Welcome back to our weekly diabetes information column, Request D’Mine — along with your host veteran type 1, diabetes author and instructor Wil Dubois. This week, Wil requires on a couple question about low carb, low-fat diets and some not-so-pleasant complications which simply add over the mixed wellness bag individuals with diabetes are already taking. Read on to learn what might help…
Got your personal questions? Email us in AskDMine@diabetesmine.com
Bhassker, form 2 from India, writes:As a 22-year diabetic on insulin (both Humalog and Lantus) and also a recent convert to LCHF (Low-Carb High-Fat diet),I’d like your view on if good control of blood sugars with just a little assistance from insulins is better than a very tight control by diet. My HbA1c is 6.4 and I’m aiming to move below 6.
Wil@Ask D’Mine replies: I think Omnes viae Romam ducunt. That’s Latin for “all roads lead to Rome.” In addition, it is my doctrine for diabetes control. There is no one right, or better, or worse way to get to the destination of the city of control. Any street, any therapy, which gets you where you’re going is a good one. The trick is to get the one that’s the easiest and best route for you.
Nonetheless, it’s funny you’re writing to me in India, not Italy, because it appears to me that with the A1C of 6.4 you’ve already arrived in your destination. That’s an enviable A1C that would make most people happy. Why is it that you wish to be below 6?
My perception is that beneath 6 puts you in danger of becoming six feet beneath.
Especially for insulin consumers, most people with low A1Cs have a good deal of hypos (the revolutionary low carb folks will disagree with me), and these buggers can kill you–the hypos that is, not the revolutionary low-carb bunch. So I guess my view is that in case you truly need an A1C in the non-diabetic range, the solesafe way to do it is with diet, not utilizing any drugs whatsoever that artificially lower blood sugar.
Now, as you say that you’re a recent convert to the low carb diet, I wish to caution you that you may want to reduce your insulin doses. You likely won’t need just as much to cover the reduce effect meals. Can you do away with them and still get even lower sugar? Not to rain on your own Roman Road, but honestly, I’m doubtful that someone who requires two insulins can now get his A1C even lower with diet alone. But naturally, that depends on just how much insulin you’ve been utilizing and how high-carb you were eating before. Your weight also comes into play. In case you were quite… ah… heavy before and lose a whole lot of weight on the LCHF diet, which will change your insulin resistance. So who knows?
Oh, but please keep an eye on your cholesterol, OK? It is heart attacks which do in most form 2s. Heart attack threat is connected to cholesterol, and high fat diets may increase cholesterol. Or, as my Grandpa was fond of stating, “If it is not one thing, it is another.”
Cary, kind amazing from Nebraska, writes:My son was diagnosed with T1D in April of 2014 at age 23. He is able to control his blood sugars (on Omnipod) and in reality his last A1C was 6.0. The bad news is that almost immediately upon diagnosis he started experiencing severe foot pain and stomach problems. He’s on 1800 mg of gabapentin daily and has just been diagnosed with abnormal gastric emptying. As though which weren’t sufficient, in September that he had been diagnosed with thyroid cancer and had it all removed. Afterward, he needed to take a medical leave from law school, however, he plans on returning in January. He proceeds to have foot pain, although it is somewhat better. Why is this happening at such an early stage? Is this what he has to anticipate forever?
Wil@Ask D’Mine replies: Well, that sucks. You are correct that the diabetes shouldn’t have had the time to wreck his belly or to trigger neuropathy, which I ensure that he’s from the max-dose gabapentin he’s taking for the foot ache. The common wisdom is that the two such complications require many years of elevated blood sugars to activate. And while it is not unusual to find neuropathy present in diagnosis in type 2s–since type 2 may go unrecognized for many years–in form 1s, we do not generally detect nerve damage until ten years or more after diagnosis. In addition, it will creep up a bit at a time, rather than coming on like a storm. So something unusual is going on with your son, for certain.
Two chances jump to head, and you’re not going to like one of these one small bit. Are your law school boy a little terrible boy when he was younger? Because there’s a kind of neuropathy known as poisonous parasite that is caused by exposure to noxious chemicals… and… umm… some recreational drugs. And we also see that methanol intake can toxin the pancreas. Granted, it is a stretch, but it could be that his issues discuss a root cause of some type of toxic exposure, either casual or as the result of bemused recreational forays into the world of hazardous chemicals, rather than from biological causes. I’m just sayin’….
The other possibility, that you will like much better, is that the neuropathy (along with the gastric problems, which can also be nerve-related) may be connected to the cancer rather than the diabetes. Can he have any chemo? Although thyroid cancer is generally treated with no it, sometimes it’s wise, also some chemo drugs do cause disease, and D-folks with cancer appear to be at greater risk for the side effect. And even though he didn’t require chemo, I can’t help but wonder if the combo of both the cancer and the diabetes in the exact same time, and in the exact same era, may somehow be telling us something odd is going on that I’m not smart enough to find out for you.
However, what I’m smart enough to know is that nothing is eternally, and in such a case that is a great thing. Our bodies and our diseases aren’t carved into stone. They are dynamic, living, actually changing–and are our resources and drugs.
I will not kid you; re neuropathy has been regarded as a one-way street. In reality, your kid’s gabapentin doesn’t deal with the neuropathy; it is palliative therapy, which means it just masks the pain, at least somewhat, but doesn’t cover the matter at hand. However, I believe that will change. Why?
Because there are over 20 million men and women in the USA who have one of those flavors of neuropathy (you will find over 100 sub-types). This makes neuropathy almost as big a deal as diabetes. I can smell the cash, can’t you? And if we can, then you can bet your boots overly may Pfizer, Novartis, Sanofi, Roche, Merck, GlaxoSmithKline, AstraZeneca, and the remainder of the package.
So, sorry, so I really don’t know why this happened to him because such a young age, so soon after diagnosis. However, I assure you, this can be not what he has to anticipate eternally. Now is the darkest period of the evening. He has several dawns ahead.
Disclaimer: this isn’t a medical advice column. We’re PWDs publicly and openly sharing the intellect of our collected experiences — our been-there-done-that knowledge from the trenches. But we’re not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are just a little portion of your total prescription. You still need the professional advice, treatment, and care of a licensed healthcare practitioner.
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This material is created for Diabetes Mine, a consumer health blog focused on the diabetes area. The content isn’t medically examined and doesn’t adhere to Healthline’s editorial recommendations. For more information regarding Healthline’s venture with Diabetes Mine, please click here.
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