Zero tolerance for hypoglycemia

Wheat elimination starts you powerfully on the path to reversing diabetes. We’ve seen it many times and it continues to develop in people who kiss their bagels, pretzels, and processed foods booby-trapped with wheat goodbye.

But, as diabetics become less diabetic–a process that can occur VERY quickly, often within days of removing all wheat products from their diet–but they are taking insulin or certain diabetes drugs, there is potential for hypoglycemia or low blood sugar. Low blood sugar from diabetes drugs can be dangerous and should be avoided at all costs. (Imagine if a non-diabetic started administering insulin or blood sugar-reducing drugs–it would result in a mess.)

Unfortunately, you cannot always rely on your doctor. Most physicians are unschooled in how to cure diabetes and therefore how to manage the hypoglycemia that may develop on your way to cure. (They are very good at CAUSING diabetes, however, prescribing diets like “An 1800-calorie American Diabetes Association Diet,” a typical dietary order in the hospital that RAISES blood sugar.) It is nonetheless important to at least discuss your questions with your doctor. (If you encounter resistance, get a new doctor, preferably one in functional medicine who is more apt to understand nutrition and biochemistry.)

So I reprint a section I wrote for the Wheat Belly Cookbook that details some of the important issues to be aware of if you are diabetic on insulin or diabetes drugs and remove wheat from your diet:

There is not a shred of evidence that sugar, per se, has anything to do with getting diabetes.
Richard Kahn, PhD
Recently retired Chief Scientific & Medical Officer
American Diabetes Association

Dr. Kahn’s comment echoes conventional thinking on diabetes: Eat all the grains and candy you want . . . just be sure to talk to your doctor about diabetes medications.

If you eat foods that increase blood sugar, it increases your need for diabetes medications. If you reduce or eliminate foods that increase blood sugar, then it decreases your need for diabetes medications. The equation for most people with adult, or type 2, diabetes, is really that simple.

But several precautions are necessary if you are diabetic and are taking certain diabetes drugs. The potential danger is hypoglycemia, low blood sugars (e.g., less than 70 mg/dl) . . . as well as the uninformed objections of many doctors who have come to believe that diabetes is incurable, irreversible, and a diagnosis for life.

Some medications, such as metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and acarbose (Precose), rarely if ever result in hypoglycemia when taken by themselves. They are effective for preventing blood sugar rises, but tend to not generate blood sugar lows.

However, other medications, especially glyburide (DiaBeta, Micronase), glipizide (Glucotrol), glimepiride (Amaryl), and various insulin preparations can cause severe and dangerous hypoglycemia if taken while reducing or eliminating wheat and carbohydrates. For this reason, many people eliminate these oral drugs or slash insulin doses by 50% at the start, even if it means some temporary increase in blood sugars. The key is to avoid hypoglycemia as you consume less food that increases blood sugar, even if it means higher near-term blood sugars.

Other medications, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), exenatide (Byetta) and liraglutide (Victoza) usually do not result in hypoglycemia but occasionally can, especially if taken in combination with other diabetes drugs.

Because of the complexity of these responses, you should ideally work with a healthcare provider adept at navigating these issues as you become less and less diabetic. Problem: Most doctors and diabetes educators have no idea whatsoever how to do this, as they will tell you that, once you have diabetes, you will always have it and trying to get rid of it is fruitless and foolhardy (to the appreciative applause of the diabetes drug industry). So don’t be surprised if you are left on your own. At the very least, you want to check to see if your doctor will work with you and, if not, at least try and find another who will. Also, frequent monitoring of blood sugars is essential. I tell my patients on the path to becoming non-diabetic that high blood sugars (though maintained below 200 mg/dl) are preferable to low blood sugars (below 100 mg/dl) in this transition period. If, for instance, you are obtaining blood sugars in the morning (fasting) of 100 mg/dl, it is time to further reduce or eliminate a medication, such as glipizide or Lantus insulin taken at bedtime.

Any diabetic who wants to better understand the details of becoming non-diabetic would also benefit from knowing about the resources of Dr. Richard Bernstein, author of The Diabetes Solution. More information can be found at http://www.diabetes-book.com. The critical issue here is to understand that many people with diabetes have been told that they have an incurable condition for a lifetime and that a diet rich in “healthy whole grains” is essential—-advice that ensures you remain diabetic. Do the opposite─-eliminate “healthy whole grains,” especially the most dangerous grain of all, wheat─-and limit other carbohydrates, including non-wheat grains like millet and quinoa, and diabetes unwinds itself with reduced fasting blood sugars and HbA1c in the majority.

More recently, the American Diabetes Association’s Chief Scientific & Medical Officer, Dr. Richard Kahn, added, “Diabetes prevention is a waste of resources.” Why, think of all the money that could instead go to pharmaceutical research and marketing!

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Comments & Feedback...

  1. Mary Watson

    I was told by my family doctor that diabetes is something I will have for the rest of my life. My diabetic specialist offered no help in nutrition, only said calories in vs calories out. When I was given the book “wheat belly” it changed my life. At the beginning I had a couple episodes of low blood sugar, very scary. That is when I realized I needed to cut my insulin significantly. I have lost over 25 lbs so far and continue to lose weight. I can’t wait to get off of insulin. That is what drives me. It really was not difficult to eliminate wheat. Best decision of my life.

  2. Vickie

    A friend of mine is an insulin dependent Type 1 diabetic but wanted to eliminate wheat due to the inflammatory properties and other health problems. His endocrinologist had a fit and his labs were terrible? Where can a person to get some advice on this. His doc wants him to eat a bowl of cereal before bed because his blood sugar goes too low. This is so confusing…

    • The book referenced by Dr.D. above (The Diabetes Solution by Dr. Richard Bernstein) is apparently the bible on that. Dr. Bernstein has T1D, and pioneered how to control it with a ketogenic diet.

      T1D is a different problem than T2D, but both respond to diet (just not the diets advocated by your government or National Affliction Associations).

      • I have Dr. Bernstein’s book and read it some years ago! VERY good stuff. Did you folks know he has type 1 diabetes since childhood, was an engineer but went back to school to become a diabetic doctor? He’s the man who (I think) invented the insulin pump. He’s a pioneer in treatment. I should re-read the book as I’ve forgotten some of his info. I’m type 2—just wanted to re-inforce here that in a short time I reduced my A1c from 6.8 to 6.0 (fasting). I’ll be doing my labs again in a couple of weeks so will be anxious to see where I’m at now. I began W.B. in mid-Feb. It’s fun losing weight (get to buy new clothes LOL) when for years it was a challenge!!!!

        • Peggy Holloway

          He did not invent the insulin pump and would prefer that people use as little insulin as possible. He did invent the first personal glucose meter that was practical for individuals to use to self-monitor blood sugar. The medical establishment was very resistant to the idea.

          • > The medical establishment was very resistant to the idea.

            That seems to be their primary function.

            Bernstein became an MD because the establishment ignored his lay accomplishment of management of T1D without drugs. They are still not happy about it, because it is not helpful to the business model, and implies ominously serious issues with the consensus view of diet.

            Consensus medicine is also under pressure to acknowledge keto as the go-to treatment for epilepsy (which it used to be). If they concede that keto is effective and harmless in T1D, what’s next? Cancer, Alzheimers and most chronic diseases, that’s what. That’s really scary to someone with a mere 4 semester hours of nutrition (i.e. typical MD on an association board or special interest committee).

            In the computer industry, the semi-joke is that the function of technical standards committees is to slow R&D progress down so that designers can finish product designs. This at least has an upside. Your shiny new gadget make not be state of the art, but it plays well with others. Considering health trends, the real effect of medical standards committees and associations is far more sinister.

            Why would an MD want to be on the board of an association or committee? Speculation points in multiple directions, many not flattering. We may judge their results, by their results.

    • Bea Pullar

      Great reminder about diabetes management. Thankyou Dr Davis!
      Frequent monitoring is essential. When I was first diagnosed with T2D more than 13 years ago, I phoned a friend who I knew was doing well controlling her blood glucose. Part of her advice was to join a couple of international Yahoo groups and to learn everything I could. Dr Bernstein’s book, The Glucose Solution was one major resource. Also two of the group members were medical writers who diligently research topics and wrote books, maintained websites, and later blogs.

      As far as monitoring your blood glucose levels is concerned it is not enough to test Fasting BG, but very instructive to measure at intervals of 1 hour and 90 minutes after eating. By plotting how much a particular meal raises your BG you can decide whether to reduce your portion size, or eliminate a particular food. It does not take long to check out your standard meals – and then you have less need to check your BG after meals. Long before I changed my WOE (way-of-eating) to wheatfree, I had eliminated bread, and crackers, and snacked on cucumber slices, or tomato and cheese or something that I knew did not raise my BG significantly. When I changed over to wheatfree, I monitored my BGs as I experimented with the WB recipes, and entered these into my log and spreadsheet.

      It is also important to check your BG before you drive, and before you exercise etc – to ensure you are not at risk of having a hypo. Fortunately, I have never had a hypo – but I for years I have carried 1 oz of almonds in my handbag just in case, or to use as a snack. The general advice is to carry jellybeans – but I saw through that quite early on when I realised the folly of eating pure sugar!.

      • > The general advice is to carry jellybeans – but I saw through that
        > quite early on when I realised the folly of eating pure sugar!.

        Oh, it’s not even pure sugar (sucrose). JBs are mostly HFCS these days, plus a little “starch”, which is quite likely to be from your ‘ol pal wheat.

      • Dr. Davis

        It’s great, Bea, that you figured out on your own how to navigate diet and blood sugar to undo diabetes as much as possible.

        Note that the lessons you’ve learned that are effective are the OPPOSITE of those given to you by the American Diabetes Association and most physicians. This is the incredible situation we find ourselves in!

      • Lisa

        Thank you so much for this info. I have been type 2 for several years, but I have not done as much as I should when it come to my diet. Your info has been very helpful !!

  3. April

    I am overweight and in tests I have always shown to have low blood sugar levels and symptoms of hypoglycemia. I’ve made the assumption that this is a symptom of my body not regulating my insulin properly. I keep it in check by not going too long between meals and snacks.
    I am not diabetic or on any drugs but every time I go without wheat & grains I do well for a couple weeks and then I begin to feel the symptoms of low blood sugar… being on the verge of passing out.. etc. Even though my protein consumption is fairly high.
    Do you have any thoughts on this or suggestions? Do you think if I just keep pressing through my insulin levels will eventually normalize?

  4. Julie

    You would think that with ALL of the testimonials that continue to grow in number, paired with the reduced incidences of diabetes, crohn’s, hypothyroid, and a host of other ailments that either get “cured” or seriously reduced or alleviated with the elimination of wheat and/or a low-carb diet, that the medical community would sit up and take notice – and maybe give some weight and even some research time to this. (Gosh, what a long sentence.) I am not sure why the medical community, as a whole, seems to fear going “against the grain” (pun intended), even though people’s results are giving solid evidence. Things don’t just “go away” on their own. Is it because they are partnering with the drug industry for money? Or they get money for prescribing drugs? Or they are just not versed in it and don’t consider dietary changes a medical remedy? Hopefully soon they’ll start seriously considering what they see.

  5. stephen ottridge

    Back last September I was diagnosed with type 2 diabetes. I was put on 26 units a day of insulin. In late October I discovered Wheat Belly and cut out wheat. My weight declined, my blood sugar measurements improved and I reduced the amount of my insulin shots. The clinic agreed with what I was doing and at the next clinic in a further 3 months, my weight had dropped 30 lbs by that time, I was told I could drop the insulin altogether. I now take just 2 500 mg Metformin a day. I have never had an incidence of hypoglycemia.

  6. Ellen Lewis

    Excellent post, thank you Doctor!
    It’s so difficult to sort out such layers and layers of harm coming from the medical profession doing the wrong things while wedded to the wrong theories. I appreciate your clarity and cautions. This post can help many people stay safe in the transition phases.

    from a fellow doctor, confessing years of past practicing from these old diabetes theories.
    Ellen Lewis

  7. Anna

    Im getting confused with the removal of Carbs in our diet.. does it cause a spike on blood sugar?
    does that mean I should remove Rice in my daily diet? because Im from an Asian descent and we practically lived on eating rice every meal.. any suggestion that i can replace rice with if ever?

    • Neicee

      Hi Anna, there is no substitute for actual rice but you can do a reasonable faux rice with a method of using cauliflower. Believe you might enjoy http://www.nomnompaleo.com for some ideas. She’s Asian and has numerous recipes on her site. Oh, she has a ton of them from other locals too. Sometimes I think she incorporates too many fruits but that’s easily taken care of by eliminating. Good luck.

    • The ‘Miracle’ brand carries a shirataki rice, which I’ve used and found satisfactoy. They also make an angel hair pasta and fettuccine as well, using konjac flour….they come in a brine solution and must be drained, then rinsed before boiling.

      • Barbara in New Jersey

        These noodles are somewhat similar to mung bean or cellophane noodles. They make a “rice” version too.

        • Neicee

          Thank you both, Jan and Barbara, for the suggestions. It’s been a couple of years since trying some of those products, and unless they’ve improved I’ll pass. Do either of you know if they have? I’m so bad these days that I see no reason to put anything into my mouth that isn’t a food treat. For one thing, I can’t eat that much anymore…. ;) One bite of dark chocolate and I’m done. Never thought I’d say that!

          • Neicee….I’ve only been on WB since January so I may not be a good one to ask! They’re benign at zero carbs….one bag serves the two of us…..long shelf life, so I stock them for those few times we feel like a pasta dinner.

          • Neicee

            Jan, I still love spaghetti squash…last week made fresh pesto, grilled some large shrimp and tossed them onto the plated ‘spaghetti’ dish, added a ton of pecorino.. That and a gorgeous salad was dinner.

      • cavenewt

        Some people object to the taste of the shiratake noodles. However, they’re fine if you pretreat them as described in the excellent $5 PDF cookbook Fat Fast (which has lots of other good information too; find it on Amazon.) Basically you rinse, microwave for 1 min, rinse, microwave again, rinse.

      • Barbara in New Jersey

        I rinse and then heat the noodles in a dry fry pan. This seems to make them less chewy. I like the heavier noodle for a baked ersatz mac and cheese on a cold winter day. The angel hair seems to hold sauces better. The noodle takes on the flavor of the sauce. Noodles work well with stir fry meals, replacing the rice.
        These are different than the pasta we no longer eat. I don’t think they have changed in the last few years.

  8. HSHOBX

    I was diagnosed Type 2 in November 2012 with an A1C of 7.9. I immediately starting trying to figure this out – nutritionist was no help, GP told me to eat the FDA food pyramid…no more than 30 carbs per MEAL. Ack.

    Compulsive self-testing quickly showed me that would kill me or at least cost me an eye or a foot.

    I gave up all grains, juice, most fruits, all starchy veggies. As of today my weight is down 34 pounds and my Bayer Self-check A1C says 5.6 (last month at doctor’s it was 6.1.) My fasting glucose is under 100 every day – I want it under 90! I test all the time and I worry about hypoglycemia because I feel shaky a lot of the time. My hypothyroidism seems to have reversed itself and I was afraid I was going HYPER now so I stopped all meds including Metformin. I feel a bit better but not great. My heart seems to flutter and I break out in to a hot sweat for no reason. I am seeing a new Endo next week, hopeful for some help there.

    I guess the point is if a new doctor tested me today, they would not find me diabetic, even though I know if I go back to eating ‘normally’ I will be.

  9. Judy

    I’m glad to see you reference Dr. Bernstein. I was told when given my diagnosis of T2 that it was okay to eat sugar. It took me a couple of years struggling before I found a person who recommended Dr. Bernstein’s book and it was the first time I actually figured out what T2 was and why my body reacted the way it did. I was on glyburide when I finally found you and your book, and indeed, my blood sugar plummeted when I dropped wheat! Off the glyburide now and just on metformin. Good advice and warning on this!

  10. lynette

    I was always horrified at the diabetic/renal diet offered by my husband’s hospital. Always, always loaded with potatoes, bread, fruit, and the like. His normal blood sugar would soar to 300-400 after eating that mess. It just doesn’t seem to be something they’re able to do, incorporate this concept of wheat-free low carbohydrate eating for diabetics. And along with the high carb garbage comes low protein and fat, because … heart disease. It’s really hopeless, and though I try to keep my tinfoil hat on the closet shelf, it’s not hard to get a little paranoid about the relationship between the ADA and the drug companies.

  11. As an RN for over 25 years I had my share of instructing diabetics on the 1800 calorie ADAD. Patients blood sugars were almost always hard to control with often high BS peaks. Their MDs & my self, being a case manager, always were quick to judge & label the patient as “non-compliant”. It had to be their fault because the ADA was like their physcian “always right”. After discovering how wrong we were all these years I apologize for all the wrong info I gave patients while following doctors orders & the ADA propaganda.

  12. Thanks so much for this timely post. My mom and I were just talking about her very low fasting blood sugars. I’ve suggested she lower her evening insulin and keep testing her blood sugars to see the results.

  13. missymonypenny

    Dr. Davis,
    Thank you so much for this new post. It explains alot. I will say that even though I’m not fond of my husbands Dr, he has never said its a life long disease. He does feel that his patients can get rid of it but its beyond me how he thinks it can happen with the SAD recommended by his clinic. He stills gives us flack when we share my husbands food choices. He thinks he will develop heart disease along his journey to get rid of T2D. I hope that my hubby can stand fast on his choices & prove him wrong, so far hes doing well & another pair of shorts fell off him today! I will post labs next week. My only fear is that even though I cook his all of his meals & snacks WB style he would still cheat often. I hope his labs are better than the last time. Question, I notice alot of ppl have gotten off their insulin but still take a oral med. Is this always the case? I thought if you lose the weight & get to a god A1C level you can drop all the meds.
    Currently my husband takes 4 shots a day (Humalog 3x & Lantus 1) with Diovan 160 mg 1x & Spironolactone 50mg 1x & Bupropian HCL XL 300 mg 1x daily.

    Thanks again!

    • Dr. Davis

      The ability to to be completely free of both insulin and oral drugs depends on residual pancreatic beta cell function. If there are sufficient beta cells to produce insulin, and insulin sensitivity is restored on this dietary approach along with weight loss, vitamin D supplementation, and physical activity, then complete freedom is possible.

      If, however, the pancreatic beta cells have been too far damaged by prior bad habits, then an oral med or two may occasionally be necessary.

  14. Anna

    I am so grateful, after getting type 2 following gestational diabetes, that my initial Internet research lead me to some great resources including Dr. Bernstein’s book and the WB blog. My A1C is below 5.0, I never actually had to start medications and I am still doing well without them. Thank you Dr. Davis for spreading the word! I am convinced that obesity and diabetes are different outcomes of the same problem, which is the carbohydrate overload that our modern diet has become. It’s simply unnatural for humans to be eating so much refined sugar and grains.

    • Dr. Davis

      That’s great, Anna. It’s a darned good thing you didn’t stumble on the knuckleheaded advice of the American Diabetes Association!

  15. Laurie

    Let’s remember that we are talking about Type 2 diabetes when we talk about reversing diabetes. Type 1 (auto-immune) is not reversible. Period. I enjoy not eating wheat, but that choice has nothing to do with the myth that any dietary change can cure auto-immune, insulin-dependent, Type 1 diabetes mellitus, which I have had for 46 years. My husband has reversed his Type 2 (before any meds) with diet and exercise and eliminating wheat. But let’s be clear about the difference between Type 1 and Type 2. They are NOT the same disease.

  16. Heather R

    Dr Davis-
    I am wondering what is an acceptable increase in Blood sugar after a meal. I just started using a FSBG monitor and would like to find out if the food choices I’m making are keeping me from losing weight. For example, when I ate chicken fajitas (no tortilla of course) with sour cream and cheese my BG went from 83 to 103. Is there a specific goal to have in mind (like BS shouldn’t increase more than 20 points after a meal)? I know you say some people don’t lose weight with too much dairy in the diet and I love that stuff!! I am not diabetic and don’t think I am pre-diabetic either (A1C 5.2 in July).

    After losing the wheat some weight came off (224 down to 212 today) but I still have quite a ways to go and it has been more than a month now. Any insight would be great! Also, how long after you have a high carb food does it take to return to my “normal” blood sugar cycle? If I splurge on some ice cream is my weight loss stalled for days or hours? Thank you!!!

    Heather