Type 2 Erratic, but rising blood glucose levels.

[Alan9009]

Hi All,

I've been diagnosed as a type 2, for 2 years 4 months. I am now 58 years old. My BMI 23.8, I am 6'4" male. I am now on 2 grams of Metformin, 120mgs of modified release gliclazide and recently started on 15mgs of pioglitazone, each medication respectively per day. I have had a c-peptide test done twice now. The first c-peptide test came back at 396, but when my gliclazide modified release was increased to the maximum dose, my c-peptide reading came back as 1280.

I am on a low carb diet, my blood glucose readings fluctuate greatly in an upward motion. I am unable to eat a normal sustainable diet. I was told to eat more carbs, but this increased my blood glucose readings up to and beyond 18 mmol/l and made me very ill. The medication seems to work for a short while then has decreased effect.

Has anyone had a similar experience? I am at a loss as to what to do for the best. I am ordinarily a fit and active person, but my energy levels are now unpredictable. Also at times I get very down about it all.

 

[xfieldok]

Can you tell us what you eat in a typical day please?

And welcome to the forum. Prepare to be swamped with information.

 

[Alan9009]

Hi xfieldok, Nice to meet you.
Breakfast: 3 egg and cheese omelette.
Lunch: vegetables (cauliflower with cheese sauce, otherwise everything boiled) and a protein as in meat.
Dinner: salad (no dressing, little or no tomatoes) with fish.
Snacks: cashew, pecan and peanuts (salted or unsalted)
Drinks: tea, coffee, water (hot drinks with semi-skimmed milk and never any sugar).
E.G. Up to 8 months ago, for breakfast, I was able to eat porridge (with no sugar, the plain rough cut type, unsweetened) with half a large banana, but now this puts my blood glucose level up to 15-16 mmol/l regardless of my now additional medication.

 

[xfieldok]

Bananas and grapes are the worst two fruits for T2.

Careful with the cashews, they are higher carb than other nuts.

Coffee, go for double (heavy) cream. The skinnier the milk, the higher the carbs.

What is in the cheese sauce?

 

[xfieldok]

Going to bed now, will catch up with you in the morning.

 

[Alan9009]

Yes bananas and grapes I love, I don't eat them anymore unless I'm going to burn them off cycling. I use double cream in line with the low carb high fat regime-fortunately it's something I'm still allowed.

Normally I'll use a dried cheese sauce and make it with water, this I check for carbs. It doesn't usually coincide with a high reading. If I'm eating out (during my working day I'll eat at a carvery if I haven't been able to prepare something for lunch) so the contents of a cheese sauce will be unknown. This type of meal doesn't usually spike my blood glucose readings though.

 

[JoKalsbeek]

Hi xfieldok, Nice to meet you.
Breakfast: 3 egg and cheese omelette.
Lunch: vegetables (cauliflower with cheese sauce, otherwise everything boiled) and a protein as in meat.
Dinner: salad (no dressing, little or no tomatoes) with fish.
Snacks: cashew, pecan and peanuts (salted or unsalted)
Drinks: tea, coffee, water (hot drinks with semi-skimmed milk and never any sugar).
E.G. Up to 8 months ago, for breakfast, I was able to eat porridge (with no sugar, the plain rough cut type, unsweetened) with half a large banana, but now this puts my blood glucose level up to 15-16 mmol/l regardless of my now additional medication.

Aside from the tweaks @xfieldok suggested, I don't see anything wrong here... You could try intermittent fasting (skipping a meal, or going for OMAD, meaning one meal a day), but only if it fits your lifestyle. I don't tolerate cashews well myself so avoid those, peanuts aren't fantastic either... Walnuts and pecans are excellent though. And I don't know who told you to have more carbs (and banana...?! That's one of the worst fruits out there for a T2!), but you listen to what your meter is telling you, okay? If a food kicks up your blood sugars, then it is not doing you any favours whatsoever.

As for slowly going up, what numbers are you seeing now, that you're dissatisfied with? The spike from the banana's is obvious, but what do they look like now without them? What's your HbA1c? Sometimes there's something else going on that makes our blood sugars creep up as well. Do you have a cold, did your medication for other conditions change? Sleeping alright? Stress? There's so much that can be at fault here...

Good luck!
Jo

 

[xfieldok]

Banana only if you bonk when cycling.

 

[Alan9009]

Hi Jo,

Nice to meet you, thanks for your advice.

I only take medication for diabetes. I don't seem to have any other conditions cold etc. Stress is an odd one as I'm not sure how to gauge that. I do run my own business and get troubles with it, but I don't have a tough work regime as such. Sleep/rest is not necessarily a problem, but I attempt to make this as good as it can be and make sure I get plenty of it.

I was told by a dietician to eat more carbs. I was suffering from very bad bouts of fatigue, to the point where I was unable to work and was bedridden for two to three hours during the day. It was as if my body was not able to absorb energy from the food I was eating. Eventually I dropped the carbs dramatically and was given more gliclazide, this got rid of the fatigue. It's as if my body cannot handle carbs/sugar any more and are now detrimental to me. It seems as if they become stored in some way and build up in my system, unless I really stay on top of their intake.

The problem with intermittent fasting and/or OMAD is that my weight is slowly, but surely dropping. I feel I need to maintain my weight and have more energy.

 

[Alan9009]

Hi Jo,

My HbA1c went down to 55, but then up to 75. It's tough work keeping it down. I guess the increase in medication is troubling me and whether or not it's the right medication. As I am finding with this disease it is subject to change and I think this frustrates me somewhat.

 

[HSSS]

I was told by a dietician to eat more carbs. I was suffering from very bad bouts of fatigue, to the point where I was unable to work and was bedridden for two to three hours during the day. It was as if my body was not able to absorb energy from the food I was eating. Eventually I dropped the carbs dramatically and was given more gliclazide, this got rid of the fatigue. It's as if my body cannot handle carbs/sugar any more and are now detrimental to me. It seems as if they become stored in some way and build up in my system, unless I really stay on top of their intake.

Sigh. They just don’t get how low carb works for diabetics. It is exactly that. You cannot utilise the energy from carbs. We cannot process them efficiently. The more carbs you eat the worse your insulin resistance gets as the insulin needs to be higher and higher to overcome the carbs. By dropping carbs and forcing your own insulin up with the glicazide you reversed this. Next you need to reduce insulin resistance so you don’t need the gliclazide as much.

 

[JoKalsbeek]

Hi Jo,

Nice to meet you, thanks for your advice.

I only take medication for diabetes. I don't seem to have any other conditions cold etc. Stress is an odd one as I'm not sure how to gauge that. I do run my own business and get troubles with it, but I don't have a tough work regime as such. Sleep/rest is not necessarily a problem, but I attempt to make this as good as it can be and make sure I get plenty of it.

I was told by a dietician to eat more carbs. I was suffering from very bad bouts of fatigue, to the point where I was unable to work and was bedridden for two to three hours during the day. It was as if my body was not able to absorb energy from the food I was eating. Eventually I dropped the carbs dramatically and was given more gliclazide, this got rid of the fatigue. It's as if my body cannot handle carbs/sugar any more and are now detrimental to me. It seems as if they become stored in some way and build up in my system, unless I really stay on top of their intake.

The problem with intermittent fasting and/or OMAD is that my weight is slowly, but surely dropping. I feel I need to maintain my weight and have more energy.

It's not "as if" you're unable to deal with carbs, and they get stored, built up and whatnot... That's exactly what T2 is. An inability to process carbs. Practically all carbs turn to glucose once ingested. The glucose gets stored in fat cells, as it isn't getting burned off and has no place to go at that point, but when the fat cells are full, it spills over into everything else: your blood stream, organs, tears, saliva, urine... I remember being so fatigued I'd lay in bed and wish I could go for a lie down, then realise I already was, and it wasn't helping. Fatigued to the point of pain. Sometimes my legs would just give out, there was no strength in them, and I'd go to my knees with a rather mighty thud. (I was over 100 kilo's then. Man, that hurt...). So I do get where you're coming from. If you want to maintain your weight, eat regularly, so indeed, no fasting or OMAD, but eat as low carb as possible. Maybe go carnivore (nearly or totally no carb) , or keto (20 grams or less a day). You'd be able to snack in between, as long as it'd be a no or nearly zero carb snack, like pork scratchings for instance... You'd keep your weight up to par without upping your blood sugars. You don't need carbs to keep your energy up.

 

[HSSS]

I’d just add that if you are trying to maintain weight that you should add more fats to your diet.

They dont effect bgl and despite all the hysteria of the last 50yrs all the current science seems to being saying it’s the carbs causing heart disease etc not fats. Many find their weight, cholesterol blood pressure all drop when they replace carbs with fats. Crazy isn’t it?

 

[Chunters]

I seem to be in a very similar place but don't have have any answers, sorry. I'm now on Gliclazide and low carbing (not Keto levels). My HbA1C and my daily numbers are just rising. 10g - 20g of carbs in a meal shoots my post meal numbers up to 18 at 2 hours, taking up to 5 hours to get back below 8.5. I don't have 10g - 20g of carbs every meal btw! Then when the numbers return to normal it's often a quick decent to hypo so I can't do OMAD which I used to do quite a lot and which worked really well for me. I've not had a c-pep test yet, maybe my next step.

 

[JoKalsbeek]

I seem to be in a very similar place but don't have have any answers, sorry. I'm now on Gliclazide and low carbing (not Keto levels). My HbA1C and my daily numbers are just rising. 10g - 20g of carbs in a meal shoots my post meal numbers up to 18 at 2 hours, taking up to 5 hours to get back below 8.5. I don't have 10g - 20g of carbs every meal btw! Then when the numbers return to normal it's often a quick decent to hypo so I can't do OMAD which I used to do quite a lot and which worked really well for me. I've not had a c-pep test yet, maybe my next step.

If you hypo, it's most likely related to the gliclazide. It causes hypo's. Certainly did for me. If you go lower carb or OMAD, to get better control, the glic'll throw a wrench in. It's not a good combination. You could try speaking to your prescriber to see whether it can be adjusted down, if that is what you want, of course.

 

[Chunters]

If you hypo, it's most likely related to the gliclazide. It causes hypo's. Certainly did for me. If you go lower carb or OMAD, to get better control, the glic'll throw a wrench in. It's not a good combination. You could try speaking to your prescriber to see whether it can be adjusted down, if that is what you want, of course.

Thanks Jo. Yes, should have mentioned I've no experience of hypo's before the Glic. So far all conversations with the DSN about Glic have concluded with either 'increase your dose by another tablet' or 'have a banana at lunchtime' I agreed to move to 2 tablets a day but resisted the move to 3 and 4. I do want to adjust down / come off completely but in the first few weeks (I've been taking it for about 7 weeks) the Glic did seem to be working. Then I had to take a course of steroids for a week - control went haywire and doesn't seem to have significantly stabilised since. I don't think the steroids caused my BG control to fall off a cliff edge but I don't suppose they helped anything but my asthma I'm going to see my DSN again in the few weeks and will discuss a plan that will get me off Glic.

@Alan9009 sorry for hijacking your thread, you've had some good advice, good luck.

 

[deszcznocity]

Hi xfieldok, Nice to meet you.
Breakfast: 3 egg and cheese omelette.
Lunch: vegetables (cauliflower with cheese sauce, otherwise everything boiled) and a protein as in meat.
Dinner: salad (no dressing, little or no tomatoes) with fish.
Snacks: cashew, pecan and peanuts (salted or unsalted)
Drinks: tea, coffee, water (hot drinks with semi-skimmed milk and never any sugar).
E.G. Up to 8 months ago, for breakfast, I was able to eat porridge (with no sugar, the plain rough cut type, unsweetened) with half a large banana, but now this puts my blood glucose level up to 15-16 mmol/l regardless of my now additional medication.

Your blood glucose level is not erratic, your body behaves adequately in relation to what you eat.

In in glycemic load terms:
1 banana is an equivalent of 6 teaspoons of sugar
120g grapes = 4 teaspoons of sugar
150ml porridge = 5 teaspoons of sugar

Please google Dr Unwin’s NICE Endorsed Sugar Equivalence Infographics for more.

I can see you are doing a lot to cut the carbs. That's fantastic. My advice:
take (double) cream instead of milk (any type of milk has carbs)
do not eat any fruits at all (tomatoes are fruits) - if you are worried about lack of vitamins if you do - google dr gary fettke is fruit good or bad for you
do not eat nightshade vegetables (google it - they are causing inflammation in a lot of people)

 

[HSSS]

Thanks Jo. Yes, should have mentioned I've no experience of hypo's before the Glic. So far all conversations with the DSN about Glic have concluded with either 'increase your dose by another tablet' or 'have a banana at lunchtime' I agreed to move to 2 tablets a day but resisted the move to 3 and 4. I do want to adjust down / come off completely but in the first few weeks (I've been taking it for about 7 weeks) the Glic did seem to be working. Then I had to take a course of steroids for a week - control went haywire and doesn't seem to have significantly stabilised since. I don't think the steroids caused my BG control to fall off a cliff edge but I don't suppose they helped anything but my asthma I'm going to see my DSN again in the few weeks and will discuss a plan that will get me off Glic.

@Alan9009 sorry for hijacking your thread, you've had some good advice, good luck.

If those opposing pieces of advice were given simultaneously (one will increase insulin and the possibility of hypo and the other will raise bgl/treat a hypo) I despair.

Steroids do send bgl crazy. Variety, dose and individual dependant of course

 

[xfieldok]

One of the frustrating things for T2s is that there is no one size fits all.

I am ok with winter tomatoes. When they are in season and super sweet, I have to stay clear.

Some people can tolerate porridge and some can't.

This is why the meter is vital in tailoring your own food choices.

 

[JoKalsbeek]

Thanks Jo. Yes, should have mentioned I've no experience of hypo's before the Glic. So far all conversations with the DSN about Glic have concluded with either 'increase your dose by another tablet' or 'have a banana at lunchtime' I agreed to move to 2 tablets a day but resisted the move to 3 and 4. I do want to adjust down / come off completely but in the first few weeks (I've been taking it for about 7 weeks) the Glic did seem to be working. Then I had to take a course of steroids for a week - control went haywire and doesn't seem to have significantly stabilised since. I don't think the steroids caused my BG control to fall off a cliff edge but I don't suppose they helped anything but my asthma I'm going to see my DSN again in the few weeks and will discuss a plan that will get me off Glic.

@Alan9009 sorry for hijacking your thread, you've had some good advice, good luck.

Oh yes, up the carb intake to match the medication.... That's next to insanity, but a piece of advice that's not as rare as it should be. And yes, steroids will make your blood sugars go nuts. Steroids send a signal to your liver to dump glucose like nobody's business. So it does, and it takes a good long while to taper off again.

Honestly... If there's another nurse in the practice, you might want to switch. This one isn't particularly helpful.