Continuing weight gain for resistance training with Type 2?

[murks]

Hi everyone!
I've been recently diagnosed with T2 at age 37 (T1 blood tests still pending) and am looking for guidance on how to put on weight again for resistance training without messing up my blood glucose or other serum markers.

Background: I started resistance training (as per the Starting Strength model) a bit over 1.5 years ago and intentionally gained 17 kg in a year (from 80 kg to 97 kg at 179 cm height) to support muscle growth. Plenty of rice and 10-15% fat red meat in there. Half a year ago, I went to my GP for bad sleep (wake up multiple times, to pee or for no apparent reason) and she found me too fat, and so did some blood tests. HbA1c was 48 mmol/mol and liver enzymes and lipids were elevated. Oops. Honestly, I may even have had (Pre-)Diabetes before and just didn't know about it, because I haven't been tested in that direction in a very long time. So in the last half year-ish since October (8 months now?) I've hired a dietician who also does barbell training and with his help (and pleny of cardio on top of training) shed about 20 kg (this morning: 78-ish kg) while continuing to train, monitoring my glucose with a finger prick thing and occasionally a Freestyle Libre. My lipids and liver enzymes recovered, but my HbA1c first went down to 46 and then _up_ to 49. My glucose doesn't seem to be going down, though I might be detecting a _very gentle_ downward slope in the 2-month view of my 2h postprandial data since I've been put on Metformin.

I'm miffed that my glucose and HbA1c didn't react to the weight loss, but also learned in the "Type 2 Diabetes Remission" course on the "MyWay digital health" page that it might take a year or more for the pancreas to recover in some people.

Now, I'd like to continue my training and put on more strength and muscle. I'm still working with my dietician and he suggested going slowly and carefully. Fair enough. I think I'll try to keep carbs on the lower end while still permitting training and upping the fat.

I've searched the forum for "weight gain muscle" and combed through 30 pages of results, but nothing seems to exactly describe what I'm trying to do here.

I don't compete, but my consistent training probably moves me closer to an athlete than the general population. My Diabetes nurse at my GP's told me I need to forever keep my weight in the 60 to 80 kg range, but I can't do that if I want to gain strength and muscle My impression is that she knows what to do for the general population, but is clueless about people like me. I am now fairly lean at a BMI of 24.3, as attested by my dietician, and I suspect it's not about the body weight per se, but rather the body composition.

So.


2. Does anyone have strategies to drive resistance training without aggravating or progressing the Diabetes and keep liver and lipids happy?
3. Is there some way to find out how busted my pancreas is? What could one glean from an "Insulin Resistance" blood test as offered by Medichecks and other labs?
4. Has anyone done DEXA scans to check body composition while resistance training to steer weight gain in the face of Diabetes?

[Edited by moderators to comply with forum rules]

 

[murks]

I've been reading the Bloodsugar 101 site and it says that my current 2h postprandial measurements of around 7.2 to 7.8 are too high. Also just got an update that my HbA1c is 48, also too high. I suppose that my 1x 500mg of Metformin a day won't help here.

Last week, I changed my diet to eat 130g carbs on off days and 160g on workout days (down from 150 and 180g, respectively). I fear I'll have to radically cut that down to double digits instead to normalize blood glucose... Anybody have experience with carbs this low and trying to resistance train?

 

[Melgar]

Hi @murks , looking at your carb intake of 130 grammes of carbs on off days and 160 grammes on workout days you have plenty of room to drop down your carb intake further. Looking at those stats it seems your body is still not able to cope with those amounts of carbs. I say that as a person who was a competitive runner up until around 10 years ago. I'm lean and fit still and I too have problems with elevated blood sugars.

I see from a previous post that you are awaiting tests for T1 DM. I'm assuming those tests involve C- Peptide and antibody tests and the reasoning behind the possibility of T1 is your age. Have those results come through yet? If you are confirmed T2 then you can actually drop those carbs significantly, along with an increase in protein and fats. I'm not an expert on diet, so I will leave that to other members who are more knowledgeable to give you suggestions. There are many athletes who do reasonably well on a keto diet, so their carb intake is significantly lower.

You may wish to try a Continuous glucose monitor (cgm) which will give you a much better idea of how well your body deals with the food you eat. I'm assuming you already have a glucometer and use a finger prick to draw blood to test your body's response to the foods you consume.

If your T1 tests have not come through yet, then I suggest you wait for the results just in case you are confirmed as T1, in which case be guided by your diabetes team.

Edited to add that resistance training usually helps to lower blood sugars.

 

[Resurgam]

@murks I have been able to regain strength eating no more than 40 gm of carbs a day, so much so that I have gone back to work after having to give up as I could not heave the knitting machines around any longer.
As you are eating over 100 gm of carbs a day you have a lot of leeway in reducing your BG levels if it does turn out you are type 2. For an ordinary type 2 lowering carbs almost always equals lower blood glucose. You can have various other more interesting things - but for a lot of people around 50 gm of carb a day is their resolution.
Every year I can test my ability to cope with the local Arts University having three departments using knitting machines. I try to do them in no more than 10 working days, and even though the number of machines is gradually creeping up I have managed that easily in the last few years.

 

[murks]

Thanks for your input!

I see from a previous post that you are awaiting tests for T1 DM. I'm assuming those tests involve C- Peptide and antibody tests and the reasoning behind the possibility of T1 is your age. Have those results come through yet?

Exactly. They haven't yet... I'll wait and see.

I happen to have a nutrition coach who also does heavy resistance training, but he is sceptical of dropping carbs to keto levels for performance reasons. I'll see I'm using a Libre 2 currently and an Accu Chek Instant. Gonna switch over to the Dexcom ONE+ probably, because the Libre 2 is more expensive and often off compared to the finger prick. I think I have amassed 5 replacement sensors so far...

You can have various other more interesting things - but for a lot of people around 50 gm of carb a day is their resolution

Thanks, good to know, gives me a rough target.

---

Something else, the Bloodsugar 101 site instilled some panic in me that I need to urgently get my blood sugar averages down to the low 5 range, preferably by controlling post meal sugars hard, or risk organ damage. Is that still consensus in the forum? The site was seemingly not updated with newer studies after the 2010s or so. I asked my Diabetes nurse to give me access to insulin and she said nuh-uh.

 

[lovinglife]

Thanks for your input!


Exactly. They haven't yet... I'll wait and see.

I happen to have a nutrition coach who also does heavy resistance training, but he is sceptical of dropping carbs to keto levels for performance reasons. I'll see I'm using a Libre 2 currently and an Accu Chek Instant. Gonna switch over to the Dexcom ONE+ probably, because the Libre 2 is more expensive and often off compared to the finger prick. I think I have amassed 5 replacement sensors so far...


Thanks, good to know, gives me a rough target.

---

Something else, the Bloodsugar 101 site instilled some panic in me that I need to urgently get my blood sugar averages down to the low 5 range, preferably by controlling post meal sugars hard, or risk organ damage. Is that still consensus in the forum? The site was seemingly not updated with newer studies after the 2010s or so. I asked my Diabetes nurse to give me access to insulin and she said nuh-uh.

I’m not surprised your diabetic nurse refused insulin, your numbers are only in the pre diabetes range, which as yet in the UK isn’t a recognised diagnosis just a “heads up” to tell you to maybe need to look at your lifestyle to lower your number before it tips over into an official diagnosis.

As someone who was previously diagnosed as T1 and put on insulin right away, later to have the diagnosis changed to T2, my numbers were massively higher than yours with finger prick tests in the high 20s low 30s and a HbA1c of 99. I certainly would have questioned my DSN sanity if they’d offered me insulin with the numbers you are experiencing

 

[Melgar]

I would give them a nudge on those T1 tests. In my personal opinion your blood sugars are not high enough to warrant insulin. Here in Canada, and I believe other countries are the same, they will not even test adults for auto antibodies until your HbA1c is around 9% , that means your average blood sugars on your cgm will be around 12 mmol/ls. Far higher than yours are at the moment. Taking insulin when your blood sugars are pre-diabetic bordering diabetic could put you at serious risk of hypoglycaemia, which is a very serious situation, potentially life threatening. I don't wish to frighten you, but it's a reality as your pancreas, from the figures you have provided, is still producing a lot of insulin. If you do come back as a T1 then your HCPs will advise you and support you through, what is a life changing health condition.

If you do not have T1 then hopefully your Dr will investigate why your blood sugars are elevated. I'm sure your Dr has reviewed your meds, if you are taking meds. Just to give you an example of the type of meds that are known elevators of blood sugars, here are several examples:

Corticosteroids (steroids) like prednisone,
Beta blockers like propranolol,
Blood pressure meds , hydrochlorothiazide , which can cause diabetes in as little 9 weeks.

If T2, your best option, if you do not wish to be on blood sugar lowering meds, is to reduce your carb intake. T2 is itself a serious health condition which can result in loss of limbs and eyesight, if not properly managed.

Edited to add properly managed.

 

[murks]

Thanks for the additional input. I wasn't sure if I was crazy or... not crazy enough. FWIW, my GP diagnosed me as T2 (pending T1 tests) because I started with a HbA1c of 48, went down to 46 and then up to 49, before it went down to 48 now. So, uh, yeah. I take no other meds than Metformin.

T2 is itself a serious health condition which can result in loss of limbs and eyesight, if not properly managed.

Yeah, so this is what riles me up. Where can I learn what "properly managed" means because I know what Diabetes can do and I want none of it. Bloodsugar 101 has a seemingly hardline opinion on this (get BG to normal levels or else), but guidelines seem more relaxed... so, who is right?

For example, my eGFR has been dropping from 80 mL/min 8 months ago to 79 to 77 now (reference range 90 -- 120). Serum Creatinine has crept up from 103 to 106 in the same time frame (reference range 64 -- 104; I take Creatin). Should I panic?

Also, sorry if this has been discussed exhaustively elsewhere, please point me there if so. I'm still digesting all the info I'm reading...

 

[Melgar]

@murks, properly managed means keeping your blood sugars within range if you are using the Time in Range feature on your cgm. I set my cgm range at 4 - 7.5 mmol/ls. I did have it set at 4.5 - 10.5 mmol/ls, but my blood sugar levels improved somewhat, mostly from increased exercise. I do between 20,000 - 30,000 steps a day. Probably averaging out to around 25,000 steps a day, 6 days a week, I factor in a rest day. I also take an off label med that forces my pancreas to produce more insulin. I don't produce enough insulin, neither do I have insulin resistance.

Classic T2 diabetes usually means you have insulin resistance, that means your cells are not insulin sensitive. To counter this lack of insulin sensitivity your pancreas has to produce a lot more insulin to counter this resistance to insulin.

Managing your blood sugars means being aware of how your body responds to the foods you eat. I live in Canada, so we use mmol/ls. So in reality that would mean if my blood sugar levels , pre prandial are around 6 mmol/ls then I would like to see my post prandial levels within 2 mmol/ls of my pre prandial levels. If I start at 6 mmol/ls I want to see my sugars below 8 mmol/ls 2 hours after eating.

I also try and avoid high spikes of blood sugar. When I look at my cgm graph I try and avoid those high spikes. If I eat a slice of GF bread, I would expect to see a high rise in my blood sugars to over 14 mmol/ls. I don't want to see that. Keeping your blood sugars in range will, hopefully translate to a HbA1c under 6%. Exercise can raise your blood sugars, but hopefully this translates to increased insulin sensitivity over all. Which means your body is more efficient at using your blood sugars for energy without having too much insulin circulating in your system along with raised blood sugars. I hope that helps.

 

[murks]

Thanks, that's helpful. I have much to learn

I have a review with my Diabetes nurse soon, I'll ask her more questions, like what about my Type 1 blood tests and what to do about my kidneys and my newly diagnosed stage 1 diabetic retinopathy.

 

[EllieM]

For example, my eGFR has been dropping from 80 mL/min 8 months ago to 79 to 77 now (reference range 90 -- 120). Serum Creatinine has crept up from 103 to 106 in the same time frame (reference range 64 -- 104; I take Creatin). Should I panic?

I wouldn't personally be panicking but I would definitely be discussing the results, and the fact that you take creatine , with your DN. This article here suggests that it can be problematic if you have kidney issues?

Creatine Information | Mount Sinai - New York

Learn about Creatine or find a doctor at Mount Sinai Health System.

www.mountsinai.org

I'm not a doctor and we can't give medical advice anyway so I would suggest you do your own research on this.

As for the egfr , I've been running at <90 for the last 10 years (at least) but in New Zealand they just get marked as fine as long as I am over 60. But this is possibly because I've been T1 for 55 years and some kidney wear and tear is expected and not concerning? Apparently for women it's normal for it to drop by 1 for every year you are over 30?

Quote from my medical lab results
Reporting of eGFR assumes stable renal function. The GFR range for a young adult female is 78-158. From age 30, values fall by approximately 1 mL/min/year.

This article here says under 90 indicates mild kidney impairment

Can GFR Be Improved? Lifestyle Changes That May Help

Learn about positive lifestyle changes that may improve your glomerular filtration rate (GFR) and slow the loss of kidney function if you have chronic kidney disease.

www.healthline.com

I have a review with my Diabetes nurse soon, I'll ask her more questions, like what about my Type 1 blood tests and what to do about my kidneys and my newly diagnosed stage 1 diabetic retinopathy.

I do have experience with background retinopathy, which I've had on and off for literally decades. My understanding is that the best thing you can do for it is keep your bgs inder control, and mine has never required treatment. (When I was twenty they told me that II would probably need laser treatment by the time I was forty but my diabetic control was very poor when I was twenty and I'm 63 now...) So I wouldn't panic about that, as long as you keep your blood sugars under reasonable control and (very important) attend all your eye checks so that they can treat your eyes if they need to. The treatment for diabetic eye disease has improved dramatically over the years.

 

[murks]

Thank you, that is good to know! I'll continue reading more stuff.

 

[murks]

I've been watching the channel of https://www.youtube.com/@nourishedbyscience and found this video particularly interesting:

. He suggests regular DEXA scans and HOMA-IR tests to gauge visceral fat and insulin sensitivity. I think I can use that to guide my weight gain for training.