2 Years Low Carb - Wanting to Quit?

[CrumblingWall]

Do you test at home yet? I'd ask for another test, maybe HbA1C. If you do another GTT, insist on an insulin test for the 3 points as well. It'll give a clearer picture to know if there is a lot of insulin floating around or not. I'd say there is if you landed at 3.9 by the 3 hour mark. 14.2 is a bit high though, isn't it. I'd consider sticking to low carb till you get more answers.

Hba1c is fine. Low carb makes me feel miserable, I don't want to do it anymore. Plus, my urologist said low carb caused the kidney stones. I don't want more of them. I honestly cannot believe what I am reading in previous endocrinologist writings ... first, he claims I had insulin resistance due to low carbing but my c-peptide was down low (below normal range)...then he clearly misspells hyperglycemia with hypoglycemia lol. Then he saw me spiking to around 10 mmol/l while in hospital eating the food and said "it is normal". I am getting myself to endocrinologist today, see what an independent mind can tell me.

My current doctor thinks that there are two possibilities: I need more time to come out of ketogenic mode and start producing insulin or pancreas is kaput for some reason (not autoimmune, no pancreatitis or trauma), it just refuses to produce enough insulin, and that's that.

 

[bulkbiker]

Ah, yeah, I remember. 2h - 14.2 mmol/l. I did come down to 3.9 mmol/l at 3 hours though which was weird. Your resistance looks pathological, while mine is still not clear what it is. I am leaning more and more to something bad and not physiological though. I find it weird: the doctors I talk to, all of them just cannot tell me straight to my face what this is and what to do about it. Just that it is not diabetes. Idk ... that 2h GTT is very diabetic.

Sounds a bit like mine from 2 years ago

I did the test without carbing up beforehand to see what my response would be to a large influx of glucose. Whilst not quite so high as yours my peak was quite dramatic with an over compensation afterwards down to 4.1 mmol/l at 2 1/4 hours.

 

[CrumblingWall]

Sounds a bit like mine from 2 years ago
View attachment 37566

I did the test without carbing up beforehand to see what my response would be to a large influx of glucose. Whilst not quite so high as yours my peak was quite dramatic with an over compensation afterwards down to 4.1 mmol/l at 2 1/4 hours.

Did you do one after carbing up? I honestly don't see how my issue is insulin resistance. All I can find with my parameters is that pancreas mirrors type 1 response when not carbed up, so it produces not enough insulin to deal with sudden carbs load. It then takes time for it to get itself together and slowly manufacture insulin to deal with hyperglycemic crisis at hand. So, I did tumble down to hypo 3.5 hours later which looks like way later than your curve which means either larger insufficiency or something else....\

Read this: which one do you think corresponds to us? http://meridianvalleylab.com/wp-content/uploads/2018/07/Kraft-Interp-Guide-2018.pdf

 

[bulkbiker]

So, I did tumble down to hypo 3.5 hours later which looks like way later than your curve which means either larger insufficiency or something else....

I think it just shows your insulin resistance was greater than mine at that time.

I had no desire to carb up so haven't tried another OGTT but might this year as I want to get more testing done. However I'll do it uncarbed again as that is my way of life now. I didn't have my insulin resistance measured at the exact time of the OGTT but a few months after I had Fasting Insulin of 7.85 and FBG of 5.0 which gave me a level of IR at 1.70.

 

[CrumblingWall]

I think it just shows your insulin resistance was greater than mine at that time.

I had no desire to carb up so haven't tried another OGTT but might this year as I want to get more testing done. However I'll do it uncarbed again as that is my way of life now. I didn't have my insulin resistance measured at the exact time of the OGTT but a few months after I had Fasting Insulin of 7.85 and FBG of 5.0 which gave me a level of IR at 1.70.

I am emailing the private hospital I was at and see what all the records about me say. If they measured insulin at various points, yay, if they did not, how would they know it is insulin resistance ... for all I care, it could be pancreas getting weak for whatever reason.

P.S. in that link, it seems I would fit Pattern III-B: Insulin Resistance

 

[bulkbiker]

I am emailing the private hospital I was at and see what all the records about me say. If they measured insulin at various points, yay, if they did not, how would they know it is insulin resistance ... for all I care, it could be pancreas getting weak for whatever reason.

P.S. in that link, it seems I would fit Pattern III-B: Insulin Resistance

That would be incredibly useful info to have but I fear they won't have measured it.
It seems the UK is way behind in measuring endogenous insulin production which is crazy considering the amount of misdiagnosis it could avoid.

 

[CrumblingWall]

That would be incredibly useful info to have but I fear they won't have measured it.
It seems the UK is way behind in measuring endogenous insulin production which is crazy considering the amount of misdiagnosis it could avoid.

So how do they know it is my problem...you can't tell especially when c peptide was below range before test. It is annoying...here is a thing. I am trying to add more carbs and my experience is the same as in GTT. Going high for 2.5 hours and then start to come down at 3 hours. It is really weird and annoys me so much. If I had a concrete number such as insulin during GTT then I would know for sure what is wrong. I guess I produced enough insulin eventually but it took some time. Also, when that happened they did ring alarm bells and put in a cannula and something into my veins. Hope it wasn't insulin..

 

[bulkbiker]

I guess I produced enough insulin eventually but it took some time.

That sounds to me like pretty strong insulin resistance?

when that happened they did ring alarm bells and put in a cannula and something into my veins. Hope it wasn't insulin..

More likely to be a glucose infusion that simply started the whole process off again..

Have you ever tried a virtually zero carb diet just to see if it helps?

 

[CrumblingWall]

Yes, I don't know if it helped. I did not eat carbs so there was no problem.

I doubt it was glucose, why infuse someone with glucose again when they just went high during the test?

 

[bulkbiker]

Yes, I don't know if it helped. I did not eat carbs so there was no problem.

I doubt it was glucose, why infuse someone with glucose again when they just went high during the test?

You said you went "hypo" afterwards.. glucose would be the obvious "cure" for that although in your case probably completely unnecessary.

 

[CrumblingWall]

You said you went "hypo" afterwards.. glucose would be the obvious "cure" for that although in your case probably completely unnecessary.

I went hypo when they transported me to NHS hospital. Measured myself at 3.9 shaking and sweating. The last official measurement they said to me was 7.x and that it was coming down. They also looked certain just by seeing me that it will come down...why were they so certain?

 

[bulkbiker]

why were they so certain?

No idea.. I was 3.8 mmol/l last night before bed and felt fine though so... I was coming to the end of my first hard dry fast.

 

[Brunneria]

They also looked certain just by seeing me that it will come down...why were they so certain?

maybe because you were not showing any overt signs to T1 and ketoacidosis.

 

[CrumblingWall]

maybe because you were not showing any overt signs to T1 and ketoacidosis.

Maybe but to prevent ketoacidosis one does not need a lot of insulin floating around.

I keep reading studies out there and find most of them blame reduced insulin secretion not resistance for delayed reduction in glycaemia.

 

[CrumblingWall]

I just went to endocrinologist. She disagreed with the person 2 years ago. She said my c peptide is below normal range ( though when questioned, admitted that normal range applies only to high carb diet). She then said I should not have insulin resistance because I am not overweight. I told her about glucose curves where BG stays high for 2.5 hours and then comes down. She basically said it is weird but could be explained with me still having insulin production.

She basically uttered words MODY! And told me about another guy with similar issues. Negative antibodies, bad glucose handling and that he is being tested for MODY....

I was told to start eating 150 g of carbs a day and repeat OGTT after 2 weeks although there is no need if my BG still spikes.

 

[liza_h]

@DCUKMod
Talked with the doc. She said: "carbs should be consumed before physical activity. Also, eat less frequently and sometimes practice intermittent fasting. This should improve insulin sensitivity.".

In other words, she does not think my issues are very pathological. But I probably have inclination to insulin resistance which means: building muscle mass to soak up the glucose, exercise and consuming enough carbs to not cross ketosis threshold. Looks like I have a new year resolution for myself then....it will probably be swimming!

You mention swimming... which is great exercise. I would also recommend cross-fit to build stamina and weight training to help build muscle mass, esp overhead press, leg extension, leg press. Apparently bigger muscle mass helps with insulin resistance. I'm hypo plus pre-diabetic and still working out what's best for me - however the exercise is definitely helping as I'm feeling better than I have in 10 years!

 

[halfpint]

I think sometimes doctors dismiss your questions because they don't actually know the answer and wont admit it, result, standard reply 'its normal' or worse 'its all in your head' ! All very helpful.
If you are hypothyroid you will invariably have some insulin resistance, because the body will automatically start slowing down all metabolic responses because you are hypothyroid. Your FT3 level is irrelevant because they have not tested for RT3, and its the relationship between RT3 and T3 that is more important. Too much RT3 to T3 (T3 is the active hormone, RT3 is the brakes) if you have too much RT3 in relation to T3 its similar to shovelling coal on a closed down fire, it doesn't burn, just smoulders, so you metabolism will stay slow. Chucking a load of carbs at it will have the effect of you putting on weight and high spikes, if your thyroid is naff, its naff, it will only make a difference if you have been long term seriously LC on low cals/fasting, then even a small increase in cabs could make a difference.
I'm not sure about the carbing up for OGTT because I've had several while on pretty low carb (less than 50gm a day) and passed with flying colours, i.e. not going above 6.4mmol/l (ish) at any time. I assume its because my liver is empty of glycogen and simply sucks up most of the glucose, which it can do even in the absence of insulin ! leaving just a bit which I produced enough insulin to cover, yet a normal sandwich would send me up to 13 or 14 for hours.
If you are insulin resistant, do an honest look at yourself, are you over weight, are you carrying excess around the middle, do you exercise enough (realistically), and what are you eating.

 

[CrumblingWall]

I think sometimes doctors dismiss your questions because they don't actually know the answer and wont admit it, result, standard reply 'its normal' or worse 'its all in your head' ! All very helpful.
If you are hypothyroid you will invariably have some insulin resistance, because the body will automatically start slowing down all metabolic responses because you are hypothyroid. Your FT3 level is irrelevant because they have not tested for RT3, and its the relationship between RT3 and T3 that is more important. Too much RT3 to T3 (T3 is the active hormone, RT3 is the brakes) if you have too much RT3 in relation to T3 its similar to shovelling coal on a closed down fire, it doesn't burn, just smoulders, so you metabolism will stay slow. Chucking a load of carbs at it will have the effect of you putting on weight and high spikes, if your thyroid is naff, its naff, it will only make a difference if you have been long term seriously LC on low cals/fasting, then even a small increase in cabs could make a difference.
I'm not sure about the carbing up for OGTT because I've had several while on pretty low carb (less than 50gm a day) and passed with flying colours, i.e. not going above 6.4mmol/l (ish) at any time. I assume its because my liver is empty of glycogen and simply sucks up most of the glucose, which it can do even in the absence of insulin ! leaving just a bit which I produced enough insulin to cover, yet a normal sandwich would send me up to 13 or 14 for hours.
If you are insulin resistant, do an honest look at yourself, are you over weight, are you carrying excess around the middle, do you exercise enough (realistically), and what are you eating.

That is not true. If insulin is absent, you will go high and stay high, maybe BG reducing somewhat if you move and jump a lot. I noticed that my BG goes down if I move around or do some hand swinging, but when I sit down and do nothing, it creeps back to before-exercise level. The endo said she does not know why if I make no insulin, I reduced my own glycemia during GTT test back then. Maybe I manufactured enough insulin eventually and it shows I still have some capacity but ... who knows.

I am not overweight, normal amount of fat around abdomen, no exercise (cause no energy) and I eat mostly home-cooked foods.

 

[halfpint]

That is not true. If insulin is absent, you will go high and stay high, maybe BG reducing somewhat if you move and jump a lot. I noticed that my BG goes down if I move around or do some hand swinging, but when I sit down and do nothing, it creeps back to before-exercise level. The endo said she does not know why if I make no insulin, I reduced my own glycemia during GTT test back then. Maybe I manufactured enough insulin eventually and it shows I still have some capacity but ... who knows.

I am not overweight, normal amount of fat around abdomen, no exercise (cause no energy) and I eat mostly home-cooked foods.

OK then explain why I can drink 75gm of pure glucose and not go above 6.4, tested every 15 mins, but any other source of carbs, even 20 gm would put me over 10/14 mmol and keep me there for 2-4 hours! Perhaps my body only recognises glucose as warranting insulin release. Even hospital tests come up with the same result. If I exercise my BGs go up they never reduce with exercise. But that aside, if you hypothyroid and not exercising enough then insulin resistance is causing at least some of your problems, you could also just have a slowly failing pancreas due to age, it happens. If phase 1 insulin release is failing, often the first one to go, then your BGs will already be going up leaving much more for the second phase insulin release to deal with, hence staying up for longer and taking longer to come back down.
Staying relatively LC is sensible, you will find your own level of carb intake that your body can cope with, if it pushes you too high then reduce what your just ate. Its all very well for doctors to tell you its normal, half of them are talking through their posterior, and its not their eyes and feet that will be damaged, its yours.

 

[CrumblingWall]

OK then explain why I can drink 75gm of pure glucose and not go above 6.4, tested every 15 mins, but any other source of carbs, even 20 gm would put me over 10/14 mmol and keep me there for 2-4 hours! Perhaps my body only recognises glucose as warranting insulin release. Even hospital tests come up with the same result. If I exercise my BGs go up they never reduce with exercise. But that aside, if you hypothyroid and not exercising enough then insulin resistance is causing at least some of your problems, you could also just have a slowly failing pancreas due to age, it happens. If phase 1 insulin release is failing, often the first one to go, then your BGs will already be going up leaving much more for the second phase insulin release to deal with, hence staying up for longer and taking longer to come back down.
Staying relatively LC is sensible, you will find your own level of carb intake that your body can cope with, if it pushes you too high then reduce what your just ate. Its all very well for doctors to tell you its normal, half of them are talking through their posterior, and its not their eyes and feet that will be damaged, its yours.

I am sorry if I have sounded annoying. I just never heard of someone performing way better by drinking pure glucose at a high carb count compared to lower carb count from complex carbs. I certainly have failed my OGTT twice and it was pretty clear that there are issues.

But also: your body does not absorb anything else but glucose. If you eat complex carbs, they break down to glucose and are sent to the bloodstream. Blood flows around beta cells and they sense increase in BG, so they dump insulin.

I also never heard of pancreas just stopping to produce insulin with age. I tried to google something like that months ago and they always claim it is due to some misfortune like pancreatitis that it can happen. Pancreas won't fail unless something is attacking it.

But yes, I honestly were ok on low carb until I got hit with kidney stones, so got scared into dropping it.