Chili

My slow cooker breakfast chili.

Makes 10-12 individual serves.

I developed this recipe over the past year or so and found a one-cup serve did not spike me at breakfast. Of course, it can be eaten at other times of day if you prefer. 

Ingredients 

All are approximate, American equivalents in brackets.

• 1kg Minced beef (2-3 lbs ground beef)
• One cup chopped celery
• 2 large or 3 medium sliced carrots
• 1 sliced medium to large onion
• 1 can diced tomato
• 3 crushed/minced cloves garlic
• 1 crushed or grated knob of ginger
• 150gm dry weight (4-5 oz) red kidney beans
• 2 tbs paprika
• 1 tbs cumin seeds
• 1 tbs oregano
• 1 quill or 1 tsp cinnamon
• 1 cup beef stock
• Chili to taste. I use 2 or 3 very hot birds-eye from my garden. Use your favourite.

Method

I set this up in the evening and leave it in the slow-cooker on low overnight. It can also be cooked in a large saucepan on the stove or in the oven but you'll have to work out your own timing for those methods.

At least 8 hours prior put aside the red kidney beans in a couple of cups of water to soak.

I use a wok for preparation but any large skillet will do. I use olive oil for medium heat frying. Fry the meat in batches, separating any clumps and add to the slow cooker when browned. At this stage the slow cooker is on high.

Add a little more oil and fry the onion on medium heat until translucent. Add the ginger and garlic and continue stir-frying. As the onion begins caramelising add the carrot and celery. Stir-fry until those are beginning to soften then add the can of diced tomatoes and all the spices and herbs. When the mixture begins bubbling transfer to the slow-cooker and change the temperature to low.

De-glaze the wok or skillet with the stock (I sometimes finish the de-glaze with a little red wine) and add the liquid to the slow-cooker. Drain the beans and add them to the mix and stir well. If the mix is too dry add a little water but not too much. Put the lid on and leave it on low for six to eight hours.

I have a one-cup serve for breakfast next morning and store the remainder, after removing the cinnamon quill, in one-cup containers in the freezer.

Options

I often add other veges in modest portions if I have them in the fridge: capsicum (bell pepper), cabbage, broccoli, cauliflower etc. Similarly I might add some extra herbs from the garden (thyme, mint, parsley, basil) or other spices (nutmeg, turmeric) for some flavour variations. I have not worked out the carb count but this does not spike me after breakfast. The main carbs are from the beans, onion and carrot if you want to cut further.

Cheers, Alan

Everything in Moderation - Except Laughter

How Many Grams of Carbs Per Day Should I Eat?

How many carbs? What are the limits?

Now that the diabetes world has begun to wake up to the fact that type 2 diabetes is a condition of flawed carbohydrate tolerance I see this question repeatedly on forums and reddit. The time has come to make a brief but clear statement on that subject. 

It is per meal which matters, not per day. Your blood glucose rises and falls after every meal or snack containing carbohydrates. Your blood glucose is not stored up for one big spike at the end of the day. 

My meter used at my peak after eating guided me to these personal per meal limits:

• Breakfast: <10gms carb
• Lunch: <15gms carb
• Dinner: 40gms+ carb
• Snacks: the same as the previous meal but not more than 15gm.

But those are just my personal limits. Every type 2 has slightly different levels of insulin resistance, first phase insulin response, levels of fitness, other health problems, signalling flaws for glycogen release, dietary limitations, the list goes on. Therefore your limits will be different to mine. 

Discover them using this technique at your peak timing after meals: Test, Review, Adjust

How Does Hyperglycemia Cause Damage And What Can We Do To Avoid It?

I have read many research papers since my diagnosis seventeen years ago but until very recently I had never seen a research paper specifically addressing in detail the subject of how and why high blood glucose levels cause harm to our bodies. It seems to me that understanding that is basic to finding better ways to maintain long term diabetes health.

This report was published in the Warwick UK University News last month: New study sheds light on how blood vessel damage from high glucose concentrations unfolds. The underlying research study can be found here: Activation of the unfolded protein response in high glucose treated endothelialcells is mediated by methylglyoxal. 

The scientists were interested in discovering the effects of hyperglycemia on endothelial cells and how that contributed to the development of vascular complications of diabetes. They were also looking for methods to reduce those effects.

As I am not a biochemist I found the Warwick report analysis of the paper more understandable. This is the section I found particularly interesting:

Hyperglycemia is the condition in which an individual’s blood glucose is abnormally high and is commonly caused by diabetes.

The researchers confirmed that glucose metabolism in endothelial cells is increased in high concentrations of glucose. They showed for the first time that this occurs because an enzyme that metabolises glucose in these cells, called hexokinase-2 (HK2), degrades more slowly in high glucose concentration and thereby metabolises more glucose than normal. Increased glucose metabolism is the driver of metabolic dysfunction of endothelial cells in model hyperglycemia.

They were able to correct this effect using a novel dietary supplement previously developed by the research team called a glyoxalase 1 inducer or Glo1 inducer.

They also found that the HK2 effect was the major mechanism increasing formation of a reactive glucose-derived substance called methylglyoxal (MG), known to be increased in diabetes and linked to damage to blood cells, kidneys, retina and nerves in arms and legs in diabetes – so-called vascular complication of diabetes.

MG binds and modifies proteins, causing them to become misfolded. In this study the researchers identified 222 proteins susceptible to MG modification and this activates a protein quality surveillance system called the unfolded protein response, which removes damaged proteins. When the unfolded protein response is overworked with a high level of misfolded protein substrate it causes an inflammatory response and there is an increased risk of blood clot formation. These processes contribute to blood vessel damage involved in the development of vascular complication of diabetes.

My focus is slightly different. The scientists found a dietary supplement may help; to me that might be useful some time in the future but is much less important than this: “When the unfolded protein response is overworked with a high level of misfolded protein substrate it causes an inflammatory response and there is an increased risk of blood clot formation. These processes contribute to blood vessel damage involved in the development of vascular complication of diabetes.”

Over the years since I first began using Jennifer’s Test, Test, Test method to modify my menu I have slowly formed the opinion that maintaining peak post-prandial blood glucose levels as close to non-diabetic as I reasonably can is much more important than other tests such as A1c or fasting blood glucose.

I believe this research adds support to my ideas but I emphasise the following is purely my personal opinion as a long term type 2 diabetic.

• Our bodies have a natural ability to heal most wounds or damage with time.
• Short term blood glucose spikes above high normal (~8 mmol/l or 140 mg/dl) cause immediate damage. The higher the spike, or the longer it is maintained, the worse the damage. 
• I believe that damage can be repaired by our body given sufficient time but repeated frequent hyperglycemia can have a cumulative effect if the damage exceeds the body's ability to repair it in time.The body needs periods of normal blood glucose level to repair past harm. Constantly elevated blood glucose levels, even if only slightly above normal, impair the body's normal healing processes.

Put those thoughts together and I see a need to concentrate on two separate but allied blood glucose goals:

• I aim to maintain steady blood glucose levels as close as is reasonably possible to non-diabetic. 
• Avoiding brief blood glucose spikes is wise but nobody is perfect and they will happen. I aim to minimise their frequency and level.

My personal definition of a non-diabetic range is 4-8mmol/l or 70-140 mg/dl. 

In my own experience reducing post-meal spikes also improved my steady levels between meals. For that reason I have concentrated on minimising post-meal spikes as my main treatment goal. I suffer from dawn phenomenon but I do not get too concerned about fasting blood glucose provided it is not too high and peak post-prandial results are good; to me fasting blood glucose is a diagnostic indicator rather than a management tool.

Provided my levels between blood glucose spikes are good I don't get too excited when occasional spikes occur. Instead I try to learn from them and discover the cause and try not to repeat them.

I practise what I preach. My doctor's report has changed very little since I wrote this in 2015: Are Diabetes Complications Inevitable? Not necessarily...

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There Is Nothing I Could Eat I like More Than my Eyes

Slow Cooked Beef Brisket

I bought my first slow cooker a few weeks ago. In the past I used stove-top large saucepans for slow cooking and braising. The method worked but needed regular stirring to prevent sticking. When a post-Christmas special appeared for a very cheap large slow cooker I decided to give it a try.

I wish I’d bought one years ago! I have experimented a few times now. I prepare the veges and meat after breakfast, toss them and some stock and liquids in the cooker and lift the lid eight or nine hours later for a delicious dinner.

This is my favourite of the recipes I have tried so far. It didn’t occur to me to take pictures last night; I will add them next time I cook it.

Beef Brisket

Ingredients

Portion sizes, herbs etc are flexible. Adjust to suit your own taste.

• 1-1.5Kg (2-3lbs) beef brisket or any similar cut. I prefer a piece at least 2-3cm (1”) thick and roughly rectangular which fits comfortably in the cooker.
• 1 large or 2 medium onions, sliced.
• 1 large or 2 medium carrots.
• 1 cup chopped celery
• Chopped herbs to taste. I used parsley, thyme, rosemary and mint from my garden.
• 2 or 3 bay leaves.
• 1 teaspoon mild paprika.
• 1 cup red wine.
• 1 can (400gm, ~1lb) chopped tomato.
• 1-2 cups beef stock (or pork or chicken; I make my own from bones and herbs).
• 2 cloves garlic.
• Salt and pepper.

Optional: 3-5cm (1½ “- 2”) chunks of potato.

Method

Serves 4 or more  depending on appetites and portion sizes.

Slice the carrots lengthways, cut them into rough chunks and place them on the floor of the cooker to become a base for the meat.

Roughly trim excessive fat from the beef. Leave some on for flavour. Lightly salt both sides of the meat and place it in the slow cooker. Grate some pepper over the meat to taste.

Fry the onions in oil in a skillet until soft, add the chopped celery and minced garlic and continue frying until the onions are starting to brown then transfer the cooked veges to the slow cooker.

Deglaze the skillet with the cup of wine and add the liquid to the cooker. Add the paprika, chopped tomato and stock. Stir to mix the liquids and settle the meat among the veges. If necessary add water sufficient to come just level with the meat.

Cook on low for 8 or more hours (my cheap cooker has only three heat settings: low, high, keep warm). As my spouse likes potatoes I added some chunks into the liquid around the meat at the 4 hour mark. Possibly those could be included at the start.

Serving.

Gently remove the meat from the cooker, trying not to remove too much attached liquid and veges as you transfer it to a cutting board.

Using a slotted spoon remove the carrots (and potato if added) from the sauce and transfer them to a serving dish. Don’t get too fussy if some liquid and other ingredients stick to the carrots or potato.

Remove the bay leaves and blend the remaining liquid and contents with a stick blender to become a smooth sauce. Use a potato masher if you don't have a stick blender. It doesn't have to be perfect.

Carve the meat across the grain into roughly 6mm (1/4”) slices and transfer to a serving dish. Pour the sauce liberally over the meat.

Diners serve themselves from the dishes.

I have not worked out the carbs, fat etc but the main carbs are in the onions, carrot and potato if added. This did not even cause a blip in my 1hr post-meal blood glucose test.

Bon Appetit

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

There is Nothing I Could Eat I like More Than my Eyes

What is a Balanced Diet For a Type 2 Diabetic?

This question came up on one of the forums I am on recently. There were many conflicting responses, often including discussion about various macronutrients (fat, protein, carbohydrates) and micronutrients (minerals, vitamins etc), the evils of sugar, cholesterol and saturated fats, the need for lots of fruit or grains etc etc. A lot of people also went into great detail about maximum and minimum percentages for fats, carbs and protein.

I believe in KISS, so I try to keep it simple with easy to follow rules for my way of eating. As I have to eat this way for the rest of my life I do not want an excessively complicated food selection system.

My definition of a balanced diet for a type 2 diabetic (me) is pretty basic and not in terms of percentages of anything. The basic description is simple, although the personal investigation creating the way of eating I follow today was fairly complex. The links at the foot of this post describe the journey to this point.

The simple version:

• I let my meter show me my carbohydrate limits for the time of day and the meal.
• I let common sense and satiety limit my protein and fat portions.
• I include a reasonably wide variety of vegetables in my menu, favouring fresh and seasonal vegetables where possible.
• I also include fruits but those are limited to minimise blood glucose spikes.

In applying those basic rules for myself I also take these factors into account:

• Variety in choices of meats, fish, seafood, dairy, vegetables and fruits makes the menu interesting and also improves the chances of getting all needed vitamins and micronutrients.
• Excess of any macronutrient is not wise.
• Excessive restriction of any macronutrient is just as unwise.

 These links to past posts expand on those points and others: 

• Food, Farmers and Factories
• Test, Review, Adjust
• Are Carbs Really Necessary?
• Vegetables
• Grazing
• Red, Red Wine
• Yoghurt
• Eggs, Carbs and Cholesterol
• Cinnamon, Spices, Herbs and Similar
• Food and Recipes

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There Is Nothing I Could Eat I like More Than my Eyes

Small New York Baked Low Carb Cheesecake

I posted the recipe for a delicious Large New York Baked Low Carb Cheesecake based on one posted by Angie, Granny Red, on the ADA forum a couple of years ago. It is a rather big cheesecake which I cut into 16 portions of 6gms carb each. 

Since then I have experimented several times with a reduced size because I found the large cake was too big for our needs. This is the recipe for those who prefer a smaller cake. The size reduction not only cuts the cost in half but is a little easier to prepare and needs less cooking time. The slight increase in egg proportions also tends to make a creamier texture.

I have modified the Splenda and sugar proportions as a reasonable compromise between my wife's sweet tooth and my need to keep the carbs down. Feel free to adjust that to suit yourself as the carb count will be directly reduced as you reduce the sugar. The nutrition count is based on the listed details. 

Ingredients

Crust 

1 cup almond flour or meal

2 tablespoons(tbsp) Splenda
1 tbsp sugar

4 tbsp butter, melted 

Filling 

12 oz (375gm) cream cheese

1/3 cup Splenda

2 tbsp sugar

2 eggs

1 teaspoon(tsp) vanilla extract

1/2 tsp lemon extract or a good squeeze of lemon; orange can be substituted as a variation.

8 oz (300ml) sour cream

Note: the eggs, cheese and sour cream need to be at room temperature. If the cheese is too stiff to beat easily, sit the containers in warm water for a little while until the cheese softens. 

Method

Crust Base 

Use extra butter to grease an 8 or 9 inch (20-25cm) spring-form pan. I also put a circle of greased brown paper on the bottom to be certain the cake does not stick; this step may not be necessary if you use a non-stick pan. 

 

Mix the splenda and almond flour (sometimes I make my own coarse version from almonds in the blender; it works just as well) with melted butter, press evenly onto the bottom of the pan for a thin layer without holes and press any excess up the sides of the pan. If you don't have enough almond flour to go all the way up the sides don't worry; it's not really critical as long as the base is covered. Set the pan aside while mixing the filling. 

Filling 

Beat the cream cheese until light and creamy, keeping the mixer on a low-medium setting throughout the beating and mixing process. Add the mixed splenda and sugar a little at a time and continue beating until creamy.

Add one egg at a time and beat briefly after each egg. When the eggs have been mixed into the cream cheese add vanilla and lemon extract (or lemon juice) and mix briefly until just combined. Add the sour cream last and beat briefly until fully incorporated. 

Baking 

Pour the mixture into the springform pan. Bake at 300 F or 150C for about 40 minutes then check to see if it is set and starting to brown slightly on top. If not, let it cook for another 15 minutes. Try not to over-cook it as it may become too dry. When it is set and beginning to brown turn off the heat, prop open the oven door slightly and leave it in the oven for at least an hour. 

Remove it from the oven and allow it to cool in the spring-form pan to room temperature before placing it in the fridge until the next day. Don't try to serve it on the day of cooking; it will not be set properly if you do. Do not be disappointed if it sinks slightly in the middle. That is normal, or, at least, it was for the ones I made.

The result is 8-12 satisfying slices. I individually wrap some in clingwrap for the freezer; they freeze and defrost well.

Nutrition	per serve:	8	12
Kcals	3000	375	250
Fat	275	34.4	22.9
Carb	100	12.5	8.3
Fibre	12	1.5	1.0
Protein	62	7.8	5.2

Bon appetit, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Fat: The New Health Paradigm

I have just read the opening summary of a startling document published by the Credit Suisse Research Institute.

Fat: The New Health Paradigm

I predict that this publication is going to become one of the most hotly debated documents in the fat vs carbs diet wars this year. The conclusions the authors arrive at are summarised very succinctly on the opening pages.

Their conclusions will not surprise many in the on-line diabetes community as most of us have been saying this for years (for example Eggs, Carbs and Cholesterol, Cholesterol, Fats, Carbs, Statins and Exercise) but they will cause consternation in many of the world's respected dietetic and diabetes authorities. This is not a journalist's article or a book by an organisation with an agenda or a diet to sell; it is a very well researched and supported scientific paper.

Below are abbreviated selections from the summary; these statements are well supported in the body of the document which I am still in the process of studying. I decided to post early to alert readers to the document and allow others to read it in full.

••
Triangulating several topics such as anthropology, breast feeding, evolution of primates, height trends in the human population, or energy needs of our various vital organs, we have concluded that natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
••
Saturated fat has not been a driver of obesity: fat does not make you fat. At current levels of consumption the most likely culprit behind growing obesity level of the world population is carbohydrates.

••
A proper review of the so called “fat paradoxes” (France, Israel and Japan) suggests that saturated fats are actually healthy and omega-6 fats, at current levels of consumption in the developed world, are not necessarily so.
••
The big concern regarding eating cholesterol-rich foods (e.g. eggs) is completely without foundation. There is basically no link between the cholesterol we eat and the level of cholesterol in our blood.

••
Doctors and patients’ focus on “bad” and “good” cholesterol is superficial at best and most likely misleading. The most mentioned factors that doctors use to assess the risk of CVDs—total blood cholesterol (TC) and LDL cholesterol (the “bad” cholesterol)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles (pattern A or B) and the ratio of TG (triglycerides) to HDL (the “good” cholesterol).

••
Based on medical and our own research we can conclude that the intake of saturated fat (butter, palm and coconut oil and lard) poses no risk to our health and particularly to the heart. 

••
The main factor behind a high level of saturated fats in our blood is actually carbohydrates, not the amount of saturated fat we eat. Clinical trials show that a low carbohydrate diet is much more effective in lowering the level of saturated fat in our blood than a low-fat diet.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter

I Think I May Have Diabetes...

"I think I may have diabetes....and I don't want to die..."

The wording varies but I see this question with increasing frequency on all the forums I read. I have written replies to these posts so often I felt it was time to archive a standard response.

The web is a wonderful source of information but too often people who really should be asking questions like this of their doctor are asking strangers on the net. 

My usual answer is very brief and says exactly that: see your doctor. I highlighted that because it needs to be emphasised.

Unfortunately that isn't always immediately possible for everyone. There can be many reasons for that.  The most common excuses are lack of money, lack of availability of medical support or simply fear of hearing bad news. 

For those with an urgent need and obvious hypo or hyper symptoms or who have tested repeatedly high on a glucometer the suggestion changes from "see your doctor soon" to "get to an ER (emergency room) fast". 

For others unable to see their doctor soon I urge them to at least make the appointment. Do what is necessary to find the money or time or courage but not seeing the doctor can turn out to be much more expensive in the long term. 

Another variant has appeared recently. Some doctors appear hesitant to diagnose if A1c is OK but fasting or casual blood glucose are just over diagnostic thresholds even when the patient has some symptoms. Too many doctors appear to have forgotten that A1c was only recently approved as a diagnostic tool because the patient can be diabetic if other indicators are high despite a normal A1c. I see an increasing number of posts from people in those circumstances who were told they are “borderline” - whatever that means - or “you are not diabetic yet, just eat healthy and exercise and you'll be fine” without a meter or other advice being prescribed.

At this point I will remind readers: I am a diabetic, not a doctor, and only a doctor can diagnose diabetes.

What follows are suggestions for people whose situation is not urgent, who have a long wait to see their doctor or who have seen their doctor but are still unsure. 

Part 1. Discovery

Obtain a home blood glucose test meter and an adequate supply of test strips. How you do that will vary depending on your local health support system. In the US cheap meters and strips are available from several sources; Walmart's Relion Prime was one of the first cheap meters but you may find others if you search. Note that the cost of test strips will be more important than the cost of the meter in the long term. In Australia you will have to pay full price until you are officially diagnosed, but check with the chemist because there are often discount specials.

When you get your meter read this (click on it): Painless Pricks.

 

Test four times a day for two or three days: immediately on waking (fasting) and one hour after your last bite of breakfast, lunch and dinner. The results you are hoping for are as follows:

• Fasting: 4 to 5.5 mmol/l (Australia, Canada, UK or other millimole countries) or 70 to 99 mg/dl (USA and other milligrams countries).
  
• Post-meal: 4 to 8mmol/l or 70 to 140mg/dl.
  

If all your tests are inside those ranges, relax. Diabetes is most unlikely to be your problem. Don't throw your meter away because it may be wise to occasionally test in future years to see if anything has changed. In that case be aware that test strips have an expiry date.

If any of your results are outside those ranges immediately wash your hands and re-test. If, after re-testing, it is still out of range just record it the first time. If a second test at another time is out of range make an appointment with the doctor for qualified diagnostic testing. 

Part 2. Action.

If your tests were outside the ranges read this while you wait for your appointment with the doctor: Getting Started

 

For those unable to obtain a meter, this may help while waiting to see the doctor: What to Eat at First

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 

There is nothing I could eat I like more than my eyes

Blood Glucose Targets 2015

Several years ago I investigated the different targets suggested by three major respected US diabetes authorities. As a result I wrote this: Blood Glucose Targets. My 2006 summary included this comparison table:

Over the years those have changed very little. The 2015 comparison noting significant changes in bold is:

Sources: ADA, Joslin (up-dated 2018), AACE. 

The ADA and Joslin now agree on the looser 2hr post-prandial target of 180(10) and both have also lowered the threshold for fasting. The AACE guidelines are unchanged. If you read the details on the linked pages all add caveats concerning relaxation of targets in case of other medical conditions, age etc.

Thirteen years after diagnosis, thankfully still free of complications, I see no reason to significantly change my closing remarks originally written nearly ten years ago.

The AACE advise much tighter post-prandial targets. I doubt that anyone would consider the American Association of Clinical Endocrinologists, a professional community of several thousand physicians specializing in endocrinology, diabetes, and metabolism as a bunch of fanatical radicals. Nor would they be promulgating guidelines impossible to be attained by the majority.

Unfortunately, nobody but pro-active type 2 diabetics talks much about 1hr PP targets. My personal logic is that I treat their 2hr as my recommended max peak for any post-prandial, as I discussed in When To Test? Those AACE guidelines then agree very closely with Jennifer's Test, Test, Test advice. Make your own judgment on which of those guidelines you think will lead to fewer complications.

Sadly, it appears that only 1/3 of senior diabetics are achieving even the loose ADA targets, but that is a discussion for another topic.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Comments Allowed

I was a little disappointed to notice the lack of comments over the past year or so.

Recently a friend informed me she tried to comment and was blocked.

I had not checked my blog settings for years, as I didn't see a need to change them. I was surprised to find Google had changed my settings without my knowledge and comments were now restricted.

I have changed them back. I welcome comments from anyone, anonymous or named. My only restriction is to moderate them before publishing.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Are Diabetes Complications Inevitable? Not necessarily...

This is a very personal post, reporting on my own recent reports on three aspects of my health: my eyes, my heart and my other affliction, leukaemia.

I am writing this partly to celebrate but also to motivate any newly diagnosed type 2 diabetics, shocked and scared, who have been warned by their doctors of the inevitability of their diabetes progressing to complications. I suppose some doctors feel they need to do that to scare new people into making lifestyle changes, but too often I find dire predictions of long term complications or heart attacks lead to loss of hope. That can lead to a 'why bother' mentality. 

Please, do not give up. I know managing type 2 diabetes can be bloody inconvenient. You will have to make some annoying changes to your life such as pricking holes in yourself, adding some activity to your day, forever watching what you eat and drink and possibly taking meds and insulin. 

Let me assure you: taking control of your blood glucose levels is worth the trouble. I am just one example of many I read on the better diabetes forums where pro-active type 2s are learning how to take control.

Possibly my continuing story will give you hope.

I was first diagnosed with leukaemia and type 2 diabetes in 2002 at the age of 55. I discovered early I could do nothing at all about the leukaemia; for that reason I concentrated on beating the diabetes. I was thirsty for knowledge. For the first couple of years I spent a lot of time learning from many wise people, mostly on usenet. Some were medical professionals but most were experienced diabetics. I learned something from all of them, even if the main thing I learned was how to tell good advice from bad because, unfortunately, a lot of it was bad. I still believe the best advice was Jennifer’s Test, Test, Test: “Use your body as a science experiment.” 

I tested and experimented to find what worked for me. On usenet over the next couple of years I gradually changed from reader and student to lay advisor, passing on information based on my experience. In 2004 I joined some online forums. In 2006 I started this blog. 

Eventually I wrote a book based on my experience to help any newly diagnosed people who might not be computer-savvy. Of course, as my suggestions for good type 2 management differ significantly from the mainstream there will always be critics. In part this is a response to the critics, describing the results of practising what I preached for the past decade.

Motivation

We each must find our own motivation for maintaining the discipline. For me, it is my sight. Since the day I first learned about the possible complications of diabetes my over-riding motivation has been my vision. I came to accept the possibility of death and I certainly don't want to lose limbs from neuropathy or kidneys from nephropathy, but the thought of living in darkness scared me silly. I have tremendous respect and admiration for vision-impaired people who successfully live with that daily. But I do not want to join them. I am a reader of books, an appreciator of beauty, a user of computers and above all I want to see my grand-daughter’s joy as she grows and learns.

The tests used by doctors to monitor our diabetes such as HbA1c, fasting blood glucose and post-prandial blood glucose are all important but they are really only surface indicators. I use those indicators to set my goals, but they don't directly alert me to dying nerves or optic cells. The acid test is whether complications eventually appear as the years pass. 

Limbs and Kidneys

So far neither blood tests nor physical symptoms, including filament tests by my podiatrist, have indicated any signs of neuropathy or nephropathy. I am hopeful that will continue.

Eyes

I had some good news last month. It is over thirteen years since diagnosis and I had not seen the ophthalmologist since 2010. I had a good report then after a scare in 2006 when he discovered minor scars from healed retinopathy. The scars had disappeared by then. This recent visit was almost identical to that 2010 consultation.

The waiting room was packed. After various eyesight checks on new strange machines by the assistant, then the anaesthetic drops, followed by the dilation drops, then another wait, then more tests on machines, I eventually saw the ophthalmologist. He did a very thorough inspection. He warned me that as I age (I am now 68) I may start developing cataracts but at this stage I had no problems apart from inevitably getting older. I wanted reassurance so I asked specifically about retinopathy, macular degeneration and glaucoma as there is some family history of the latter. He re-inspected carefully. He expressed no concern and no evidence of past damage. Then he complimented me on my "superb diabetes control with respect to eye health". I cannot express in the written word how happy that made me feel. Is there a cloud ten above cloud nine? At his request we then spent a few minutes of his valuable time discussing the Test, Review, Adjust technique.

OK, that covers the ‘opathies. None at all. But there is another lurking danger for diabetics: the heart. 

Heart.

I dropped Lipitor ten years ago; the more I read about statins the less I am convinced of my need for one. My doctor has been polite and patient with me when I have consistently refused a statin for the past nine years despite high cholesterol by official standards. My HDL and triglycerides are fine but my LDL is very high. He suggests that may be because of my low-blood-glucose-spike (which many interpret as low-carb) way of eating. He strongly recommended I have a stress echocardiography accompanied by ultrasound of my heart, mainly to reassure him I am not going to keel over tomorrow. I had those tests last September. First, the gooey preparation and the ultrasound, twisting to awkward positions. Uncomfortable but not painful. Then walking faster and faster on the treadmill, with wires hanging off me, having problems reaching the heart rate he wanted. Eventually we got there. As I cooled down it was fascinating seeing the movies of my own heart pumping away on the playback screen of the ultrasound. 

The cardiologist was very thorough and pleased with the results. It seems my heart and vascular system are in fine shape. No problems at all. I will continue to refuse the statin and eat low-carb, moderate fat, for good blood glucose levels. I no longer care at all what my LDL is.

Leukaemia

 

Finally, although I would like to, I cannot forget my Chronic Lymphocytic Leukaemia sitting in the background like the Sword of Damocles. I make no claims about my diet or lifestyle for that. I’m just lucky I suppose. All of my indicators have improved over the years until almost all are in normal range. I still have hypogammaglobulinemia associated with the CLL but one of the indicators for that, IgM, has crept back into normal range. The IgG and IgA are still low, but oddly I don’t seem to be catching anything despite wandering the far corners of the world since diagnosis. I saw the haematologist quarterly at first, then every four months, then every six, now I waste his time annually.

The haematologist, ophthalmologist, podiatrist (who displays my book at reception and has sold several copies) and my General Practitioner tell me to keep doing what I’m doing. 

That sounds like good advice to me. I will heed it.

Cheers, Alan
Everything in Moderation - Except Laughter