Suddenly, food was the enemy. Everything that went in your mouth had the potential to cause you to have your feet amputated and go blind. Sounds a bit extreme now, but at the time, that’s what went through my mind every time I picked up a fork.

Many people will try to tell you what you can and can’t eat as a diabetic. Most will be well-meaning. Most won’t have a clue. Including, apparently, the American Diabetes Association.  The ADA is still recommending a low-fat diet high in complex carbohydrates.

I’ve yet to meet, or hear of, a Type 2 diabetic that could maintain good control on that type of diet.

Rather than compounding the problem by telling you what you should or should not eat, I’d recommend a simpler method: eat by your meter.

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Non insulin-using Type 2’s however often feel they don’t need to wear a medical alert.

I wear a dog-tag style necklace identifying myself as a diabetic for a couple of reasons:

1.) I frequently travel alone. If I were mugged and knocked unconscious in a distant city, it could literally be days (or never) before I was identified and a family member familiar with my medical history could be contacted.

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Frozen shoulder is a condition in which adhesions in your body’s joints (typically the shoulder) cause severe pain and restrictive movement.

Prior to my diagnosis, I spent several years with limited range of motion in my shoulder and a burning pain sensation that rarely, if ever, went away. It was never actually diagnosed as frozen shoulder, but looking back, that’s undoubtably what it was.

The shoulder tends to eventually “unfreeze” and the pain goes away (to some extent at least), but people have been known to suffer from frozen shoulder for up to five years.

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The HbA1c test is used to monitor your diabetes. It is an average of your blood glucose levels over time and gives you a good idea of how well you are controlling your diabetes.

The A1c is a blood test. Blood is drawn and (usually) sent to the lab for the test. Some doctor offices now have ”instant A1c” test equipment in their offices.

The basic science behind the A1c works something like this: the red blood cells in your body pick up glucose that is flowing in your blood. This is normal and happens to everyone. If you have high levels of glucose in your blood, your red blood cells pick up more glucose than normal. The shorthand “HbA1c” stands for glycosylated hemoglobin. 

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The classic symptoms are: extreme thirst, frequent urination, extreme weight loss and fatigue. These can come on quite quickly in a type 1 diabetic, but can develop slowly in a type 2.

The thirst and urination are obviously tied together - this is your body’s attempt to get rid of the excess glucose. If glucose levels are high enough, the glucose will begin to “spill” into your urine. This can result in your urine leaving a “sticky” residue (more likely to be noticed if you are a man, for obvious reasons.) The weight loss and fatigue are similarly tied together. As your systems for processing glucose break down, your body has increasing difficulty getting the food energy it needs, and will resort to breaking down itself for energy.

Constant hunger. As stated above, if you are an undiagnosed diabetic your body’s cells are probably starving for nutrition and signaling that they need food, even if you’ve just eaten. As a type 2, you’re probably producing an excess amount of insulin, which is triggering hunger symptoms.

Itchy skin, especially after high intake of carbohydrates. I literally felt itchy everywhere after drinking Gatorade, prior to diagnosis. It got to the point where I thought I was allergic to it. Turns out it was just the high level of high fructose corn syrup that it contains.

Flushing/sweating after eating. This is a common reaction to high blood glucose level spikes that follow eating a meal.

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Unless you are taking insulin, you’re going to have to watch what you eat closely. “Eating by your meter” is what a lot of Type 2’s call it. If what you ate causes you to have blood glucose readings over 140 two hours after your meal, you better reconsider whether that is a food you can eat.

I generally eat breakfast at home and dinner seems to be easier if you’re eating out. I generally have eggs,  cottage cheese, or bacon for breakfast. Dinner just seems to be easy as well: a lean meat and some veggies, hold the potatoes. Most restaurants will let you substitute the veggie of the day for the potato.

Lunch, on the other hand, is harder. I’ve never been one to pack my lunch and I rarely take a full hour for lunch, so I was in the habit of hitting the fast food places for lunch. When you are a Type 2, you begin to notice that very few menu items at fast food joints don’t include bread, potatoes, fries, pasta or some combination of the above.

Your meter will tell you if you can tolerate any of the above, but if you are like me, you most likely need to avoid those types of food choices.  

Over time, I’ve come to learn a few things I can do to allow me to still grab a quick lunch at a fast food place.

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How often should I check? At first, pretty much all the time. The only way to come to grips with your diabetes is to learn, as soon as possible, how well your medications are working and what effect various foods have on your blood sugar. If you are a Type 2 Diabetic, your doctor may only write a prescription for testing 2 times a day. I’d recommend more, at least at first. If you have to, pay cash for extra strips.

A good plan for someone recently diagnosed would be to check your blood glucose:

1. First thing in the morning - Before you brush your teeth or have anything to drink, preferably.
2. Two hours after you took your first bite of food for the day.
3. Immediately before lunch.
4. Two hours after your first bite of lunch
5. Immediately before your evening meal
6. Two hours after your first bite of your evening meal
7. Last thing you do before you go to bed

Why test so much?

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Often considered the “last resort”, insulin is always an option. Sometimes a doctor will prescribe insulin for a newly diagnosed Type 2 diabetic in order to get dangerously high levels down to a more normal range before trying pills or other injected medicines. Hypos, dangerously low blood sugar, are always a concern when injecting insulin. If a patient doesn’t respond to oral medications or oral medications stop being effective, many type 2 diabetics will “progress” to injecting insulin. An inhalable version has been developed, but it is still most commonly injected.

For oral medications there are several different types: Biguanides, Meglitinides, Sulfonylureas, Thiazolidinediones, Alpha-glucosidase inhibitors, DPP-4 inhibitors and incretin mimetics. I’m not going to get into the science behind them, but a general overview as well as some brand names are below. At the end of the article are some links to various sites that have good descriptions of the science behind these drugs.

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There is a prevailing opinion that fat people get Type 2 Diabetes *because* they are fat.

At the same time, there’s plenty of evidence that Type 2 Diabetes is an inherited genetic disorder of the metabolic system that is progressive.

Why is it so hard to believe that the bad genes came first and *caused* the weight gain? Hmm, a person with an inherited genetic disorder of the metabolism system is putting on weight…go figure.

Maybe, just maybe, the disease came first. Slowly impeding the processing of glucose in the body. Slowly causing ever increasing amounts of insulin to be released in order to deal with all that glucose. Slowly increasing the insulin resistance, allowing that excess insulin do the second part of its job- store fat.

Is it really so hard to believe that maybe Type 2 Diabetics tend to be fat *because* they have a disease, instead of vice-versa?

I’ve yet to see a good study that conclusively points one way or the other. There’s no doubt that the vast majority of people with Type 2 are fat.

Maybe there’s a reason for that?

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