By Salihu Lukman, PhD
Twitter Handle: @SalihuLukman

Published in Daily Trust Newspaper (incomplete version): January 2, 2020

Hypoglycemia is worse than hyperglycemia according to doctors, hence it should be avoided under all circumstances as much as possible. It may damage some brain cells that cannot regenerate. I had fasted the complete holy month of Ramadan (29 – 30 days) from sunrise until sunset without any problem with sugar control. Three months later (August) HbA1c had dropped further to 6.4 % (prediabetic), it shot up to 6.8 % in October and ultimately stabilized at 6.1 % (prediabetic) in January 2016 (less than 1 year from the start of treatment) as well as January 2017. My weight had stabilized at 78 kg in 2017. Even though the sugar level had stabilized, but I would one in a while check my blood sugar level using my glucometer most especially during cheat periods. On a few occasions, I would record hyperglycemia and would identify the cause to become more cautious with my diet. Someone may ask, what about the doctor who failed to inform me that I was diabetic since 2013? Actually, I had wanted to take him to task by suing him for grave negligence. I am a staunch proponent of taking doctors to task in case of any negligence that may arise in their course of patient management. I believe that this would make them become very vigilant and improve patient management. Unfortunately, one hears of medical negligence and mismanagement almost everyday in Nigeria without any serious litigation. Only recently a medical doctor in Adamawa state was barred from practicing for life owing to gross mismanagement of a patient. If not for my relocation in 2014 to another town about 500 km away, I would not have allowed the matter to just die.

An important event took place in June 2016 during the holy month of Ramadan that changed the entire management strategy. I had started fasting here in Saudi Arabia and then traveled to Nigeria for the summer vacation. I continued to fast in Nigeria but then I started recording hyperglycemia 2 hours after suhur (just before dawn) meal. To counteract this effect, I increased the Metformin dose slightly, then I recorded hypoglycemia just before breaking my fast i.e. sunset. This happened repeatedly a couple of times. At this point, I took one of the most important decisions in my life without consulting any doctor. Not even my wife knew about it until when I told her later. I stopped fasting and stopped taking Metformin. I changed my diet completely to one that was made up of only high fiber. These include beans porridge (fate in Hausa) with spinach and oats porridge with spinach. Yes, you read it correctly, oats porridge. I must confess that I have been blessed with a very passionate and ingenious person as my better half, who breaks all barriers to see to it that I am healthy. She would invent different dishes just to satisfy my craving for my favorite dishes despite my diabetic condition. Whenever I would talk about oats porridge and tuwon oats (thick oat pudding prepared from powdered oats) with okra or kuka soup nobody knows that oats can be put to such use. I would always advise her to apply for food patents whenever I noticed a new meal. To be candid, she is the most intelligent person I have ever seen in my life and she remains my greatest ‘asset’.

I monitored my blood glucose after I stopped taking the Metformin and surprisingly, the glucose levels were within normal ranges. I continued until January 2017 when I took the HbA1c test to find out how I was faring. It was 6.1 % – what a surprise! I was also gradually losing weight and in January 2019 my test result read 5.8 % and my weight had dropped to 72 kg. As per Saudi Arabian range, 5.8 % falls within the normal range, hence I had successfully fought diabetes to a standstill. Nonetheless, I still had a low glucose tolerance level. Declaring me non-diabetic based on the test result did not mean that I was free to go back to my pre-diabetic stage where I would eat anything without any consideration for the carbs content. I still take my low carb, high fiber diet until today and my blood sugar has been normal. In just 15 months, I was able to successfully wean myself off any diabetic medication or insulin injection. Even doctors are surprised about my relying on dietary modifications and weight loss alone to abstain from taking any diabetic medication. In fact, most of them would be hesitant to tell you to go without taking any medication and rely on dietary modifications and weight loss alone. When I asked my doctor at the beginning of the treatment if I would ever live without taking any diabetic medication again, he replied no. Well, I have achieved just that and I am sharing my success story to encourage diabetics that they can actually live a healthy life without taking the diabetic medication depending on the extent of their sugar control and adherence to the necessary lifestyle changes. More importantly, they can also live a healthy life while taking the medication without any diabetic complication provided they will control their blood sugar level always. Currently, I weigh 70 kg and still counting down, remember that I weighed 86 kg in 2015 when I started treatment for diabetes and 90 kg in 2013. I lost a total of 20 kg altogether. I have resumed fasting in Ramadhan since 2017 without encountering any problem again.

Now, let me shed light on some diabetic dietary myths by presenting some ABCs of junk foods and healthy foods. Sometimes you can hear a diabetic telling you that the following food items are good for a diabetic: pasta, couscous, Indomie, maize or millet pap, etc.

Vegetable oils are the umbrella that may actually represent soybean oil, corn oil, groundnut (peanut) oil, palm oil or sunflower seed oil. Their chemical structures are similar in that they are all unsaturated oils except palm oil coconut oil which are saturated oil. If you are on a low cholesterol diet, then palm oil is a no-no for you because of its high saturated fat content (50 %). Trans fats are found in processed foods. Food manufacturers in the US must list trans fat on food labels. Words like “hydrogenated” or “partially-hydrogenated” are used to identify trans fats that are hiding in your food. Other saturated fats are those found in meat and dairy products which are generally solid at room temperature. On the other hand, unsaturated fats and oils are generally liquid, even when refrigerated. These trans fats raise your LDL cholesterol levels (the bad kind) and lower your HDL cholesterol levels (the good kind) at the same time. Hence, they raise your risk of developing heart disease, stroke, and type 2 diabetes. Vegetable oils with the exception of palm oil and coconut oil contain the essential fatty acids omega-6 which are essential for our body, yet, our body cannot manufacture them and must be taken in through diet. Pure groundnut oil processed from groundnuts and sold by Kuli-kuli (groundnut cake) vendors is the most reliable groundnut oil and has a lower smoke point than the conventionally packaged vegetable oils and that is why it is not economical for frying purposes. Unfortunately, the good unsaturated oils can also be hydrogenated to create trans fats and a more shelf-stable product. I hope NAFDAC ensures that the so-called vegetable oils are not hydrogenated.

What is usually sold on shelves as butter is actually margarine. These are two different fats with different nutritional values and ingredients. While butter contains saturated fats, many brands of margarine contain trans fat listed as “hydrogenated oil” or “partially hydrogenated oil” on the ingredients list. Trans fat should be completely avoided according to health experts. Before 1990s, trans fats were regarded as a healthier alternative to saturated fats, hence margarine was promoted as a heart-healthy option over butter. However, since the recent discovery that trans fats are bad, many margarine companies in the US have reformulated their product and eliminated trans fats. The popular Blue Band ‘butter’ is nothing but margarine. Pure and natural butter is sold by Fura Da Nono vendors as Man Shanu. The best and recommended butter for diabetics is peanut butter called Tunkuza in Hausa. Health experts recommend that one takes one tablespoon of Extra Virgin olive oil daily owing to its heart-healthy benefits.

Processed foods have a generally bad reputation and bring to mind things like additives, preservatives, sweeteners, colors, excess sugar or sodium. They contribute to public health problems like obesity, high blood pressure, and type 2 diabetes. Processed foods are better viewed on a spectrum of minimally (e.g. roasted nuts, canned tomatoes, canned sardine) to heavily (e.g. crackers, potato chips, cookies, microwaveable dinners, hot dogs, sausages) processed foods. However, certain foods benefit from processing. These include milk (pasteurized to kill bacteria), dried fruits (have more fiber and phenols – an antioxidant), etc. Refined foods mean they have been stripped of nutrients through processing such as white flour instead of whole grains. Pasta and couscous are made from refined wheat, hence possess a higher glycemic index than pasta made from whole wheat. The same thing applies to processed and refined parboiled or white rice and brown rice. Processed foods are linked to increased rates of anxiety, depression and colon cancer. Glycemic index (GI) is an estimate of how blood glucose levels are affected by carbohydrate foods. High GI food can raise blood glucose levels faster than low GI food. A sudden spike in blood glucose levels is undesirable in persons with TTD. As a rule, proper diabetic diets should have a low glycemic index or load. Junk foods are usually heavily processed and refined, hence possess high GI and calories. Healthy diets are unrefined fresh or minimally processed foods that possess high fiber and other nutrients and have a low GI. Examples of healthy foods and snacks for diabetics include whole beans (starch-resistant and high in insoluble fiber), oats (whole grains and contains soluble fiber), whole grain wheat, carrot (high in insoluble fiber), apple (high in insoluble fiber), avocado, almond, salmon, veggies, Zogale (moringa), etc.

One key point for the successful management of any disease is the patient’s ability to read and research about the disease as widely as possible irrespective of one’s discipline. This is will go a long way in simplifying the work of the doctor. You should be able to take charge of your wellbeing and discuss extensively with your doctor about any management plan. Based on your readings, be willing to provide the relevant details that could guide your doctor in charting an appropriate management plan for you, do not wait for your doctor to ask you for the details. This is one thing that has been helping me to manage any disease that comes my way. You can find articles with more details on diabetes and nutrition than what I presented above in the following websites: www.verywellhealth.com and www.verywellfit.com. In case you are a diabetic or one of your loved ones is and want to get more details on the different food recipes and effective blood glucose monitoring plan, contact me using Whatsapp only on +2349031310423.

Dr. Salihu Lukman an assistant professor at the University of Hafr Al-Batin and writes from Saudi Arabia. Email: slukman@uhb.edu.sa