Insulin Resistance--not getting good info (long)

Factual Questions
1

Hi all. here comes a lot of information. IANA hypochondriac; quite the opposite, in fact.

I was recently diagnosed as insulin resistant, which was not a surprise as I’ve been complaining about symptoms for a few months. I think I have a good sense of what to do with my diet and exercise. I’ve read several books and looked around online. However, I’ve found a few points where it seems someone should have given me information but didn’t. The major points:

  1. How long I should fast before a glucose tolerance test.
  2. The dietary recommendations for the period before the GTT, which I’ve seen referenced in several places.
  3. That if a second fingerstick is needed, it should be on a different finger (Accu-Chek was upset that I didn’t know this, though their manual doesn’t seem to state it).
  4. That Type II diabetes and PCOS may co-occur (not that anyone ever suggested this to me as a possibility when I complained that despite BCPs to manage my PCOS, I still couldn’t lose weight despite diet and exercise).
  5. That eating higher-fiber foods before other foods could slow absorption of glucose from other foods.

This all makes me wonder what else I don’t know or am not being told. Therefore, I’d like your best guesses, based on your experiences, about what I might not be hearing from my providers and the world of diabetes information.

I’m meeting with a diabetes educator in a couple of weeks to talk nutrition and exercise. I haven’t waited for that appointment to roll around, but instead looked at a number of resources for revamping my diet and exercise patterns in an informed and non-stupid way. The ADA’s exchanges are worse food (e.g., red meat, pasta casseroles, potatoes, cheese, general “American” food) and more of it, that I normally ate anyway. I’ve been looking at Whitaker’s Reversing Diabetes, which advocates high vegetable, low fruit and grain, low protein and low fat, and has few exclamation points compared to many of the diabetes books out there. I’ve followed his references to the pages with glycemic index lists. I’ve read about, and agree with in a layperson’s way, the notion that not all carbohydrates are the same. His strategy makes sense to me. I would like your opinions on exchange vs carb counting vs this seeming hybrid of exchange + GI.

I haven’t been able to get weight off by exercise or exercise and diet in the last decade (I’m talking 4 hours a day on an exercise bike for two months with no weight loss, though I did get a lot of television watched). I also didn’t have PCOS before that, or some other Cushing’s-like symptoms (most taken care of by BCPs). I’ve been checked for Cushing’s and had sonogram/CAT scan/MRI to rule out an androgen-secreting tumor. And yes, I’m having this conversation with my shiny new internist. And yes, I’ll consider doing what the diabetes educator says, but only if what s/he proposes is not stupid or worse than my previous diet, and to demonstrate my compliance so that if this isn’t sufficient, my doctor will believe me when I say that I have tried. (Shoshana: “I have spent 4 hours a day on an exercise bike for two months with no weight loss. Want to see my graph?” Doctor in 1994: “You need to exercise more.”) I also have asthma, and have switched to Intal from albuterol etc. because many allergy and asthma medications seem to worsen a muscle burning/cramping problem I also have, also dating from about a decade ago.

I’ve eaten as Whitaker suggests for three days and have exercised aerobically at least half an hour a day. I have also increased the amount of time I spend thinking lovely thoughts, visualizing insulin knocking and GLUT-4 opening the door to usher in only the glucose that’s necessary, attending to my breathing, etc. I have been surprisingly unfamished, though I can’t at all figure out how to eat as he suggests and actually get to 1,800 calories a day–I keep coming up short, and no one could eat enough green peppers to increase the total. I can live with this.

However, whether this is an artifact of having my very own glucometer (rather than using friends’) or something else, while my FBS and postprandial numbers aren’t high in the grand scheme of things, they’re higher than they’ve ever been. Granted, I didn’t have the meter before I started tweaking my diet and exercise, but I have tested over time and haven’t had numbers this high. I keep reading studies in which many people are able to lower their numbers in a few days to a week on the same regimen I’m following, so I feel alarmed/ripped off. What do you make of this?

All thoughts, ideas, and information are much appreciated.

2

G’day

It is very hard to sort out the gold from the dross in dieting advice. But you really ought to examine the work of Dr. Kerin O’Dea, who very successfully treated insulin resistance and type II diabetes in Australian Aboriginal subjects by switching them to a diet that was very low in carbohydrate.

Dr Bernstein’s Diabetes Solution by Richard K Bernstein MD is supposed to be very good.

Michael R Eades MD and Mary Dan Eades MD claim very good results treating type II diabetes, insulin resistance, hyperinsulinaemia, hypertension, arteriosclerosis, and obesity with a diet low in carbohydrate, moderate in protein and fat, and rich in leafy vegetables. It also involves avoiding trans- fatty acids and alpha-lineolic acid and concentrating on oils high in lineolic acid. Their reasoning sounds convincing to me, and it also sounds okay to my brother (who is a medical doctor with a research masters in biochemistry). Check out their book Protein Power ISBN 0-7225-3961-4.

I must say that the GI approach doesn’t sound very convincing to me: it replaces narrow spikes of insulin with broad humps, but it doesn’t reduce total insulin exposure. Try a low-carbohydrate approach and see how it works. If the Drs Eades are right you should see improvement within a week, and if you make no progress after a month you can always switch back with nothing lost, right?

Regards,
Agback

3

I’ve read that low-carb diets really do help with insulin resistance. I follow the Paleo diet (mostly). I eat almost no processed foods (no refined flour, no hydrogenated-anything oil or fat, very little grains, legumes and dairy.)

I’ve seen my total cholesterol/triglycerides go down and my ratio of HDL to LDL improve. I don’t have problems with insulin resistance that I know of, so I can’t speak to that. A lot of people on the Paleofood list talk a lot about insulin resistance though.

I also lost 30 lbs. And I feel better. YMMV, of course. And some people don’t want to give up the carbs.

I do miss sandwiches though.

4

Thanks Agback and Archergal. What I’m trying sounds similar–5-8 non-starchy vegetable servings, 3-4 fruit, 3-4 whole grain, 3-4 protein, olive oil for cooking. Nice to hear some science as well as testimonials.

5

You can check Atkins as well. http://atkinscenter.com I have been on Atkins for 4 months and I have lost 40 pounds. My cholesterol number are back in the normal ranges, my blood pressure is back in and my energy level is way up. I have even recently taken up exercising.

I still have a long way to go at 6’ 278 pounds but the difference so far is incredible.

2 of my uncle’s have been diagnosed with Type II diabetes and both have gone on Atkins which has helped decrease their need for medication.

6

Please don’t hurt me for bumping this once. I could really use more information. Thanks.

7

The standard procedure for the Glucose Tolerance Test involves a 10-hour fast prior to the test. This is to ensure that the resulting glucose profile reflects only the response from the glucose solution, not from anything else eaten prior to the test. Your diet prior to the fasting period should not affect the results, though.

If a second fingerstick is required, you are supposed to use a different finger to obtain the sample. This is because taking multiple samples from the same finger usually involves some squeezing, which can alter the concentrations of the various tissue fluids, leading to erroneous results. That said, I’ve used to same finger for several successive tests but did not see any significant difference in results.

Studies have shown that women with PCOS are at an increased risk for developing Type 2 diabetes, even when comparing weight-matched populations.

I’m not familiar with Whitaker’s book, but switching to a diet of lower GI foods certainly makes sense for you. I eat a high-carbohydrate/low-fat/low-protein diet with minimal high-GI foods, and my blood glucose is relatively stable, despite my not having any insulin-producing beta cells.

It sounds to me like you’re taking a very reasonable approach toward combating your insulin resistance through daily exercise and some dietary modifications. This is a plan you are likely to be able to adhere to, and you shouldn’t get discouraged just because you aren’t seeing results right away.

Also note that high-protein diets can be particularly dangerous for diabetics, as they can increase the risks of kidney damage and cardiovascular disease.

8

**cynic, ** thank you.

In 7 days on this diet/exercise plan, I haven’t been hungry, haven’t been hypoglycemic except when I’ve eaten grains, have lost 7 pounds, and have reduced my FBS from 132 to 103 and my post-prandial BS from 219 to 104–so I’m feeling pretty good about being able to sustain this for a while.