Is this the end of the line?

[DavidGrahamJones]

I've been very successful over the last 5 years or so, with keeping my BG in check with HbA1c around forty something, maybe not perfect and could do better (maybe). My carbs are usually less than 50gms per day.

Last year, after seeing a GP who specialised in metabolic problems I was advised to inject Victoza, not for the type II but to help the metabolism. I also had to see the endocrinologist because of liver function problems (not been right since I took Rosiglitazone) as well as the metabolic problem and his advice was the same.

Injecting Victoza obviously helped with controlling my BG and may even led to the odd additional 'one piece of toast won't hurt'. The usual dawn phenomena problems disappeared completely but there was no change in the way my metabolism so I eventually decided, with the GPs agreement that I should stop the Victoza, it was costing the NHS £130 a month and I was not getting any benefit.

I then started to have great difficulty in getting stable BG readings (thank heavens for Libre) and after my HbA1c has been in the 50s. I also had a C-pep and insulin resistance test done (been doing thtat for years) and the c-pep showed that my pancreas is producing less insulin and my insulin resistance has done it's usual up and down (is it directly related to weight).

I have noticed how much my mood changes when my BG goes up , how my eyes are affected, and how ****** I feel generally. I've been under quite a bit of stress recently, being executor to my dad's will and having an objectionable sister as well as having do a lot of DIY in my dad's house 30 miles away, I'm knackered all the time and I need to concentrate on me. House exchange is imminent, so now's the time.

So, a few questions.

As much as I like the idea of only taking Metformin (I question it's efficacy - re Dawn Phenomena) maybe I should admit that additional medication is a requirement?
Do you think Victoza may have affected my pancreas in any way (Victoza is meant to improve Beta cell function), should I go back to it if GP agrees?
A fellow type II and friend, someone who enjoys his food (got to be careful, he might read this), has been prescribed Empagliflozin and lost two stone without trying. Does anyone have experience of this drug. Is it worth discussing with GP?

Thanks in advance.

 

[Oldvatr]

It seems you are channel flipping the diabetic meds to fix a different problem which you call Metabolism, but which you are careful not to specify further. This makes it difficult for us to comment. As you know, we are not allowed to offer medical advice, and it sounds like it is not really a diabetes problem as you seem to be keeping your levels within a reasonable range. I could hazard a guess that it is a weight problem in which case we may be able to help, but you are low carbing already, so it may still be something else. Have you had your thyroid functions tested recently? What was your last blood panel like?

This may not help, but I personally would consider that if Low Carb does not work, then perhaps a quick reset with Newcastle, or trying fasting may benefit, but again this may be counter to the metabolism problem. Without more info for that concern, then we are pushing water uphill with a spoon.

There is a thread for medications such as the SGLT-2 inhibitors that you could peruse for experienced info and advisories. I used one briefly, and it did nothing for me except give me a monster UTI that needed a severe talking to with a very strong antibiotic.

 

[bulkbiker]

I've been very successful over the last 5 years or so, with keeping my BG in check with HbA1c around forty something, maybe not perfect and could do better (maybe). My carbs are usually less than 50gms per day.

Last year, after seeing a GP who specialised in metabolic problems I was advised to inject Victoza, not for the type II but to help the metabolism. I also had to see the endocrinologist because of liver function problems (not been right since I took Rosiglitazone) as well as the metabolic problem and his advice was the same.

Injecting Victoza obviously helped with controlling my BG and may even led to the odd additional 'one piece of toast won't hurt'. The usual dawn phenomena problems disappeared completely but there was no change in the way my metabolism so I eventually decided, with the GPs agreement that I should stop the Victoza, it was costing the NHS £130 a month and I was not getting any benefit.

I then started to have great difficulty in getting stable BG readings (thank heavens for Libre) and after my HbA1c has been in the 50s. I also had a C-pep and insulin resistance test done (been doing thtat for years) and the c-pep showed that my pancreas is producing less insulin and my insulin resistance has done it's usual up and down (is it directly related to weight).

I have noticed how much my mood changes when my BG goes up , how my eyes are affected, and how ****** I feel generally. I've been under quite a bit of stress recently, being executor to my dad's will and having an objectionable sister as well as having do a lot of DIY in my dad's house 30 miles away, I'm knackered all the time and I need to concentrate on me. House exchange is imminent, so now's the time.

So, a few questions.

As much as I like the idea of only taking Metformin (I question it's efficacy - re Dawn Phenomena) maybe I should admit that additional medication is a requirement?
Do you think Victoza may have affected my pancreas in any way (Victoza is meant to improve Beta cell function), should I go back to it if GP agrees?
A fellow type II and friend, someone who enjoys his food (got to be careful, he might read this), has been prescribed Empagliflozin and lost two stone without trying. Does anyone have experience of this drug. Is it worth discussing with GP?

Thanks in advance.

I've said this before but... I think you should try a month of pure carnivore. The 30 day meat and water trial just to see what happens. You have nothing to lose by doing it and you never know.. maybe the 50g of carbs per day is just keeping you from ketosis and weight loss.

 

[DavidGrahamJones]

It seems you are channel flipping the diabetic meds to fix a different problem which you call Metabolism, but which you are careful not to specify further.

I'm intrigued that you should think I was being careful, it was not intentional. Yes, there are two problems, personally I believe they are related, maybe they're not. I was advised to take Victoza because of a metabolic problem.

The fact is that over decades I have followed a low calorie diet, when I started a low carb diet, I didn't replace the carb calories with fat calories, so a further reduction. My daily calorie intake was less than one thousand and I know because I weighed things and I have some software which I just plug in the weights of individual foods and out pops the calories, carbs, protein etc (further seven things). The problem was that I never lost any weight despite consuming considerably less than my BMR of 2300 calories and even increasing my calorie intake by consuming cream and yogurt I have actually gained weight. This has been described as a Metabolic problem by the medical profession, not me. My own GP said my Metabolism was broken but had no advice hence my journey to a GP specialising in metabolism, at my own cost of course. I don't care what they call it, I just want it fixed. My visit to other specialists were because of wonky liver function results which started after I took Rosiglitazone and why I stopped taking that drug and why it is no longer available in the UK. I was not the only one affected.

So, for some time I have had this 'metabolic' problem but have controlled my BG by diet. Now I have both problems and my questions were not for advise, they were for opinion.

 

[DavidGrahamJones]

I've said this before but... I think you should try a month of pure carnivore. The 30 day meat and water trial just to see what happens. You have nothing to lose by doing it and you never know.. maybe the 50g of carbs per day is just keeping you from ketosis and weight loss.

I quote 50gms as an overestimate. I have gone through long periods of weighing food and using the software, but not at the moment, too many things going on with trying to sell dad's house.

Thanks for your opinion, a 30 day meat and water trial is something I will investigate, I can see organizational problems but I will definitely look into it further.

 

[Andydragon]

I'm intrigued that you should think I was being careful, it was not intentional. Yes, there are two problems, personally I believe they are related, maybe they're not. I was advised to take Victoza because of a metabolic problem.

The fact is that over decades I have followed a low calorie diet, when I started a low carb diet, I didn't replace the carb calories with fat calories, so a further reduction. My daily calorie intake was less than one thousand and I know because I weighed things and I have some software which I just plug in the weights of individual foods and out pops the calories, carbs, protein etc (further seven things). The problem was that I never lost any weight despite consuming considerably less than my BMR of 2300 calories and even increasing my calorie intake by consuming cream and yogurt I have actually gained weight. This has been described as a Metabolic problem by the medical profession, not me. My own GP said my Metabolism was broken but had no advice hence my journey to a GP specialising in metabolism, at my own cost of course. I don't care what they call it, I just want it fixed. My visit to other specialists were because of wonky liver function results which started after I took Rosiglitazone and why I stopped taking that drug and why it is no longer available in the UK. I was not the only one affected.

So, for some time I have had this 'metabolic' problem but have controlled my BG by diet. Now I have both problems and my questions were not for advise, they were for opinion.

Less than 1000 calories a day sounds like your body would get used to being so low and you wouldn’t lose weight. A quick google (so take with huge pinch of salt) does say that too few can stall your metabolism. But you do say you increased your calories

your friend, do you know if his hba1c is similar to yours? It sounds like he might be one of those people who don’t adjust what they eat and rely of drugs to address the sugar. It’s a pathway to insulin. I know cause it was me a few months ago, it works for a while but the bloods will keep going up

As for adding victoza, there is a whole pathway to follow:
https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#drug-treatment-2

It appears to say you need to be reading > 58 before they add a 2nd drug, so you don’t seem to currently be at the stage where they would add.

I’ve only just had daplogflizin added to my metformin and bydureon. But I’ve been on those 2 for over a decade, the paths and drugs offered are probably different to when I was given them. I know that I was taken off bydureon in the past (cost!) and once my bloods increased again I was only allowed back on it because I’d had it historically

 

[Oldvatr]

I know CICO is going out of fashion, but I have my own take on it called FIFO (Food In, Food Out) which basically states that what food goes in must go somewhere. It doe not vanish by magic and cannot be created by magic either since we do not photosynthesise and also according to the First Law of Thermodynamics - Matter is neither created nor destroyed.

So we expect anything we take in to be processed into basically CO2, CH4, water and waste products which should all come out one end or the other and even in between. So an increase in weight implies either it is being converted into higher density (eg muscle) tissue like a Black Hole, or is is sticking to bits it should not. Most of our weight is water, and apart from our skeletal system which generally remains static, then it is in fat.

So Fat is the one control parameter we try to control But there are at least 2 types of fat. Glycogen stores in the muscles + liver, and lipid fat in the adipose tissues incl the liver. The glycogen stores can be depleted fairly easily and this type of fat is mainly water so is a good target to aim at. It can be tackled usually with exercise, reduced calorie diet, and also by low carb diet. But Low Fat diets do not tackle this particular form of fat since lipid fat is only converted to glucose when there is a defined need (usually starvation or fasting)

The second form of fat is lipid fat mainly based on triglycerides and cholesterol overcoats. This fat is stored in special areas on the back, midriff, and thighs but its purpose is protection of our vital functions. Thus it is the fat that the body always tops up when it can and only releases when it is absolutely necessary. It is therefore the stubborn spare tyre and the stuff that gets hoovered out by liposuction when all else fails.

Now Low Carb has been shown to be effective in reducing this fat as has crash diets like Newcastle or the 800 Blood Sugar diets, and also by fasting. It requires quite severe treatment and even then is slow to go, and as an added bonus, these two diets seem to be well suited for diabetic glucose control too.

So if you are Low carbing already and its not working then something is amiss. We can convert food into fat from any of the food sources it seems. If you are cutting one and it has no impact then your body is using one of the other macronutrients instead. There are 4 basic macros to play with - Carbs, Protein, Fat and fibre. Fibre is easy - it goes in one end and out the other and we soon get to know if its not coming out as expected. The other 3 are the ones we have to manipulate to control weight. We do not manufacture fat from the air, so one of those is being used to compensate for the other ones being restricted. As @bulkbiker says,something is slipping past the gatekeeper. Even if you are one of those who put on weight by looking at food, you can only create fat by either eating it or by synthesising it from things you eat and drink that is the essence of CICO.

You mention that your insulin levels have dropped. Is this compared to when you were suffering Insulin Resistance, or compared to normal people? A drop in IR may indicate some success with the diet removing adipose fat, but the jury is still out on that.

 

[DavidGrahamJones]

This may not help, but I personally would consider that if Low Carb does not work, then perhaps a quick reset with Newcastle, or trying fasting may benefit, but again this may be counter to the metabolism problem. Without more info for that concern, then we are pushing water uphill with a spoon.

I forgot to reply to this bit earlier, sorry. Low carb is obviously keeping my BG to a certain level, just not low enough. If I should forget low carb all together, my BG would be seriously out of control. I don't know if this gives an idea of what's going on but yesterday I ate scrambled egg for breakfast, a small pork rib for lunch, rack of lamb peas, leaks and broccoli for dinner. Nothing else, no snacks. Coffee and tea with skimmed milk. This morning my BG was 15. I have tried fasting in the past and it makes a difference to morning readings, it is something I should pursue before thinking of extra meds.

 

[DavidGrahamJones]

I know CICO is going out of fashion, but I have my own take on it called FIFO (Food In, Food Out) which basically states that what food goes in must go somewhere. It doe not vanish by magic and cannot be created by magic either since we do not photosynthesise and also according to the First Law of Thermodynamics - Matter is neither created nor destroyed.

One slight problem with the First Law of Thermodynamics with reference to the body. It assumes that the body, like a store manager closing his books at the end of the day, counts up calories in, calories out and then deposits the excess into the fat 'bank' or subtracts the deficit from the fat ‘bank’. The body is far more complex than that.

I spent years wondering when the cutoff was, when did the body work out if I was eating too much. The answer is that it doesn't.

Burning calories as energy or storing it as fat is tightly controlled. As we eat, calories go in. Calories go out as basal metabolism (used for vital organs, heat production, etc) and physical activity. Fat can go into storage or it can go out of storage.
Hopefully everyone would agree that the main hormone involved in whether fat is burned or stored is insulin.

 

[DavidGrahamJones]

But you do say you increased your calories

Yes, based on the theory that eating too little means the body gets used to it etc etc. Basically it's much more complex.

your friend, do you know if his hba1c is similar to yours?

I had spoken to him about low carb and it wasn't happening so he ate as normal and let the drugs do the work.

I've always felt that dealing with diabetes is very much like keeping plates spinning on a stick. Not so bad if it's one plate on a stick, it just gets trickier as you get more plates spinning. Very much a balancing act. At least I have some extra things to think about and consider. Thanks for the Victoza URL.

 

[DavidGrahamJones]

There are 4 basic macros to play with - Carbs, Protein, Fat and fibre. Fibre is easy - it goes in one end and out the other and we soon get to know if its not coming out as expected. The other 3 are the ones we have to manipulate to control weight. We do not manufacture fat from the air, so one of those is being used to compensate for the other ones being restricted. As @bulkbiker says,something is slipping past the gatekeeper. Even if you are one of those who put on weight by looking at food, you can only create fat by either eating it or by synthesising it from things you eat and drink that is the essence of CICO.

As mentioned before, CICO is an over simplification. I was talking to HID about this, she studied Thermodynamics as part of her degree. The human body and weight loss or gain was never mentioned. The First Law of Thermodynamics applies to a closed system whereas the human body is not a closed system.

 

[Oldvatr]

One slight problem with the First Law of Thermodynamics with reference to the body. It assumes that the body, like a store manager closing his books at the end of the day, counts up calories in, calories out and then deposits the excess into the fat 'bank' or subtracts the deficit from the fat ‘bank’. The body is far more complex than that.

I spent years wondering when the cutoff was, when did the body work out if I was eating too much. The answer is that it doesn't.

Burning calories as energy or storing it as fat is tightly controlled. As we eat, calories go in. Calories go out as basal metabolism (used for vital organs, heat production, etc) and physical activity. Fat can go into storage or it can go out of storage.
Hopefully everyone would agree that the main hormone involved in whether fat is burned or stored is insulin.

That's why I went for the physical food which turns to glucose and lipids rather than that mythical kcal of CICO.

Indeed Insulin is the king of storage. It is also the gatekeeper for glucose to get into the cells not just for storage but also its use, but just as importantly it also controls glycogen being converted back into glucose and water.

The Krebs cycle also defines a second hormone which is the antithesis of insulin in that it stops the action of insulin. It used to be called adrenaline, but it now has a different name : epinephrine. This is often why blood sugars rise during periods of stress because it is the fight or flight hormone.

As an aside it also explains why speed drug amphetamine is also used as a slimming aid as it has the same basic chemical and biological action.

I am NOT suggesting you become a speedfreak to solve the metabolism issue since speed is a dangerous and addictive stimulant. Please do not be tempted.

 

[Resurgam]

I too have a long history of low calorie diets low in fat high in carbs and my Hba1c doesn't match the sort of BG levels I see - though I don't have a constant monitor and go by after meal levels which are usually under 7mmol/l yet I have Hba1c of 42. I reverted back to eating low carb whenever I got out of the clutches of the HCPs because that is what makes me feel well, and I would simply refuse to do any other way of eating now but it really does seem as though something broke and might never recover normal working.

 

[Dr Snoddy]

I know CICO is going out of fashion, but I have my own take on it called FIFO (Food In, Food Out) which basically states that what food goes in must go somewhere. It doe not vanish by magic and cannot be created by magic either since we do not photosynthesise and also according to the First Law of Thermodynamics - Matter is neither created nor destroyed.

So we expect anything we take in to be processed into basically CO2, CH4, water and waste products which should all come out one end or the other and even in between. So an increase in weight implies either it is being converted into higher density (eg muscle) tissue like a Black Hole, or is is sticking to bits it should not. Most of our weight is water, and apart from our skeletal system which generally remains static, then it is in fat.

So Fat is the one control parameter we try to control But there are at least 2 types of fat. Glucogen stores in the muscles + liver, and lipid fat in the adipose tissues incl the liver. The glucogen stores can be depleted fairly easily and this type of fat is mainly water so is a good target to aim at. It can be tackled usually with exercise, reduced calorie diet, and also by low carb diet. But Low Fat diets do not tackle this particular form of fat since lipid fat is only converted to glucose when there is a defined need (usually starvation or fasting)

The second form of fat is lipid fat mainly based on triglyverides and cholesterol overcoats. This fat is stored in special areas on the back, midriff, and thighs but its purpose is protection of our vital functions. Thus ist is the fat that the body always tops up when it can and only releases when it is absolutely necessary. It is therefore the stubborn spare tyre and the stuff that gets hoovered out by liposuction when all else fails.

Now Low Carb has been shown to be effective in reducing this fat as has crash diets like Newcastle or the 800 Blood Sugar diets, and also by fasting. It requires quite severe treatment and even then is slow to go, and as an added bonus, these two diets seem to be well suited for diabetic glucose control too.

So if you are Low carbing already and its not working then something is amiss. We can convert food into fat from any of the food sources it seems. If you are cutting one and it has no impact then your body is using one of the other macronutrients instead. There are 4 basic macros to play with - Carbs, Protein, Fat and fibre. Fibre is easy - it goes in one end and out the other and we soon get to know if its not coming out as expected. The other 3 are the ones we have to manipulate to control weight. We do not manufacture fat from the air, so one of those is being used to compensate for the other ones being restricted. As @bulkbiker says,something is slipping past the gatekeeper. Even if you are one of those who put on weight by looking at food, you can only create fat by either eating it or by synthesising it from things you eat and drink that is the essence of CICO.

You mention that your insulin levels have dropped. Is this compared to when you were suffering Insulin Resistance, or compared to normal people? A drop in IR may indicate some success with the diet removing adipose fat, but the jury is still out on that.

Hi, I am a bit confused about glucogen in the liver. Could you be thinking about glycogen, an energy storage polysaccharide? The only references that I can find for glucogen refer to a product used to treat hypoglycemia.

 

[Oldvatr]

Hi, I am a bit confused about glucogen in the liver. Could you be thinking about glycogen, an energy storage polysaccharide? The only references that I can find for glucogen refer to a product used to treat hypoglycemia.

Corrected. The hypo treatment is called glucagen BTW. I get confused myself because the creation of glucose from lipids is gluconeogenesis because fatty amino acids are glucogenic. The process of Fructolysis is the conversion of fructose into glucose, lipids, and lactose. Also it converts some to glycogen Confused? Moi? Yup.

Not helped by u and y being adjacent keys on my typewriter.

 

[Oldvatr]

Corrected. The hypo treatment is called glucagen BTW. I get confused myself because the creation of glucose from lipids is gluconeogenesis because fatty amino acids are glucogenic. The process of Fructolysis is the conversion of fructose into glucose, lipids, and lactose. Also it converts some to glycogen Confused? Moi? Yup.

Not helped by u and y being adjacent keys on my typewriter.

Further confused by
https://en.wiktionary.org/wiki/glucogen

The Welsh dictionary also has it spelt this way

 

[bulkbiker]

Further confused by
https://en.wiktionary.org/wiki/glucogen

The Welsh dictionary also has it spelt this way

Glucagon? the antithesis of insulin produced by the alpha cells in the pancreas maybe?

https://en.wikipedia.org/wiki/Glucagon

 

[Oldvatr]

Glucagon? the antithesis of insulin produced by the alpha cells in the pancreas maybe?

https://en.wikipedia.org/wiki/Glucagon

My post had Glucagen with an 'a'
As in
https://www.glucagenhypokit.com/

Glucagon is shown as being the substance that is injected and is the hormone you mention.

Are we all clear now?

It seems that textbooks written up to 1913 were using Glucogen as per Webster medical dictionary, but then sometime later it got renamed as Glycogen. My confusion stems from doing my initial research into the Krebs Cycle (before it was also renamed Citric Cycle), and it seems the textbook I was reading being old used the original terminology. It has stayed in my mind since. I have also read other medical papers on cellular functions that also use the old terminology so it seems there will be a time before us dinosaurs retire and take the ultimate hypo in the sky.

Sorry. It is what it is. I will just have to remember that glycol antifreeze tastes sweet which is why it is such a problem for pets. Also glycerine is made from sugar and this is what cholesterol is made of

 

[bulkbiker]

My post had Glucagen with an 'a'
As in
https://www.glucagenhypokit.com/

Glucagon is shown as being the substance that is injected and is the hormone you mention.

Are we all clear now?

It seems that textbooks written up to 1913 were using Glucogen as per Webster medical dictionary, but then sometime later it got renamed as Glycogen. My confusion stems from doing my initial research into the Krebs Cycle (before it was also renamed Citric Cycle), and it seems the textbook I was reading being old used the original terminology. It has stayed in my mind since. I have also read other medical papers on cellular functions that also use the old terminology so it seems there will be a time before us dinosaurs retire and take the ultimate hypo in the sky.

Sorry. It is what it is. I will just have to remember that glycol antifreeze tastes sweet which is why it is such a problem for pets. Also glycerine is made from sugar and this is what cholesterol is made of

But glucagon is the antithesis of insulin rather than epinephrine surely? At east that's how Prof Bikman explains it

 

[Oldvatr]

But glucagon is the antithesis of insulin rather than epinephrine surely? At east that's how Prof Bikman explains it

https://mcb.berkeley.edu/labs/krant...-SPRING2008-LECTURE7-METABOLIC_REGULATION.pdf

Epinephrine stops insulin storing glycogen and increases use of glycogen to provide energy in the cells. Insulin is still needed to keep the door open so blood glucose can enter the cell as well. So in effect it switches from storage mode to use mode. Remember that insulin is both the gatekeeper of the storage action, but is also needed for glucose burning. It turns the three-way valve to the next position in the boiler.