Blood sugar spike at lunchtime despite low carb and IF… help! (Also micro-rant)

[iwilltouchyourcat]

Hello all, and apologies for the constant questions- I’m new to this!
My blood sugar has greatly reduced which I attributed to a combo of low carb, intermittent fasting (initially 16:8) and also having sitagliptin added following my hospital stay. A week or two ago, after being on sitagliptin for 3 weeks, I started getting hypos in the afternoon/evening (3.2-3.6 on more than a few occasions) so I decided to try stopping the sitagliptin (as some research suggests that you may need to adjust meds when adopting the new lifestyle). Since then I’ve noticed my blood sugar is normally around 5 in the morning but spikes up to 10 before lunch despite not eating anything. Today it was 12.2 although I had just done 10,000 steps. I was gutted. After an hour or so it was back down to 5 again. I don’t want to go back on the tablet again but I don’t want to undo all the hard work I’ve done by stopping the meds too early -but similarly I don’t want hypos either, and I’m wanting to reduce meds as much as possible longer term with use of diet and exercise and until now that seemed to be working and a real hope. I was so happy at first because it felt I could really undo some of the damage Ive done to myself but now I’m so worried… also I have my first appointment with the diabetic specialist next week and am very nervous they’ll try and push more meds and disagree with my diet and just tell me to lose weight (I have, but need to lose more)… it’s just all so overwhelming at the moment. Sorry for what became a bit of a rant!

 

[Resurgam]

I do that if I don't eat breakfast - it is the liver releasing glucose to help us if we need to exert ourselves to find breakfast.
By eating a small amount of carbs with breakfast the rise is stopped and I then eat again 12 hours later. Perhaps if you try it and compare your levels you'll see something similar.

 

[catinahat]

Today it was 12.2 although I had just done 10,000 steps. I was gutted.

If you haven't put any glucose in that 12.2 after exercise was stored glucose on its way out. Why would you be gutted ? Surely one of the main reasons for exercise it to use up excess glucose

 

[Lamont D]

Hi,

Hello all, and apologies for the constant questions- I’m new to this!
My blood sugar has greatly reduced which I attributed to a combo of low carb, intermittent fasting (initially 16:8) and also having sitagliptin added following my hospital stay. A week or two ago, after being on sitagliptin for 3 weeks, I started getting hypos in the afternoon/evening (3.2-3.6 on more than a few occasions) so I decided to try stopping the sitagliptin (as some research suggests that you may need to adjust meds when adopting the new lifestyle). Since then I’ve noticed my blood sugar is normally around 5 in the morning but spikes up to 10 before lunch despite not eating anything. Today it was 12.2 although I had just done 10,000 steps. I was gutted. After an hour or so it was back down to 5 again. I don’t want to go back on the tablet again but I don’t want to undo all the hard work I’ve done by stopping the meds too early -but similarly I don’t want hypos either, and I’m wanting to reduce meds as much as possible longer term with use of diet and exercise and until now that seemed to be working and a real hope. I was so happy at first because it felt I could really undo some of the damage Ive done to myself but now I’m so worried… also I have my first appointment with the diabetic specialist next week and am very nervous they’ll try and push more meds and disagree with my diet and just tell me to lose weight (I have, but need to lose more)… it’s just all so overwhelming at the moment. Sorry for what became a bit of a rant!

The drug sitagliptin (januvia) should not be driving your blood glucose levels into hypoglycaemia.The drug is designed to increase insulin response when eating. This is because you are likely to have insulin resistance. Or your insulin response is weak.
I would maybe ask your doctors to have a review and tests to see what is the reason behind the readings and symptoms that you are getting.
The fasting levels are in normal levels, sitagliptin would not push your levels up when fasting unless there is another reason for the hypo readings. Even ten thousand steps, should not put your blood glucose levels into hyperglycaemia.

 

[iwilltouchyourcat]

Hi,


The drug sitagliptin (januvia) should not be driving your blood glucose levels into hypoglycaemia.The drug is designed to increase insulin response when eating. This is because you are likely to have insulin resistance. Or your insulin response is weak.
I would maybe ask your doctors to have a review and tests to see what is the reason behind the readings and symptoms that you are getting.
The fasting levels are in normal levels, sitagliptin would not push your levels up when fasting unless there is another reason for the hypo readings. Even ten thousand steps, should not put your blood glucose levels into hyperglycaemia.

Thank you for your responses. Saw diabetes specialist team and they think I have type 1 latent autoimmune diabetes. I’ve just had the blood tests and am waiting for the results. My blood sugar has been all over the place- not as high as when I went in with dka but I am doing omad and low carb/cal and despite this my morning to lunchtime readings remain between 9-13. Any exercise at all pushes my readings up to mid teens. It all started off so well.

I’m ‘gutted’ because whatever I seem to do doesn’t seem to be working and I’m trying to do everything I am recommended in terms of diet and exercise.

 

[EllieM]

I’m ‘gutted’ because whatever I seem to do doesn’t seem to be working and I’m trying to do everything I am recommended in terms of diet and exercise.

If you turn out to have T1 then you will eventually need insulin to replace the insulin you are not making. Low carbing will reduce the amount of insulin you need and exercise is good for you whatever type of diabetes you do or don't have, but if your issue is lack of internally produced insulin then you'll need to inject it. (Though some LADA folk manage longer than others without insulin).

On the plus side, it may give you a bit more freedom with diet because you'll be able to inject to balance your blood sugar. And as a T1 on insulin, you'll get better NHS access to goodies such as cgm/libres and go to a hospital diabetic clinic rather than depend on your GP.

What's happening about your medication while you wait for the test results?

 

[Mbaker]

I think you should be proud of your attempts to take control of your health. My view is that is whether you end up insulin dependent or not, consider giving your body what it needs to thrive.

The more "open" junk food options are not health promoting. As an example this morning I had salmon and eggs for my main breakfast, with a side dish of berries, yogurt and low carb nuts - that will keep me going till dinner (easily, with no snacks); my organs will be happy, as are my taste buds. If there are no dietary religions employed, that breakfast could work for any version of diabetes based on one's taste preferences.

You are right to be wary of drugs. I feel these should only be used short term (with the exception of complete medical necessity such as insulin dependency). "We" are always told this is safe then for example this is the latest of a long line of potential side affects for the "safe" Metformin:

So the article uses the word "may", but my principal is to try to not be at the potential scene of a crime if at all possible.

 

[EllieM]

If there are no dietary religions employed, that breakfast could work for any version of diabetes based on one's taste preferences.

or food allergies ...

You are right to be wary of drugs. I feel these should only be used short term (with the exception of complete medical necessity such as insulin dependency).

I've got to respectfully disagree with you on that. As an insulin dependant T1, I've been on blood pressure meds for thirty years. Given the effects of high blood pressure on eyes and kidneys, and the fact that as a diabetic my eyes and kidneys are at relatively high risk, I'm glad to say that my eyes and kidneys are fine after 50 years of T1 and I feel the bp meds have played a part in that.
And yes, when I was pregnant I was on different blood pressure meds, because the ones I was on weren't tested as safe during pregnancy.

 

[iwilltouchyourcat]

If you turn out to have T1 then you will eventually need insulin to replace the insulin you are not making. Low carbing will reduce the amount of insulin you need and exercise is good for you whatever type of diabetes you do or don't have, but if your issue is lack of internally produced insulin then you'll need to inject it. (Though some LADA folk manage longer than others without insulin).

On the plus side, it may give you a bit more freedom with diet because you'll be able to inject to balance your blood sugar. And as a T1 on insulin, you'll get better NHS access to goodies such as cgm/libres and go to a hospital diabetic clinic rather than depend on your GP.

What's happening about your medication while you wait for the test results?

Thank you for the reply. I’m in metformin and gliclazide (both max doses) and was on sitagliptin but for some reason this resulted in me getting random hypos (after food, before food, didn’t see a pattern other than it was I no the evening) so they stopped it. DN said will wait for results of c peptide and gad and thyroid bloods before we change anything but just to check ketones regularly in case of another dka. When I came out of hospital I went low carb and IF, and bm came down initially- but now, despite eating very little and fasting 20 hours a day my blood sugar is high in the morning, higher at lunch then goes down to 5/6 by evening. If I exercise it goes higher. I had 5 carbs in my evening meal yesterday after a bm of 6, and after that my bm was 10.4. This morning 10, and just now 14.4. I’ve eaten nothing since 6pm last night and just drunk water. Trace ketones which is expected due to low carb and fasting. I am losing weight (6 kilos total). I have coeliac disease also, and am vegan. I just feel like giving up. I think insulin is going to be the next step whether type 1 or 2, which is fine, I am just so disheartened by working so hard and after an initial few weeks of it going down, my bloods are back up albeit not as much as when I was admitted with dka. This is all so new to me, was diagnosed t2 5 years ago and all was fine initially then it’s suddenly fallen apart. I don’t know what to do and depending on which doctor I speak to (a&e, gp) they’ve given me different advice. It seems like my pancreas has flipped me the finger and regardless of what I do nothing seems to bring my bm down.

 

[EllieM]

I am just so disheartened by working so hard and after an initial few weeks of it going down, my bloods are back up albeit not as much as when I was admitted with dka. This is all so new to me, was diagnosed t2 5 years ago and all was fine initially then it’s suddenly fallen apart.

If you have T1/LADA, then it makes sense that low carb and meds would initially work, because your insulin production gradually goes down, and a person on a low carb diet needs less insulin than they did before. Unfortunately low carb stops working when your insulin production goes down even lower. It's very very common for LADAs to be initially misdiagnosed T2,

 

[iwilltouchyourcat]

If you have T1/LADA, then it makes sense that low carb and meds would initially work, because your insulin production gradually goes down, and a person on a low carb diet needs less insulin than they did before. Unfortunately low carb stops working when your insulin production goes down even lower. It's very very common for LADAs to be initially misdiagnosed T2,

Thanks. My DN was like ‘you’ve got coeliac, you have an under active thyroid and meds have stopped working, I’m pretty sure you have type 1’ but I will just wait and see on the bloods. It would I guess explain why low carb isn’t working and all meds are doing is keeping me out of hospital at this point. I dread to think what my bm would be if I was eating higher carbs and not doing IF!

 

[Mbaker]

or food allergies ...



I've got to respectfully disagree with you on that. As an insulin dependant T1, I've been on blood pressure meds for thirty years. Given the effects of high blood pressure on eyes and kidneys, and the fact that as a diabetic my eyes and kidneys are at relatively high risk, I'm glad to say that my eyes and kidneys are fine after 50 years of T1 and I feel the bp meds have played a part in that.
And yes, when I was pregnant I was on different blood pressure meds, because the ones I was on weren't tested as safe during pregnancy.

Absolutely fine with differing views, this helps shape others decision making processes. I have never liked pharmacy, they use minute relative risk to prove a point, usually after torturing the data, or "fix" a strawman.

I was misled on Metformin which began to damage my kidneys and not informed of the downsides. I never took BP tablets when advised to. I went from 140 / 150 over around 80 to circa 120 / 70 with dietary and lifestyle changes; had this not worked I would have taken the lowest med dosage possible.