Introduction - T2D
2t9nty
Posts: 1,631 Member
Hello...
I am a type 2 diabetic and have been taking metformin 1000's twice a day. I have been observing a somewhat low carb diet to try to address the glucose levels. I am fairly active, and I will get 8000 to 14000 steps most days. My goal with eating has been about 50 grams (net) per day, and I have been reasonably successful with this.
My glucose levels seem to bounce around a lot with no real predictability. 90 min after eating at night, I will check glucose and get a reading of 124. 10 hours later my fasting glucose will be 145. Then other days the same readings will be 119 and 105. I understand there is a "dawn phenomenon" with some people, and I wonder if anyone has any ideas about why I see it sometimes and not others? I will get my first A1C since diagnosis in January, so that will be a better indication of how I am doing in general.
I have been using MFP for a couple of months as I have been more aware of eating and watching carbs. I have mostly read a few of the threads and not had much to say. I decided it was probably time to introduce myself.
Thanks...
I am a type 2 diabetic and have been taking metformin 1000's twice a day. I have been observing a somewhat low carb diet to try to address the glucose levels. I am fairly active, and I will get 8000 to 14000 steps most days. My goal with eating has been about 50 grams (net) per day, and I have been reasonably successful with this.
My glucose levels seem to bounce around a lot with no real predictability. 90 min after eating at night, I will check glucose and get a reading of 124. 10 hours later my fasting glucose will be 145. Then other days the same readings will be 119 and 105. I understand there is a "dawn phenomenon" with some people, and I wonder if anyone has any ideas about why I see it sometimes and not others? I will get my first A1C since diagnosis in January, so that will be a better indication of how I am doing in general.
I have been using MFP for a couple of months as I have been more aware of eating and watching carbs. I have mostly read a few of the threads and not had much to say. I decided it was probably time to introduce myself.
Thanks...
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Replies
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Welcome!
Here are a few half-baked thoughts....
I'm just starting my second year of LC eating (also on 2000mg of Glucophage XR), and I still can't predict my BG all that well. If it's higher than I think it should be, I test up to 12x/daily - waking, before each meal, and 1 and 2 hours afterwards.
If you're willing to test that often while your BG remains a concern, this should give you a more complete picture of how your BG relates to your diet, meds, exercise, and weight loss than a single, annual A1c test (which doesn't measure BG directly and can be susceptible to false readings).
If not, you might want to consider getting your A1c checked every couple of months.
Without knowing more about your diet and timing of your metformin and exercise, I'd venture to guess your somewhat LC diet is actually pretty low in net carbs, since your post-prandial readings of around 120 aren't high at all for a T2D.
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Welcome aboard.1
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You can also use a phone app called MySugr to enter all those bg readings into and it can give you a ballpark idea of what your A1c will be based on those entries. The more entries you make per day, the more accurate it's guesstimate should be.
It can also help to show you patterns on a daily basis. You may be able to see things in those patterns that make sense in time.3 -
It dawned on me that different glucose meters have a wider or slimmer margin of error.
FYI, Consumer Reports rated them not too long ago, and I wound l up switching to Bayer's Contour Next (cheap meter, cheap strips, fast, convenient, reliable & accurate).
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My glucose levels seem to bounce around a lot with no real predictability. 90 min after eating at night, I will check glucose and get a reading of 124. 10 hours later my fasting glucose will be 145. Then other days the same readings will be 119 and 105. I understand there is a "dawn phenomenon" with some people, and I wonder if anyone has any ideas about why I see it sometimes and not others? I will get my first A1C since diagnosis in January, so that will be a better indication of how I am doing in general.
Two things seem to influence my dawn phenomenon:
Elevated reading when I go to sleep
Higher calorie consumption for several days
I was diagnosed with diabetes 15 months ago - and have largely kept my BG readings within the normal ranges. Dawn phenomenon has been the hardest to conquer. Eating the Blood Sugar Diet (a very low calorie diet) consistently drops my fasting blood glucose into the 80s. In contrast - when I eat a maintenance level of calories, my fasting blood glucose typicaly runs 95 - 105. Within those two ranges, the highest fasting blood glucose levels comes when I eat something relatively high in carbs close to bedtime and my BG level does not drop back to a low level before I go to sleep.
Rather than having a target of 50 net grams/day, you might want to target a lower amount within a 2 hour period. You are likely to have more success if your BG always stays within the normal rages - which is not likely if you eat all of your 50 net grams at once (for example). 20 net grams/2 hours works for me. (That also has the advantage that I can eat more grams of carbohydrates overall than if I cap the daily amounty at 50. Depending on how frequently I eat, I can comfortably eat 100 grams or so.)
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Welcome to the group! As Sunny_Bunny_ said, you may be able to see patterns in your readings. Have you noticed that your numbers were higher after eating certain foods?0
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I am new enough at this that I am still getting used to the idea. Initially I tried the blocks that were in the diabetic handouts the doctor's office gives you. My numbers were bad. I tried a few weeks of the Zone, and they improved. I switched to counting carbs, and they were even better.
The patterns that I seem to see is that usually lower carbs seem to produce better numbers, but it is not a perfect predictor. If I goof up and have a higher carb day, it takes a few days for them to go down again. It is not just the next number that is bad. I don't have any associations with certain foods yet.
I am checking twice a day. One is fasting when I get up. The second is 90 min or so after eating supper. I take the metformin 1000's with breakfast and supper.1 -
The patterns that I seem to see is that usually lower carbs seem to produce better numbers, but it is not a perfect predictor. If I goof up and have a higher carb day, it takes a few days for them to go down again. It is not just the next number that is bad. I don't have any associations with certain foods yet.
I am checking twice a day. One is fasting when I get up. The second is 90 min or so after eating supper. I take the metformin 1000's with breakfast and supper.
The liver is good at storing matter it can turn into glucose (so if it has stored quite a bit, it may take a bit of diligence to deplete your stores). Otherwise your blood glucose level (aside from the dawn phenomenon) is usually a pretty instantaneous response to what you put in your mouth.
To start with I tested 4-10 times a day, depending on whether I was eating food I'd already tested or not. I test in the morning, but all of the rest of my testing is testing (or confirming my response hasn't changed) to specific foods. That means I test before my first bite, at 1 hour after my first bite, then at two hours. If hour 2 is higher than hour 1, I also test at 3 hours. I had my blood glucose largely within normal (i.e. always below 140) within 3 days by using this testing regimen.
It isn't clear to me how you plan to discover an association with foods when your tests aren't connected to eating particular foods.
Metformin is not a fast acting medicine, so if your goal for your 90 minutes after supper test is to see how you are responding to the metform, it isn't likely to tell you much.
If I was limited to 2 test strips a day, I'd test one food a day for a while: eat the food, test at 1 hours, then at 2 hours to get the peak of the spike, and how quickly it comes down. Once I knew a food was safe, I'd mostly eat that food (boring) aside from testing the one new food a day. (I had the luxury of nearly unlimited test strips, so I could test everything new I ate.)
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@neohdiver, is it accurate that you could deplete your liver's gluvose pantry by eating very low-carb, low-calorie for a few days? Would you then rely on fasting BG or overall BG to check?0
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This is an article that I think can be very helpful in understanding how to test your BG. If you follow the links to the two previous articles in the series, there is more information, but this is the one with the actions to take:
https://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16/
In addition, I was listening to Dr Adam Nally not to long ago who said the liver will produce between 80mg and 280mg of glucose at some rate which I can't remember. What stuck out to me was the huge variance between 80 and 280 where the max is 3.5x larger. I intend on going back and re-listening to that podcast of KetoTalk.
The reason I mention this is I think it goes well with understanding your own situation. As @neohdiver mentioned, dietary changes can take some time to really affect your BG. If you move toward ketosis, it may take time for your liver to prefer to make ketones rather than glucose. I'm not sure if moving to full time ketosis is something that will slow the production of glucose by the liver or not. I think it is something I would like to see studied.
It also depends on what is causing your diabetes. The most common cause is insulin resistance. However, that is not the only cause. I had read of other causes, but am just now really getting into trying to understand them because I found out I am not IR. My elevated BG seems to stem from stress (excess cortisol) and some minor micronutrient deficiencies. Therefore, the treatments suggested for treating IR would have and have had no effect on my BG.
The medical profession is still dominated by those who want to treat symptoms and not underlying causes. Dr. Mark Hyman has a good video regarding this:
https://www.youtube.com/watch?v=IhkLcpJTV9M
Welcome to the group. You will find there are many people here more than willing to help you on your journey with both personal insights as well as providing links to more information. If you haven't already looked at the launchpad and the Diabetic Discussions (http://community.myfitnesspal.com/en/discussion/10482542/diabetic-discussions#latest), I would recommend taking a look at those.3 -
cstehansen wrote: »This is an article that I think can be very helpful in understanding how to test your BG. If you follow the links to the two previous articles in the series, there is more information, but this is the one with the actions to take:
https://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16/
Thanks. That is a great article for T2Ds on how to test your BG cheaply and effectively. (The meters on the market have changed a bit since the article was written.)
@baconslave - for diabetes list1 -
Thanks all - lots of good information here. I am early in the T2D journey, and I have a lot to sort out. I also just got back from a post-Christmas trip to see the in-laws, so I will try to process some of this tomorrow...1
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Thanks all - lots of good information here. I am early in the T2D journey, and I have a lot to sort out. I also just got back from a post-Christmas trip to see the in-laws, so I will try to process some of this tomorrow...
The good news is this is a marathon and not a sprint. The bad news is this is a marathon and not a sprint.
Good because there is no pressure to solve it over night. Bad because you will likely never be able to just forget about it because you will have to make choices based on the T2 diagnosis the rest of your life.
To be truly successful you will have to do a lot of trial and error (aka n=1 experimentation). From all the research I have seen so far, there is nothing that works for everyone. This is a great forum for finding out what works for most, many or some. Start with the things that work for the highest percentage - which you already have given you have reduced your carb intake. Then add in other changes as they make sense and monitor the effects.1 -
OK - I have installed MySugr to keep up with all this on an ongoing basis, and i entered my last 120 glucose readings into a spreadsheet to get a mean and use an online formula I found to predict A1C. I have a doctor's appt. to check on progress and the A1C Jan 9 (which is three months after my diagnosis).
The prediction is 6.3 which is a lot better than the 12.8 I got in October. Between the metformin and the changes in diet, I am making progress. I can fine tune all this as time goes on.7 -
OK - I have installed MySugr to keep up with all this on an ongoing basis, and i entered my last 120 glucose readings into a spreadsheet to get a mean and use an online formula I found to predict A1C. I have a doctor's appt. to check on progress and the A1C Jan 9 (which is three months after my diagnosis).
The prediction is 6.3 which is a lot better than the 12.8 I got in October. Between the metformin and the changes in diet, I am making progress. I can fine tune all this as time goes on.
Wow! That's tremendous progress.
It took a few months for my BG to really settle down, so to me it makes sense to give yourself some fine tuning time.
Nice going!0 -
Thanks - this is all uncharted territory for me.0
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@neohdiver, is it accurate that you could deplete your liver's gluvose pantry by eating very low-carb, low-calorie for a few days? Would you then rely on fasting BG or overall BG to check?
Very low calorie seems to be the key for me.
Very low carb, moderately low calories, didn't get there for me - I ever got to consistently have fasting blood glucose readings in the 70s & 80s on a 1200 calorie, 20 net carbs/2 hours diet.
When I dropped to 800 calories a day (the Taylor/blood sugar diet - with doctor's supervision), and kept the same carb intake (20 net carbs w/i 2 hours), within a week I was consistently having a fasting blood glucose reading between 70 and 89, and between meal readings were 90-110.
I rely on both fasting and overall to check. I look for below 90 fasting & below 110 between meals (anytime at least 2 hours after eating).
I'm now working on figuring out what maintenance looks like in order to stay within those ranges - once the craziness of the holiday work schedule is over. It may include 16:8 fasting - some research suggests extended fasting will deplete the liver stores.1 -
cstehansen wrote: »This is an article that I think can be very helpful in understanding how to test your BG. If you follow the links to the two previous articles in the series, there is more information, but this is the one with the actions to take:
https://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16/
Thanks. That is a great article for T2Ds on how to test your BG cheaply and effectively. (The meters on the market have changed a bit since the article was written.)
@baconslave - for diabetes list
That's pretty much how I managed my diabetes from the day I was diagnosed. I was lucky in that mine was easy to get under control - my doctor had been regularly testing me so we caught it early.
(After most of about 7 months of control, I started actively working on remission via Taylor's research (Blood Sugar Diet), which is a different path.)0 -
cstehansen wrote: »This is an article that I think can be very helpful in understanding how to test your BG. If you follow the links to the two previous articles in the series, there is more information, but this is the one with the actions to take:
https://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16/
Thanks. That is a great article for T2Ds on how to test your BG cheaply and effectively. (The meters on the market have changed a bit since the article was written.)
@baconslave - for diabetes list
That's pretty much how I managed my diabetes from the day I was diagnosed. I was lucky in that mine was easy to get under control - my doctor had been regularly testing me so we caught it early.
(After most of about 7 months of control, I started actively working on remission via Taylor's research (Blood Sugar Diet), which is a different path.)
Taylor's results were outstanding - and so were yours, if memory serves. Do I correctly remember two of your feet stcking out of one former pant leg?0 -
@neohdiver, is it accurate that you could deplete your liver's gluvose pantry by eating very low-carb, low-calorie for a few days? Would you then rely on fasting BG or overall BG to check?
Very low calorie seems to be the key for me.
Very low carb, moderately low calories, didn't get there for me - I ever got to consistently have fasting blood glucose readings in the 70s & 80s on a 1200 calorie, 20 net carbs/2 hours diet.
When I dropped to 800 calories a day (the Taylor/blood sugar diet - with doctor's supervision), and kept the same carb intake (20 net carbs w/i 2 hours), within a week I was consistently having a fasting blood glucose reading between 70 and 89, and between meal readings were 90-110.
I rely on both fasting and overall to check. I look for below 90 fasting & below 110 between meals (anytime at least 2 hours after eating).
I'm now working on figuring out what maintenance looks like in order to stay within those ranges - once the craziness of the holiday work schedule is over. It may include 16:8 fasting - some research suggests extended fasting will deplete the liver stores.
Thanks for the insights.
How about protein? Dr. Bernstein warns against undereating protein for fear of losing muscle mass, apparently preferring some degree of gluconeogenesis from dietary protein over the risk that it will come instead from lean tissue....0 -
Thanks for the insights.
How about protein? Dr. Bernstein warns against undereating protein for fear of losing muscle mass, apparently preferring some degree of gluconeogenesis from dietary protein over the risk that it will come instead from lean tissue....
I target protein consumption at the quantity needed to maintain lean body mass - around 60 grams, for me. (carbs below net 20 in any 2 hour period, target of 60 grams of protein, target of ?? (I haven't figured out maintenance calories yet, but somewhere around 1400). The rest comes from fat, since there isn't any other source.1 -
Two separate things - carb limits created T2D control immediately - no weight loss necessary. But since I had to watch every bite I ate in order to control the diabetes, I used it as an excuse to lose the weight.
Taylor's results were outstanding - and so were yours, if memory serves. Do I correctly remember two of your feet stcking out of one former pant leg?
Dr. Taylor's method was an attempt to induce remission (a step beyond control). I've beem partially successful - I am now prediabetic, rather than diabetic. I don't know that I'll get the rest of the way, but I've reversed it sufficiently that I can enjoy an occasional carb treat without messing up my fasting blood glucose or between meal baseline.2 -
FYI, if you really want to deplete glycogen stores quickly, the best way to deplete liver glycogen is through fasting. Low-carb/hypocaloric with ONLY enough protein to maintain lean tissue is next.@neohdiver, is it accurate that you could deplete your liver's gluvose pantry by eating very low-carb, low-calorie for a few days? Would you then rely on fasting BG or overall BG to check?
To carry it to the next-level, do an all-over body weight-training circuit (work the shoulders, biceps, triceps, back, glutes, hamstrings, quads and calves) to fully-deplete muscle glycogen as-well.2 -
OK - I have installed MySugr to keep up with all this on an ongoing basis, and i entered my last 120 glucose readings into a spreadsheet to get a mean and use an online formula I found to predict A1C. I have a doctor's appt. to check on progress and the A1C Jan 9 (which is three months after my diagnosis).
The prediction is 6.3 which is a lot better than the 12.8 I got in October. Between the metformin and the changes in diet, I am making progress. I can fine tune all this as time goes on.
That is totally amazing! You are doing great and your Dr. will be very pleased. It is so gratifying for a Dr. to see a patient who takes advise seriously and does something about their issues and improve their life style. Your progress is awesome!
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albertabeefy wrote: »FYI, if you really want to deplete glycogen stores quickly, the best way to deplete liver glycogen is through fasting. Low-carb/hypocaloric with ONLY enough protein to maintain lean tissue is next.
To carry it to the next-level, do an all-over body weight-training circuit (work the shoulders, biceps, triceps, back, glutes, hamstrings, quads and calves) to fully-deplete muscle glycogen as-well.
There are data-based studies documenting hypocaloric diets depleting glycogen stores (Specifically two studies by Taylor, and a number of post-bariatric surgery studies). Most of what I've found on fasting (and I've tracked down pretty much everything Fung has commented on) is theoretical/predictive. I believe I've found a single reported data-based study supporting the use of fasts extending at least 14 hours (going from memory).
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That is totally amazing! You are doing great and your Dr. will be very pleased. It is so gratifying for a Dr. to see a patient who takes advise seriously and does something about their issues and improve their life style. Your progress is awesome!
Thanks - on a technicality, he gave me some sheets with the USDA recommendations for a balanced diet and another couple of sheets about blocks and being intentional about balancing meals themselves. I tried that for a couple of weeks and it seemed cumbersome and did not seem to help my numbers. I then tried the Zone and saw some improvement. As I read more, I decided to try reducing carbs to 10% of my caloric intake, and this is when I started seeing the real improvement. I have been pretty good with this diet - no cookies or fruitcake over Christmas even.
I am confident he will be pleased with the improved numbers and my determination with this. He won't care so much about my tossing out the dietary guidelines he gave me. I have lost weight this past year, and that is helping I am sure. I am down about 50 pounds for 2015, and I want to lose another 30. BP is down as is cholesterol, so that is good too.
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Fantastic - a true LC success story!
Just out of curiosity - do you recall what exactly led you to try LC?0 -
Just out of curiosity - do you recall what exactly led you to try LC?
The diet the doctor gave me did not seem too much different from what I was doing already. I realize he has patients who eat a lot of junk, but I was already eating a pretty good diet by USDA standards. When logging everything and being very careful with this diet did not seem to be doing much for my numbers, I decided there had to be something better.
I read The Zone by Sears, and he was making a connection between hormones and diet. It was lower in carbs and had a lot of rules. I increased my awareness of glycemic index. I eliminated bread, potatoes and rice. My numbers were showing a little improvement.
I started looking around on the internet. Various people seemed to be reporting success managing diabetes with a LC diet. It was somewhat appealing because there was not the Sears obsession with lean meat. It seemed as if it would be relatively easy to follow. I was already logging what I ate, and I changed the macronutrient ratios to reflect 10% carbs, 65% fat and 25% protein. The numbers started looking better, and I have been feeling pretty good.
I am paying more attention now to spreading my carbs out a little during the day. Neodiver made a great suggestion with the limit of carbs per two hour period that I am trying to be more aware of. When my calories are low for the day, it is the fats category that is short, so I am trying to be more mindful there. Anyway, I am learning as I go.
I am doing two glucose checks a day - one fasting and the other post prandial. I am making progress, and I am sure there will be some more tweaks as I go, but I don't want to go too crazy with changing things and not giving them a chance to "settle."
The "dawn effect" thing still irritates me. Post prandial last night was 114, so I am patting myself on the back. Fasting this morning was 134. Oh well... I am realizing that I have a diet that is sustainable, and that my glucose levels suggest I will have a significantly better A1C at my next appointment in Jan.
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@2t9nty - It sounds like you're on the right track. Congratulations!
@Neohdiver's carbs/hour limit is similar to Dr. Bernstein's recommendation of spreading carbs throughout the day (he suggests starting with 6g for breakfast and 12g each for lunch & supper). It works.
I'm not aware of any research, but it seems sensible to do the same with protein, both to avoid muscle loss and to reduce BG increases from excess protein. (@albertabeefy might have a different take, though ??).
The dawn effect was the last thing to subside after my BG and weight had drifted down following initial drops, but it did eventually improve.
Taking 500-1000g of metformin XR before bed has been part of the routine, since my morning BG was too high otherwise. (I still take 2000g per day, with 500-1000g in the morning and the remainder timed 6-8 hours before I expect to have my biggest meal. Experimenting with immediate-release metformin when things don't go according to plan is one of the things on my self-experiment list for 2017...)
Best of luck for continued gains.. er, losses in '17!1
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