28 Experts Answer Questions About Diabetes T2 & Prediabetes

Here are the questions we asked the experts:

1. Is diabetes on a decline?
2. What diabetes diet and management mistakes do you see most people with diabetes make?
3. What tips would you give to someone who is newly diagnosed?

And here is what they had to say.

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Dr. Matthew Mintz

A1: Diabetes is not on the decline, but rather type 2 diabetes is on the increase. The increase in T2DM correlates with our populations increase in obesity. Now, more than ⅔ of Americans are overweight or obese, and while the rate of rise may have plateaued a bit, incidence of T2DM has not. In addition, T2DM increases with age. As we are living longer, we are likely to see more diabetes.

A2: I think the biggest diet mistake patients make is thinking by refraining from eating sugar, their diabetes will get better.

While eating sugar or sugary products isn’t great, the most important factor is weight loss. While there is varying evidence on different types of diets, in general, a calorie is a calorie. For example, a patient might eat a few pieces of candy a day, and think that if she stops this, it will improve her diabetes.

In fact, it is unlikely that refraining from a few pieces of candy a day will promote enough weight loss to improve diabetes. Patients need to know that they should both eat healthy, and decrease portions. You can have an extremely healthy diet, but if your calorie content is too high because of portion sizes, then you are unlikely to lose weight and improve diabetes.

I think one of the biggest management mistakes made is use of finger stick glucose monitors. The public seems to generally know about diabetics checking their sugar, and because insurance usually covers glucose monitors, they are often highly promoted by the industry. However, if you are Type 2 diabetic and are not taking insulin or a sulfonylurea, then there is no need to check your finger stick glucose even once a day.

The best measure of glycemic control is A1c. Unless you are going change your diet based on your measurement of a particular food’s effect on your blood sugar (which most patients will not do), then measuring pre- or post-prandial finger stick glucose is not very helpful. Finger stick glucose is incredibly helpful in managing insulin as well as checking for hypoglycemia in patients taking sulfonylureas- the only medication that causes hypoglycemia other than insulin. I guess a related mistake is the use of sulfonylureas for T2DM. There are so many agents now available that lower sugar, don’t cause weight gain, and don’t cause hypoglycemia. But for cost, there is really no reason to use a sulfonylurea.

A3: My tips for a newly diagnosed patient would depend on their baseline A1c. If the newly diagnosed diabetic had a low A1c, like 6.5-7.5, my advice would be that we caught this early and weight loss with diet and exercise will likely keep things stable. If their A1c is high, my advice is that while we may not be able to get them off medication, even if they lose weight, the main goal is to:

• prevent the complications caused by diabetes, such as heart attack, stroke and renal failure and
• keep the sugar under good control so that we can keep them off insulin.

Dr. V. Mohan

A1: Diabetes is certainly not on the decline. On the other hand, the numbers are rapidly going up. According to the International Diabetes Federation (IDF), Diabetes Atlas, 7th edition, the number of people with diabetes in the world was   415 million in the year 2015 and these numbers are further projected to increase to 642 million by the year 2040.

In India, the number of people with diabetes was 32 million in the year 2000.  This has now increased to almost 70 million in the year 2015 and is expected to go up and reach a figure of 123 million in the year 2040.

In metropolitan cities like Chennai where the prevalence is to be 2-3% in the 1970s and 8-10% in the 1980s and 1990s, today nearly 25% of the adult population has diabetes.

The other worrisome facts about diabetes particularly in developing countries like India is that it used to be considered a disease of old people, rich people and an urban phenomenon. Today, it has moved to middle and the lower socio economic strata of society. It has also started affecting the youth and the rural areas are also facing the burnt of diabetes epidemic. This makes it a huge financial burden not only on the individual and his/her family but also the society at large.

A2: As diabetes is a life long disease, individuals who have diabetes have to follow a disciplined life as far as diet and exercise is concerned. When people are fully diagnosed, they tend to pay attention to the disorder. However, very soon they forget about it and tend to eat the wrong food and stop exercising. Many also stop going for regular check up with the doctor or the diabetes center. This leads to uncontrolled diabetes, eventually leading to the complications of diabetes.

A3: A person who is newly diagnosed has a wonderful opportunity to keep his/her diabetes under good control. If during the first 10-15 years, diabetes is kept under good control, it is very unlikely that in their life time, they will develop complications of diabetes. This is because of the so called a “legacy effect” or the metabolic memory hypothesis which states that if the first few years, diabetes is controlled well, the effect of good diabetes control continues for a long period thereafter. On the other hand, if the first few years are neglected and the diabetes is not controlled, thereafter even if one tries to control the diabetes, it may be too late, as the seeds for the complications of diabetes are already sown.

Dr. Michael Klaper, MD

A1: No! As Western societies become more obese and sedentary, the incidence of type II diabetes in increasing at alarming rates.

A2: They focus on avoiding sugars when the problem of insulin resistance stems from fat accumulation in muscles, liver and pancreas - and which can be largely avoided and often reversed by adopting a low-fat, whole food, plant-based diet.

A3: Read these books!

Dr. Neal Barnards - Program for Reversing Diabetes and Dr. Joel Fuhrman - The End of Diabetes.

Will Duboi

A1: I don’t think it matters. We have a HUGE pool of un-diagnosed people who are declining in health with each passing day. This giant reservoir of untreated diabetes, combined with an existing base of chronically ill individuals, is well posed to bankrupt American healthcare.

Is it growing exponentially? No, certainly not in terms of new onset, but the impact on our resources will be the same as if it were. In terms of new onset, If anything, the declining obesity rates suggest at least a plateau of new cases, but again, the undiagnosed cases are hiding the true scope of the problem facing us. It will out-grow our system whether it's declining or not.

A2: Most diabetes is type 2. Most type 2s never get any diabetes education. As such, they really don’t know what to do, and it’s no reflection on their intelligence. The most common error is assuming sugar is sugar. Most people with type 2 try to avoid “sugar” but they’ve never been educated to know that the largest source of glucose is from empty carbs. I’ve seen people going the extra mile to avoid sugars, but instead increasing their carb intake to ill effect.

A3: irst, don’t panic. It’s possible to live long and healthily with diabetes. Second, no guilt. You did not do this to yourself. It was simply in your genes. Third, get smart. To live long and healthily you need to understand your enemy. Learn, learn, learn. And lastly, it really isn’t as hard as you think it’s going to be. You’re going to be OK.

Dr. Carl Knopke, MD

A1: In my area I am not seeing a decline in diabetes. We are still seeing plenty of diabetics. On the other hand, we have seen an explosion in medications used to treat diabetes and in general this seems to have resulted in better control. There has also been new guideline statements from organizations such as AACE/ACE that are recommending less use of medications that cause a rise in insulin and relying more on medications that do not cause a rise in insulin levels. I think that this is a good thing and is probably contributing towards an overall improvement in diabetes.

A2: I see several problems.

"Eat more fruits and vegetables", has long been a mantra of dietary recommendations. This advice is easy for people to accept but unfortunately, is also easy to misinterpret.

Most people I see perceive an equivalence between fruits and vegetables and even more so an equivalence among different types of fruits. Perhaps more to the point, people don't recognize a fruit when they see one. Also, people often have food aversions to vegetables and so they gravitate toward fruits. They want the sweeter fruits such as pineapple, mangos, oranges, peaches, etc.

People don't realize that items such as avocado, bell peppers, tomatoes, and cucumbers are actually fruits. When you compound this with the idea that most people perceive a more is better philosophy, then people really tend to overdue it on their fruits. This results in higher blood sugars are more weight gain. People become frustrated by the apparent disconnect and they go back to their old way of eating which is how they arrived at their state of diabetes in the first place.

The second problem I see is that people are still following old dietary models that encourage you to eat less fat.

Dietary guidelines have started to change, as I feel they should, towards greater fat intake. Now this may still be a controversial topic among many people, but at the minimum, I think we can agree that we could at the least encourage more "good fats", and stop vilifying all fat intake in the diet. If you will accept these, then I might even suggest that we could stop vilifying saturated fats.

There is a lot of literature to suggest that we should stop this as well. But patients get confused. They want to the do the "new thing" and be on a high protein diet but then they simultaneously try to be low carb and low fat. Think egg whites and yogurt. The problem is that fat is satiating and it does not affect your insulin levels at all. Therefore, if you want to be on a diet that is comfortable, makes you feel good and causes you to lose weight, then you ought to include more fat in the diet.

This brings me to yogurt and the 3rd problem.  It is not that yogurt is a bad thing. People don't know how to read nutritional labels. This results in a number of problems. The first is that people will blindly pick a yogurt that has 5 gm of protein and 35 gm of carbs mostly in the form of sugars. This surely is not good. The more educated among my patients will instead choose a yogurt such as greek yogurt, which they were told contains a higher amount of protein, but then again, they fail to realize that even some of the good yogurts, contain a lot of sugar. And lastly, people will pick out a product that is "good for them" according to this new model of eating, such as cottage cheese or milk, and then they will choose the low fat option, which will not help them with satiety.

The last problem is the combination of fat and carbs. People will say that they have heard that fat is good for you so that start to load up on this, all the while not paying attention to the amount of carbs that they are choosing to eat. When people eat fat and carbs together, I compare this to an Oreo cookie. Not good.

Nutrition Facts

Serving Size: 34 g
Serving per container about 16
Amount Per Serving
3 Cookies (34g)
% Daily Value*
Calories 160
Calories from Fat 60
Total Fat 7g 11%
Saturated Fat 2g 10%
Trans Fat 0g 0%
Monounsaturated Fat 3g 0%
Cholesterol 0mg 0%
Sodium NaNmg 6%
Potassium 55mg 2%
Total Carbohydrate 25g 8%
Dietary Fiber 1g 3%
Sugars 14g
Protein 1g
Vitamin A 0%
Calcium 0%
Vitamin C 0%
Iron 8%

A3: People are really worried when they are newly diagnosed. Most will have friends or family members who are or have been on diabetic medications for their entire lives. They also know the horror stories of heart disease and potential for strokes that diabetes can lead to.

They are really scared and often feel that they have been handed a death sentence. I reassure people that none of these things are true. Diabetes is typically the result of a full scale attack of excess carbohydrates via the standard American diet on the endocrine system The body is pretty resilient but after many years of this diet, the body's defenses start to cave and diabetes is the result.

Turning this around revolves around instituting therapies to change eating behaviors towards a diet that is lower in processed carbohydrates and higher in protein and fat. People need to eat real food. It is very gratifying to me when we are able to turn things around for people. We are typically able to pretty rapidly get people off of insulin and their heavy load of diabetic medications when they start to eat the right food and this will also cause them to lose weight which people obviously like.

Dr. Barry Sears

A1: No. It has risen by 44% since early 1990s (Stokes and Preston PLsS One  12::e0170219 (2017)  In the same article, it is now estimated that diabetes is the cause of death after heart attacks and cancer.

A2: Lack of guidance or compliance. Data from the Joslin Diabetes Center indicates long term compliance to a calorie-restricted, 40-30-30 diet is a successful way to manage the condition (Hamdy et al BMJ Open Dia Res Care 5:e000259 (2017). It has also been shown that an even more calorie-restricted high-protein, moderate carb, low-fat diet can reverse type 2 diabetes in one week (Lim et al Diabetologia 54:2506 (2011.

A3: Immediately follow the Joslin Diabetes Center guidelines to manage the condition before the beta cells in the pancreas are completely damaged by inflammation.  These guidelines are very similar to those of the Zone Diet.

Kelly Austin, ND

A1: No, diabetes rates have nearly doubled in the last 20 years. We see children now being diagnosed with diabetes, and the African American and Latino population being affected more than ever. obesity rates are on the rise to which tend to go hand-in-hand.

A2: Most people are still not focusing on carbohydrates being the culprit. Most people are focusing on fat being the culprit.

A3: Patients need to monitor their carbohydrate intake and stick to a low carbohydrate diet. Recommending oatmeal for breakfast is not appropriate. Focus on increasing good fats, moderate your protein intake and eat vegetables for your carbohydrate consumption. Moving everyday is also important. Even if it's just a walk, movement must be a part of your daily lifestyle.

Prof David Segal

A1: Not at all, both type 1 and type 2 diabetes are increasing in prevalence. So long as the obesity epidemic marches on and a sensible diet and lifestyle continue to be ignored the burden of diabetes will continue to grow.

A2: People fail to believe that diabetes is manageable and more importantly that they need to manage it. They need to educate themselves on diabetes management, internalize the information and execute on the behaviours that result in good diabetes management.

People do not plan meals and understand how important this component is in diabetes management.

Good medications exist and wok well if taken appropriately.

A3: Accept the diagnosis, don't fight it. If you don't like it do something about it. No doubt type 2 diabetes is reversible in its early stages.

• Educate yourself.
• Build a team of knowledgeable and supportive health care professionals. Turn family and friends into allies, not accomplices.
• Eat properly, exercise more and learn to control diabetes, don't let it control you.

Christina Ghosn

A1: Without doing extensive research myself I can't honestly answer this. From what I see in social media and local communities I would say that Type 1 diabetes is on the rise.

This thought is just from personal experience. When I was growing up there was only one student in my Middle school and high school who had diabetes. That was a school of about a thousand kids. Now with my own teens in the public schools I know of a dozen or so students in the High School with diabetes. Granted my kids high school is 2000 students but still that is a large number of students with diabetes. I see more an more students in elementary where I substitute with diabetes as well. Not sure if the number of children with diabetes is increasing proportionally with population growth. I also believe more people are being diagnosed with Type 2 diabetes. That increase may be in part to better access to health care and diagnosing T2D earlier.

A2: I'm not comfortable suggesting what mistakes others might make in diabetes management. Managing diabetes, any variety, is a difficult and frustrating challenge. I can share mistakes I've made in raising three children with diabetes.

Like I said above managing diabetes is challenging and it isn't uncommon for the person with diabetes/child with diabetes to forget to bolus for a meal or snack. When my children were younger and I was in complete control of managing their diabetes I too would forget to bolus them or miscalculate how many carbs are in a meal. Thus, highs happen. While I try my hardest not to berate myself or my children for those highs it sometimes happens. The lectures or discouraging words used to discuss the missed bolus are not helpful, especially when the child already feels like crud due to a high blood sugar. I also wish that I had been more selective in what foods I allowed my kids to eat.

I have always said and still say a person with type 1 diabetes can eat everything anyone without diabetes can eat. But that doesn't mean the person with diabetes should eat the high calorie, high carb, high sugar snacks anymore than a person with diabetes should eat them. Helping kids with or without diabetes make good food choices is pivotal in helping them live healthy. Habits are developed early in life and continue to form throughout life. Braking a bad habit is more difficult than building a good habit. I wish I had helped my kids build better food choice habits early on in their lives rather than focusing on their perceived right to eat all the junk all the other kids were eating.

A3: Be patient with friends and family who want to offer advice or stories from their own lives. It is never easy to hear about how your friends aunt lost a leg to diabetes but the story that friend is sharing is how they are trying to empathize and connect with you or your newly diagnosed child. It is likely that those stories or advice about eating is coming from a place of love and concern.

Those friends or family will never truly understand the challenges of diabetes but if they are talking to you about diabetes it means they are trying.

• Don't berate yourself too badly. Diabetes has highs and lows literally and figuratively. Do your best when you can. Do what's needed when your best seems a bit too difficult.
• Try your hardest not to make everything about diabetes whether it is you managing your own or you managing children. Ask yourself if you would do something or allow something if diabetes wasn't part of the equation, if the answer is yes, then let the answer be yes and plan accordingly.
• Find your tribe. Diabetes can be a lonely disease for the person with it, the parents of a child with diabetes, and siblings or spouses of people with diabetes. Reach out and find others like you, be it online or in your local community, you do not have to feel alone.

Thaddeus Gala, DC

It's our doctors fault! They are not correctly approaching the issue!" Is what one attendee proclaimed at a recent workshop. Yes, it is true, diabetes is stripping people and the country of health, quality of life and vitality. And, one of the biggest misconceptions is the notion that many physicians and lay people consider diabetes to be simply a blood sugar issue. Or, that by cutting or counting carbs, they can manage the condition successfully.

Worse yet, many people under medication guidance with "stable" blood sugar readings feel they are successfully managing their condition. Sadly, this medication myth often leads to a worsening and progression of the disease.

We now know that diabetes is linked in part, if not wholly, to subclinical inflammation. By lowering inflammation in the body, in addition to relaxing sugar intake, we can often times work towards reversal or complete remission of diabetes. This often leads to a reduction or Complete elimination of medication requirements. While there are many foods and lifestyle behaviors that can increase inflammation, there are many foods and supplements that can decrease inflammation. Getting the blood test- hs-CRP is a good preliminary measurement of inflammation within the body. Taking a good quality fish oil, vitamin d and multi-vitamin with chromium in conjunction with focusing on lean meats and vegetables, has resulted in many of our patients having near immediate improvements with their diabetes.

Stephen M. Pribut, DPM, FACFAS

A1: Statistics show the opposite. And the increase over the past 30 years in obesity has been a factor.

A2: It is important to learn how to handle diabetes from the start. Dietary changes must be made the proper diet must be studied and then planned. Weekly planning can help make it easier to know what foods you should eat and what meals you should have.

A3: One of the very important things to do is weight management and exercise. Exercise alone will not accomplish weight management, but it can be a motivator and assist in weight reduction. Exercise has many benefits for health. It can help with high blood pressure, depression, lessen the risk of metabolic syndrome and increase your focus among other benefits. Ask your doctor for an exercise prescription. And perhaps find a certified personal trainer with experience with diabetes and weight related issues.

The next thing is to make sure you follow up regularly with getting eyes, kidney and feet (sensation especially) checked as is recommended. This is an important life long habit you need to follow. It will minimize the risk of developing complications related to your diabetes.

Dr. Russell Schierling

Although some experts argue otherwise, the number of people with blood sugar dysregulation issues continues to explode in both America and around the world. Click here to read full response on his blog.

Joanne Laufer Milo

A1: Absolutely not!  It’s definitely on the rise, both in the US and worldwide. Just saw a presentation this afternoon at the University of California Irvine by a top researcher on islet and stem cell transplantation. I’ll see if I can get that slide for you, if you’d like.  It’s an astronomical increase, across all ages, all types and all countries.

A2: Here are some points:

• living in denial … just want to eat what they want
• it’s too hard to manage shots, insulin, carb counting, blood sugar testing
• not understanding the nutrition content in restaurant food
• depression
• food is comforting.  Limiting food is NOT comforting.

A3: Read online community blogs to understand how people like you are managing diabetes … both the glorified stories as well as the struggling stories.

• Find an endocrinologist and diabetes educator who actually listens to you and spends time
• Find a support group filled with optimistic and health oriented diabetics … stay connected

Dr. Sonica Krishan

A1: I do not think so. It is particularly because in my country i.e. India, diabetes is greatly prevalent and a common lifestyle disease. Whereas millions of people world-wide are suffering from this dreaded disease and mortality is being reported due to diabetes complications, it is also perceived that more than 80% of diabetes deaths occur in low and middle-income countries. Every 10 seconds, a person dies of diabetes complications. Also, in the same 10 seconds, 2 people are diagnosed as diabetics. And sadly India is believed to be announced as the Diabetic capital of the world.

A2: Diabetes is not considered now as a disease of the rich people alone; rather it is a disease of sedentary people with unhealthy diet and lifestyle habits. Unhealthy eating habits, inactive lifestyle and stress seem to be major cause for rise in number of diabetic patients. The diet blunder is taking in of sweet foods (diabetics are often sweet toothed), sweetened fruits as well as juices and carbohydrate rich diet like taking rice, wheat flour, potatoes etc. And lifestyle discrepancies include leading a sedentary life with reduced amount of daily walks and necessary exercise schedules, and also enhanced levels of stress and strain only add to the management mistakes. A big mistake is missing on these diet and lifestyle restrictions and only popping in diabetes medicines, this all would do more harm than good.

A3: A person who is newly diagnosed with diabetes is surely at the verge of developing diabetic impediments sooner or later. I would advise that he needs to follow stringent diet as well as lifestyle guidelines which would a big help to him/her. There are many herbs as specified in Ayurveda text which can be taken, and yet patience and perseverance on the part of the diabetic individual is needed. This is because it is easier to combat diabetes in the early stage of disease.

Although lifestyle changes – ensuring a healthy diet and pursuing an active life – are imperative, vegetables like bitter gourd and fruits like jamun and bilva could be used regularly in diet plans. Yoga poses like dhanurasana, Shavasana, Paschimottanasana, Yogmudrasana, Sarvaangasana, Utaanpadasana and kandharasana are helpful to be included in everyday exercise modules. Some Ayurveda Herb Remedies for diabetes include taking ponded seeds of bitter gourd twice daily with warm water, fresh juice extracted by grinding fresh bitter gourd and taking tender leaves of Neem and Bilva first thing in the morning on an empty stomach are excellent cure. Also, taking care of your weight, drinking water from copper vessel, and meditating for at least 20 minutes a day would be added support.

Dr. Phyllisa Deroze

A1: No. Diabetes is on the rise and more people who are not the "typical" candidate are being diagnosed. Young people are getting T2 and older people are getting T1. People without a family history of diabetes are being diagnosed.

A2: Not understanding that carbs are not just in desserts. Rice is just as much a carb as a banana as ice cream.

A3: I would tell anyone who is newly diagnosed to take it one day at a time, one meal at a time. You won't get it all right at once and that's okay. Take your medication and don't beat yourself up.

Dr. Shira B. Eytan, MD

A1: CDC data shows a decline in new diagnoses of diabetes in the US since 2008. Although this is good news, we are far from winning the war on diabetes. Over 9% of the American population has a diagnosis of diabetes, and many of these people are undiagnosed. I would like to see not only the incidence of diabetes declining, but also the rates of hospitalizations, complications, and mortality decrease over the next several years to say that we are making a dent in this epidemic.

A2: I often see people afraid of hypoglycaemia, and eat (too) frequently to avoid this. The key to avoiding hypoglycaemia is not necessarily frequent meals, but finding the correct balance of nutrients in your meals to keep blood glucose levels stable for hours. This includes smaller portions of complex carbohydrates, balances with healthy fats, fiber, and protein.

A3: It's important to focus on correcting eating habits and lifestyle changes early on in your disease. Even a small amount of weight loss (7%) could make a large dent in a patient's insulin resistance for many years. Losing some weight and making some changes at diagnosis can make a world of difference down the road!

Dr. Louise Achey

Dr. Louise didn't have much to say other than giving these 5 tips on how to minimize the pain of sore fingers from blood sugar testing:

1. Relax by taking a slow breath right before you poke. Tensing up makes it will hurt more and moves blood away from the surface of your skin, making you have to poke again or poke even deeper.
2. Wash your hands in warm water right before doing the poke. This cleans your skin nicely and brings your blood close to the surface so you don’t have to poke as hard to get a good drop of blood.
3. DON’T use alcohol wipes on your fingers before poking. They only remove surface dirt and make your fingers more sore afterward.
4. Poke a spot halfway between the middle of your finger and where your fingernail starts. Looking at your finger sideways so it makes a half circle like the bottom half of a clock face, pick a spot halfway between the 6 o’clock spot (the exact middle of your finger, where you have most of your nerve endings) and the 9 and 3 o’clock spots (the edges of your fingernail) to do your poke. Poking here hurts less and doesn’t damage the nerves on the most sensitive area of your fingers.
5. Unless you have symptoms of low blood sugar or you think your blood sugar could be changing rapidly, poke your hand or arm instead. Most machines today allow you to use these “alternate sites” for getting a blood sample.

Amanda Goodwin

A1: I actually feel that diabetes is on the rise. 75% of Americans are experiencing blood sugar dysregulation.  Diabetes is not just on the incline for those that are overweight.  Many who are lean also are experiencing diabetes.  Diabetes is predicted to continue to increase over the next few decades.

A2: Many diabetics that I see are consuming too many carbohydrates. This includes things like pancakes, waffles, cakes, pies, cereal, cookies, grains, soda, but also dried fruit, fruit juice, popcorn, white potatoes, inflammatory oils, harmful sweeteners and processed foods. I also find many clients skip breakfast or consume a high carb breakfast which sets them up for sugar crashes throughout the day.

A3: I would suggest the client follow a lower carb, Mediterranean or ketogenic diet. Diabetics also need to address their stress level. Other helpful tips would be to sleep 8 hours each night, drink more clean water, and exercise. Walking 20-30 minutes a day can really be helpful in stabilizing blood sugar levels.

Dr. Carolyn Dean

A1: According to epidemiological statistics, Type II diabetes is on the rise and this adult onset condition is affecting more and more young people.

The reasons include obesity largely due to people continuing to eat beyond feeling full because they don’t feel satisfied. Satisfaction with a meal comes from obtaining the requisite nutrients. The current diet is sadly lacking.

One of the most important minerals for preventing diabetes is magnesium. A hundred years ago we could obtain 500 mg of magnesium in an average diet. Today we are lucky if we manage to get 200mg. (Grober)

One of the medical signs of diabetes is magnesium deficiency, however most doctors - not having learned about nutrient deficiencies in medical school - ignore this clue and rarely if ever prescribe magnesium. Doctors think magnesium is a laxative and rarely use it except in very high amounts as a colon purge before a colonoscopy.

Even though magnesium is responsible for up to 800 enzyme processes in the body, it is not part of a normal electrolyte panel. That’s because they are still using the antiquated serum magnesium test. The magnesium in serum has to be in a very tight range to keep the heart beating properly. If the serum magnesium level goes down, the body immediately responds by pulling magnesium out of storage in the bones or muscles and puts it into the blood. If the serum magnesium test is in the middle to low range, that actually indicates a serious magnesium deficiency. Since the serum magnesium test usually stays in the normal range, doctors no longer bother testing for it! If it is below their normal, they recommend IV magnesium in hospital settings and magnesium oxide orally. However, magnesium oxide is only 4% absorbed, which means 96% ends up flushing through the intestines as a laxative.

A2: The complications or comorbidities of diabetes include hypertension, elevated cholesterol, heart attack, stroke, and kidney disease. Unfortunately when someone is diagnosed with diabetes, doctors become very proactive in examining for any evidence of these comorbidities. They have even begun prescribing “preventive” medications for these conditions.

However, the drugs for diabetes, hypertension, and high cholesterol all rob magnesium from the body - and magnesium deficiency is a causative factor in all these conditions. It’s an impossible Catch 22 where the drugs given cause the condition they are trying to prevent. Because doctors do not consider magnesium deficiency in their management of diabetes they are unaware that they are making the patient worse. Doctors just continue to believe that diabetes as well as hypertension, elevated cholesterol, heart attack, stroke, and kidney disease cannot be cured and simply worsen until the burden of disease kills them.

A3: I recommend people order a magnesium RBC test online. A magnesium RBC test is more accurate than a serum magnesium test. You can obtain one without a doctor’s script at www.requestatest.com. Ionized magnesium testing is the best test for the level of magnesium ions, however it is only used in research labs. The magnesium RBC test and looking for magnesium deficiency symptoms is the best way to following your need for this mineral. I have a list of 100 factors that contribute to magnesium deficiency and dozens of symptoms and conditions related to magnesium deficiency in my book The Magnesium Miracle (2014) or in online blogs and articles.

The next step is to find a magnesium that does not cause the laxative effect so you can take therapeutic amounts. I used to suffer heart palpitations and leg cramps caused by magnesium deficiency but I also have mild IBS which means any magnesium pills or powder give me the laxative effect. I successfully invented a non laxative magnesium called ReMag, which is the first truly therapeutic magnesium because you can take amounts high enough to overcome long-standing magnesium deficiency without losing the mineral due to the laxative effect.

Grober Uwe, et al. Magnesium in Prevention and Therapy. Nutrients 2015 Sep; 7(9): 8199–8226.

Robert P Goldman, MD

A1: In the near term, as long as carbohydrate consumption remains at record levels and prices for carbohydrate foods are subsidized by the US government, I expect diabetes rates to continue to rise. Over the long term, however, I would expect Type 2 diabetes rates to gradually fall.

Epigenetic control of the genes that influence insulin response to glucose levels should, over several generations, mute rising insulin levels and insulin resistance. It is already being reported that the rate of Type 2 diabetes in children is starting to fall in the highest risk populations. I suspect this is due to changes in the epigenetics of these children as they now may be the third generation exposed to high volume consumption of high fructose corn syrup sweetened beverages which began in the early 1980s.

A2: The use of glucose monitors centers the attention of both patients and physicians on glucose levels. However, high levels of insulin overpower receptors for Insulin Like Growth Factor (IGF-1 Receptors). In the ovary, this stimulates an overproduction of testosterone and androstenedione from the Theca cells and induces PCOS or a PCOS like state. There are many tissues with IGF-1 receptors including the endothelium of arteries and cancer cells in breast, prostate and bowel. Even if insulin and glucose are balanced so that blood glucose levels are acceptable, the patient would be much better off if carbohydrate consumption were minimized so that insulin levels could also be minimized. Much of the damage to the diabetic body, high estrogen and testosterone, atherosclerosis and excess rates of breast, prostate and bowel cancers is probably driven by high levels of insulin stimulating IGF-1 receptors. In addition, use of artificial sweeteners, although they do not raise blood glucose, they are still read as sweet by taste buds that have been found in the intestine. This causes the pancreas to increase insulin production. Even without high glucose, the high insulin can still cause damage by overstimulating IGF-1 receptors.

A3: I would center my advice to the patients on a low carbohydrate diet consisting mostly of high fiber vegetables by volume. The main beverage should be water and no artificial sweeteners should be used in any beverage. Use of a small amount of sugar would be better. A mostly plant based, whole food diet with low fat protein sources would be ideal.

Sissi Cossio, MD

A1: Diabetes Mellitus is a disease that it is increasing in frequency in all ages. In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. In the US , it is estimated that 5 – 10 % of people with diagnosed diabetes have type I Diabetes Mellitus. Type I diabetes Mellitus remains the most common form of diabetes in the youth., accounting for almost all cases in children under 10 and the vast majority of diabetes cases among teens.Although the incidence of type 2 diabetes mellitus is also increasing in children.about 208,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.25% of that population. In 2008—2009, the annual incidence of diagnosed diabetes in youth was estimated at 18,436 with type 1 diabetes, 5,089 with type 2 diabetes.

A2: In general a diabetes diet is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. It’s all about portion control and moderation, not restriction.

Common mistakes that patient with diabetes make are:

• not taking in consideration that there are several factors affecting blood sugar: like stress, changes in activities and hormonal patterns.
• guessing blood sugars, and not checking them frequently
• guessing carbohydrate counting; it’s important to read labels and measure out foods until you get better at predicting how it will impact your blood sugars.
• not taking responsibility for their own disease management, with so many daily variables affecting diabetes management it is crucial the patient and family are very well informed and educated in how to adjust their treatment
• been too relaxed in regards to treatment or expecting perfection at all times: Diabetes management is a daily challenge. It is important to find a middle point to improve your management process, and achieve the best goals that you can . Every day is a challenge and not the same

A3: Communicate with your diabetes management team frequently, but take ownership of your diabetes management. Be very well informed about all the new technology available for diabetes management (phone apps for insulin calculations, and carbohydrate counting, the used of continuous glucose sensors, insulin pumps and insulin pens).

• Be compliant with your medical appointments.
• It is important that the child and specially teenagers learn to incorporate this disease as part of their daily routine. If they feel this is a stigma or something to hide they will be more chances of poor compliance with their treatment.
• Eat healthy and exercise frequently: Exercise helps lower blood sugar levels and can make you feel better. It’s also good for your circulation, because your blood vessels take a beating from increased blood sugar. Eat a good heathy diet.
• Be compliant with your blood glucose checks, they are important to know for therapeutic decisions and your daily insulin management.
• Be very well informed about the treatment of high blood or low blood sugars, and how to adjust your insulin regimen when you are sick or your level of activity change.
• Be sure you adjust your treatment to continue your life style without restrictions, not the opposite.

Dr. Westin Childs

A1: In my experience it doesn't seem that diabetes is in decline, in fact I tend to see more of it than in previous years. I think the difference is that people are more aware and I tend to see patients hovering in the pre diabetic range more so than the overt diabetic range. I also tend to see patients with high fasting insulin levels that aren't quite "diabetic" but still need treatment.

A2: One of the biggest mistakes is obviously not paying attention to what you eat. I have some patients who are afraid of eating Banana's because of the sugar but will replace it with something like gluten free brownies or bread. The first step when diagnosed should be taking an inventory of what you are eating and then comparing that to a "real whole food" based diet and then eliminating anything that doesn't fit.

A3: The best way to manage diabetes and insulin resistance is by taking it seriously. Newly diagnosed patients need to change their diet, they need to change their lifestyle, they need to start exercising more and they should consider using some targeted supplements that have been clinically proven to reduce insulin resistance. Just doing one of these things is not as effective as doing them all together.

Dr. Hinckley

A1: I do not see Diabetes on the decline in my patient population. This is because of 2 main reasons. One is that doctors are getting better at looking for it in non classical patients (younger thinner healthier). The more we look for it, the more we find it.

The second reason is that my patient population is getting less healthy- less exercise, poorer diets, frenetic pace of life. Despite a recent push for healthier choices like McDonalds healthy menu, etc, we don't have the time to invest in good food and good exercise. When we take the time to make it a priority, we will likely see diabetes decline.

A2: The most common mistakes I see are trying to eat less often and less calories, but not necessarily focused on carb type and carb content. There are so many products out there advertised as healthy that aren't really healthy at all!

A3: Advice I would give someone who is newly diagnosed: Keep a food/exercise journal on your phone. Not too elaborate because we don't want you to burn out on doing this. This is a mindfulness-based practice that will help you over the long run see what you're actually doing, not beat yourself up for mistakes, but slowly and steadily make changes. Then see a nutritionist who can help you with the necessary medical knowledge to make the best changes to overcome diabetes.

Sharon Castillo

A1: Diabetes is not on a decline. Per Dr. Joel Wallach, a renowned biomedical researcher, naturopathic physician, and owner of ‘The Wallach Revolution says that “Diabetes is one of the leading causes of death in the world.” I agree with him because in today’s world, we see a lot of children suffering from diabetes which was unheard of in the old days. Despite the rise and development of research and medical knowledge and facility, the no. of diseases especially diabetes has been on the rise too. This involves both Type 1 and Type 2 diabetes.

A2: I think the diet that most diabetics make is skipping breakfast which is the most important meal of the day. Others have their meals through fast food chains which are devoid of vital nutrients. Having a sedentary lifestyle is another management style that is not good for diabetics.

A3: According to Dr. Joel Wallach, supplemental chromium will prevent and treat diabetes as well as hypoglycemia. The University of Vancouver, BC, Canada stated that “Vanadium will replace insulin for adult onset diabetics”!

The diagnosis of diabetes is very easy and it should be considered in any disease where there is a chronic weight loss or weight gain. Frequent urination and chronic thirst are warning signs that should be explored. A six-hour GTT will show a steep rise of blood glucose at 30-60 minutes to over 275 mg% and may keep rising to over 350 and stay elevated after 4-6 hours.

The urine should be tested for sugar with the “dipstick” test every time the blood is tested for sugar. A positive diabetic will always include a positive urine sugar during the six-hour GTT. A morning fasting urine sugar test us useless for the initial diagnosis of diabetes. Blood of the diabetic is also typical in that the lipids and cholesterol are elevated as well as the sugar.

Treatment of diabetes should include chromium and Vanadium at 25 mcg/day in the initial stages to prevent “insulin shock” (sudden dropping of blood sugar because of a relative insulin overdose). Keep checking urine blood sugar before and after meals, as the blood sugar level drops and you can reduce your insulin one or two units per day, go up to 25 mcg b.i.d., then t.i.d.; then go to 50 mcg b.i.d., etc.

You will also need to deal with food allergies that cause celiac-type intestinal lesions (i.e., wheat gluten, cow’s milk, soya, etc.) and supplement with betaine HCl and digestive enzymes at 75-200mg t.i.d. before meals. The intestinal lesions take 60 – 90 days to heal.

Dr. Tunis Hunt

A1: Diabetes is on the rise. Compare the 1 million we had in 1980 to the 29 million we have today. It is a growing epidemic with 70+ million PRE diabetics.

A2: Diabetics need to realize that the diet that led them to diabetes must be changed if they desire health. Not to simply rely on their medication to keep their "levels' normal. The root cause to the vast majority of Type II Diabetes is "insulin resistance". Only when a diet that doesn't cause insulin surges are followed will a diabetic see improvement. Eating high starchy foods and breads in "moderation" is not acceptable if they have a desire to see their condition improve.

A3: Realize first that in most circumstances they have the power to improve their condition. They don't have to "accept" their diagnosis as a life long sentence. There are countless individuals who improve their glucose levels and even discontinue using medications when a proper plan is taken. A very low glucose and refined carbohydrate diet together with nutrients that can help with insulin sensitivity can be very effective in helping a diabetic restore their health.

Dr. Taz Bhatia, MD

A1: Yes, diabetes is declining! There are fewer cases of diabetes currently – the first decline in years. I think some of this may be a better overall understanding on the dangers of sugar, low fat diets, and the importance of food and exercise.

A2: I think there is still too much emphasis on carbohydrate counting, sugar substitutes, and moderate glycemic healthy foods, like whole grain pasta, breads and cereals, where the emphasis needs to be on healthier fats, protein, and fiber from fruits and vegetables.

A3: Understand the role of your diet in the disease and your digestive health. Eating the right foods and improving the digestive process is fundamental to improving insulin regulation. Improve your microbiome by adding in probiotic rich foods like bone broth and fermented veggies, and add probiotics and digestive enzymes to lower the digestive burden. Once you get this right, exercise will continue to improve insulin regulation. I recommend exercise that doubles or varies your heart rate and weight training two times per week.

Dr. Carol Peters-Tanksley

A1: I have no opinion or basis to comment on whether or not diabetes is on the decline.

A2 & A3: A big mistake when dealing with diabetes is to see your doctor as the one to fix you. Your doctor and the other members of the healthcare team are absolutely vital, but it’s you who is in charge. Nobody else cares as much about your health as you do. No pill can magically fix you if you don’t take responsibility for your lifestyle. Make the decision right now that you will remain in charge – of your health, your lifestyle, and your healthcare.

Making changes in lifestyle or eating patterns is challenging. You’ll be more successful in doing so if you find and focus on a big WHY. Do you want to stay healthy long enough to see your grandchildren grow up? Are there significant goals you want to accomplish in your life? Keep that WHY in front of you as you make one small lifestyle change after another.

Your body was not created to process the many chemicals and artificial substances present in much of our modern diet. If it’s got a long list of ingredients and has a long shelf life, it’s probably processed. Each week, take one processed food you’re used to, and replace it with something less processed. Instead of sweetened breakfast cereal, try steel-cut oats or even instant oatmeal. Replace your frozen TV dinner with chicken stir-fry you prepare at home. Keep this up weekly until 80-90% of your food is unprocessed (or at least less processed). More unprocessed food will make your diabetes easier to control, and your whole body healthier.

Daniel Rasmussen

A1: According to the American Diabetes Association: Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death. In 2016 This has increased by 15% to 76,488 death certificates.

A2: Most people make the mistake of following the diet they are taught in the classes provided at hospitals and conventional Diabetes treatment centers. Contrary to what many are taught, they should eliminate all dairy, all grains, fruit drinks, coffee and move towards a whole foods diet.

A3: Conventional Medicine says that Type 2 Diabetes can only be managed, however we have seen that it can be completely reversed and prevented with lifestyle changes and as a result medications would not be necessary. This has to be supervised in a clinical setting such as Pinnacle Integrative Health that takes this specialized approach.

Disclaimer: The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of TheDiabetesCouncil.com.

TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on June 1, 2020