Welcome! I’m the unofficial welcome wagon to all T2 diabetics. This way of eating KICKS DIABETES TO THE CURB! I’m trying to be as thorough as possible, so this is long, but there will be a summary at the end.
I was a T2 for 30+ years, on insulin 12+ of those years. In under 2 months, I was off the 100 u of insulin I was on when I began. In under 10 months, I was off even metformin, with an A1c of 5.5%. I consider my diabetes to be in remission; I’m not cured. I’m pretty sure I’d still fail an oral glucose tolerance test. But having a body that works without any medications in a non-diabetic manner is miraculous to me.
This post is part of an archive of Frequently Asked Questions (FAQs) from the Eat Like a Bear weight loss group, of which I’m an admin. You can join the group here: https://www.facebook.com/groups/EatLikeABear/
Here’s the thing: I’m not unusual around here. We have SO many bears who’ve gotten off medications and gotten their A1cs down to normal range; the only difference with me is I can’t shut up about it. 😉
NOTE: The US measures bG in mg/dL; everyone else measures in mmol/L. To convert, divide the US value by 18 or multiply the non-US number by 18 to make it understandable to you.
Here’s what you need to know: some medications need to be adjusted right from the start. Insulin obviously needs changing when your diet changes significantly, but there’s a number of medications that will need adjusting also, especially the sulfonylurea class of drugs, e.g. glyburide, gulipizide, gliquidone, glisoxepide and glyclopyramide. To find out if your drug will need adjusting before you start, google for it’s side effects; if hypoglycemia is a side effect, it will need adjusting before you start.
If you are on an SGLT-2 inhibitor, like Invokana or Jardiance, please google for the black box warning NOW. These medications have horrible side effects, including causing diabetic ketoacidosis, necrotizing fasciitis and increased risk of amputation. I nearly died from the first two and lost half a toe. IMO, high bG is much less dangerous than these drugs; I don’t understand why they’re still on the market.
The most common (and in my opinion best) diabetes medication is metformin. Metformin causes digestive upset in some people, so is recommended to be taken with food and/or often prescribed in an extended-release form. If it doesn’t cause digestive upset in you, you can take it as prescribed. If it does, you may want to take it just with meals; my endo said that it takes several days to start/stop working, so the timing of doses is less important than with other medications. Talk to your pharmacist if you’re uncertain; they generally know more about medication than doctors do.
Because metformin has been around a long time, we know very well what the side effects are. Besides digestive upset, metformin can prevent absorption of vitamin B-12 and thus cause a deficiency, the most common symptom being fatigue since B-12 deficiency is a form of anemia.
While I was still on metformin, I took a good B complex daily, well away from my metformin dose. The B vitamins are all required by the biochemistry that makes cellular energy from glucose; I’ve always felt that if glucose can’t get into my cells easily, I need to make sure it can use it very efficiently.
(A “good” B complex is one which has all bioidentical B vitamins; there are genetic issues that some people have that prevent them converting from some of the other forms. I’ve never done the genetic test, but always figured it was safest to just take the type I know my body can recognize. I use this product: https://amzn.to/2ZuWsfA Anna Sul uses a more natural approach, incorporating nutritional yeast in her diet as a source of B-12 and bee pollen and beef liver supplements for Bs in general.)
Though metformin is one of the drugs which theoretically does not cause hypoglycemia, it can in extreme circumstances. Metformin works by preventing the body from making glucose, which is why I went on it while I was trying to get off insulin. However, it turns out that if you’re fasting, preventing your body making glucose *can* cause hypoglycemia, but that is more of a long-term problem than something to worry about as you start.
Speaking of hypoglycemia, it pretty much will happen. If you’ve been a T2 any length of time, you know when your bG went up, the doctor added more meds. Well, this goes the other way around, as your insulin resistance improves, your bG will go low and medications will be taken away.
As noted, insulin and sulfonylurea drugs will need to be adjusted right away. But many other medications will be adjusted as you go along. You will need to be in very close contact with your doctor or diabetes educator to assist you in adjusting meds as you proceed. Your doctor may not be familiar with this way of eating, but given they knew how to increase meds as you worsened, they ought to be able to figure out how to reduce them as you improve.
The lows can happen MUCH faster than you expect, so be prepared. I recommend you keep glucose tablets from a pharmacy on hand, or a more frugal option, both smarties and sweetarts are nearly pure glucose and will correct bG rapidly. The general recommendation is to take 15g of carb to correct a low, but as you go along, you will likely find the smallest amount possible to just raise your bG enough and not overshoot.
When you treat a low with glucose, you should also eat something with a bit of protein and fat, to sustain bG over time, like nut butter, cream cheese or pepperoni. Recheck your bG in 10-15 minutes to see if it’s responding.
Though glucose is obviously a carb, treating a hypo episode is NOT breaking your fast. It’s medicine and you need it. Further, it’s evidence that your diabetes is improving! Just continue your normal eating/fasting plan – there’s no failure here.
If you have hypoglycemic symptoms, it may not be from low bG. In my experience, it’s much more common for it to be caused by low sodium. Insulin “tells” the kidneys to retain sodium and water, which is why so many of us have edema and high BP; so when you start this way of eating, your insulin drops tremendously and your kidneys decide to get rid of that extra sodium and water. Very often, just eating some salt or drinking some pickle juice will fix the symptoms faster than you can even check your bG.
For me, low BP occurs most often when I’m exercising. I was carrying little fast-food packets of salt for emergencies, but recently switched to carrying concentrated electrolytes.
Please do read all about electrolytes. We T2s tend to have much more extreme issues with electrolytes because insulin has been bossing our kidneys around for so long. Insulin causes the kidneys to excrete potassium, so we commonly are low in that. Studies have shown that diabetics are commonly magnesium deficient as well. Read all about how to avoid these issues here: https://reversingdiabetes.xyz/blog/electrolytes
Besides needing to lower diabetic medications, you will likely need to lower hypertension medications as you go along. It is somewhat silly to take medications to assist in losing water and sodium, then have to eat salt to raise your BP. I have found this adjustment much more problematic than adjusting diabetes medications, myself. You *need* a home BP cuff to learn how your body reacts. Besides losing diabetic medications, you’ll likely lose BP meds as well as you proceed.
You may have low bG and NOT have hypoglycemic symptoms. This is much more normal than you might think. We’ve been trained to think anything under 70 mg/dL is low, but in my experience, my bG can be below 70 rather often without symptoms. When you’re firmly in ketosis, your body has lots of ketones available for energy, so the amount of glucose it needs is lesser. I run in the 60s quite often, even sometimes in the high 50s. You can correct if you want and if you feel safer above 70, but I personally think that if I feel OK and my bG is not dropping further, it’s not needed. To correct a minor low, the best thing to eat is a high fat food with some protein, something like pepperoni, cream cheese or macadamia nuts. This will cause a slow, gradual rise in bG, sustained over time.
If you are trying to reduce insulin, whether the kind that is injected or the homemade stuff we T2s make so much of, you may want to be looser with your definition of high bG at the start. I always considered 140 the cutoff for it being too high, but once I was convinced elevated insulin was worse for my health than elevated bG, I changed my cutoff to 200 to reduce insulin. My experience is that reducing insulin means correcting insulin resistance and hence eventually getting to much lower bG. Though I began this deciding that just staying below 200 was “good enough,” 10 months in, I find myself annoyed when my bG gets to 100, as I’ve grown accustomed to much lower numbers.
You will need to be testing bG a LOT. I began using a regular finger-poke bG meter, but have found having a continuous bG monitor to be much more informative. I use a Libre, which many insurance companies will pay for even for T2s; it’s even approved by Medicare now.
Many of us are accustomed to measuring preprandial and postprandial numbers on a bG meter to see what spikes our bG. But with the Libre, I can see that my bG runs 10-15 points higher the next day after certain things that didn’t even cause much of a spike. It’s also how I learned that it was very normal for me to run in the 60s overnight. And frankly, poking your arm once every 2 weeks is a lot more pleasant than poking your finger 8-10 times a day. Talk to your doctor about prescribing one for you.
Many of us find that the largest amount of healing occurs from extended fasts. While I firmly believe that you can reverse T2 just doing the normal Eat Like a Bear protocol of eating one meal a day, always keto and usually a Ridiculously Big Salad, the fastest results will come if you add some longer fasts.
To learn more about how fasting affects diabetes, I highly recommend Dr. Fung; either look him up on Youtube or buy this book https://amzn.to/2MIHuwZ (affiliate)
Dr. Fung saved my life. I credit him with teaching me not to eat and Amanda with teaching me what to eat.
Now for the bad news: lowering insulin will cause weight loss, but we T2s have way more insulin resistance than most.
We may lose weight more slowly than the average bear because we have more healing to do.
But the good news is that addition of fasting, even the intermittent sort, makes keto much more efficient for weight loss. You *will* lose weight on ELAB. Just don’t compare yourself to the superstar weight loss folks in this group; your journey will be longer, but will include much more profound healing.
I find that focusing on my diabetes rather than weight loss kept me very motivated at the start. That and the many non-scale victories! You can read more about my journey here: https://reversingdiabetes.xyz/blog
To summarize:
* talk to your doctor or diabetes educator often
* adjust some meds before you begin, especially insulin and sulfonylurea meds
* adjust other meds as you go along, both diabetic and hypertension meds
* SGLT2 inhibitors = bad
* metformin = good, but take B-12, or better yet, all the Bs
* for minor hypoglycemia, treat with a high-fat food that has some protein
* for more scary lows, keep a source of glucose handy
* for hypoglycemic symptoms without low bG, you probably need salt ASAP
* all the electrolytes! not just sodium, but potassium and magnesium too
* you may want to loosen up your definition of “high” bG when you start to help reduce insulin
* test bG often, consider a Libre to make it easier
* extended fasts help even more than intermittent fasting – Dr. Fung!
* weight loss may be slower, but it will happen
Now go forth and KICK DIABETES TO THE CURB!