The puzzle that is BG
2t9nty
Posts: 1,647 Member
So yesterday was one of those days. The bishop was making his visit at the parish. I was distracted getting out of the house. I neglected to take morning meds (metformin, etc.), and I did not catch it until I went to take evening meds. It was a busy day, and I tried to eat properly, but I went over on carbs. There are not always good choices, and you do the best you can. I had over 10K steps just in the course of the day.
I checked glucose when I got home at 4 or so. It was 123, so about where I might have expected. I checked again at 6 before eating and it was 91. I ate supper and discovered I had not taken the morning dose of metformin. I guess there was some residual effect and maybe some still in the bloodstream after 24 hours. This stuff is not formulaic.
I checked glucose when I got home at 4 or so. It was 123, so about where I might have expected. I checked again at 6 before eating and it was 91. I ate supper and discovered I had not taken the morning dose of metformin. I guess there was some residual effect and maybe some still in the bloodstream after 24 hours. This stuff is not formulaic.
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Wow, sounds tricky alright... @RalfLott knows quite a bit about this stuff... I'm flagging him down with an '@'
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The numbers have been low for the past couple of days (for me anyway). Two hours after supper last night was 116, and I was at 103 this morning. It was 107 when I got home from work. I am going with the good numbers this week, but I would have expected things to be higher Sunday.
My next appointment is March 13. I want to have my A1C down again. The meter says my 30-day average is 116 which bodes well.1 -
It sounds like things are moving in the right direction for you. Even on a busy, less than perfect day. That's great!
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It sounds like things are moving in the right direction for you. Even on a busy, less than perfect day. That's great!
Yep!
Sounds like your liver and pancreas have enjoyed the holiday and are rewarding you for your kindness. The preceding dose of metformin (XR?) probably also plays a role, though in my case, my BG will dutifully start to climb if I skip even one whole day.
Time + restraint = results. Congrats!
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It sounds like things are moving in the right direction for you. Even on a busy, less than perfect day. That's great!
Yep!
Sounds like your liver and pancreas have enjoyed the holiday and are rewarding you for your kindness. The preceding dose of metformin (XR?) probably also plays a role, though in my case, my BG will dutifully start to climb if I skip even one whole day.
Time + restraint = results. Congrats!
No XR here. It is just the standard generic metformin 1000 twice a day. I like to think the liver is making a recovery. My fasting morning readings have been lower and sometimes a little under the last reading the night before. This is heading in the right direction.1 -
This Sunday was better. I remembered my morning meds, and I kept net carbs to 12.2
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It sounds like things are moving in the right direction for you. Even on a busy, less than perfect day. That's great!
Yep!
Sounds like your liver and pancreas have enjoyed the holiday and are rewarding you for your kindness. The preceding dose of metformin (XR?) probably also plays a role, though in my case, my BG will dutifully start to climb if I skip even one whole day.
Time + restraint = results. Congrats!
No XR here. It is just the standard generic metformin 1000 twice a day. I like to think the liver is making a recovery. My fasting morning readings have been lower and sometimes a little under the last reading the night before. This is heading in the right direction.
You're more likely to have spikes (not to mention GI distress) if you take immediate release metformin. Your blood level peaks and falls quite a bit sooner than on XR, so your timing (best before meals) could be pretty important.
Since generic XR is cheap, even out of pocket, I'm puzzled why your doc would prescribe IR. ??0 -
You're more likely to have spikes (not to mention GI distress) if you take immediate release metformin. Your blood level peaks and falls quite a bit sooner than on XR, so your timing (best before meals) could be pretty important.
Since generic XR is cheap, even out of pocket, I'm puzzled why your doc would prescribe IR. ??
Good question with the XR. I may ask him about it at the next appt. I had a little GI distress early, but that seems to have "passed."0 -
You're more likely to have spikes (not to mention GI distress) if you take immediate release metformin. Your blood level peaks and falls quite a bit sooner than on XR, so your timing (best before meals) could be pretty important.
Since generic XR is cheap, even out of pocket, I'm puzzled why your doc would prescribe IR. ??
Good question with the XR. I may ask him about it at the next appt. I had a little GI distress early, but that seems to have "passed."
Haha, Good call! I have to think your sermons are rich in well-turned phrases.
Dr. Bernstein in his Youtube teleseminars often advocates both XR and the name brand Glucophage to minimize unpassed GI distress.
I wonder if having a combo of XR and IR might give you the most flexibility, so if you wind up changing your game plan by eating earlier than you'd expected, you can take an IR before a meal.0 -
Thanks - I am curious about levels of metformin in the bloodstream. If I check glucose late afternoon or before supper at night, it will often be my lowest reading of the day - in the 90's a couple of times recently. At that point it will be 10 or 11 hours since the morning metformin dose. I am not really sure I understand how metformin works. Does it have an impact over time in terms of "conditioning" organs and cells or does the presence of it in the bloodstream have an impact when food is being processed?1
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Yes, metformin does build up, but missing a dose should still result in a small increase in BG / decrease in effectiveness. Miss it for a week, though, and you will see progressively larger increases in BG as the levels you have previously built up wear down.
As to timing, keep in mind that the XR is still known to have peaks. If you switch to an XR, you might want to watch meal timing. Honestly, though, I doubt it will be enough to notice. Metformin works with or without food, but the individual goal makes it important as to whether to have it working with or without food. The idea is to minimize glycogen release, which happens at all times and more so when not obtaining glucose from food (in healthy individuals). If your goal is to minimize glycogen release around meal times because post-meal is where you struggle with higher BG's, then you want it to be most effective during the time window shortly after eating. If, on the other hand, your issue is with too much glycogen release while fasting, then the time should match that. For example, if your problem is morning fasting BG's, then a Metformin dose expected to work in the 2hr.-8hr. window should be taken before bed.
ETA: The XR version is also known to be easier for some who experience negative GI side effects from metformin.2 -
I can also personally attest to having almost no reactions to be brand name version, Glucophage XR. I've got three doses left out of my first 30 day Rx, and I'm happy to report that most of the reactions I had related back to me not having a gallbladder rather than reactions to the medication. The effect might have been augmented slightly by the meds, but not enough to rule it out as cause. I've found out that for now, my insurance is going to keep paying for it, and I'm happy for that for the time being. 2 more months until next bloodwork.1
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My BG levels have been fairly boring recently. For today so far
Fasting 4:30 AM - 10 hours since eating: 118
90 min after breakfast - 7:45 AM: 117
Before lunch - 11:30 AM: 119
105 min after lunch - 1:15 PM: 109
My readings an hour after eating and two hours after eating are often almost identical. I tend to check just once in that window if I am home. Today is my day off, so it is not a problem to check. It is also my most sedentary day. If I am at work I will check on rising, when I get home and two hrs(ish) after supper. When I get home will be the low for the day as a rule.0 -
@midwesterner85 - That's some great information. I really have very limited experience with Metformin/Glucophage...and my prior experience was all bad. I either had to carb load or go keto to avoid side effects, and keto without a gallbladder had it's own bundle of side effects... This time around it is better. I'm almost ready to start tracking and dialing back the carbs again....fully.1
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KnitOrMiss wrote: »@midwesterner85 - That's some great information. I really have very limited experience with Metformin/Glucophage...and my prior experience was all bad. I either had to carb load or go keto to avoid side effects, and keto without a gallbladder had it's own bundle of side effects... This time around it is better. I'm almost ready to start tracking and dialing back the carbs again....fully.
Are you taking your Glucophage with, before, or after meals?0 -
So far I've been taking it (it's still only once a day, will be reevaluated when I got back to the doctor in April) with my breakfast with my digestive enzymes, which means I've taken a bite or two of food before taking the pill, but before half my meal... I've taken it on an empty stomach before a meal before, when I realized it was the same time of day but I wasn't going to be eating soon... I just feel that I have the "narcing" reactions less when I take it during the day. Taking it at night didn't help the daytime reactions...at least not to where I could readily tell the way I can when I take it with breakfast.
I know it's supposed to be 24 hours, but my body has ALWAYS processed meds out sooner. Ibuprofen is supposed to be a 4-8 hour efficacy, and generally, by hour 3, it's worn off for me. Tylenol only works if I take it with aspirin and/or caffeine (like in Pamprin or Excedrin)... Same with vicodin or whatever I've had after surgery...2 hours 45 minutes or 3 hours, and it's wearing off. If the pain is bad (like after my ankle surgery), I literally had to set an alarm for myself to wake up or make sure i took the meds specifically on a schedule, because if it had time to wear fully off before the new dose was starting, oh, man, it was horrific. I had anesthesia for my gallbladder surgery, and they said it could be 24-48 hours before I felt normal. 8-12 hours later, I was completely out of the feelings of it. I have to have triple the numbing agent to have dental work done, etc.
I don't know what causes it, but it is genetic, because my dad is exactly the same way. But it means I also tend to have far less of side effects - like unless I'm worn out almost dead, vicodin doesn't make me sleepy. It really stinks... The things that are supposed to help don't always.
What is the critical point about timing? For me, it's about keeping the insulin under control, and my issues are throughout the day, so taking it mid-morning makes the most sense to me.... Do docs prescribe starting with it at night due to the side effects and such? Or is there more science there?0 -
I have been (too) busy with work and got a couple of nights with poor sleep. Glucose levels responded to the stress I guess, and so I have had some discouraging numbers - 173 two hours after supper a couple of nights ago and average for yesterday was 129. I am staying the course here, but I guess there are ups and downs.
As one of those data points, someone in the church made me some crab soup that I had some of two nights ago. I pulled out all the visible potatoes and carrots before eating it, but I think some of the potatoes had dissolved gone "into suspension." I thought I would be OK, and even with the estimated milk in the recipe I entered, I thought my carbs were in the hunt. One hour after eating it, my glucose was 167. An hour after that, it was 173. I guess this is a lesson learned about my reaction to potatoes.2 -
I have been (too) busy with work and got a couple of nights with poor sleep. Glucose levels responded to the stress I guess, and so I have had some discouraging numbers - 173 two hours after supper a couple of nights ago and average for yesterday was 129. I am staying the course here, but I guess there are ups and downs.
As one of those data points, someone in the church made me some crab soup that I had some of two nights ago. I pulled out all the visible potatoes and carrots before eating it, but I think some of the potatoes had dissolved gone "into suspension." I thought I would be OK, and even with the estimated milk in the recipe I entered, I thought my carbs were in the hunt. One hour after eating it, my glucose was 167. An hour after that, it was 173. I guess this is a lesson learned about my reaction to potatoes.
It is difficult when people try to do something nice for you, but due to a lack of understanding give/offer you something that has that kind of effect. My wife is the office manager at our church, so I end up at our monthly new comer's lunch because she has to be there. It can be difficult to walk the line between being polite and appreciative but not eating stuff you know will have an adverse affect on your BG. We have to be wary of everything that we don't make ourselves whether it is in a restaurant or made by someone else.
Fortunately, this is a marathon and not a sprint. A bad day here and there won't kill you as long as they stay far enough apart.3 -
cstehansen wrote: »
Fortunately, this is a marathon and not a sprint. A bad day here and there won't kill you as long as they stay far enough apart.
True enough. I need to do damage control and minimize the bad ones. It is a little irritating though that it was not like I decided to eat two doughnuts at coffee hour knowing the consequences. I was trying to be good. I just have a nuanced understanding of "good" now.
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It can be hard to pin down culprits! Things I thought I had figured out I now realize I completely gaffed. I suspect there are gangs of significant variables we'll never be aware of...0
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I have probably shared more than some what to read in terms of my n=1 experiments. However, I think we all have to do this because I have yet to find a quality medical study where 100% of those in the sample group responded the same way. We are all ultimately responsible for our own health and therefore have to be willing to do our own experiments. There are lots of potential culprits out there from too much protein which affects some but not other to "slow" carbs which some can eat and other can't. The list goes on and on.
@2t9nty - I do want to add that the lack of sleep is a very likely culprit in at least exacerbating the response you had to that soup. Lack of quality sleep will spike cortisol in almost everyone which will in turn spike glucose. In my own personal case, I know if I get poor sleep multiple nights in a row, I can expect every reading I take (which is from 3 to 8 a day) will be higher and may stay higher for a few days.3 -
Hang in there @2t9nty it takes time to get it under control, but you're clearly moving in the right direction. Stress, lack of sleep and illness (cold, flu) have a devastating affect on my BG.
But in one year I went from an HBA1C of 6.3 which required 310 units of insulin a day to achieve to a 5.5 with no insulin, and I've been a T2 diabetic for 11+ years. I still have to inject periodically if something sends me out of control (i.e. the items listed above and the occasional poor meal choice), but 90% of the time I'm med-free. I'm definitely still a diabetic, but it's very manageable now with diet and exercise and I hope when I finish losing weight my body will function even better.
I wish you all the best with your journey.3 -
PaleoInScotland wrote: »Hang in there @2t9nty it takes time to get it under control, but you're clearly moving in the right direction. Stress, lack of sleep and illness (cold, flu) have a devastating affect on my BG.
But in one year I went from an HBA1C of 6.3 which required 310 units of insulin a day to achieve to a 5.5 with no insulin, and I've been a T2 diabetic for 11+ years. I still have to inject periodically if something sends me out of control (i.e. the items listed above and the occasional poor meal choice), but 90% of the time I'm med-free. I'm definitely still a diabetic, but it's very manageable now with diet and exercise and I hope when I finish losing weight my body will function even better.
I wish you all the best with your journey.
Good insights and great progress!0 -
PaleoInScotland wrote: »Hang in there @2t9nty it takes time to get it under control, but you're clearly moving in the right direction. Stress, lack of sleep and illness (cold, flu) have a devastating affect on my BG.
But in one year I went from an HBA1C of 6.3 which required 310 units of insulin a day to achieve to a 5.5 with no insulin, and I've been a T2 diabetic for 11+ years. I still have to inject periodically if something sends me out of control (i.e. the items listed above and the occasional poor meal choice), but 90% of the time I'm med-free. I'm definitely still a diabetic, but it's very manageable now with diet and exercise and I hope when I finish losing weight my body will function even better.
I wish you all the best with your journey.
Thanks - this is a speed bump on the road. I know that, but it was still discouraging. I was only diagnosed T2 in October, so I don't have the experience with the ups and downs really. I guess I don't know what to expect because I seem to have responded well to the LCHF diet, and my BG numbers have been mostly on a good downward trend. I am staying the course. When I got home from work today, it was 107. I liked that, so maybe I am back to normal (well, as normal as I get).1 -
Another thought is that in a cream based soup, many still use a Roux as a thickener, @2t9nty ... so you could have been wheated or glutened, both of which can have an amplified effect. Also, using milk or half and half instead of cream in a cream soup will increase the sugars in the broth part of the soup, even if it doesn't taste sweet...and most consider it "healthier" due to the lower fats, etc. Just a few more items to consider...
Even if you aren't auto-immune, gluten can often have a very negative effect on the body, particularly when other health issues are also at play.1 -
I keep hearing from many drs, and apparently there's a study out somewhere (AND I WANT THAT LINK), that gluten causes leaky gut in EVERYONE. The gut regenerates fast so many are ok. The damage heals pretty quick. But the people with genetic predisposition to gluten sensitivity or autoimmunity, or already have a gut in bad shape (antibiotics and etc) can't heal as fast, so they get gluten proteins in the blood which confuses/activates the immune system, and since the proteins resemble some body tissues (called molecular mimicry) the activated immune system attacks those body tissues, too. Many think that all autoimmunity is caused by food sensitivities like this ans dairy or legumes or nightshades. Other causes are heavy metal toxicity (think mercury from fish or dental amalgams) or sensitivities to molds or chemicals in their environment.
There: a TL;DR for every autoimmune summit lately.
You can take a $380 blood test through dr Osborne (glutenfreesociety.org) that will determine if you have those genes for gluten sensitivity...or you can eliminate it for 30 days...1 -
Yeah, I have been told, I want to say it was Dr. Mark Hyman?, that if you are even remotely gluten sensitive, it can take 6 MONTHS to heal from a single instance of gluten intake - intentional or not... I think it was Dr. Hyman and the other lady from...and adrenal summit that focused on auto-immune issues, and 4 things EVERY autoimmune patient should do:
Quitting gluten
Addressing yeast
Adding T3 Meds
Adding Progesterone, if warranted
Ashwagandha was a supplement they mentioned that pretty much EVERYONE can benefit from, too...
Looked back, it was the adrenal reset summit. Let me know if you want me to scour my notes, @baconslave and see what else I can find...0 -
Dr. David Perlmutter perhaps? He's very anti-grain (as I'm sure is known by most) and seems to relate EVERYTHING back to gluten and gut. @baconslave0
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KnitOrMiss wrote: »Another thought is that in a cream based soup, many still use a Roux as a thickener, @2t9nty ... so you could have been wheated or glutened, both of which can have an amplified effect. Also, using milk or half and half instead of cream in a cream soup will increase the sugars in the broth part of the soup, even if it doesn't taste sweet...and most consider it "healthier" due to the lower fats, etc. Just a few more items to consider...
Even if you aren't auto-immune, gluten can often have a very negative effect on the body, particularly when other health issues are also at play.
One of the issues is that you don't thump a free melon. You don't want it to sound like the inquisition when someone brings some soup by...
I am guessing it was made with milk, thickened with flour, AND had potatoes that had cooked to nothing and could not be fished out because they were in suspension. I have learned a lesson here about not taking much for granted wrt to food.0 -
Dr. David Perlmutter perhaps? He's very anti-grain (as I'm sure is known by most) and seems to relate EVERYTHING back to gluten and gut. @baconslave
I heard it from Tom O'Bryan. But he never gave the source. I'll have to look around.1
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