Atkins Diabetes Revolution (11 page)

DIABETES BY THE NUMBERS

You officially have Type 2 diabetes when your fasting blood sugar (FBS) is 126 mg/dL or higher on two separate blood tests, or when your blood sugar is above 200 mg/dL two hours after a meal or at the two-hour point in a glucose tolerance test.At this point, you would be at the fifth stage of the progression—significantly elevated blood sugar, insulin resistance, and high insulin production. If that’s where you are, let’s hope you can still avoid the sixth and final stage, Type 2 diabetes with low or virtually no insulin production.It’s no fun having to take oral antidiabetic medications or, worse, to give yourself daily doses of insulin.Don’t put this book down until you’ve learned how to take immediate steps to avoid these consequences.

WARNING SIGNS OF DIABETES

A shocking number of people have progressed to Type 2 diabetes and don’t even realize it. Following is a list of common symptoms that patients with diabetes may experience.You must see your doctor as soon as possible to evaluate any of the following symptoms:

• Extreme thirst
  
• Extreme hunger
  
• Frequent urination
  
• Weight loss without trying
  
• Unusual fatigue
  
• Blurry vision
  
• Irritability
  
• Tingling or numbness in hands or feet
  
• Frequent skin, bladder, or gum infections
  
• Slow healing of cuts and bruises
  

THE MOST IMPORTANT TOOL

The hallmark of Dr. Atkins’ approach was his focus on the role of insulin and glucose function. He believed that it goes to the very heart (pardon the pun) of maintaining optimal health, preventing disease, and even treating chronic illness. Because insulin is a basic and fundamental hormone, whose job it is to regulate how your cells use energy, any disruption in this hormone’s function will interfere with your health. And in today’s sedentary, “carb-o-holic” society, insulin function is disrupted in an extremely large percentage of people.

That is why in his practice, regardless of the patient’s weight and reason for coming to see him, Dr. Atkins almost without exception performed a five-hour glucose and insulin tolerance test (GTT). This is not a standard test, as it is time-consuming and expensive. Nevertheless, he believed the GTT is the best way to find out how your body reacts to carbohydrates. A
single
test such as fasting blood sugar is like a snapshot; the GTT is like making a movie of your metabolism.

It is through observing the results of thousands of patients and correlating the results with their reported symptoms that Dr.Atkins came to fully understand the importance of controlled-carbohydrate nutrition in the prevention of diabetes and heart disease and in the treatment of the other chronic health problems that plague us today. By observing the changes in blood sugar and insulin levels that occur during the test, he learned just how early on we can diagnose those at risk for developing the metabolic syndrome. He also learned how, with proper education and intervention, we can not only prevent the metabolic syndrome, but also stop the progression to prediabetes and Type 2 diabetes.

If after reading this far you think that you might have the metabolic syndrome or prediabetes, you need to be your own patient advocate and have a serious discussion with your doctor about performing the full five-hour glucose tolerance test.

DISCUSSING THE GTT WITH YOUR DOCTOR

If your doctor tells you you don’t need the glucose tolerance test, what should you say? We suggest that you ask your doctor to order the test anyway. Offer to pay the bill ahead of time. Call your insurance carrier and obtain a letter indicating the company will cover the cost (if it will).You could also offer to pay a deposit and ask for the bill to be filed with your insurance carrier. Most physicians will agree to order the test if the cost doesn’t directly affect them. Some insurance plans will charge a physician for ordering a test not considered “medically necessary.” In that case, your only choice is to pay the bill yourself.You may be able to negotiate a discount for cash payment.

PREPARING FOR THE GTT

For the results of your oral glucose tolerance test to be accurate, you will need to start preparing a few days in advance. The test is only accurate if you’ve been eating 150 or more grams of carbohydrate a day for several days running. Of course, if you’re following the standard American diet, you’re eating that much and more and you won’t have to change your diet to prepare for the test. If you’ve been following a low-carbohydrate eating plan, however, you’ll have to go off it and eat at least 150 grams of carbs each day for four days. Is that a reason to eat a whole bunch of jelly doughnuts? No way. Use those carb grams on the best possible foods, such as whole grain breads, fruit, potatoes, legumes, and starchy veggies. Spread the carbs evenly across your meals,and eat them with foods that contain protein and fat.

Before the test, you must fast for 12 hours. It’s okay to drink as much water as you want during this time. You’ll also be able to drink water during the test, but you won’t be able to eat (or smoke). Some prescription medications, such as thiazide diuretics, beta-blockers, oral contraceptives, steroids, and some psychotropic medications, can affect the results of your test. Be sure to tell your doctor about all your medications in advance and discuss whether any will affect the test.

DOING THE GTT

As we just discussed, if you are currently restricting carbs, to ensure an accurate result on the glucose tolerance test, you’ll have to prepare a few days in advance by eating more carbs. The GTT has three components: It measures blood sugar levels, insulin levels, and the presence or absence of sugar in the urine. The first blood sample, taken before you drink the glucose solution, measures what’s called your
baseline
fasting blood sugar and insulin.A urine specimen is also tested for the presence of glucose. (If glucose is found in the baseline urine sample, your doctor should check your fasting blood sugar before proceeding with the test.) It is then up to your doctor’s discretion whether to give you the glucose drink or proceed instead with a postprandial test—see page 71 for more on that. Assuming it is okay to proceed, you then drink a measured amount of a very sugary solution to test your body’s response over the next five hours.

Here are the measurements Dr. Atkins would take during the glucose tolerance test:

Here are the measurements Dr. Atkins would take during the glucose tolerance test:

Dr. Atkins would ask his patients to keep a journal noting any symptoms they experienced after drinking the glucose solution and the time the symptoms occur. Some people will feel fine during the test; most people do not. It is useful to be able to correlate symptoms with abnormal results on the test. He also found that charting symptoms can be an eye-opener for patients, helping them understand that the migraine headaches or intense irritability they may have experienced in the past can be related to an unstable blood sugar pattern.

During the test,if the blood sugar goes too high early on,the patient may feel sleepy or nauseated, or have difficulty concentrating. Later, as the blood sugar drops too low or too fast, the patient may experience irritability, shakiness, palpitations, headache, anxiety, and numerous other symptoms. The more symptoms the patient has, the more carb intolerant he or she is,even if the blood sugar and insulin numbers are not yet way out of line. How you feel during the test is your window into your body and this silent illness.Your symptoms provide you with valuable information about the ups and downs in your insulin and blood sugar and how much stress these vacillations put on your body.

Linda K. was obese and had severe and frequent migraine headaches. When Dr. Atkins gave her the GTT, her insulin was mildly elevated at the start of the test and went up very high as the test continued. Although her blood sugar levels didn’t rise above the normal levels, she reported typical symptoms. At the half-hour mark, for instance, she was lightheaded and had a headache. By the two-hour point, she still had those symptoms—but in addition she was now nauseated and jittery. By the fourth hour of the test, she had all the previous symptoms, plus irritability. The symptoms correlated with her rising insulin levels. When she started following the Atkins Nutritional Approach, she lost weight but, even better, her insulin normalized and she was free of her migraines as long as she continued to follow her individualized controlled-carb plan.

WHAT THE GTT REVEALS

Back in Chapter 2, the stages of insulin/blood sugar abnormalities that culminate in Type 2 diabetes. They’re important enough to bear repeating.

The first four stages are milestones on the road to diabetes:

1. Insulin resistance of cells
   
2. Insulin resistance with hyperinsulinism (the production of large amounts of insulin)
   
3. Insulin resistance with hyperinsulinism and reactive hypoglycemia (low blood sugar)
   
4. Insulin resistance and hyperinsulinism with impaired glucose tolerance (prediabetes)
   
5. Type 2 diabetes with insulin resistance and high insulin production
   
6. Type 2 diabetes with low or virtually no insulin production
   

The GTT is valuable because it reveals the
earliest
signs of hyperinsulinism, stage 2 on the six-stage continuum to diabetes. Insulin levels can be higher than normal even before the blood sugar becomes unstable enough to cause many symptoms.

The case of Joe B. illustrates this point very clearly. Joe was 52 years old when he first came to see Dr. Atkins. At five feet seven inches, weighing 208 pounds, and with high blood pressure, he showed the classic signs of the metabolic syndrome. His fasting blood sugar was 87 mg/dL, and during the GTT, his blood sugar rose to 158 at the end of the first hour. His insulin, however, soared sky-high. At the one- hour point, it reached 347 µIU/mL, which indicates hyperinsulinism with insulin resistance. Had Joe been given only the standard FBS test as part of an annual checkup, or even if he had taken the usual two- hour GTT, both of which check only blood sugar levels, his hyperinsulinism would have gone unnoticed until things got much worse.

Unless someone who is at stage 2 makes dietary modifications, insulin resistance and high insulin production will continue and reactive hypoglycemia (stage 3), with all its unpleasant symptoms, will surely follow. Dr. Atkins diagnosed hypoglycemia from the glucose tolerance test when the blood sugar dropped 60 points or more from one hour to the next or there was more than a 100-point change between the highest and lowest reading during the test. As the six stages make clear, hypoglycemia is not the opposite of diabetes. Rather, it’s on the continuum that leads inexorably to diabetes.

The following chart and its comments parallel Dr.Atkins’thoughts regarding optimal blood sugar levels. As you can see, there is a difference between what are considered normal ranges and what he considered optimal.

GLUCOSE TOLERANCE TEST—GLUCOSE AND INSULIN VALUES