BootCamp for Betics

Hey Betics - 

Is anyone else freaking tired? Like, ALL the time?

I can't remember the last time I woke up feeling "refreshed" and ready to start the day (who ARE these people who can wake up "refreshed," anyway?)

Well, I've been doing some research and some experimentation for this past somewhat sleepy and miserable year.

You might be surprised to learn that there are more than fifteen possible reasons that a person with diabetes might suffer from chronic or incidental inexplicable fatigue, and most of these causes can be tested for, and treated.

I want to produce a free community webinar about this very topic, but first, I'd like to know whether you'd be interested in attending or not.

If you'd be interested in learning more about battling diabetes fatigue,

vote in my poll

and let me know!

With Betic Love,
Kara


P.S. Tell your friends

I totally tried Afrezza. Here is my official review of this high cost, inhalable insulin:

About a year ago, I decided I wanted to try Afrezza, the new (at the time) inhalable insulin.

My Endocrine PA wasn’t comfortable prescribing Afrezza (it had never been prescribed by anyone in her clinic before), and she wanted me to meet with one of the M.D. Endocrinologists in the office before getting the prescription.

Naturally, getting an appointment with the Endo M.D. took 8 months.

During that 8 months, I did some research and prepared my presentation to the Endo.

I’ll spare you the details, but here are the resultant highlights of the proposal I submitted to the Endocrinologist:

1. I would start by trying the 4-unit inhalable insulin cartridges (Afrezza comes in 4, 8, and 12 unit cartridges)
2. I would wait until my blood sugar was high (>250) before trying Afrezza, just because I’d  heard that 4 units of Afrezza does not affect the diabetic human body as predictably as 4 units of human or analog injectable insulin, so to play it safe, it’s best to start off with a high blood sugar before inhaling 4 units of Afrezza.
3. I would not use Afrezza regularly or even daily. I would use it for incidental cases only (unexplained highs, occasional planned carbohydrate binging, etc.) - this is because I learned that some people experience what amounts to a “tolerance” to Afrezza. In other words, the more often you use it, the less effective Afrezza becomes.

My Endocrinologist is pretty practical, and I think the fact that I'd done so much research helped me establish credibility with her, so she agreed to let me try the Afrezza.

But first, I had to wait for the insurance company to deny coverage.

Then, I had to wait for the insurance company to deny the appeal and prior authorization for coverage.

After receiving the expected insurance denials, I found and printed a coupon from the Afrezza webpage. Then I went into the pharmacy, coupon in hand, and shelled out $150 cash for my box of Afrezza cartridges, which is a pretty great discount, considering I would have paid more than $300 without the coupon.

That afternoon, I ate a carby snack and chose not to take any insulin, so that I could purposefully cause my blood sugar to go above 250 so that I could try my Afrezza.

After thoroughly following the instructions on the Afrezza package insert, I took my first “puff.” Then I waited. You can watch what happened in the video below, or your can read the short version below (just scroll past the video).

Here’s the short version:

• I purposefully caused my blood sugar to go high, so that I could safely experiment with this insulin.
• With a blood sugar of 275, I took a puff of Afrezza
• 5 minutes after the puff, my blood sugar was 268
• 10 minutes after the puff, my blood sugar was 269
• 15 minutes after the puff, my blood sugar was 246
• 30 minutes after the puff, my blood sugar was 222
• 60 minutes after the puff, my blood sugar was 196

Since the initial experiment, I’ve tried Afrezza numerous times and had a bunch of interesting experiences. Here’s what I’ve found:

1. The higher my blood sugar is, the less effective Afrezza is. For example, Afrezza doesn’t do much to my blood sugar if I’m super high (>350). It works best when I’m in the 200-300 range.
2. If I use Afrezza too frequently, it seems to become less effective over time.
3. When Afrezza works for me, it works VERY quickly to lower a high blood sugar (80 mg/dL in 60 minutes!).
4. 4 “units” of Afrezza equals about 1½ units of Humalog (for me). So it’s definitely not as potent as injectable short acting analogs.
5. I do not plan to use Afrezza regularly, as part of my daily routine.
6. I will use Afrezza as my “rescue inhaler” for high blood sugars.
7. Mannkind should not market Afrezza as an inhaler that can be used regularly.
8. Mannkind should market Afrezza as a rescue inhaler for high blood sugar. A rescue inhaler that all occasionally hyperglycemic diabetics should have.
   

Do you have experience with Afrezza? Leave a note in the comments!

I get a lot of questions from folks asking about natural remedies for diabetes, and I thought this short video would help clear things up.

Hey Betics,

I get a bit of mail from folks wondering about my thoughts on the low-carb-high-fat (LCHF) diet (also known as Way-Of-Eating or WOE) and why I'm not pushing this as a lifestyle to everyone who has diabetes.

Here's one of my latest responses to one of the more polite inquirers about this:

Thanks so much for you email! How funny you should ask about LCHF - I'm actually in the middle of Dr. Bernstein's book right now. I'm pretty familiar with the LCHF movement, though I wouldn't call myself a dedicated subscriber at this time.

I think the LCHF results that people are reporting are really promising, but absent a comprehensive study similar to the DCCTs that occurred in the 90s, I'm forced to hold back a true opinion because the only published evidence of LCHF's success is anecdotal and/or represents results from a very small study (though the evidence is, admittedly, quite compelling).

My focus is to spend less time encouraging others to conform to a specific treatment method (and LCHF is certainly one method that has resulted in success for many), and instead encourage people to focus on getting their blood sugar into target range as often and as safely as possible. For some, that might mean adopting the LCHF lifestyle. For others, it might mean something completely different. 

There are three other concerns I have about LCHF. Since you've been working with this WOE for awhile, maybe you can share your thoughts on them?

1. One concern I have is its sustainability. Are people actually going to be able to keep doing it for the rest of their lives? Obviously, some people are very successful at LCHF, but I'm not sure it's sustainable for every diabetic. 

2. Next is affordability - eating healthful, unsaturated fats and ensuring you're getting enough protein, etc. can be expensive. This may not be practical for people in lower income brackets. 

3. Lastly, and this is a big unknown for me - is adopting the LCHF way of eating a veritable rabbit hole of increased insulin resistance, essentially ensuring that if you start LCHF, you won't ever be able to stop, or even cheat? If you fail at LCHF, would you be worse off than if you'd never tried it in the first place due to the increased insulin resistance caused by the inevitable intake of saturated fat, the increased rate of gluconeogenesis, and the increase in hepatic glycogen conversion?

LCHF is a method of blood sugar control that I definitely intend to try, so perhaps I'll have more interesting things to say about it once I've done so.

Thanks for your email, it forced me to get my thoughts about this down on paper. I want my efforts with BootCamp for Betics/PureDiabetes to be as accurate and as helpful as possible, so, if you have some data that can help push me into the LCHF camp, I would love to hear it!

Thanks,
Kara

Hey Friends,

This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.

Update 3/6/17
This is an update based on a Facebook discussion about how successful Metformin is, overall, at reducing weight in the general diabetic population. 

Note: Studies don't show consistent weight loss with metformin use, that's for sure. My hypothesis is that in order to experience successful weight loss on Metformin, you have to meet some very specific conditions. First, you have to be euglycemic virtually all of the time before starting the metformin. This is hard to do, especially when you're on insulin. You also have to remain euglycemic as you continue to take the metformin. And insulin dependents have to do this by adjusting (read: reducing) basal and bolus dose calculations. This is not easy. But starting metformin while euglycemic and remaining euglycemic throughout the treatment will, I hypothesize, result in weight loss, because it results in less sugar in the blood, which means less required insulin, which means less fat storage. I was a sample size of one, of course. And my experiment was driven by personal curiosity, not scientific inquiry. I will post this on the blog to make that part more clear. I would like find some research on whether metformin has caused weight loss in people withOUT diabetes. I'm sure it's out there, and that I just haven't found it yet.

Now, continue on to the article below.

Hey Betics,

Many of you are aware that I recently started experimenting with metformin, which is a medication typically prescribed to people with type 2 diabetes. But, according to many reputable sources, metformin can also help type 1 diabetics (along with insulin, of course, which is required for type 1s) with blood sugar management.

I wrote about metformin in my I'm using a diabetes drug recreationally article a few months ago. Feel free to read that at your leisure.

My main goal in starting metformin was to see if this medication could help stabilize and flatline my blood sugar levels during and after exercise.

Exercise had been so frustrating. Every time I went to an exercise class with a perfect blood sugar, my blood sugar would go up by 60 to 100 mg/dL. Yes, you read that correctly. Exercise *raised* my blood sugar.

Now, you might be wondering, "Why the heck did your blood sugar go UP during exercise? Isn't it supposed to do DOWN?"

Let me explain.

I take insulin. I take basal insulin, which is used to counteract the baseline level of glucose that's always hanging around in my blood thanks to my liver's gluconeogenesis. I also take bolus insulin, which helps the food I eat (mostly carbohydrates), once it's digested into glucose, get into my cells. I also use bolus insulin to treat incidental high blood sugars. Insulin moves sugar from my blood into my cells. My cells like this, because my cells use that sugar for energy (and some other stuff).

I did a bunch of experiments with exercise. More specifically, I wanted to compare my blood sugar's reaction to exercise while my cells were in a starving state vs. my blood sugar's reaction to exercise when I had bolus insulin on board (non-starving state).

I started capturing blood sugar data surrounding my exercise events.

RESULTS OF EXERCISING IN A NON-STARVING STATE
Let's say I eat breakfast at 8am, and take 4 units of bolus insulin.

The insulin helps my breakfast carbs get into my cells to give me energy.

Yay! Now, let's say I exercise at 10am, with a starting blood sugar of 140. I still have some insulin in my blood, and I have some very satisfied cells that are full of energy.

But, during the exercise, my cells start using up that energy. And my cells start to run out of energy. So my cells get hungry.

But guess what. There's still some sugar in my blood because my blood sugar is 140, AND there's still some insulin in my blood because, well, even short acting insulin stays in the blood for up to 6 hours.

So, my body uses the remaining insulin to suck as much sugar as possible into my cells to give me more energy.

At the end of the exercise, my blood sugar is down to 40, and I'm shaky, clammy and need a snack.

Naturally, because I feel so awful, I eat and eat and eat, which results in a high blood sugar a few hours later, and then I get to enjoy a blood sugar roller coaster for the rest of the day.


RESULTS OF EXERCISING IN A STARVING STATE
I'd wake up, and I would NOT eat anything for breakfast.

Then, at noon, I'd go to my exercise class with a blood sugar of, for example, 120. I'd exercise for the full hour, and then check my blood sugar immediately after the exercise. 200. My blood sugar was 200.

​Seriously, what??

Here's what happened. My cells were hungry. Since I hadn't eaten breakfast, those cells didn't have much energy to start with. So, I started exercising and I pretty quickly used up all the energy in my cells. But, since I didn't have any extra insulin in my body, there was no insulin available to pull sugar from my blood into my cells to give them more energy.

But it didn't end there. Did you know that you liver is supposed to store glucose, and give you a few squirts of that glucose when you need it?

Well, one of the times you need glucose is when your cells become starving. So, noticing that my cells were starved of energy, my liver helpfully squirted a bunch of glucose in my blood, raising my blood sugar to 200.

And...guess what. I didn't have any bolus insulin on board to carry that sugar into my cells. So basically, my cells were starving, and there was plenty of sugar in my blood to feed them, but unfortunately, the insulin required to move the sugar into the cells just wasn't there. So I had starving cells and high blood sugar.

So, HOW THE HELL is someone on insulin supposed to exercise while keeping their blood sugar at a flat line (or as close to target as possible)???

I contemplated three potential solutions to this problem.

One potential solution was to do my exercise in a starving state, and then use Afrezza, the super-fast-acting inhalable insulin, right after exercise, to lower my blood sugar. This is something suggested by my friend Dr. Gaja Andzel, whom I trust completely to give me diabetes-related advice. But, my doctor here in Wisconsin is pretty risk-averse, so I'm still in the process of convincing her to let me try Afrezza.

Another potential solution was to try metformin, a drug that suppresses the liver's glucose-squirting activities and reduces insulin resistance, to see if I could exercise in a starving state without getting that extra sugar kick from my liver.

Another potential solution was to try experimenting with the timing of my breakfast, insulin doses, basal rates, etc. I've been there, done that. It's pretty hit or miss at first, but you can eventually get it right. I know some athletes who've been really successful with this method. If you need some coaching on this, Dr. Matt Corcoran from Diabetes Training Camp is a great resource.

​My goal was to flatline my blood sugar during and after exercise. Since I couldn't get access to Afrezza (that's coming soon, I promise!), and since mucking with my dosing and rates is not easy and affects everyone differently, I decided to try metformin to suppress my liver from squirting a bunch of sugar into my blood during exercise.

I did some research. Then I did some asking around. Then I talked with my doctor and she agreed to prescribe me metformin. Then I did some more research and wrote the I'm using a diabetes drug recreationally article. And then I started taking metformin.

I decided to take the extended release version of metformin (marketed as ER or XR), because I'd heard horror stories about side effects from the "regular" metformin. The effects of extended release metformin apparently aren't as severe.

That's not to say there weren't side effects. For me, the side effect was pooping. Lots of pooping. It lasted about six weeks and then I didn't have the effects anymore. Other than that, I've experienced no other negative side effects.

My instructions were to start taking 500mg/day for a week, then increase by 500 each week until I reached the max dose of 2000mg/day.

During the dose increases, my blood sugars were all over the place. I was playing with basal rates, recalculating insulin sensitivity factors, adjusting bolus ratios, etc., and my blood sugars were all over the place. I was high, and low, and high, and low and on a total roller coaster for a few months. I decided to stick with 1500 per day, and do somebaseline testing.

Once I reached a dose of 1500 mg per day and did some baseline testing, I noticed three things:

1. I didn't need as much basal insulin. Due to the metformin, I had to reduce my original basal insulin by about 15%
2. I didn't need as much bolus insulin. Due to the metformin, I had to reduce my bolus insulin by about 10%
3. I had VERY little, if any, increase in blood sugar during exercise. Metformin solved my "exercising while starving" problem.

Once I reached 2000 mg per day, I noticed two more things:

1. I had to reduce my original basal insulin dose by 20%
2. I had to reduce my original bolus insulin dose by about 15%

So, overall, I'm getting exercise without screwing up my blood sugar. I'm also taking less insulin overall. Do you know what that means?

It means that since I finished the baseline testing and got the initial metformin-induced roller coasters under control, I've lost about a pound per week.

Why? Well, insulin is a hormone that helps glucose get into your cells, which your cells use as energy. If there's an overabundance of energy in your cells, your cells store that energy as fat. Yep. Insulin is a fat storage hormone.

You NEED insulin to survive, though. If you don't have insulin (either from a vial, a pen, or from your own pancreas), you will die.

Striking a balance among exercise, blood sugar levels, insulin, metformin, eating, and weight loss/gain is hard. Like, really hard. But I'm not going to complain about that.

What I will continue to complain about, however, is how much we have to FIGHT to get the diabetes supplies, education, and care we need in order figure stuff out like this.

Next up, Afrezza. They're marketing it all wrong. I'm going to run some experiments with it starting in May, and perhaps we can set Mannkind straight.

With Betic Love,
​Kara

This video contains instructions for drawing insulin into a syringe from a vial.

Hey Betics! Three quick things:


Thing #1: 
A company called OneDrop just released a subscription service that comes with a glucose meter and unlimited test strips, and this is not a joke.

I'll write a full article later with more details, but I wanted to make sure you got the news right away. I will say that UNLIMITED does not mean as many as you are able to hoard (bummer). It means as many as you actually use.

Still, this could be really freaking awesome for those of you who

1. have crappy prescription coverage
2. have no prescription coverage at all
3. have a strict test strip limit

Thing #2
I got some great feedback after I sent out the Diabetic Thanksgiving Survival Guide last month. One of you kindly advised me that the survival guide can be used for more than just Thanksgiving dinner. I'm not sure why I didn't think of this, but apparently you can use the Thanksgiving Survival Guide for parties, special events, holiday dinners and any other way it works for you. So, in case you have upcoming special events, here's the link to download the Thanksgiving guide (again).

Thing #3
I've recently learned there's a great need for a diabetic-friendly meal plan service that tells you specifically what to buy, what to cook, how to cook it, and how many carbs are in it, etc. I need to know more about what that service needs to look like before I start working on it (confession: I've already started working on it a little bit). So, if you have some time today, can you click the link below and give me some direction, here?

Sure, I'll give you some feedback.

Sorry, Kara. I'm too busy to help you.

With Betic Love,
Kara

​I gained a full percentage point.

Hey Betics,

I just checked my A1C and the results are very grim. My A1C increased by a full percentage point between September and December.

The reason? Well, I slacked off for about two months and stopped paying attention to my diabetes. And, as my A1C indicates, I am again forced to acknowledge (for the millionth time) that there is no time off from diabetes.

Ugh.

It is time to get my butt in gear and solve this problem. I know I can lower my A1C within the next month, but only if I start paying attention to my diabetes again.

Here's what I'm going to do.

1. I'm going to check my blood sugar more often.

2. I'm going to stop eating crap. Or, at least, I'm going to reduce the amount of crap-eating. This should be easier now that Christmas is over.

3. I'm going to reset my baseline blood sugar by doing a series of mini-fasts over the course of 3 days.

4. After I fix my baseline, I'll decide what to do next.

And - 

I'd like you to join me.

I'm inviting everyone on this list (type 1, type 2 and type 1.5) to join me for my next online Baseline Blood Sugar Challenge Event, which starts January 1. This is a 3-day blood sugar reset program.

Registration is FREE until December 31.

So, if your blood sugar is behaving badly thanks to the holidays, join me in setting our baseline blood sugars straight.

This is likely the last time I'll be offering this $59 web event for free, so if you haven't tried this yet (or if you did this in September and want to do it again), now is the time!

Will you join me?

Sure, I'd love to kick my baseline blood sugar's ass.

I'm not sure. Tell me more about it.

See you there!

With Betic Love,
Kara

P.S. If you'd like to invite a friend or family member, use one of the social share links below.

P.P.S. This course uses video, textual content and email. That means program registrants will get a daily email for 3 days. If you aren't available January 1-3, you can still register today and complete the course at a later date as long as you save the emails.

A few months ago, my little brother (age 34) contacted me and said, “I need to talk to you about something. I think I have insulin resistance.”

“Why do you think that?” I responded.

“Well, our entire family has type 2 except for you,” he said. “So I’m pretty much doomed to get type 2.”

“Yep. you’re probably right,” I agreed.

“And I’ve been slowly gaining weight since I became an adult, which could be due to my lifestyle, but it could also be due to the fact that I’m becoming more insulin resistant as I get older.”

“That’s usually how it works,” I confirmed.

“And as a response to my insulin resistance that’s been getting worse over time, my pancreas has been producing more and more insulin. Which causes extra weight gain,” he said.

“All true. Where are you going with this?” I asked

“Well, my fasting glucose and glucose tolerance tests and my A1C are all normal. So according to the docs, there’s no sign of diabetes.”

“Right,” I said. “No one actually tests positive for diabetes or pre-diabetes until they’ve become so insulin resistant that their pancreas can no longer keep up. Basically, the only time you’ll get an interesting test result is when it’s already too late.”

“So,” said my brother, “I could be very insulin resistant, but I wouldn’t necessarily see anything interesting on a test, because my pancreas could be chugging along like the little engine that could, squirting out an ass ton of insulin into my body to keep my blood sugar normal, all the while secretly petering out and basically dying a slow pancreatic death.

“Well, it's more complicated than that, but as a summary, it's close enough,” I said.

“So at some point, my pancreas won’t be able to keep up with the demand for insulin, and then my blood sugar will finally start going high, and then I’ll be pre-diabetic, and eventually I’ll become diabetic.”

“Yes. All of this is true.”

Then he said, “Well, wouldn’t it be better for me to know that I’m insulin resistant NOW, when I’m 34, instead of in 20 or 30 years when it’ll be too late?”

And this stopped me in my tracks, and my heart sank.

I started to think.

He was so, totally, absolutely, 100% right. If my little brother is doomed to become diabetic, wouldn’t it be better to know NOW instead of in 20 or 30 years? Yes. Yes, it totally would.

I started to think even harder. Here’s what I thought:

Fact 1: Type 2 diabetes starts with insulin resistance, which is, at least partially, genetic. Quite simply, your body stops being efficient about its use of insulin, and so your pancreas has to start squirting more insulin (a fat storage hormone) into your body, which makes you hyperinsulinemic (too much insulin in your body), which, in many cases, causes you to get chubbier and chubbier.

Fact 2: Over time (years and years), your pancreas gets so exhausted from all the extra work that it just can’t keep up.

Fact 3: Your pancreas becomes even weaker as your cells continue to become more insulin resistant, and finally your pancreas just can’t squirt out enough insulin anymore, and your pancreas starts to peter out, and at some point during this process, your blood sugar starts to go up and you become pre-diabetic or diabetic.

The next logical question in my thought process was this: Why isn’t everyone in the entire world getting tested for hyperinsulinemia on a regular basis? Because wouldn’t the presence of hyperinsulinemia be a pretty damned clear indicator that you have insulin resistance?

Yes. Yes it would.

As it turns out, there are a couple of pretty cheap blood tests that can diagnose hyperinsulinemia in a person who otherwise appears healthy.

I immediately got on the phone and called my good friend Ed, who is a family medicine practitioner in Phoenix, and is also a type 1 diabetic.

I asked him, “Why wouldn’t doctors just test everyone for hyperinsulinemia, which, in many cases would indicate early-on insulin resistance and then we could better predict and ultimately prevent type 2 diabetes?”

Ed said, “That’s an interesting idea, but I’m not sure we can guarantee positive outcomes by telling people they’re insulin resistant. We already have tests for pre-diabetes and metabolic syndrome, which are known precursors to diabetes. And, there’s no real compelling evidence that a metabolic syndrome or pre-diabetes diagnosis is going to cause someone to implement the life changes they need to implement to avoid becoming diabetic.”

[interjection: Ed agreed that the diagnoses of these diabetes precursors typically occur when a diabetes onset is imminently likely, or, in other words, these diagnoses typically occur at the tail end of the insulin resistance duration. You know. Once you’re already old and set in your ways].

Then Ed asked, “If an actual diagnosis of metabolic syndrome or pre-diabetes doesn’t result in a lower eventual diabetes diagnosis rate, then what good will come of an even earlier insulin resistance diagnosis?”

My friend Dr. Ed has a good point. In fact, a recent study confirms how good his point is.

But I still wanted to believe that a early absolute predictor of type 2 diabetes would cause a younger person to take steps to prevent the eventual diabetes diagnosis. Wouldn’t it?

Ed said, “We don’t actually know the answer to that, because there’s not enough data. That would have to be a really long and expensive study, spanning many decades.”

And then, I started doing more random thinking. And here’s what I randomly thought.

Fact 4: People get diagnosed with metabolic syndrome or prediabetes only after their pancreas has had years to slowly peter out from exhaustion.

Fact 5: Most medical professionals will tell you that your goals in preventing diabetes are to eat right and exercise while ensuring that your blood sugar stays in target range.

I’d like to pick apart these facts. First, I think, “eat right and exercise” is a fine thing to say, but I have two problems with this advice.

The first problem I have with this advice is the TIME at which we’re giving it. Once you have a prediabetes or metabolic syndrome diagnosis, it’s almost too late. You’ve probably already gained a bunch of weight over the years as a result of your insulin resistance, you probably feel like crap, you’ve probably spent years developing habits to compensate for how your body feels as a result of the insulin resistance and, essentially, the barriers to “eat right and exercise” are unbelievably high. If you say “eat right and exercise, because you are going to get diabetes” to a 65 year old with insulin resistance, this advice is likely going to be far less catalytic than if you were to tell a 35 year old the same thing.

The second problem I have with the common “diabetes prevention” advice is that it isn’t focusing on outcomes more specific than “not getting diabetes.” The outcomes that a hyperinsulinemic normoglycemic at-risk person should instead focus on are, in my opinion, these:

1. Reducing insulin resistance
2. Preserving pancreatic endocrine function

[Note: If you are type 1 and at risk of insulin resistance, don’t bother getting these tests and don't bother preserving pancreatic function. Just work on reducing insulin resistance.]

And certainly, “eating right and exercising” can contribute to both of these goals. But the “eat right and exercise” advice is nowhere near specific enough to actually help someone who wants to reduce insulin resistance and preserve pancreatic function! There’s also a whole bunch of other stuff (besides “eating right and exercising”) that you can do to reduce insulin resistance and preserve pancreatic function. And, there’s a bunch of stuff you can do to ruin your progress toward these goals. As a diabetic community, we aren’t giving at-risk people the tools they need to reduce insulin resistance and preserve pancreatic function (But I will! I promise! That’ll be another blog post!).

So, if you have a family member who is at risk of diabetes, telling them to “eat right and exercise” just isn’t likely to work. Here’s what to do instead:

1. Encourage your family member to get tested (every year or two) forfasting insulin levels to see if the pancreas is overproducing insulin (hyperinsulinemia) or under producing insulin (hypoinsulinemia). This should start at age 35 or anytime they become overweight. [Note: hyperinsulinemia, in rare cases, is an indicator of a handful of other health conditions. So check with your doctor about these.]
2. Encourage your family member to also get their fasting glucoselevel or their A1C tested every year or two.
3. Have your family member track the results of their fasting insulin levels from year to year. Does the fasting insulin level increase from year to year? If so, insulin resistance could be getting worse.
4. Does your family member notice lower fasting insulin levels from year to year and higher fasting or average glucose readings? This could indicate depressed pancreatic function and could turn into pre-diabetes or metabolic syndrome.
5. If your family member has/had gestational diabetes or PCOS, they are automatically at risk.
6. If your family member is at risk of diabetes, help them take steps to reduce insulin resistance and preserve pancreatic function. I’ll write another article about how to do this soon. I’ll send it to my email list as soon as I publish it.

What’s my point, here? I have several.

1. I don’t think the medical community is diagnosing pre-diabetes early enough. We’re diagnosing pre-diabetes when, for most people, it’s too late. We have the capability to pre-diagnose pre-diabetes YEARS earlier, and we’re not doing it.
2. People at risk of type 2 diabetes need to get the right information at the right time about how to delay or prevent type 2 diabetes.
3. There’s a ton of stuff you can do to delay or prevent diabetes, and the earlier you start, the better.
4. Diabetes is extremely expensive for an individual. Preventing diabetes is, by comparison, dirt cheap, as long as you do it in a way that is actually effective.

  
As it turns out, my brother is indeed hyperinsulinemic. But he’s also 34, so there are steps he can take NOW to reduce insulin resistance and preserve pancreatic function and potentially delay or even prevent a diabetes diagnosis. My next article will be for him and for everyone else who needs to do the same.

I’m sure he’s really excited to have his big sister boss him around and tell him what to do. It’ll be just like old times.