I would agree you are not a candidate for medications, and there are no natural supplements that look particularly promising at this time. Fish oil seems reasonable, so does vitamin D.
I think there is good reason to believe that increasing your HDL as much as possible, especially the large HDL particles that can only be detected with specialized lipoprotein testing, is a promising strategy for maximizing your beta cell function. An eating strategy low in total carbohydrate and animal fat and high in protein may be the best bet, along with resistance training and cardio training.View Thread
Ok. So assuming your speculations and interpretations are correct (which they probably are) then what is the optimal eating and exercise approach over the next decades (both in theory and in practice)?
How much cardio versus resistance training? What kind of muscle fibers and how much muscle do you want?
I don't have definitive answers, but I think this type of intellectual exercise is important for forming a long-term plan (which can be modified as new research evidence emerges regarding pathophysiology of diabetes and clinical effects of various eating and exercise strategies).View Thread
Although the patients in the DeFronzo study were different from your situation (they were not lean and fit with IFG), I now suspect I have underestimated the potential degree of insulin resistance, especially in muscle, in lean patients with IFG, IGT, and type 2 DM. I know there is poor beta cell reserve in lean type 2 DM, but the research summarized above points to insulin resistance similar to what we find in individuals with obesity (with and without type 2 diabetes).
With less fat to lose than most others with prediabetes/type 2 DM, there is much less opportunity to "reverse" the diabetes (or diabetes risk), however the greater the degree of insulin resistance the greater potential for gains made by cardio and resistance training.
Again, I applaud your important efforts to fight this with conditioning and diet optimization.
Yes and no. C-peptide is a useful way to get a general handle (rough estimate) on beta cell function when the insulin level is uninterpretable due to "exogenous" insulin (insulin taken as a medication).
A low c-peptide in type 2 diabetes indicates poor beta cell function, and a fairly high c-peptide indicates moderate beta cell function.
However, I do not believe the c-peptide can be used to calculate beta cell function with the same degree of confidence as when the insulin level is used.
C-peptide and insulin are made simultaneously in a 1:1 ratio in the pancreas, and the levels of c-peptide and insulin in the blood rise and fall together and are correlated, however the degradation rates differ between them and therefore the correlation is far from perfect, making it difficult to confidently convert c-peptide levels into insulin levels for the HOMA equation.
Pancreatic beta cell function can be roughly estimated by measuring fasting insulin and glucose simultaneously (ask your doctor for these blood tests), then using this downloadable calculator (HOMA calculator) to assess the estimated beta cell activity and insulin resistance.
HOMA stands for "homeostasis model assessment". The general concept is that the higher your insulin resistance (due to excess body fat, genetics, or other causes), the harder your beta cells need to work to produce enough insulin to keep the glucose levels normal. Someone with lots of insulin resistance, say twice as much (200%) of a normal healthy person, will have to have lots of beta cell activity (150% or 200%) just to compensate. Over many years of excess beta cell activity (over 100% activity), then in SOME individuals the beta cell activity will start to peter out, as reflected by lower insulin levels (or inappropriately non-elevated insulin levels in the face of mildly elevated glucose), and the calculator will indicate there is only around 50% beta cell activity. The A1c doesn't start to go up into the prediabetic range (A1c 6.0-6.4) until the beta cell activity is around 60%-50%. Beta cell activity in the 40% or less range is what we see in type 2 diabetes.
If we measured insulin and glucose and used the HOMA calculator in seemingly normal patients with moderate-to-high risk of eventual type 2 diabetes--such as patients with parents or siblings with type 2, or in patients wiith obesity, then we could probably clarify the diabetes risk even sooner. We would not have to wait until beta cell function is 60%. We could spot it when it is at 80% etc. and monitor it. I think this is a concept scientists should explore further as a potential component of a national diabetes prevention/reversal strategy.
So I encourage you to download the HOMA calculator and assess your beta cell function and insulin resistance if you can get simultaneous fasting insulin and glucose levels.
Most, but not all, people with type 2 diabetes have enough remaining insulin-producing function to achieve diabetes remission--normal blood sugar levels without medication. The goal of lifestyle change is to get as close to remission as possible--a process I call "diabetes reversal". To learn more, please see my two-part series "What is Diabetes Reversal".
I encourage all people who are fighting against type 2 diabetes to consider my views on how to eat, as explained in my seven part series "eating for diabetes reversal". Michael Dansinger, MDView Thread