Frustrated

[starlightrays]

I'm a young type 2 diabetic (28, diagnosed at 14) and I've been using the keto diet (OMAD, ~20 carbs maximum daily) to manage my diabetes since Nov 2021. Overall it's been great and I managed to get to a place where I no longer needed my Gliclazide at all, but I hit these rough patches where for no seeming reason my bloods go out of control again. Despite no diet change (I have very little meal variation) my bloods went from 6 to 14 post meal today, and that's after taking gliclazide to help again. Normally I'd only see a 2mmol rise maximum, if at all!

Oddly enough this happened the same time last year and prompted C-Peptide testing which just confirmed I'm not 1, 1.5. I also had later genetic testing ruling out MODY. I am so frustrated and tired of no answers from doctors or other diabetics not relating. I've had suggestions off the diabetic nurse that "maybe my mouthwash has sugar in" or that "your body can store sugar more in the winter" which seems like a cop out when I don't eat much sugar to accumulate? It's horrid having people assume you must be lying about your diet too! I'm just wondering if this happens to anyone else as I'm fed up...

 

[bulkbiker]

I'm a young type 2 diabetic (28, diagnosed at 14) and I've been using the keto diet (OMAD, ~20 carbs maximum daily) to manage my diabetes since Nov 2021. Overall it's been great and I managed to get to a place where I no longer needed my Gliclazide at all, but I hit these rough patches where for no seeming reason my bloods go out of control again. Despite no diet change (I have very little meal variation) my bloods went from 6 to 14 post meal today, and that's after taking gliclazide to help again. Normally I'd only see a 2mmol rise maximum, if at all!

Oddly enough this happened the same time last year and prompted GAD testing which just confirmed I'm not 1, 1.5. I also had later genetic testing ruling out MODY. I am so frustrated and tired of no answers from doctors or other diabetics not relating. I've had suggestions off the diabetic nurse that "maybe my mouthwash has sugar in" or that "your body can store sugar more in the winter" which seems like a cop out when I don't eat much sugar to accumulate? It's horrid having people assume you must be lying about your diet too! I'm just wondering if this happens to anyone else as I'm fed up...

Has anyone ever suggested either a fasting insulin test or a c-peptide to see how much insulin you are producing?

 

[starlightrays]

Has anyone ever suggested either a fasting insulin test or a c-peptide to see how much insulin you are producing?

Hi, I apologize as I called it a "GAD" test for some reason and have now edited my post, but yes I had a C-Peptide test when this happened last year ruling out T1 and T1.5, followed by genetic testing ruling out MODY. Don't know where I got "GAD" from, my mistake!

 

[Lobsang Tsultim]

Could your rise be due to a non-diet factor like an infection, stress or injury? Last summer while strimming the lawn edges, I caught my bare ankle with the string. My blood sugar levels went up sharply and stayed elevated for three or four days.

 

[Robbity]

If you can't account food-wise for a one-off sharp rise it's also worth considering a "contaminated" finger, so worth washing hands and doing a clean finger re-test in such a case.

I find that most of my higher results are due to non-food causes. Health, pain, stress levels, and some medications all do this for me, but generally these cause higher levels both before and after eating.

 

[starlightrays]

Could your rise be due to a non-diet factor like an infection, stress or injury? Last summer while strimming the lawn edges, I caught my bare ankle with the string. My blood sugar levels went up sharply and stayed elevated for three or four days.

I have high levels of stress in my life from being a fulltime carer and unsavoury neighbours. Unfortunately I can't magic wand that away (wish I could!) but it's strange if it's only giving me highs some of the time. I do have other health conditions but my endo or other doctors never suggest them as being a cause for raised glucose. I make sure to prioritise sleep.

If you can't account food-wise for a one-off sharp rise it's also worth considering a "contaminated" finger, so worth washing hands and doing a clean finger re-test in such a case.

I find that most of my higher results are due to non-food causes. Health, pain, stress levels, and some medications all do this for me, but generally these cause higher levels both before and after eating.

The highs are pretty consistent and can last weeks so I don't think that's the problem, but I do wash my hands very frequently. It's the same with illness - even when I had COVID I only noticed a 2mmol rise for a couple of days when I had fever. These spikes really seem to come from my meals even though they're ketogenic and are such large spikes (for me) at 6mmol+ For example I've been going from 6-7 to 14mmol. The post meal highs are keeping my sugar higher at fasting. It's baffling as it's the exact same meals I was fine with - including bacon and egg! I remember last year being accused of being untruthful for saying scrambled eggs alone were spiking my glucose by 5mmol, but it did and is again it seems...

This is also including me going from being medication free to back on the maximum dose of Gliclazide.

 

[Antje77]

I had a C-Peptide test when this happened last year ruling out T1

C-peptide measures how much insulin you produce. It's a complicated thing because what is normal, high or low also depends on blood glucose at the moment of the blood draw.
Do you know the actual result from your test?

In very early T1 (LADA) it's not unusual to produce normal amounts of insulin, sometimes even high normal.
So a very low C-peptide with high BG is indicative of T1 (or other varieties where you cannot produce sufficient insulin).
A very high C-peptide is indicative of T2.
But anything in between is inconclusive.

 

[plantae]

Although "your body can store sugar more in the winter" sounds wrong (although I don't know if it's wrong or not), there's plenty of evidence on Google Scholar that your BSL can increase in the winter. Where does this glucose come from since you're on such a low carb diet? Gluconeogenesis (worth reading). I don't know if glucose produced via this pathway can be stored in the liver as glycogen to be released as glucose later -- I don't see why not though, although homeostasis and natural insulin probably moderates it -- but either way it seems plausible that gluconeogenesis up-regulates to provide the extra glucose the body needs/wants as documented in the studies

 

[AloeSvea]

The body also upregulates glucose-making because the intricate and multivaried signaling system is malfunctioning. Due to a whole bunch of possible reasons, and in a whole bunch of possible stages in the blood glucose regulating system.

 

[starlightrays]

C-peptide measures how much insulin you produce. It's a complicated thing because what is normal, high or low also depends on blood glucose at the moment of the blood draw.
Do you know the actual result from your test?

In very early T1 (LADA) it's not unusual to produce normal amounts of insulin, sometimes even high normal.
So a very low C-peptide with high BG is indicative of T1 (or other varieties where you cannot produce sufficient insulin).
A very high C-peptide is indicative of T2.
But anything in between is inconclusive.

I don't remember the exact result, but I was told it was a normal amount. This made sense to me as pre-keto taking insulin even in high amounts did nothing, but when I was struggling with these highs after the test using the insulin again (briefly, with permission from my diabetic nurse at the time) lowered my levels. I put this down to keto and IF lowering my insulin resistance. I think I will try and get the exact result this week though.

My endocrinologist is very confident I have type 2 and I do agree. I was diagnosed with type 2 diabetes alongside PCOS, struggle with centripetal weight and type 2 runs in the family. The only thing I wonder if potentially having lipodystrophy impacts how easy it is to control my diabetes, but sadly it's so rare I find people don't know - the doctor himself said he would have to go research it. I'm still waiting to hopefully be contacted about testing for that, but my endocrinologist did say he was happy to just treat me as type 2 with a PCOS element - even though he agreed my body fat composition and having NAFLD under the age of 10 could mean lipodystrophy. My high cholesterol has also been ruled as non genetic as my mother was tested.

Although "your body can store sugar more in the winter" sounds wrong (although I don't know if it's wrong or not), there's plenty of evidence on Google Scholar that your BSL can increase in the winter. Where does this glucose come from since you're on such a low carb diet? Gluconeogenesis (worth reading). I don't know if glucose produced via this pathway can be stored in the liver as glycogen to be released as glucose later -- I don't see why not though, although homeostasis and natural insulin probably moderates it -- but either way it seems plausible that gluconeogenesis up-regulates to provide the extra glucose the body needs/wants as documented in the studies

Oh, I'm sure it does. I just can't really accept going from a 2 hour rise of 6-7mmol after the same meals to numbers in the teens, especially when I'm trying to lower my a1c.