A lot has changed in diabetes treatment since I was diagnosed with type 2 diabetes (T2D) in 1996.
At that time, I knew nothing about T2D — much less what it meant for my life. Through a lot of trial and error, following the research, and working with my physicians, I’ve learned a lot about the disease — and how to manage it — in the 22 years since my diagnosis.
Here are just a few of the ways my journey with type 2 diabetes has evolved over the years.
Changes to my T2D diet
Back in 1996, a low-fat diet was the standard treatment, and everyone was told, “If you just lose 5 or 10 pounds, your diabetes might go away.” So I dutifully followed the American Diabetes Association (ADA) 1,500-calorie exchange diet. On this diet, foods were divided into categories: starch, meat, vegetable, fruit, dairy, fat, and “free food” (foods with 20 calories or fewer per serving).
With this method, you were allowed a certain number of exchanges at each meal — one exchange had approximately the same nutritional composition as others in that category.
At that time, you were urged to eat more starches. Because starch makes blood sugar levels rise, a diet that encouraged you to eat more of it made no sense to me and to a lot of others as well.
Still, I stuck with this diet for about six months and lost 30 pounds relatively quickly. The problem was that I was ravenously hungry 24 hours a day, and I thought of food all the time. I almost always went to bed hungry.
Eventually, I decided I really didn’t want to spend the rest of my life thinking about nothing but food, so I switched to what I called a “lowish-carb diet” that included things like plain yogurt, vegetables like broccoli and cauliflower, and some berries.
When I switched to this diet, my hunger disappeared. I wasn’t losing as much weight, but my blood sugar levels improved, and at this point I think my blood sugar levels are more important than weight.
Gradually, physicians and nutritionists have moved toward recommending fewer carbohydrates (especially highly processed carbohydrates) and urging people instead to eat whole foods and healthy fats like olive oil and avocado. More and more even support low-carb diets.
I’m much happier with my diet now. I like the fact that I can eat fatty foods like cheese, and I no longer have any interest in foods like bread and pasta. The main problem for me is social. It’s hard to find things I can eat at restaurants or potluck dinners and often bring my own food or end up ordering the same thing over and over, which gets a bit dull. But at least I can watch other people eating lasagna and blueberry pie without wanting any.
Of course, no diet is perfect for everyone. What works for me might not work for you. A low-carb diet is a good place to start, because it helps control blood sugar levels and can also encourage weight loss. If low carb isn’t the right choice, try something else. I recommend testing your blood before and after meals (“eat to your meter”) to see how the diet affects your blood sugar.
More treatment options
Just like diet plans, in 1996 there was little choice in drugs used to treat T2D. You either took a sulfonylurea, metformin, or insulin. Today, there are myriad drugs to treat T2D — so many that it’s hard to keep track.
After I was diagnosed, I started taking metformin. About eight years later, I was struggling to get my A1c to lower levels. I asked my doctor if I could try insulin in addition to metformin. I’ve been on a long-lasting insulin (called a basal insulin) ever since and have been able to manage my A1c levels.
Just like diet, there is no one-size-fits-all treatment plan for everyone. If you’re unhappy with your medications or just curious about what else is out there, talk to your doctor about your goals and how you can achieve them.
Perceptions of diabetes
Another thing that has changed is ideas about causes of diabetes. The thinking used to be that you overate and became obese, the obesity caused insulin resistance, and the insulin resistance caused your T2D.
While it’s still true that being overweight or obese puts you at risk of T2D, the medical community is realizing that your genes can play a big role in your risk as well. Certain populations may be genetically predisposed to T2D itself, or to insulin resistance, which can lead to T2D.
When I was diagnosed 22 years ago, my fasting blood glucose level was about 300, my hemoglobin A1c level was about 13, and when they tested my urine for sugar, they thought their machine was broken because the numbers were so high.
Now my fasting levels are usually below 100, my A1c is in the low 5s, and there’s no sugar in my urine. In short, I’m much healthier than I was before, and thankfully haven’t experienced any complications.
The road up to now hasn’t always been easy, but the work is worth the reward.
After my diagnosis, I made it my mission to learn as much as I could about the disease — both to manage my own T2D, and later to help others with it as well. In those early days, it helped that I had a science background (I was a PhD dropout) and I enjoyed reading about how the disease worked. Back then I also joined an email list with others who have T2D, and it proved to be a great resource. Over the last 22 years, I’ve become something of an expert on the subject – I even wrote a book with the hopes of sharing what I’ve learned.
So if you’ve recently received a T2D diagnosis or you’ve hit a wall after years of living with T2D, don’t despair. Yes, it’s hard. But with time, you’ll work out a new way of life that is so much better than what you had before.
I’ll be rooting for you!
Gretchen Becker studied biology for eight years at Radcliffe/Harvard, where she was a PhD candidate, published two papers in peer-reviewed journals, and then dropped out to take a more lucrative job as a live-in maid in Manhattan. After hitting the “glass ceiling” in the world of domestic service, she moved on to other jobs including lab technician, newspaper reporter, woodenware salesperson, cheese plant worker, and tax assessor. For many years, she was a freelance editor of medical books and journals. Since her diagnosis of type 2 diabetes in 1996, she has devoted much time to learning about this chronic disease and to using her background in both science and journalism to help educate others with T2D throughout the world (via the internet) so they can take control of their disease and avoid serious complications. She runs the blog Wildly Fluctuating and is the author of “The First Year: Type 2 Diabetes” and “Prediabetes.” She also co-authored “The Four Corners Diet.” She lives on a small sheep farm in Vermont.