Read Atkins Diabetes Revolution Online
Authors: Robert C. Atkins
WHAT YOUR FUTURE HOLDS
Often when people are first diagnosed with Type 2 diabetes, they go home with dark and gloomy images of a lifetime administration of insulin, wounds that won’t heal, or even amputations. Those images are worst-case scenarios, but they are real possibilities—especially if you continue to eat in the way that led you to gain weight and become diabetic in the first place. In case your blood sugar has been too high and your mind foggy, let us remind you: The diet that brought you here is the one that includes large amounts of nutrient-empty carbohydrates.
Continuing on that diet could even cause your doctor to prescribe insulin unnecessarily. In our experience, many people are put on insulin even when they continue to produce high amounts of it themselves. That’s because their blood sugar is so high that their doctors assume they are no longer producing enough insulin. One reason blood sugar might be so high is that their diets may be chock-f of the high-carb foods that cause blood sugar to skyrocket.
Unfortunately, most doctors simply assume that their patient needs insulin without investigating any further (e.g., performing the two- hour postprandial test discussed in Chapter 6).They prescribe a powerful hormone that you may have to take for the rest of your life without any real understanding of whether you truly need it. Dr. Atkins could never understand why the postprandial test is so often skipped.When- ever he considered prescribing insulin for a patient, he would order a two-hour postprandial test that let him compare the fasting blood sugar and fasting insulin levels with the levels reached two hours after a high-carb meal. This is how he would find out how much insulin was being produced and what the patient’s glucose response was.
One of the downsides of prescribing the powerful hormone insulin is that in
the absence of carbohydrate restriction
it will often cause weight gain.With the exception of metformin, the other drugs used to stimulate insulin production and increase insulin sensitivity are also problematic when it comes to weight management, which makes every other aspect of managing diabetes more difficult. Remember Larry H., a patient we discussed back in Chapter 3? When Dr. Atkins first saw Larry, he had been taking glipizide (Glucotrol) for a year. Not surprisingly, he had gained weight over that period and was now carrying 255 pounds on a five-foot-nine-inch frame. Aside from making him gain weight,the glipizide wasn’t doing much for Larry.His fasting blood sugar was just over 200 mg/dL and his glycated hemoglobin (A1C) was 7.3 percent. Dr. Atkins immediately switched Larry from glipizide to metformin. Within four weeks, he began losing weight and his fasting blood sugar was down to 130 mg/dL, a definite improvement, but Larry remains a work in progress.
Of course,some patients most certainly do need insulin and always will. In those cases, the ABSCP can still be very helpful. By controlling the carbohydrates in the diet, people who must take insulin can gain better control over their blood sugar, have a chance to decrease their insulin doses, manage their weight more successfully, and avoid the dangerous hypoglycemic episodes that plague so many diabetics who use insulin.
Your future doesn’t have to be a downward spiral of multiplying drugs, insulin administration, and poor health. Even if you have gone so far down the diabetes road that you must use insulin, it is still possible to slow or even halt the progression to more serious illness.
The next two chapters will discuss high blood pressure and heart disease—two very common complications of diabetes. But, as you’ll learn in later chapters, you have the power to limit the complications of diabetes and to optimize your health
COMMON DRUGS FOR TYPE 2 DIABETES
Although Dr. Atkins used very few of the following medications, we think it is important that you understand how they work and their potential side effects.
Drugs for treating Type 2 diabetes fall into these main groups:
S
ULFONYLUREAS
. These drugs stimulate your pancreas to release more insulin. They include chlorpropamide (Diabinase), tolazamide
(Tolinase), glipizide (Glucotrol), tolbutamide (Orinase), glimepiride
(Amaryl), glyburide (DiaBeta, Micronase), glibenclamide, and gliclazide.
Side effects
include weight gain, fluid retention, and a slightly increased risk of a cardiac event such as a heart attack.
M
EGLITINIDES
. These drugs stimulate your beta cells to produce insulin. They include repaglinide (Prandin), nateglinide (Starlix), and mitiglinide.
Side effects
include diarrhea, headache, and a slightly increased risk of a cardiac event such as a heart attack.
B
IGUANIDES
. The only drug now available in this group is metformin (Glucophage). Although the mechanism of action is not fully understood, metformin probably works by making your cells more sensitive to insulin and reducing glucose production in your liver. Metformin doesn’t cause weight gain or fluid retention.
Side effects
include nausea, diarrhea, and a metallic taste in the mouth. (Our experience has been that most people can adjust to any gastrointestinal side effects by starting with a lower dose and gradually increasing to the prescribed amount.) People with heart failure or kidney disease should not take this drug.
T
HIAZOLIDINEDIONES
. Also known as TZDs or glitazones, these include rosiglitazone (Avandia) and pioglitazone (Actos). These drugs improve your sensitivity to insulin.They are usually prescribed in combination with other diabetes drugs.
Side effects
include weight gain, fluid retention, anemia, and liver problems.These drugs can be very risky for people with heart failure.
C
OMBINATION
T
HERAPY
. The combination of metformin and glyburide (Glucovance) is often used to increase insulin sensitivity and to help your pancreas release more insulin.
Side effects
include diarrhea and hypoglycemia. I
NSULIN
. If your diabetes has progressed and you can no longer produce much or any insulin, you may need to administer additional insulin. Insulin use is complex; miscalculated doses can lead to hypoglycemic episodes.If you are on insulin and using the ABSCP,it is essential that you plan ahead and work with your doctor to adjust your dosage as your blood sugar begins to stabilize naturally.
Side effects:
Insulin usually causes weight gain.
WHAT’S YOUR DIABETES IQ?
The more you know about managing diabetes, the easier it will be for you to follow the ABSCP and avoid complications.Check your diabetes knowledge with this quiz.
1. Call your doctor if:
2. Check your A1C knowledge:
3. Which of the following diabetes drugs
don’t
cause weight gain?
4. Insulin may be needed if:
Answers
d,True.3.b.4.d.
c,False;b,False;1.c.2.a,True;
TWIN PEAKS: HIGH BLOOD PRESSURE AND HIGH BLOOD SUGAR
They are like two sides of the same coin: If you have high blood pressure, you’re very likely also to have high blood sugar—and vice versa. This is because they are both evidence of the same underlying metabolic imbalance. Correct this imbalance and both will likely improve.
BLOOD PRESSURE BASICS
Let’s start by taking a look at what blood pressure is and why it matters. Your blood pressure is a measure of the force your bloodstream exerts against the walls of your arteries as your heart beats and rests. It’s measured in two numbers: the systolic pressure, when your heart contracts and pumps the blood, and the diastolic pressure, when your heart relaxes between beats. When discussing blood pressure, the systolic number is always given first, followed by the diastolic number, as in 127 over 84 (usually written as 127/84).
When those numbers are too high, you have high blood pressure, also known as
hypertension.
Hypertension is linked to increased risk for heart attack, congestive heart failure, stroke, and kidney damage. Today about 50 million Americans—one in four adults—have high blood pressure.
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Hypertension is sometimes called the silent killer, because it doesn’t really have any symptoms. Many people who have it don’t know it.
HYPERTENSION GUIDELINES
In the United States,the official guidelines for diagnosing hypertension are set by the National High Blood Pressure Education Program,part of the National Heart, Lung, and Blood Institute. The guidelines were updated in 2003.Here’s how your blood pressure measures up according to the new guidelines:
Under the old guidelines, which date back to 1997, what’s now de- fined as prehypertension was called
high normal.
With this change in the guidelines (published in 2003), about 22 percent of American adults, or about 45 million people, are now classified as having prehypertension.
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The new guidelines are based on evidence that damage to the arteries occurs at blood pressure levels that physicians previously deemed acceptable. These studies have also shown that prehypertension is very likely to progress to hypertension as well as to additional health problems, unless changes are taken to correct the underlying cause.Controlling insulin levels and weight with the ABSCP addresses the underlying causes of high blood pressure.
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Just as conventional medicine has recently begun to understand the importance of screening for glucose abnormalities by defining prediabetes, it is recategorizing blood pressure values to allow for earlier identification and treatment of this potentially devastating disease. The root of the blood pressure problem in some people is the same metabolic imbalance we have discussed in previous chapters: high-carbohydrate intake, leading to excessive fat storage, leading to inflammation at the cellular level. You may recall the discussion in Chapter 4 regarding endothelial dysfunction and its relationship to insulin/blood sugar abnormalities. Because endothelial cells line all blood vessels, all blood vessels are at risk for damage. This is why we are committed to helping you identify where you are on the blood sugar imbalance continuum—and to halting its progression.
At first glance the new guidelines seem like a good thing. No one was more of an advocate of early identification of health risks and intervention than Dr. Atkins. If these revisions led to lifestyle changes, in the form of exercise and dietary recommendations that could impact the underlying cause, we would be well on our way to truly addressing the epidemics of obesity and diabetes. Our fear is that, instead, these new guidelines and recommendations could lead millions of Americans not to better health but to the pharmacy—and to the “Band-Aid” solution of pharmaceuticals that are both expensive and potentially dangerous.(See Appendix 6,Drugs for Hypertension,on page 475.)
In this sense, the new guidelines are a bonanza for the companies that make blood pressure drugs.Most people with high blood pressure need at least two and often three drugs to bring it down,and they must take the drugs indefinitely.
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Moreover, assuaged by a false sense of security,people on these drugs may not realize that,although their blood pressure may improve,the underlying condition silently progresses.
GETTING AN ACCURATE BLOOD PRESSURE READING
Your blood pressure normally varies quite a bit—as much as 20 points or more—over the course of a day.A single reading showing high blood pressure doesn’t necessarily mean you have hypertension. If your doctor suspects hypertension,your blood pressure reading may be repeated during the course of the office visit to be sure the stress of the visit itself isn’t raising your pressure. You may be asked to monitor your blood pressure yourself at home for a few days or to return to the office for another reading. On occasion, you may be asked to wear a monitor that records your blood pressure over 24 hours.