Defeat Diabetes

2 mins read

Dr Penny Figtree from Port Macquarie has been a GP for 20 years. For a long time, Dr Figtree watched her T2DM patients’ health decline despite numerous attempts to help them through lifestyle changes and medication. After unsuccessful interventions, she discovered the carbohydrate-insulin model of obesity, which showed how the right nutrients could control hunger. She became obsessed when she shared this approach with a new patient who achieved remarkable results. Each patient she treated experienced incredible success, leading her to believe that a low carb approach is life-changing.

Medical history May 2022

  • 69 year old woman
  • Type 2 diabetes:
    • 10 years on insulin managed with Toujeo insulin 28u daily and rapid-acting Novorapid 10 units bd complicated by weekly hypoglycaemic episodes. 
    • Linagliptin 5mg daily 
    • Unable to tolerate GLP-1 agonists
    • HbA1c 6.7%
  • Obesity:
    • Past gastric sleeve, Optifast, consulted dietitians
    • Weight 102 kg 
    • BMI 41
  • Diabetic kidney disease:
    • eGFR 30-51 ml/min/1.73m2. No albuminuria
  • Hypertension:
    • Candesartan, Spironolactone
  • Fatty liver disease
  • Atherogenic dyslipidaemia: Rosuvastatin
  • Sleep apnoea
  • Migraine: Gabapentin, Sodium Valproate, Propanolol, Botox injections
  • Hypothyroid: Oroxine
  • Past ca bowel
  • Specialists involved: Endocrinologist, Nephrologist, Gastroenterologist, Neurologist

Management

  • Presented wanting to lose weight in May 2022.
  • A very low carbohydrate diet was commenced with Toujeo halved, and NoVo rapidly stopped from day 1 of the diet.
  • Blood glucose remained under 10mmol/L; after 5 days, the Toujeo insulin also ceased. Blood glucose remained well controlled with just diet and Linagliptin.
  • On Day 5 the patient felt very lightheaded and unwell. Blood pressure at home was 100 systolic. Spironolactone was ceased.
  • On day 10, blood tests revealed that the eGFR was 31 mmol/L. Candesartan was ceased.

Progress over time

At 18 months, Patient X has:

  • Achieved T2DM remission with HbA1c of 5.4% 
  • Lost 10 kg and feels so much better, and her family cannot believe the difference. She loves not having to fear a hypo.
  • Her blood pressure remains well controlled, and she is still off Candesartan and Spironolactone.
  • Remains off insulin 
  • EGFR improved from 30-50 to consistently 60- 72 ml/min/1.73M2
  • Triglycerides improved from 2.2 to 1.8 mmol/L 
  • Liver function tests have not changed, possibly due to the Valproate.
  • This patient was a challenge at first, with rapid medication reduction being necessary. The doctor needed to have close contact to rapidly reduce insulin and blood pressure medications in the first few weeks. 

After that, it was just support and encouragement! This patient was reluctant to follow the diet, but she has managed to stay on track and continues to do well 18 months later. Her renal physician and endocrinologist from Sydney are AMAZED! She had previously had bariatric surgery, tried Optifast and seen many dieticians. 

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