If your goal is to live free of diabetes and reverse the underlying cause of prediabetes or “adult onset” (type 2) diabetes…
- Are you actively followed by a doctor or provider? If not, get one! If you ever had complications like ketoacidosis, or if you have symptoms from your diabetes like low blood sugar or then you need to be seen right away!
- Measure yourself. Weight twice daily. Check your glucose once daily, at different times: either fasting before breakfast or 1-2 hours after meals. Postmeal measurements can tell you which meals boosted your blood sugar more.
- Get labs every 3 months or so. Hemoglobin A1c is a key measure of blood sugar over time. It tells you how much blood sugar has been circulating in your blood for the last 3 months or so. Lower is better, usually under 5.7 is normal.
- Consider measuring your insulin resistance by measuring your triglyceride to HDL ratio. Ideally this is close to 1. If your triglycerides are much higher than your HDL, it generally means you have a lot of insulin resistance. The below steps can help you reverse insulin resistance!
- If you have diabetes, then you basically already have coronary heart disease to some extent. See our checklist on preventing heart disease!
- Eat less fat, especially unhealthy fat. Ideally, saturated fats like from dairy, meat, coconut, or palm should never hit your gut again. Trans fats like from meat and “hydrogenated” oils are even worse.
- Eat a lot less meat, dairy, cheese, and processed foods like desserts. Less meat also means less branched chain amino acids, which are another cause of insulin resistance.
- Eat more fiber-containing foods like beans, lentils, intact whole grains, vegetables, unprocessed potatoes, and berries. If you can make these foods 100% of what you consume, you may even reverse your diabetes altogether.
- Shift your food to earlier in the day. Eat a healthy breakfast. Try to stop eating by 7pm. The same food eaten later in the day causes more insulin resistance than if you eat that food earlier.
- Slim down. Losing belly fat alone can help reverse insulin resistance. See our weight loss checklist. Measure your waist circumference or just pinch your abdominal fat. If you can pinch an inch or more, you are carrying a diabetes-causing load of body fat.
- Walk frequently, especially after meals. Measure your steps using your smartphone or a pedometer. The more the better!
- Exercise in all its forms is ideal for insulin resistance. The best exercise is whatever you will do the most of. Ideally, get your pulse elevated. Do at least 30 minutes of moderate intensity exercise every day (where you can talk but not sing). In addition, do strength or resistance training at least twice per week. If you are sedentary, build up to exercise gradually.
- If you make big lifestyle changes like those listed above, then see your provider frequently to make sure you are doing it safely. You especially need to worry about removing medicines for diabetes or high blood pressure. If you get too much of these drugs, they can lower your sugar or blood pressure to dangerous levels.
- The best drug for type 2 diabetes is probably metformin. It is cheapest, does not cause low blood sugar, and it has the best outcomes. It even helps prevent prediabetes from becoming diabetes. It is unsafe to take if you have advanced kidney failure (Glomerular Filtration Rate is less than 45). The main side effect is diarrhea, which usually goes away after a few days. If you cannot tolerate metformin, you can try again in a few months. Often people are eventually able to take it.
- If you take blood pressure medicines, shift 1 or more of your blood pressure medicines to bedtime. This has been shown in multiple studies to reduce the lifelong risk of diabetes by over half. Not sure why. As always, consult with your provider on medication changes.
Diabetes is the great challenge of our time. It turns out if you take a population of humans, and train them to eat more and more high-calorie, fatty and sugary foods with each passing year, they start developing type 2 diabetes by the millions.
Currently about 9-10% of adults worldwide have diabetes. By 2050, many experts predict that number will triple in countries like the United States, to ⅓ of all adults. We are moving in the wrong direction.
Diabetes is a classic “mismatch disease”. We develop it because our Cro Magnon bodies are mismatched to our modern day society lives. Think slight, thin runners on the savannah munching roots, tubers, and leafy greens all day, with the occasional bite of fish or small game. Our hunter gatherer ancestors and modern day hunter gatherers typically consume 100 grams of fiber per day, compared to our measly 15 grams that is typical today.
Cheeseburgers, chicken nuggets, pizza, soda, and donuts are not exactly what we were designed to consume. So when we flood our bodies with these foods, where do the excess calories go? Many of those calories get deposited in the organs of our body like our muscle and liver. We use the term “insulin resistance” to describe when fatty liver and muscle cells are unable to soak in excess glucose (sugar) from the blood and store it away as glycogen, so glucose builds up in the bloodstream. When our body cannot keep up with the rising glucose in our blood, we call it diabetes. So the underlying cause of diabetes is insulin resistance, which is caused by the buildup of fat inside the cells of the muscle and liver and other organs.
How much insulin resistance do you have? We all lie on a spectrum, and our own insulin resistance is determined by our genetics, our diet, and our lifestyle. In general, the less insulin resistance you have, the healthier and more diabetes-resistant you are. Insulin resistance increases meaningful medical problems like diabetes, kidney failure, memory decline, and heart attacks. We can get a rough measurement of our insulin resistance by measuring our blood triglyceride to HDL ratio. We have more insulin resistance at the end of each day than at the beginning. Exercise drops our insulin resistance not only long term, but in the hours after exercising.
It turns out that you can reverse your insulin resistance. Food in particular may be the #1 factor. Foods that cause insulin resistance and diabetes include anything with excess fat, especially saturated or trans fat, like meat, dairy, eggs, desserts, processed foods especially those containing palm or coconut oil anything with excess calories foods rich in branched chain amino acids, including meat, dairy, and eggs foods that cause inflammation
To reverse your diabetes, we recommend building a lifelong habit of consuming more fiber-rich whole plant foods. These are naturally low in harmful fats and rich in water and fiber. Special mention to legumes (beans, lentils), whole grains, and vegetables. When people switch to this whole foods, plant based diet, this change alone is frequently sufficient to lead to reversal of insulin resistance and type 2 diabetes.
Other behaviors which play a very large role in reversing diabetes include: exercise in all its forms, adequate sleep (7-8 hours of natural sleep), mindfulness, and stress reduction.
- Don’t make any medication changes without consulting with your doctor or provider.
- If you are ever having low blood sugar, then this is an emergency. Make an appointment soon with your doctor. Adjust your diabetes medicines so you are not having low blood sugar. Low blood sugar can kill!
- If taking diabetes medicines other than metformin, beware low blood sugar. Metformin alone cannot cause your blood sugar to decrease below normal. But most other diabetes drugs can! If you are slimming down or losing weight, while taking diabetes drugs, you are at the greatest risk. When people slim down or lose weight (thru healthy changes like a plant based diet, exercise, or through unhealthy changes like surgery or cancer or a cocaine habit), their diabetes gets under better control and they need less diabetes medicines. THe drugs that pose the greatest risk of low blood sugar are insulin and sulfonylurea drugs like glyburide, glipizide, glimepiride.
- If type of your diabetes is not 100% clear (type 1, type 2, etc) then get a C-Peptide blood test. This can pinpoint the cause of your diabetes. Type 1 diabetes is from an autoimmune destruction of your body’s insulin secreting pancreatic cells. Type 2 is due exclusively to insulin resistance. Type 1.5 is a combination of both. If you have type 2 diabetes, it can be completely reversed in most cases by reversing your insulin resistance.
- If you take insulin for type 2 diabetes, find out if you can switch to a healthier alternative. If you have adequate insulin production, then you may be able to get off insulin in the long term (don’t stop any medicines without consulting with your provider!). Insulin itself can cause weight gain and it can cause the underlying cause of type 2 diabetes to get worse.
- If you have prediabetes and you are gaining weight, then it is likely a matter of time before you develop diabetes. The good news: lifestyle change now can prevent diabetes altogether in most people, regardless of their genes.
Poster for this Checklist
Want a daily reminder of how to achieve these goals? Print out the checklist and put it on the fridge or give it to your physician and ask them for their support.
Are you a health care provider that would like to spread the messages of these checklists? Are you working through one of these checklists and would like a larger reminder? Join our health poster of the month club.
Is this checklist missing something? Do you have a success story from trying this checklist out? We would like to hear any and all feedback.
We are a small organization that hopes to help people take control of thier health. Our work would not be possible without your help.
Have a story?
Have you experienced your own journey to better health? Have our checklists been a helpful guide? Do you have a friend of family member that has been affected by a medical condition?
Take control of your health, one checklist at a time.
Sign up for our monthly poster club or newsletter.
Nano J, Carinci F, Okunade O, et al. A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach [published online ahead of print, 2020 Mar 2]. Diabet Med. 2020;10.1111/dme.14286. doi:10.1111/dme.14286
ICHOM Diabetes in Adults Working Group, Type 1 and Type 2 Diabetes in Adults, November 2018, (available at: http://www.ichom.org/medical-conditions/diabetes)
W Kempner, R L Peschel, C Schlayer. Effect of rice diet on diabetes mellitus associated with vascular disease. Postgrad Med. 1958 Oct;24(4):359-71.
D M Dunaief, J Fuhrman, J L Dunaief, G Ying. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Journal: Open Journal of Preventive Medicine; ISSN 2162-2477; Vol. 02; Issue: 03; Start page: 364; Date: 2012.
S Steven, E L Lim, R Taylor. Population response to information on reversibility of Type 2 diabetes. Diabet Med. 2013 Apr;30(4):e135-8.
E L Lim, K G Hollingsworth, B S Aribisala, M J Chen, J C Mathers, R Taylor. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011 Oct;54(10):2506-14.
C B Trapp, N D Barnard. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010 Apr;10(2):152-8.
J W Anderson, K Ward. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979 Nov;32(11):2312-21.
I M Rabinowitch. Effects of the High Carbohydrate-Low Calorie Diet Upon Carbohydrate Tolerance in Diabetes Mellitus. Can Med Assoc J. 1935 Aug;33(2):136-44.
I M Rabinowitch. Experiences with a High Carbohydrate-Low Calorie Diet for the treatment of Diabetes Mellitus. Can Med Assoc J. 1930 Oct;23(4):489-98.
D R Young, W M Vollmer, A C King, A J Brown, V J Stevens, P J Elmer, S Craddick, D L Sturtevant, D W Harsha, L J Appel. Can individuals meet multiple physical activity and dietary behavior goals? Am J Health Behav. 2009 May-Jun;33(3):277-86.
Rabinowitch IM. Effects of the High Carbohydrate-Low Calorie Diet Upon Carbohydrate Tolerance in Diabetes Mellitus. Can Med Assoc J. 1935 Aug;33(2):136-44.
Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979 Nov;32(11):2312-21.
Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010 Apr;10(2):152-8.
Sample, I. (2014). Diets high in meat, eggs and dairy could be as harmful to health as smoking. Retrieved August 22, 2016, from https://www.theguardian.com/science/2014/mar/04/animal-protein-diets-smoking-meat-eggs-dairy
Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, Fontana L, Mirisola MG, Guevara-Aguirre J, Wan J, Passarino G, Kennedy BK, Wei M, Cohen P, Crimmins EM, Longo VD. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014 Mar 4;19(3):407-17.