Atkins Diabetes Revolution (5 page)

ONWARD TO PREDIABETES

The earliest three stages of the progression to diabetes can go on for months or even years before you move on to the next stage. After a while, however, even all that extra insulin can’t force enough glucose to enter your cells. The amount of sugar in your blood begins to peak at higher than the normal range. You now have reached the fourth stage: You have not only hyperinsulinemia but also
hyperglycemia
— elevated levels of blood sugar. What some people will then develop is what Dr.Atkins called a high-low curve.One to two hours after a high- carb meal, the blood sugar goes higher than it should, provoking symptoms such as sleepiness or a strong desire to nap. This is followed by the belated insulin spike, which causes hypoglycemia with the symptoms described above. This stage, in which the temporary elevation of blood sugar two hours after a glucose challenge during a glucose tolerance test goes above 140 mg/dL (milligrams per deciliter) but is still less than 200 mg/dL, is called impaired glucose tolerance. (We’ll explain more about how we measure blood sugar levels and what they mean in Chapter 6, Diagnosis: Diabetes.)

As the condition progresses, your fasting blood sugar (the amount of sugar in your blood after not eating for 8 to 12 hours) will slowly begin to rise. Once your fasting blood sugar hits a level of 100 mg/dL to 125 mg/dL, you have impaired fasting glucose, or prediabetes. Dr. Atkins observed that individuals with this condition could also have above-normal levels of blood sugar after eating a high-carbohydrate meal. Florence S. is a good example. At 61 years old and five feet three inches tall, she weighed 141 pounds. Florence had signs of metabolic syndrome and was taking a number of medications for high blood pressure and abnormal lipids. During her glucose tolerance test (GTT), her fasting blood sugar was 114, revealing prediabetes; at the half-hour point of the GTT, her blood sugar was 198; at one hour, 215; at two hours, 173; at three hours, 83; at four hours, 76; and at five hours, 89. As you’ll learn in a later chapter, this blood sugar pattern is the “high-low curve.”

If you have progressed to impaired glucose tolerance or if you have reached the point of impaired fasting glucose, you have what is called
prediabetes.
Now things are getting really serious—so serious that we’ll have to spend all of Chapter 5 discussing prediabetes and what it means for your health.

Unless action is taken to stop the underlying cycle of insulin resistance and hyperinsulinism, then the body’s compensatory mechanism of overproduction of insulin will continue. As your insulin resistance becomes more severe, your blood sugar levels become increasingly difficult to control and your pancreas becomes increasingly stressed. Without proper intervention, you’ll move from prediabetes to the next stage of full-blown Type 2 diabetes.

ARRIVING AT DIABETES

Stage 5 represents the early phase of true diabetes. In this stage, your fasting blood sugar is usually 126 mg/dL or higher, and your blood sugar after meals will consistently be even higher above the normal range. At this point, most people continue to have high levels of insulin production combined with severe insulin resistance.

Unless dramatic intervention occurs, the huge amounts of insulin your pancreas is forced to produce will eventually lead to a loss of pancreatic beta cell function.Indeed,you may lose so much beta cell function that your pancreas is making little or no insulin. By now, to survive,you will require the daily administration of insulin.When this happens, you have reached stage 6—insulin-dependent diabetes.

Oftimes, it is only when you have reached these last two stages that a diagnosis of Type 2 diabetes is finally made. Now the diagnosis is hard to miss. Your fasting blood sugar is in the diabetic range of 126 mg/dL or higher, and the classic symptoms of increased thirst, increased hunger, and increased urination occur. In some cases, unexplained weight loss and blurred vision also occur. By now, insulin resistance, hyperinsulinism, and hyperglycemia have been present for a long time, perhaps years, silently causing damage.

ARE YOU AN UNDIAGNOSED DIABETIC?

According to the American Diabetes Association, of the 18 million Americans with Type 2 diabetes, somewhere between 5 million and 8 million don’t know they have it. Here’s one reason that early diagnosis is so important: Retinopathy, blood vessel damage to the eyes, begins to develop at least seven years before clinical diagnosis of Type 2 diabetes is made based either on symptoms or standard blood tests.
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Some undiagnosed diabetics will find out the hard way: when they end up in the emergency room with a heart attack, a stroke, kidney disease, or other vascular conditions. Others will learn the truth when they visit the doctor for something else and a routine blood test reveals their disease. Could you be one of them?

BLOOD SUGAR BY THE NUMBERS

According to the American Diabetes Association,the definitions of normal and impaired blood sugar are:

Normal Fasting Blood Sugar (FBS).
Although there may be some variation among testing labs, normal FBS ranges from 65 to 99 mg/dL (milligrams per deciliter) after a fast of 8 to 12 hours. The measurement is accurate only if you haven’t eaten for at least 8 hours before your blood is drawn.

Impaired Fasting Glucose (IFG).
A blood glucose level between 100 and 125 mg/dL (5.5 to 6.9 mmol/L [millimoles per liter]) after a fast of at least eight hours.If you have IFG,you have prediabetes.
Impaired Glucose Tolerance (IGT).
You have impaired glucose tolerance if two hours after eating a carbohydrate test meal your blood sugar has risen to above 140 mg/dL but stays below 200 mg/dL. If you have impaired glucose tolerance, you have prediabetes, whether or not you also have impaired fasting blood sugar.

Diabetes.
Fasting blood sugar of 126 mg/dL or higher on two readings after fasting for at least eight hours indicates diabetes. An alternative measurement is a postprandial (after a meal) blood sugar of 200 mg/dL or higher two hours after a high-carbohydrate meal on two different days,or similar results at the two-hour point during an oral glucose tolerance test.
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Being diagnosed with high fasting blood sugar is like being told you’re a little bit pregnant—things will become more apparent very soon. That’s what happened with a patient named Donna G. Less than a year passed from the time her doctor told her she had high fasting blood sugar to the time she came to see Dr. Atkins to treat her full- blown Type 2 diabetes. If only she had started on the Atkins program when she was first diagnosed with high blood sugar, she might well never have gone on to that point. As it is, following the program has helped her quite a bit. Her fasting blood sugar over the past several years has always been steady at around 100 mg/dL.

Current medical guidelines say that if you have
any
of the risk factors for diabetes, your doctor should regularly check your fasting blood sugar level. But if you’ve been paying attention, you now know that by the time your fasting blood sugar is high, the damage has already started. (We’ll discuss tests to detect blood sugar abnormalities in Chapter 6, Diagnosis: Diabetes.)

The onward march toward diabetes and steadily worsening health might seem inevitable. Not so! At any point along the way it is possible to stop the progression. The sooner the better, of course, but even if you have reached stage 6 of diabetes, the Atkins Blood Sugar Control Program can help you manage the disease and help you to stave off some of its worst consequences.Please read on—that’s what the rest of this book is all about.

DO YOU HAVE A BLOOD SUGAR PROBLEM?

The effects of the blood sugar roller coaster on your health and well-being are fairly predictable. Compare your symptoms to the following list of the most common symptoms of abnormal blood sugar. Score each symptom according to how you experience it:

0 = never

1 = mild and/or rarely

2 = moderate and/or up to twice a week

3 = severe and/or more than twice a week

Add up each column and then multiply the sum by the number at the top of that column. Now add all the numbers together. Remember, all the answers in the 0 column = 0. If your score is 12 or more, you’re probably experiencing some blood sugar abnormalities. Please see your doctor to explore the issue further, especially if you also have any risk factors for diabetes.

A NEW PATH WITHOUT PILLS

After a 30-year hiatus, Ann McKay has returned to the very same program with which she initially experienced success. It is now helping her restore her health.

I’ve had a serious weight problem all my life. In fact, I did Atkins for the first time 32 years ago when Dr. Atkins’ original book,
Dr.Atkins’Diet Revolution,
was published. I am a registered nurse and, at the time, I was working on a surgical unit. Although I was doing well on Atkins—losing weight and feeling good—the surgeons I worked with were vehemently against it. They told me I was going to get sick and that it would ruin my kidneys.They were on me about it every day.Atkins was a brand-new concept at the time, and I thought, “Well, what if they’re right?” So I did go off the program after about 12 weeks. During the 30 years since then, I have been on every conceivable diet there is, never with any real success.

In 1996, I was placed on the drug Lupron and had a hysterectomy. From that point on, my weight problem only got worse. No mat
ter how little I ate, no matter what diet I tried, I simply could not lose any weight.

N
AME
: Ann McKay

A
GE
:57

H
EIGHT
: 5 feet 0 inches

W
EIGHT
B
EFORE
:

    
247 pounds

W
EIGHT
N
OW
:

    
205 pounds

About two years ago, I found myself at a depressing 247 pounds—I’m only 5 feet tall—and wearing a size 26. I also discovered that my blood sugar level was going up—it was around 170 mg/dL. When I spoke to my primary-care doctor about it, he wanted me to go on a 1,500-calorie-a- day American Diabetes Association (ADA) diet. I told him, “Well, I’ve been on a 1,000-calorie diet pretty much my whole life, one way or another, and it hasn’t worked.”

I had even been hospitalized in the 1970s for my weight problem, where I was placed on a 700- to 800-calorie-a-day diet. I remember waiting for my eight o’clock snack of Tab soda and celery sticks. It was really sad. I was there for three and a half weeks and I gained 5 pounds.

All these years later, not wanting to be put on yet another low-calorie diet, I asked my doctor,“What about Atkins?”And he said,“Oh, I just lost 40 pounds on Atkins! But I don’t want you on it.” He was apparently concerned about my medical history—I’ve had some serious health problems. I don’t think he wanted to do the close monitoring that he thought would be necessary if I went on Atkins. So, he handed me the 1,500- calorie ADA diet and said, “Try this for two weeks and then come back and we’ll see what we’re going to start you on.” I knew what that meant: He was going to put me on diabetes medication.

When I got home, I was very upset. I knew I had the phone number for The Atkins Center somewhere in my house and began madly sifting through my papers to find it.When I called the number, a nurse answered the phone and I spilled my guts to her. “I just left my doctor’s office and I’m very angry and upset,” I said.“I know where’s he’s heading. He wants to put me on medication. Also, I’ve been seeing him for hypothyroidism, and I feel he’s not looking at it properly.All my hormone levels are normal but I know there’s something wrong with my thyroid. I was just wondering if Dr. Atkins still sees patients?” I was told he did. I breathed a sigh of relief. She faxed me a questionnaire that day, I filled it out and, three weeks later, I had my appointment. I did one day of lab work and then saw Dr. Atkins the very next day.