Confused with my macros

[moraccomoo]

Hi. I was diagnosed as Type 2 (a1c was 11.9%). Now trying to improve without meds or insulin. Last a1c was 8.9%. expecting a much further drop in next one.

I am very confused with the state I was in when i was diagnosed. Sugar levels were dangerously high but i was wondering if it was just an acute IR because of these reasons:

1. C peptide was normal. So my pancreas is still producing enough insulin. There shouldn't be much beta cell destruction.
2. Insulin resistance should have been high. High blood sugar levels were indicating that
3. Blood pressure was normal
4. Diagnosed grade 1 fatty liver but LFT readings were normal. Why?
5. TG, HDL, LDL were abnormal but ECG and ultrasound were normal
6. GAD showed negative. So doc ruled out type 1

Is it really diabetes or just advanced state of IR? TG/HDL ratio (poor man's IR prediction) was >7. So it was pretty bad.

I'm trying hard to make things normal and reverse my insulin resistance. Asking these questions because i want to know if I can get to keep the benefits while returning to normal way of eating (healthy). Or would diabetes return and bite me.

 

[Antje77]

Insulin resistance IS diabetes, as soon as it makes your hba1c go over 48 mmol/l (same as 6.5%).
Prediabetes is also insulin resistance, when it has led to an hba1c of between 42 and 48 (or 6 and 6.5%).

With your initial hba1c of 11.9% (106 mmol/mol), your blood glucose must have been around 16 mmol/l for a couple of months at least, which means diabetes.

Well done on reducing your hba1c!

I'm trying hard to make things normal and reverse my insulin resistance. Asking these questions because i want to know if I can get to keep the benefits while returning to normal way of eating (healthy). Or would diabetes return and bite me.

If by going back to normal, you mean going back to your previous diet, I don't think it likely your numbers will stay low. Some members find that they can eat a little more carbs without spiking after a while though.

 

[catinahat]

returning to normal way of eating (healthy).

Surely your previously "healthy" diet caused you to develop T2 (insulin resistance) and fatty liver.
I would have thought that your new diet, which is reducing your HbA1c, improving your insulin resistance and more than likely resolving your fatty liver issue, is more deserving of the title healthy.

 

[Member34835]

Sounds as if your diagnosis was classic metabolic syndrome (fatty liver, abnormal lipids, abnormal hba1c).
As this is caused by diet, the only way you can reverse this is, as you've discovered already, is by diet. Meds can tackle the symptom of high blood glucose slightly but wont' prevent the complications caused by high insulin levels.
On a practical note this means you've got to find a way to eat like this consistently whilst enjoying your life and I think people do struggle with that understandably but it is best if you proceed with the idea of a lower carb diet being for life not just as a quick fix.

 

[HSSS]

. Sugar levels were dangerously high but i was wondering if it was just an acute IR because of these reasons:

1. C peptide was normal. So my pancreas is still producing enough insulin. There shouldn't be much beta cell destruction.
2. Insulin resistance should have been high. High blood sugar levels were indicating that
3. Blood pressure was normal
4. Diagnosed grade 1 fatty liver but LFT readings were normal. Why?
5. TG, HDL, LDL were abnormal but ECG and ultrasound were normal
6. GAD showed negative. So doc ruled out type 1

Is it really diabetes or just advanced state of IR? TG/HDL ratio (poor man's IR prediction) was >7. So it was pretty bad.

I'm trying hard to make things normal and reverse my insulin resistance. Asking these questions because i want to know if I can get to keep the benefits while returning to normal way of eating (healthy). Or would diabetes return and bite me.

acute IR is type 2 in essence
1. c peptide usually is normal, or even more commonly high, in type 2. Sometimes it falls after many years of damage.
3. you dodged the high bp bullet at least. Be grateful
4. because it’s not got bad enough for the levels to be compromised maybe. Again that would be a bonus. Diagnosed on what basis?
5. Dysfunctional Lipids (high to especially) are another classic metabolic type 2 issue. Ecg and ultrasound might be related to detecting the same cvd conditions but won’t show cholesterol results. Good that they are clear though. (And there’s huge controversy over the connections around cholesterol as well you’ll soon find).
6. Positive Gad confirms type 1. Negative isn’t as conclusive. It’s possible,to be Gad negative and type 1 sometimes. However you do sound classic type 2.

what are you choosing to do to manage this? It’s obviously helping. Well done. Are you happy with the changes? Do you feel there’s room for improvements in effect or satisfaction?

what do you consider the healthy you want to return to? The same things that got you here in the first place?

 

[moraccomoo]

Thanks for all your insights.

I seldom drink alcohol, consume sweetened beverages, ice cream, confectionaries, dairy and cakes. I wasnt addicted to any type of food especially sugar. Have been sugar free for about 2 years now. As an South Asian vegan, my diet is high in carbs though and there werent many options earlier. By "returning to earlier healthy food" I mean stopping this restrictive diet and IF and have occassional rice and potatoes.

 

[moraccomoo]

1. c peptide usually is normal, or even more commonly high, in type 2. Sometimes it falls after many years of damage.

I am not sure how it can be normal as diabetes/insulin resistance is caused by high insulin in the body. It should be actually abnormally high after all these years of high glucose (I wouldnt have reached 11.9% in months i believe).

 

[moraccomoo]

what are you choosing to do to manage this? It’s obviously helping. Well done. Are you happy with the changes? Do you feel there’s room for improvements in effect or satisfaction?

Yes I'm happy but it feels like life suddenly got busy and demanding.

Alternate day fasting, 48 hour long fasting once a month.
No sugar, fruit as it was earlier
No processed foods
Low carb, high fat
30 mins HIIT, weight training on alternate days
1 hour jogging on weekends
Conciously avoiding stress in work and life.

 

[moraccomoo]

Sounds as if your diagnosis was classic metabolic syndrome (fatty liver, abnormal lipids, abnormal hba1c).
As this is caused by diet, the only way you can reverse this is, as you've discovered already, is by diet. Meds can tackle the symptom of high blood glucose slightly but wont' prevent the complications caused by high insulin levels.
On a practical note this means you've got to find a way to eat like this consistently whilst enjoying your life and I think people do struggle with that understandably but it is best if you proceed with the idea of a lower carb diet being for life not just as a quick fix.

That makes lot of sense. I will start looking at carbs as occasional treats

 

[moraccomoo]

4. because it’s not got bad enough for the levels to be compromised maybe. Again that would be a bonus. Diagnosed on what basis?

Ultrasound

 

[HSSS]

Thanks for all your insights.

I seldom drink alcohol, consume sweetened beverages, ice cream, confectionaries, dairy and cakes. I wasnt addicted to any type of food especially sugar. Have been sugar free for about 2 years now. As an South Asian vegan, my diet is high in carbs though and there werent many options earlier. By "returning to earlier healthy food" I mean stopping this restrictive diet and IF and have occassional rice and potatoes.

So back to what got you here then? Maybe a little rice and potatoes might be ok if it doesn’t start you on a slippery slope again. And probably you won’t need to fast as much if it’s not agreeable to you but if you got here without all those other things you list I think these types of carbs might be your triggers unfortunately, along with a genetic short straw.

Once you’re back under control then testing will show what you can allow as a treat. By then you might not crave them so much and have found likeable suitable alternatives you end up preferring. Lots of us do. Cauliflower rice with flavourings is a good starting place.

are you testing before and after meals now? It’ll really show you which foods are your personal issue.

 

[HSSS]

I am not sure how it can be normal as diabetes/insulin resistance is caused by high insulin in the body. It should be actually abnormally high after all these years of high glucose (I wouldnt have reached 11.9% in months i believe).

Normal is a wide range. Maybe you’re near the top ? How quickly did you get to 11.9% you didn’t say. Weight, genetics, diet and ir are all combinations that can get you there by slightly different paths . Some effecting individuals more than others do.

 

[HSSS]

Yes I'm happy but it feels like life suddenly got busy and demanding.

Alternate day fasting, 48 hour long fasting once a month.
No sugar, fruit as it was earlier
No processed foods
Low carb, high fat
30 mins HIIT, weight training on alternate days
1 hour jogging on weekends
Conciously avoiding stress in work and life.

All sound good healthy improvements suitable for life to me. Yes its a huge amount of change and adjustment to get our heads round and you‘ve made a lot of them. Well done indeed. It does become more normal and sustainable the longer you do it for and the better you feel for it.

The only thing I see that might be an issue is the fruit. Some are high carb (like pineapple, bananas and grapes) and the fructose, that won’t show on a glucose meter, can contribute to fatty liver if you eat more than the small amounts the liver is designed to cope with at any one time. (It was designed for winter fat storage in cave man times). Berries are the safest option in small amounts.

 

[moraccomoo]

So back to what got you here then? Maybe a little rice and potatoes might be ok if it doesn’t start you on a slippery slope again. And probably you won’t need to fast as much if it’s not agreeable to you but if you got here without all those other things you list I think these types of carbs might be your triggers unfortunately, along with a genetic short straw.

Once you’re back under control then testing will show what you can allow as a treat. By then you might not crave them so much and have found likeable suitable alternatives you end up preferring. Lots of us do. Cauliflower rice with flavourings is a good starting place.

are you testing before and after meals now? It’ll really show you which foods are your personal issue.

Yes but not always. I test post prandial levels only during breakfast.

Thanks for your advice, I then gotta use carbs as occassional treats and compensate (with fasting or workouts) if my levels shoot up. I am losing my carbs craving slowly anyway. Bigger problem is lack of choice. Keto and other LC diet plans in the internet are available for western veggies and grain. Indians as they tend to be more carb based have fewer options. Not much studies available for those options too.

We replaced white rice with brown that comes with bran. Will try cauliflower rice.

 

[moraccomoo]

All sound good healthy improvements suitable for life to me. Yes its a huge amount of change and adjustment to get our heads round and you‘ve made a lot of them. Well done indeed. It does become more normal and sustainable the longer you do it for and the better you feel for it.

The only thing I see that might be an issue is the fruit. Some are high carb (like pineapple, bananas and grapes) and the fructose, that won’t show on a glucose meter, can contribute to fatty liver if you eat more than the small amounts the liver is designed to cope with at any one time. (It was designed for winter fat storage in cave man times). Berries are the safest option in small amounts.

Sure will keep fruits to minimum.

 

[moraccomoo]

Normal is a wide range. Maybe you’re near the top ? How quickly did you get to 11.9% you didn’t say. Weight, genetics, diet and ir are all combinations that can get you there by slightly different paths . Some effecting individuals more than others do.

I have never tested my blood sugar levels before so I can only guess based on when I noticed few of the symptoms (feet numbness, mood swings). My ball park is at least since 2018-2019.

 

[moraccomoo]

All sound good healthy improvements suitable for life to me. Yes its a huge amount of change and adjustment to get our heads round and you‘ve made a lot of them. Well done indeed. It does become more normal and sustainable the longer you do it for and the better you feel for it.

The only thing I see that might be an issue is the fruit. Some are high carb (like pineapple, bananas and grapes) and the fructose, that won’t show on a glucose meter, can contribute to fatty liver if you eat more than the small amounts the liver is designed to cope with at any one time. (It was designed for winter fat storage in cave man times). Berries are the safest option in small amounts.

Right, I meant I don't eat fruits earlier anyway.

 

[HSSS]

Yes but not always. I test post prandial levels only during breakfast.

why only breakfast?

Might be worth checking the rise from pre to post prandial in other regular meals give you so you know the good from the bad.

Ideally you want to be back as close to preprandial as you can within 2 hrs as a general rule to be creating a “normal“ non diabetic responose. Within 2mmol is a good guideline to attempt as a type 2.

Some foods types will rise and fall faster or slower but this is a good all round target.

 

[Resurgam]

I'm a bit worried about the reference to 'treats' 'healthy diet' and 'normal' all being associated with some really high carb foods which are almost bound to mean spikes in blood glucose, which you don't seem to test for.
Diabetes is not about sugar, both starch and sugars are digested and enter the blood stream, where they have to be dealt with.
I suspect that a vegan diet is always going to bring more problems finding low carb options, and the proteins and fats which form the main stay of my diet are not available to you, but perhaps some gentle exercise to counter rises after meals might be one option?

 

[moraccomoo]

I'm a bit worried about the reference to 'treats' 'healthy diet' and 'normal' all being associated with some really high carb foods which are almost bound to mean spikes in blood glucose, which you don't seem to test for.
Diabetes is not about sugar, both starch and sugars are digested and enter the blood stream, where they have to be dealt with.
I suspect that a vegan diet is always going to bring more problems finding low carb options, and the proteins and fats which form the main stay of my diet are not available to you, but perhaps some gentle exercise to counter rises after meals might be one option?

Well that's my concern too if you read few of my comments above. Indian vegetarian diet has 99% of options high in carb. Best we can do is to limit the portion size and have it with high fibre, high fat accompaniments.
My body is handling it pretty decent. Comes to 140mg/dl in 2 hours.