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Type II Diabetes: Self Care and Self Treatment

There is good news in, at least in those whose bodies are still producing insulin. We are learning more each day about insulin resistance and how to reduce it. Although all forms of diabetes are thought to be degenerative, progressive, and incurable, there is more and more acknowledgment among those who work with diabetics that there is such a thing as remission, or a return to “normoglycemia” (that is, normal levels of glucose in the blood). Where remission is not achieved, insulin resistance can be improved or stabilized, and the progression of the disease can be slowed or halted, with the possibility of delaying or avoiding late-stage symptoms such as blindness, neuropathy, rotting of the extremities, and heart and kidney failure.

If you are a Type I diabetic, and now take insulin, none of the advice that follows can be expected to change your need for it. It may be good advice for you and for most people—and perhaps for people with the rarer forms of diabetes—as well as for the Type II diabetics for whom it is designed. It will not produce insulin for you if your body is depleted and no longer doing so. There are on-going debates about this topic and they will no doubt continue as long as humans exist.

General Limitations
Any discussion of self-treatment for diabetes has to take the following into account:
• Although diabetes is an ancient disease, effective treatment of it is in its infancy
• Nutritional science is in its infancy
• Nutritional and diabetic research are most often funded by drug companies, who have their own agenda that determines the possible answers by determining the questions
• Government nutritional data on food is sound—in fact, it’s the gold standard—but its recommendations on diet are deeply flawed by subservience to American agribusinesses. The notorious pyramids are not promulgated by the National Institutes of Health or any other part of Health and Human Services, but by the Agriculture Department. (Harvard’s Nutrition Source provides evidence-based alternatives.)
• News on valid nutritional research is often badly reported—sometimes beginning with the conclusions drawn by the researchers themselves—and almost invariably picks up distortion by the press and/or by popular enthusiasms as it spreads
• Our limited knowledge about food is surrounded by a thick cloud of faddism, pseudoscience, and baseless belief

General Principles for Care and Treatment
Reach and/or maintain a healthy weight. Losing excess body fat is the single biggest harm-reduction and self-treatment step you can take. Weight loss of as little as 5-10% significantly reduces your risk for diabetes and heart disease; as a bonus, and of course assuming you’re losing fat and not starving yourself (we note in passing the usual disclaimers: not all diabetics are fat, not all fat people are diabetic, body types vary and so on), a 10% weight loss is the threshold at which people usually start noticing and telling you that you look great. For diabetics, the specific helpful mechanism is that reducing both body fat and dietary fat halts or reverses the progression of insulin resistance, meaning your body is better able to use the insulin it produces.

Work it! For diabetics, “use it or lose it” has a particularly literal pungency. You’ve already chosen, or are contemplating the choice, of self-reliance. That includes moving your body around to do your work in the world, and to play and rejoice in it. Activity—work, play, motion, some sweat now and then, some sprinting now and then—all will help with fat elimination and weight control, condition a healthier heart, and specifically and independently reduce insulin resistance, making for a healthier, livelier and yes, even sexier you.

Eat right. In what has become something of a cliché, food activist Michael Pollan distills human wisdom about diet into seven words: “Eat food. Not too much. Mostly plants.” He goes on to say, “A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by [“Eat food”…There are lots of edible foodlike substances in the supermarket, often] in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. [A] health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.”

For diabetics, “not too much” has a specific meaning. Your body does not respond to food, and particularly to easily soluble carbohydrates (sugars and starches), particularly in large quantities, in a normal way. High quantities of protein and fat together promote insulin resistance, and thus your diabetes. In short, you need to strike, pretty much at every meal and snack, an optimal balance of nutrients that is going to satisfy you and is not going to make you sicker. Complacency will kill you, most likely after it cripples you. You can just knock fifteen years off your life expectancy now, and apologize in advance to the people who will have to take care of you—or you can log and meter your eating for the rest of your life. Bonus tip: In study after study, keeping a complete record of everything that passes your lips throughout the day has been shown time and again to be the single most effective tool for weight loss.

Let yourself get hungry. As a Type II diabetic, you may have forgotten what hunger feels like. That’s because once your blood glucose levels leave the normal range—whether they are chronically too high or periodically too low—you will crave food. You will feel “hungry” in the sense of feeling not-so-good-and-food-will-make-me-feel-better. You will be not just eager but literally anxious to eat. You will feel this pretty much most of the time. Real hunger is a different feeling—a kind of emptiness in the middle, sometimes accompanied by mild transitory pain: the “pangs” of hunger. Once you find the sweet spot for the content of an optimal meal, the false hunger abates. Something like four hours after eating, true hunger will probably appear. Oddly, its effect (and affect) will probably not be “MUST. HAVE. FOOD. NOW.” It will more likely be “Oh, I guess I should eat something.” Welcome this novel feeling, and nurture it by not eating too often.

There is no magical food. There is no diabolical food. That said, there are some very good foods, and some not so good. For diabetics, wild-caught fish is the animal protein of the gods. Vegetables are God’s gift to satiety. Olive oil protects the at-risk heart while hard animal fats stress it. Beans and legumes judiciously mixed with whole grains provide complete protein, without the fatty overhead of most meats. Various specific foods like bitter melon, nopal, buckwheat, possibly cinnamon, seem to reduce blood glucose. Excess salt raises blood pressure for most. Most important, no one food or combination of foods will have as much impact on blood sugar and general health as reaching and maintaining a healthy weight.

Do not starve yourself. There are various ways of starving yourself; almost all fad and crash diets depend on it. You want a diet—in the general sense of the totality of what you eat—that is sustainable. Whenever you consider a modification to your plan, you need to ask yourself: Can I continue to sustain this practice for the rest of my life? If the answer is no, then what’s the point?
Avoid food fads and pseudoscience. If an Internet search on a food topic—acidity and alkalinity of foods, say or glycemic index—produces a page of nearly identical language, claims of miracles cures, claims of suppression by the medical establishment, repeated appeals to the non-peer-reviewed “research” of someone who has a vague claim to the title “doctor”—run, do not walk, to the nearest exit. You are in food fad land and food faith land, and your brain as well as your health is in danger.

Be Kind To Your Feet. You’ll Miss Them When They’re Gone.
Inspect your feet. The standard recommendation in the U.S. is daily inspection. In the UK, the recommendation is twice daily—diabetics are instructed to work a foot inspection into their lunch break. Look for fungus, calluses, corns, any hardening of the skin or softening and swelling of the nails. Never ignore pain. You’re lucky you can still feel it.

Treat your feet. Study the structure of any abnormality—so you can trace its origin, and fix or replace any shoe or sock that causes you problems, and so you can properly attack hardened skin or softened nails with pumice stone and emery board. Consider fungus to be your mortal enemy—it’s at best opportunistic toward any other weakness or abnormality of the skin, and at worst, can actually cause potentially ulcerating wounds. Keep fungus from spreading to the nails if at all possible—once it takes root there it’s extremely difficult to dislodge. It could easily take another article this length to address treating nail fungus, but recent promising research tends to confirm the effectiveness of a widely-touted folk remedy you may already have in your medicine cabinet: Vicks VapoRub. (If you use a generic, check its “inert ingredients” for thymol, a thyme oil derivative that may actually be the strongest antifungal agent, although the camphor also has some effect.)

Protect your feet. If your feet are enclosed in shoes or work boots through most of the working day, you may need to develop the habit of regularly giving them some light and air. Consider washing them or wiping them down with a hand disinfectant as you change into slippers or sandals. Conversely, if your barefoot habits are contributing to foot problems, give them up as readily as you would an ill-fitting pair of shoes.

Use your feet. If you let foot problems limit your mobility, you’re headed down a slippery slope. Do your protection, treatment and maintenance so that you can keep those feet active and flexible—that’s protection and maintenance, too.

A Word of Encouragement
As a diabetic, dietary management may seem dauntingly complicated. On the other hand, a few simple principles go a long way:
• Eat lots of vegetables
• Avoid processed foods and high-glycemic carbs (the notorious “white foods”)
• Be moderate in your consumption of everything else

And although your biochemistry has changed, the physics of weight loss and weight maintenance has not changed:
• calories consumed < calories expended = weight loss
• calories consumed = calories expended = weight maintenance
• calories consumed > calories expended = weight gain

You do the math.

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