Finding the ideal amount of carbs: BG stability or average more important?

Glink

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Hi folks,
Long story short, when I was diagnosed with PD (IFG) almost 2 yrs ago I immediately went very low carb and this helped a lot at first, then numbers crept up more, crossing into diabetic levels and I got metformin, which helped again. (It's likely that I am very early stage LADA, but they don't do the GAD test where I live in Canada, so for the time being it's PD as long as I can keep my #s low enough on offical tests.)

Last fall I was really feeling hungry all the time and also having a hard time with fatigue when I really wanted to exercise a lot, so I decided to raise my carb intake a bit-- like from 20-30 net g/day to more like 100, while still avoiding the things like grains and potatoes that really send me high. It's been lovely eating a wider range (Apples! I love the occasional apple now! No longer worrying about "too much" broccoli or whether I can use onions in supper!) and I haven't gained weight or anything, but I'm trying to figure out the effect on my blood sugars.

It seems that with this higher level of lowish carb eating my average BG (according to HbA1c) got a bit better, but my stability of BG (by home testing and symptoms) got a bit worse. Fasting hasn't really changed; still prediabetic. I'm not sure which is more important, stability or average. I feel better in terms of symptoms when it's more stable, but I can exercise more with these additional carbs. Anyone else familiar with this, or have information or opinions? Thanks!
 

Bluetit1802

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Stability.

The smaller the variances the better. It is the swings up and down that cause the problems. I would be happier with a slightly higher base line (fasting and before meals etc) than low base line and more swings up and down. It is only through wearing a Libre sensor that I have come to see this in my own levels. The graphs show it all.

The HbA1c is just an average and we all know averages mean very little. Someone with a low base line, including overnight, will have a lot of lows counted in that average, whereas the highs are restricted to a relatively short period post meals - but these highs are the damaging factors, and the ones that make you feel rough.
 

Bluetit1802

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I don't think we are talking "stable high". But if we were, then stable high is far better than high with big swings
 

Freema

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all in all I think it depends on at what levels..

http://www.phlaunt.com/diabetes/14045678.php :

"Keeping Blood Sugars Below 140 mg/dl at All Times Improves Survival of Seriously Ill Patients"

"Beta Cells Die Off in People Whose Fasting Blood Sugar is Over 110 mg/dl (6.1 mmol/L)"

 
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Brunneria

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I go for stability over average too.

I spent a week on hol last Autumn eating carbs and doing strenuous (for me) walks to burn off the carbs.

Wearing the Freestyle Libre showed that my average reading only rose by 0.1mmol/l compared with the week before - but I quickly developed stabbing neuropathy type pains in my feet (blood glucose ranged from 3.7 to a little over 12mmol/l)

Back to normal (bg range around 5-7 mmol/l) the pains faded within days.

I found it very motivating, and won't be doing the blood glucose swings again. I hope.
 
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douglas99

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Ah, we're all different.
I have a very stable 'normal' hba1c, stick to the guidelines for the normal population, as per this site, who aren't diabetic, and seem to manage ok, I have no neuropathy, or other complications, but do exercise rather than being inactive.
 

Bluetit1802

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Ah, we're all different.
I have a very stable 'normal' hba1c, stick to the guidelines for the normal population, as per this site, who aren't diabetic, and seem to manage ok, I have no neuropathy, or other complications, but do exercise rather than being inactive.

I do hope you can continue this way and that accidents and injury or illness don't get in your way. :)
 

Glink

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Hm. Sounds like there's no real consensus on this, except that ideally you achieve both.

I have a "normal" HbA1C also. But I do have symptoms when my BG goes high.

There is very little if anything I can do to get my fasting #'s to look non-diabetic, and I have mostly accepted that at this point. My postprandial go highish, but since low GI/low carbing they don't go super duper high (generally not over 8 unless I eat something stupid like rice, which I just...don't. I mean I did once since diagnosis and it was horrific enough to deter me for a long while!). It's a weird middle ground of not being "normal" but not being anything anyone is that clinically worried about--hence all my attempts to self manage by tweaking my diet etc. I am lucky in that exercise and weight are not a concern here (except in that exercise raises my BG a bit; thanks liver you big dumper you!).

I guess since I can't get fasting below 6.1 at all times, I might be wise to try to cut back on the carbs again and try to get the postprandials consistently lower. My suspicion is that eating some carbs again has stimulated more insulin release, which has then lowered my averages (lows, which are never "bad" low for me, are lower/longer?). But if my HbA1c goes up a bit in order to minimize my highs, that might be worth it.

Blah. Why can't this be more straightforward!? I see my GP for my check-in soon and assuming my quarterly HbA1c loooks good he'll just be totally happy even though I'm having symptoms again. Feeling like it's time to once again take things into my own hands!
 

Glink

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I've also, over this same time period, become less anemic due to a totally unrelated issue, and I understand that might affect HbA1c but don't completely understand how. Now I'm wondering if the lower HbA1c might just be an artifact of fixing that, though...So many moving parts in these bodies!
 

Bluetit1802

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I've also, over this same time period, become less anemic due to a totally unrelated issue, and I understand that might affect HbA1c but don't completely understand how. Now I'm wondering if the lower HbA1c might just be an artifact of fixing that, though...So many moving parts in these bodies!

If you are anaemic (or have been) your HbA1c may not be a true representation depending on the type of anaemia you have. This is because the HbA1c relies on you having normal standard haemoglobin, which certain anaemics don't have. Many other people also don't have standard haemoglobin because their red blood cells don't live for the standard 8 to 12 weeks that the HbA1c relies on. . Not everyone falls within standard, in fact, many don't. If our red blood cells live longer than 8 to 12 weeks or less than 8 to 12 weeks our HbA1cs won't be accurate.

The correct test for anaemics is the Fructosamine test. Many (most) GPs are reluctant to order this because it is more expensive and very few labs actually do them, so the sample has to be sent away. It is similar to the HbA1c in that it works on a rough average, but instead of over 2 to 3 months it is over 2 to 3 weeks. Then there is the OGT which is a test of your post meal reaction. You drink some glucose - usually Lucozade, and are tested before, at an hour and again at 2 hours. It may be worth your while discussing these 2 tests with your GP.

https://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker/

http://www.diabetes.co.uk/hba1c-test.html

Limitations of HbA1c tests
Whilst HbA1c tests are usually reliable, there are some limitations to the accuracy of the test. For example, people with forms of anaemia may not have sufficient haemoglobin for the test to be accurate and may need to have a fructosamine test instead.
 

Juicetin

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I'm slightly anaemic, I wonder if that's affecting my hbA1c.
 

Bluetit1802

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I'm slightly anaemic, I wonder if that's affecting my hbA1c.

You need to Google. It depends which type of anaemia you have and I can't remember. I think it may be the iron deficiency one but honestly don't know.
 

Kristin251

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Hm. Sounds like there's no real consensus on this, except that ideally you achieve both.

I have a "normal" HbA1C also. But I do have symptoms when my BG goes high.

There is very little if anything I can do to get my fasting #'s to look non-diabetic, and I have mostly accepted that at this point. My postprandial go highish, but since low GI/low carbing they don't go super duper high (generally not over 8 unless I eat something stupid like rice, which I just...don't. I mean I did once since diagnosis and it was horrific enough to deter me for a long while!). It's a weird middle ground of not being "normal" but not being anything anyone is that clinically worried about--hence all my attempts to self manage by tweaking my diet etc. I am lucky in that exercise and weight are not a concern here (except in that exercise raises my BG a bit; thanks liver you big dumper you!).

I guess since I can't get fasting below 6.1 at all times, I might be wise to try to cut back on the carbs again and try to get the postprandials consistently lower. My suspicion is that eating some carbs again has stimulated more insulin release, which has then lowered my averages (lows, which are never "bad" low for me, are lower/longer?). But if my HbA1c goes up a bit in order to minimize my highs, that might be worth it.

Blah. Why can't this be more straightforward!? I see my GP for my check-in soon and assuming my quarterly HbA1c loooks good he'll just be totally happy even though I'm having symptoms again. Feeling like it's time to once again take things into my own hands!
Another thing you might look at aside from carbs of course is protein. Many of us notice if we over eat protein in a day, not just a meal but the days worth, our fastings and the whole next day our bs will run higher. If I way over eat it, which is easy to do as I never have more than 2.5 oz per meal, my bs will run high for days. For me, in my best estimation, once my glycogen stores are full it will take days for me to deplete glycogen get back to normal numbers. I'm not built like a brick house so my protein requirements are quite small. Protein and carbs both add to the glycogen pool, fats very little. That's why I do a keto less than 20 c per day, MODERATE protein based on my ideal body weight (.8-1g per kg of ideal body mass) and just enough fat to satisfy.

It's all very complex finding the right balance.
 

Glink

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Ha, well, joke's on me because the results to my quarterly bloods just came back and my HbA1C has actually risen as of this last quarter, after falling for the latter part of 2016. It just took a while to reflect the somewhat-subtle dietary change, I guess (9 months). But I guess the rise in symptoms is reflected in the average as well as in the spikes now. Guess I have to face the music and cut back my carbs more again. We'll see if I can figure out how to do that without affecting my athletic performance as much, and leaving me so hungry every night. (Kristin, I don't know how you function on so little--I don't think I could do it, but I suspect I'm a bigger build and also younger than you, and I do bike commute an hour a day, which takes a bit of energy even before I hit the gym.) I wish there were actually some guidance to this stuff, but the dietitian I got sent to when recently diagnosed was just useless. Darn it, I was really enjoying a little fruit here and there, and not weighing my broccoli. It "seemed" healthier--less neurotic and more well-rounded--but I guess healthy is not healthy for me. Boo.
 

Kristin251

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Ha, well, joke's on me because the results to my quarterly bloods just came back and my HbA1C has actually risen as of this last quarter, after falling for the latter part of 2016. It just took a while to reflect the somewhat-subtle dietary change, I guess (9 months). But I guess the rise in symptoms is reflected in the average as well as in the spikes now. Guess I have to face the music and cut back my carbs more again. We'll see if I can figure out how to do that without affecting my athletic performance as much, and leaving me so hungry every night. (Kristin, I don't know how you function on so little--I don't think I could do it, but I suspect I'm a bigger build and also younger than you, and I do bike commute an hour a day, which takes a bit of energy even before I hit the gym.) I wish there were actually some guidance to this stuff, but the dietitian I got sent to when recently diagnosed was just useless. Darn it, I was really enjoying a little fruit here and there, and not weighing my broccoli. It "seemed" healthier--less neurotic and more well-rounded--but I guess healthy is not healthy for me. Boo.
Sorry to here your news. I'm sure I am older and smaller. 52 years old and 122 pounds

Seriously. I spent 50 years always hungry and watching the clock. In walked my magical avocado. I have no hunger and constant steady high energy. It was literally my magic bullet!!! I have no energy ups and down. The fat and fiber and few carbs is the perfect combo for me. Such a healthy fat too. I eat at least one a day (divided with each meal and as a snack ) It does amazing things for my bs too. It slows and keeps lower all potential spikes from carbs or protein

I hope you like them lol. Try at least a half if not a whole one with every meal. I don't think anyone can over eat them!! It's the only thing I found that at least sort of work should with bf. Eat with CELERY not chips haha.
 

Bluetit1802

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Ha, well, joke's on me because the results to my quarterly bloods just came back and my HbA1C has actually risen as of this last quarter, after falling for the latter part of 2016. It just took a while to reflect the somewhat-subtle dietary change, I guess (9 months). But I guess the rise in symptoms is reflected in the average as well as in the spikes now. Guess I have to face the music and cut back my carbs more again. We'll see if I can figure out how to do that without affecting my athletic performance as much, and leaving me so hungry every night. (Kristin, I don't know how you function on so little--I don't think I could do it, but I suspect I'm a bigger build and also younger than you, and I do bike commute an hour a day, which takes a bit of energy even before I hit the gym.) I wish there were actually some guidance to this stuff, but the dietitian I got sent to when recently diagnosed was just useless. Darn it, I was really enjoying a little fruit here and there, and not weighing my broccoli. It "seemed" healthier--less neurotic and more well-rounded--but I guess healthy is not healthy for me. Boo.

Sorry to hear this, but it shows we can never relax or become complacent. This low carb way of eating has to be for life, at least for most of us.
 

Robbity

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I aim for stability. And I definitely agree that LCHF is for life, but even though I keep pretty closely to my chosen carbs limit, I find other issues sneak up and "bite me on my bum": stress, illness, pain, etc can and do all have effects on my glucose levels that I would prefer to be without. So the better I can keep my levels stable, the less impact I hope these other issues will have on them.

Robbity
 
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Glink

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Yeah, I guess my new challenge has to be to figure out what my "magic avocado" is--what will give me the energy and satiation without raising my sugars. (I do enjoy avocado, pretty much daily, but they are not the magic for me they seem to be for some. Same with celery.) I got the sugars mostly worked out but lost the exercise capacity and never stopped being hungry because my only tool for bringing down highs was fasting. I'm no pro athlete but I do like to work out and think I should be able to do so without getting weak & dizzy! Anyway, blah blah blah. Thanks for the support.
 

Kristin251

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Yeah, I guess my new challenge has to be to figure out what my "magic avocado" is--what will give me the energy and satiation without raising my sugars. (I do enjoy avocado, pretty much daily, but they are not the magic for me they seem to be for some. Same with celery.) I got the sugars mostly worked out but lost the exercise capacity and never stopped being hungry because my only tool for bringing down highs was fasting. I'm no pro athlete but I do like to work out and think I should be able to do so without getting weak & dizzy! Anyway, blah blah blah. Thanks for the support.
Here's the deal with me. Exercise raises me more than anything. Then I get hungry because I spike. Then incoming insulin. Then low then hungry. Exercise is great but messes with my bs too much.

Finding the right balance for bs and insulin throughout the day is very tricky. Keeping steady bs is key but easier said than done when we mix carbs, protein and exercise in. Do you exercise in the morning? Any chance you can move it to later?
 
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