Please eat some carbs.

Hey Dad,

I promise you can eat foods you love.  I know you don't really believe me.

You are right that if you were to eat a bunch of potato chips or pizza it would raise your blood sugar pretty high, but that doesn't mean they're off limits.  It means that you need to eat smaller portions of them and you need to eat them with something else (like lean protein and vegetables) so that you feel fuller and have more than just carbohydrates in your system.

I've been talking to a lot of diabetes educators and from what they've told me about their patients' concerns, you are not alone.  A lot of folks believe that having diabetes means that they cannot have any sugar at all ever again.  I'm worried that by severely restricting your carbs to less than 20g per day, you are actually doing more harm than good for your body.  In fact, it's that kind of limitation that prevents you from eating the foods you love, not the diabetes itself.

I know there is a lot of information out there about super low carbohydrate and mostly- or all-protein diets and there are people who swear that it's the best way to cure type 2 diabetes, but I am highly skeptical for a few reasons.  

First, Dr. Atkins and his ilk have made a lot of money selling books and related products promoting their diets.  I doubt their science because it is motivated by profit.  If they were truly honest about the health benefits and risks, they would not just publicize the good, but they would also look at the other side and take a critical view of their own research.  Super low carbohydrate diets are controversial in part because they make huge claims with insufficient science to back them up.

Next, it isn't clear how sustainable an extremely low-carb diet is in the long-run.  Sure, they can help you drop weight quickly and pull your blood glucose under tight control in short order, but they also come with additional health risks like kidney damage--something you're already experienced when following Atkins when you were just trying to lose weight.  In fact, even Dr. Atkins warned that people who already have problems with their kidneys should exercise caution in using his diet plans and should do so under medical supervision.  Unfortunately, many people don't realize that there is a problem with their kidneys until the damage is done.

Another problem you, yourself, have experienced is hypoglycemia when you're doing physical work.  Like it or not, your body really needs carbs for energy.  If having diabetes generally means that one way or another your body's ability to use glucose is out of whack, then cutting it off actually works against your goal of restoring a healthy balance by pushing it further out of whack.

I know it's a lot to take in and what I'm saying is running counter to what you've believed for a long time.  For now, I think it would help if you made sure to add a little carbohydrate to every meal, preferably something whole grain or fresh fruit.  When you're back to work, please pack yourself some small carb snacks so you can keep from bottoming out. It's also a good idea to have some emergency sugar on hand, like a couple of sugar packets or hard candy that you can chew, so that you can head it off when you feel it coming on.

Love,

Mel

Fear of the known

Hey Dad,

I'm so sorry to hear that you're sick again.  It's weird for all of us that you're not running around like a crazy man since it's not like you to sit still.  I can only imagine how hard it is for you.  Thank you for talking to me about what's going on because I think I can help, if you'll let me.

I was thinking about our last visit and I get why you've been down.  You've been one of the most able bodied people I've known, always working or tinkering with something.  Lately, though, you haven't had the energy you need and your kidneys aren't doing so great.  I wish you'd slow down, but I understand that that's just not your way.  Even if you wanted to, your job won't really let you and it's not like losing that job--and your insurance--would help.  I get that and I wish it were different.  No matter what, you are still one of my heroes.

When mom called to let me know you were in the hospital again and that your A1C test came back so high, I thought about Uncle J and I was pretty sure he was on your mind, too.  I can't believe it's been almost a year since he passed.  Even though your brother had a long, devastating fight through just about every catastrophic complication that can come from diabetes, that doesn't mean that it will happen to you.  You know how important it is to bring your A1C down and to keep your blood glucose levels from fluctuating too wildly throughout the day, so I won't belabor the point.

I am worried, however, that you are going to be too hard on yourself and burn out quickly.  I know you're not new to diabetes, but it's been years since you last actively managed it and I'm going to dig up some resources to make it easier for you.  Let me know if I'm pushing too hard since that's the last thing I want to do.

Love,

Mel

Let's get this started.

Years ago, Dad was diagnosed with type 2 diabetes.  This wasn't surprising since it runs rampant in his family.  For a time it seemed that he was able to manage it effectively with diet, but lately new health complications have brought diabetes back to the forefront.  These are scary times for him, especially since he's seen diabetes devastate friends and family members.

As it happens, I'm writing a dissertation on diabetes care.  Through numerous interviews with diabetes educators, many hours of professional talks and seminars, and compulsive reading and viewing of everything I can get that will help me understand the field of diabetes care, I now find myself in a good position to help even if I am not a health care professional.

On a recent trip to visit Dad, we were talking about the situation and the difficulties he's been having with making lasting lifestyle changes.  Like a lot of working men, he works too many hours for too little pay.  He also has little control over his schedule, which makes it difficult to eat on a regular schedule or to even get into doctors offices for follow up.  He doesn't have the luxury of a well-defined lunch break with a table, chair, microwave, and refrigerator.  And what is he supposed to eat, anyway?

He wanted me to write a book for how to manage diabetes as a working man, but since if I do that my dissertation won't get written, I've decided to start this blog instead.  I am writing for my dad, but it is really an open letter to anybody who is grappling with managing diabetes on a tight budget and around long, physically demanding work days.

The "working man" isn't just men.  They're the people whose work and living conditions make it difficult to control their blood sugar.  I hope that what I write here will help them.