How I came to know that I am diabetic

Last November I realized that I had diabetes.  For years I’ve worried about becoming diabetic because it runs in my family.  Since about last summer, I’ve suspected that I might be diabetic but put off going to the doctor, for the ailments from which I suffered were not so acute that I felt compelled to consult the medical profession.  A good friend who is a missionary in Africa told me last Spring that he had returned to the US to deal with his failing health and learned that he was diabetic.  When he described his symptoms, such as constant thirst and blurred vision, I wondered if I too was becoming diabetic.

Finally, it came to a head in November because my wife asked me to put some carriage lights up on our garage.  After the first weekend of some minor work around the garage, my feet were in pain which seemed disproportionate to the level of exertion.  Not only so, but I fell off the ladder twice and also stumbled on the last step leading down to the garage.  I was wondering if this lack of co-ordination could have anything to do with diabetes.  So I looked it up and found that it was so.  I then investigated each of my other problems to see if there was a relation to diabetes and concluded that I had such a convergence of symptoms that I should get myself tested.

Pre-Diabetes or just Diabetes?

So I went to a walk-in clinic and asked to be tested for diabetes.  The physician took my blood pressure and filled out an order for blood work which she told me to take to nearby blood lab after fasting twelve hours.  When the lab work returned the clinic called me back in to inform me that I was not diabetic.  My blood worked showed a HbA1C of 6.0 and fasting glucose of 6.0 (108).  All clear, the doctor said.  But since I had elevated cholesterol levels he suggested avoiding saturated fat, high cholesterol foods, and since uric acid levels were higher than normal, he suggested eating less red meat.  (On my low carb diet, I’m actually doing nearly the opposite of what he suggested).

If not diabetic, I asked him, then why did I have symptoms (viz. peripheral neuropathy) consistent with diabetes.  He seemed to have no answer.  One conspicuous problem with his diagnosis, was that he did not even mention prediabetes.  Prediabetes is a condition of having abnormally high blood sugar but not at levels that the medical profession or the diabetes associations would consider diabetic.  At present, however, there is some dispute as to the accuracy of the term “prediabetes” since some therapists today would consider it only a milder form of diabetes.  Indeed, Dr. Richard Bernstein, who has a very successful practice of helping his patients control their glucose levels, says that he would treat prediabetics as diabetics (see The Diabetes Solution, p. 35).  I conclude that prediabetes is merely a less severe form of diabetes.  The prediabetic’s glucose levels are above normal but not so high that the medical profession, in general, is happy treating you.  You aren’t dying fast enough for them.  To be sure, I was sick, but not sick enough.  To relieve any doubt that I am diabetic, I will now explain the many diabetic symptoms that I had which are caused by elevated blood sugars, and I urge anyone with the same symptoms to take them more seriously than I did.  The websites which I link to are by no means definitive but merely representative expressions of how each symptom is potentially caused by diabetes.

My Diabetic Symptoms
citizenship day

On citizenship day, 28 February 2011, Petros showing visceral obesity

  1. Obesity:  According to Gary Taubes’ research, the main cause of obesity is insulin resistance resulting in elevated blood sugars.  This is also what causes the cravings and any excessive eating.  Thus, obesity is a symptom not a cause of diabetes.  I was 65 lbs overweight and had a waist measurement (pants size, i.e., not true waist) of about 43 inches.  The pot belly (a.k.a. visceral obesity) is the most dangerous form of obesity.  I have struggled with my weight during my childhood and it started to become a problem again in my late twenties.
  2. High blood pressure:  In November when the physician tested me, I had a reading of 140/90.
  3. Peripheral neuropathy:  I had frequent and debilitating tingling in my hands when holding steering wheel, canoeing, playing guitar, or typing on a keyboard.  I’ve had this problem for about the last ten years. Peripheral neuropathy also probably explains the pain I had in my feet after doing the work in the garage.
  4. Skin Tags: I seemed to be getting a large number of these in the last few months.
  5. Dizziness:  I had a single incident of dizziness last summer that caused me considerable concern.
  6. Sleepiness:  I became sleepy after every meal except, most of the time, breakfast.
  7. Dry mouth and bad breath:  I experienced dry mouth that drinking seemed to help only a little.  Also, my wife began to complain that I had persistent bad breath.
  8. Loss of proprioception:  This is also related to peripheral neuropathy.  But I felt that I should explain why I fell three times as I explained above.  Proprioception is the sense of where the different parts of your body are, and I had apparently lost some of my sense of where my feet were and where they were going.
  9. Scalp acne: I have had chronic scalp acne for about ten years.
  10. Diabetic dermopathy (shin spots) and other sores that take a long time to heal.  I have a line of about four inches long of scars on both legs, right along where the shin bone is closest to the surface of the skin, which was caused by frequent scabbing.  I only learned today that this condition is called shin spots or diabetic dermopathy.
  11. Arthritis:  My pain was similar to a basketball injury of spraining a finger (finger jam).  But I couldn’t remember injuring myself.  But it was so severe in both hands that, if I shook hands with someone, I would winced in pain.  It wasn’t until I went on the low carb diet and lowered my glucose levels that I realized this arthritis was related to diabetes, because it has nearly completely disappeared.  I had had the arthritis for about 9-12 months.
  12. Athlete’s foot:  I have this condition frequently; blood sugars apparently feed the fungus.
  13. Ingrown toenail infection:  I had my worst infection ever last Fall.
  14. Tendonitis:  I had a couple years ago a very bad rotator cuff tendonitis and often experienced severe achilles heal tendonitis.  These injuries occurred especially when I was a member of a gym.  Here is the dilemma:  I thought that exercise was necessary for weight control but my high blood sugars were making it difficult to exercise.  Now I am able to control my weight through low carb dieting, and I believe I will be less susceptible to injuries.

These symptoms are all related to elevated glucose levels, and many of them are going away now that I am on a low carb diet leading to much lower blood sugar levels.  While in the prediabetic range, my average blood sugar was nearly double normal.  The percentage of glycated hemoglobin (HbA1C) of 6.0 showed that I had an average glucose of 7.8 (141) for the last three months, while normal levels are much lower (4.6 (83) fasting glucose is normal).  So for quite a number of years, my glucose levels were causing problems to my nerves, to my skin, and likely to many other tissues and systems.  Problems to the kidneys and arteries, for example, are less discernible but much more dangerous.  So it is important to take visible manifestations seriously and to control them through the reduced intake of carbohydrates.  Carbs are poison.  Well, they are to those with diabetes, even those like myself who are in the prediabetic range.

Carbs are poison: carpal tunnel or peripheral neuropathy?

Carbs are poison (for those with elevated glucose levels)

I’m going to start a new tag/category called “Carbs are Poison”. This is my new motivational motto as I have entered a major lifestyle change that took place two months ago.

About sixty days ago, I learned that the tingling I feel in my hands was related to elevated glucose levels in my blood stream. I’ve had this tingling in my hands for about ten years now, and it affects my comfort when driving, playing a guitar or ukelele, typing on a keyboard, and even holding a cell phone to my ear. I would have to lower my hands below my waist and shake them out to get rid of the tingling.

For years I thought that it was carpal tunnel, and generally speaking, my investigations into the question showed that carpal tunnel was work related, i.e., caused by repetitive use of, e.g., a keyboard or a jack hammer. But the more accurate term for my condition is peripheral neuropathy, a condition whose most common cause is diabetes. Once I learned this about two months ago, I was certain that I was diabetic.

Well, I also have four risk factors: I am (1) Asian, (2) obese, (3) over 40, and (4) I have a family history in that my brother, my mother, my grandmother and my grandfather all have/had type II diabetes. So I immediately went into get tested for diabetes and the hbA1c test came back 6.0, which means that I am prediabetic (between 5.6-6.9; 7.0 is considered diabetic).

But later, through reading Nikolaos Papanas, Aaron I. Vinik, and Dan Ziegler, “Neuropathy in prediabetes: does the clock start ticking early?” (Nat. Rev. Endocrinol. 7 [2011] 682-690), I confirmed that my symptoms were related to prediabetes–this is one that my physician couldn’t answer, “If I’m not diabetic, then why do my hands tingle?” The article shows that prediabetics with impaired glucose tolerance are more likely to have peripheral neuropathy and non-diabetics with peripheral neuropathy are likely to be prediabetic. The elevated glucose levels in the those with impaired glucose tolerance, i.e., those whose glucose levels don’t immediately come down from a high carb meal, can have the nerve damage that is related to peripheral neuropathy. The damage was so severe that I had for about one year started to experience severe arthritis in my finger joints.

It stands to reason that a low carb diet would have the benefit of helping me to control my glucose levels. I was especially informed by Dr. Richard Bernstein, who has made numerous appearances on Youtube. But I’ve also had some experience with low carb dieting in the past. So on November 28, 2012, I used the occasion of the twelve hour fast for my blood test, to begin a new low carb regimen. This is day 60, and here are the results so far:

  1. My blood glucose levels went down immediately from HbA1C 6.0% (=3 month average of about 7.7) in my blood test to about 5.4 (when testing with personal glucose tester).
  2. Within two weeks my blood pressure has come down from high (140/90) to normal levels (127/82).
  3. The tingling in my hands largely subsided immediately after beginning the low carb diet. At day 60, I’ve been typing at this keyboard for several minutes now, without any tingling.
  4. My arthritis is almost completely gone with some mild problems in only a few of the joints, particularly my right middle finger. Nevertheless, I can snap my fingers in both hands with no severe pain as before.
  5. I’ve lost about twenty-five pounds.
  6. I’ve come down two pants sizes, as my waist has shrunk from 43 to 39 inches.
  7. I feel less sleepy after eating.
  8. I have greater energy levels and enjoy exercising and long walks (except when my knees give me problems).

My low carb diet does require fat: it is not a low fat diet! However, I am consciously trying to eat only to satiety. I snack on low carb foods when I feel cravings or hunger between meals, but after the first few days, the intrusive thoughts of food and the cravings subsided. I now avoid all sugars and starches to the degree practical. Here are the main foods I avoid:

  • any thing with flour
  • bread
  • desserts with flour and sugar
  • potatos
  • carrots
  • lentils, beans, peas
  • sweet potatoes
  • milk
  • rice
  • candy
  • fruit

Here are some typical foods that I eat:

  • meat, fish, poultry (including the skin and organs)
  • spam, corned beef, sausages (kosher salami, summer sausage. pepperoni)
  • eggs
  • hard cheese (brie, gorganzola, blue, cheddar, gruyere, etc.), low carb/high fat yogurt
  • 18% table cream; whip cream (in home-made non-sugar, low-carb ice cream)
  • coconut milk or cream
  • tofu
  • pumpkin
  • onions and garlic
  • avocados (ca. 1 per day)
  • tomatoes
  • green vegetables: cabbage, lettuce, cauliflower, broccoli, eggplant, zucchini
  • olives
  • non-sweet pickled cucumbers and asparagus
  • mushrooms
  • turnips (small amounts in soup)

I am drinking no sweetened beverages. I have lowered my caffeine intake because I find that it stimulates the cravings for carbs. I drink a lot of water flavored with lemon or lime juice (e.g., Real Lemon), and now copious amounts of cold, weak green tea (1 tsp loose tea or 1 tea bag makes three litres). Since one is in a state of ketosis (using one’s own fat for energy), the low carb diet requires drinking a lot.

Finally, I am abstaining from alcoholic beverages for until I’ve reached my weight loss goal (at least 65 lbs–or down to about 180 lbs).