Disappointing lab results
cstehansen
Posts: 1,984 Member
As background, I was diagnosed T2D last year with A1c of 6.6. I did the only thing that seemed logical and cut my carbs significantly, not to keto levels, but much lower than the typical diet and got my A1c down to 5.9 in about 4 months. At that point, I moved to just being a bit stricter than the ADA recommendations and it went up to 6.2 in about 6 months.
This motivated me to really take it seriously which is when I went Keto back in August. It appeared to be working as my BG readings were lower than they had been. I was still experiencing the "dawn phenomenon" but those went from about 115 to about 102 average. As for PP readings, they went from over 100 to usually in the 90's and frequently in the 80's. The only spikes I get are after working out.
I used an online calculator and these readings to get an estimate of my A1c, and it came back at 5.2. However, at my appointment yesterday, I got my results which was 6.3!
This appointment was with my GP who was not happy about my cholesterol readings, other than my HDL of 70. LDL did go up, but not enough to have me concerned. The A1c is what has me perplexed.
Both my GP and Endo seem to be predisposed to thinking the only solution outside of a generic "eat better and exercise" is to write a prescription.
When I tried to discuss the post exercise spikes with my GP, he said that doesn't happen and that after exercise is the lowest it will ever be. Given you can find many articles about this with a simple Google search, I have decided he may be a good GP, but he clearly doesn't know diabetes.
In my research so far, IR is the most common cause of T2, but there are others - thyroid, under-production of insulin and stress. Given I have never been obese, and even when my BMI was above normal, it was due primarily to lifting weights consistently for the last 30+ years, my body type/shape has never fit the IR model.
Doing additional research after my appointment has led me to believe the under-production of insulin and/or stress (which would include the fact I still don't get enough sleep) make more sense as to a cause in my case rather than IR. However, both my GP and Endo think an insulin test is unneeded.
All that said, I have an appointment with a doctor who is on the list on Jimmy Moore's website. I listened to part of an interview Jimmy had with this doctor about a book he had written which Jimmy found very impressive. The appointment is Monday. I don't expect everything to be solved in one appointment, but I am hoping to get some answers.
This motivated me to really take it seriously which is when I went Keto back in August. It appeared to be working as my BG readings were lower than they had been. I was still experiencing the "dawn phenomenon" but those went from about 115 to about 102 average. As for PP readings, they went from over 100 to usually in the 90's and frequently in the 80's. The only spikes I get are after working out.
I used an online calculator and these readings to get an estimate of my A1c, and it came back at 5.2. However, at my appointment yesterday, I got my results which was 6.3!
This appointment was with my GP who was not happy about my cholesterol readings, other than my HDL of 70. LDL did go up, but not enough to have me concerned. The A1c is what has me perplexed.
Both my GP and Endo seem to be predisposed to thinking the only solution outside of a generic "eat better and exercise" is to write a prescription.
When I tried to discuss the post exercise spikes with my GP, he said that doesn't happen and that after exercise is the lowest it will ever be. Given you can find many articles about this with a simple Google search, I have decided he may be a good GP, but he clearly doesn't know diabetes.
In my research so far, IR is the most common cause of T2, but there are others - thyroid, under-production of insulin and stress. Given I have never been obese, and even when my BMI was above normal, it was due primarily to lifting weights consistently for the last 30+ years, my body type/shape has never fit the IR model.
Doing additional research after my appointment has led me to believe the under-production of insulin and/or stress (which would include the fact I still don't get enough sleep) make more sense as to a cause in my case rather than IR. However, both my GP and Endo think an insulin test is unneeded.
All that said, I have an appointment with a doctor who is on the list on Jimmy Moore's website. I listened to part of an interview Jimmy had with this doctor about a book he had written which Jimmy found very impressive. The appointment is Monday. I don't expect everything to be solved in one appointment, but I am hoping to get some answers.
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Replies
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Sorry to hear the results were not where you expected them to be. I understand and agree with your plan to see a different doc with a background in your precise health concerns. That's always smart. I've found, generally speaking, that I prefer docs with DO behind their name over MD. They just seem more in tune to overall health and are more cutting edge and up to date. I searched high and low for the doc I just recently found because I wanted that Doctor of Osteopathy behind his name. I wish you well and much success as you continue your journey!0
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Sorry for your lab results not being as good as you wanted. I hope you can get all that straightened out with the new doctor! I'm worried about going in for my recheck on my cholesterol now. I hope everything goes well Monday!1
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That's weird that he wouldn't test insulin. That's one of the diagnostic tests for those with insulin resistance. If it is a bit high = insulin resistance. If it is low = could be LADA.
Are you sure your Dawn phenomenon is lower? Do you test it at various times in the morning, or in the very early hours of the day? I just ask because I am wondering if your liver is pumping out more glucose than you thought. Perhaps that with higher BG after workouts was enough to raise your A1C?
You may want to do some excessive testing for a few days. Maybe checking every hour or so, especially around meals and see what your body is doing.
Otherwise, my guess is stress. That can do it.
Keep us updated. I'm interested to know what the other doctor says.
And congrats on the good HDL.3 -
I agree the A1C seems out of place, but it isn't fool proof. There are various factors that could cause A1C to appear better or worse than BG results would indicate. It would make more sense to me to use more, well... useful data.
You already know about a common spike post-exercise. My suggestion is to decrease intensity. Do you use a HRM while exercising? If yes, try to monitor your HR and keep it below 70% max HR. Your Google searches probably already turned up the issue of rising BG at high intensities, so I'm aware this probably doesn't add much for you.
Otherwise, I don't suggest stressing too much about 6.3%. That is still low enough to alleviate concern of long-term complications. If you know your BG's are good (it sounds like you have enough variety of testing times to show this) and the A1C is showing higher than reality, then my 2 cents is to go off of BG's first.0 -
A1C is +-0.5%
so your readings are really:
6.1-7.1
5.4-6.4
5.7-6.7
5.8-6.8
also, bleeding or taking asprin, E, or C will throw off the test...as will having high triglycerides (and fat loss will cause a boost in trigs)
I guess my point is, it's only one metric, and if in the last 6-8 weeks you are supplementing or taking any blood thinner for pain/fever/etc, or if you have lost fat, then you aren't going to get a truly accurate test - there should be more indicators than just this one prior to drugs being prescribed, in my opinion, but doctors are a bit drug happy.1 -
@cstehansen - Not only are there non-glucose factors that may give distorted A1c readings, as @tcunbeliever and @midwesterner85 point out, but there are also different ways to run the test itself and differences from lab to lab.
Dr. Bernstein thus suggests that frequent spot BG tests are preferable - assuming you're using a reliable meter.*
I well understand the desire not to take pills, but they are not all bad. Since you're recently diagnosed, your goal is to beat your diabetes into submission and cure the *kitten* thing, not just control it!
Control is my best scenario, having come late to the LC party, but I've been able to get on top of it with very picky eating and Glucophage XR, which some believe lowers your risk for other things you don't want. Perhaps if you were to drive your BG down with the aid of Glucophage, you could get back off it relatively quickly....
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*My research turned up the best price/quality combo as the Bayer Contour Next, which you can get for $5 on Amazon, and soon-to-expire test strips are cheap, too. So I got 4 of them and pile of strips.
I test 5-10x daily. If something seems out of place, I'll try a different meter. They've been remarkably close to each other and are almost always +/- 7 of a previous result from the same sample. (Beware - the prior generation Bayer Contour is not in the same league!)2 -
I appreciate the feedback. I am thinking that if it is lower insulin production rather than IR, then logic would state IF is not as good an option as spreading food throughout the day. Even with low carbs, spreading what I am eating out more would seem like it would work better than the 16/8 schedule I have been on for nearly 2 months.
Workout intensity is already something I am evaluating. As a told my wife last night, I probably do not need to be working out the way I do at my age. It's not like I am training for any major competitions or sports anymore. Also reducing my workouts could allow me to reduce overall caloric intake by about 1/3 to a more "normal" amount is probably healthier.
Triglycerides are still good at 54 and HDL is good at 70. LDL being above target is not overly concerning because the ratios of HDL to total and of HDL to total are still good. From what I have seen on the dr I am seeing on Monday, I think he will be agreeable to doing more tests like LDL-P which is a better indicator than just LDL in addition to insulin.
@nvmomketo I do check within a few minutes of waking up every day, and my schedule is very regular - up at 4:45am M-F and checked by 4:55 and up at 6 on the weekends and checked by 6:10. On the weekends, it will go down into the 90's within an hour or so, but on the weekdays when I go to the gym, it can take 3 hours or more from when I get home from the gym for it to get back into the 90s. That first reading is the one that has dropped almost 15 pts.1 -
Trigs and HDL are the important ratios. LDL isn't as important, if at all, and unless I forgot something, can actually be protective of long term mental health. @cstehansen
I would agree with dialing back the exercise, because my basic assumption would be that you have a glycogen burst released from the liver at some point during the workout, hence the increased glucose numbers.
The thyroid and adrenal stress can definitely be a factor.
Something that shocked the heck out of me was that sleep alone can cause insulin resistance. If you have 1 hour less than optimum (number varies from 6-10 per person, usually), per day, 4 days in a row, you have created a level of insulin resistance. Period. It really helped me to prioritize my sleep, even if I'm not getting optimum numbers yet, I'm still better than I was.
http://chrismasterjohnphd.com/2016/08/24/insulin-resistance-isnt-all-about-carbs-and-insulin/
This really helped me get my head around insulin resistance in general, and it actually makes quite a bit of sense to me why your exercise and eat a ton scenario prior to your diagnosis could have triggered the cellular energy excess creating the insulin resistance, etc.
I hope you get some amazing information from that doctor on Monday. I'm seeing my PCP on Monday, and I hope to dive into this somewhat... She's been talking off and on about genetic testing, and I'm just waiting to see what we'll do...1 -
Lots, lots, lots of good input on this thread. I too, am sorry your A1C is not where you expected. I agree with your decision to seek another appt with a provider who may be more savvy about the whole diabetic process and have insight as to how to tease out the triggers for your A1C increase. Will be looking forward to your update and sending good thoughts your way in the meantime.0
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I decided to do multiple checks after the gym today every 30 minutes. Seems my peek is about an hour after I get home from the gym as it is starting to come down now. Gym is closed tomorrow, but I plan on taking my glucometer with me and do some testing while I'm there as well to see if it is spiking during exercise or only after.
@RalfLott, you check even more than I do and I thought I was compulsive about it. I think I average 4-6 times a day. That is going up right now because I MUST figure out when it is getting elevated since PP, which would be the normal time, is not it. Those are consistently between 83 and 94.
I have two Freestyle Neo monitors. I have tested them together and they are consistently within a 2-3 points of each other. I also have taken one with me to both my GP and Endo and tested and gotten within 2-3 of what their meters read, so I feel pretty good about the accuracy of them.
For now, it is just a matter of enjoying Thanksgiving as I still have much to be thankful for and wait for my appt on Monday.3 -
I would definitely look into LADA. It certainly seems possible and you need to know for sure as you will lose all insulin production at some point if it is. LADA is T1D that just takes its time attacking the beta cells. They should test you for antibodies to confirm. This is serious and could land you in ICU with DKA if someone doesn't catch it soon enough.
Eating keto should help slow down the beta cell death though so you're still doing the right thing.
I really hope there's just some fluke and maybe even a bad test or something but you need to get a doctor willing to test for antibodies for you asap.5 -
Sunny_Bunny_ wrote: »I would definitely look into LADA. It certainly seems possible and you need to know for sure as you will lose all insulin production at some point if it is. LADA is T1D that just takes its time attacking the beta cells. They should test you for antibodies to confirm. This is serious and could land you in ICU with DKA if someone doesn't catch it soon enough.
Eating keto should help slow down the beta cell death though so you're still doing the right thing.
I really hope there's just some fluke and maybe even a bad test or something but you need to get a doctor willing to test for antibodies for you asap.
Wow.
@Sunny_Bunny_ - Would you expect LADA to cause BG spikes during/after exercise, though not PP?
@midwesterner85 @cstehansen0 -
Sunny_Bunny_ wrote: »I would definitely look into LADA. It certainly seems possible and you need to know for sure as you will lose all insulin production at some point if it is. LADA is T1D that just takes its time attacking the beta cells. They should test you for antibodies to confirm. This is serious and could land you in ICU with DKA if someone doesn't catch it soon enough.
Eating keto should help slow down the beta cell death though so you're still doing the right thing.
I really hope there's just some fluke and maybe even a bad test or something but you need to get a doctor willing to test for antibodies for you asap.
Wow.
@Sunny_Bunny_ - Would you expect LADA to cause BG spikes during/after exercise, though not PP?
@midwesterner85 @cstehansen
PP, the food would stimulate insulin though, right? Just the volume of it. If there is protein it should stimulate more insulin and that should, theoretically take care of rising BG PP.... If carb intake is low, BG shouldn't go up too much either.
I'm guessing here. Please correct me where I'm wrong. I tend to get a lot of this stuff mixed up still.0 -
I'm just saying that something other than lifestyle may be the explanation for this one. Everything about low carb and incorporating exercise "should" have brought that A1c down. Since it didn't go down and actually even went up, LADA does seem to be a possible factor.0
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I had thought about LADA, but didn't say anything because the BG's don't match A1C anyway. It can't hurt to test for antibodies and rule it out though. But yes, LADA and everyone else would expect PP spikes. Reactive hypoglycemic may follow that spike with a hypo while uneducated type 1's (including LADA), and 2's will follow that spike with a slow or no drop. Non-diabetics will see a faster and appropriate drop.1
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I want to say thank you for all the responses. I have been reading about LADA quite a bit today. Honestly it is pretty scary. I read part of something from the Mayo Clinic site which she and I both thought described me perfectly. After being an athletic 215 pounder for nearly 20 years, I very easily dropped to 195 in about 18 months at which time I got diagnosed with T2 despite having BF % of about 18-19 which is pretty good for a 45 yo desk jockey. Currently holding at 182 with no effort.
I am now not sure it is the exercise that is jacking up my BG. Given it is a holiday, I did not go to the gym this morning, but I did test about every half hour from when I got up at 6 until 10. It steadily rose for the first 3 hours I was up before starting to drop again. I only had black coffee. No calories of any kind since dinner last night. Perhaps I am just getting a weird am spike after I get up. I was moderately active just getting stuff done before the in-laws came over but nothing strenuous.
Very strange. Definitely think LADA needs to be part of the discussion with the Dr Monday.
To make things even crazier, 2 HR PP of 82. Of course had a LC meal, but these PP readings are what have been throwing me off.0 -
cstehansen wrote: »I want to say thank you for all the responses. I have been reading about LADA quite a bit today. Honestly it is pretty scary. I read part of something from the Mayo Clinic site which she and I both thought described me perfectly. After being an athletic 215 pounder for nearly 20 years, I very easily dropped to 195 in about 18 months at which time I got diagnosed with T2 despite having BF % of about 18-19 which is pretty good for a 45 yo desk jockey. Currently holding at 182 with no effort.
I am now not sure it is the exercise that is jacking up my BG. Given it is a holiday, I did not go to the gym this morning, but I did test about every half hour from when I got up at 6 until 10. It steadily rose for the first 3 hours I was up before starting to drop again. I only had black coffee. No calories of any kind since dinner last night. Perhaps I am just getting a weird am spike after I get up. I was moderately active just getting stuff done before the in-laws came over but nothing strenuous.
Very strange. Definitely think LADA needs to be part of the discussion with the Dr Monday.
To make things even crazier, 2 HR PP of 82. Of course had a LC meal, but these PP readings are what have been throwing me off.
FYI, here's a snippet from a discussion on aerobic vs. anaerobic exercise in T1Ds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/figure/fig1/ from Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/During anaerobic exercise, a rise in catecholamines and a failure in circulating insulin levels to increase at the end of vigorous exercise in individuals with type 1 diabetes increases glucose production by the liver while limiting glucose disposal into skeletal muscle (lower panel). Because of the mismatch in glucose production and utilization, circulating glucose levels rise and hyperglycemia can occur.1 -
cstehansen wrote: »I want to say thank you for all the responses. I have been reading about LADA quite a bit today. Honestly it is pretty scary. I read part of something from the Mayo Clinic site which she and I both thought described me perfectly. After being an athletic 215 pounder for nearly 20 years, I very easily dropped to 195 in about 18 months at which time I got diagnosed with T2 despite having BF % of about 18-19 which is pretty good for a 45 yo desk jockey. Currently holding at 182 with no effort.
I am now not sure it is the exercise that is jacking up my BG. Given it is a holiday, I did not go to the gym this morning, but I did test about every half hour from when I got up at 6 until 10. It steadily rose for the first 3 hours I was up before starting to drop again. I only had black coffee. No calories of any kind since dinner last night. Perhaps I am just getting a weird am spike after I get up. I was moderately active just getting stuff done before the in-laws came over but nothing strenuous.
Very strange. Definitely think LADA needs to be part of the discussion with the Dr Monday.
To make things even crazier, 2 HR PP of 82. Of course had a LC meal, but these PP readings are what have been throwing me off.
FYI, here's a snippet from an discussion on aerobic vs. anaerobic exercise in T1Ds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/figure/fig1/ from Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/During anaerobic exercise, a rise in catecholamines and a failure in circulating insulin levels to increase at the end of vigorous exercise in individuals with type 1 diabetes increases glucose production by the liver while limiting glucose disposal into skeletal muscle (lower panel). Because of the mismatch in glucose production and utilization, circulating glucose levels rise and hyperglycemia can occur.
Thank you so much. We had a massive hailstorm here in April such that we had to move out of our house for almost 4 months. This may sound crazy, but we had softball sized hail that went all the way through not just the roof, but in some spots through the ceiling.
Anyway, you can imagine how that completely screwed up my routine. I quit running and have pretty much just done strength training since then. Based on this, if I do have LADA, it would seem logical that the hyperglycemia associated with anaerobic exercise described in this article could apply to me as well especially given it says it could have an effect up to 24 hours later.
Now I have more n=1 experimentation to do with readings before, during and after different types of exercise.1 -
cstehansen wrote: »FYI, here's a snippet from a discussion on aerobic vs. anaerobic exercise in T1Ds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/figure/fig1/ from Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/During anaerobic exercise, a rise in catecholamines and a failure in circulating insulin levels to increase at the end of vigorous exercise in individuals with type 1 diabetes increases glucose production by the liver while limiting glucose disposal into skeletal muscle (lower panel). Because of the mismatch in glucose production and utilization, circulating glucose levels rise and hyperglycemia can occur.
Thank you so much. We had a massive hailstorm here in April such that we had to move out of our house for almost 4 months. This may sound crazy, but we had softball sized hail that went all the way through not just the roof, but in some spots through the ceiling.
Anyway, you can imagine how that completely screwed up my routine. I quit running and have pretty much just done strength training since then. Based on this, if I do have LADA, it would seem logical that the hyperglycemia associated with anaerobic exercise described in this article could apply to me as well especially given it says it could have an effect up to 24 hours later.
Now I have more n=1 experimentation to do with readings before, during and after different types of exercise.
It will only add to what has already been a pretty interesting ride for you! (Even without the sci-fi scene you described...)
Here's the first of several video segments by Dr. Bernstein on exercise. He's a lifelong T1D who figured out the LC approach on his own, and he's still doing resistance training in his 80s.
One of the things I admire most about him is his foregone conclusion that diabetics are entitled to expect the same BG levels as non-diabetics.
https://www.youtube.com/watch?v=Z80-c0CXYqc
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cstehansen wrote: »FYI, here's a snippet from a discussion on aerobic vs. anaerobic exercise in T1Ds:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/figure/fig1/ from Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769951/During anaerobic exercise, a rise in catecholamines and a failure in circulating insulin levels to increase at the end of vigorous exercise in individuals with type 1 diabetes increases glucose production by the liver while limiting glucose disposal into skeletal muscle (lower panel). Because of the mismatch in glucose production and utilization, circulating glucose levels rise and hyperglycemia can occur.
Thank you so much. We had a massive hailstorm here in April such that we had to move out of our house for almost 4 months. This may sound crazy, but we had softball sized hail that went all the way through not just the roof, but in some spots through the ceiling.
Anyway, you can imagine how that completely screwed up my routine. I quit running and have pretty much just done strength training since then. Based on this, if I do have LADA, it would seem logical that the hyperglycemia associated with anaerobic exercise described in this article could apply to me as well especially given it says it could have an effect up to 24 hours later.
Now I have more n=1 experimentation to do with readings before, during and after different types of exercise.
It will only add to what has already been a pretty interesting ride for you! (Even without the sci-fi scene you described...)
Here's the first of several video segments by Dr. Bernstein on exercise. He's a lifelong T1D who figured out the LC approach on his own, and he's still doing resistance training in his 80s.
One of the things I admire most about him is his foregone conclusion that diabetics are entitled to expect the same BG levels as non-diabetics.https://www.youtube.com/watch?v=Z80-c0CXYqc
Thank you again. This series of videos was already on my "to watch" list, but I hadn't gotten to them. I watched this one and will watch the one on aerobic exercise later today time permitting. Clearly he has done something right given he has made it into his 80's as a T1 which is rare.2 -
@cstehansen -
Yeah, Dr. Bernstein is one of the wonders of the world!
Actually, he is just extremely motivated (and very smart) - he pretty much figured on his own out how to deal with T1 (LC + exercise + insulin very carefully timed and selected). He never accepted many "established principles" taken for granted by other "experts" until he personally put them to the test - which naturally gave him a very jaundiced view of the ADA.
The other vids in his "Diabetes University" series on Youtube are filled with insights from decades of closely observing thousands of diabetic patients he has treated. (Only downside - you'll need a lot of time to watch them all.)3
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