31/07/2026
Makes sense to me.
Apparently, eating less carbohydrate is extreme
… but urinating out the excess glucose is modern medicine.
Type 2 diabetes is diagnosed when glucose in the bloodstream remains too high.
One class of diabetes medication, namely SGLT2 inhibitors, lowers blood glucose by stopping the kidneys from reabsorbing some of it. Instead, that glucose leaves the body through the urine.
That is the actual mechanism. The FDA describes it plainly: these medications increase urinary glucose excretion.
Yet suggest reducing the foods that create the largest glucose demand in the first place, and suddenly people become deeply concerned:
- Your brain needs carbs.
- That’s too restrictive.
- You can’t sustain that.
- Everything in moderation.
- Just take the medication and eat a balanced diet.
So let me understand the logic.
Eating carbohydrates.
Digesting them into glucose.
Absorbing that glucose into the bloodstream.
Releasing more insulin to manage it.
Then taking medication so the kidneys can remove some of that glucose…
That’s considered reasonable, but reducing the carbohydrate entering the system?
That’s considered dangerous?
We have created a bizarre medical contradiction: Removing glucose after it enters the bloodstream is treatment whilst reducing the dietary source before it gets there is deprivation.
Dietary carbohydrate is not literally identical to table glucose. Different carbohydrates are digested and absorbed at different rates. Protein can also contribute to glucose production, and the liver can manufacture glucose when needed.
All true, but none of that changes the central physiological fact that carbohydrate is the macronutrient with the greatest immediate effect on post-meal blood glucose.
This doesn’t mean everyone with diabetes should stop medication tomorrow. SGLT2 inhibitors may provide important heart and kidney benefits in appropriately selected patients and people taking insulin or glucose-lowering medication should not drastically reduce carbohydrates without monitoring. Their medication may need to be adjusted to prevent dangerously low blood sugar or other complications.
This does expose the question we apparently aren’t supposed to ask being why is carbohydrate reduction so often treated as a last resort when carbohydrate intolerance is sitting at the center of the condition?
If someone cannot tolerate lactose, we remove lactose. If someone reacts to gluten, we investigate gluten. If alcohol is damaging the liver, we don’t prescribe a medication and insist alcohol must remain part of a balanced lifestyle.
However, when someone cannot properly handle a large glucose load, we tell them they still need bread, cereal, pasta, crackers and fruit throughout the day, then chase the resulting glucose with progressively more medication.
That isn’t addressing the entire cause. It’s managing the downstream traffic while refusing to close a few entrance ramps.
Type 2 diabetes is more complex than you ate sugar. Fat mass, muscle mass, sleep, stress, liver function, visceral fat, medications and pancreatic capacity all matter.
Complexity should not, however, be used to deny the obvious which is if your body is struggling to process carbohydrate, changing the amount and quality of carbohydrate is a rational therapeutic tool.
Not a moral punishment, not a fringe ideology, not diet culture, but basic human physiology.
Yet many patients are still given prescriptions before anyone has meaningfully discussed:
- Removing sugary drinks and juice
- Eliminating constant snacking
- Replacing refined starches with protein-rich whole foods
- Building muscle to improve glucose disposal
- Adjusting carbohydrate intake to their actual glucose tolerance
- Measuring fasting insulin before glucose control deteriorates further
Medication may be necessary, but medication should not make nutrition irrelevant.
Lowering a number is not automatically the same thing as correcting the metabolic environment that caused the number to rise.
If a clinician is comfortable prescribing a drug that makes you excrete glucose, but becomes offended when you ask whether eating less carbohydrate might help, they are defending a nutrition doctrine, not following the logic of the disease.
The kidneys should not be the first place we discuss reducing glucose exposure. The grocery cart should be.
