Still looking for answers.

[Nicksellick]

Hi All,
Despite being diagnosed nearly two years ago, I’m still trying to sort out what is best for me, what works, what doesn’t, etc.
My initial HBA1C was 118. With a huge dietary change, increased exercise and 4 Metformin a day, I got it down to 53, then 48, and then 43.
My last result was slightly up at 49.
I’m trying to be stricter and do more exercise, but I am feeling quite despondent.
I can’t afford a CGM at present and I wonder if, as an ”over thinker”, the data would freak me out!
Although I am very pleased that I reduced my A1C, the tests I do seem to indicate a high fasting glucose level.
If my liver is, at least in part making the problem worse, no amount of carb cutting or increased exercise will help.
is that correct?
I know a few people that were diagnosed with lower A1C’s that were immediately prescribed Gliclazide as well as Metformin. Is this regional?
Sorry this is such a rambling post.
Any comments would be very welcome.
I don’t currently feel in control!

 

[Oldvatr]

Think of your liver as a rechargeble battery. It stores mainly carbs in the form of glycogen but has the capability of creating new glucose from lipid fats stored in the adipose tissues. When you eat a carb strong meal. you use some in exercise and basic living, but any excess gets put away in the liver for a time when the glucose levels drop, which is during the night or fasting periods. The liver unwraps stored glucose when it thinks you need energy such as when you wake up or when it senses a boost is needed.

While you are charging the liver up with an excess intake, then it will not deplete its stored energy , so is capable of keeping bgl levels quite high if it wants to. The idea of diets is to deplete the liver so that it eventully gets th message that a lower level of glucose is survivable and boosts to lower levels. It is a matter of survival. So Low Carb diets reduce carb intake to deplete the liver, and fasting can help reset the thermostat so it does not feel the need to keep bgl levels high.

have a look at Intermitttent Fasting (based on work done by Jason Fung et al) as another tool you can use with the diet. And remember that every carb in => glucose for storage if not used.

PS I am a T2D using Gliclazide - I do LCHF but use the glic to give me some headroom so I can follow a higher carb intake, and have a more varied diet that is simpler for me to cater for. That is my choice, but my GP is trying to stop my Glic since he feels there are better meds now. I disagree with that hypothesis having had bad experiences with some of the newcomers. I have a happy relationship with my Glic and we understand each other. for me it works well.

It will be an area thing. You will find the GP is constrained by the CCG (Care Commissioning Group as was but now renamed as something else in some areas.) These are the bean counters that control what goes on in your area for primary care (GP's and associuated HCP;s outside the hospitals) They can override the medical guidelines from NICE it seems where they feel the guidelines are inappropriate for their area or their budget.

 

[Nicksellick]

Think of your liver as a rechargeble battery. It stores mainly carbs in the form of glycogen but has the capability of creating new glucose from lipid fats stored in the adipose tissues. When you eat a carb strong meal. you use some in exercise and basic living, but any excess gets put away in the liver for a time when the glucose levels drop, which is during the night or fasting periods. The liver unwraps stored glucose when it thinks you need energy such as when you wake up or when it senses a boost is needed.

While you are charging the liver up with an excess intake, then it will not deplete its stored energy , so is capable of keeping bgl levels quite high if it wants to. The idea of diets is to deplete the liver so that it eventully gets th message that a lower level of glucose is survivable and boosts to lower levels. It is a matter of survival. So Low Carb diets reduce carb intake to deplete the liver, and fasting can help reset the thermostat so it does not feel the need to keep bgl levels high.

have a look at Intermitttent Fasting (based on work done by Jason Fung et al) as another tool you can use with the diet. And remember that every carb in => glucose for storage if not used.

PS I am a T2D using Gliclazide - I do LCHF but use the glic to give me some headroom so I can follow a higher carb intake, and have a more varied diet that is simpler for me to cater for. That is my choice, but my GP is trying to stop my Glic since he feels there are better meds now. I disagree with that hypothesis having had bad experiences with some of the newcomers. I have a happy relationship with my Glic and we understand each other. for me it works well.

It will be an area thing. You will find the GP is constrained by the CCG (Care Commissioning Group as was but now renamed as something else in some areas.) These are the bean counters that control what goes on in your area for primary care (GP's and associuated HCP;s outside the hospitals) They can override the medical guidelines from NICE it seems where they feel the guidelines are inappropriate for their area or their budget.

That’s a fantastic reply. Really interesting.
Thank you.
I like the idea of LCHF, but the brain washing of the last 50 years is proving quite hard to overturn!
I can’t pour cream into my coffee, delicious though it is, without feeling guilty.

 

[JoKalsbeek]

That’s a fantastic reply. Really interesting.
Thank you.
I like the idea of LCHF, but the brain washing of the last 50 years is proving quite hard to overturn!
I can’t pour cream into my coffee, delicious though it is, without feeling guilty.

Turn that around again: guilty pleasures are the best pleasures, no?

 

[Oldvatr]

That’s a fantastic reply. Really interesting.
Thank you.
I like the idea of LCHF, but the brain washing of the last 50 years is proving quite hard to overturn!
I can’t pour cream into my coffee, delicious though it is, without feeling guilty.

Indeed. But the benefits are real. so it is a path you can follow to good effect.

I find that the HF in LCHF should really mean healthy fats, i.e. natually processed fats not industrial seed oils, which can cause inflammation and are mostly Omega-6 fats which are not the essential ones we absolutely need. Double cream is nice, but it may be overkill, and is not essential. I have myself increased my use of butter and lard, but not to extreme. Provided you feel satiated after, that is ok.

 

[MissMuffett]

When I first discovered keto/LCHF I relished the fact I could use butter and double cream without feeling guilty. I’m overweight and all my friends think it’s that that is making me fat! I’m fed up of explaining it to them, as you said they have been brainwashed by the last 50 years of low fat and carb loading and definitely steer well clear of saturated fats!

 

[Outlier]

No need to fret about exercise. It's healthful to do some, but each of us has to work within our own limitations, and a lot of us can't do much anyway. It certainly doesn't make any difference to weight control - if it did, jockeys and ballet dancers wouldn't have to keep to such strict food intake levels.

 

[JenniferM55]

Think of your liver as a rechargeble battery. It stores mainly carbs in the form of glycogen but has the capability of creating new glucose from lipid fats stored in the adipose tissues. When you eat a carb strong meal. you use some in exercise and basic living, but any excess gets put away in the liver for a time when the glucose levels drop, which is during the night or fasting periods. The liver unwraps stored glucose when it thinks you need energy such as when you wake up or when it senses a boost is needed.

While you are charging the liver up with an excess intake, then it will not deplete its stored energy , so is capable of keeping bgl levels quite high if it wants to. The idea of diets is to deplete the liver so that it eventully gets th message that a lower level of glucose is survivable and boosts to lower levels. It is a matter of survival. So Low Carb diets reduce carb intake to deplete the liver, and fasting can help reset the thermostat so it does not feel the need to keep bgl levels high.

have a look at Intermitttent Fasting (based on work done by Jason Fung et al) as another tool you can use with the diet. And remember that every carb in => glucose for storage if not used.

PS I am a T2D using Gliclazide - I do LCHF but use the glic to give me some headroom so I can follow a higher carb intake, and have a more varied diet that is simpler for me to cater for. That is my choice, but my GP is trying to stop my Glic since he feels there are better meds now. I disagree with that hypothesis having had bad experiences with some of the newcomers. I have a happy relationship with my Glic and we understand each other. for me it works well.

It will be an area thing. You will find the GP is constrained by the CCG (Care Commissioning Group as was but now renamed as something else in some areas.) These are the bean counters that control what goes on in your area for primary care (GP's and associuated HCP;s outside the hospitals) They can override the medical guidelines from NICE it seems where they feel the guidelines are inappropriate for their area or their budget.

Thank you for this explanation. I was going to create a thread about what's baffling me this morning, but this thread looks to be pertinent. Sorry @Nicksellick hope you don't think me rude for butting in .

Since 1st June I've been very strict with my diet, all foods consumed have been measured and analysed. I can honestly say carbs consumed are mostly under 15g a day, some days much lower but never over 20g until yesterday. Yesterday I had a week moment and ate 17.5g carb worth of chocolate. Not so bad really as my total carbs for yesterday was 38g. Yesterday morning my BS reading was 6.2, after the chocolate I kept checking to see if there's a spike, there were none. After the chocolate I recorded a 6.1, then 5.4 and 5.1 just before bedtime. First thing this morning (6:15am) my reading was 6.4 which is normal, I've taken my BS reading again since (9:30am, I don't know why as I've only had 2 glasses of water) and it recorded 7.7, checked again and got another 7.7 result. Your explanation @Oldvatr looks to be spot on. Not sure what this exactly means, but I'm going to keep checking. I've an annual appointment with the DN on 20th Aug so I'll certainly discuss this with her.

As an aside, despite being so strict, I'm still the same weight as I was over a month ago which is soooo frustrating.

 

[Outlier]

As an aside, despite being so strict, I'm still the same weight as I was over a month ago which is soooo frustrating.

It's only a month. While we might think or see nothing is happening, our bodies can be dealing with a significant number of changes, which in turn spark other changes. Bodies seek safety and homeostasis, which is why they take a while to show significant change. Then one day we realise - any number of things we didn't expect, which were related to our illness and management of same. Hold on to your hollyhocks and keep the faith.

 

[JenniferM55]

It's only a month. While we might think or see nothing is happening, our bodies can be dealing with a significant number of changes, which in turn spark other changes. Bodies seek safety and homeostasis, which is why they take a while to show significant change. Then one day we realise - any number of things we didn't expect, which were related to our illness and management of same. Hold on to your hollyhocks and keep the faith.

Thank you for your reassurance, sometimes that's all we need. Hollyhocks are blooming lovely right now!

 

[Nicksellick]

Thank you for this explanation. I was going to create a thread about what's baffling me this morning, but this thread looks to be pertinent. Sorry @Nicksellick hope you don't think me rude for butting in .

Since 1st June I've been very strict with my diet, all foods consumed have been measured and analysed. I can honestly say carbs consumed are mostly under 15g a day, some days much lower but never over 20g until yesterday. Yesterday I had a week moment and ate 17.5g carb worth of chocolate. Not so bad really as my total carbs for yesterday was 38g. Yesterday morning my BS reading was 6.2, after the chocolate I kept checking to see if there's a spike, there were none. After the chocolate I recorded a 6.1, then 5.4 and 5.1 just before bedtime. First thing this morning (6:15am) my reading was 6.4 which is normal, I've taken my BS reading again since (9:30am, I don't know why as I've only had 2 glasses of water) and it recorded 7.7, checked again and got another 7.7 result. Your explanation @Oldvatr looks to be spot on. Not sure what this exactly means, but I'm going to keep checking. I've an annual appointment with the DN on 20th Aug so I'll certainly discuss this with her.

As an aside, despite being so strict, I'm still the same weight as I was over a month ago which is soooo frustrating.

Not at all, the more the merrier. Not sure I understood the higher reading after two glasses of water though!

 

[Nicksellick]

Following on from this as I.F and T.R.F has been mentioned.
if my fasting BG is quite high, it seems logical to me that prolonging the fast would result in a higher average for the day! Or does prolonging the fast, over time, help to bring down the fasting BG? I have been having an eating window of around six hours which seemed to work for me in that I found it quite easy to stick to.

 

[Oldvatr]

One problem that T2D face is hyperinsulinemia, which is high and persistent levels of insulin due to insulin resistance. Every snack or carb nibble will work to keep the levels raised, and long term this is believed to be harmful. The idea of fasting is to break this chain by a true zero carb condition (water only fasts) instead of the nibbles. This allows the insulin to gradually drop and eventually become more normal. If repeated intermittently, then this will eventually re program the system and reduce Insulin Resistance.

It is thought that intermitttent fasting is better than a regular fast period, since the body will adjust the metabolic rate to synchronise with a regular cycle, thus negating its effects. Intermittent keeps it on its toes and avoids this metabolic adjustment. It is the same principle that low carbers should also adopt, which is the converse of fasting, and is add an occasional carby treat to again wake up the metabolic system that will also be trying to settle into a regular pattern of low carb (or actually any) diet.

 

[Nicksellick]

Thank you. really clear explanation.
Bt intermittent fasting are you meaning 24 hours with nothing but water on occasion, or days of very low calorific intake followed by “normal ” days?

 

[Oldvatr]

Thank you. really clear explanation.
Bt intermittent fasting are you meaning 24 hours with nothing but water on occasion, or days of very low calorific intake followed by “normal ” days?

You choose whatever you feel comfortable with. Water fasts are obviously a minimalist requirement. Perhaps have a read of Jason Fung for better info. It is not a technique I use myself, so I have no experiences to share. But there are many on this forum who use it sucessfullly and at varying degrees of 'severity'.

One thing I think may be of interest. I believe that those using carb restriction find that they can fast easier than those who calorie restrict. I found carb restriction alone was sufficient to kick my IR into touch, But we all vary.