Misdiagnosed Diabetes

It's been a while since my last post, but I'm back with an interesting update on the diabetes front. Looks like I may not have Type 2 diabetes after all, but some version of Type 1, which was only discovered by questioning conventional diabetic advice and being proactive in my own research.

It's been almost 4 years since my prediabetes diagnosis and I'm still struggling to get my HbA1c down from 6.5%. In layman's terms, the HbA1c test measures the average of blood sugars over a 3-month period and ideal ranges are high 4s and low 5s. When my GP handed me the UK diabetes guidelines, I immediately doubted the dietary recommendations because I was already in the habit of avoiding processed foods, eating whole grains, reading nutrition labels and watching my fat intake. This prompted me to question my diet and lifestyle and dive into the diabetic literature. I thought I was a skinny-fat person and experimented with a vegan diet, inspired by Dr. Neal Barnard's program for reversing Type 2 diabetes. I started weight training to build more muscle to improve insulin sensitivity and lost a little bit of weight; however, none of this reduced my HbA1c sugar levels from 6.5%. The lowest I've been able to get my bloods down is 6.4%, which is when I wrote this post praising veganism, which in hindsight was not a significant improvement at all.

Last year my cousins put me in touch with Dr. Salzarulo and he gave me the best advice and changed my diet from low-fat, high-carb vegan to low-carb, paleo-esque carnivore. He also urged me to buy a glucose monitoring device to get a feel for how certain foods affected my blood sugar, which the NHS told me was not necessary. This was a total game changer for me and as I started measuring my morning fasting blood sugars and my postprandial sugars, I began to notice a few things:

• My blood sugars would go up after I ate, which is normal, but then they stayed elevated all day. In healthy non-diabetics, blood sugars will go up within a healthy range and then return to fasting baseline levels usually 2 hours after eating and with Type 2 diabetics, depending on the severity of insulin resistance, blood sugars should eventually come down at some point after eating. Mine did not and I could never get my blood sugar as low or close to my fasting blood sugar in the mornings. 

• My blood sugars would spike when I ate healthy carbs, like beans or sweet potato, even in the recommended portion sizes alongside fat and protein. I noticed the fewer carbs I ate, the better my sugar readings were.

• Sometimes I would eat a low-carb dinner like a large piece of salmon with lots of non-starchy veggies and I would have high blood sugar after wards and the following morning too.

• I can only hit near normal blood sugar readings by eating a very low-carb diet whilst keeping my portions small.

This past May I was introduced to Jessica Apple, founder of online diabetes magazine A Sweet Life. I started telling her my diabetes story and she asked me, "have you ever been tested for LADA?" In all my endless research about Type 2 diabetes, I never came across the phrase LADA or latent autoimmune diabetes in adults. LADA is similar to Type 1 in that the pancreas is losing it's ability to produce insulin and overtime will stop altogether, but it's more gradual. Insulin is the hormone that controls blood sugar and is responsible for moving sugar from the blood into our cells for energy use or fat storage. We cannot live without insulin and we cannot maintain healthy blood sugar levels without it. LADAs are often misdiagnosed with Type 2 diabetes because of age, but LADAs are usually leaner, physically active adults. Hello light bulb!

I went to NYC in June and immediately paid for Type 1 diabetes testing, which was expensive. I had my C-peptide levels measured because this peptide generally matches insulin levels and can indicate how much insulin your body is producing. Low levels of C-peptide and insulin paired with high blood sugars usually points to Type 1 diabetes whereas in Type 2 diabetics, you find high blood sugars alongside high C-peptide levels which indicates high insulin levels due to insulin resistance. One exception is someone with advanced Type 2 diabetes and overtime has not managed their blood sugars, thus killing the pancreas's ability to make insulin. I also tested for GADA and ICA antibodies, which looks to see if the autoimmune system is attacking the pancreas thus killing it's ability to make insulin.

Out of a normal range of 1.1 to 5.0, my fasted C-peptide levels came in at 1.1 and on this day my fasting blood sugar was 104 mg/dl and my HbA1c was 6.5%. My doctor said that my C-peptide was very low, but my fasting blood sugar was in the prediabetic range and my HbA1c was in the diabetic range. After reviewing my low-carb food diary along with my lab results, my doctor said that my diabetes looked like an autoimmune issue as in Type 1. Surprisingly I tested negative for the antibodies, but according to several diabetic forums this is not uncommon. Dr. Salzarulo thinks I need insulin therapy, but advised me to start working with a diabetic doctor probably an endocrinologist. Unfortunately, I'll have to wait until I get back to the US and get health insurance. In the meantime he suggested I go very-low carb, which is where I am today.

There's still more testing to be done and I don't have all the answers yet, but I finally feel like I have a better grasp on my diabetes. What I want you take away from this rather long technical post is that when faced with disease, it's important that you do your own homework and research. I would have never gotten to where I am today if I had solely taken my GP's advice. 

Skinny Diabetes: What is a carbohydrate?

daily lunch ritual includes canned tuna, lots of non-starchy veggies and avocado

The other day I was talking diet with a friend and she said "I don't really eat carbs, I hardly ever eat bread," then she proceeded to eat her usual breakfast of Activia fruit yogurt, light granola and a ripe banana. Unbeknownst to her, this breakfast was pretty much all carbohydrates and high in sugar. It dawned on me then that the definition of carbs can be a bit murky for some and sometimes limited to hamburger buns, pasta and cookies. Carbohydrates are so much more than this and today we are going to do a 101 on carbohydrates, which is really important for skinny diabetics and anyone wanting to reduce their overall glycemic load.

The Science

Scientifically a carbohydrate is a compound made up of carbon, hydrogen and oxygen and nutritionally it comes in two forms: simple form as in sugars and complex forms as in starches and fiber. All carbohydrates, with the exception of fiber, get broken down into a simple sugar called glucose in the body. Fiber is an indigestible carb which is why high-fiber foods are especially good for diabetics and moves things along in the large intestine. In essence all carbohydrates are sugars and if you need to reduce your sugar intake, then you must look at your overall carbohydrate intake.

Defining Carbs

As a skinny diabetic, I'm sensitive to all carbohydrates which I only discovered by measuring my blood sugars post meals. Not only do I have to be mindful of the quality of my carbohydrates, but the quantity plays an equally important part in keeping my blood sugars stable and in a healthy range. However, in my experience this advice isn't emphasized enough and what I find are Type 2 diabetics eating wholewheat bread and whole grain cereals with reckless abandon. 

In the beginning of my diabetic journey, my definition of carbs was limited to the usual suspects like cookies, desserts, french fries and anything bread-y. Now when I hear the word carbohydrates the following comes to mind:

• healthy whole grains including gluten-free grains, whole wheat bread & pasta, all breakfast cereals
• starchy beans including black beans, lentils and dips like hummus
• dairy which includes all milks, yogurts especially the non-Greek variety with fruit and anything creamy
• root vegetables especially when cooked like carrots
• all fruit
• any processed food claiming health or marketed as low-fat, fat-free, low-sugar or sugar-free

If you're a skinny diabetic or have blood sugar issues, then you've got to be careful with even the healthiest of carbohydrates as I've listed above. My doc told me to get a blood glucose meter and to learn how my body reacts to various carbs and portions and I recommend the same to you. Also as a rule of thumb always eat your carbs with healthy fats and/or protein and limit your servings. My doctor said a serving size of starchy carbs is 1/2 cup, but I find this challenging and tend to overeat. In general I swap out carbs for non-starchy vegetables which are low-carb and high in fiber.

It's now been three years since being diagnosed as pre-diabetic and it's taken this long to finally get where I am in terms of understanding it all and managing my blood sugars. Am I perfect? No. Have I reversed my diabetes? No, but I'm much better at being consistent and accepting what is. Next I'll talk about various ways you can approach a low-carb diet, but I'll wrap this up with some advice. One of the first things my doctor said to me was that if I focused on the foods I couldn't eat, I would lose. Instead focus on all the wonderful foods that you can enjoy and in recent months, this really has sunken in. 

Skinny Diabetes: Weight Loss

When I was diagnosed as pre-diabetic in 2013, one of the first things I did was look into books on preventing and reversing diabetes. One of Amazon's top sellers is Dr. Neal Barnard's 21-Day Kickstart which is a vegan whole foods diet plan that is low in fat and high in carbs. I devoured this book and it opened my eyes about the environmental impact and ethical issue related to consuming animals products. It also helped me understand the relationship between food and health, because up until this point I believed that I could exercise my way out of a bad diet and that being somewhat slim equated to being healthy. This book catapulted me into veganism and I loved the idea that I could eat all the carbs I wanted and reverse my diabetes, as long as it was low-fat whole foods and vegan. Needless to say this plan didn't work out for me for many reasons, one being that I wasn't overweight.

The majority of people who develop pre-diabetes and Type 2 diabetes are overweight and it's this excess body fat that has lead to insulin resistance and diabetes. That is why when you research treatment for Type 2 diabetes, weight loss is key to reversing the disease. Here's how it works in layman's terms. When we consume any kind of carbohydrate, the sugars and starches get broken down into glucose and our pancreas secretes the hormone insulin to carry that glucose out of the blood and into our fat, muscle and liver cells for energy use or stored energy. If you have too many fat cells tucked into your muscle cells, then the muscle cells find it difficult to absorb the glucose and it starts to accumulate in the blood also known as high blood sugar. Eventually your pancreas will dump more insulin into the blood in order to bring down the elevated blood sugar and this leads to insulin resistance, where the cells are not responding to the effects of insulin. Left untreated and Type 2 diabetes begins, when blood sugar is elevated all the time. This is one way people develop Type 2 diabetes and weight management is a huge factor in this scenario. So if an overweight Type 2 diabetic adopts new healthy habits that result in weight loss, they should see improvement in their blood sugar readings. This is one of the reasons that people find success on Dr. Neal Barnard's plan because they swap processed, refined and highly fatty foods with healthy naturally low-fat whole foods which leads to weight loss. But what if you're a skinny diabetic and weight loss isn't an issue?

Information and treatment for skinny diabetics is hard to come by and I've had to dig deep and piece information together to understand why I developed diabetes and what's a healthy and sustainable path to reversing my Type 2. As a skinny diabetic I can tell you that learning how my body reacts to carbohydrates has been crucial to managing fasting blood sugar levels; as well as, learning about body composition and "skinny-fat" syndrome, having a balanced exercise regime with an emphasis on resistance training and understanding how an unhappy stressful mind can lead to diabetes. I'll address each of these points in future posts under Skinny Diabetes.

(***Picture up top was taken a few months post diagnosis)