Diabetic Review

[mazza 2]

Hi Everyone,
Just wanted your opinions on my latest diabetic review with my DN. Basically, I've been low carb since diagnosis in 2018. I've never managed to get into non-diabetic numbers but have maintained pre-diabetic numbers. Last year my A1c was 45 but this year it's increased to 50 without any changes in my diet or exercise. I am slightly under-weight and am pretty strict with my diet. My DN seems to think that considering my weight and diet that I need to take Linagliptin as my pancreas function is getting worse. She told me that people who are not overweight tend to go on insulin sooner than those who are not and it's just my body letting me down. I have told her that I will think about taking Linagliptin but I would like another A1c test in 6 months first and decide what to do once I have the results. She was o.k with this but gave me the impression that it would just keep progressing. Does anyone have any ideas what I can do to try and lower my A1c or do you think she is correct? I know our bodies are all different but it's quite disappointing after being so committed to this new lifestyle change for so many years. Thanks all.

 

[MissMuffett]

Hi it must be disheartening after you’ve been very strict with yourself and doing every right. How low carb have you been? I’m starting carnivore (zero carbs) as I’ve been under 20g carbs a day and my BG was still in the teens without medication I’m not suggesting you go there but just sympathising

 

[Deleted member 527103]

@mazza 2 have you ever been tested for Type 1 diabetes.
If you are eating very low carb, are underweight and your levels are rising, you may be one of about 30% of people misdiagnosed with type 2.

 

[mazza 2]

Hi it must be disheartening after you’ve been very strict with yourself and doing every right. How low carb have you been? I’m starting carnivore (zero carbs) as I’ve been under 20g carbs a day and my BG was still in the teens without medication I’m not suggesting you go there but just sympathising

Well, my diet is consists of meat with vegetables ( above ground only) or salads with fish or meat, breakfast is greek yoghurt with a few frozen raspberries. I sometimes have sandwiches with low carb bread from seriously low carb website. I do have a low carb biscuit or cake for dessert from seriously low carb website or I make my own. I rarely drink alcohol but when I do it's dry white wine which actually keeps my levels low into the following day. I do check my bloods regularly and they don't really go higher than 7's. So I'm not sure what's going on really.

 

[mazza 2]

@mazza 2 have you ever been tested for Type 1 diabetes.
If you are eating very low carb, are underweight and your levels are rising, you may be one of about 30% of people misdiagnosed with type 2.

I haven't been tested for type 1 and the DN didn't suggest any further investigations but I did ask her about a C-peptide test but she said it wouldn't tell me anything as it would show my insulin output is low. Is there a test I could have?

 

[ianf0ster]

I have no evidence on which to base the following:
My opinion which is worth only a little in this case, since although an ex-TOFI and T2D in remission , is :
1, Your DN is probably old-school and so thinks that T2D is inevitably progressive.
2. There is no reason (that I can think of) for slim T2 people to need Insulin more than or 'earlier' than others, especially since most T2D's in remission are relatively slim (at least compared with what they were before).
3. There are other causes of high BG than just food. These include some potentially long term things such as stress, illness, medications (statins and Steroid being the most common).
4. Consider how strict have you been, how often do you actually measure - both carbs and BG? Is there a possibility of carb creep due to complacence
5. Is it possible that you have been a slow LADA rather than straightforward T2 all along?

 

[ianf0ster]

Well, my diet is consists of meat with vegetables ( above ground only) or salads with fish or meat, breakfast is greek yoghurt with a few frozen raspberries. I sometimes have sandwiches with low carb bread from seriously low carb website. I do have a low carb biscuit or cake for dessert from seriously low carb website or I make my own. I rarely drink alcohol but when I do it's dry white wine which actually keeps my levels low into the following day. I do check my bloods regularly and they don't really go higher than 7's. So I'm not sure what's going on really.

Curiouser and curiouser. If your BG doesn't ever go as high as 8.0, then to get an HbA1C of 50, it isn't going down much, even overnight or whilst fasting.
Or are you snacking (even on seriously low carb) ?
By the way, low carb alcohol like dry white wine isn't free of diabetes consequences since the carbs from your food still eventually get processed, just over a longer period and/or at a time you don't anticipate and so when you aren't measuring your BG. Also alcohol is very calorific and so can cause fatty liver - the one driven by alcohol rather than the carb driven one.

 

[mazza 2]

Curiouser and curiouser. If your BG doesn't ever go as high as 8.0, then to get an HbA1C of 50, it isn't going down much, even overnight or whilst fasting.
Or are you snacking (even on seriously low carb) ?
By the way, low carb alcohol like dry white wine isn't free of diabetes consequences since the carbs from your food still eventually get processed, just over a longer period and/or at a time you don't anticipate and so when you aren't measuring your BG. Also alcohol is very calorific and so can cause fatty liver - the one driven by alcohol rather than the carb driven one.

Hi, thanks for your input. I don't think I have carb creep as I haven't changed my eating pattern but I will start to log everything I eat and work out the exact carbs for a week to see if I'm miscalculating anything, I'll let you know. I don't drink alcohol very much, maybe a couple of times a month and then I only have one or two medium glasses, so I don't think that would make such a difference and my liver results have been fine. The DN advised me to eat more protein which is probably a good idea so I'll do that as well. I check my blood levels on waking and before and 2 hours after eating and they don't increase more than 2 points so that seems o.k. I think my last glucose monitor wasn't working properly because the predicted A1c was way out so I have changed to the tee 2 which I'm hoping will be more accurate. Thanks for your help.

 

[0110]

Hi, thanks for your input. I don't think I have carb creep as I haven't changed my eating pattern but I will start to log everything I eat and work out the exact carbs for a week to see if I'm miscalculating anything, I'll let you know. I don't drink alcohol very much, maybe a couple of times a month and then I only have one or two medium glasses, so I don't think that would make such a difference and my liver results have been fine. The DN advised me to eat more protein which is probably a good idea so I'll do that as well. I check my blood levels on waking and before and 2 hours after eating and they don't increase more than 2 points so that seems o.k. I think my last glucose monitor wasn't working properly because the predicted A1c was way out so I have changed to the tee 2 which I'm hoping will be more accurate. Thanks for your help.

Hi - what seem to be your morning fast numbers? And pre meal and after meal numbers?

 

[Lupf]

Hi @mazza 2 please recall that the precision of an HbA1c test is ±6%, so 50 is not really different from 47 for a single test. If your next test is okay again, I would consider it a blip.

 

[mazza 2]

Hi - what seem to be your morning fast numbers? And pre meal and after meal numbers?

Morning numbers range from 5.8 to 6.7. So today fasting number: 6.7 on waking pre breakfast 7.3 2 hours later: 7.5. Pre lunch 6.5 2 hours later 6.3
Pre dinner 6.2 and 2 hours later 7. Before bed 6.4. Thanks

 

[mazza 2]

Hi @mazza 2 please recall that the precision of an HbA1c test is ±6%, so 50 is not really different from 47 for a single test. If your next test is okay again, I would consider it a blip.

That's what I'm hoping hence I didn't want to increase medication yet. Thanks

 

[0110]

Morning numbers range from 5.8 to 6.7. So today fasting number: 6.7 on waking pre breakfast 7.3 2 hours later: 7.5. Pre lunch 6.5 2 hours later 6.3
Pre dinner 6.2 and 2 hours later 7. Before bed 6.4. Thanks

You ask me they are v good numbers

 

[Mimidou]

Morning numbers range from 5.8 to 6.7. So today fasting number: 6.7 on waking pre breakfast 7.3 2 hours later: 7.5. Pre lunch 6.5 2 hours later 6.3
Pre dinner 6.2 and 2 hours later 7. Before bed 6.4. Thanks

Hello,
Sorry to hear that despite being so good with your carb intake, your levels have gone up. I do think it fluctuates really.
I was diagnosed with T2 in November 2018 myself with an Hba1c of 50, but since then I've been told I'm in the pre diabetic range as my levels are around 43, 44 and 45.
I do eat low carb bread, a small portion of brown rice, loads of vegetables, fruits lean chicken, sea foods and I go for a 30 minutes walk everyday.
Stick to your diet and good idea to take another test in 6 month's time.
Don't get too stress and hopefully our levels are in the right range with your next test.

 

[MattInUSA]

I am slightly under-weight and am pretty strict with my diet.

Maybe it is insulin resistance, but I'd get tested for autoimmune issues. LADA and MODY in particular. You'd need to be tested for antibodies. A C-peptide and fasting insulin wouldn't hurt either to see what you're producing and what your HOMA score is (basically a division of your fasting insulin and glucose). You may be spinning your wheels trying to keep your A1C down when you're not doing anything wrong. If your pancreas is pooping out for whatever reason and you need a bit of insulin, so be it. You can still be healthy and it's not anything you've done wrong.

 

[mazza 2]

Hello,
Sorry to hear that despite being so good with your carb intake, your levels have gone up. I do think it fluctuates really.
I was diagnosed with T2 in November 2018 myself with an Hba1c of 50, but since then I've been told I'm in the pre diabetic range as my levels are around 43, 44 and 45.
I do eat low carb bread, a small portion of brown rice, loads of vegetables, fruits lean chicken, sea foods and I go for a 30 minutes walk everyday.
Stick to your diet and good idea to take another test in 6 month's time.
Don't get too stress and hopefully our levels are in the right range with your next test.

Thanks for that, I was initially diagnosed with an A1c of 76 and with a low carb diet my lowest level was 45, so I'm hoping it will go back down. This is the first time in 5 years that I have gone back into diabetic numbers so I am a little disappointed but onwards and upwards!!

 

[mazza 2]

Maybe it is insulin resistance, but I'd get tested for autoimmune issues. LADA and MODY in particular. You'd need to be tested for antibodies. A C-peptide and fasting insulin wouldn't hurt either to see what you're producing and what your HOMA score is (basically a division of your fasting insulin and glucose). You may be spinning your wheels trying to keep your A1C down when you're not doing anything wrong. If your pancreas is pooping out for whatever reason and you need a bit of insulin, so be it. You can still be healthy and it's not anything you've done wrong.

Hi MattinUSA
I did ask the nurse for a c-peptide test but she said it would show that I wasn't producing enough insulin!!! I might go private and at least (as you say ) I can stop beating myself up about it. Thanks

 

[Hiitsme]

Hi @mazza 2

I feel for you and have had to been even more strict with carbs myself. For me it has been stress related . I did only go up to 48 but now being very strict it is coming down again but so hard to stick to. I had got down to 30:s but with my husband's terminal illness and death HbA1c just went up even keeping to same diet. I also wonder if it increases with age.

 

[Oldvatr]

If it was pancreas deficiency getting worse, then I would expect to see meal responses to get worse. Yours seem fine, so I would query the DN diagnosis. It may be insulin resistance or creepy carbs, but again, your readings do not seem to support that hypothesis either. If you are low carbing, then it is possible that protein is causing a rise in long term levels since you are probably making glucose from protein especially if you are going into ketosis. Maybe upping the fat content will counteract the protein creep.

i log my results, and I can see if my average levels are rising over time. I recently suffered carb creep myself, and my levels rose by a couple of points. I identified the culprit, and my levels have dropped back again now.

One other confounder that may be at play is hormonal changes can affect bgl levels.

for me, I found that two of my meds actually pushed my bgl up by 2 mmol/l and I found this by noting those days when I forgot to take my morning meds, and saw the drop was consistent. Process of elimination identified that my prostate med and my blood pressure med were responsible, so I had to reduce carbs to compensate.

Personally I had my HbA1c at 106 and I was maxed out on Metformin, Actos and Gliclazide. My doctor told me my pancreas was bust and I had to go onto insulin therapy for life. I refused, and joined this site. My HbA1c results since have all been either non diabetic or prediabetic but none above 48. So my GP was well intentioned but WRONG. My pancreas has recovered now and although I use a small amount of gliclazide, it is minimum dose. Tonight I ate a meal of commercial fajita mix, stirfry veg, all ro[[ed up in a large carb filled (white processed flour) pancake. My readings for pre/ 2hrPP / 4 hr were 6.1/ 5.1 / 4.7 mmol/l so I am deffo in control again.

 

[mazza 2]

If it was pancreas deficiency getting worse, then I would expect to see meal responses to get worse. Yours seem fine, so I would query the DN diagnosis. It may be insulin resistance or creepy carbs, but again, your readings do not seem to support that hypothesis either. If you are low carbing, then it is possible that protein is causing a rise in long term levels since you are probably making glucose from protein especially if you are going into ketosis. Maybe upping the fat content will counteract the protein creep.

i log my results, and I can see if my average levels are rising over time. I recently suffered carb creep myself, and my levels rose by a couple of points. I identified the culprit, and my levels have dropped back again now.

One other confounder that may be at play is hormonal changes can affect bgl levels.

for me, I found that two of my meds actually pushed my bgl up by 2 mmol/l and I found this by noting those days when I forgot to take my morning meds, and saw the drop was consistent. Process of elimination identified that my prostate med and my blood pressure med were responsible, so I had to reduce carbs to compensate.

Personally I had my HbA1c at 106 and I was maxed out on Metformin, Actos and Gliclazide. My doctor told me my pancreas was bust and I had to go onto insulin therapy for life. I refused, and joined this site. My HbA1c results since have all been either non diabetic or prediabetic but none above 48. So my GP was well intentioned but WRONG. My pancreas has recovered now and although I use a small amount of gliclazide, it is minimum dose. Tonight I ate a meal of commercial fajita mix, stirfry veg, all ro[[ed up in a large carb filled (white processed flour) pancake. My readings for pre/ 2hrPP / 4 hr were 6.1/ 5.1 / 4.7 mmol/l so I am deffo in control again.

The nurse did mention Gliclazide but said as I was on a low carb diet I couldn't have it. I did notice two or three weeks before my test my levels were higher than normal. I had a few hospital tests coming up and a few social events so I put my higher results down to that. I asked the nurse if this could have affected the results but she said the A1c was over 3 months so it wouldn't have affected the results. I am thinking of ordering a home A1c test but not sure how accurate they are but I might do that and test in 3 months, Thanks for you help.