Not Everyone May Be Able To Achieve Remission But People Who Are Younger Male Have Had Type 2 Diabetes For Less Than Six Years And Lose More Weight Are More Likely To Be Successful
Until recently, type 2 diabetes has mainly been managed by controlling risk factors such as high blood pressure, cholesterol and blood sugar levels usually by prescribing drugs. But this approach doesn’t address the underlying causes of type 2 diabetes such as problems with the hormone insulin no longer effectively controlling blood sugar.
While taking drugs can help to manage blood sugar levels, it won’t help unpick the biological causes behind type 2 diabetes. A growing body of research shows that losing weight, either through surgery or dieting, can help address some of the underlying causes of type 2 diabetes. It does this by helping the body control blood sugar levels. This is significant as controlling blood sugar by improving how insulin is made and works is key to bringing type 2 diabetes into remission.
Our review found that meal-replacement diets helped around one in three people successfully achieve remission, while low carbohydrate diets were able to help around one in five people achieve remission. People who lost weight using both of these diets were able to stay in remission for up to two years if they maintained their weight loss. Low calorie and Mediterranean diets were also able to help people achieve remission but at much lower rates. Only around 5% of people on low-calorie diets stayed in remission after one year, while only 15% of people on a Mediterranean diet stayed in remission after a year.
When Combining Keto And 5:2 Intermittent Fasting On Fasting Days Do You Still Follow The Macro Guidelines For Keto
On the two days of fasting, should the 500 calories consumed be of the same macro proportions as followed on the normal keto days? Or can you consume 500 calories of any food without going out of ketosis?
I don’t generally recommend people to count calories. Fasting means not eating anything at all, so there is no ‘counting macros’. Dr. Mosley’s 5:2 diet allows 500 calories of whatever you like. But that’s his diet, not mine. I advocate intermittent fasting, with no calories.
Dr. Jason Fung
Reversing Diabetes 101 With Dr Sarah Hallberg: The Truth About Carbs Blood Sugar And Reversing Type 2 Diabetes
You may have heard a lot about type 2 diabetes, but do you know what it actually does to your body?
Many Of Us Rely On Carbohydrates As Our Main Source Of Energy Carbohydrate
All the carbohydrates you eat and drink are broken down into glucose. The type, and amount, you consume can make a difference to your blood glucose levels and diabetes management.
There are different ways to describe carbohydrates. One way of doing this is to group them into those that contain mostly starch , and those that contain mostly sugars, such as fruits , some dairy foods , sweets, chocolate, sugary drinks and desserts.
I Eat Almost No Carbs And My Blood Sugar Is Still High Charlottes Story
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Meet Charlotte Faith.
Diagnosed with type 1 diabetes at the age of 14, Charlotte weighed only 83 pounds.
Even though she ate large amounts of food, she found herself ravenously hungry and began gaining weight rapidly. Only 1.5 years following her diagnosis, Charlotte gained about 70 pounds, weighing over 150 pounds.
Soon after, Charlotte embarked on a journey to lose weight and fully control type 1 diabetes, which involved eliminating heavily processed foods and eating a low-carbohydrate paleo diet.
In combination with moderate exercise, Charlotte began losing weight. As a paleo food blogger, she made sugar-free, “low carb” treats to satisfy her cravings for carbohydrate-rich food and was able to lose about 32 pounds.
Charlotte limited her carbohydrate intake to no more than 50 grams per day, yet still experienced high blood glucose values after eating a banana or half a sweet potato.
She often complained to herself: “I eat almost no carbs and my blood sugar is still high! How is this possible?”
In addition, Charlotte developed hypothyroidism and lost her period for 7 years.
: Treating Type 2 Diabetesand Why ‘eat Less Exercise More’ Doesn’t Work
With the explosion of type 2 diabetes, there has also been an explosion in the treatments offered. Many new drugs have been brought to market, and there are hundreds of lifestyle interventions to choose from.
The problem with a medication-based approach is that youâ€™ll most likely have to be on these medications for the rest of your life. They are expensive and many come with a host of side effects. The medication approach focuses on management of diabetes, not reversal. Taking medications for type 2 diabetes combats the end result, which is rising blood sugar, but does not address the root causesâ€”insulin resistance and carbohydrate intolerance.
â€?Shifting the paradigm to diabetes reversal, however, means addressing the root causes of type 2 diabetes.
Most lifestyle interventions focus on eating less and exercising more. But many patients have tried this and have seen minimal results, while also fighting unsustainable hunger and cravings. The problem with these programs is that they tend to be high in carbs, even if they are cutting back on calories. When you eat a high-carb diet, the resulting increase in your blood sugar triggers an insulin response in your body, and insulin blocks your bodyâ€™s ability to burn fat. Insulin actively blocks the breakdown of stored body fat, meaning that as long as insulin is high, it will be very difficult to lose weight, even if you are eating very little.
Drinking Too Little Water Leaving Yourself At Risk For Dehydration
Left unchecked, going low-carb can increase the risk of dehydration, as well as electrolyte imbalances, Urbanski explains. This happens because when the body stores carbohydrates, it stores water along with it. Furthermore, in response to reduced blood sugar levels, the body doesn’t produce as much insulin. In turn, the kidneys expel both water and sodium from the body, she says.
Also, if your low-carb plan involves removing a lot of sodium-laden foods like potato chips from your diet , it can also lower sodium levels.
Both dehydration and too-low sodium levels can bring on lightheadedness and dizziness, as well as keep the cells throughout the entire body from optimally functioning, she says. Keep open lines of communication with your healthcare team before loading up on salty foods, however. In people with uncontrolled high blood pressure or congestive heart failure, for example, increasing sodium intake may not be a healthy option, she says. As for water intake, the National Academies of Sciences, Engineering, and Medicine recommends 13 cups of fluid per day for men and about 9 cups per day for women, but ask your healthcare team about the optimal amount of fluid for your individual health.
Check out Diabetes Daily’s article “” for more information on this popular eating plan.
How Long Does It Take For Your Body To Get Used To A Low Carb Diet
While the length of time it takes to adapt to a keto diet varies, the process begins after the first few days. Then, after about a week to 10 days, many low-carbers suddenly start to feel the positive effects of keto-adaptation. They report improved mental concentration and focus and more physical energy as well.
Getting All Of Your Carbs At Once Rather Than Spreading Them Out
The lower you make your carb intake goal, the more difficult sustaining the diet 24/7 can become, Urbanski says. In some cases, you may be tempted to “save” your carbs for dedicated high-carb treat meals or snacks, but resist the urge. Evenly distributing carb intake throughout the day is critical for preventing large dips and spikes in blood sugar, as well as keeping energy levels up and the brain working at top speed. Sheth recommends that most people with type 2 diabetes aim to consume 30 to 45 grams of carbs per meal; to figure out the right balance for you, divide your goal number of daily carbohydrates by the number of meals you plan to eat throughout the day. Snacks also count toward this total but should generally be lower in carbs compared with meals.
Focusing Too Much On Total Carbs And Not Enough On Carb Quality
For the best health, following a low-carb diet shouldn’t just be about what you cut, it should also be about what you add into your nutrition plan, Zanini says. After all, a healthy diet meets all of your body’s nutritional needs and doesn’t exceed your body’s caloric needs.
But when people become narrowly fixed on reducing carbs, they can easily wind up replacing those carbs with high-calorie fats, as well as chemically laden sugar-free foods and artificial sweeteners. When following a low-carb diet, the more you can focus on whole, unprocessed foods, the better. These foods can certainly include high-fat foods such as olive oil, avocado, walnuts, and salmon, but the exact amount of fat you should eat depends on whether you are following a ketogenic diet or trying to build lean muscle through an increase in dietary protein, Urbanski says. Again, keeping an open dialogue with a registered dietitian is helpful.
Still, you don’t have to work directly with a registered dietitian to take advantage of their knowledge. The Academy of Nutrition and Dietetics is a great resource for expert nutritional information, eating strategies, and healthy recipes.
How Long Does It Take To Lower Blood Sugar On A Low Carb Diet
Lessons LearnedLow Carb ExperienceHigh Carb ExperienceTake insulin at meal start, after, or not at all.Critical to take insulin before mealsEasier to track boluses – one or two unit boluses stop lowering blood glucose in ~2 hoursHarder to track boluses – large doses can still be lowering glucose at 4+ hours
What To Do If Your Blood Sugar Levels Are Higher Than Normal
If your fasting or post-meal blood sugar readings are consistently higher than normal, you may have prediabetes or diabetes. If you suspect you have diabetes or prediabetes, you should see your healthcare provider as soon as possible.
Symptoms of diabetes, beyond elevated blood sugars, may include increased thirst and urination, severe fatigue and excessive hunger. For more details, see our guide to common .
Why Your Fasting Blood Sugar Might Still Be High On Low Carb
It’s not too uncommon to have slightly high fasting blood sugar on low carb and keto diets. Is this a problem? It depends on your insulin levels, as outlined by Dr. Ted Naiman below. If you’re insulin sensitive, and have slightly higher fasting blood glucose, it’s likely just fine. More The dawn phenomenon – why are blood sugars high in the morning? Insulin Advanced low-carb topics Diabetes Dr. Naiman Earlier with Dr. Naiman All earlier posts about Dr. NaimanContinue reading >>
What To Know About Low Carb Diets And Managing Your Diabetes
You shouldn’t cut carbohydrates out completely. Here, a registered dietitian offers tips and a well-balanced recipe to try.
When you think of carbohydrates, you probably think of bread, pasta and potatoes. But carbs are also in grains, legumes, starchy vegetables, milk, yogurt and fruit. They’re one of the three main energy sources in our food and they provide the body’s preferred fuel source for the brain, nervous system, and exercising muscle: glucose.
Unfortunately, patients with diabetes have difficulty converting that glucose into energy.
“The body needs the hormone insulin to convert glucose into energy, but for patients with diabetes, they either don’t make enough insulin or the insulin they make doesn’t work properly,” says nutritionist Joyce Patterson, M.P.H., R.D.N., B.C.-A.D.M.
When glucose can’t be used, it stays in the blood and results in high blood sugar. The worst offenders for these spikes are added sugars and refined grains, like white rice, and sugary beverages such as soda and juice.Patients with diabetes take medications to help increase their insulin levels or make insulin function properly so their bodies can get the energy it needs.
So if fat and protein are energy sources for the body too, why not just eliminate carbs from your diet? Well, there’s a lot of reasons, actually.
What To Do If Your Blood Sugar Levels Are Lower Than Normal
Blood sugar levels that are below 70 mg/dL are known as hypoglycemia. Symptoms of hypoglycemia include heart palpitations and feeling lightheaded, jittery, irritable, fatigued, or sweaty.9
Low fasting blood sugar levels can occur if you have diabetes and your medication does not match your carbohydrate intake. So it’s very important to let your healthcare provider know you’re following a low-carb diet so they can adjust your medication to match your carb intake.
In people who do not have diabetes, low fasting blood sugar levels may be the result of a serious underlying medical condition such as an eating disorder or a tumor. If your fasting blood sugar is low and you do not take diabetes medications, see your healthcare provider.
Low blood sugar levels after eating are often called reactive hypoglycemia. This can occur in people with diabetes, as well as those with normal fasting blood sugars. How it should be treated depends on what the underlying cause is. But if you have low blood sugar and experience symptoms, you can remedy this in the short term by eating something with carbs or sugar.
High-carb intake may cause reactive hypoglycemia in people who are very insulin sensitive or have experienced massive weight loss.10 A low-carb, high-protein diet has been found to improve reactive hypoglycemia in adults who have undergone weight-loss surgery.11
Higher Fasting Glucose On Ketogenic Diets: Reason To Worry
The vast majority of people who adopt a low carb or ketogenic diet experience stunning improvements in blood glucose control and insulin levels. Carbohydrate restriction is so effective for type 2 diabetes and metabolic syndrome, in fact, that researchers have said it should be “the default treatment” for these issues, and those who follow it are typically able to reduce or eliminate many medications, including insulin. However, individual variability being what it is, a small percentage of patients see a rise in fasting blood glucose after some length of time on a very low carb diet. Considering that elevated fasting glucose is part of the diagnostic criteria for both type 2 diabetes and metabolic syndrome, is this seemingly paradoxical rise a reason for concern?
As is true for so much of functional medicine, it’s all about context. A fasting blood glucose that’s higher than one would typically expect in someone adhering long-term to a very low carb diet doesn’t automatically indicate anything nefarious. There are many reasons why FBG might be elevated, and many ways to assess metabolic health and glucoregulation beyond just this one measurement.
“Adaptive Glucose Sparing”
Fasting Glucose – Limited and Misleading!
Fasting glucose and A1c are both measurements solely of blood glucose. However,
Here’s how HOMA-IR is calculated:
Glucose in mass units
HOMA – IR =
: Research On Ketogenic Interventions For Type 2 Diabetes
Clinical trials have proven a low-carb, high fat diet to be significantly more effective than programs that encourage you to eat less and exercise.
Low-carb, high fat lifestyles have not demonstrated an increased risk in cardiovascular disease. Patients in our clinical trial also had a significant reduction in triglycerides, which are associated with risk for cardiovascular disease, in just 10 weeks.Â¹
56% of patients were able to lower their HbA1c to below the diagnostic threshold for type 2 diabetes, and 47.7% were able to reverse their diabetes, which we define as lowering their HbA1c below the diagnostic threshold while eliminating their diabetes-specific medications .Â¹
Here Are Three Specific Ways That Keto Improves Diabetes:
#1: Weight loss
Standard diabetes protocols attempt to stimulate weight loss through calorie reduction. Unfortunately, long-term calorie restriction leads to a sustained metabolic slowdown, and the weight comes back when normal portions are resumed.
Keto, however, has been shown to help with weight loss and weight maintenance in obese and diabetic populations. In one study sponsored by Virta Health, type 2 diabetics lost an average of 30.4 pounds after one year of supervised Keto dieting.
#2: Blood sugar control
Keto is the opposite of a high-carb diet. By keeping carbs low, the Keto diet removes the dietary driver of diabetic hyperglycemia.
#3: Insulin function
Those with late-stage type 2 diabetes often need insulin injections to manage their blood sugar levels. But since insulin itself isn’t the problem, but rather the body’s healthy management OF insulin, this is more of a bandaid than a cure.
Ways To Include Good Quality Carbohydrates In Your Diet:
- Choose wholegrain breads and cereals.
- Have fruit whole, rather than as a juice. Eating an apple with the skin on, for example, will provide more fibre than drinking a glass of apple juice.
- Ring the changes with quinoa and bulgur wheat as an alternative to pasta.
- Try seeds, nuts and pulses as lower carb sources of fibre
- Choose unsweetened milk and yogurts
How Does Carbohydrate Affect Anyone With Type 1 Diabetes
All carbohydrate is converted into glucose. In someone without diabetes, the body produces insulin automatically to deal with the glucose that enters the blood from the carbohydrate-containing food that we eat and drink.In Type 1 diabetes the same principle applies, but because your body doesn’t produce any insulin, you have to take insulin, either by injections or a pump. This will help to lower the glucose in the blood after eating carbohydrate-containing foods. Most people follow twice-daily or basal bolus insulin regimes.
How Does Carbohydrate Affect Anyone With Type 2 Diabetes
For people with Type 2 diabetes who may be overweight or obese, reducing the calories you eat helps to lose weight. This can be done through different means including following a low carb diet or simply reducing the current amount of carbs you eat. People have successfully followed low carb diets to lose weight and manage their diabetes including lowering their HbA1c, cholesterol and blood pressure levels as well as reducing the amount of diabetes medications they take. If you are taking diabetes medications that put you at risk of hypos, checking your blood glucose levels regularly and speaking to your healthcare team to review your medications will help to reduce your risk of hypos when you restrict your carb intake.
A Word About Lada Latent Autoimmune Diabetes In Adults
If all of the information in this post does not help you understand your rising blood glucose on the low-carb diet, and your blood glucose continues to rise higher and higher, not only in the morning but at other times of day, there may be a potential issue of latent autoimmune diabetes in adults , also sometimes called type 1.5 diabetes.11
Both Dr. Hallberg and Dr. Fung say they see LADA regularly among their patients who may have been misdiagnosed with type 2 diabetes and have LADA instead.
LADA is like type 1 diabetes in that antibodies are attacking the insulin-producing cells of the pancreas, but it arises in adulthood, not childhood or adolescence. Diabetes researchers note that LADA also has features of type 2 diabetes, but the patients usually are thinner and progress to needing insulin faster because their insulin producing beta cells have been attacked by antibodies. The highest rates of LADA are found in Northern Europe, with up to 14% of type 2 diabetics actually having it.12
“I test serum C-peptide and insulin in everybody in my Intensive Dietary Management program,” notes Dr. Fung.” I re-check them over time and it often takes 6 months to 1 year to clinch the diagnosis. I would suspect about 5-10% of my type 2s are actually LADA.” Dr. Naiman has similar experiences and routines.13
What Happens When We Eat Carbohydrates Protein And Fat
â€?Your blood insulin responds very differently to different macronutrients. Fat does not impact blood insulin levels. Carbs have a high impact, and protein impacts them moderately, but fat has no impact.
Carbs and fats can both provide energy for the bodyâ€”but not at the same time. When carbs are abundant in the diet, carbs function as the preferred fuel source. But when carbs are limited in the diet, fat becomes the preferred fuel source.
When you reduce your intake of one macronutrient, you have to increase your intake of at least one other macronutrient to avoid feeling hungry and not have enough energy.
In a low carb, high-fat diet, fat provides you with the energy your body needs, and it also reduces hunger and cravings.
How Many Carbs Should A Type 2 Diabetic Have In A Day
The Basics of Counting Carbs
You can use these basic tips to help manage your carb consumption: Foods that contain carbohydrates include starches, fruits, vegetables, dairy products, beans, and sweets. Most people with type 2 diabetes should stick to eating around 45 to 60 grams of carbohydrates per meal.2 ??? 2016 ?.
Not Regularly Communicating With Your Healthcare Team
Your diabetes care team can help you determine the right low-carb approach for you, but it can also help to avoid any bad, potentially dangerous, or life-threatening side effects of going low-carb to help manage type 2 diabetes.
You and your doctor may need to lower or change your meds to avoid low blood sugar, or hypoglycemia; cardiovascular complications; and diabetic ketoacidosis , which is a health emergency. This is especially true for people taking insulin, insulin-promoting drugs, or blood pressure medications, Urbanski says. Additionally, SGLT2 inhibitors, oral medications that assist the kidneys in lowering blood glucose levels, push some people into potentially fatal DKA, with low-carb intake further exacerbating that risk, she says. “It’s recommended that someone on SGLT2 inhibitors should not go on a low-carb diet or should first discontinue and change medications under their doctor’s supervision,” she says. According to the Food and Drug Administration, examples of SGLT2 inhibitors include canagliflozin, dapagliflozin, and empagliflozin.
Personalizing Your Diet Based On Blood Sugar Response
In addition to seeing your healthcare provider, there are steps you can take to reduce your blood sugar levels. If you check your blood sugar after meals and keep track of those measurements, along with the types and amounts of food you ate, you may be able to see which foods are problematic.
Although an increase in blood sugar is usually due to eating high-carb foods, all carbs are not the same when it comes to raising blood sugar. Because starchy foods digest down to glucose very quickly, some starchy foods may end up having a much greater impact on blood sugar than you might expect.
For instance, even though a banana tastes sweeter than a baked potato, the potato may actually have a bigger impact on blood sugar.13
Because high-carb foods have the biggest impact on blood sugar levels, it makes sense to reduce them, no matter what type of diet you follow. The American Diabetes made this point in a 2019 paper on nutrition for people with diabetes.14
Sometimes making gradual changes can work best. Our guide, Eating better: six steps down carb mountain, can help you lower your carb intake, one step at a time.
If you’ve been diagnosed with type 1 or type 2 diabetes, our guide to the best foods for diabetes can help you make choices that may reduce your need for blood sugar control medications.
If a food or beverage seems to be causing your blood sugar to rise too much, try leaving it out of your diet for a few days to see if you notice a difference.