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Old 12-12-2015, 17:51   #1
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Hi All,

Apologies in advance for a slightly long winded post but hopefully it will be of interest to some! I am as yet undiagnosed but following a recent discussion with my GP, I would like to ask your collective opinion regarding my blood sugar oddities.

I have a family history of type 2 diabetes and although I'm a slim bloke, had not been the most active person over the last 10 years (I'm 34 now). My diet was also terrible consisting largely of carbs on top of carbs with little to no exercise. I started to become suspicious something was amiss when I developed itchy feet, lethargy and a general feeling of something being off. On the advice of a family member I purchased a glucose meter and after a couple of weeks of testing found that although my fasting levels were good (4.4), my postprandial levels were getting quite high following carb rich meals (anything around 8-9 or even 10mmol at 45 mins to 1 hour and falling to around 7 or under at hour 2 and back to normal at hour 3).

I saw a doctor (who was not my normal GP) and he largely dismissed it, took an A1C which was later confirmed to be apparently normal and told me not to worry. However, due to my family history I felt compelled to address it.

This all happened around June of this year and since then, I have changed from being a couch potato into the polar opposite. I walk every day after meals, do Interval Training and have cut my carb intake dramatically, favouring veggies, proteins and healthy fats. Due to a much healthier diet lower in calories, I've lost weight on my already slim frame and have thankfully regained some of the muscle definition I had in my youth (I'm now 70kg, 6ft tall). My fasting sugar is still the same (around 4.4) but lately I have noticed a change in my postprandial levels which I hope is a good thing, but I'm really not sure whether it's my body regaining it's insulin sensitivity or the fact that somehow my insulin levels have started to rise.

After a carby meal, my blood sugar will now get up to around 6 or 7 at 30 to 45 mins, immediately dropping to around 4.8 and stay there for around 30 mins to a hour, then slowly start climbing to around 6 for another hour and then returning to fasting levels at hour 4.

So my question is basically this, of the 2 of these outcomes, which is better?

1. A big spike around 8 -9mmol 30 minutes after eating, which stays for nearly an hour but returns to fasting levels at hour 2-3,

OR

2. A quickly corrected sugar level of 6-7mmol, going to 4.8mmol at around 30 mins to 1 hour, then rising later to around 6-6.5mmol, being slowly corrected to fasting levels around hours 3 to 4.

My doctor said that it would appear that I have regained my insulin sensitivity and admitted that this is not something he'd seen before, however he couldn't explain the late rise other than saying it could be protein/fat being absorbed later.

Do you think that the above suggests I have regained some insulin sensitivity/first phase insulin response or does it point to increased insulin production by my body?

Obviously having typed all this, I can see this sounds like a rambling load of old waffle, but I'm hoping some kind soul will have had a similar experience or have some scientific insight to share!

Thanks in advance!

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Old 12-12-2015, 18:34   #2
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Please forgive me if I don't address your specific questions, but what you've described is absolutely familiar to those of us in the diabetes 'club', so rest assured we fully accept what you're saying. It's just that you're being led a bit stray by doctors who brush off test results without giving you the actual numbers, pat you on the head & tell you not to worry. Almost to a man, we are accustomed to getting brushed off by docs who don't have a clue about diabetes or its management. I commend you for sticking to your guns and pursuing the issue.

Although doctors, for whatever reasons, fixate on fasting readings, it is postprandials that are the early warning signs of metabolic malfunctions. Since you already have a meter, we have a method to our madness, and we call it eat-to-your-meter. Following this technique, you will gain more information about your body and your condition than anything the docs can come up with.

The other thing I suggest, despite your family history of type 2, is that your doctor needs to test you for autoimmune antibodies as well as c-peptide. You are slim and you are young (I can say that because I'm twice your age. ), both of which signal the possibility of type 1 or 1.5 (LADA)




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Last edited by Shanny; 12-12-2015 at 18:46.
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Old 12-12-2015, 19:28   #3
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That's really helpful, thanks.

Yes, it definitely feels like I've been given the brush off before but I have a new doctor now who thankfully seems more receptive.

I'll take your advice and probably get the GAD and C Peptide tests privately sometime over the next couple of months.

What I find confusing though is if my pancreas/insulin response had become impaired as per those with LADA, does the recent change to the way my body is processing carbs (i.e the apparent return of a first phase insulin response which prevents my levels climbing too high) suggest that LADA is less likely?

I guess I'm hopeful that my extreme changes to diet and exercise helped me to lose some visceral fat, regain some pancreatic function and reduce insulin resistance: ie. I was showing prediabetic/type 2 symptoms but have managed to regain some control through diet and exercise?

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Old 12-12-2015, 19:40   #4
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As Shanny says, the figures you should focus on are the post meal numbers. When we've got problems with processing carbohydrate, it's there that we will first see the evidence.

At the surgery, checking blood sugar is easy to do, and some doctors rely on them to point up an issue - so they don't see anything unusual unless you had a nice big snack an hour before your appointment.

The HbA1c test could also be entirely in the "normal" range too. This figure represents the proportion of your hemoglobin permanently bonded to glucose. It maps (crudely) to your average blood sugar over roughly the last three months. But the important word here is "average". For instance, and we'll use my figure as an example, my HbA1c is currently 5.0% (or 31 mmol/mol using the international standard that your doctor should be using). That maps to an average blood sugar of 5.4 mmol/L. On the face of it, a very good (non diabetic) figure. Perhaps I had low numbers of 5 and highs of 5.8 - entirely satisfactory. Or did I have lows of 3 and highs of 8 (after meals)? Without that information the figure in isolation is of doubtful value. That said, your doctor should give you the data.

Your post meal surge followed by a sudden drop, followed by a bit of a climb and a slow fall suggests some degree of insulin resistance but not too severe at the present. To get an idea of What is a Normal Blood Sugar? have a look at the link and then look at How Blood Sugar Control Works--And How It Stops Working

Those two links are part of Blood Sugar 101 - a very helpful site discussing diabetes in all its complications. Well worth a hour or two.

to the forum.

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Old 12-12-2015, 19:44   #5
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Thanks John, I appreciate the insight.

I'll definitely get the necessary tests to rule out LADA as I'll feel better knowing there I stand.

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Old 12-12-2015, 20:01   #6
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Just a detail that I discovered (the hard way). Weight loss and Exercise is all too often treated by doctors as the way to eliminate the problems of diabetes type 2.

That does help - a little but the main approach to control lies in what we put in our mouth. Not "how much" - but "what". We do need to examine our way of eating. Notice, I don't use the word "diet". That four letter word carries too much baggage of being temporary and we can't afford that luxury. Five years back I changed my way of eating - permanently.

The approach focuses on cutting back on the food group that causes blood sugar to rise and provides nothing that we can't get for other foods. My intake of carbohydrate was cut (and stays cut) back to somewhere around 40 to 50 grams per day. I eat a respectable level of protein and a substantial portion of healthy natural fats. All in all, around 2,200 calories per day. In the first six months of my time with this condition I lost 2 stone in weight (without trying). Another link to explore Getting started on LCHF Part 1: Clean out day | The Science of Human Potential but just one caution. Professor Grant makes reference to a "Whatever Day" but since diabetes doesn't take days off, we can't afford to either

So, whether your doctor finally says, "sorry, you've got diabetes..." or not, your pattern of post meal figures suggests you could benefit by exploring this change. Think about it.

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Old 12-12-2015, 20:32   #7
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I guess my best advice would be "Stop eating carby meals."

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Old 12-12-2015, 22:14   #8
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Thanks guys,

Yes, in line with the exercise I have dramatically decreased the number of refined carbs I eat and get most of my carbs from vegetables and small qualities of steelcut oats and occasional small portions of shortgrain rice; sorry, I should have made that clearer. I have also upped my protein and healthy fats as you suggest.

My main question really stemmed from some recent 'tests' I did to see how well my body tolerates carbs and on the surface I would seem to have improved my early response compared to a few months ago. Although my 2-3 hour seems slighty slower to return to fasting, my bodies prevention of the early rise I had before keeps me from going over 7mmol most of the time, even with larger quantities of carbs.

It just seemed a bit anomalous compared to other accounts I'd read of peoples diabetic/prediabetic insulin response, in that the first phase is the first to go, followed by the second, followed by fasting; I hadn't read any reports of people regaining their first phase but having a change/ slight decline in their second phase

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Old 12-12-2015, 23:31   #9
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What you describe is what most people are looking for and this is why many people go into denial and let diabetes get a good foothold in our lives. People often are looking for rules to follow and basically there are none. I only know of one valid rule and that is what works for me, may not work for you and another way some people use is your mileage may vary (YMMV). Yes, there can be a second rule and that is unmanaged diabetes can be deadly, but I prefer saying that the progression can be prevented or halted for several decades of you manage your food and if needed, your medications.

Always strive to manage diabetes and realize that you may be similar in some ways to another person, but you have to discover for yourself what is happening to your body and work diligently to develop habits that fit managing what happens to you and not worrying about why you cannot manage your diabetes like another person.

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Old 12-13-2015, 00:03   #10
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Forget the "refined carbs" business, and discontinue the oats and rice.

All grains are high-concentration carbohydrate, and pretty much a no-no for us.

No more than 50 gm of carbohydrate per day should be where you start, but feel free to go lower.

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