Good diet and active, why am I having high fasting BG?

[120673]

Hi
I am a in my mid 40s and think I may be prediabetic. Over the last 3 years I have gained some weight, leaving me probably 15lbs over weight. This happened since an injury to my hip immobolised me and then I had a hip replacement.
I was really struggling to lose the weight and also having very low energy. My exercise is somewhat limited as the young age I had hip replacement means anything with impact has to be avoided...but I walk an hour minimum daily, briskly, and do power yoga 3 times a week but this is becoming increasingly difficult as my muscles are painful with slight exertion and my energy is so low. For the last 10 years I have not eaten any gluten as it makes me ill, so had a relatively low carb paleo type diet for over 10 years, full of veggies, organic meat. My biggest crimes are a bit of fruit and milky lattes! I am medicated for a slightly underactive thyroid and the full panel of bloods are okay.
I sought some advise from a nutritionist, who suggested a keto diet, ultra low carbs at less than 30g. He suggested I got a glucose/ketone monitor purely to measure my ketones.
This was a month ago and I discovered really by accident all my fasting glucose readings were pre-diabetic. I've tested on awakening, using 7ish, then without eating after being up 60-90 minutes, often gone up to 8, never falls much, so I don't think it is dawn phenonemon. After eating a very low carb meal, the numbers barely change and never over 8 at any time...the lowest reading I've had at all is 6.2 and that was after a 24 hour fast.
I've been ultra strict on the carbs, missing my apples a lot but adjusting...I've maybe lost a little belly fat but don't weigh myself so not certain.If anything the waking glucose has been climbing over this month. I was hoping to see some results dropping.
I have low blood pressure and blood lipid profile was excellent.
So my question is, what else cause this to happen, as everywhere I look I get told to avoid things like pop, cakes, starch etc, a list of things I have not eaten for 10 years. I feel the weight gain may be because of this, rather than the cause.....? Any other things I can try?

 

[asparagusp]

Welcome 120673. I can't answer your question. However I'm interested to know where your nutritionist is based as I am seeking one with a good knowledge of Diabetes.

 

[GrantGam]

Hi
I am a in my mid 40s and think I may be prediabetic. Over the last 3 years I have gained some weight, leaving me probably 15lbs over weight. This happened since an injury to my hip immobolised me and then I had a hip replacement.
I was really struggling to lose the weight and also having very low energy. My exercise is somewhat limited as the young age I had hip replacement means anything with impact has to be avoided...but I walk an hour minimum daily, briskly, and do power yoga 3 times a week but this is becoming increasingly difficult as my muscles are painful with slight exertion and my energy is so low. For the last 10 years I have not eaten any gluten as it makes me ill, so had a relatively low carb paleo type diet for over 10 years, full of veggies, organic meat. My biggest crimes are a bit of fruit and milky lattes! I am medicated for a slightly underactive thyroid and the full panel of bloods are okay.
I sought some advise from a nutritionist, who suggested a keto diet, ultra low carbs at less than 30g. He suggested I got a glucose/ketone monitor purely to measure my ketones.
This was a month ago and I discovered really by accident all my fasting glucose readings were pre-diabetic. I've tested on awakening, using 7ish, then without eating after being up 60-90 minutes, often gone up to 8, never falls much, so I don't think it is dawn phenonemon. After eating a very low carb meal, the numbers barely change and never over 8 at any time...the lowest reading I've had at all is 6.2 and that was after a 24 hour fast.
I've been ultra strict on the carbs, missing my apples a lot but adjusting...I've maybe lost a little belly fat but don't weigh myself so not certain.If anything the waking glucose has been climbing over this month. I was hoping to see some results dropping.
I have low blood pressure and blood lipid profile was excellent.
So my question is, what else cause this to happen, as everywhere I look I get told to avoid things like pop, cakes, starch etc, a list of things I have not eaten for 10 years. I feel the weight gain may be because of this, rather than the cause.....? Any other things I can try?

Not all diabetics became diabetic because of being overweight. For many, it's genetic or environmental factors that are the cause. You've gained just over a stone which isn't too much weight, but are you overweight in general? Being overweight can affect your insulin sensitivity, leaving your BG higher than it should be.

Did you have a go at the keto-diet and what were your BG's like?

I'd go for a glucose tolerance test at your local surgery and request an HbA1c test also. This will ascertain whether you are pre-diabetic or diabetic. It's the only way to know for sure:

http://www.diabetes.co.uk/what-is-hba1c.html

http://www.diabetes.co.uk/oral-glucose-tolerance-test.html

Since you have your own BG meter, there's no reason why you couldn't do the GTT yourself.

 

[Totto]

Hi @120673, I think that part of your problem is too low dose thyroid hormone, or possibly you don't do well on Levothyroxine only.

Hypothyroidism and diabetes is a very common combination, both T1 and T2.

 

[120673]

Thanks for your thoughts.
I'm not on levothyroxine, I'm on Armour and I have been on that journey! I am pretty sure that the thyroid is as good as it can be.
I have done the keto diet for just shy of 4 weeks with excellent compliance - and the fasting blood glucose is, if anything, going up not down. I was not overweight at all prior to gaining the 15lbs, so the total I need to loose is about a stone. What frightens me a little is the upward trend for no apparent reason.
I think what I was trying to ask is what environmental factors could be at play and what can I do about them, if anything. I have my genetic profile from 23 and me and there are not any risk factors identified there. Do I just watch as the sugars ineveitably rise?!!
aspargusp - my nutritionist is not seeing patients, he tours doing lectures and research - I pulled in a favour so he can't help.

 

[GrantGam]

Thanks for your thoughts.
I'm not on levothyroxine, I'm on Armour and I have been on that journey! I am pretty sure that the thyroid is as good as it can be.
I have done the keto diet for just shy of 4 weeks with excellent compliance - and the fasting blood glucose is, if anything, going up not down. I was not overweight at all prior to gaining the 15lbs, so the total I need to loose is about a stone. What frightens me a little is the upward trend for no apparent reason.
I think what I was trying to ask is what environmental factors could be at play and what can I do about them, if anything. I have my genetic profile from 23 and me and there are not any risk factors identified there. Do I just watch as the sugars ineveitably rise?!!
aspargusp - my nutritionist is not seeing patients, he tours doing lectures and research - I pulled in a favour so he can't help.

It may be that whatever factor is contributing to your elevated BG is outwith your control. It's possible you may require medication in order to keep on top of things.

You should really pay a visit to your GP if you're concerned.

 

[120673]

I'm not in the medication range yet, but I am just looking for ideas or factors I may have missed in the hope of not getting there

 

[GrantGam]

I'm not in the medication range yet, but I am just looking for ideas or factors I may have missed in the hope of not getting there

It's easier to get an Hba1c that classes you as a diabetic than you might think; especially with your lowest ever BG being 6.2mmol/L.

You can use this to see what your A1c would look like:

http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

It doesn't seem like you're missing anything really. You understand the importance of a proper diet and regular exercise, which are the building blocks for successful management of diabetes/pre-diabetes.

 

[Glink]

I can't explain the "why" but your story is not the only one of its type. It's good that you have a metre and are already being proactive about your carb intake. Have you/your clinicians considered LADA (and perhaps the MODYs)?

I am just a bit younger than you but also have shades of other autoimmune goings-on and mysterious thin-fit-no risk factor prediabetes (with diabetic readings when I am not super careful with carbs). Fasting glucose is my biggest challenge too. Metformin has helped a little, I think. A lot of the prediabetes conventional wisdom does not apply and this can be really frustrating. Hopefully you can find some proactive clinicians; mine where I live do not test for LADA so they are just waiting and watching my slow decline, basically. I expect I will end up on insulin eventually and am just doing what I can to possibly slow progression while trykng not to have expectations that are unrealistic for my individual situation.

Good luck!

 

[120673]

thank you, that is both reassuring and depressing. Will look at the test you mention.

 

[tim2000s]

I wonder if both @120673 and @Glink, you would benefit from an autoimmune antibody test. You are both suffering what appears to be pre-diabetes but without the indicators of metabolic syndrome. It's possible that you are late & slow onset T1 rather than T2, especially with other Autoimmune issues going on.

 

[Glink]

Yeah, we're basically functioning under the assumption that that's what's going on for me, even though the health system where I live doesn't officially recognize 1.5/LADA so I get the same stupid (for me) advice everyone else prediabetic does and no antibody testing. At one point I had to say point blank to my doctor, "I bike commute 2 hours a day, take a yoga class, and lift weights 3x/week. How much more exercise do you think I need to get? Do I need to quit my job and exercise all day?" After that he stopped telling me to cut out sugar (that I didn't eat/drink) and start exercising and started grumbling about how skinny I'd gotten! <eyeroll>

Even though I'm not looking forward to injections or worrying about hypos, a small part of me is looking forward to being on insulin eventually so I can eat some carbs again. I miss apples. And beets. And grains. I don't know if you get symptoms other than fatigue, @120673, but I find that the lower I can keep my sugars the better I feel (other than the hunger from not eating when my sugars run high!) and the fewer symptoms I get. I gained a lot of weight for no apparent reason right before I got diagnosed (like 30 lb, which left me still in the "normal" range but at the top end and way more than I'd ever weighed before, even at 10 mos pregnant!) and then lost it really quickly, but the loss it seems to have slowed before it got too alarming.

Anyway, I try not to let it get me down that I don't see the success of "reversing" prediabetes that many others experience. (There is at least one thread by mere here feeling discouraged, though!) I just assume I have a different form of the disease and the failure of my body is not my fault. There's only so much you can do--although I have no known risk factors and am the first in my family to experience diabetes, there are a lot of random genetic mutations we have yet to discover or understand, and we just have to live with them. If you haven't yet, I'd encourage you to see your GP about this, just to have someone monitoring your situation and aware in case things take a sudden turn for the worse.

 

[120673]

I miss apples. And beets. And grains. I don't know if you get symptoms other than fatigue, @120673, but I find that the lower I can keep my sugars the better I feel (other than the hunger from not eating when my sugars run high!) and the fewer symptoms I get. I gained a lot of weight for no apparent reason right before I got diagnosed (like 30 lb, which left me still in the "normal" range but at the top end and way more than I'd ever weighed before, even at 10 mos pregnant!) and then lost it really quickly, but the loss it seems to have slowed before it got too alarming.

Oh for an apple! I haven't eaten grain for years as it makes me unwell, lots of joint pain, wondering now if it is more about the glucose than a food intolerance. I have had joint pain from sugary foods for years but missed that clue. But I am missing fruit like crazy!! I have also gained this weight despite trying really hard to shift it, ways that again seem to succeed for others. It is incredibly frustrating to do everything right and still get fatter and less fit!!
On ultra-low carbs (4 weeks now, but long term on a "normal" low carb diet) my joint pain is better I have noticed, but not gone. Weight totally unchanged (again this seems unusual from reading others experience). However, my exercise tolerance also seems to have declined in this time. If I run up a single flight of stairs my legs ache for several minutes. If I try to do HIIT, my old routine was 8 x 30 second hill sprints twice a week - now I do 4 increasingly laboured, if I try again within 7 days I simply cannot run at all. I have been pretty active in the past, but for 3 years, perhaps more, it has been hard to do anything without the aching to the point my legs wont work and this is more noticeable than ever on this diet regime. The worst is hanging washing out - my arms just won't stay above shoulder level! No signs of any metabolic syndrome though outside of glucose being raised. You seem to be able to exercise loads so I wonder if this is different or related to glucose too? How are you fueling all that exercise if the cells are struggling to get glucose in? Maybe you are fully fat adapated? I can't seem to get into ketosis at all (checked blood and urine)?!! So disappointing to see no improvement in fasting glucose when I have done such a strict regime and even 24 hour water fasts. I think I'm right in thinking most people would see a change on this regime pretty quickly? I'm thinking that if this is the problem, insulin may make a difference to how I feel as I could get my hands on some of this energy floating around? What symptoms do you get if your glucose is high?
I've booked to see GP, but it is weeks to get an appointment. Sounds like the test is not offered as standard anyway. Will insulin levels be measured?
Is there a private lab that runs the antibody test?
Feel like this could really be what is going on, not great news but at least makes sense.

 

[Indy51]

Hmmnn, muscle pain - are you taking a statin by any chance, @120673?

The other possibility that occurred to me is ITB/TFL syndrome. Have you been assessed by a physio?

 

[Indy51]

Going back to your original post, since you've been low carb Paleo for quite a while, you might have physiological insulin resistance. Mark Sisson has a post about it:

http://www.marksdailyapple.com/do-low-carb-diets-cause-insulin-resistance/

Possibly you might do better by adding back some good carbs (like sweet potato) at night or post exercise?

 

[Brunneria]

@Glink

I just wanted to say that I loved your last post, and your attitude.
You are in a tough situation, but it looks like you have your head on straight and are handling it in the best possible way.
Brilliant.

 

[120673]

Going back to your original post, since you've been low carb Paleo for quite a while, you might have physiological insulin resistance

I've looked at that. I don't think it applies as i am for whatever reason not going into significant ketosis. Also with PIR glucose levels rarely as high as mine and drop with a meal. Mine is elevated all day, with small increase after eating lc.also, I dont think the carbs were low enough to induce this, I ate sweet potato and starch like beets, just never grains or sugar except fruit. Bring honest I probably overdid the fruit! Pir seems to develop over a long period of ultralow carbs. Will experiment at some point with this but want to try for ketosis so not keen to undo last 4 weeks until I've really given it a go!

the other possibility that occurred to me is ITB/TFL syndrome. Have you been assessed by a physio

Ha, I am one! Definitely not mechanical. I have hip dysplasia and joint replacement age 40 one side. The other needs doing and hurts, and itb is involved but I accept that....however, the "other" joint pain I get is deep ache in all joints and the muscle ache is in whatever muscles move significantly like the arms doing washing, gluts climbing a hill etc been tested for inflammatory arthritis and heaps of other stuff, all clear...just never considered glucose until recently.
No statins. Blood lipids are excellent.

 

[120673]

Oops, messed up quotes bit awkward on small tablet!

 

[Glink]

Oh for an apple! I haven't eaten grain for years as it makes me unwell, lots of joint pain, wondering now if it is more about the glucose than a food intolerance. I have had joint pain from sugary foods for years but missed that clue. But I am missing fruit like crazy!! I have also gained this weight despite trying really hard to shift it, ways that again seem to succeed for others. It is incredibly frustrating to do everything right and still get fatter and less fit!!

I had to eat literal balls of gluten (hardly any carbs) for 6 wks to test for celiac to determine that it was the carbs that were the problem not gluten. That was super fun.

On ultra-low carbs (4 weeks now, but long term on a "normal" low carb diet) my joint pain is better I have noticed, but not gone. Weight totally unchanged (again this seems unusual from reading others experience). However, my exercise tolerance also seems to have declined in this time. If I run up a single flight of stairs my legs ache for several minutes. If I try to do HIIT, my old routine was 8 x 30 second hill sprints twice a week - now I do 4 increasingly laboured, if I try again within 7 days I simply cannot run at all. I have been pretty active in the past, but for 3 years, perhaps more, it has been hard to do anything without the aching to the point my legs wont work and this is more noticeable than ever on this diet regime. The worst is hanging washing out - my arms just won't stay above shoulder level! No signs of any metabolic syndrome though outside of glucose being raised. You seem to be able to exercise loads so I wonder if this is different or related to glucose too? How are you fueling all that exercise if the cells are struggling to get glucose in? Maybe you are fully fat adapated? I can't seem to get into ketosis at all (checked blood and urine)?!! So disappointing to see no improvement in fasting glucose when I have done such a strict regime and even 24 hour water fasts. I think I'm right in thinking most people would see a change on this regime pretty quickly? I'm thinking that if this is the problem, insulin may make a difference to how I feel as I could get my hands on some of this energy floating around?

A couple things in here. One is that autoimmune things tend to travel with friends, so things like joint achiness may be another "unrelated" but associated issue. I have some other vaguely-autoimmune but undiagnosed things that cause periodic flare ups of joint pain/redness/swelling, rashes, etc. So even when blood glucose is the answer, it's not always THE answer. It may be AN answer.

What symptoms do you get if your glucose is high?

This one is easy for me. I get all the textbook diabetes symptoms: excessive thirst and urination, thrush, fatigue, blurred vision, irritability, swelling hands and feet, occasional random boils that take forever to heal. And in the immediate, I get shaky and those "hangry" type feelings that I was previously told (with never any lab tests to corroborate) were LOW blood sugar signs--now that I have a metre I know that for me those are actually signs of HIGH glucose and I have to skip meals until it goes back down to feel better.

I've booked to see GP, but it is weeks to get an appointment. Sounds like the test is not offered as standard anyway. Will insulin levels be measured?
Is there a private lab that runs the antibody test?

Yeah, it's probably not an urgent thing, but I'm glad you're seeing the GP and I hope they take you seriously. I had these symptoms for a couple years before I suddenly gained that weight, and it wasn't until the weight gain that I was taken seriously! Because apparently a thin person getting close to no longer being thin is more alarming to medicine than a thin person feeling awful for years. Grr...
They probably won't test insulin levels. Probably *will* test fasting BG, maybe a glucose tolerance test, and *maybe* a fasting c-peptide (sort of approximates an insulin test). Ideally they would do a GAD test if those are not good, to screen for LADA (not 100% sensitive/specific, but my understanding is that it flags most cases). There is private pay but you may still need a prescription for some tests--all this seems to vary regionally. I'm in Canada and my province doesn't do GAD test at all but the next province over would have tested me for free by now.

Feel like this could really be what is going on, not great news but at least makes sense.

You may find it interesting to browse the LADA/Type 1.5 forum here just FYI. I do it from time to time to get an idea of what that's like since it seems very likely that it will eventually be where I end up.

Good luck! Keep us posted as to how things are going. I find there are good days and bad days.

 

[120673]

@Glink, thank you, no idea how long this has been going on but I think some time. Be nice to know why I am noticeably more grumpy, like way more sometimes! I will go to GP armed with info now at least which is a great help