Type 2 diabetes
Type 2 diabetes is by far the commonest form of diabetes (around 90% of all cases). The disease is getting more and more common, and there’re already around 330 million type 2 diabetics worldwide.
Most people who are affected are overweight (especially those carrying excess abdominal fat) and middle aged or older. People with high blood pressure and unfavorable cholesterol numbers also run an increased risk of developing the disease.
For more on the background to the epidemic, how you can test if you have diabetes and how to naturally regulate your blood sugar:
Here you’ll find more specific information on the cause of and treatment for type 2 diabetes.
Table of contents
- The cause of type 2 diabetes
- Other lifestyle modifications
- Dietary supplements
- More education
The cause of type 2 diabetes
Type 2 diabetes – previously called “adult onset diabetes” – results when the body no longer can handle large amounts of blood sugar. Large amounts of the blood sugar-lowering hormone insulin need to be produced, but this will still not be enough, because the sensitivity to the hormone decreases. At the time of diagnosis type 2 diabetics often have ten times more insulin in their bodies than what’s normal. As a side effect all this insulin causes fat storage and weight gain, something that often has been going on for many years before the disease is diagnosed.
So what’s the cause of this? This is still controversial and much debated. But there’s a clear correlation with the amount of sugar in the food. The more sugar people consume the more they get diabetes in the long run. According to a recent investigation this correlation is found in all countries around the world.
Probably also contributing is ingestion of other rapidly-digested carbohydrates, such as white bread and pasta, because these too cause a rapid rise in blood sugar. Here too there are clear linkages: people who eat more simple carbohydrates are more likely to get type 2 diabetes.
The associations between sugar, rapidly-digested carbohydrates and type 2 diabetes hold even in more rigorous studies. To give advice in favor of carbohydrate-rich food increases the risk of getting type 2 diabetes and worsens blood sugar levels in people who already have type 2 diabetes.
Type 2 diabetes could thus very well be called sugar disease. But then do remember that starch in the bread turns in to glucose in the stomach – white flour is in fact also a form of sugar.
Treatment of type 2 diabetes
Avoid eating large amounts of sugar and starch and your blood sugar will be better from the first meal on. Your probably unhealthily high insulin levels will drop to normal levels. Because insulin is a fat storing hormone it has likely contributed to your overweight. When insulin levels drop most people will feel more satiated, eat less and gradually lose weight.
If you’re lucky, especially if you haven’t had type 2 diabetes very long, this action may be all that’s needed to become healthy.
Try it yourself: LCHF for beginners
NOTE: If you’re being treated with insulin or insulin releasing tablets (Sulfonylureas) you may need to taper off this medication if you are eating fewer carbohydrates.
Other lifestyle modifications
To eat significantly fewer carbohydrates is definitely the most important thing. I heartily recommend that initially you put all of your self discipline into changing your eating habits. It’s hardest in the beginning (first weeks and months).
Gradually, as your new eating habits start to flow easier you can start trying other positive lifestyle changes that can further improve your health and weight. There are two additional things that may be helpful:
According to recent studies there is one supplement that can help many with type 2 diabetes a little: Vitamin D. Many people are deficient in Vitamin D, especially during the winter months. Studies show that supplementation can improve blood sugar and insulin sensitivity somewhat in type 2 diabetes. In addition this may cause weight loss.
Around 4 000 IU daily (100 µg) may be appropriate for most people with type 2 diabetes.
If diet changes and other lifestyle changes don’t improve blood sugar sufficiently, then medication is added.
Metformin tablets are without doubt the first-line treatment of choice. It’s an old and proven treatment. It has been proven to improve not only blood sugar but also general health in type 2 diabetics.
Unfortunately, some patients are unfortunately plagued by digestive problems (stomach pain, diarrhea) from the tablets. This side effect usually subsides with time. For susceptible people it may be wise to start with a small dose (0.25 – 0.5 g daily) that can then gradually be increased.
The dose of Metformin may be increased up to the highest dose the stomach will tolerate. A dose of two grams daily is often sufficient for a positive effect, and the maximum dose is three grams daily.
2. GLP-1 analogues?
When not only Metformin is sufficient, or if you don’t tolerate it, then what to do? This is controversial today.
Often insulin injections are used. I’d strongly advice against this if you are overweight, because you then usually already have pathologically high insulin levels in your body. To add MORE insulin in this situation often causes a gradually worsening of disease and an increase in obesity. It will make you sicker and fatter. It will increase the risk for cancer and in addition the risk for heart disease probably goes up.
If you’re already on insulin treatment you may need to taper off and go off it when you eat fewer carbohydrates and/or take other medication.
A newer and better alternative is injections with the hormone GLP-1. It produces an increased satiety, a lower blood sugar and often a substantial weight loss (over 20 lbs is common). This, in addition to Metformin, is what I use with my patients as needed. The effect on the majority of patients is very positive for both blood sugar and weight.
Type 2 diabetes is closely tied to the “western disease”, i.e. the Metabolic Syndrome.
Can you cure type 2 diabetes?
In only six months? Without medications or surgery? This study suggests this:
Type 2 diabetes
Pictured above is a large number of blood glucose readings in a type 2 diabetic in the first six months on an LCHF diet. The blue area corresponds to optimal blood glucose levels. Please note that not one single elevated number was recorded after a few months! And then after just three days she was even able to stop daily 70E insulin injections. She also lost 68 lbs in the first year.
The story behind the image: Type 2 diabetic becomes symptom-free on an LCHF diet (Google translated from Swedish)
Overweight diabetics (both type 1 and type 2) will as a rule lose fat weight on a low-carbohydrate diet.
But what happens to blood lipid levels when you eat less carbohydrate, and a higher proportion of fat? The fact is that recent studies (contrary to what was previously believed) show clearly improved cholesterol numbers.
Blood pressure also often improves on a low-carbohydrate diet. Which partly, but not completely, is explained by the weight loss.
I’ve heard of many people that have had to reduce or stop using blood pressure medications, when their blood pressure had dropped too low.
With insulin-treated diabetes it’s important to monitor your blood sugar closely in the beginning when starting an LCHF diet! A diet including few carbohydrates usually causes a greatly reduced need for insulin. It’s then important to adjust (lower) the doses sufficiently to avoid that blood sugar drops too low. This should, if possible, be done with support of your physician or diabetes nurse, especially if you have limited experience of insulin adjustment yourself.
Insulin for type 2 diabetics
A suggestion from Dr. Vesti Nielsen (specializing in internal medicine): reduce insulin doses by 25-30% from day one, when on an LCHF diet. Monitor your blood sugar closely and adjust doses accordingly. Most people can cut their insulin dose in half in 3-6 days. The low-carbohydrate diet Dr. Nielsen used in his study was moderately strict: 20% carbohydrate (around 100 g daily).
Dr. Mary Vernon suggests (with a strict low-carbohydrate diet, < 20g carbs/day) that insulin doses below 10E daily can be terminated immediately, while higher doses can be cut in half immediately. Blood sugar needs to be monitored closely before and after meals in the beginning, and doses have to be adjusted until your levels are good.
It’s not uncommon for type 2 diabetics to be able to manage without insulin after a while (days to months) on a low-carbohydrate diet.
Treatment with tablets
Even doses of certain tablet treatments for diabetes may also need to be reduced after some time on an LCHF diet. The risk of the blood sugar dropping too low is however smaller than what it is from insulin injections. If treated with any other diabetes medication you should closely monitor blood sugar to be safe, when you change your diet. The exception is Metformin tablets, which don’t make the blood sugar drop too low.
If you’re not taking any medication for your diabetes (or Metformin only) you don’t need to worry about blood sugar dropping too low on an LCHF diet.
If blood sugar drops too low
Immediately eat something carbohydrate-rich, such as a fruit or a sandwich. A glass of juice or glucose tablets may also work well. They raise blood sugar. If your blood sugar drops too low you should strongly consider reducing your medication. If you need help doing this contact your doctor.
In addition to type 1 and 2 there are a couple of other forms of diabetes. LADA-diabetes is a not too uncommon form (perhaps as much as 10%), that has been described as “halfway between type 1 and type 2”. As with type 1 you have antibodies that attack the insulin producing beta cells. LADA first debuts later in life than type 1 and develops more slowly.
MODY diabetes is a rarer form that is caused by a genetic abnormality.
- Intense blood sugar regulation with drugs seem to increase, not decrease, the risk for disease and death! Gerstein HC, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59.
- Diabetics that medicate their blood sugar to a low level or are on insulin die prematurely: Currie CJ, et al. Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. The Lancet, Early Online Publication, 27 January 2010.
Monitoring your blood sugar yourself seems to have a small positive effect, even for diabetics that are not insulin-treated:
- Farmer AJ, et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012;344:e486.
Of course, how great the effect will be depends entirely on whether the monitoring leads to an improved lifestyle. Just checking your blood sugar and writing down the number in a book will of course not make you any healthier at all. Monitoring of blood sugar for non-insulin-treated diabetics should be used for pedagogic reasons or for the purpose of improving diet and exercise treatment.
Main page on diabetes
One reason to care
High blood sugar produces a risk for severe complications in the long run. It “eats” away the body’s small blood vessels. The higher the blood sugar the higher the risk for heart attack, blindness, amputations and other misery.
Just ask Richard Roseman, one of millions of victims of common complications of diabetes:
Obviously one would want to avoid this. But a conventional low-fat diet (today’s dietary guidelines) and medications in principle never cures diabetes. In the best case scenario the disease is kept under control without causing major damage. At worst it will go like it did for Richard Roseman. Or worse.
A better treatment than this is needed. It exists, and it’s obvious and logical when you understand.
Insulin and the fear of natural fat
This knowledge was partly forgotten when the insulin came. In a too great a reliance on the new, one seems to have believed that diabetics without problems could inject unlimited amounts of insulin, in order to normalize blood sugar, and thereby be able to eat more blood sugar-raising carbohydrates. But excessive doses of insulin have negative long-term effects, and this has become more and more obvious – in studies as well as in reality. Excess insulin makes you gain weight, and is likely dangerous in other ways.
A presentation on diabetes and a low-carbohydrate diet by Mary C. Vernon, an American physician, since long specializing on the subject.