Am I on the wrong track completely?

NeetaMD said:

Hi @AndBreathe, thanks for your comments about calorie requirements. I agree calorie requirements are not an exact science, however, for years my husband and I were the same height and weight and ate the same portions of the same food but 2 years ago that all began to change when I started to lose weight for no discernible reason. I am now 2 stone lighter than he is?

I am not too careful with fat intake and already eat nuts and nut butter most days but remain cautious about adding too much more of saturated fats as I have inherited high cholesterol and despite the statins have to keep my cholesterol intake moderate.

By the way I don’t normally use a Libre monitor and currently is only the second time I have tried it but I do have sessions of monitoring by finger prick. All my listed HbA1c’s are from venous sample at the doctors surgery. You asked about my lows and 5 to 6ish is my usual fasting levels.

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Metabolisms can, and sometimes do, change. One of the most common reasons is thyroid irregularities, which can cause both slowing and quickening of the metabolism. I really wouldn't hang too much on a comparison with a male. In fact, peer comparisons are often tricky as publicised data tends to be from studies using lots of folks. If you aren't "typical" then that data is useless.

It could be worthwhile eating normally for you and recording everything to eat and drink and log it in something like MyFitness Pal, or Chronometer to gauge your calories. It is easy to under or over estimate our consumption.

Going back to your initial post, you talk of a DIY OGTT; how do you intend to structure that? Replicating a lab test is quite, and in any case, a GTT is no longer the gold standard for diagnostic purposes, except for in gestational diabetes. It can, however give a decent idea about insulin resistance and 1st/2nd phase insulin responses.

Personally, I found it a vile test and wouldn't repeat it.

In terms of your fasted levels; early morning fasting tests are not necessarily representative of your true lows. Those quite often happen overnight, or in my case late afternoon.

You could ask for a fructosamine test if you suspect your hba1c might be off.....

NeetaMD said:

@AndBreathe thanks again for your comments.

I know other people do it but I’ve never calorie counted and don’t intend to start now unless it’s to guage how many grams of carbs I’m consuming and my response to these. I have to be honest I know I have a healthy appetite and eat a good balanced diet incorporating a wide range of good quality foods in adequate quantities and shouldn’t be losing weight. I have no thyroid problems.

I am going to try a DIY OGTT to give a clearer picture of my response to a measured amount of glucose. I have found the instructions for this from my local health authority and have ordered the same glucose liquid that they use. I will obviously not be able to have my venous blood measured but will record the CGM readings and do finger pricks as well. My daughter had it done recently whilst she was pregnant and she didn’t find it too unpleasant. I’m a big girl now and can do hard things!

Joking aside, I just want to get to the bottom of this and start to feel well again.

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In my suggestion tracking your diet was about how much energy you are taking in, versus that which is expended. As you are a runner, I’d expect you needing more than MrsMighins who considers a little light crochet to be strenuous exercise.

In terms of your proposed GTT! It is important you consume at least 130gr carb a day for several days prior to the test. Failing to do so can skew results as you are comparing responses to a reduced carb diet to the published “norm” whereby the vast majority of the great unwashed consume more than 130gr carb a day.

As a matter of interest, do you know how many grams of carb you are consuming daily?

NeetaMD said:

@AndBreathe

Hahaha ’runner’ is probably stretching it! I’m a 70 yr old woman who runs/jogs 3 miles in around 32mins 3 times a week using around 350cals each time. One portion of fish and chips a week would cover that!

Remember I am not diabetic so don’t overly restrict my carbs but mainly just make lower GI choices and eat around 150 to 200g of carbs a day. This won’t be a problem in the days before an OGTT

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I assume that your figures for calories consumed on your regular trundle is generated by a smart watch or such like? A bit like calories required to maintain weight, that's all based on who knows what, but I doubt it's as a result of a deep test programme.

In terms of GI choices, in my experience a 50gr portion of x,y, or z of lower GI carbs (like wholemeal bread/pasta or whatever) just shows it's rise and fall slightly differently. For me, and I stress me, I find pasta of any kind gives me a rise that isn't high, but it is sustained. To be fair it is many moons since I ate pasta as I have to be gluten-free nowadays and I choose not to use modified products. If I just do without, I can't be tripped up by unexpected gluten if a mistake is made.

You mention there being nothing wrong with your thyroid? Have you had full panels done, including T4, T3 and antibodies? In my experience if TSH is in the NHS's acceptable range, labs won't test anything else.

In terms of the Libre, are you confident is is accurate for you? It rarely is for me. When I use a Libre, I look at the graphs and trends. My signature has my A1c profiles over the years (I must update it, but I remain on the same lines) are lab venous blood tests, but Libre usually has me in the low 20s. One time even 19.

From what I read, in your shoes, I would try to just get on with my life, eating a bit more and see what happens. You and your doctor have had a really good dig around and found nothing. Sometimes we have to accept that, and review over time. Obviously if anything alarming turns up, your GP is your first port of call.

More and more investigations could just bring stress which really doesn't help blood glucose numbers (in me, and many others, in any case).

Whatever you decide; good luck with it all.

NeetaMD said:

Hi @AndBreathe thank you again for your comments.

My Libre has been pretty accurate as I have checked it against finger prick readings and these have been either the same or close.

My weight loss is unlikely due to overactive thyroid as my pulse rate is pretty low at around 50 to 55 bpm so I’m not pursuing any other testing in this area.

You are right that sometimes you have to draw a line and just get on with life making good, healthy choices and maybe eating a bit more. I would really like that if I could feel better in myself. Maybe smaller more frequent meals would help?

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For me, when i have to (i.e. weight has dropped and other strategies haven't helped), i find it easier to manage a nutrient and calorie dense snack in the afternoon - cheese, pork scratchings, a few nuts. That way, when I have regained the lost weight, I can just drop he snack, then reassess after a few weeks what's going on.

Obviously we all have to find our own ways to balance the scales, but I would ask you to concentrate on (whatever) weight gain you want to achieve and forget pricking fingers or wearing Libres for a while.

You will always have the option of seeking medical advice if anything else crops up, but the last thing you need is to "win" the label of "worried well", as that in itself can lead to bigger problems along the road.

Hi I'm not quite sure why you are not considering that you are early LADA? Surely your BS tests and HBA1C would indicate beyond pre-diabetes? Many of us on this forum including myself have found unexpected weight loss with higher than expected BS and needed to go onto insulin after tablets eventually failed. I went thru this and despite keeping the carbs down I found my BS continued to rise. I was declared T2 (wrongly?} due to my age at the time (50) and no antibodies were found. A C-Peptide test showed low'ish levels but not right down to T1 level. I have been on Basal/Bolus insulin for a good few years. I would disagree with some posts, but it's your choice, about Calories. Calories are not based on good science for what you eat as the body treats the three main food groups in different ways and a Calorie can be any combination of those food groups. I would think about each of the food groups. Carbs are the main cause of BS and weight gain. Fats and Proteins can help you feel full without much effect on BS or weight.

I find that really interesting as before I was diagnosed prediabetic (but was struggling with tiredness etc) I also had incidents of low blood sugar symptoms resolved by eating. When I went to Dr I found I was prediabetic, tried 800 cal fast for a while aiming to reverse it and then when I brought back some carbs I had those symptoms of feeling sick after eating, brain fog etc, lost weight and then a hba1c of 80. It all happened within a year. I've been wondering how I had those low blood sugar in incidents before I was on insulin or any other medication ifnI was becoming diabetic at that point. I thought it was only the medication that caused the lows. So when the pancreas is on its way out can you get highs and lows even without any medication?
I do think your symptoms seem like early Lada although my weight loss (without dieting) only started when my hba1c was high (as far as I know - what was weight loss due to diet and what due to diabetes?). I wonder if your Dr would test for antibodies.