • 463 David Mendosa // Feb 9, 2013 at 8:14 am

    Dear Mary Ann,

    As Chuck writes, your message is an inspiration for all of us. And a lesson. You are doing almost everything right and made only one mistake. That was in telling your nutritionally-challenged doctor what you eat. If you do keep her informed, consider that it is to educate her. No law requires us to follow a doctor’s advice that we know is wrong.

    Namaste,

    David

  • 464 Mary Ann // Feb 9, 2013 at 9:38 am

    David,

    I have not spoken to my doctor yet and was not sure if I should tell her what I eat. I’m thinking I should just say “low carb” as a generic term and not go into specifics. She probably would be horrified at how low I keep my carbs (5-20) from green leafy, cruciferous vegetables and consume absolutely no grains or sugar, but lots of coconut oil, butter, and not so lean meat. My daily calories are 80 percent fat, 15 percent protein, and 5 percent or less carb if I can manage it. You are right, I don’t think she is ready to accept the real deal, yet. I just know it has worked for me and I want to delay the progression of this disease for as long as possible.

    Thanks!

  • 465 Richard // Feb 9, 2013 at 5:10 pm

    Well done Mary Ann. I wish you the best with your new diet. I know how you feel about talking to the doctor. Mine keeps telling me to eat 300g+ of carbs every day and have little or no fat. I also get told that my blood glucose is fine as long as it stays below 11mmol/li (about 200).

  • 466 Mary Ann // Feb 9, 2013 at 7:29 pm

    Richard,

    It is so sad that doctors do little to educate patients on how to alleviate or reduce symptoms and just want to add a medication to solve the problem. The want to be absolved of any liability instead of truly advocating for an individual’s well being. We all have to be our own advocates. I’m just glad I was “shocked” out of my carb coma and realized I am the only one who can change this. It takes time and is challenging. I know that I can’t have most carbs and must keep my blood glucose levels as low as possible. My doctor didn’t even expect me to try to lower them or provide any information on how to do it. I’m pretty disgusted actually. I’ll probably be labeled as non-compliant for not adhering to the ADA diet and for taking myself off blood pressure meds. We all must have higher expectations for our health management than what our doctors provide.

  • 467 Chuck Boyer // Feb 11, 2013 at 7:37 am

    A strong Amen! from this corner, Mary Ann. Kudos to you.

  • 468 Lise // Feb 11, 2013 at 7:54 am

    Mary Ann, I boldly tell my doctors what I will or will not take, and about my diet. They are generally clueless and only interested in giving out sample medication or writing prescriptions.

    I was not diagnosed with diabetes, even with A1C levels at 6.2, feeling quits ill when I ate too many carbs, and having hypoglycaemic type passing out episodes quite frequently.

    A1C is down to 5.8 and they claim that’s perfect. Blood fasting levels were 87.

    Right now I am dealing with gut motility problems and have to do my own research, come up with my own dietary nerds and continue exercising. Absolutely no help from the doctors except for pushing meds. Useless is a word I use frequently.

  • 469 Richard // Feb 18, 2013 at 1:14 am

    Had an interesting diabetes clinic this week – my first for ten months and it will be another ten before the next. A1C was up slightly on last time at 5.0, where previously it was 4.8. All of my blood test results are now normal though and my cholesterol is down again, despite the high fat diet. My weight is stable now too. Over the ten months I lost one pound so I am now 154 pounds, which isn’t too bad for my 5′9″.

    The interesting part was the discussion around my diet. Last year I was reprimanded for my high fat, ow carb diet, with the standard advice to eat lots of whole grain carbs (up to 300 grams per day). I argued the point and pointed out that my blood results were hugely improved over the three months since I was diagnosed.

    This time around the diabetes nurse was really pleased with the results and said she had talked to a dietician. The dietician had said to her that athletes require a minimum of thirty grams of carbohydrate per day but that people like me who were exercising daily, but not to the level of an athlete, needed a minimum of just ten grams.

    What a turn around! It makes me wonder if the studies are finally starting to filter through from medical science into medial practice over here in the UK. I hope it continues.

  • 470 David Mendosa // Feb 18, 2013 at 8:32 am

    Dear Richard,

    That’s better. But they are still not right. No carbs are known to be essential. But as Dr. Bernstein says, maybe something in carbs will eventually be found to be essential, so a very low-carb rather than a no-carb diet makes sense. I have followed a very low carb diet continuously since 2007, consuming fewer than 50 grams of it on almost all days.

    Namaste,

    David

  • 471 Richard // Feb 18, 2013 at 1:18 pm

    I am always around 20g-40g per day anyway. I’m not sure if it’s possible to eat with zero carbohydrates – especially not for vegetarians like me.

  • 472 Arun Prabhu // May 6, 2013 at 9:24 am

    This week I recorded my lowest ever a1c that is 5.2. Te recapitulate my previous posts I am under no diabetic medication.
    The factors that I can think of that pushed by a1c lower could be the following.

    1. Decrease in my weight. I now weigh 118 lb at 5′7” ( BMI 18.5)

    2. Hiked my daily walk distance to 10 km / day in 2 sessions ( 7+3)

    3. A bit more reduction in daily intake of carbs. I do eat small portions of fruits daily.

    My greetings to all,

    Arun

  • 473 David Mendosa // May 6, 2013 at 10:08 am

    Dear Arun,

    That is a wonderful A1C level! Congratulations. I agree that the reasons you give for that success are absolutely correct. Keep it it — but don’t lose any more weight! You are fine just the way you are.

    Namaste,

    David

  • 474 Arun Prabhu // May 6, 2013 at 8:00 pm

    Thanks David. I do not think my weight will go down any further. Just that I was inspired by your own strategy to be at the lower end of the normal range in weight, sugar levels and the like!

    Namaste,

    Arun

  • 475 Eric Anderson // May 23, 2013 at 10:23 pm

    The Doctor Bernstein levels are very atainable. My A1C is 4.5

    I eat a Ketogenoc diet 8% Protein 5% Carbs and 87% fat.

    I do modified fasting of 360 calories in a 36 to 40 hour window and 3840 in an 8 to 12 hour eating window.

    I get the benifits of ADF, Protein Cycling, and ketogenic diet. Lots of autophagy and great blood sugars, ketones, and lipid profile. Why not try for OPTIMAL?

  • 476 ro // May 25, 2013 at 6:24 am

    My client a1c levels is a 5.5 the doctor took her off medicine if she continues to take the medicine what can happen?

  • 477 Tutu // Jun 20, 2013 at 4:05 am

    My hemoglobin level is 11.9 and i have been tested for HBA1C at fasting time (before meal in the morning time). My HBA1C results shows 6.2 ; In the report it is given as 6 to 6.5 as Excellent. Also my doctor asked me to test for normal blood sugar before meal and PP(Post Paradinal) . The result that came as follows :
    Before meal at Fasting level : 97
    PP : 104

    I am under 30 years of age . Ami i diabetic? is the above reports normal?

  • 478 David Mendosa // Jun 20, 2013 at 7:18 am

    Dear Tutu,

    Your A1C level is in the range where no one can determine if you have diabetes or not. You will need to take different tests to decide.

    Namaste,

    David

  • 479 CHUCK F // Jun 23, 2013 at 9:16 am

    Last A1c was 5.5 & DR. said I could go off Metformin ER ( I asked to be taken off). My DR./labs says long as its under 6.0 I am ok.
    Test , fasting twice a day with bg in 80’s /with some in the 90’s with about 2 a month in low 100’s
    (-109: possible stress?) Hope to go lower. Am I ok?
    Can I Go lower?/” Normal BG” as DR. Bernstein
    says? Have read his books& gone through this website. Any thoughts comments? Diabetes complications scare me because my Father had all of the complications from it. I am a male in my 50’s that works a blue collar job(12 years till retirement & really don’t have any support structure.
    Thank You
    Chuck

  • 480 Eric Anderson // Jun 23, 2013 at 12:08 pm

    @Chuck
    My A1C is 4.5
    Sometimes my night BS is 90
    I will ask to add METFORMIN so I can keep night time BS closer to the OPTIMAL 78 to 83 range,
    As noted before home testing is not so accurate in the 80 to 100 BS levels. Hmm! Eric

  • 481 David Mendosa // Jun 23, 2013 at 3:50 pm

    I think that your strategy of adding some metformin is a good one. Obviously, it’s working for you as your outstanding A1C level proves.

    Namaste,

    David

  • 482 David Mendosa // Jun 23, 2013 at 3:53 pm

    Dear Chuck,

    By coincidence you and Eric wrote at the same time with a different take on the same question of metformin. Please consider his strategy. You might also want to get into a discussion with him about his metformin strategy.

    Namaste,

    David

  • 483 Nelle // Jun 23, 2013 at 5:18 pm

    @Chuck-

    You have a support structure. You have us.

  • 484 CHUCK F // Jun 23, 2013 at 5:45 pm

    I want normal BG’s but I always thought it is better to do it without medications. I know Metformin has been around for a long time.

    Thank you
    Chuck

  • 485 Nelle // Jun 23, 2013 at 6:00 pm

    I think you’re wise to be cautious about medications but sometimes we can’t do it without some pharmaceutical help. Metformin is one of the oldest and most tested of the medications but as my doctor says “it’s not a totally benign drug.” It can have very good results but one of the side effects that worries me is that it can present a danger if you have to have surgery. Something about interaction with anesthesia and problems with the kidneys. So they recommend you go off the Metformin several days before any surgery. But what if you need emergency surgery? So anyway, it is something you have to think carefully about but Metformin is a drug that you can stop taking if you want to without adverse side effects and try to control BG with diet. Unlike stopping statins or aspirin which Dr. Bernstein says can increase your risk of heart attack or stroke. I wish my Dr. hadn’t put me on those.

  • 486 Eric Anderson // Jun 23, 2013 at 6:22 pm

    Chuck
    Here is a study that demonstrates big benifit of lower Insulin. As Metformin reduces the amount of glucose from the liver (Gluconeogenesis) it also reduces the Insulin response so we get lower glucose, Insulin, A1C and on average longer healthier life (IMO)

  • 487 David Mendosa // Jun 23, 2013 at 6:33 pm

    Dear Nelle,

    You are so right!

    Namaste,

    David

  • 488 Eric Anderson // Jun 23, 2013 at 6:35 pm

    Here is a link.

    http://circ.ahajournals.org/content/98/5/398/F2.expansion.html

    Demonstrates the advantage of being in Q1 (Optimal) vs Q 2,3,4, or 5

  • 489 David Mendosa // Jun 23, 2013 at 7:40 pm

    Good advice, Nelle. Thank you.

    Namaste,

    David

  • 490 David Mendosa // Jun 23, 2013 at 9:13 pm

    Dear Eric,

    Thanks for the added incentive to keep our A1C levels as low as we can!

    Namaste,

    David

  • 491 CHUCK F // Jun 24, 2013 at 4:28 pm

    Thank you all

    Chuck F

  • 492 BOB // Jun 27, 2013 at 7:22 pm

    Very informative site. My A1C is 6.8 with BG of 90 and my doctor has never said anything about diabetes to me. I wonder why? my weight is 130 lbs, height 5′3″. MY creatinine level is always above range. After reading all these comments I am now very confused and worried. Maybe I should be on Metformin?

  • 493 David Mendosa // Jun 27, 2013 at 8:27 pm

    Dear Bob,

    Your A1C is at a level where you could have diabetes. You need to have your doctor give you a further test to determine if you do. You almost certainly have at least pre-diabetes and need to cut back on carbs and get your body mass index, or BMI, down to normal.

    Namaste,

    David

  • 494 Sacdiyo // Aug 6, 2013 at 9:24 am

    I am 29 years old. Iam 5′4 and weight 190. I had gestational diabetes I asked my doctor to check my hgb A1c and it is 6.7. I am so afraid what will the doctor . I don’t want to hear diagnose of diabetes. Is there other test I can get to confirm if am diabetic. Because I only get hgb A1c

  • 495 Sacdiyo // Aug 6, 2013 at 9:25 am

    Sorry I have hx of gestational diabetes

  • 496 David Mendosa // Aug 6, 2013 at 11:44 am

    Yes, either one of two other tests that your doctor can give you will confirm whether you have diabetes. Your A1C level is in the range where it alone won’t tell you whether you have it. Of course, it does tell you that you have at least pre-diabetes, so now is the time more than ever to start to manage it by losing weight, eating fewer carbohydrates, and walking more and/or being more active in other ways.

    Namaste,

    David

  • 497 Sacdiyo // Aug 26, 2013 at 11:25 pm

    My doctor told am diabetic based on my hgbA1c but I don’t have to start any pills

  • 498 David Mendosa // Aug 30, 2013 at 1:02 pm

    Dear Sacdiyo,

    What are you then doing to manage your diabetes? A very low-carb diet with lots of exercise, I hope. And what is your A1C level. You really need to know this yourself and not just rely on your doctor to know it.

    Namaste,

    David

  • 499 Diann // Oct 10, 2013 at 1:03 am

    My first AC1 was 6.0 I was also diagnosed with hypothryroidism at the same time. I was put on synthroid and told I was pre-diabetic because of that one ac1 test and he wanted to put me on meta-for.. I declined. I preferred to see how my blood sugar would react to the thyroid med. 3 months later my ac1 was 5.9. I went to an endo who told me I had Hashimoto’s disease. He said I just needed to watch my diet and that I wasn’t diabetic. My last AC1 was 5.8. I hadn’t changed anything except taking the thyroid meds. I have since stopped drinking soda and I am interested in seeing how that changes my AC1. I enjoyed your article because it was very confusing to read one article saying 7.0 and below was normal and another that or 6.0 and lower was normal, depending on what literature I looked at. I think it’s disturbing that there isn’t a solid consensus and that people are being put on meds depending on which range the doctor is using.

    Diann

  • 500 Lynette // Jun 14, 2014 at 8:20 pm

    Tons of comments and interesting but long. Finally had to stop reading.
    Technically I do not have diabetes yet but beg to differ. A1C of 5.2% (came down from 5.7%) but BG ranges up to 11.4 immed after meals. (I am in Canada- to calculate X by 18). Then they usually normalize quickly. Therefore, if I happened to have a random BG at the lab- and was “caught” at that moment- diabetes could be diagnosed.
    Therefore- I think much of the less than ideal A1C’s we have, have to do with quick and sharp spikes post meals that no one picks up on. After all- who checks at the 1 hr mark or even sooner? These are NOT what a healthy body would allow and I think drive the sub-optimal A1C’s that physicians are not alarmed at. After all- first phase insulin response is the main thing that “goes” in pre-diabetes and at initial diagnose-of course depending on age. The older you are the more hidden diabetes is.
    That’s all for now- more comments another time.
    I have found some ways that are helping the spikes post meal and can be helpful but I do think things are advancing too quickly and I need the help of medication. I have been trying to outrun it for 10+years and as I age, 53 now- I think it finally has a hand on my shoulder.