[rramd]

We should all have the goal of normalizing our blood sugars. All of the problems associated with diabetes are the direct or indirect results of hyperglycemia, except of course dangerous hypoycemia. A normal blood sugar is ~83 mg/dl, corresponding to a HA1c of 4.55. Blood sugars should stay at ~ 83 mg/dl before and after meals. To achieve this, most of us will have to limit carbs to no more than 30-32 g per meal, and probably far less than 30 g at breakfast due to the Dawn Phenomenon, and normalizing blood sugars will require eliminating simple sugars from our diets, including fruits and milk (fructose and lactose are simple sugars), and eliminating starches, including breads and whole wheat, and other grains and rice, including wild rice, and potatoes, since all starches rapidly break down into simple sugars in our digestive tracks. This will also be easiest to achieve if we exercise vigorously each day and maintain a weight close to our ideal body weight, so that we eliminate insulin resistance. The elimination of insulin resistance will result in the need for only small insulin doses before each meal, minimizing the guesswork in calculating these doses. Significant insulin resistance, resulting from high BMI's, leads to such large does of pre meal insulin being required, that it becomes almost impossible to correctly guess the correct premeal insulin dose, resulting in frequent episodes of significant hyperglycemia and hypoglycemia, the inevitable result of a high carbohydrate diet. Almost all diabetic complications are reversible with blood sugar normalization, starting a few months after you achieve normal blood sugars. Doctors don't often recommend normal blood sugars because it is very difficult for a doctor to achieve normal blood sugars in a patient, and impossible if ADA recommendations for a high carbohydrate diet are followed. Only a patient, following a low carbohydrate diet, and taking charge of his or her own diabetes management, can have any real hope of achieving normal blood sugars. Read Dr. Bernstein's Diabetes Sulutions to learn the fine points of achieving and maintaining normal blood sugars. Of course, if your pancreas is still capable of producing significant amounts of endogenous insulin, normal blood sugars will be much easier to achieve and your diabetes may be curable, but remember that many Americans who do not have blood sugars or HA1c's that would give them a diagnosis of diabetes, or even prediabetes, still have blood sugars that are high enough to cause significant harm in the long run, including an increased risk of heart disease, and most people who are overweight, even if they have no limit to their ability to produce endogenous insulin, still will have insulin resistance due to their increased fat-to-muscle ratio, and hyperinsulinemia will be the inevitable result. Hyperinsulinemia, as all diabetics who have started taking insulin shots while following a high carbohydrate diet know, results in significant weight gain. High serum insulin levels cause hunger. Being overweight with too much body fat and too little body musculature will produce a need for high circulating insulin levels to bring down high blood sugars, and whether tbe insulin comes from your pancreas or from the injection of insulin, an increased appetite and inevitable weight gain will be the result. Severe hyperinsulinemia will make it much harder or impossible for almost anyone to achieve a normal body weight and ,blood sugar normalization. It will become difficult to even maintain current body weight, but instead weight will steadily and progressive increase each year, resulting in increasing difficulty controlling blood sugars and body weight, a vicious cycle, until the affected person figures out that we should all be on low carbohydrate diets that minimize or eliminate simple sugars and starches. These are the foods humans have grown accustomed to since the advent of modern agriculture 10,000 years ago. But our basic physiology has not changed and our bodies are not designed to handle a chronic excess of simple sugars and starches. The cultivation of crops including fruit orchards, wheat fields, and rice patties, and the herding of goats and cattle that has allowed a bountiful supply of fresh milk, is the event that set into motion our current accelerating epidemic of type 2 diabetes and all of its consequences. We need to return to the diets our hunter-gatherer ancestors followed by necessity, fish, meat, and non-starchy vegetables such as green beans and leafy vegetables, and we should remember that while equal amounts of carbohydrates elevate blood sugars about five times as much as proteins, proteins still elevate blood sugars although slowly, so proteins need to be included in your calculations when determining premeal insulin doses. Fats have no effect on blood sugars and are also beneficial in that they are better at promoting satiety. Trans fats and a diet very high is saturated fats is probably not heart healthy, but I am not as certain about the adverse health effects of a diet high in saturated fats if carbohydrates are kept low, but I'm still staying away from pure lard and I don't plan to fry my bread in butter as my grandmother did. She died of a stroke in her 60's and I expect to live in good heath much longer. However, in general most fats are healthy as long as you are eating a low carbohydrate diet. There are essential fatty acids that we derive only from fats, and essential amino*acids that we derive from proteins but their are no essential fruits or no essential carbohydrates, and any trace elements, minerals, and dietary fiber that we might need can be easily obtained from non-starchy vegetables. Multi-vitamins are unnecessary and may even be harmful in that the absorption of vitamins is often by passive diffusion across the cell membranes of the tissues lining our intestines, so that too much of one vitamin may result in too little absorption of competing vitamins, and the same probably is also true for the absorption of minerals and necessary trace elements, many of which are probably still unknown to science. We also need to balance our need for sun exposure to produce vitamin D with the risk associated with excessive sun exposure, so supplemental vitamin D may be warranted for some people. Most other vitamen supplements are simply a waste of money and especially for the fat soluble vitamins, potentially dangerous in high doses. Multi-vitamins have never been shown to benefit people, and many studies have suggested the opposite.