Double diabetes

A “new” form of diabetes appears to be rearing its ugly head these days, a combination of type I and type II diabetes. The new disease seems to arise when doctors treat patients with type I diabetes, the rarer form of the disease in which patients can’t make enough insulin. (In contrast, Type II diabetic patients (about 90% of diabetes sufferers) make too much insulin because they are resistant to its effects.) During treatment these type I diabetics take insulin shots to replace the insulin they can’t make, and in the process become Type II diabetics as well.

As the CNN article in puts it:

Doctors are seeing a new phenomenon dubbed double diabetes that makes it harder to diagnose and treat patients.

The above statement implies that doctors are having patients with this combined type of diabetes appear in their offices for the first time. The sad truth is that the doctors themselves create this “double” diabetes. Let me explain.

Before I explain why, you’ve got to understand one thing: most doctors are scared to death of dietary fat. That’s why they’re afraid of low-carbohydrate diets. It’s not the low-carbohydrates that worry them, it’s the high fat. The protein content of both low-fat diets and low-carb diets is about the same—there is a little more protein in a low-carb diet compared to a low-fat one, but not that much. The big difference is in the fat content. Since food is made of only three macronutrients—fat, protein, and carbohydrate—changing one means a change in another if calorie content is to stay the same. If you keep the protein about the same, reduce the carbohydrates markedly—as you do with a low-carb diet—then the fat quantity of the diet has to increase. And that’s the part that terrifies unenlightened physicians about low-carb diets.

When a patient with newly diagnosed type I diabetes presents to a doctor for treatment, here is what typically happens. The patient is started on a regimen of insulin injections that the physician feels comfortable with given the severity, or brittleness, of the patient’s disease. With most physicians this is a combination of long-acting and short acting insulin administered by the patient several times per day. The patient is warned about the effects of too much insulin, which causes a drastic drop in blood sugar and, consequently, dizziness, sweating, nausea, and even unconsciousness. The patient is instructed to immediately consume a high-carbohydrate beverage or take glucose pills if any of these symptoms occur. And, as always, the doctors put these patients on low-fat, high-carbohydrate diets because they know that diabetics are more prone to heart disease, and, hey, we all know that fat causes heart disease, right?

When the patients return to the clinic for their follow up visit, the doctor checks a blood value called a HgA1c (pronounced hemoglobin A one C), which is a lab test that more or less gives an average of blood sugars over the past 30-60 days. If the HgA1c is high, then the doctor figures—correctly—that the blood sugar has been too high, and then increases the dose of insulin. The patient goes away, follows the doctor’s orders, comes back, and repeats the entire process. Ultimately, the point is reached in which the patient is taking huge doses of insulin, still has elevated blood sugars, and is becoming obese and insulin resistant. And, now has both type I and type II diabetes—double diabetes. And it’s all caused by focusing on using more and more insulin to control the ever-increasing blood sugar levels while at the same time treating the excess insulin by having the patient consume more carbohydrates to keep from having the insulin knock the blood sugar too low.

I’ve seen patients on 150 and more units of insulin per day who are still having difficulty controlling their blood sugar levels. To give you an idea of how high that really is, you’ve got to realize that the pancreas of a person who is in good heath and doesn’t have any kind of diabetes produces about 30 units of insulin per day, which is plenty to keep blood sugar in check. So the 150 units is about 5 times more insulin than a person needs. And too much insulin promotes insulin resistance, which requires even more insulin in a vicious cycle, upward spiraling effect. The result is a patient who has type I diabetes, i.e., can’t make enough insulin, and type II diabetes, is administering too much and is insulin resistant.

How to control it? With a carefully constructed and controlled low-carb diet combined with a regimen of much lowered insulin dosages.

The patient should be instructed in injecting insulin to cover the carbohydrate (and protein, to an extent, since a portion of the protein converts to sugar) of each meal with small doses of regular insulin. If you or anyone you know has type I diabetes (or type II, for that matter) the best thing you can do is get a copy of Dr. Richard Bernstein’s book The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution.

Dr. Bernstein is a phenomenal story. He came down with type I diabetes when he was a child and went on to develop just about every bad complication one could have. He became an engineer and married a doctor. When the first glucometers came on the market, they were huge, expensive pieces of equipment, available only to only hospitals. Using his wifely physician connection, Mr. Bernstein finagled a glucometer and started experimenting using himself as a subject. After an extensive period of fiddling with foods and their effects on his blood sugar, he found that he could control his brittle blood sugars nicely with a low-carb diet and small amounts of insulin. He continued to refine his methodology and finally wrote a paper about his experiences and submitted it to a number of medical journals. His submissions were rejected by all with the explanation that he wasn’t a doctor so what he had to say wasn’t really valid.

He decided to remedy the situation by enrolling in medical school when he was 45. He did so, graduated, and is a practicing diabetologist in Mamaroneck, NY. I can’t recommend him or his books highly enough. If you have diabetes and follow his instructions, I can assure you that you will never develop “Double Diabetes.”

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