Anorexia- Pre diabetes - false good a1c-

[Elenas]

I don’t know if it’s the good place to write this, maybe it would fit better in an ED forum but let’s so if anyone can help me.

So I’m having insulin resistance and pre diabetes but also developed anorexia nervosa 2 years ago.
I’m currently relapsing with anorexia and barely eat anything of my days, I also do lot of cardio/fitness everyday.

Yesterday while doing a check up with my endo she said my a1c is now very optimal at 4.7, and my fasting insulin is almost in range at 8, so everything is good in the paper. I’m thin so she can’t say nothing about my weight anymore. Like for her my labs and stats are now perfect.
She knows I’m having an ED and I ‘ve told her that in this period I’m struggling to eat … but I don’t think she clearly picture well the situation.
You know she is still congratulating me for « improving my labs results », I don’t know if she realize that for that I’m NOT eating more than 700 calories a day, and most of the time eating only 400 calories.

The reality is that if I would eat normally I would have complete different result and that my insulin resistance/ pre diabetes isn’t improving and it’s still there and serious.

Now my issue is that she said that she doesn’t think I need metformin anymore because my labs results are good!!! I had to beg her to prescribe metformin , she accepted but decrease my dosage by half. I’m completely panicking .
The thing is that every time I eat a normal meal I spike BS. I told her but she is basing her conclusion on my perfect a1c so she said « no everything is fine! ».
And so now without the help of metformin how will I manage my BS , how will I feel confortable to eat ( knowing that eating is a struggle for me currently ) If I know that I will spike my BS, It won’t encourage me to eat and I’m afraid to use this reason to not eat at all anymore.

I know that if she remove the metformin I would have the best excuse to let me dive into anorexia because I don’t want to spike and food is my enemy because it makes me spike and it kill my body.

Now I will be honest with you if I’m that alarmed is that I’m afraid to gain weight after I stop metformin. I was taking a lot of metformin recently because I noticed the more I take it fasting, the faster I’m losing weight…. And so yes it was also my tool to help me lose the weight I JUST don’t know how I WILL DO WITHOUT. I’M IN A COMPLETE PANIC STATE

Well what can I do to let me prescribe more metformin, what can I do to show her I heavily spike insulin and BS other than a1c ?

 

[Antje77]

Hi @Elenas , I'm so sorry to hear you're having such a hard time struggling to balance your prediabetes, your relationship with food and your endo.

I don't have any experience with eating disorders or prediabetes, but let me tag @AndBreathe for you. She is a thin T2 who has gotten both her diabetes and her ED in remission.

Wish you all the best and sending hugs.

 

[andromache]

I don’t know if it’s the good place to write this, maybe it would fit better in an ED forum but let’s so if anyone can help me.

So I’m having insulin resistance and pre diabetes but also developed anorexia nervosa 2 years ago.
I’m currently relapsing with anorexia and barely eat anything of my days, I also do lot of cardio/fitness everyday.

Yesterday while doing a check up with my endo she said my a1c is now very optimal at 4.7, and my fasting insulin is almost in range at 8, so everything is good in the paper. I’m thin so she can’t say nothing about my weight anymore. Like for her my labs and stats are now perfect.
She knows I’m having an ED and I ‘ve told her that in this period I’m struggling to eat … but I don’t think she clearly picture well the situation.
You know she is still congratulating me for « improving my labs results », I don’t know if she realize that for that I’m NOT eating more than 700 calories a day, and most of the time eating only 400 calories.

The reality is that if I would eat normally I would have complete different result and that my insulin resistance/ pre diabetes isn’t improving and it’s still there and serious.

Now my issue is that she said that she doesn’t think I need metformin anymore because my labs results are good!!! I had to beg her to prescribe metformin , she accepted but decrease my dosage by half. I’m completely panicking .
The thing is that every time I eat a normal meal I spike BS. I told her but she is basing her conclusion on my perfect a1c so she said « no everything is fine! ».
And so now without the help of metformin how will I manage my BS , how will I feel confortable to eat ( knowing that eating is a struggle for me currently ) If I know that I will spike my BS, It won’t encourage me to eat and I’m afraid to use this reason to not eat at all anymore.

I know that if she remove the metformin I would have the best excuse to let me dive into anorexia because I don’t want to spike and food is my enemy because it makes me spike and it kill my body.

Now I will be honest with you if I’m that alarmed is that I’m afraid to gain weight after I stop metformin. I was taking a lot of metformin recently because I noticed the more I take it fasting, the faster I’m losing weight…. And so yes it was also my tool to help me lose the weight I JUST don’t know how I WILL DO WITHOUT. I’M IN A COMPLETE PANIC STATE

Well what can I do to let me prescribe more metformin, what can I do to show her I heavily spike insulin and BS other than a1c ?

That sounds very uncomfortable. The doc says great, your A1C's great and double hurrah you can reduce the drugs. But you know that it's not great at all: your relationship with food has gone off the rails and this poses dangers to your health that you understand but your doctor doesn't.

I'm a recovering anorexic myself, so I do get it when you describe how you feel and your anxiety around food and weight. I had no metabolic trouble when I was actively anorexic long ago, so I don't have personal experience of those extra complications, but I can sort of imagine them.

First of all, I think you need professional advice to help you deal with these conflicts within yourself. If you do not have an ED counsellor, please try to get one. Also, your own GP might be able to help you: hospital specialists are usually only interested in their specialist malady, while your GP is interested in you. A good one can be a blessing and I would urge you to take your difficulties to him/her if you have not yet done so.

Beyond that, I have nothing to offer but my own experience, which is that, if you can come to see food as medicine, it will reward you. It has taken years - decades, actually - to get here. It was really only when metabolic health concerns arose that I found my path - a path of low(ish)-carb, nutritious whole food - meat, fish, eggs, cheese, nuts. beans, lentils, green veg etc. I am no longer even middle-aged, but am probably in better shape now - certainly in better metabolic shape - than I have been for years and years.

Fate plays a mean trick on an anorexic who develops metabolic dysfuntion (or vice versa). As if an anorexic needed any further excuse to starve, starve, starve! That is why treating food as your medicine is key, I think, and why nutrient-dense foods that will not upset your blood glucose control are an essential part of your recovery. You sound like a person with a lot of self-knowledge. But anorexia is a wily foe, and it can outsmart the smartest. That's why I really do think you need professional help with this.

 

[AndBreathe]

Hi Elena, I'm sorry to hear you are having such issues at the moment. As someone who lived with anorexia (many moons ago, long before diabetes came to call), I can identify with the grip of anorexia and the feeling of loss of control.

As @andromache has suggested, it would be helpful if you could find someone to discuss your anorexia with - someone who understands how EDs work. In turn a harsh likelihood is they will know nothing about diabetes or insulin resistance.

My suggestion right now is that you need to prioritise the shorter time, which is the likely impact of your continual starvation. That isn't a story that ends well. Hearing you describe taking a lot of Metformin, because it helped you lose weight, that doesn't sound like a [particularly healthy behavior, so perhaps a break from Metformin might not be such a bad idea, if it is an enabling tool to your ED

I would suggest that insulin resistance and raised blood sugars will do you no long terms harm for quite some time, whereas starvation can reach crisis point quickly.

I'm very sorry if what I write seems harsh, but when it comes to EDs, only you can do something about it.

 

[Resurgam]

You do REALLY know that it isn't food which spikes you but carbohydrate?
You do REALLY know that the Metformin doesn't lower glucose levels after eating - I hope?
The concept of eating killing you is rather worrying, as the truth is the reverse case. We need to have protein and fat to survive, to maintain our bodies and live well.
To keep my Hba1c at the top of normal I need only eat something like a couple of eggs and a bit of salad with a cup of creamy coffee in the morning, and then I go 12 hours before eating again. That might seem OK to you - I get told that is not right, but I am still overweight thanks to being pushed into eating all the wrong things for so long.
Most people don't need a lot of food if they eat correctly - it is OK to be thin, but you don't have much leeway when your reserves are low and need to keep yourself nourished and healthy. Winter is coming and becoming ill is something to avoid.

 

[Elenas]

You do REALLY know that it isn't food which spikes you but carbohydrate?
You do REALLY know that the Metformin doesn't lower glucose levels after eating - I hope?
The concept of eating killing you is rather worrying, as the truth is the reverse case. We need to have protein and fat to survive, to maintain our bodies and live well.
To keep my Hba1c at the top of normal I need only eat something like a couple of eggs and a bit of salad with a cup of creamy coffee in the morning, and then I go 12 hours before eating again. That might seem OK to you - I get told that is not right, but I am still overweight thanks to being pushed into eating all the wrong things for so long.
Most people don't need a lot of food if they eat correctly - it is OK to be thin, but you don't have much leeway when your reserves are low and need to keep yourself nourished and healthy. Winter is coming and becoming ill is something to avoid.

Well as I'm vegetarian and I have egg intolerance, I have difficulty to enjoy something that won't spike me. When I eat cucumber, Mizo soup and cauliflower it doesn't spike me but this is not a lot of calories... and so the anorexic me is very happy but I know that my body ask for more. As soon as I include lentil, beans, rice , potatoes ... I will spike so I feel finally good and nourished but I spike it's really discouraging.

For metformin , me this medicine make my blood sugar drop a lot especially if I take it fasting, it really made a difference to lost weight in my case. I know for some people It does nothing but me It 's game changing.

 

[Resurgam]

Well as I'm vegetarian and I have egg intolerance, I have difficulty to enjoy something that won't spike me. When I eat cucumber, Mizo soup and cauliflower it doesn't spike me but this is not a lot of calories... and so the anorexic me is very happy but I know that my body ask for more. As soon as I include lentil, beans, rice , potatoes ... I will spike so I feel finally good and nourished but I spike it's really discouraging.

For metformin , me this medicine make my blood sugar drop a lot especially if I take it fasting, it really made a difference to lost weight in my case. I know for some people It does nothing but me It 's game changing.

Oh dear - I really do not know what to suggest which would have the same effect as the protein and fat foods which have sorted out my type 2. Some of the foods I eat might help a bit....
I do like the frozen stir fry from Lidl which comes in three different styles - I usually only buy the lowest two, but you might find them filling and tasty. I cook them with a little butter to stop them sticking.
I have mashed swede as a potato substitute and add in cream or butter. Any left overs are mixed with vegetables such as cooked peas or runner beans, or sprouts and fried gently, then covered in grated cheese and put under the grill.
One dish I devised which many people like is steamed cauliflower, not quite cooked, placed in a warm dish, then covered in cream cheese or sliced mozzarella, then a sprinkle of herbs or paprika or other spice, than covered in grated hard cheese and put in the oven until the cheese is just melting and very lightly tanned.
Metformin instructions are to take it with food - I tried it and it caused dreadful incontinence as it made violent efforts to turn me inside out.
I find legumes rice and potatoes are all far too high in carbs for me to include in my menu. Avoiding them would definitely help to keep your blood glucose in range, and there are some really tasty comforting foods which might help you see that you can eat and not see spikes.