Diabetes: Additional thoughts 

Conventional markers used for diagnosing and managing diabetes have recently come to question. This blog addresses some of these issues. 

Fasting glucose levels may be misleading:

The fasting glucose test, used to diagnose diabetes, has flaws. If your reading exceeds 126 in the morning, you’re labeled diabetic—though this threshold was lowered from 140 in 1997, reclassifying  nomillions overnight. Such changes are often driven by financial interests rather than medical evidence.

After fasting overnight, glucose levels drop but may rise before morning activity due to the Dawn Phenomenon. Hormones like cortisol and glucagon signal the liver to release glycogen, raising blood sugar from 70-80 at 8 hours after dinner to 120-140 later. This natural process means fasting glucose readings can be misleading.

A Continuous Glucose Meter (CGM) provides a clearer picture by tracking daily curves and averages. If your average stays below 180, focus on a Plant-Based Whole-Food (PBWF) diet and regular exercise (e.g., 10,000 steps daily) rather than medications.

Post prandial (pp) blood sugar levels can also be misleading:

Doctors advise keeping post-meal glucose under 180, promoting low-glycemic foods. However, Dr. John McDougall argued that while refined starches are harmful, complex starches in whole foods are beneficial. Temporary spikes (even 250-350) aren’t alarming if your diet is controlled.

Avoiding glucose spikes by consuming protein or fat instead is misguided—these foods can increase heart disease risk. For example, prawns have a glycemic index of zero but are high in protein. Likewise, fructose powder (GI of 25) can contribute to diabetes and fatty liver despite its low glycemic impact.

Continuous glucose meter

I recommend that one should get a Continuous Glucose Meter and monitor his daily graph and average glucose level. If your daily average is below 180 try to control diabetes only by sticking to PBWF diet and walking 10,000 steps daily or some other exercise routine. 

HbA1C: A more reliable marker

HbA1C, tested every 3-6 months, is a better long-term marker. Previously, an A1C of 6.5+ was considered diabetic and 5.7-6.4 prediabetic. However, in 2018, the American College of Physicians (ACP) revised guidelines, recommending diabetics on medication maintain A1C between 7.0-8.0. If you’re on meds and below 7.0, you may be harming yourself unnecessarily.

The J-Curve: Over-treatment can be harmful

A major study (ACCORD, 2001-2008) performed on 28,000 people, funded by the pharmaceutical industry, aimed to prove tight glucose control improves health. Instead, it showed the opposite: aggressive control of blood sugar, blood pressure, and cholesterol increased all-cause mortality. Despite this, results were suppressed for a decade. In 2018, the ACP finally updated their guidelines, discouraging overly strict blood sugar control.

Take control of your diabetes

Many doctors resist these new guidelines, as they impact their business. If you’re on diabetic meds, consider dietary changes recommended by PBWF doctors to reduce or eliminate medication. Medications may do more harm than good—moderation is key.

As per the data from the study, the lowest all cause mortality is for A-1C in the range of 7.6 to 8.2.

Conflicting Diabetes guidelines 

There are three different guidelines currently prevailing in United States: 

1. The American College of Physicians (ACP) recommends maintaining A1C between 7.0 and 8.0.

2. The American Diabetes Association (ADA) recommends maintaining A1C under 7.0

3. The American Association of Clinical Endocrinologists (AACE) recommends maintaining A1C below 6.5 (March 12, 2018).

Most doctors who treat diabetic patients like to follow AACE or ADA guidelines. I don’t blame them – it is good for their business. If you were in their shoes you would probably do the same.

The difference between ACP and AACE guidelines can be as much as half their income.

Reducing medications 

It is very important for diabetic patients to cut down on their medication as they change their diet and lifestyle to PBWF/IF/10K because their blood sugar can go down too low; a condition called hypoglycemia which can be more harmful than hyperglycemia.

Is Insulin safe?

Many diabetics transition to insulin shots after a few years on medication. While doctors often assure that insulin is safe, there are conflicting views on its long-term safety.

Insulin helps the body move glucose into muscle cells, acting like a key to unlock the cells. Excess sugar is stored as fat, but fat isn’t converted back into sugar. When the body runs out of sugar, it uses fat to produce ketones for energy. Even without food intake, the body maintains a baseline level of insulin called basal insulin. Bolus insulin is fast-acting and released during meals.

In type 2 diabetes, two things can happen: reduced insulin sensitivity and decreased insulin production by the pancreas (sometimes called type 1.5 diabetes). In some cases, increasing insulin sensitivity isn’t enough, and supplemental insulin is required. However, not all patients on insulin lack insulin production; these cases are rare. Despite what you may have heard, insulin can have serious side effects that need close monitoring. Here are some examples:

1.Hypoglycemia: 

Causing blood glucose levels to go dangerously low resulting in fainting or even death. You must reduce your insulin dose or medication doses at the same time you make changes to your diet and lifestyle. Do not start a  juice fast or Ekadashi or Navratri fasts without cutting down your insulin or diabetic medications in consultation with your physician.

2.Weight Gain

Insulin makes you gain weight (fat) or makes it hard to lose fat.

3.Allergies:

Insulin injections can sometimes cause systemic allergies like itching and rashes across the body, trouble breathing, nausea, rapid heart rate, sweating and low BP.

4.Lipodystrophy: 

Symptoms include thickening or pitting of the skin and patches.

5.Oedema: 

Swelling of arms and ankle

6.Other miscellaneous side effects:

* Headache

* Flu like symptoms

* Dizziness, lightheadedness, shakiness and blurred vision

* Tingling in your hands, feet, lips, or tongue

* Trouble concentrating or confusion

* Hunger

Glycemic vs Insulin Index

Diabetic patients are often advised to eat low Glycemic Index (GI) foods. However, this approach focuses on managing blood glucose levels (a symptom) rather than addressing the underlying cause—insulin resistance.

The Glycemic Index, developed over 30 years ago at the University of Toronto for research purposes, measures how foods affect blood glucose. It primarily depends on the quantity and type of carbohydrates but is also influenced by other factors such as:

• how the carbohydrate is entrapped in the food,
• how the food is cooked,
• the fat and protein content of the food
• the amount of organic acids in the food
• the impact of other foods consumed along with the food in question.

The Glycemic Index (GI) is based on a serving size containing 50 grams of available carbohydrates (excluding insoluble fiber). Since some foods are low in carb density, this can lead to anomalies—like carrots having a GI of 91, while M&M peanut candies are classified as low-GI.

However, GI is not a reliable predictor of an individual’s glycemic response, which can vary significantly between people. A better measure is the Glycemic Load (GL), which considers the actual carbohydrate content of a serving. The Glycemic load is obtained by multiplying the Glycemic Index with the weight of a serving in grams. Even with similar GL, insulin responses can differ across individuals. For managing diabetes, it’s more important to focus on insulin load, best measured by the Insulin Index (II). Unlike GI or GL, the II also accounts for the impact of protein and fat. Moreover, GI and GL don’t reflect how blood sugar rises and falls over time. This is why continuous glucose monitoring is superior to relying solely on postprandial readings. The Insulin Index compares foods based on equal caloric content (e.g., 1,000 kcal) and is scaled relative to white bread, while GI is usually scaled to pure glucose. Relying on GI alone can lead to flawed decisions—such as avoiding healthy foods like carrots (GI: 91) while favoring prawns (GI: 0), beef (GI: 21), yogurt (GI: 62), or even fructose powder (GI 25).

My advice: Focus less on GI and GL. If you follow a whole-food, plant-based (WFPB) diet with intermittent fasting, you don’t need to stress over food choices. Eat freely within the WFPB framework—your body will naturally guide you. For more information please watch the linked videos below.

Why are my Morning Fasting Blood Sugar Levels high

The Cure for Type-2 Diabetes

Diet Drug and Diabetes

Insulin is the Cause of Most Major Illnesses

Basal/Bolus Insulin and Carbohydrates