Here's the first of a number of case reports, to inspire future low-carb doctors.
Jacques is in his 50's and has been my patient for almost a year. His medical history: Type 2 diabetes, hypertension, dyslipidemia, overweight, high waist circumference. His medications include Glyburide 2,5 mg twice a day, Metformin 850 mg three times a day, Irbesartan 300 mg once a day and amlodipine 10 mg once a day.
His blood sugar levels are not well managed, and he has occasional hypos.
In January 2017, I give him my little speech about changing his eating habits/reducing carbs. He replies that he's not interested.
Fair enough.
So I stop his glyburide, and I prescribe Invokana 100 mg once daily, and then 300 mg once daily. And I send him to a diabetes educator, for traditional management and follow ups.
End of January 2017: Unbeknownst to me, he attends one of my free public conferences on reversing diabetes with a low-carb diet, dragged by his wife. The following day, they both start eating low carb.
February 2017: I have to deprescribe Invokana, because his blood-sugar levels are too low. (Now, I don't leave patients on SGLT2 inhibitors anymore when they start their low-carb journey).
March 2017: Metformin must be cut in half, and so is Irbesartan because his blood pressure is getting too low.
April 2017: His blood sugar levels are too low again. I deprescribe Metformin completely. His blood pressure averages 133/81.
June 2017: Blood work reveals a HBA1c that went from 0.066 (January 2017) to 0.056. He's below the threshold for diabetes (0.065 in Canada). I deprescribe what he had left as hypotensive medication.
July 2017: Every single blood pressure value is normal. His blood sugar levels are still dropping, and stay mostly within the normal range. His weight has dropped from 200 pounds (91 kg) to 174 pounds (79 kg).
Can he do this long term?
Hell yeah! was his answer.
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Dr. Èvelyne Bourdua-Roy, posted with patient's permission
P.S. Are you curious about the wife? She's doing fabulous beyond any reasonable medical expectation, and she might agree to let me tell you her story eventually.
