Conventional: A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. Carbohydrate intake should be monitored using carbohydrate counting or experienced-based estimation. The Recommended Dietary Allowance for digestible carbohydrates is 130 g/day, which will provide a sufficient amount of glucose needed to fuel the central nervous system without reliance on glucose production from protein or fat. Using foods with a low glycemic index that are rich in fiber and other important nutrients is encouraged.
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“High glycemic index foods are going to be primarily processed foods,” says Lori Chong, RD, CDE, at The Ohio State University Wexner Medical Center in Columbus. Those processed foods tend to have more white sugar and flour in them, which are higher on the GI, she says. Foods lower on the GI include vegetables, especially non-starchy vegetables, like broccoli, cauliflower, and leafy greens and whole-grain products, such as brown rice (as opposed to white rice), Chong says. She notes that even many fruits are low on the GI, with pineapple and dried fruit being some of the highest (Berries, apples, and pears tend to be fairly low.)
In obese young people, decreased β-cell function has recently been shown to predict deterioration of glucose tolerance (4,78). Additionally, the rate of decline in glucose tolerance in first-degree relatives of type 2 diabetic individuals is strongly related to the loss of β-cell function, whereas insulin sensitivity changes little (79). This observation mirrors those in populations with a high incidence of type 2 diabetes in which transition from hyperinsulinemic normal glucose tolerance to overt diabetes involves a large, rapid rise in glucose levels as a result of a relatively small further loss of acute β-cell competence (3). The Whitehall II study showed in a large population followed prospectively that people with diabetes exhibit a sudden rise in fasting glucose as β-cell function deteriorates (Fig. 5) (80). Hence, the ability of the pancreas to mount a normal, brisk insulin response to an increasing plasma glucose level is lost in the 2 years before the detection of diabetes, although fasting plasma glucose levels may have been at the upper limit of normal for several years. This was very different from the widely assumed linear rise in fasting plasma glucose level and gradual β-cell decompensation but is consistent with the time course of markers of increased liver fat before the onset of type 2 diabetes observed in other studies (81). Data from the West of Scotland Coronary Prevention Study demonstrated that plasma triacylglycerol and ALT levels were modestly elevated 2 years before the diagnosis of type 2 diabetes and that there was a steady rise in the level of this liver enzyme in the run-up to the time of diagnosis (75).
Some people with diabetes use a computerized pump -- called an insulin pump -- that gives insulin on a set basis. You and your doctor program the pump to deliver a certain amount of insulin throughout the day (the basal dose). Plus, you program the pump to deliver a certain amount of insulin based on your blood sugar level before you eat (bolus dose).
Whole-body insulin resistance is the earliest predictor of type 2 diabetes onset, and this mainly reflects muscle insulin resistance (26). However, careful separation of the contributions of muscle and liver have shown that early improvement in control of fasting plasma glucose level is associated only with improvement in liver insulin sensitivity (20,21). It is clear that the resumption of normal or near-normal diurnal blood glucose control does not require improvement in muscle insulin sensitivity. Although this finding may at first appear surprising, it is supported by a wide range of earlier observations. Mice totally lacking in skeletal muscle insulin receptors do not develop diabetes (27). Humans who have the PPP1R3A genetic variant of muscle glycogen synthase cannot store glycogen in muscle after meals but are not necessarily hyperglycemic (28). Many normoglycemic individuals maintain normal blood glucose levels with a degree of muscle insulin resistance identical to those with type 2 diabetes (29).
Everybody and their brother is jumping on the Diabetes bandwagon. I remember when Dr. Neal Barnard and Dr. Gabriel Cousens were the only two advocating a vegan diet to reverse Type 2 Diabetes and nobody was listening. Now, it seems there is some Doctor who pops out of the woodwork who claims to have the “Real” cure. Bottom line a ketogenic diet is dangerous for diabetics. It has been proven through studies that high fat diets are detrimental for glucose control. Fasting is also hit and miss for glucose control. As each person’s body is different and responds differently, a keto diet may work at first, but over time blood sugar numbers will rise. I tried a keto diet for 8 weeks. First three weeks it worked great then my glucose numbers slowly started to rise and it started to get hard to control my numbers. Same with fasting. My body responds to eating smaller meals every two hours, 90% vegan and raw. I eat chicken and fish sparingly. It works for me. But, I have known many diabetics who ended up in a bad place on a keto diet. In the long run it is a big fail. There are no studies that support it, whereas there are numerous studies (even government funded studies) that support a vegan diet to reverse diabetes.
Khodneva, Y., Shalev, A., Frank, S. J., Carson, A. P., & Safford, M. M. (2016, May). Calcium channel blocker use is associated with lower fasting serum glucose among adults with diabetes from the REGARDS study. Diabetes Research and Clinical Practice, 115, 115-121. Retrieved from http://www.diabetesresearchclinicalpractice.com/article/S0168-8227(16)00070-X/abstract
“The degree of carbohydrate restriction that we recommend to establish and then maintain nutritional ketosis depends upon individual factors such degree of insulin resistance (metabolic syndrome or type 2 diabetes?) and physical activity. These starting levels of carb restriction typically vary between 30 and 60 grams per day of total carbs. The best way to determine one’s carbohydrate tolerance is to directly measure blood ketones with a finger-stick glucometer that also accommodates ketone testing.
Yes and no. If you learn to live a healthier lifestyle and stay with it for your remaining years, then yes it can be reversed. This assumes you realized your diagnosis early and you are able to get your A1c below 6%. If you realized your diabetes too late or your A1c is not coming down without insulin then probably not. This is easier to reverse when you are overweight or obese but not so if your BMI is below 25.
Together with evidence of normalization of insulin secretion after bariatric surgery (84), insights into the behavior of the liver and pancreas during hypocaloric dieting lead to a hypothesis of the etiology and pathogenesis of type 2 diabetes (Fig. 6): The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol (85), which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function. However, of note, observations of the reversal of type 2 diabetes confirm that if the primary influence of positive calorie balance is removed, then the processes are reversible (21).
A rapid-acting inhaled insulin (Afrezza) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease. It comes as a single dose cartridge.Premixed insulin is also available for people who need to use more than one type of insulin.
Exenatide (Byetta) was the first drug of the GLP-1 agonist group. It originated from an interesting source, the saliva of the Gila monster. Scientists observed that this small lizard could go a long time without eating. They discovered a substance in its saliva that slowed stomach emptying, thus making the lizard feel fuller for a longer time. This substance resembled the hormone GLP-1.