@Sid Bonkers, here's the problem, for most people, type 2's diabetes is a progressive disease IF needed dietary changes are not made and physical activity is not increased, regardless of whether medication is used or not. Yesterday, I came across an interview that represents the best of standard of care for type 2 diabetes in the US...
https://wa-health.kaiserpermanente.org/podcast-living-with-diabetes/
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In it, we meet Harry who was diagnosed with type 2 diabetes in 2005. At that time is blood pressure, cholesterol, triglyceride, and glucose levels were increasing. He had arthritis. He led a sedentary lifestyle, was overweight, ate white rice at most meals, liked and ate "sweet foods", and didn't eat a lot of fruit and vegetables. He doesn't state what his top weight was, but does mention that he did weigh 235 pounds at some point after he began changing his diet and exercising in 2012.
In 2012, he was informed he had an A1c of 12.2% and that he would need to start insulin. By that time he was experiencing his first complication of diabetes: peripheral neuropathy which he described as affecting his lower legs and "numb toes". He asked for 6 months to make needed lifestyle changes. The doctor agreed but reminded him that he had indicated he would so previously but had not. Faced with the possibility worsening complications, he began to make slow changes.
At Christmas, he was given a Fitbit. This got him up an moving. When he realized he could easily walk 5,000 steps a day, he upped his goal to 10,000 steps (and continues to maintain that level of walking today).
He began reading books on how to lose weight. He was clear from the onset that he didn't want to restrict his eating to the point that he couldn't see himself maintaining for the rest of his life so he chose to eat smaller portions and to eat less than 200 g carbohydrates a day. By doing this, he began losing 1 to 2 pounds a week. His weight which previously had been 235 pound dropped to 180 pounds. At the time of the interview in 2016, he has maintained his weight of 180 pounds for 1 1/2 years.
At first his A1c was checked quarterly, then every 6 months, and now yearly. His eyes are checked yearly. His last 4 A1c's have ranged from 5.5% to 5.7%. He does this with diet and exercise only. He never has taken insulin or diabetes medications. He still has arthritis. He doesn't state if his other symptoms related to metabolic syndrome and/or diabetes improved or not. I assume they did but I don't know. [Edit]: His eye health remains healthy, no problems have been noted.
He continues to eat less than 200 g carbs a day. He now eats low carb tortillas, lean meats, particularly turkey, fruits and vegetables, and smaller portions of brown rice.
[Edited to add]: He also states that diabetics can eat whatever they want in moderation, just in smaller portions and only occasionally.
Sometime after his high A1c in 2012 he took a Living Well With Chronic Conditions workshop. Following that he took the one specifically for diabetes and later began facilitating these workshops himself. He finds his ongoing participation in these workshops helpful.
Initially he was intimidated by the fitness of people who worked out at the gym, so he and his wife signed up for the Silver Sneakers instead which is an exercise program specifically designed for seniors. They didn't go at first, but once they got started, they liked it. Today in addition to walking, he also works out at the gym, typically on the exercise bike and rowing machine. He also does resistant weight training but doesn't try to over exert himself.
What surprises me is that he's able to maintain a non-diabetic A1c eating 200 carbs a day. I'm going to speculate that this is due to his exercise regimens which include working out at the gym and walking a minimum of 30 minutes a day.
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He's fortunate. I also was diagnosed with type 2 diabetes in 2005 (or 2006) and maintain a similar A1c, but if I eat more than 50 - 60 carbs a day, even with walking, my glucose levels would exceed 140 mg/dl which is known to cause damage. That said, I can knock a high glucose level down by up to 90 points with a 2 to 3 mile walk.
Last night I had a muffin that was about this size of my fist with dinner. I have a Paleo muffin made with almond flour once a week, but they were out, so I got a gluten-free muffin instead. My 2-hour post meal glucose level was 232 mg/dl so I immediately went our for a brisk 2 mile walk which dropped my glucose level to 141 mg/dl. Admittedly, I would have liked it lower, but it was late so I went to bed. Glucose level was 108 mg/dl upon awakening this morning.
Here's what we know and don't know about Harry...
I know of no hospital or health insurance sponsored diabetes workshops or classes in the US that teach the low carb diet even though we have at least 25 studies now demonstrating that it works. I doubt Harry learned about low carb in the workshops he took because the class I took through our hospital's diabetes clinic in 2009 still promoted normal carbohydrate intake, though to their credit I do recall them discussing whole grains and making the suggestion to eat only half of a banana, not a whole banana. That diet is what I've eaten my entire life, up until 2015, and my diabetes got worse and worse until I started the LCKD two years ago.
200 carbs a day is not low carb.
While he does have a non-diabetic A1c, we don't know the upper range of his daily glucose levels. Again, any level above 140 mg/dl is damaging.
We don't know if his peripheral neuropathy is better, stable, or worse. He didn't say.
Standard of care in the US...
What we know about the standard of care in the US is that while many doctors know of the low carb diet today, too many continue to discount it as "unsustainable therefore not worthy of consideration".
Standard of care treatment for diabetes continues to be classes that teach [higher carbohydrate] diets that require medication to work, and slow but continued progression for most. And once you cross over into type 2 diabetes, you are pressured to take diabetes medications and a statin.
Sadly, whether you're willing to acknowledge it or not, medical care today is strongly influenced by the pharmaceutical industry and dietary guidelines are strongly influenced by the "big food" industry.
Change will only happen through forums like this and researchers like Volek and Phinney.
