Diabetes Follow-up Appointment at 3 Months

[Winnie53]

In early February, I had an A1C of 9.9 - (normal range is 4.0 - 6.0). What a shock.

I immediately began researching it on the internet. Lucky for me, one of the first links I came across was an article on www.mendosa.com that described David Mendosa's success bringing his blood glucose levels back into the normal range with a diet developed by Dr. Bernstein. For the first time since I was diagnosed with pre-diabetes in 2004, I had hope.

I tracked down a local copy of Bernstein's book and started reading. Next, I bought a glucose meter, lancet device, and strips, and started testing. Then I shopped for the "right" foods, purged and gave away foods consisting of grains or sugar, and started the LCHF diet.

In March, I went to my first doctor appointment to discuss my "out of control type 2 diabetes" and was pressured to start metformin and a statin. Thank goodness I brought my blood glucose meter so I could show the doctor how much progress I'd made.

He'd had other diabetic patients on the low carb diet. Somewhat reassured I was at least eating at least 30 - 50 carbs a day, he agreed to see me again in two months to continue discussing my treatment.

Between jobs, I decided to postpone my job search so I could develop my own treatment plan.

On the LCHF diet for three months, I'd lost 12 pounds then stalled. My blood glucose levels dropped from a high of 282 mg/dL (15.7 mmol/L) to a range of 105 - 145 mg/dL (5.8 - 8.1 mmol/L). Not as good as I'd hoped for, but progress. My next appointment was coming up, and I'd need another round of lab work in preparation. I requested additional tests based on the readings I'd done.

The lab results became available in waves.

Iron was normal, vitamin D was low. After researching my thyroid results I discovered I've had subclinical hyperthyroidism for up to 12 years and not one of my doctors told me. Comprehensive metabolic panel, and mircoalbumin, creatinine, and ratio were normal. These results meant my liver and kidney function were not only normal, but had improved.

A1C was 5.5 and normal. I'm "no longer diabetic". Yay!

Changes in lipid panel between February and May were disappointing: cholesterol increased, 229 to 236 mg/dL; triglycerides decreased, 126 to 123 mg/dL; HDL increased, 44 to 50; LDL increased, 165 to 166 mg/dL; and my triglyceride/HDL ratio improved, 2.86 to 2.46 - (a ratio of <2 is desired).

Inflammation measures were mixed: CRP was 0.5 - (<0.8 is normal) - and hsCRP-(Cardio) was 4.9 mg/L, high - (reference range: low <1.00; average 1.00 - 3.00; high >3.00) - so I have more work to do there too.

To bottom line it, clearly, there was no need to start metformin, but the doctor could still argue for me to start a statin, which, after reading the studies, I believe would not be right for me personally. I don't want the established risk of increased glucose levels, nor the increased risk of cognitive impairment, peripheral neuropathy, or accelerated atherosclerosis. In my mind, the risks outweigh the limited benefits, if any, again, in my case. I believe I can improve blood viscosity, and reduce arterial inflammation and plaque with nutritional supplements.

Continued in next post...

 

[Winnie53]

The day of my appointment started and ended unexpectedly, but the appointment itself, though intense, went as well as it could have.

I had to drive a friend to an early morning meeting which cut into my prep time a bit.

After my appointment, I learned that an old acquaintance had died, due to hypertension and hyperglycemia. My first thought was how sad, I wouldn't have the opportunity to reminisce with her about the community work we'd done together 20 years earlier.

After further reflection, my next thought was I hope this isn't a sign of things to come for me.

That morning, I printed out studies that established statin risks and the treatment protocol for subclinical hyperthyroidism so the doctor wouldn't put off my concerns. Then I gathered the medical records and lab results I'd gotten the day before from my former endocrinologist and naturopath.

Recalling that appointments are 15 minutes, if that, in the end I decided to leave the statin studies at home, and instead make and take a list of what I wanted out of the meeting...

Needs:

- Quarterly lab tests so I can make adjustments to my diet or nutritional supplements, if needed.
- Referral to a nutritionist to review what I'm eating.
- Have doctor examine my thyroid for nodule(s) or goiter.
- Possibly request a referral to a bariatric doctor to provide medical supervision if I decide to do an extended fast.

Issues:

- Diabetes - need to reduce A1C of 5.5 to <5.0; reduce 2-hour post glucose level from 120 - 140 mg/dL range to under 120 mg/dL.
- Cholesterol/lipids - need to reduce triglyceride/HDL ratio of 2.46 to <2.
- Arterial inflammation - need to reduce hsCRP-(Cardio) level
- Subclinical hyperthyroidism - continue to monitor and hope it spontaneously resolves as my overall health continues to improve
- Inflammatory bowel disease - ask for a referral to a gastroenterologist if flare doesn't remit in the next month or so

Strategies:

- LCHF diet
- Nutritional supplements
- Add berberine, 500 mg, 3 x day, or do an extended fast if blood glucose levels don't drop into normal range.

Thank goodness I did this. The appointment was rushed, start to finish, and he did most of the talking.

He surprised me by no longer wanting to put me on a statin because the "LDL standard had just changed to 190 mg/dL" and I was in the 160's. He agreed to the quarterly lab tests for now, also to the referral to a nutritionist. He reviewed my thyroid history and lab results. I was told that hsCRP-(Cardio) as a heart disease marker and the diagnosis of subclinical hyperthyroidism are both considered "controversial" (which typically means the doctor hasn't had the time to read the studies). He agreed to monitoring the thyroid after I declined referral to an endocrinologist. He examined my thyroid at my request. It felt normal. That was good. He didn't know who to refer me to for monitoring if I did an extended fast which was understandable. I need to make inquiries locally, regionally too perhaps.

The best part was that he agreed to order the quarterly lab tests but gave me the option of not having to pay for a doctor appointment to review them together, which saves me money, so I'm a happy girl.

I miss the days when doctors had more time with their patients. It's not their fault. It's the healthcare system. I think today more than ever before we need to become more knowledgeable about our health issues and treatment options so we can partner with our doctors and, hopefully, make more informed decisions.

 

[Safi]

Some very good progress there @Winnie53 - well done you

 

[Lamont D]

Well done @Winnie53,

You should write a blog, and then expand it, to include other things you have experienced.

 

[Winnie53]

Thanks Nosher. I'm trying to document my experiences here so I don't forget how exciting and difficult this process has been for me, with all its emotional ups and downs. It occurred to me last week that a blog would better serve this purpose, but at the same time, then I'd miss out on all the great interactions I experience on the forum. As you can tell, I'm going back and forth on this.

My long term goal is to start a local support group for type 2, diabetic low carbers, not sure when though. Maybe this fall. There's so much to learn.

Ultimately I'd like to put all the helpful information I've come across here and elsewhere into a blog here so I'll have something to refer locals to for the basics on type 2 diabetes and it's treatment. I continue to feel disappointed that healthcare providers aren't telling their patients about the LCHF diet option. I'd like to see that change.

I really appreciate all your posts on reactive hypoglycemia. I wasn't familiar with this condition until recently. Not a fun condition to have, of course, but interesting to learn about.

 

[Ian DP]

Great progress. Well done.

 

[LucySW]

Yes, you've done so much, Winnie. Really well done.

 

[Medusa41]

Fabulous to hear Winnie53

 

[Lamont D]

Thanks Nosher. I'm trying to document my experiences here so I don't forget how exciting and difficult this process has been for me, with all its emotional ups and downs. It occurred to me last week that a blog would better serve this purpose, but at the same time, then I'd miss out on all the great interactions I experience on the forum. As you can tell, I'm going back and forth on this.

My long term goal is to start a local support group for type 2, diabetic low carbers, not sure when though. Maybe this fall. There's so much to learn.

Ultimately I'd like to put all the helpful information I've come across here and elsewhere into a blog here so I'll have something to refer locals to for the basics on type 2 diabetes and it's treatment. I continue to feel disappointed that healthcare providers aren't telling their patients about the LCHF diet option. I'd like to see that change.

I really appreciate all your posts on reactive hypoglycemia. I wasn't familiar with this condition until recently. Not a fun condition to have, of course, but interesting to learn about.

It's one of the reasons I hang out here. RH is a condition which because of its very nature, you have no choice really on your menu day after day, my meds help, but the most difficult thing is finding what to eat 7 times a day, I have now, got myself in the routine of what to shop for me and my wife, (she is T2).
One of the best things is experiencing and experimenting what food does to you and something everyday food, like baked beans, where I have to have to cook them,strain them, let them cool and then microwave them. Just to eat 10 to 12 of them, hey ho! So I only get a small rise in bloods.

The information is great and has helped me tremendously.
The low carb forum and what I try to suggest is almost identical to both T2 & RH.
There is good banter also, some special caring posters.
This forum has helped get my life back.

I still don't get, why, after going on a low carb lifestyle, posters, still want to gorge carbs!

You really are doing fantastic @Winnie53. Get that blog going and get organising.

I wish that there was an RH club around my area, but as there is only 2 of us, it would be boring!

 

[LucySW]

Nosher, you're in contact with @Brunneria? She's an RH-er.

 

[Winnie53]

Nosher, I suffered intermittent bouts of hypoglycemia in the 80's. To cope, I ate all the time. Luckily for me I had a high metabolism throughout my 20's so only gained 2 - 3 pounds a year. Hypoglycemic episodes are awful. I can't imagine having episodes every time I eat throughout the day. Your blog and posts will help people with this condition for years to come.

I'm glad you're getting the support you need here. My experience has been the same. I visit the forum a minimum of six times a day. Every day, I learn something new.

Currently, I'm reading the book, Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain -- for Life (2015) by David Perlmutter, MD, author of Grain Brain. This information, from page 107, gave me hope...

"Research is underway examining how certain probiotics might be able to reverse type 2 diabetes and the neurological challenges that can follow. At Harvard's 2014 symposium on the microbiome, I was floored by the work of Dr. M. Nieuwdorp from the University of Amsterdam, who has done some incredible research related to obesity and type 2 diabetes.(22) He has successfully improved the blood sugar mayhem found in type 2 diabetes in more than 250 people using fecal transplantation. He's also used this procedure to improve insulin sensitivity."

I found, but haven't read, one of their studies published in 2014 in the American Diabetes Association's Diabetes Care. Here it is... http://www.medscape.com/viewarticle/837381

 

[Lamont D]

Nosher, you're in contact with @Brunneria? She's an RH-er.

Yes, isn't she the best!
@Brunneria is my mentor and my tutor and I wouldn't be as good as I am without her.


No more to be said!

 

[Lamont D]

Nosher, I suffered intermittent bouts of hypoglycemia in the 80's. To cope, I ate all the time. Luckily for me I had a high metabolism throughout my 20's so only gained 2 - 3 pounds a year. Hypoglycemic episodes are awful. I can't imagine having episodes every time I eat throughout the day. Your blog and posts will help people with this condition for years to come.

I'm glad you're getting the support you need here. My experience has been the same. I visit the forum a minimum of six times a day. Every day, I learn something new.

Currently, I'm reading the book, Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain -- for Life (2015) by David Perlmutter, MD, author of Grain Brain. This information, from page 107, gave me hope...

"Research is underway examining how certain probiotics might be able to reverse type 2 diabetes and the neurological challenges that can follow. At Harvard's 2014 symposium on the microbiome, I was floored by the work of Dr. M. Nieuwdorp from the University of Amsterdam, who has done some incredible research related to obesity and type 2 diabetes.(22) He has successfully improved the blood sugar mayhem found in type 2 diabetes in more than 250 people using fecal transplantation. He's also used this procedure to improve insulin sensitivity."

I found, but haven't read, one of their studies published in 2014 in the American Diabetes Association's Diabetes Care. Here it is... http://www.medscape.com/viewarticle/837381

Yeah! Thanks for the link, interesting.
I've been here for over two years and more in my diabetic years (thanks to my docs!)
I'm still learning and meeting some great people and trying my best to help those who are confused and lost in the 'what should I do?' Posters.
I unfortunately have to do likewise to keep my bloods level. I'm in it for the long haul, my meds help but until my pancreas decides to stop messing me about, this is what I have to do. Except fasting days.
Hope you are keeping control.
Thanks for the interest!

 

[Winnie53]

Nosher, I still have a ways to go on blood glucose, even though my A1C is now normal. Will keep at it. Would not be able to do this without you all.

Oh, and I forgot to mention, in his chapter, "Feeding Your Microbiome: Six Essential Keys to Boosting Your Brain by Boosting Your Gut", LCHF is second on the list, chocolate third, and fasting sixth. Maybe we're onto something here...

1. Choose foods rich in probiotics
2. Go low-carb, embrace high quality fat
3. Enjoy wine, tea, coffee and chocolate [I did the happy dance when I read this. I've eaten dark chocolate daily my entire life. I now eat a small square of 85% cocoa dark chocolate twice a day. It doesn't taste as good as 70% cocoa though. Hopefully, with time, I'll enjoy it more. I do have one bad diet habit. After a particularly stressful day I'll break into my stash of dark chocolate truffles and have one. This is what Jenny Ruhl refers to as eating "off plan" in the Blood Sugar 101 chapter, "Making Your Diet Work". ]
4. Choose foods rich in probiotics
5. Drink filtered water
6. Fast every season

I [heart] Perlmutter.

 

[Lamont D]

Nosher, I still have a ways to go on blood glucose, even though my A1C is now normal. Will keep at it. Would not be able to do this without you all.

Oh, and I forgot to mention, in his chapter, "Feeding Your Microbiome: Six Essential Keys to Boosting Your Brain by Boosting Your Gut", LCHF is second on the list, chocolate third, and fasting sixth. Maybe we're onto something here...

1. Choose foods rich in probiotics
2. Go low-carb, embrace high quality fat
3. Enjoy wine, tea, coffee and chocolate [I did the happy dance when I read this. I've eaten dark chocolate daily my entire life. I now eat a small square of 85% cocoa dark chocolate twice a day. It doesn't taste as good as 70% cocoa though. Hopefully, with time, I'll enjoy it more. I do have one bad diet habit. After a particularly stressful day I'll break into my stash of dark chocolate truffles and have one. This is what Jenny Ruhl refers to as eating "off plan" in the Blood Sugar 101 chapter, "Making Your Diet Work". ]
4. Choose foods rich in probiotics
5. Drink filtered water
6. Fast every season

I [heart] Perlmutter.

That's a good list,
Except, I can't have the wine, hate coffee and dairy, except the yoghurt, Greek full fat with my chocolate and berries.

Enjoy your bad habit, once in a while does you no harm!

 

[Brunneria]

Hi @Winnie53

Did you ever read that Diabetes Miracle book?
It's interesting that you mentioned hypos way back, and the developed T2. Diane Cress talks about RH being a 'hidden' precursor to T2 for many of us.

And @nosher8355 lovely though it is, you have to stop saying I'm your mentor! The only thing I did was nudge... er, OK, bully you into even lower LC.

In practical terms you have far more knowledge of RH than me. For a start you have been officially diagnosed, tested and medicated! And you have a good relationship with a knowledgable consultant.

Thanks for posting all your progress and learning curves Winnie. It really helps people.

 

[Lamont D]

Hi @Winnie53

Did you ever read that Diabetes Miracle book?
It's interesting that you mentioned hypos way back, and the developed T2. Diane Cress talks about RH being a 'hidden' precursor to T2 for many of us.

And @nosher8355 lovely though it is, you have to stop saying I'm your mentor! The only thing I did was nudge... er, OK, bully you into even lower LC.

In practical terms you have far more knowledge of RH than me. For a start you have been officially diagnosed, tested and medicated! And you have a good relationship with a knowledgable consultant.

Thanks for posting all your progress and learning curves Winnie. It really helps people.

Ok, @Brunneria , you have been de-mentored, (is that a word?)
I'm still appreciative though!
And I can never thank you enough!

 

[Winnie53]

Hi @Winnie53

Did you ever read that Diabetes Miracle book?
It's interesting that you mentioned hypos way back, and the developed T2. Diane Cress talks about RH being a 'hidden' precursor to T2 for many of us.

Thanks for posting all your progress and learning curves Winnie. It really helps people.

Brunneria, the Diabetes Miracle book is still waiting to be read. Unfortunately, my ongoing IBS flare, previous chest pains, and disappointing lipid panel results have temporarily shifted my attention to books on reversing heart disease. Thank you for recommending Diane Kress' book. It's the only book I have that was written by a certified diabetes educator. It looks every bit as good as the Jenny Ruhl books. I'm really looking forward to reading it!

When the hypoglycemia started, my doctor started monitoring me for pre-diabetes. Prior to that, I had gestational diabetes too, luckily it didn't show up until just before my son's birth. Maternal grandmother had type 2 diabetes, later dementia; mother has what I'd describe as well controlled pre-diabetes and is in the early stages of dementia. So all the signs were there from the beginning.

 

[Winnie53]

As I was rewatching Jason Fung lectures today, I was struck by how many of his patients, like me, were diagnosed with type 2 diabetes only 10 years ago, but were already suffering from diabetic complications.

At the end of my doctor appointment on Wednesday, he asked, it was more of an after thought really, whether I still had feeling in the bottom of my feet. That shocked me. I do of course.

Kind of glad he didn't ask more questions. The last thing I need right now is to get into a discussion with him about my cardiovascular health. My first choice is and always will be diet, supplements, and exercise, medication only if needed.

Mentor, or no mentor, thanks for looking out for us Brunneria.