Is Diabetes a Progressive Disease?

[CL_in_NZ]

The increase in carbs after fat/protein could be from your liver from glucose strores if it happens soon after eating. When you eat those things you may be releasing insulin, dropping BG and then your liver releases to make up for it.

I can see little blips throughout the day on my libre when I am not eating. Once it starts getting to the low fours it blips up again to around 5. Quite consistent each afternoon it is interesting to watch!

On the original premise yes of course it is a progressive disease! As everyone ages their insulin resistance increases and beta cells die off. The key is to keep enough function to not go to far down the road becoming diabetic. As to how we all progress it depends on how far along we are when diagnosed and how it is managed. If you follow the standard advice you will have the standard outcome!

 

[DJC3]

There are certainly regressive components - in that eating low carb can remove many inches from the waistline, restore energy and a willingness to do housework not seen for decades, .

An interesting thread with some links I haven’t seen before, however this bit made me chuckle @Resurgam. Thanks for starting my day with a laugh.

(I’m waiting with baited breath for that effect to show on me)

 

[rom35]

Have you tested yourself with a meter after eating meat and eggs? (Only!) And you have raised blood glucose levels? Have you been documenting this? Really?

Yes. Yes. Yes.
See http://www.insulin-pumpers.org/howto/pfandbs-2.html and also find the gluconeogenesis.

As I understand it, the impact of proteins on your BG is very dependant on status of your pancreas and liver.

 

[lucylocket61]

if someone is only eating veg in order to keep their blood sugars down without meds, how do they avoid malnutrition?

 

[zand]

if someone is only eating veg in order to keep their blood sugars down without meds, how do they avoid malnutrition?

I did this for 7 weeks and stopped because of severe bone/joint pains. I should have had some fat too.

 

[AloeSvea]

It might be complex, but it happens. Dr Google says so. There's plenty of well documented empirical evidence...

Absolutely fair enough @DavidGrahamJones.

But just so I know I have understood correctly - you eat meat and eggs only, and meter it, and you see a BG rise? Or, a rise in your HBA1c if tested over time? I ask not as a test or provocation (not my style I promise) but because I will store the info as, "Yeah, I know a diabetic online who gets a blood glucose spike after eating meat and eggs."

Probably diabetic-intolerance to meat and eggs is one of the many things that there is a lot of variation? I can eat a ton of meat and eggs and not a blip on the BG meter. (I think dairy does have an insulin/glucose response though, for me. As probably everyone? But it is tiny, and does not affect my HBA1c I discovered after a couple of dairy experiments.) I can say with absolute confidence it certainly wasn't the meat and eggs of my past that got me to my screwy blood glucose non-regulation that I have today.

But very sad indeed if meat and eggs contributes to folks having T2D and being progressive. (Unless a Vegan, then it is thumbs up!) (I am obviously not a Vegan.)

So yeah - back to where we say the only way to know for yourself how food affects our blood glucose regulation is to eat and meter. (And adapt according to the info, and stop this ol type two being progressive... indeed.)

 

[AloeSvea]

Yes. Yes. Yes.
See http://www.insulin-pumpers.org/howto/pfandbs-2.html and also find the gluconeogenesis.

As I understand it, the impact of proteins on your BG is very dependant on status of your pancreas and liver.

Ok - so I will say, "I know online of at least two diabetics who meat and eggs spike them.".

And good to know re the pancreas and liver info.

 

[lindisfel]

Hi David,
We can manage without carbs but how do you get enough protein? You will lose muscle mass and it will be harder to deal with blood glucose.
I am coming up to 79 and I know I have to eat more protein to keep my muscle mass!
Best wishes with your struggle
Derek

I didn't say that! What I can say from personal experience is that after 3 to 4 years of no bread/rice/potato/past which meant I was consuming less than 40gms carb a day, confirmed by weighing everything I ate and put it into Weight By Date software to get the amount of carb along with calories, cholesterol, fat etc, my BG started to go all over the place, backed up by an HbA1c of 68 mmol/mol.



It isn't just carb that converts to glucose. This link will make interesting reading http://journal.diabetes.org/diabetesspectrum/00v13n3/pg132.htm

Again, my personal experience of a very low calorie diet, eating veg only backs that up. Eating no meat has resulted in a lovely straight line (ish) on my FreeStyle Libre between 5 and 7 and no dawn phenomenon. As soon as I re-introduce protein, and fat in the form of yogurt mainly my BG climbs and the dawn phenomenon is much more evident.



I'm well read on the whole fat/cholesterol story, not necessarily remembering everything. Another thing I can say about my personal experience, when I ate meat and yogurt my total cholesterol was 5.7, after 3 months of a very low calorie diet with considerably less meat and no yogurt it was 4. I'm not suggesting that's good, just what it was. I suffered statins for 17 years before giving them up, at least a total cholesterol of 4 means my GP and DN don't give me any grief at all. In fairness they didn't say that much when it was 5.7 because they knew I was changing things in my diet.



The FreeStyle Libre has been a boon, it's like an electronic tag, it will soon tell me when I'm doing something wrong,so it keeps me on the straight and narrow. I am familiar with the Youtube videos and the book.



I hope not, which is why I suggest possibly. I've had three c-peptide tests in 2 years which show my pancreas is producing an amount of insulin in the normal range. I have also had my insulin resistance measured 3 times in 2 years and that gives a slightly interesting result. It has gone down and then up again, even higher than before. However, from what I've recently started to read, beta cell dysfunction is more of a problem, the suggestion being that beta cell mass in a large percentage of diabetics is less than it should be, the remaining beta cells possibly making up for the shortfall, but for how long. I'm only just reading this and suggest googling "type II beta cell dysfunction", I may not be 100% correct and would welcome comments from someone with a greater understanding.

 

[Brunneria]

@DavidGrahamJones

Interesting that you say eating small amounts of yogurt will raise your blood glucose.

I find the same - when I eat cow's yog.
Goatsmilk yog does not raise my bg, even in larger quatities.

But then I have a food intolerance to the whey in cow's milk, while I tolerate goats milk with no problem.
I also have a food intolerance to soya, and the same thing happens (relatively small intake of soya => disproportionate rise in bg).

Perhaps you should consider that it may not be the protein that is causing the bg increase, but rather that food intolerances to specific proteins are causing a reaction, part of which is raised blood glucose. One way to test this is to try different proteins, in isolation. Various meats. Various fish. Various dairy products. Even compare duck eggs with hens eggs.

Lots of scope for investigation!

Edited for a typo and to add the following: I would caution you to ensure that you are getting sufficient protein, over time. Fine to reduce protein in the short term. Very unwise to reduce protein in the long term. And if offered the choice of ill-health through inadequate protein intake, or raised blood glucose and medication because of incorporating adequate protein, I would take the latter. Every time.

 

[DavidGrahamJones]

But just so I know I have understood correctly - you eat meat and eggs only, and meter it, and you see a BG rise? Or, a rise in your HBA1c if tested over time? I ask not as a test or provocation (not my style I promise) but because I will store the info as, "Yeah, I know a diabetic online who gets a blood glucose spike after eating meat and eggs."

I don't feel provoked, you ask a sensible question in a polite manner. Spike might be the wrong word. and it's not as direct as that. I'll have to go back through my FS Libre charts and food diaries to show an example. A little background might help.

I was encouraged to eat low carb about 4 or 5 years ago by a nutritional therapist and to lose weight. My GP's first reaction was similar to other GP's reaction over the last 20 years, don't do it. However, she didn't take long to realise that I was primarily trying to lose weight and she just said "just be careful of your BG levels" because at the time I was taking Gliclazide and Januvia. Within a matter of weeks and a few hypos, Gliclazide and Januvia became history, I didn't need them to keep my BG in the 5 -7 range. I could even tolerate a slice of toast on a Saturday (I wasn't completely "obvious" carb free) to go with the poached egg.

However, in late 2016 I noticed that my BG was not as well controlled as before and my HbA1c of 64 (I think) backed that up. Even the toast was causing dramatic BG rises. The dawn phenomena was also causing a major problem with my BG going from 6 to 12 at anytime after 4 in the morning, well before I was getting up to use all that glucose.

That's when I first tried a VLCD, differing to the Newcastle approach because I just ate loads of vegetables. It took maybe 2 - 3 weeks before my BG started to behave and I could keep my BG in the 5 - 7 range for most of the time, even the dawn phenomena disappeared (a godsend) until I started to re-introduce meat and eggs. Then I would start noticing that my BG would rise, maybe spike isn't the correct word, and sometimes take several hours to come back down, and the dawn phenomena would return.

Some additional information might be useful, my 3 c-peptide tests over 18 months showed insulin production in the normal range, my insulin resistance over the same period has gone from 2.4 to 1.7 to 2.8 (difficult to explain why, is my diabetes getting worse?) I'm only now looking at beta cell mass and the fact that as that mass decreases, what's left works harder to produce more insulin, up to a point. (needs further research on my part).

This is what I have noticed and I'm not suggesting everybody would have the same experience. As you can imagine, when my BG started to misbehave on 40gms carb a day (weighed and measured all food) I was at a complete loss as to what was causing it. I've manage to multitask and have attached a log from last Tuesday. I woke at 05:30, coffee with milk at 06:00, fried mushroom, egg and tomatoes at 07:00 (busy day so decided to fuel up, forget the VLCD this morning). This particular document doesn't show the max very well, but it's around 11. Possibly not a spike but perhaps a mini spike LOL

Similarly this morning, another busy day, decent breakfast same as Tuesday, BG already gone up to 9.5. I don't think this is DP because it doesn't have the same pattern as previously i.e. starting at 04:00. Hope this helps explain my claim a little.

 

[DavidGrahamJones]

I would caution you to ensure that you are getting sufficient protein, over time.

The low carb, vegan diet is too difficult for me to keep motivated. I can keep to it for 5 days because I look forward to what I call normal eating at weekends. Just by bringing in eggs one breakfast, bacon another breakfast and some sort of meat/fish on two dinners. I can also whip up a pretty mean shepherds pie made from Quorn.

This week has been slightly different because I've had two long car journeys (2hrs plus) followed by physical effort and then 2hrs back.

 

[lucylocket61]

During the week I am presently only eating vegetables, then at the weekend I splash out a bit with eggs on Saturday, bacon on Sunday and whatever meat my wife likes in the evenings. This has had the desired effect and my BG stays in the 5-7 range.

Do you mean you eat no protein for 5 days of the week?

 

[rom35]

Ok - so I will say, "I know online of at least two diabetics who meat and eggs spike them.".

And good to know re the pancreas and liver info.

I’ve made the test for you:
2 small eggs (90g) and two tablespoons of fish oil:
Start: 5.0
30m: 5.5
60m: 5.2
90m: 5.4
120m: 5.2

 

[DavidGrahamJones]

Do you mean you eat no protein for 5 days of the week?

Correct! No Breakfast, home made vegetable soup for lunch and steamed or roast vegetables for tea (dinner). Please bare in mind that this VLCD thing isn't permanent, I'm too weak a human being to keep it up week after week for more than a few months. Not sure how Dr Taylor's (Newcastle Diet) subjects manage 5 months. So, like this week when I knew I was going to have a long day involving physical labour, I made sure I had breakfast, with fats and protein. The PDF I attached to my previous post shows when I consumed my "blow out" breakfast of eggs and muschrooms. LOL

 

[AloeSvea]

I’ve made the test for you:
2 small eggs (90g) and two tablespoons of fish oil:
Start: 5.0. with a peak of 5.5, finishing two hours later at 120m: 5.2
T2 diagnosed May 2015
Last HbA1cs 39.
Diet only. Around 15g carbs a day

Ahoj Rom35! (Just looked at your profile page and saw you hail from the Czech Republic.)

You seem to be a great example of how T2D is NOT necessarily progressive, and all the power to you. Fabulous that you have normal BG levels after a few years, and found your carbohydrate tolerance level? And your level of physical activity and muscle development it seems to get back into the normal range. Impressive indeed. Could I know what your starting HBA1c was, to add to my "I know (x amount of) diabetics online who got into the normal BG range....". (Do I have conversations like this? Yes! With other diabetics IRL, and my lovely patient partner, bless him.)

But I have to say - .5 is a spike? Ending up on a .2 rise two hours later? Really? Maths and numbers are not my thing, but I don't know if I would even count that as a spike - that is what I call a 'blip'! (This is a good thing, not a bad thing.) He's still asleep so I can't ask him for the mathematical-statistical relevance line. (And yes, he and I do have many conversations about statistical significance etc etc, especially about the BG meter. Bless us.)

And great to know you clearly do not have a damaged liver and pancreas, or not so bad? As I have said so many times in diabetes forums - I would kill for numbers like that. Or at least - once maintained over time - have a huge whopping great dinner with my entire extended family, with balloons! Sigh.

And for me, I promise, it is not for want of trying - hard! (I think I have SIRD - the 'severe insulin resistance diabetes' - and boy am I grateful for this new five different types of diabetes bit that came out this year so I can write that to y'all and y'all get it then!)

Anyway. Great work Rom.

 

[AloeSvea]

@DavidGrahamJones, No wonder folks love the freestyle libre meter so much - what a gorgeous graph!

There is nothing like reading other folks' idea of a 'blow out breakfast' being eggs and mushrooms for me to be reminded what a hearty appetite I have, and especially at breakfast! . And you do physical work on that ? Goodness!

And I fully doubt that you are "weak" willed! Anybody who does a VLCD has got great willpower. (And I'm not just saying that because I have done it myself! cough cough.)

I really am sorry that you can't take meat and eggs. They provide such fabulous energy, when in fat burning mode. Have you done a looking for the spike/blip experiment like Rom has?

As I am such a carnivore, that the idea of a quorn shepherds pie makes me want to weep! Epecially when I read the ingredients:

Quorn - Ingredients. Mycoprotein™ (94%), rehydrated free range egg white, caramelised sugar, barley malt extract, acidity regulator (calcium acetate), firming agent (calcium chloride).

I can't even begin to imagine the BG spike I would have with the sugar, and the barley bloat!

But you know, I have a lot of shepherds in my family tree, some very close kin the same generation as me. A shepherd's pie without lamb? Egads!

Lamb - ingredients. Part of one dead and cooked baby sheep: fat 21g, 25g, carbs - zero!

Yeah, I feel sorry for the baby sheep. Especially as I know what kind of lives they have once it all begins (the direct path to torture and death, and that's just the home-kill ones.). Please know I am very admiring of folks who eat Vegan for the principle.

And any shepherds pie I had would have to have a low-carb mash on top, or an almond flour pastry (the latter I haven't attempted).

Excuse all the food stuff. I'm on day 3 of a no-food fast and even my beloved cat is looking yummy to me right now. (I'm kidding on the last one - honest!)

But more on topic - you seem to be a moderate-low carbing T2D success story? Getting off all your meds on moderate to low carbs? Who has experimented a lot with a vegetarian way of eating? (Have I got it right?)

 

[rom35]

Ahoj Rom35! (Just looked at your profile page and saw you hail from the Czech Republic.)

Ahoj That’s why my spoken english is sometimes like “massa bob”, as we say it in czech.

You seem to be a great example of how T2D is NOT necessarily progressive, and all the power to you. Fabulous that you have normal BG levels after a few years, and found your carbohydrate tolerance level? And your level of physical activity and muscle development it seems to get back into the normal range. Impressive indeed. Could I know what your starting HBA1c was, to add to my "I know (x amount of) diabetics online who got into the normal BG range....". (Do I have conversations like this? Yes! With other diabetics IRL, and my lovely patient partner, bless him.)

I had normal BG levels after 14 days of “no carbs” diet. It is not problem to bring it down, but to stay there
I found my carbs tolerance level by home made ogtt test wit 20g of carbs - with usage of rule of three I’ve computed the max carbs for one meal.
I dont’t know my starting hba1c. My diagnose was made on behalf of ogtt test and random BG test which was 14. My HbA1c after three month on first HbA1c test was 40.

But I have to say - .5 is a spike? Ending up on a .2 rise two hours later? Really? Maths and numbers are not my thing, but I don't know if I would even count that as a spike - that is what I call a 'blip'! (This is a good thing, not a bad thing.) He's still asleep so I can't ask him for the mathematical-statistical relevance line. (And yes, he and I do have many conversations about statistical significance etc etc, especially about the BG meter. Bless us.)

For me the “spike” is all rise of BG. And 90g of eggs is only 1g of carbs - and it elevated my BG for 0.5 points!! At the evening - where may insulin resistance is smaller than in the morning... Imagine I will eat f.e. 10g of carbs!
BG meters (accu-check) tends to be stable in measurement - so if there is an error in 5.0, the same math error will be for 5.5 - it means the 0.5 difference is without error.

And great to know you clearly do not have a damaged liver and pancreas, or not so bad? As I have said so many times in diabetes forums - I would kill for numbers like that. Or at least - once maintained over time - have a huge whopping great dinner with my entire extended family, with balloons! Sigh.

One of that (liver or pancreas) is damaged, may be both - I can tolerate only small amount of carbs. Because of my 40 level of HbA1c my Doc doesn’t allow to make more tests for me - “you have non-diabetic number, so no more specific tests needed”.
I “killed” myself for the numbers - gym each day, no more czech national bread “sumava” for me - I MISS IT SO MUCH! Hard work, burnout. Without my wife I would not done it.

And for me, I promise, it is not for want of trying - hard! (I think I have SIRD - the 'severe insulin resistance diabetes' - and boy am I grateful for this new five different types of diabetes bit that came out this year so I can write that to y'all and y'all get it then!)

So you have to totally remove the carbs from your diet and walk after each meal. And hope for improvement in the years

Anyway. Great work Rom.

Thanx and wish you my numbers asap

 

[DavidGrahamJones]

I really am sorry that you can't take meat and eggs.

Thinking aloud here, I seem to gain fat very easily. Despite what the Harris Benedict formula says about my Resting Metabolic Rate (2300 calories a day), there is absolutely no way I can eat that much, never have done.

I expect NAFL is at work here, "When your body doesn't have enough carbohydrate on hand, it will turn to protein and fat to make glucose. This reaction happens in the liver instead of the digestive tract. Your body breaks down the proteins, fats and enzymes it has to make glucose in a process called "gluconeogenesis," or the making of new sugar."

So I'm guessing that as my VLCD progresses, there will be, in theory, less fat in the liver to convert, explaining why the dawn phenomena disappears. I'm also guessing that eating meats and fats will store fat in the liver first and hence the process of gluconeogenesis can start again. I'm also noticing that if I go for a walk first thing in the morning, I'll get slightly elevated BG.

I'm not able to discuss the complexities of this disease with my GP because she'd be guessing more than I am. I think what I'm doing is "working with my meter" and I'm very fortunate to have some spare cash in my old age to pay for the sensors.

 

[ParkPrince]

I am not quite sure, sometimes it is while other times not.

 

[AloeSvea]

....So you have to totally remove the carbs from your diet and walk after each meal. And hope for improvement in the years ...
Thanx and wish you my numbers asap

Well - WAY easier said than done! To totally remove carbs from my diet? Golly Gee! Even a zero carb diet isn't really a zero carb diet. (5g of carbs and under.) But I hear your point. But I also know that ain't coming real soon! . Never say never though.

I won't be walking after every meal either! But again, it's a good regime to recommend.