diabetes 102

  • Elevated insulin and blood glucose levels are associated with a wide range of health issues including obesity, mental health, cancer, cardiovascular disease, and stroke.
  • “Normal” blood sugars are not necessarily optimal for long term health.
  • Most people are somewhere on the spectrum between optimal blood sugars and full blown type 2 diabetes.
  • Maintaining blood sugars close to optimum is possibly the most important thing you can do to manage your health, reduce body fat, and slow ageing.
  • A diet with a low insulin load will lower blood glucose and allow you to access your body fat for energy.

what is diabetes?

“Diabetes” refers to a group of metabolic diseases where a person has high blood sugars over an extended period of time.

Type 2 diabetes occurs when people become insulin resistant and their blood sugars drift higher.  The generally accepted diagnosis levels for type 2 diabetes are:

  fasting after meal
  (mg/dL) (mmol/L) (mg/dL) (mmol/L)
“normal” < 100 < 5.6 < 140 < 7.8
pre-diabetic 100 – 126 5.6 to 7.0 140 to 200 7.8 to 11.1
type 2 diabetic > 126 > 7.0 > 200 > 11.1

Currently one in twelve adults worldwide are classified as diabetic based on this diagnostic riteria.  This number is forecast to grow by more than half over the next two decades to 592 million people by 2035. [1]

Approximately ten percent of people classified as diabetic have type 1 diabetes which is a condition where a person’s immune system attacks the cells in their pancreas and from that time on they have to inject insulin to survive. [2]   While less common, we can learn a lot from type 1s who successfully manage their blood sugars.

what are the risks?

Low carb health advocates such as Dr David Perlmutter, [3] Nora Gedgaudas [4], Dr Ron Rosedale [5] and Dr William Davis [6] tell us that we should restrict carbohydrate for metabolic and brain health as well as to prevent a range of diseases.

Hba1c [7] is a test that gives an indication of your average blood sugar over the past three months.  The chart below shows one of the more confronting charts from Dr Perlmutter’s Grain Brain [8] demonstrating that the rate of brain shrinkage with age increases with increasing blood sugar.Chrome Legacy Window 22032015 14339 PM.bmp

This chart shows that an increase in HbA1c is also associated with an increased risk of cancer.

image002

This chart shows that here is a very close relationship between insulin secretion and body mass index (BMI).

jcinvest00481-0161.pdf - Adobe Reader 23042015 33022 AM.bmp

These charts show that the risk for cardiovascular disease, coronary heart disease and stroke all increase with higher blood sugar levels.

image003

Antidiabetic medication, even if it reduces your blood sugar, doesn’t help reduce your risk of cardiovascular disease, which is the number one cause of death globally.

The link between your blood glucose control and your chance of requiring a cardiac bypass is hard to argue with. [22]

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Keeping your blood sugar under control is possibly the most important thing you can do to manage your health, manage body fat, gut health, reduce your risk of cancer [11] and slow aging, regardless of whether you have been formally diagnosed with diabetes. [12] [13]

Diabetes is expensive.  In 2012 it cost the US a quarter of a trillion dollars in hospital costs and lost productivity [14] and the cost of “diabesity” is forecast to triple by 2050 grow and become a major burden our economy.

what are optimal blood sugars?

If you’re not a diabetic getting your HbA1c checked by your doctor regularly you can use your average blood sugar values from a home blood glucose metre to see how you’re tracking compared to optimal.  Blood glucose metres are available readily online or at your local chemist.  You can pick them up for less than $10.  The higher end ones will also measure your blood ketone levels. [15]

The conversion between HbA1c and average blood sugar are shown in the table below.  I have also shown various risk levels based on the cardiovascular disease data above.  If you want to calculate your average blood sugar simply take the average of all your blood sugar tests – fasting, before meals and after meals.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

Comparing the diabetes diagnosis criteria in the first table with these optimal levels it’s clear that blood sugars that are considered “normal” are far from optimal.

By the time you’re “pre-diabetic” you’re well into the danger zone.  By the time your blood sugars become elevated it’s likely that your pancreas has been trying to pump out extra insulin for some time and you are well and truly losing the battle of metabolic health.  Dr Ron Rosedale says that if you’re exposed to modern processed foods then it’s likely that you are somewhere on the spectrum between optimal and full blown diabetes. [16]

Doctor Richard Bernstein recommends an ideal blood sugar of 83mg/dL (or 4.6mmol/L) for type 1 diabetics. [17]  Paul Jaminet notes that the optimal range for blood sugar is between 70 and 100mg/dL (3.9mg/dL and 5.6mmol/L). [18]

A type 1 diabetic will carefully balance their carbohydrates and insulin doses throughout the day to try to keep their blood sugar within this narrow range.  However this is impossible on the diet recommended to them in line with the Food Pyramid / MyPlate with lots of “healthy whole grains”.

The continuous glucose monitor plot below shows the typical blood sugar roller coaster experienced by a type 1 diabetic.  This style of blood sugar fluctuation occurs to some extents in all of us to some degree, depending on our diet and our insulin sensitivity.

image004 - Copy (2)

what does insulin do?

The hormone insulin allows us to clear excess sugar from the blood and store it for later as body fat.  This adaptation was a great advantage for our ancestors who would consume sweet fruits in summer and store some body fat for winter.   It’s said that our ability to store fat via insulin enabled your ancestors to survive through the ice age. [19]  The people who couldn’t do this so well aren’t your ancestors, if you know what I mean.

Achieving nutritional ketosis is all the rage these days, but what it means in simple terms is that you have low enough levels of insulin to enable stored body fat to be used for energy. [20]  If your insulin levels are too high you’ll end up storing more of your food as fat.  You’ll then need to eat extra to make it through the day. [21]

In the next article we’ll look at what you can do to normalise your blood glucose levels by choosing foods with a low insulin load.

references

[1] http://www.dailymail.co.uk/health/article-2997882/Diabetes-epidemic-400-million-sufferers-worldwide-Number-condition-set-soar-55-20-years-unless-humans-change-way-eat-exercise.html

[2] http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1

[3] http://www.drperlmutter.com/

[4] http://www.primalbody-primalmind.com/about-nora-gedgaudas/

[5] http://drrosedale.com/#axzz3TzvVehTb

[6] http://www.wheatbellyblog.com/

[7] http://www.diabetes.co.uk/what-is-hba1c.html

[8] http://www.amazon.com/Grain-Brain-Surprising-Sugar-Your-Killers/dp/031623480X

[9] http://www.drperlmutter.com/important-blood-test/

[10] http://www.cardiab.com/content/12/1/164

[11] http://freetheanimal.com/2009/02/sugar-feeds-cancer.html

[12] http://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16

[13] http://www.drperlmutter.com/important-blood-test/

[14] http://care.diabetesjournals.org/content/36/4/1033.full

[15] http://www.ebay.com.au/itm/like/251841014229?limghlpsr=true&hlpv=2&ops=true&viphx=1&hlpht=true&lpid=107&chn=ps

[16] https://vimeo.com/52872503

[17] https://www.youtube.com/watch?v=zJGAbZIvRh8

[18] http://perfecthealthdiet.com/2011/11/safe-starches-symposium-dr-ron-rosedale/

[19] http://www.primalbody-primalmind.com/

[20] http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis

[21] https://www.youtube.com/watch?v=Yo3TRbkIrow

[22]  http://www.cardiothoracicsurgery.org/content/3/1/63

33 thoughts on “diabetes 102”

    1. HbA1c is an approximation of average blood sugars over the last three months.
      So if you’re trying to estimate your HbA1c use all your blood sugar data, both fasting and after meals.

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  1. I love your focus on insulin, as I also believe that it is more important than glucose response. However, I would be interested in your opinion of resistant starch, a specific type of dietary fiber that ferments in the large intestine and directly improves insulin sensitivity. Wouldn’t that be more like treating the cause instead of avoiding the symptoms?

    See http://www.resistantstarch.us/health benefits/blood-sugar-benefits/ for the data. We are expecting the United States Food and Drug Administration to rule on a health claim petition that resistant starch helps reduce the risk of type 2 diabetes because it improves insulin sensitivity, especially in individuals with prediabetes. (https://www.regulations.gov/#!docketDetail;D=FDA-2015-Q-2352)

    Not all types of dietary fibers do this. For instance, the cellulose from plant cell walls is a bulking fiber, but is minimally fermented and does not have these effects. The resistant starch information fits with your data, as green bananas, beans, lentils, and unprocessed grains are all rich in resistant starch.

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    1. Thanks Rhonda. Reducing insulin load is certainly just one part of the story. A reduction in insulin load also implies and increase in indigestible fiber which is good for the gut (see https://optimisingnutrition.com/2016/05/02/insulin-load-the-greatest-thing-since-carb-counting/). There are lots of low insulin load high fiber high nutrient density veggies to be had (https://optimisingnutrition.com/2015/10/05/ketogenic-fibre/). We’ve got Tim Steele in our Facebook group and there are ongoing discussion about RS. It certainly seems to be an interesting area. Seems to be lots of benefits but possibly some draw backs if you overfeed a narrow range of bacteria that RS address.

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      1. RS feeds a wide range of bacteria. See http://dx.doi.org/10.1038/ismej.2014.63 and http://dx.doi.org/10.1038/ncomms7342. It appears to have a keystone species that initiates the breakdown of the starch granule (Ruminococcus) but hundreds of other species are also increased, including Bifidobacteria. If individuals are lacking in Ruminococcus, they tend to be non-responders, but the entire microbiome changes once its fermentation begins.

        I know Tim, and I’ve answered many RS questions for him. I’ve been working with RS for 14 years and have trained hundreds of dietitians and other health professionals on the topic.

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  2. No, there are not. The vast majority of the studies used digestible starch as the control. Researchers try to limit the variables in studies so they can draw conclusions from the differences in results.

    A diet with a wide variety of non-starch veggies would contain a little resistant starch but there isn’t way to guess how they would compare.

    I guess I fall back on the fact that starch has always been in human diets so it naturally evolved as a major food for our microbiota.

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    1. I’ve got a friend who has just found she has pre-diabetes and has started testing her blood sugars. After meat, veg and potato her blood glucose was 9.0mmol/L. Without the potato, same meal her blood sugar is 5.3mmol/L (my wife with type 1 has a similar but more exaggerated experience). Should they eat more or less potato?

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  3. Thank you so much for this blog and the effort you put in to helping others!!! I am type 1 32 years and finding it very hard to gain control over bs levels. Read Dr B’s book and trying to put it all together to gain control. I have been eating lc for 1.5 years and am gaining weight and taking about 42 units a day. On a pump and dex I am going to try using the insulin load to see if it can help. Thank you for all your information

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