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High fasting (morning) levels - Average 12.0

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Eekey

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I have consistently high fasting (morning) levels - Average 12.0 over the last few of months.

I've been a T2 for over 10 years but my fasting levels have crept up over the last 3 years from an average of 8.0-9.0 to 12.0 now.

My diabetes nurse doesn't seem overly concerned about this.

Current meds: 2000mg Metformin and 240 mg Gliclazide (daily), 3mg Trulicity (weekly). I am fairly active - gym twice weekly etc. - and observe a lower carb and no added sugar diet.
I'm arranging my next HbA1C today to start the discussion with my health care team - last HbA1C 3 months ago was 75.

The longer these higher levels go on, the more concerned I am becoming. My current theory is that I might have been insulin resistant my whole life and now my pancreas is simply running out of it's finite insulin. Does this sound plausible or are there any other theories that might fit.
 
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Hi @Eekey I've not been in your position. Neither been T2 for so long ((started transitioning into remission immediately after diagnosis), not ever been on diabetes medications. So your 'fasting levels before the 'creep' sound high to me.

I do suffer from DP and although in remission for around 3 yrs now, my Fasting levels are still higher than what I'm told is normal at around 6.5 to 7.5.. Not much lower than they were after I had just started on Low Carb (20gms to 40gms per day).

How are your rises due to meals? Have they gone up too? - if so then it seems possible that it's just carb creep which is causing it. It's extremely easy to slip into carb creep over a period of years even at my low carb target range, so it must be even easier for you since you need to be careful to have more carbs just because of your medications could cause hypos.
 
Another thought is has there been any change in mediations? s you ae probably aware, many medications have the effect of rising Blood Glucose. The most common culprits include Statins and Steroids, but I have heard some say that some antibiotics can also do so.
Some other longer term causes of higher BG are: Injury, illness, stress, lack of sleep.
 
Possible causes of rising blood glucose readings. Well, you're another year older for one.

If your average blood glucose readings have gradually crept up, for whatever reason, your insulin resistance is likely to have risen as well.

"Lower carb" covers a multitude of eating patterns . Whilst awaiting your HbA1c results, I'd keep a food diary.
 
Yikes. I can see why you're concerned. Lower carb, does that leave wriggle room for actual low carb? (Mind you, with glic in the mix you could hypo, so test a lot!).

See whether there's anything to be gained in lowering your carbs significantly, just please be careful you don't face-plant with a hypo while you're at it. I've rarely seen a diabetes nurse concerned about anything, really... It's not their body and they're used to people having their blood sugars spinning out of control, it's par for the course. "Diabetes is a progressive condition", after all, and it's a "whelp, nuttin' to be done about it" attitude... Which is completely wrong. You have more power and input in your own health than that!

You have to live in that body for quite a while yet, better take care of it. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html Might help, but yeah... You can take this bull by the horns. Just please, test plenty as long as your meds aren't adjusted to a new status quo.
Jo
 
Thanks. Your observation on the nurse is spot on - when I've raised the concern they've simply said they have other patients that they see that are much higher... not really helpful.

To be honest my 'lower carb' diet is a little relaxed - (has been) mainly avoiding any simple carbs e.g. white bread, pasta, potato, white rice etc replacing with veggies instead, either vegetarian or white meat / fish. If I do have bread or rice etc. it's always the wholegrain version. No foods with any added sugar - including the obvious cake, desserts etc.

I've never had a hypo - the lowest reading I've ever seen was a few years ago - 4.5 after a 30 mile cycle ride and before a meal.

I was thinking of paying for a CGM for a few months so I could work-out with more accuracy what effects my levels, and when.
 
I didn't know not to mix low carb with glic... My endo told me I could not possibly hypo, but with about 40 to 80 grams of carbs a day, I most certainly did. I became confused, contrary, and weak in the legs when hitting a three. Gliclazide forces the pancreas to churn out insulin, but it doesn't stop when you've had enough to cover your foods... It just keeps going, even if you don't need more insulin. So hence the caveat. Lower carbs would be helpful to your over all health, I do believe.... But you have to be careful, and maybe adjust your medication. (Thankfully, I had a GP who DID listen and took me off the gliclazide. Otherwise I'd still be going down regularly seven years in.)

A CGM sounds like an excellent idea!

Good luck!
Jo
 
Without sounding like I’m oversimplifying it sounds like your diet is not all that low in carbs which is probably keeping the readings up a few more mmol than they might otherwise be and in turn your HBa1C is staying high.

Have you ever tried a period with low carb not just lower carb? These distinctions between whole grain and white carbs are not all that relevant given they all turn to sugar in the body.

You might be surprised by the changes you see in a few weeks if you cut down to 20/30g of carbs daily.
 
Have you heard of The Dawn Phenomena? High morning readings. Brown rice etc is still high carb sadly, I’d change to whole grain before T2 as better than processed.
I record what I have for each meal, become a habit. I’m not strict strict low carb but my nurse would highlight all the carby foods my consultant Endocrinologist said ‘You’ve got to live’! GP woukd say ‘what are you worried about, your numbers are good’? Being diagnosed T2D was a massive shock.
I’m just on Empagliflozin and the low carb.
Various situations affect my numbers, have a LOT of stress, younger brothers death by hospital negligence for instance, post-mortem,2 day inquest. Numbers rising and then went into A Fib 2nd day.
Obviously it’s a progressive disease and sadly changes needed OR end up with more medication with side effects or injection.
 

What time you beat your evening meal - try to have it earlier 6 or 7pm. It gives the body time to digest. Don’t think you eat anything because you take all that medicine. The body still can’t cope reduce carbs
 
** UPDATE **
I was perscribed Trulicity (3mg) in April 2023 which worked a bit but the nausea on day 1 was awful! that stopped in Sept 2023 when the NHS could no longer get any due to the dieting fad...
I self funded a GCM (Libre2) the give me more info so I could try and control it more view dieet. Really useful and showed what effect foods, exercise etc had not only immediately but over the following days. But after 2 months my levels were getting really high again.
I suggested to GP background insulin and he agreed. Started injecting Humulin I (30 units) in December 2023.
Now my levels are, for the first time in years, usually 'in the green'
 
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