Interesting Dr follow up with LCHF friendly doc for T2
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@cstehansen I'm still reading the series, but this seems to fit in with my unusual situation of insulin levels being high and FBG and A1C not being high YET. Now if I can figure out how to get my insulin levels down without stalling out my thyroid gland, I'll be set...(physical limitations limit exercise choices, super low carb for insulin control aggravate thyroid issues, etc.)... *sigh* Once again, finding information leads to more questions... Have you read this article yet?
tuitnutrition.com/2015/09/its-the-insulin-1.html
EDITED TO ADD: Link to pursue from comments about folks struggling with consistency/losses on LCHF/Keto... altshiftdiet.com/. Haven't read yet, but sharing in case it rings true with others.2 -
KnitOrMiss wrote: »@cstehansen I'm still reading the series, but this seems to fit in with my unusual situation of insulin levels being high and FBG and A1C not being high YET. Now if I can figure out how to get my insulin levels down without stalling out my thyroid gland, I'll be set...(physical limitations limit exercise choices, super low carb for insulin control aggravate thyroid issues, etc.)... *sigh* Once again, finding information leads to more questions... Have you read this article yet?
tuitnutrition.com/2015/09/its-the-insulin-1.html
EDITED TO ADD: Link to pursue from comments about folks struggling with consistency/losses on LCHF/Keto... altshiftdiet.com/. Haven't read yet, but sharing in case it rings true with others.
I was aware of Dr. Kraft's work first from one of the Keto Summit presenters. She was doing her doctoral theses on the topic and explained it quite well. It was also brought up in a recent Livin La Vida Low Carb podcast which was a recording of a presentation given at a low carb summit early last year.
Based on all you have posted, it would seem you are in a hyperinsulinemic state, but whether it is 2, 3 or 4, it would be hard to be sure. Since you have said you are morbidly obese, my guess would be 4 where you always have a very high level of insulin even in a fasted state. Of course, that is just based on using my logic (which has served me pretty well so far in my journey). In reality, it doesn't really matter which of these it is to some extent because all will lead to T2. It is just a matter of how soon.
Have you ever had any kind of insulin test? A fasting insulin test would likely give you some answers. However, based on the presenter from the Keto Summit and a couple others, you have to be careful with a single fasting test. Just having something stressful happen in the car ride to the office could cause a glycogen release which would cause elevated insulin. Based on what they said, if it is low, you should be fine, but a high could be artificial for reasons like that. "Normal" is 5-15, but my new doc said mine at 3 was considered normal for someone who processes carbs fine (which my other tests confirmed) but is on a keto diet (which I am).
The sucky part is insurance doesn't always cover insulin testing and, as the person you have linked to indicated, most doctors still don't understand the importance of it. Postponing diagnosis of diabetes until BG is elevated is like waiting until the elevator is plummeting rather than working on the cable when it starts to show that it is fraying.3 -
Insurance has covered all my insulin tests run by in Endocrinologist, and he's the one who said my postprandial crashes were a huge red flag of IR...and wanted it tested. @cstehansen
These are my results. I was on Metformin from October 2014 until March 2015, but the digestive side effects were nearly impossible for my dehydration issues...so I stopped it, but somewhere between end of 2015 and beginning 2016 I was off low carb for a while, but back on it some, but my thyroid can't handle it... I'm debating asking my Endo to put me back on the name brand of Met instead of generic. I was taking the XR when I did take it, but I started developing neuropathy, ad I really wasn't even on it that long, even taking B-12 and a B-Complex...
I went low carb 1/15/15 then keto 2/18/15, and my weight losses stalled out in April 2015. My worst TSH reading in this timeframe was October 2015, which was when my insulin levels were lowest, and so my endo said I couldn't keep on the plan, needed to switch up, which as you can see here is when everything went squirrelly. I'm really thinking I'm going to have to find a functional doc... The only ones I have found so far are either not close enough or I'll have to sell my soul to the devil to afford. On that low carb doc list, only one close to me is a bariatric surgeon. I just need to call and see if he does the genetic testing and all of that, or if he's only low carb friendly due to the bariatrics...
I have hyperinsulinemia on my health record, and have all the signs of cellular energy overload/resistance in addition to insulin resistance, but I don't know if there is a test for that...and I'm still fighting to understand it all...
Insulin Level
Date Result Ref Range Flag
19-Oct-16 11.3 uIU/mL 2.0-19.6 uIU/mL
31-May-16 9.9 uIU/mL 2.0-19.6
15-Apr-16 15 uIU/mL 3-19 uIU/mL.
14-Oct-15 5.8 uIU/mL 2.0-19.6
21-Apr-15 7.1 uIU/mL 2.0-19.6
29-Oct-14 7.6 uIU/mL 2.0-19.6
17-May-14 9 uIU/mL <23
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I can offer nothing but sympathy @KnitOrMiss . You and @baconslave do so much here and you rarely let your own struggles show. I hope you find your answers and your research and experiments can end soon. More referrals perhaps? At least here in Canada, the more unusual your symptoms, the further up the specialist ladder you climb. Teaching hospitals are often the best.5
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So as an update, I have been regularly checking FBG and 2hr PP for all meals since making a conscious effort to manage stress and taking the recommended supplements. I also check other times at random.
I have been using google sheets on my phone to log all of these and earlier this week moved the info to excel so I could see the trends. It seemed like the numbers were trending down, but when they are in a fairly wide range, it is kind of hard to see when just eyeballing it.
Anyway, below is a screenshot of what is on my 30 day trend. It includes the primary checks (i.e. 2hr PPb= PP for breakfast, PPl is for lunch and PPd is dinner). I also included the checks I do after workouts.
When I added the trend lines, it is pretty easy to see ALL of them are trending down. All are still higher than I would like, but this trend is quite encouraging.
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cstehansen wrote: »So as an update, I have been regularly checking FBG and 2hr PP for all meals since making a conscious effort to manage stress and taking the recommended supplements. I also check other times at random.
I have been using google sheets on my phone to log all of these and earlier this week moved the info to excel so I could see the trends. It seemed like the numbers were trending down, but when they are in a fairly wide range, it is kind of hard to see when just eyeballing it.
Anyway, below is a screenshot of what is on my 30 day trend. It includes the primary checks (i.e. 2hr PPb= PP for breakfast, PPl is for lunch and PPd is dinner). I also included the checks I do after workouts.
When I added the trend lines, it is pretty easy to see ALL of them are trending down. All are still higher than I would like, but this trend is quite encouraging.
Nice!0 -
Utterly fascinating calculation of insulin resistance I just ran across. According these calculations, there's some debate as to whether I am or am not...based on calculation alone. @cstehansen @RalfLott
https://twitter.com/tednaiman/status/814482322246365184/photo/11 -
KnitOrMiss wrote: »Utterly fascinating calculation of insulin resistance I just ran across. According these calculations, there's some debate as to whether I am or am not...based on calculation alone. @cstehansen @RalfLott
https://twitter.com/tednaiman/status/814482322246365184/photo/1
That was one of the measurements used on my labs that showed I was not IR. Also, just the fact my fasting insulin was 3. The other was a carbohydrate metabolism test where they grew some of my blood cells in and "fed" it glucose and fructose. That last test also showed I actually metabolize carbs better than average. My HOMA-IR score was 0.8 on the report, but by this calculation, it was 0.75555555..... which would be in the "excellent" range. I am guessing my report just rounded to the nearest tenth.2 -
@cstehansen - Dr. Kraft's review of different patterns in 5-hour OGTT's with hourly insulin assays (as well as your own experience) shows pretty clearly that glucose and insulin do not always travel in lockstep.
www.amazon.com/gp/aw/d/B0062EYR7U/2 -
So, in working this calculation out, at the time I was diagnosed as insulin resistant, it was lower than tests after I stopped eating low carb for my thyroid health...
May 2014 - 1.96 score (88, 9) - diagnosed as IR due to symptoms, confirmed with fasting insulin level, TSH 2.694 (Total T4 numbers through the roof - no other thyroid tests run yet)
Oct 2014 - 1.69 score (90, 7.6) - On Metformin since May, TSH 1.640, but T4 jumped high!
Apr 2015 - 1.61 score (92, 7.1) - Stopped Metformin in March, Doc confirmed acceptable due to keto, TSH 2.699
Oct 2015 - 1.22 score (85, 1.22) - full keto but gaining weight BUT - TSH skyrocketed to 3.979
Apr 2016 - 3.3 score (89, 15) - overall LC, but bad stress/food week, TSH 2.04, low free T3, no RT3, T3 Med added
May 2016 - 2.18 score, estimated - FBG not retested, insulin 9.9 - RT3 26, FT3 2.9 no others retested. doses ++
Oct 2016 - 2.54 score (91, 11.3) - Fully SAD, TSH 2.87, FT4 1, FT3 2.9, increased thyroid meds, both.
Jan 2017 - No labs, requested back onto Glucophage. Noticeable changes - less food narcolepsy reactions. Softened stool, not excessive. Very mild nausea a few times. Better sleep. Playing with timing. Likely to ask to take twice a day instead of once.
So, I have no idea what it all means, but the insulin roller coaster is still worrying, despite that it is a dynamic value that can change dramatically in a short timeframe... There is as of yet no A1C equivalent of insulin.... I do know there every time I stamped down my insulin levels, my thyroid worsened, usually significantly.
Insulin down, glucose up...though in smaller increments on the glucose side... I want a relational chart to put everything in so it makes sense how it relates!!!!2 -
@baconslave Please add this to the links in the Sticky Post. I don't know if you want LC Friendly Docs, or if this should go under the diabetes stuff, or what, but I just spent 30 minutes looking for the link because I wasn't smart enough to save it where I could find it...
Way too much good info in this post...
Thanks!!!!0 -
It's already in the Diabetic Discussions thread, but I'll put it in Open in a sec.0
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Thanks! I'm still learning to navigate that post since I don't use it often. I didn't see the link to the diabetics part because I went straight to the open thread section. My bad!
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Since this thread has come up again, I thought I would give a little more information out of it. As mentioned before, the number of labs run was extensive, so doing some additional research on what some of them mean has taken a while. One of the tests that has fascinated me was for adiponectin.
I am guessing I am not the only one who had never heard of this protein that is secreted by adipose (fat) tissue. It was listed in the section of the report dealing with diabetes along with A1c, FBG, HOMA-IR, GSP, Fasting Insulin and C-Peptide.
Basically, high is good and low is bad. This is a fairly new area of research, but the following are all correlated with low levels of adiponectin:- Insulin resistance
- coronary artery disease
- hypertension
- diabetes
- obesity
- dyslipidemia
It appears adiponectin facilitates insulin sensitivity. There is some research at the cellular and mouse levels with using it to treat insulin resistance in a couple different ways. From what I can see, this would seem like a promising venture, but like most will probably take several years to get through all the regulatory hurdles and then to the marketplace.
Despite being produced by adipose tissue, the amount produced is inversely related to the amount of body fat one has - so someone with low body fat produces more.
Additionally, levels are inversely related to triglycerides but positively correlated to HDL. So high HDL and low triglycerides would indicate high (good) adiponectin levels. This would corroborate research showing that the most important cholesterol number in terms of risk is HDL to triglyceride ratio. @RalfLott - thought you might be interested in this part.
This is a quote from the link below that I thought was amazing if this does turn out to be translated into medicinal therapy, "adiponectin may have anti-atherogenic properties." For all the pushing of statins, there is little to no evidence they actually reduce risk for most people and the risk that has been shown to be reduced seems to be based on reduced inflammation. Atherosclorosis is the first step in coronary artery disease 100% of the time. If this can be reduced using a protein the body naturally makes, that seems worlds better than using artificial medications like statins. After all, one could have an adiponectin deficiency, but there is no such thing as a statin deficiency.
Here is a link for anyone who wants to totally geek out on this:
http://care.diabetesjournals.org/content/26/8/24425 -
Thx, @cstehansen!0
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KnitOrMiss wrote: »Thanks! I'm still learning to navigate that post since I don't use it often. I didn't see the link to the diabetics part because I went straight to the open thread section. My bad!
I apologize for the wonky hoops we have to go through to find anything here even though, 1) I didn't make this nonsense and 2) I can't fix the nonsense. But if looks could kill, this platform would be dead 96.3 times over already by my hand.3 -
@baconslave.... probably that should be rounded to the nearest tenth too... and I agree. I can't begin to imagine what it's like to navigate via the app on a phone, it's hard enough on a desktop.
Just following along on this thread because I find the thyroid info fascinating and it's almost time for my 6 month update tests (end of April); and thankfully no insulin/BG issues for me.2 -
As I approach 3 months since my visit with this LCHF friendly doctor, I thought I would share some results. BTW, those of you who haven't noticed, yes, I am a nerd.
Anyway, I think this graph showing my BG readings for AM fasting, 2 hrs post lunch and 2 hours post dinner speak for itself. I had already been keto for about 4 months at this time and my BG readings and A1c had leveled off so I was seeing no additional improvement.
Although I was no longer in the diabetic range and the improvement had all been without meds of any kind, an A1c of 6.0 is not acceptable. Seeing this continued drop in my readings has been encouraging although slow. That is until about the last 10 days where my AM reading took a stair step drop of about 12 points on average from about 112 to about 100 average with 4 of the last 10 being under 100 and 2 being exactly 100.
The reasons I am sharing this are the same as why I posted this originally. Sometimes the approaches that work for most won't work. Everyone needs to remember your doctor works for you and therefore you are free to fire him/her and find a new one if s/he is not helping. Everyone should probably do some n=1 experimentation to find what does work. And finally, sometimes results are not as fast as we would like, so you have to be patient.
I found keeping this log in Excel and adding the trend lines showing the decline was very helpful. Otherwise seeing these numbers that go up and down every day may not look to the naked eye like progress because the trend line is not always clear - especially when it is a slow trend like mine shows.
In case you are wondering, that week or so with the spike in AM and the missing lunch/dinner readings in mid February was when I was on a cruise. That has been my one "cheat" since August.
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@cstehansen - that's so great that something is finally working for you, once you knew which tools to use for the job! Congrats. Interesting to see the cruise effect, but to know that it comes right back down to trending downward as soon as you resume normalcy... All the more reason to stay on task!1
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bump0
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Really interesting video. You could put that in its own thread.
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Will do.0
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>spike<0
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Almost good timing @RalfLott as I have blood draw for my next appt on the 22nd. Since I plan on getting full work up to be able to compare to the last one, some of the testing will take at least 2 weeks to get back so I won't have full results until June. I plan on giving an update at that time.2
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cstehansen wrote: »Almost good timing @RalfLott as I have blood draw for my next appt on the 22nd. Since I plan on getting full work up to be able to compare to the last one, some of the testing will take at least 2 weeks to get back so I won't have full results until June. I plan on giving an update at that time.
Are you thinking of making projections of your new numbers ?
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cstehansen wrote: »Almost good timing @RalfLott as I have blood draw for my next appt on the 22nd. Since I plan on getting full work up to be able to compare to the last one, some of the testing will take at least 2 weeks to get back so I won't have full results until June. I plan on giving an update at that time.
Are you thinking of making projections of your new numbers ?
That is a tough one. My FBG is down about 8-9 mg/dl and my after meal is down a little less than that. These aren't huge drops, however, I seem to have far fewer random spikes. Since A1c is an average, I think the leveling off of all the readings and lack of spikes may have a bigger impact than the other reading. I just don't know how much.
Last A1c was 6.0. If I use an online calculator, it tells me somewhere in the 5.5 range. That is much better and out of the official pre-diabetic range, but I am really shooting to get to 5.0 or less.2 -
@cstehansen - Good luck. I'm guessing you'll be pretty darn close if not down into the 4-zone.1
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cstehansen wrote: »Almost good timing @RalfLott as I have blood draw for my next appt on the 22nd. Since I plan on getting full work up to be able to compare to the last one, some of the testing will take at least 2 weeks to get back so I won't have full results until June. I plan on giving an update at that time.
Are you thinking of making projections of your new numbers ?
Should we start a pool?
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Ill bet a six-pack of Twinkies on 4.9.!1
https://youtu.be/8t1JN0RgvO4
