Unfortunately I'm not techno-hip enough to post links, but if you google on RC Turner and metformin and monotherapy, you will find a couple of studies which show what happens when people with diabetes get the low-fat, high carbo diet, either alone or with sulfonylureas or metformin or insulin. Six to nine years later, their beta cells are all burned out, they are insulin dependent. This is what they've got to offer us, if we don't know about Bernstein.For me the most tragic/ludicrous statement was "since a low-fat, high carbohydrate diet is known to decrease insulin resistance..." So they did this study and never tried the obvious comparison, of people normalizing their sugars via Bernstein. And it never dawned on them that their own results should have made them question their initial premise about diet. Sheesh. I quote from somebody on a committee I once served on - "hey, we've all got Phd's but we're not Stupid..." not always true, I guess.

Amen!

I often find myself wondering how many diabetics would stick with low carbing if given the knowledge and the choice: low carb and possibly get off medications and reverse any complications that you may already have developed, increase your chances for a longer healthier life and decrease the possibility of more complications or developing any at all or continue to eat as you are and take more medication?
Low carbing does involve a certain amount of self-denial and self-discipline. How many would choose this WOL over not needing much self-discipline or self-denial and simply swallowing a pill a couple of times a day or injecting insulin and pretty much eating whatever you pleased even if it meant eventual insulin injections?
I read many posts all over the forum from people who are struggling with low carb and giving up their old favorite foods. Granted, diabetics have a bit more motivation to stick with it as the consequences of not sticking with it mean a return to more medication or insulin injections and the very real possibility of worsening health, but given that humans can be very short sighted by nature, how many would choose the medication over dietary changes and the trade off of better health in the future by excercising some self-discipline over eating what you want now?
Add to that the pervasive attitude in America today that pills "fix" everything and I have the sad feeling that many would choose the medication over the dietary changes.
While working for a doctor for a couple of years, I observed the difficulty that many seemed to have even sticking to the much higher carb ADA diet...it seemed that they either just didn't know what kind of damage that they were doing to their bodies or just didn't care when faced with the prospect of cutting back on eating pies, cakes, cookies, doughnuts, etc... Then the ADA comes out with the position that sugar is perfectly okay for diabetics...as long as they "cover" it with more medication. Is the ADA simply being pragmatic in their recommendation knowing that most people won't comply with cutting back on sugar (or cutting it out altogether) no matter how much they are told that it's going to hurt them and make them sicker and simply recommending that diabetics go ahead and eat it but increase their medications to compensate? I don't have the answer to that one.
I know for myself, I would rather low carb for life than go back to feeling like I did and taking several pills each day while the pounds piled on and my condition worsened.

Conspiracy theorists might say the situation is even more ominous than just a lack of will power. The drug companies make a huge amount of money each year providing diabetics with the meds they need to compensate for their high carb diets. If all type 2s were successfully engaged in a low carb diet, the cost to the drug companies would be immense.

So many profound issues in this thread.

I've often speculated that many times our physicians, deep in their heart of hearts, know what the really effective treatement is, but are constantly weighing in their own minds the tradeoff between optimal treatment and the ability to obtain compliance with their instructions. I think that sometimes they knowingly instruct patients suboptimally because they know that at least they can obtain a given level of compliance and thereby provide their patients some treatment which is effective. If they attempt to provide truly optimal treatment they run the risk that they'll make matters worse if the patient doesn't fully comply.

For instance, if my doctor tells me to keep my carbohydrate count below 30 grams per day and consume as much fat as I wish, what are the risks? If I cheat and eat 100 or 200 grams CHO / day with the increased fat intake, they are considerable. The excess insulin produced will stimulate my liver to produce adipose tissue, raise my LDL cholesterol, lower my HDL and increas triglycerides. In short, make matters worse.

The line of least resistance for them is to follow the ADA party line, and rest assured that they're not opening themselves up to a malpractice suit. The medical literature is replete with recommendations about the "proper" treatment and diet for diabetes. They can always cite it if anybody challenges their dietary recommdations.

While I'm sure that the drug companies would lose a great deal of revenue if all type 2's began low carbing, not all type 2's would be able to discontinue medications simply because of low carbing. Some type 2's have too many burned out beta cells to control by diet alone by the time that they are diagnosed. Nor do I believe that all type 2's would choose low carbing over medications if given an informed choice. Heck...ask any group of doctors how well their patients comply with even the ADA diet, let alone low carb. Type 1's would also continue to require insulin and other medications whether they were low carbing or not, just less of them.
My whole point in the above post is that many would rather take the medications than change their eating habits even knowing that the dietary changes would offer them less complications and better health in the long run. I've run into this myself with people I know at work who would rather continue to take medication because they simply aren't willing to give up the foods that the medication allows them to eat and still maintain some degree of control although I have to admit that I find that whole line of thinking puzzling to say the least. Then again, perhaps it's really no different than people who continue to smoke even though they know the dangers that it presents to their bodies and even after they've been diagnosed with lung cancer or COPD.
I think this applies with any diet that people are "told" to go on. Unless it's their choice, chances are good that they won't be committed to it for the long haul.

Well, here I am replying to my own thread. Many interesting thoughts here - sometimes I think they've just bought into the "evil fat" theory so much that they are blinded. For instance - two hours ago, I had dinner- grilled steak, daikon "homefries" radicchio,bacon and gorgonzola salad. A nice meal. And now two hours later, my bg is 86. With NO medication. But my old Dr. would have just flipped. BACON? SATURATED FAT? RIBSTEAK? She would rather have me eating baked potatoes(nothing on them, natch) beans, corn, pasta, with lots of glyburide to barely bring the bg down to 180. Go figure.

The one that gets me is where the doctors prescribe 'just' insulin and no glucophage/metformin to make the injected insulin more effective....