All Posts tagged sugar

Diabetes: Prevention and Treatment

“All I had was a bologna sandwich on white bread and a glass of sweet tea and my glucose is 250!” So went a call from “Sue”, a patient this week who already knew she had impaired glucose tolerance (IGT) or “pre-diabetes”. Now it’s beginning to look like she may actually have full-blown type 2 diabetes. Her only symptoms had been some vision changes – sometimes her vision seemed a bit blurry and other times fine. After seeing her ophthalmologist, she noticed that the change in her glasses hadn’t fixed the problem. Her fasting blood sugar had been 110 (normal is below 100 and diabetic is above 125). Likewise, her HbA1C (the blood test that reflects a person’s average blood sugar over the previous 3 months) had been 6.1 – not yet in the clearly diabetic range (6.5 and up), but already in the IGT range.

​Like so many entering into diabetes, Sue had only subtle symptoms and her initial blood work had been fairly unimpressive. Also like so many in the early stages of diabetes, she had little feel for the impact of foods and drinks (like white bread and sweet tea) on her blood sugar. We had actually just had an appointment that morning where we had begun to discuss foods to limit, including “sweets” and “whites” – breads, pastas, potatoes, rice. We had prescribed a glucose meter to check her blood sugar. At this stage it was more as a teaching tool to check her glucose at various times such as fasting in the morning, after a meal, when her vision was blurry, and so on.

So, what now for Sue? She has four choices. One would be to let this diagnosis scare her and just try to ignore it and stick her head in the sand (or sugar bowl). Unfortunately, diabetes is a diagnosis that has a nasty habit of refusing to be ignored. Over time, if ignored, it will bring nerve, eye, heart, kidney, circulation, and brain injury, or, in some cases, put a person into the hospital with a diabetic coma (from extremely high blood sugar). Yah, not a good choice to try to ignore it. I don’t have many patients going this route, but I do have just a few who check things so infrequently and haphazardly that they are close to this. I always hope they’ll change their ways before the bad stuff really starts happening.

The second choice would be to not change her lifestyle but treat with medicines and monitor her sugar along with other important risk factors like blood pressure and cholesterol. This is certainly a better choice, but a bit expensive. It’s a little like trying to put out a fire while sprinkling gas (in this case, flammable sugar) on it.

A third choice would be for her to “tweak” her lifestyle and take medicines to make up for any shortfalls in her efforts. We’re getting better now. If she can perhaps lose 10 or 15 pounds out of the 50 extra that she has on board, that will help substantially. In terms of exercise, a study where the “exercise group” did a 30 minute walk five days a week showed an eleven year delay in the onset of diabetes compared with the “no exercise group” – a rather huge impact. Likewise, cutting out sweets (or substituting Splenda) and limiting whites (and substituting whole-grain alternatives as much as possible) can have a major impact. Even if Sue isn’t perfect in these efforts, it will have a significant effect on her diabetes and allow her to reduce the number of meds needed to control her diabetes well.

The final choice is certainly what I love to see. This is where the person really changes their life. They begin to learn the ins and outs of a healthy diabetic diet. They exercise six days a week and slowly work their way down to their ideal weight and maintain it. These folks, the few, the proud, the diabetic marines, are able to essentially eliminate the risk factors normally associated with diabetes while minimizing the medicines that may be needed. And they feel great. We have a man whose HbA1C was 12 – terrible! He became a “change your life” kind of guy and now has his HbA1C down in the 6’s with no diabetes meds. At our office, we follow people in all four categories, but the more we can encourage into this last category, the better we like it. So if diabetes is raising its ugly sugar-coated head in your life, don’t stick your head in the sugar; change your life – the rewards are sweet.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835


Will you go blind?

If you could predict blindness 20 years before it happens and then take steps to avoid it, would you?

Diabetic retinopathy is the leading cause of blindness in the United States. Get your sugar tested and know your numbers. Talk to our providers about how to avoid diabetes. Dig deeper into what nutritional and health changes you can make to change your future.


Book Review: “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” by Robert Lustig, MD

Robert Lustig, MD’s book Fat Chance is a quick, well referenced follow-up to his wildly popular YouTube video “Sugar: The Bitter Truth”. In this book he lays out the clear physiological pathway in which excess sugar (specifically fructose) is the key toxin causing so much obesity and metabolic disease. The twin cofactors of our lack of fiber (to blunt the rate of sugar absorption) and our lack of exercise (to increase our per minute use of glucose) play a role as well.

In this paradigm change is necessary for all of us we hope to avoid certain metabolic catastrophe. He lays our several key elements necessary for our health. Including reducing sugar consumption, increase real/whole food consumption, and in reducing the overly processed packaged food dependency we have as a nation. He outlines why this is both behavioral (we choose the wrong foods) and physiologic (our bodies push us to choose the wrong foods) and how to address both. In the end he even outlines his argument for governmental policy to help us change.

I was very pleased to read this book. I was very glad to realize that 90% of the points he makes in this book we already teach through the practice’s nutritional counseling program. I was even pleased to read him talk about ‘real food spoils.’ It does by the way.

I would highly encourage everyone interested in true health and the physiology that regulates it to read this book. I borrowed mine from the county library but like it so much I’ll order a copy to own.

In that vein we will be using a simple recommendation scale for our book reviews. We will recommend one of the following actions for each book:

  • Skip It for those books you needn’t bother exploring. You only have so many books you’ll read in your lifetime and we don’t want you to waste it on one like this.
  • Skim It for those books that deserve some consideration. Maybe use a highlighted copy and read the yellow parts or even run by the bookstore and just browse the chapter headings. There are a few useful tidbits in these books but not a many.
  • Borrow It is for books that you really ought to read fully. Once you’ve read them, send them packing so they don’t clutter up your life.  You may not need them again, ever.
  • Buy It are books you need to own. These books need a place on your shelves either in hardcopy or electronic. They are books you’ll think about and lend out. Books you’ll look back on and be glad you own.
  • Study It are books that need a physical presence in your life and something close at hand. They are books you’ll review over and again. You’ll be reading your own highlighting and think “That’s a great point!” all over again.  Few books deserve this level of consideration and fewer still will hold this level of recommendation over the course of your lifetime.

For Robert Lustig, MD’s book Fat Chance I give it a Buy It rating.