Atkins Diabetes Revolution (13 page)

In Dr. Atkins’ opinion, nothing could be better designed to turn you into a perpetual patient destined to face increasingly severe health problems as time goes by.If you have diabetes,your body can’t process carbohydrates normally. Does it make any sense at all to prescribe a diet that is 55 percent or more carbohydrate? Of course not. The logical treatment is a low-carbohydrate regimen that uses protein and fat to stabilize your blood sugar and preserves your pancreatic function.

Dr. Atkins battled the medical establishment on this issue for decades. In the few years before his death, he was heartened to find that mainstream research was increasingly bearing out his ideas, and that some of his colleagues had spoken out on the folly of high-carb diets for those with blood sugar abnormalities. Dr. Gerald Reaven, who first defined syndrome X (now called the metabolic syndrome), is one of them. In an important article written for heart doctors in 2001, he plainly stated that “in the absence of associated weight loss,the usually recommended low-fat, high-carbohydrate diet makes the manifestations of syndrome X worse.”
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In the end, only you can decide what’s best for your health—in concert with your physician. You can choose to use the Atkins approach, or you can choose the ADA approach. If, despite everything you’ve read so far in this book, you make the ADA choice, be aware that your odds of doing well on it are low.

That’s not just our opinion—it’s the result of an important study that appeared in that most mainstream of medical publications, the
Journal of the American Medical Association,
in January 2004. Researchers from the U.S. Centers for Disease Control and Prevention and the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases looked at 12 years’ worth of diabetes data from national cross-sectional surveys. What they found is that only about a third of all adults with Type 2 diabetes were meeting treatment goals for their blood sugar, their blood pressure, or their blood lipids. How many were meeting their treatment goals for all three risk factors? A mere 7 percent.
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Could there be a more clear illustration of the fact that putting people with Type 2 diabetes on the ADA diet and bombarding them with drugs is a complete failure? Their inability to meet treatment goals is putting these patients at greater risk for the multiple complications of diabetes, not to mention other health problems and side effects from the arsenal of prescription drugs.

There are several possible reasons for these appalling statistics. The main one, of course, is simply that people with diabetes should not be eating a high-carb diet.A second reason is that many people undoubtedly find it impossible to comply with the ADA dietary guidelines— this diet seems designed to cause hunger and cravings in patients with this metabolic pattern. The third possibility is that many people mistakenly believe that their diabetes medications allow them to eat anything they want without ill effect. That leads to the disastrous result of greater fat storage, higher blood sugar and blood pressure, lipid problems,and increased risk of suffering a heart attack or stroke.And that’s just for starters. Farther down the road are kidney disease, blindness, amputations, and other unpleasant—even deadly—complications.

We sincerely hope that the rising tide of evidence in favor of the low-carb approach to treating diabetes will soon become an unstoppable tidal wave that will prove to the medical establishment that providing these diagnostic and treatment tools will benefit their patients.

ARE YOU AN UNDIAGNOSED DIABETIC?

If you think you might have an undiagnosed case of diabetes, take this self-test and share the results with your physician.

Do you experience the following symptoms?

• Extreme thirst
  
• Extreme hunger
  
• Frequent urination
  
• Weight loss without trying
  
• Unusual fatigue
  
• Blurry vision
  
• Irritability
  
• Tingling or numbness in hands or feet
  
• Frequent skin,bladder,or gum infections
  
• Slow healing of cuts and bruises
  

Chapter 7

MANAGING YOUR DIABETES

All too many patients arrived on the doorstep of Dr.Atkins’office only after they had received a diagnosis of diabetes. When you’re told you have a serious disease, it’s usually pretty terrifying. And that fear often drives people to consider alternatives to what their mainstream doctors advise. That’s where Dr. Atkins usually came in. Perhaps the patient had heard a success story about someone who had used his approach,or maybe they had read one of his books and felt it was talking to them. Very often, they felt that medicine had failed them, and they just wanted to get their health back.

Dr. Atkins had two goals for his patients with diabetes. First, by teaching these patients the Atkins Blood Sugar Control Program (ABSCP), he helped them get their blood sugar under control. Second, he worked with them to cut back on the amount of medication they took each day. Success comes when a patient has good blood sugar numbers and needs no drugs at all, or is down to the least possible number of drugs taken in the smallest possible doses. Most of Dr. Atkins’ patients were able to achieve that success within a year. Many were also well along to achieving their weight-loss goals.

TRACKING YOUR BLOOD SUGAR

If you have diabetes, your primary goal is to bring your fasting blood sugar below 126 mg/dL—and preferably to 100 mg/dL or less. Once you start following the ABSCP, this may happen with surprising speed, but for many people some time may be required to return the insulin/glucose metabolism to normal functioning. After all, it took a long time to get to this stage of diabetes. You can’t expect to reverse years of high blood sugar overnight.

You’ll monitor your progress by using a home blood sugar meter.A number of high-quality meters are now available at pharmacies or medical supply stores.Work with your doctor or pharmacist to choose the one that’s right for you and learn how to use it correctly.

When you start following the ABSCP, your meter becomes a useful tool for monitoring your progress. Check your blood sugar first thing in the morning before eating or drinking anything other than water and keep a record of the numbers. (If you’re taking insulin, you’ll probably need to test your blood sugar several times a day—first thing in the morning, just before meals, and at bedtime.) As you change your way of eating and start exercising more, you should see your blood sugar numbers improve.Once you’ve got your blood sugar normalized and your glycated hemoglobin (A1C) number is coming down (see page 78), you don’t need to check your blood sugar quite so often.Every other day is fine at that point,unless your doctor instructs you otherwise. As your blood sugar continues to improve, you can move to checking it just twice a week. Continue to keep a record—we think you’ll be very pleased with the results.

Important note:
Talk to your doctor about what to do if your blood sugar goes up to a higher level or drops to a lower level than is usual for you.You will probably be told to call him or her if your blood sugar rises beyond a particular level—be sure you and your doctor are in agreement as to what that level should be.Illness,infection,surgery, or high levels of stress can make your blood sugar go higher than is normal for you. Call your physician if you don’t feel well or have new symptoms that you can’t explain.

THE A1C TEST

A blood test called the glycated hemoglobin (A1C) is extremely important for tracking your blood sugar over time. This test measures the amount of sugar that has become bound to a protein molecule called hemoglobin, which is found in your red blood cells. The A1C is sometimes called the blood test with a memory, because it gives a pretty good picture of what your blood sugar has been doing over a three-month period.Once a person has been diagnosed with diabetes, the A1C is the standard method used to assess “glycemic control,” or how close your blood sugars are to the normal range. A normal A1C result in a healthy person without diabetes would be in the 4 to 6 percent range.When diabetes is first diagnosed, a person’s A1C will probably be above that range, possibly even as high as 15 percent. The higher the A1C, the greater the risk for diabetes-related complications such as kidney disease, eye disease, and nerve damage.

The standard therapeutic goal for people with diabetes, as set by the American Diabetes Association (ADA) and other professional organizations,is an A1C of 7 percent or less.Dr.Atkins’goal for his patients was 6 percent or less. Almost all his patients achieved significantly lower A1C numbers within a few months of controlling their carbohydrates and exercising more. His recommendation was to have the A1C test done every three months until good control, meaning A1C below 7, was achieved, then two or three times per year unless there is weight gain or a worsening of blood sugar control.

THE SCOOP ON ANTIDIABETIC DRUGS

If you are diagnosed with Type 2 diabetes, in addition to the high-carb ADA diet, your doctor will almost certainly put you on one or more prescription drugs to control your blood sugar. You may also be prescribed drugs to control your blood pressure and blood lipids.

Dr. Atkins believed that drugs for treating blood sugar abnormalities and diabetes should be avoided if at all possible. If your diabetes is far advanced, however, drugs may indeed be necessary. In serious cases, he had no hesitation in prescribing drugs, but there were only two blood sugar medications he used: metformin (Glucophage) and, if necessary, insulin.

Why did Dr. Atkins avoid all the other drugs that are often prescribed for controlling blood sugar? Let us explain. Some of the drugs prescribed for Type 2 diabetes stimulate the pancreas to release more insulin; others make your cells more sensitive to insulin. The fact is this: No drug works as well as controlling your carbs and getting more exercise.And most drugs for diabetes end up actually making your situation worse. Why? Because with the exception of metformin, every drug for diabetes makes it almost impossible to lose weight and may well make you gain weight.In addition,some diabetes drugs make you retain water, which can only worsen blood pressure (creating the scenario for, yes, more medications). Dr. Atkins felt that almost all diabetes drugs get you into a futile cycle that leads to larger doses of more drugs, rather than actually improving your health.

As a result, the only drug (other than insulin when necessary) Dr. Atkins usually prescribed for blood sugar abnormalities was metformin (Glucophage).This is the only diabetes drug that doesn’t cause weight gain. Metformin is helpful for people who have dangerously high blood sugar that needs to be lowered quickly—more quickly than dietary change and exercise alone can accomplish. It’s also helpful for those who are very metabolically resistant to the effects of dietary change and exercise. For these patients, taking metformin can be very helpful, and Dr.Atkins didn’t hesitate to prescribe it—along with the Atkins Blood Sugar Control Program, of course. As the combination starts to work, the metformin dose can often be gradually reduced and eventually stopped. There are, of course, some who may need to remain on it indefinitely.

Often, Dr. Atkins’ patients came to him already taking two oral diabetes drugs—usually metformin in combination with another drug such as glyburide (Glucovance), which is an insulin-stimulating drug. In most instances, he would switch the patient to metformin alone.As the ABSCP begins to lower blood sugar, the insulin-stimulating drugs can lower blood sugar
too much,
causing a dangerous hypoglycemic reaction.
An important precaution:
If you take any of these medications and are about to start following the ABSCP,speak with your doctor first. You need to plan a strategy for lowering your medications as your new dietary approach starts to work. It is, of course, still necessary for you to continue to monitor blood sugar readings at home.

THE INSULIN DECISION

If you have progressed to stage 6 of Type 2 diabetes, the beta cells in your pancreas are now producing less insulin than you need. In fact, after years of a high-carb diet and high blood sugar, your beta cells may not be making much insulin at all. You need insulin to survive, however, so at this point you will probably have to start administering this powerful hormone to yourself, often several times a day. Your insulin dose, the type of insulin you use, and when you administer it depend on a number of factors. Every person who needs to use insulin is different,and you’ll have to work closely with your doctor to design an individualized program that works for you.

Because taking insulin can cause dangerous episodes of hypoglycemia, and because it almost invariably causes weight gain, Dr. Atkins always aimed to help patients who were using it to discontinue it or reduce their dose. Fortunately, many of his patients were able to do exactly that by following the ABSCP. In fact, there were situations where the patient was able to discontinue the use of insulin immediately. (See the case of Glenda Carter on page 151 for an example of someone who was able to stop using insulin as a result of the ABSCP.) Let us say at once, however, that this is not always the case. Stopping or changing your dose of insulin must be handled on an individual basis, working with your doctor and closely monitoring your blood sugar. This is a complex process that needs to be handled carefully—
never try to adjust your insulin dosage without discussion with your physician.

When you start controlling your carbs and bringing your blood sugar under control, you break a vicious, long-standing cycle in your body. When your blood sugar finally stabilizes, the beta cells in your pancreas may very well be able to resume their normal response. Insulin production will often improve—in fact, it may even return to normal levels.