Help! Insulin Resistance

BishyAnt said:

Hi there, wonder if you guys could give me some advice. A while ago I started intermittent fasting as a way of shifting weight. It seemed to keep my weight stable, but I really never lost any despite having a decent diet and exercising. After reading about insulin resistance, I had a diabetes test at the docs (all results were normal) so I bought a blood sugar monitor (True Metrix Air) to try and understand what was going on. My blood sugar seemed high to me (around 7 mmo/l first thing in the morning - even after fasted for 14 hours) and recently I've made the change of cutting out carbs, increasing protein in my diet etc, but nothing really seems to consistently lower my blood sugar. As I understand it, this means I have insulin resistance, so I'm trying to build muscle, reduce carbs and still practise intermittent fasting.

However, I'm still not seeing results - my blood sugar results seem totally unpredictable and don't seem to reflect my habits. I'm monitoring what I eat with regard to my blood sugar spikes, but the lack of cause and effect is incredibly demoralising. Any words of advice as how to proceed?

Many Thanks!

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Hi

7 isn't unusual for a first thing in the morning result. Why did it seem high to you?

As you're learning, many things affect the current level of blood glucose, not just what you ate recently. Our livers are able to add glucose from stores through a process called gluconeogenesis, and they will do that whenever they think we need a bit more fuel. You wouldn't expect to make a long journey by car keeping the throttle at exactly the same spot all the way, just as our livers open and shut the glucose throttle all the time. They can get it wrong, too. One of the times livers typically add glucose is first thing in the morning.

The lack of cause and effect on current levels that you're seeing is not really unusual at all. This is why the HbA1c measure, which looks at where your blood glucose levels have been for roughly the past three months. is used as a more dependable measure. Fingerprick readings are fine for telling you where you are right now, but that's limited to the points you are able to test at. You can't test while you're asleep, or when you're driving, or in the middle of exercise. And there's not a lot of point in testing just for the sake of it, as you are finding out.

Secondly the tests themselves have a measure af allowable inaccuracy, which for fingerprick tests is plus or minus 15% of the true value. So for a true BG value of 5.0mmol/l a meter could return a result of anything from 4.3 to 5.8 mmol/l and be accurate enough. In addition, the glucose content of capillary blood is not necessarily the same as venous blood (used for lab tests) - see the link.


So I'd advise finding out what your HbA1c is and worry less about what random test results say. HbA1c results of 38-42mmol/mol are "normal" - most non-diabetic people are in that region (graph attached). 42 to 48 is what's called "pre-diabetes" but is possibly an indication that there is some level of insulin resistance. The agreed convention is that type 2 diabetes will automatically be diagnosed in anyone with an HbA1c confirmed to be above 48.

BishyAnt said:

Thanks so much for the responses. @KennyA I assumed it was high as I'd been fasting for 14 hours or so by this point, and compared to other results I'd read, looked high. My general readings just seem to fluctuate whether I'd fasted/not fasted, I was hoping for a more causal relationship between what/when I'd eaten and my results.

Learning a lot about this at a rapid pace thanks to your responses! Having contacted my doctors again, they advised me that my HbA1c wasn't checked as my random glucose was normal at 4.8 - I'd never had a result this low on my home kitr (and for reasons @KennyA suggested).

My drive in starting all this I wanted to get some hard stats on how intermittent fasting was affecting my body in order to lose weight, but it doesn't seem like it's something I can get definitive and dependable results on (at home anyway).

Cheers

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Some people (I was one) find in the early days that your liver goes out of its way to keep your BG where the liver's got used to it being. In one way this isn't a bad thing: the liver's using up its stores (it keeps about a day's worth of glucose ready to synthesize) and if, as I did, you want to get into ketosis those stores have to be run down.

So you might find that initially IF doesn't seem to be having much impact. I didn't really set out to do IF, it just sort of happened as a consequence of keto and not feeling I wanted or needed to eat.

There is an assumption around that if you test and your BG is (say) 6.0 that that sets a level. Everyone's BG fluctuates all the time and you don't know wthere it's 6.0 and rising, 6.0 and falling 6.0 and stable or 6.0 and wobbling about a lot. If you're interested, it might be worth trying a CGM for a week or two - there's a free trial of the Abbot Libre, but only if you're diagnosed diabetic. You could also google "CGM glucose graphs" or something similar (I think I found a lot on Reddit) and have a look at the BG variance in people who are not diabetic, as well as the responses to food, and how BGs rise and fall.