RalfLott wrote: »

bjwoodzy wrote: »

Personally, taking Metformin is like swallowing air. It would do virtually nothing for me. I was on 1500 mg/day, so my GP put me on two kinds of insulin, after only one kind wasn't doing enough. My FBG is probably always going to be a bit "high", but then again, what is "normal blood glucose", really?

I feel like the more I stay strict 20g/carbs a day and not worry too much about calories and keep my protein under 80g/day, the better my levels might be, or at least stay the same. But I'm a bit worried that my GP will think 150-170 a.m. FBG and PP BG of between 140-155 is still too high for her liking and wants to put me on something, when Glucophage is not available as a co-pay item thru my insurance. And I am someone whose BG used to be close to 200 in the mornings, never lower than 140-ish pre-meals, and never lower than 170 post-meals...am currentlys not on any drugs whatsoever, since May...controlling BG via diet alone.

That's quite a puzzle. @albertabeefy?

Without seeing more lab work I can't make a very educated guess, but I'd certainly look at a few things:

The first is glucagon - as RalfLott already suggested:

There are a few reason glucagon can be elevated, and we know from significant research that:

• diabetics frequently exhibit an inappropriately-high glucagon response to meals, especially Type I's, and;
• Post-prandial hyperglucagonemia worsens significantly during the first year after a diagnosis of Type I.

@bjwoodzy , I don't know if your diagnosis is one of Type I or Type II ... But from what you're telling us I'd speculate Type II with an impaired insulin-response (in terms of both insulin-sensitivity and production). If you're not getting regular C-Peptide testing in addition to your HbA1c and other labs, you likely should. That will give you a good idea of where your insulin-production is. In addition to the insulin-response issue (and/or compounded by it), I'd suggest it possible you're also one of us lucky people with an impaired suppression of postprandial glucagonemia, which frequently contributes to elevated postprandial blood glucose.

Also of note, @bjwoodzy ... and not to scare anyone here - but just as a note to ensure it's eliminated as a possibility ... there is a rare tumor of the alpha cells known as a glucagonoma that can contribute to this. Again, it's extremely rare (like 1 in 20 million rare), so don't worry - but it's something you should always eliminate as a differential if you haven't already. Because of it's rarity most GP's would never think to look for it, honestly. There's also the possibility of a genetic mutation which impairs glucagon-receptor function - again, very rare.

Regarding hyperglucagonemia - FYI some Type II medications are even known to cause this, even if they initially LOWER glucagon levels. A study of liraglutide (which is a glucagon-like peptide-1 agonist, for those that care) showed "In contrast to its acute glucagon-lowering effect, chronic treatment with liraglutide is associated with increased postchallenge hyperglucagonemia in patients with early T2DM."

The next thing I'd look at is insulin. Both production (and supplementation) as well as resistance.

Just using myself as an example now - I'm both insulin-resistant (especially if I have any even moderate levels of visceral fat) and insulin-deficient. My pancreatic β-Cells are so damaged I hardly produce any insulin. It's probably a combination of latent autoimmune β-Cell failure (I've a strong family Hx of Type I) and over-abuse of my pancreas when I was younger.

Regarding visceral body fat - for me this is the weight that goes on first if I gain. I can gain 10lbs with no loss of abdominal definition simply because my body tends to store it as visceral fat first, rather than subcutaneous. Keeping myself lean and with as little visceral fat as possible seems to be the single-biggest contributor to my own glycaemic control - simply because what little insulin I naturally produce can more effectively be utilized by my boy in this state. (That's an n=1 example of myself ... it may not apply to everyone or anyone.)

I'd like to state here that many diabetics in the same boat as me require (or can benefit from) basal and/or bolus insulin. (Too many physicians rely on other pharmaceuticals first ... when, imho, insulin - especially basal - should be one of the first interventions - especially if a C-Peptide level is reduced - in combination with a reduced carbohydrate diet).

Without basal insulin my FBG is typically about 7.5mmol/L (about 135mg/DL for the Americans in the crowd). With basal insulin I can correct that to a fairly-consistent 5.5mmol/L (99 mg/DL). I don't require bolus due to my low-carb diet and my timing of carbohydrate intake to (generally) coincide with exercise. As my exercise levels drop with age, though ... I'll certainly continue to monitor and revisit all that.

OK @RalfLott has seen my comment before on my past, so he may or may not remember a lot, but a couple things...

I am type 2. I don't think my recent readings are trending that high, in comparison to my old readings, which I thought I was clear about. Again, I'm not on ANY meds, where I was on a *kitten* load before. My diagnosis BG reading was over 400 and my A1C was 12-something percent. It has since gone down to about 7.3 and that was in June prior to starting keto.

Also note: I was just sharing my thoughts and experience, I don't want anyone to think I'm desperate for help or anything, and I'm feeling GREAT. Would I like to always have the "typical" ideal BG readings that the ADA and my doc wants me to have? Sure, but those numbers are ideal according to whom? I feel like a lot of it is arbitrary.

The only bugger for me right now as far as my blood sugar goes is dealing will the peripheral neuropathy in my feet that comes and goes (it's worse at night when I sleep), and can get worrisome for me when I'm out walking, as it's easy to not feel my feet and trip/fall. But that is only a problem after about two miles, or in really cold weather. It's been coming on slowly since about 2010, but it does feel like it's more mild now than it was say, last year (pre-keto), however, it could just be in my head, since I'm feeling better x10 in so many other areas of my body, by comparison.

Yes, I would love to know the cause of my BG being higher but keep in mind, I was always coming up with higher readings than some, even when on so much insulin (2 kinds, one of them over 115 units/day). My dad had horrible type 2 for the last ten or so years before he died (not of diabetes complications) and did not fare well at all with sugars, was out of control in his later years due to dementia and basically us just letting him eat what he wanted rather than fight with him (that was 13 years ago, before hardly anyone—even doctors— knew much about dementia and the kind he had, called Pick's).

I am due for another blood panel but I'm waiting for my health coverage renewal stuff to come in the mail.

Thanks

bjwoodzy wrote: »

Would I like to always have the "typical" ideal BG readings that the ADA and my doc wants me to have? Sure, but those numbers are ideal according to whom? I feel like a lot of it is arbitrary.

How to put this.....

I already have mild CVD , and I'm betting the farm and my one pair of eyes, one pair of feet, one mind, and one short life left, that I will be no worse off trying to keep my BG as close to non-diabetic levels as I possibly can through diet and exercise, with only "minor" pharmaceutical assistance (a constant dilemma, them meds).

The ADA's guidelines do seem arbitrary.. According to some, they'd rather set them too high than deal with lawsuits from people whose BG crashed when they failed to reduce their meds after getting their BG down. I'd say they're not arbitrarily low, in any event

The resesrch suggests your risk for CVD, Alzheimer's, auto-immune problems, infections, and other undesirables starts to climb in direct proportion to the elevation of your BG over normal, non-diabetic levels.

Of course, that doesn't mean any individual is condemned to get any of these things - but at this distant point in my life, I'm sure as *kitten* not going to roll the dice!

RalfLott wrote: »

How to put this.....

I already have mild CVD , and I'm betting the farm and my one pair of eyes, one pair of feet, one mind, and one short life left, that I will be no worse off trying to keep my BG as close to non-diabetic levels as I possibly can through diet and exercise, with only "minor" pharmaceutical assistance (a constant dilemma, them meds).

The ADA's guidelines do seem arbitrary.. According to some, they'd rather set them too high than deal with lawsuits from people whose BG crashed when they failed to reduce their meds after getting their BG down. I'd say they're not arbitrarily low, in any event

The resesrch suggests your risk for CVD, Alzheimer's, auto-immune problems, infections, and other undesirables starts to climb in direct proportion to the elevation of your BG over normal, non-diabetic levels.

Of course, that doesn't mean any individual is condemned to get any of these things - but at this distant point in my life, I'm sure as *kitten* not going to roll the dice!

I forgot to mention that my hypertension and cholesterols were all normal again, as of August They were not, pre-keto (Aug. was me 2 months into it)

Heart disease def runs in my family, and while I don't doubt the high BG over time may affect autoimmune stuffs (mom already has pretty bad arthritis, a few kinds of it, plus chron's and polymyalgia), so I'm not rolling any dice either, but I do have to wait for my insurance stuff to come thru the mail before I go off bounding to the lab to learn more.

But thanks to @albertabeefy - I know about this c-peptides thingo and I will see if I can get tested for it. Po' folks insurance plan may or may not cover that, so I will have to tug at my doc's lab coat, maybe, and see.

bjwoodzy wrote: »

omigosh I'm not trying to come off as a blitch, but I realize I just sounded like one. O:

I didn't see it that way. But then again, I'm not the 'sensitive' type.

bjwoodzy wrote: »

I forgot to mention that my hypertension and cholesterols were all normal again, as of August They were not, pre-keto (Aug. was me 2 months into it)

Yay! I'm never as concerned about cholesterol as some - but normalizing hypertension is AWESOME!! Good Job!

bjwoodzy wrote: »

...But thanks to @albertabeefy - I know about this c-peptides thingo and I will see if I can get tested for it. Po' folks insurance plan may or may not cover that, so I will have to tug at my doc's lab coat, maybe, and see.

C-peptide is unfortunately not as inexpensive as HbA1c testing.

I have no idea as to the costs or coverage of it in the USA. For Canadians, however ... It's covered by our various provincial health care plans and all a diabetic Canadian needs to do is request it of their physician - which I know sounds great, but I pay a LOT of federal and provincial income tax as well as far-too-much capital-gains tax. I get my c-peptide test done yearly. It's also covered by NHS in the UK - though their physicians can be more restrictive in requesting it from what I've heard.

albertabeefy wrote: »

I have no idea as to the costs or coverage of it in the USA. For Canadians, however ... It's covered by our various provincial health care plans and all a diabetic Canadian needs to do is request it of their physician - which I know sounds great, but I pay a LOT of federal and provincial income tax as well as far-too-much capital-gains tax. I get my c-peptide test done yearly. It's also covered by NHS in the UK - though their physicians can be more restrictive in requesting it from what I've heard.

Yeah, I'm totally OK with paying for my own health coverage, vs. increasing taxes and whatnot, for not just myself, but for everyone else in the country, who, frankly...eat and take care of themselves like total *kitten*

RalfLott wrote: »

bjwoodzy wrote: »

albertabeefy wrote: »

I have no idea as to the costs or coverage of it in the USA. For Canadians, however ... It's covered by our various provincial health care plans and all a diabetic Canadian needs to do is request it of their physician - which I know sounds great, but I pay a LOT of federal and provincial income tax as well as far-too-much capital-gains tax. I get my c-peptide test done yearly. It's also covered by NHS in the UK - though their physicians can be more restrictive in requesting it from what I've heard.

Yeah, I'm totally OK with paying for my own health coverage, vs. increasing taxes and whatnot, for not just myself, but for everyone else in the country, who, frankly...eat and take care of themselves like total *kitten*

I dunno.

Think back to the foods available at your schools, the nutrition instruction you received, the food ads and product placement on TV when you are forming your eating habits.

Then there's the relative cost of preventing diabetes, NAFLD, etc. as opposed to the costs of treating heart disease, obesity, etc., and the amount of money devoted to education/prevention/early detection as opposed to treatment.

Are we saving money for our future or doing right by folks in need if we make everyone pay out of pocket for all their diagnostic tests, because they've unconsciously developed poor food habits?

The government should start by adhering to the Hippocratic Oath of first do no harm and stop pushing the SAD. If they stopped pushing it (including only funding research aimed at trying to support it), that would remove a lot of the financial support to the misinformation and would free up financial support to the truth.

Part of the problem of "free" healthcare or very low cost (small co-pay) healthcare is it discourages an individual from looking at making better decisions, IMHO. I compare it to car insurance. If car insurance covered filling our car with gas, none of us would care if we got 4 mpg or 40 mpg and would therefore not necessarily do the required maintenance on the car to ensure the car ran efficiently (tune-ups, properly inflated tires, etc.). And, I do put my money where my mouth is on this by carrying a high deductible insurance with an HSA account where I pay everything until deductible is met. Entering my 3rd year with the plan, and even with all the health issues I have had, I have come out ahead with money accumulating in my HSA.

RalfLott wrote: »

Are we saving money for our future or doing right by folks in need if we make everyone pay out of pocket for all their diagnostic tests, because they've unconsciously developed poor food habits?

I said "I".

"I" have no problem paying for "Me"