Issue #4

Dear Metabolic Mavericks,

There’s a special kind of insanity that occurs in those sterile examination rooms where we’re told, with unwavering confidence, that our worsening health is simply “disease progression” rather than treatment failure. It’s like being a passenger in a car that’s clearly heading toward a cliff while the driver assures you this is the only possible route to your destination.

I’ve spent countless hours watching doctors frown at my lab results, only to prescribe more of the same interventions that failed to improve those very numbers. It’s medical gaslighting at its finest: “The treatment is working perfectly; it’s your body that’s the problem.”

The moment I realized I needed to fire my endocrinologist wasn’t dramatic. There was no shouting match or flipping of examination tables (though the fantasy has crossed my mind). Instead, it was the quiet epiphany that I was paying hundreds of dollars per visit to have my research dismissed, my improvements minimized, and my concerns translated into prescriptions.

It’s a peculiar arrangement we’ve accepted: paying professionals to ignore us. Like subscribing to a restaurant that keeps serving food you’re allergic to, but insists you keep coming back because they have the credentials to determine what you should be eating.

This issue chronicles my reluctant revolution—how I transitioned from compliant patient to self-advocate, and how my health markers improved as a direct result. More importantly, it provides a framework for determining when to trust medical wisdom and when to challenge it.

Because the most important medical decision you make might be walking away from care that has become its own form of harm.

Rebelliously,
MrT2D

LEAVING FOR A CARE TEAM THAT ACTUALLY CARES

^{In boardrooms across America, healthcare administrators track metrics that have increasingly little to do with actual health. Patient satisfaction scores, time spent per appointment, prescription adherence rates—all optimized for efficiwency and billing, rarely for outcomes.}

^{This creates a peculiar incentive structure where your endocrinologist is often rewarded more for keeping you medicated and compliant than for actually improving your health. It’s not malicious; it’s simply the system working as designed.}

^{“Most doctors genuinely want to help patients,” explains Dr. Samantha Rivera, an endocrinologist who recently left hospital practice to start her own direct-care clinic. “But they’re trapped in a system that gives them seven minutes per patient and a checklist of guidelines to follow. Deviating from those guidelines—even when they’re clearly not working for a specific patient—requires justification, documentation, and often, administrative pushback.”}

^{The result? A form of medical gaslighting where patients who don’t respond to standard protocols are made to feel that they, not the treatment approach, are the problem.}

Consider these common phrases that should trigger immediate skepticism:

^{“This is just how diabetes progresses.” / Translation: Our protocol isn’t working, but we’re not changing it.}

^{“These dietary approaches aren’t sustainable.” / Translation: We have no training in supporting lifestyle changes.}

^{“Your improvements must be due to the medication.” / Translation: We take credit for positive changes but blame you for negative ones.}

^{“That approach isn’t evidence-based.” / Translation: Pharmaceutical companies haven’t funded research on it.}

^{The most insidious aspect of this dynamic is how it undermines patients’ confidence in their own experiences. When your daily glucose readings show improvement from dietary changes, but your doctor dismisses them as “anecdotal,” you begin to doubt your own data. When your weight drops and energy improves from intermittent fasting, but you’re told it’s “just water weight” or “unsustainable,” your legitimate progress is reframed as temporary or meaningless.}

^{This isn’t healthcare. It’s gaslighting with a prescription pad.}

^{The Metrics That Matter vs. The Metrics They Measure}

^{This chart compares commonly used health metrics with potentially more meaningful alternatives.}

MY RELUCTANT REVOLUTION: HOW I BECAME MY OWN ASSISTANT ENDO 

^{It wasn’t a single dramatic moment that led me to fire my endocrinologist, Dr. Peterson. It was death by a thousand clipboard questions.}

^{For three years, I dutifully appeared every four months in his beige waiting room, surrounded by pharmaceutical posters promising miracle medications. Each visit followed the same script: weight check (increasing), blood pressure measurement (concerning), A1C review (stubbornly elevated), and the inevitable adjustment to my medication regimen (always upward).}

^{“Your numbers aren’t where we want them,” he would say, staring at his computer screen rather than at me. “We’re going to increase your Januvia and add a low dose of insulin. The diabetes is progressing.”}

^{When I mentioned reading about intermittent fasting and carbohydrate restriction, his response was always some variation of: “Those approaches aren’t sustainable. Let’s focus on what we know works.”}

^{What worked, apparently, was watching me get progressively sicker while checking more medication boxes.}

^{The breaking point came during my twelfth visit. I’d spent the previous two months meticulously tracking my glucose, experimenting with time-restricted eating, and eliminating refined carbs. My home glucose readings had improved dramatically.}

^{“Interesting,” Dr. Peterson said, glancing at my carefully prepared spreadsheet for approximately 2.7 seconds. “But your A1C is still 7.9, so clearly whatever you’re doing isn’t working. We need to be more aggressive with medication.”}

^{When I pointed out that my A1C had actually improved from 8.3 at my last visit, he shrugged. “That’s within the margin of error. Let’s not get excited about normal fluctuations.”}

^{That night, I realized I was paying $250 per visit (after insurance) to have my data ignored and my questions dismissed. The next morning, I canceled my next appointment and used that money to purchase a continuous glucose monitor instead.}

^{Six months later, my A1C was 6.2—the lowest it had been since diagnosis. I’d lost 34 pounds. I’d eliminated two medications entirely. And I’d learned more about my personal glucose responses than three years of specialist visits had ever revealed.}

^{I didn’t fire my endocrinologist because I think doctors are unnecessary. I fired him because I finally recognized that in the current medical system, nobody will ever care about my health as much as I do. Nobody will investigate my unique physiology with the dedication I can bring to it. And nobody has more at stake in the outcome.}

^{Sometimes self-advocacy means finding better medical partners. Sometimes it means becoming the expert yourself. And sometimes, it means having the courage to walk away from care that has become its own form of harm.}

WHEN TO TRUST VS. WHEN TO CHALLENGE: A DIABETIC’S GUIDE TO MEDICAL PARTNERSHIP

Not all healthcare providers are created equal, and not all medical advice should be treated with the same weight. Here’s your practical guide to knowing when to trust and when to challenge:

Trust When:

They discuss multiple treatment options rather than dictating one approach
Your provider should present you with choices, explain the pros and cons of each, and involve you in decision-making. “Here are three approaches we could try” is vastly different from “This is what you need to do.”

They spend time explaining the “why” behind recommendations
Good providers educate rather than dictate. They explain the mechanism of how a medication works or why a particular dietary approach might help your specific situation.

They show genuine curiosity about your self-experiments and data
A provider worth keeping will be interested in your glucose logs, dietary changes, and self-tracked data. They’ll ask questions and incorporate your experiences into treatment plans.

They’re willing to adjust treatments based on your feedback
If a medication causes side effects or a dietary recommendation doesn’t work with your lifestyle, they modify the approach rather than blaming you for non-compliance.

They acknowledge the limitations of their knowledge
The most trustworthy phrase in medicine might be “I don’t know, but let’s find out.” Beware the provider who has instant, confident answers to every question.

Challenge When:

You hear “this is just how diabetes progresses” as an excuse for worsening numbers
This fatalistic view treats diabetes as an inevitably worsening condition rather than a metabolic disorder that can often be improved or reversed with the right approach.

They dismiss lifestyle interventions as “too difficult to maintain”
This reveals their low expectations and lack of expertise in supporting behavioral change. Many patients successfully maintain significant lifestyle modifications with proper support.

They seem more concerned with guideline adherence than your actual outcomes
Guidelines are designed for population averages, not individual patients. Your provider should be willing to deviate from standard protocols when they’re not working for you.

They spend more time looking at their computer than at you
Electronic health records have turned many providers into data entry clerks. If your doctor seems more engaged with their screen than with you, your care is likely suffering.

They dismiss your research without consideration
“Don’t believe everything you read on the internet” is not a substitute for engaging with informed patients. A good provider welcomes your research and discusses it thoughtfully, even when they disagree.

FINDING A PARTNER, NOT A DICTATOR: QUESTIONS TO ASK BEFORE CHOOSING A NEW ENDOCRINOLOGIST

“What role do you see lifestyle modifications playing in diabetes management versus medication?”
(Listen for nuanced answers that acknowledge both have value)

“How do you feel about patients who want to try reducing medications as their numbers improve?”
(The right answer involves careful monitoring and supportive guidance, not automatic dismissal)

“What’s your approach when standard protocols don’t seem to be working for a patient?”
(Look for willingness to personalize treatment rather than just increasing dosages)

“How do you stay current with emerging research on diabetes management?”
(Beware of doctors who only mention pharmaceutical company educational events)

“What metrics beyond A1C do you track to assess metabolic health?”
(The more comprehensive their answer, the better)

WHAT YOUR DOCTOR DIDN’T MENTION THIS WEEK

Dawn Phenomenon More Responsive to Protein-First Breakfast Than Medication

Many type 2 diabetics experience the frustrating “dawn phenomenon”—elevated morning glucose levels despite overnight fasting. While doctors often prescribe additional medication to address this issue, new research from the University of Melbourne suggests a simpler approach: eating protein before carbohydrates at breakfast.

The study found that consuming 20-30 grams of protein (about 3-4 eggs or a large protein shake) 15-30 minutes before any carbohydrates reduced the morning glucose spike by an average of 28% compared to eating a traditional carbohydrate-rich breakfast.

“The protein-first approach appears to stimulate a first-phase insulin response that’s often blunted in type 2 diabetics,” explains lead researcher Dr. James Patel. “It essentially primes the metabolic pump before the glucose load arrives.”

The most significant finding? This dietary sequencing approach outperformed additional medication in 78% of study participants. Yet most patients report their doctors have never mentioned meal sequencing as a management strategy.

Stress-Induced Hyperglycemia: The Missing Piece in Diabetes Management

While most diabetes education focuses on diet and exercise, emerging research suggests psychological stress may be an equally important factor in glucose management—one rarely addressed in standard care.

A 12-week study from Johns Hopkins University found that simple stress-reduction techniques including guided breathing exercises, progressive muscle relaxation, and brief mindfulness practices reduced average glucose levels by 12-18 mg/dL in participants with type 2 diabetes, comparable to the effect of some oral medications.

“The physiological mechanisms are well-established,” notes Dr. Elizabeth Warren, the study’s lead author. “Stress hormones like cortisol and adrenaline directly raise blood glucose and increase insulin resistance. Yet this pathway is rarely addressed in conventional diabetes care.”

The study found particularly strong effects in participants who practiced stress-reduction techniques before meals and at bedtime—precisely when stress-induced hyperglycemia tends to be most pronounced./

BEYOND THE ABSTRACT

Glycemic Variability Stronger Predictor of Complications Than A1C, 10-Year Study Finds

A groundbreaking 10-year prospective study published in the Journal of Clinical Endocrinology and Metabolism has found that glycemic variability—the degree to which blood glucose levels fluctuate throughout the day—may be a stronger predictor of diabetes complications than the traditionally emphasized A1C.

The study, which followed 1,200 participants with type 2 diabetes, found that those with high glycemic variability had a 64% higher risk of developing retinopathy, nephropathy, and neuropathy compared to those with stable glucose levels, even when matched for identical A1C values.

What it means in plain English: Your quarterly A1C test provides an incomplete picture of your metabolic health. The “roller coaster” effect of blood glucose rising and falling dramatically throughout the day appears to cause more damage than steady, even slightly elevated levels.

Practical implications: This finding underscores the value of continuous glucose monitoring and dietary approaches that produce steady glucose levels rather than the spikes and crashes common with high-carbohydrate diets. It also challenges the conventional medical focus on A1C as the primary metric of successful diabetes management.

The catch: Despite this research, most insurance companies still won’t cover continuous glucose monitors for type 2 diabetics who aren’t on insulin, and many endocrinologists continue to focus primarily on A1C rather than glucose stability. This represents yet another area where patients may need to advocate for care aligned with current research rather than outdated guidelines.

PIPELINE PERSPECTIVE

Are Metabolic Surgery Benefits Achievable Without Surgery? New Research Points to Yes

For years, bariatric surgery has been considered the most effective intervention for type 2 diabetes, with remission rates of 60-80% in appropriate candidates. Now, research from the University of California suggests the metabolic benefits may be achievable without going under the knife.

A three-phase protocol combining specific nutritional approaches, targeted supplements, and precision movement patterns produced diabetes remission in 47% of participants after one year—approaching the success rates of surgical interventions but without the associated risks, costs, and permanence.

The protocol includes:

An initial 2-week very low calorie diet (similar to the pre-op diet given to bariatric patients)

A 10-week carbohydrate-restricted, protein-sparing modified fast

A gradual transition to a personalized nutrition plan based on continuous glucose monitoring data

Specific supplements targeting gut hormone pathways (including berberine, resveratrol, and specialized pre/probiotics)

A movement protocol emphasizing brief, intense resistance training and post-meal walking

“We’re essentially mimicking the hormonal and metabolic changes seen after bariatric surgery, but through non-surgical interventions,” explains Dr. Rebecca Chen, the study’s lead author. “While the success rate isn’t quite as high as surgery, the approach carries substantially lower risk and cost.”

The medical establishment perspective: Mainstream medical organizations remain skeptical, noting the protocol’s complexity and questioning long-term adherence rates. Several professional associations have issued statements emphasizing that bariatric surgery remains the “gold standard” intervention for appropriately selected patients.

DIY potential: While the complete protocol requires medical supervision, many elements—including post-meal walking, carbohydrate restriction, and certain widely available supplements—can be implemented by motivated patients under appropriate medical monitoring.

EDITOR’S CORNER

Welcome to the second issue of Mr. T2D! Your response to our first newsletter was overwhelming—it seems the diabetes rebellion is larger than even I imagined.

Many of you shared your own stories of medical gaslighting, surprising recoveries, and the challenges of navigating a healthcare system that often seems designed to manage disease rather than restore health. These stories confirm what I suspected: there’s a growing community of diabetics who refuse to accept the standard narrative that our condition only moves in one direction.

This issue’s focus on medical partnerships versus medical dictatorships clearly struck a nerve. To be clear: I’m not anti-doctor. I’m anti-dogma. There are brilliant, open-minded endocrinologists practicing today who embrace patient partnership and remain curious about approaches beyond standard protocols. If you’ve found one, treasure them.

But for those trapped in dysfunctional medical relationships, remember this: breaking up with your doctor isn’t failing at healthcare. Sometimes it’s the first step toward reclaiming it.

In future issues, we’ll explore the emerging science of continuous glucose monitoring, dive deep into various nutritional approaches for diabetes management, investigate the connection between sleep quality and insulin sensitivity, and continue highlighting the stories of ordinary people achieving extraordinary health transformations.

Until next month, keep your glucose steady and your medical skepticism healthy.

— MrT2D