The internet as tons of info on diabetes. Not all of it is accurate. Never have I been slapped with this reality as when trying to learn about managing diabetes. And yes, I’m aware of the irony of saying that on the internet. This post is not a medical journal (you knew that) and I am nowhere close to an expert. I’m just a guy with type 2 trying to make sense of it. Here is what I think I know.

What is diabetes?

Here is my oversimplified description. Muscles use sugar (glucose specifically) as fuel. Glucose is brought to muscle cells via blood. Muscle cells, being cells, need to keep their insides in and the outside stuff out – they are sealed units. So how does the glucose move from the blood into the cell? Insulin. Insulin is a hormone produced in the pancreas. It is the key that unlocks the muscle cell’s seal for glucose to get in.

Blood sugar levels go up after you eat and is supposed to go down as muscles burn it as fuel. When that flow of glucose into cells is doesn’t work right, the glucose stays in the blood and you end up with high blood sugar. The term diabetes is short for diabetes mellitus, which is mix of Greek and Latin “passes through like honey”. Because of high blood sugar, the urine of someone with diabetes tastes sweet (eww! thanks for Thomas Willis who did the taste test in 1675).

So simply put: diabetes is the case where your blood sugar it too high for too long.

Types

The types of diabetes describe what is interrupting the sugar/muscle flow.

• Type 1 – you are not making enough insulin
• Type 2 – you are making enough insulin, but the muscles aren’t responding to it
• Gestational – you are having a baby and that messes with your hormones.

Why is high blood sugar bad?

Sugar molecules are boulders compared to small blood vessels, like the ones in the eye, nerves, and kidneys. As long as sugar levels go down soon after eating, these blood vessels are fine. But when they stay high, the relentless avalanche of sugar boulders flowing through these tiny tubes can eventually damage them. This can lead to:

• Eye damage (retinopathy) which includes cataracts, glaucoma, and even blindness
• Kidney damage (nephropathy) because the kidney has millions of tiny blood vessel clusters that filter waste. Damaging these can lead to kidney failure requiring dialysis or transplant
• Nerve damage (neuropathy) resulting in tingling, numbness, or burning pain. Left untreated can lead to blisters, infections, and may require amputation.
• Heart attack and stroke (cardiovascular disease)
• Possible hearing loss, Alzheimer’s, and depression.
• and more.

What do I do about it?

This is where I get confused – but I think I got this.

It doesn’t take long on Google to find helpful people with advice on managing diabetes. The problem is good sounding advice often contradicts other good sounding advice. In this section I will explore some of these contradictions. I’ll end with what I am doing about it – for what that’s worth.

Diabetes merely describes the fact that a one has high blood sugar. The sad reality is no one knows for sure what’s going on to cause that situation. Type 1 is probably the immune system attacking the pancreas’s ability to produce insulin. Gestational has something to do with having a baby. Type 2 – which is what I’ve read the most about – is a mystery.

It is important to know that no one knows while trying to decide what actions to take. This is because so many advice givers claim to know. And they are very convincing.

• Dr. Jason Fung says type 2 diabetes results from insulin losing its effect in the same way that alcohol or drugs lose their effects.
  • Your body develops a tolerance to the thing, and it takes more of the thing to get the same results.
  • He claims that if the thing is insulin, it is called insulin resistance and the result is diabetes.
  • The thing to do then is intermittent fasting to give the body a chance to recover from the excess insulin.
• Dr. Neal Barnard says type 2 diabetes is a problem with the muscle cells.
  • If insulin is the key and the muscle cells have a lock, diabetes is gum in the locks.
  • He claims that gum comes from animal fat
  • The thing to do then is to stop eating animal products.
• Dr. Sarah Hallberg says type 2 diabetes is disease of diet.
  • Everything you eat is either carbohydrate, protein, or fat. Eating protein doesn’t raise blood sugar much, and neither does eating fat.
  • She claims one has high blood sugar because of eating eat too much carbohydrates.
  • The thing to do then is to stop eating carbohydrates.

One says “eat whatever you want, just take long pauses between meals”. Another say, “eat all the carbohydrates you want, just not animal fat.” Another says “eat all the fat you want, just no carbohydrates.” Each is a doctor. Each, I believe, is well meaning and sincere. Each says “my patients’ success demonstrates I’m right”. Clearly they can’t all be right – at least not in the root cause.

It is clear, though, that each is saying “watch what you eat” and that is where the answer lives. So my glucose meter is my eyes on the road. As long as I stay between the lines, what I’m eating is working.

In short: what do I do about it? 1) follow my doctor’s advice. 2) eat good.

What am I eating?

I started by trying to follow the Mediterranean diet. I decided this a week before my diagnosis because studies say it’s the best diet (I went to the doctor for the same reason I was changing my diet – needed to start taking care of myself). After diagnosis other articles said it was good for diabetes too. And I loved that diet.

As I tried to add variety, I thought I’d play it safe by following Barnard’s advice and avoid animal products. Despite being one of the three contradictory doctors I listed above, his claims are backed by not just anecdotes from his patients, but by actual research studies. The study doesn’t validate the “gum in the lock” theory, only points to how well a vegan diet helps manage blood sugar. So I mixed up salmon and olive oil with the occasional Indian chickpea and curry.

I found myself slowly adding more vegan dishes and fewer meat based meals. Not out of any profound change in philosophy – just cuz I liked it. Now that I am a near-vegan (aka flexitarian), I find the reasons to be vegan compelling, so I will more often than not stick to plant-based from now on.

At my last check-up my doctor said I basically don’t have diabetes any more – at least my blood sugar levels would not support such a diagnosis if he had never known the previous levels. Between diet and getting back into running, I’ve never felt healthier!