Atkins Diabetes Revolution (10 page)

I was so happy when I read the July 7, 2002, article in the
New York Times Magazine
confirming that Dr. Atkins’ controlled-carbohydrate program was a healthy lifestyle, despite its allowance of natural fats and eschewing of excessive consumption of fruits and grains. Finally, someone else was explaining why low-fat dieting hasn’t worked for countless people! I had some new ammunition for the naysayers around me, friends and family alike, who’d been telling me that eating the Atkins way would come back to haunt me.

I have since gone through another painful divorce. I also changed jobs and moved. These kinds of stresses commonly cause people to overeat and eat the wrong kinds of foods. But I managed to control the stress through exercise, refusing to revert to the old, sick me. My two-year-old twins, one boy and one girl, are going to need me for the next 20 or 30 years. I have every intention of being here for them.

Note: Your individual results may vary from those reported here.

Chapter 5

WARNING: PREDIABETES!

As the term implies, there can be no clearer warning of impending Type 2 diabetes than the fourth stage of the six-step progression: prediabetes—or, more technically, insulin resistance with hyperinsulinism and impaired glucose tolerance. For many years, before it was given official recognition, doctors called this stage a variety of names, such as the insulin resistance syndrome, subclinical diabetes, borderline diabetes, or mild diabetes.

In 2002 and 2003, the American Diabetes Association revised its guidelines for the diagnosis and treatment of diabetes.
1
Among other things, the new guidelines formally defined prediabetes.You have pre- diabetes if you have one or both of these blood sugar problems:

• Impaired fasting blood sugar (also known as impaired fasting glucose, or IFG). To measure your fasting blood sugar (FBS) level,a blood sample is taken in the morning after you have fasted for a minimum of eight hours. Normally, your blood sugar at that point would be less than 100 mg/dL. If it’s between 100 mg/dL (5.6 mmol/L) and 125 mg/dL(7.0 mmol/L),you may have impaired fasting blood sugar. If it’s higher than that, you may have diabetes. A single high blood sugar reading on the fasting blood sugar test isn’t necessarily a definite indication that you have prediabetes. If the elevation is found on a second test on another day, however, this is a reliable indication.
  
• Impaired glucose tolerance (IGT). This condition is defined by an abnormal rise in blood sugar after consumption of a specifically defined amount of carbohydrate. People who have IGT don’t produce insulin quickly enough after a meal to clear away the blood sugar, so they become hyperglycemic an hour or two after meals (this is known as
  postprandial
  hyperglycemia). IGT has two components—the blood sugar rise just discussed, and the slow initial response in insulin production. To diagnose IGT, doctors use the 2-hour oral glucose tolerance test.After a fast of 8 to 12 hours,your fasting blood sugar is measured.You then drink a sugary liquid and your blood sugar is tested at the 1- and 2- hour marks. Normally, your blood sugar would go up no higher than 140 mg/dL 2 hours after having the drink. If your blood sugar goes above 140 mg/dL(7.8 mmol/L) but stays below 200 mg/dL(11.1 mmol/L), you have impaired glucose tolerance.
  2
  We’ll go into the details of the very useful 5-hour oral glucose tolerance test in Chapter 6, Diagnosis: Diabetes.
  

These blood sugar cutoff points for prediabetes are based on a large body of research showing that damage to the tiny blood vessels of the eyes and kidneys starts to happen at these levels—in other words, the damage to your body from hyperglycemia has already begun.

Clearly, if you have prediabetes, you already have a serious medical condition. And you will almost certainly develop Type 2 diabetes within ten years if you are overweight unless you take action now.
3
Prediabetes should be your wake-up call to take charge of your health.

When Justine M. came to see me, she related the following history. In 1996, at age 52, five feet one inch tall, and weighing 237 pounds, her laboratory results were close to normal, with a fasting blood sugar (FBS) of92. By 1997, her weight had climbed to 248 and her FBS had climbed to109. A year later she had put on another 10 pounds and her glycated hemoglobin (A1C) had climbed to a diabetic level of 8.3. She was referred to me three years later, at which time she weighed 306 pounds. Her girth at her navel was 60 inches and her BMI was 58! Justine was taking two
medicines for blood sugar and one for blood pressure. Now, two years later, after following Atkins, she weighs 191 pounds, her waist is down to 41 inches, and she is medication-free. Her labs look like this: FBS: 102; c-peptide: 2.2; A1C: 5.7; cholesterol: 159; triglycerides: 42; HDL: 57; and LDL: 93. She looks great, feels great, and, as a bonus, her medication costs have plummeted.
    —M
ARY
V
ERNON

SCREENING: TOO LITTLE, TOO LATE

As Dr. Atkins knew from observing patients over the years, the standard blood sugar tests do not detect the presence of insulin and glucose changes early enough. Also, the fasting blood sugar test is not foolproof. By now you realize that this process can be diagnosed and treated at an earlier stage if your doctor knows how to test for it.

Today the American Diabetes Association guidelines call for routine fasting blood sugar tests on everyone over age 45.If the test is normal,it should be repeated at three-year intervals.If you have other risk factors for diabetes, the guidelines call for testing to start earlier and to be repeated as appropriate.
4
Unfortunately, the screening guidelines often aren’t always followed, which is why about a third of diabetes cases in the United States go undetected. If everyone with just a single risk factor for diabetes were screened, nearly 100 percent of all cases would be found.
5

Here’s the problem: Some doctors are not following the current testing guidelines, but even if they were, many people would still not be diagnosed early, as early as possible. We have a diagnostic test that Dr. Atkins believed was imprecise and used too late in the game. No wonder so many people are slipping through the cracks!

THE PREVALENCE OF PREDIABETES

Just about everyone who develops Type 2 diabetes has prediabetes first. According to the National Institutes of Health, at least 20.1 million people in the United States ages 40 to 74 had prediabetes during the years 1988–1994.
6
That works out to 21.1 percent of the population. But today many people much younger than age 40—even children and teens—have prediabetes. That means the total number of people with this condition is probably considerably larger— perhaps as many as one in three Americans.

THE PREDICTIVE POWER OF PREDIABETES

There’s strong evidence that having prediabetes is almost as dangerous to your health as having diabetes itself. By the time your blood sugar falls into the prediabetes range, your risk of heart disease and of dying goes way up.
7
,
8
Recently, researchers found that many people hospitalized for heart attacks have undiagnosed prediabetes or diabetes. A recent study in Sweden, for instance, looked at 181 patients admitted to the hospital for heart attack. During their hospital stays, 31 percent were found to have diabetes and 35 percent to have prediabetes—but not one of them knew it. This was no fluke. Three months after discharge,the blood sugar tests were repeated and the results were consistent.The authors noted that perhaps the true prevalence of diabetes in patients admitted for heart attacks could be as high as 45 percent.
9

The results of this study reinforce what Dr.Atkins said all along:It is absolutely imperative that early screening and treatment become standard practice to avoid heart attacks in those who have not yet even been diagnosed with prediabetes. We are committed to giving you the tools to prevent getting even this far.Undiagnosed prediabetes almost guarantees that the silent damage will continue until it reveals itself in an acute cardiovascular event. Let’s try to make sure that doesn’t happen to you.

HOP, SKIP, AND A JUMP TO DIABETES

If you have prediabetes and don’t do anything about it, what are your odds of progressing onward to full-blown Type 2 diabetes? Dr. Atkins was convinced it was almost a guarantee. A study of a large group of people in Holland showed that over a six-year period, 64.5 percent of those who had both impaired fasting glucose and impaired glucose tolerance became diabetic. That compares with only 4.5 percent of those who had normal glucose levels at the start of the study. To put it another way, the people with IFG and IGT had roughly ten times the risk of developing diabetes as the people with normal blood sugar.
10

In his practice, Dr. Atkins frequently encountered this situation. Many of his patients came to him only after they had progressed to full-blown Type 2 diabetes, which could have been avoided had they started on a controlled-carb program the moment they received a diagnosis of the metabolic syndrome. One good example of this is RuthT. Several years before Dr. Atkins first saw her, her doctor had told her she had the metabolic syndrome and advised her to lose weight. She failed at every diet she tried, however, and by the time she came to see Dr. Atkins, she had become diabetic. It was only when she started following his dietary approach that she had any success with weight loss and improving her blood sugar and lipids. If only she had taken the controlled-carb route sooner! She could easily have avoided the unseen damage from years of high blood sugar.

At 39, Janet M. came to me complaining of fatigue. She generally felt terrible and had begun to lose weight. Her initial blood sugar was 326, indicating diabetes, with a glycated hemoglobin (A1C) higher than 16 and a nondetectable c-peptide, indicating that she was not producing insulin and therefore had late-onset Type 1 diabetes. Her cholesterol was 217, triglycerides 179, HDL 46, and LDL 135. As she wanted to use as little medication as possible, she chose to begin to control her carbohydrates, took about ten units of long-acting (NPH) insulin twice a day, and carefully checked her blood sugars. When her blood work was rechecked three months later, her fasting blood sugar was normal at 96, her A1C was normal at 5.3, and her lipids had improved. Her cholesterol was now 165, her triglycerides 47, her HDL 62, and LDL 93. She had also regained the 15 pounds she had lost as a result of her severe Type 1 diabetes.

  —M
ARY
V
ERNON

COULD IT BE TYPE 1 DIABETES?

If you’ve been given a diagnosis of prediabetes,you’ll also know that you have a good chance of progressing along the continuum to diabetes— unless you’re able to
immediately
make the appropriate lifestyle changes. So, if you suddenly start having symptoms such as excessive thirst and hunger and frequent urination, it’s natural to assume that you’ve tipped over into Type 2 diabetes. That may well be the case, but it’s also possible that you have a late-developing case of Type 1 diabetes. Although this form of the disease usually strikes people under age 25, it can occur at any age. When it happens to older people, it’s generally known as latent autoimmune diabetes in adults (LADA). This is a serious condition that needs to be diagnosed and treated quickly to avoid dangerous complications.See your doctor at once if you suddenly notice symptoms of diabetes.

DO YOU HAVE PREDIABETES?

Do the following statements describe you? Your answers will determine if you have prediabetes.

1. I am overweight and my excess fat tends to be in the abdomen.
   

a. True

b. False

1. I don’t get much exercise.
   

a. True

b. False

1. I have two or more signs of the metabolic syndrome (see Chapter 4).
   

a. True

b. False

1. My doctor has told me I have the metabolic syndrome.
   

a. True

b. False

1. My doctor says my fasting blood sugar is above 100 mg/dL but below 125 mg/dL.
   

a. True

b. False

1. I have taken an oral glucose tolerance test and my blood sugar was above
   140 mg/dL but below 200 mg/dL.
   

a. True

b. False

If you answered true to any of the first four statements, you may well have prediabetes. If you answered true to the fifth or sixth statement,you almost certainly already have prediabetes and need to take immediate action to prevent Type 2 diabetes. Please read on for more information to discuss with your doctor.

Chapter 6

DIAGNOSIS: DIABETES

It is a sad day when we have to tell a patient that he or she has Type 2 diabetes. As upsetting as this news is to patients, it is made worse by the knowledge that the situation could have been prevented. That’s why we wrote this book.It is our hope that by reading it,you will never need to have this unpleasant conversation with your physician—or if you’ve already had that conversation, that
Atkins Diabetes Revolution
can deliver new hope.

If you’ve already been diagnosed, you have likely been told to follow a low-calorie, low-fat diet, take prescription medications, and engage in regular exercise. With the exception of exercise, that’s a bleak prospect—years of denying yourself food when you’re hungry and popping pills that are expensive and often have unpleasant—or even dangerous—side effects. Fortunately, there’s another option. Dr. Atkins’ teachings can introduce you to a way of eating to control your diabetes that is easy to stick with for the long term. These teachings can also show you the way to a future without drugs—or, at the very least, lower doses of those drugs. You’ll still have to exercise, but we have tips for you on how to make it an enjoyable part of your life. (See Chapters 22 and 23.)