Morning readings always over 8.5

[jem1]

Through low carbing and exercise I have lowered my HBA1C from 68 to 50 over 4 months (which I’m delighted about) and have dropped nearly a stone and a half in weight. I’m on one dose Alogliptin daily. However much I low carb/don’t eat after 6pm/5 Pilates classes a week/swim 500m every morning at 0630 - my fasting glucose is consistently above 8.5 (to around 9.5). I’ve requested a CGM but I don’t qualify and have lowered my HBA1C by finger prick monitoring before and after every meal which has been really successful as I don’t eat again until my sugars are around 6.
I was gestationally diabetic with a BIG genetic predisposition (father, grandmother, great grandmother, 1st cousins on insulin) and they predicted I’d be on insulin after my daughter was born - that was 19 years ago BUT I’m still managing to bat it from my door. Consultant has suggested semaglutide next if my levels haven’t altered when I next squeak to him in June. I have spent 24 years battling blood sugars and am happy to keep battling against medication if I can.
All help and advice gladly received - even if it is to recommend an increase in medication!

 

[Lobsang Tsultim]

Sounds like you’re in control and doing well. Morning levels are stubborn, aren’t they? There may be a free trial available for a Libre - it’s only one but a fortnight of continuous data might shed some light on what’s happening.

 

[catinahat]

Well done @jem1 your improvement in HbA1c is excellent
If I were in your shoes, before considering extra medication I would see if I could cut a few more carbs from my diet.
After all we don't actually need any carbs, and all medications come with their own set of possible side effects, for me more drugs would be a last resort.

 

[HSSS]

At 50 they want a second line medication? I’m surprised as that’s not within the standard guidance. I’m also surprised you have a consultant as most type 2 don’t. Would he consider a cpeptide test to see what state your insulin production is in before adding more meds as it could help decide the best direction to go (insulin resistance or lack of insulin needs different approaches).

Morning fasting can be stubbornly high if properly low carb due to adapative glucose sparing and it’s not pathological. Or you need to go lower than you are. How low carb are you currently? What carbs are you eating still?

 

[KennyA]

Through low carbing and exercise I have lowered my HBA1C from 68 to 50 over 4 months (which I’m delighted about) and have dropped nearly a stone and a half in weight. I’m on one dose Alogliptin daily. However much I low carb/don’t eat after 6pm/5 Pilates classes a week/swim 500m every morning at 0630 - my fasting glucose is consistently above 8.5 (to around 9.5). I’ve requested a CGM but I don’t qualify and have lowered my HBA1C by finger prick monitoring before and after every meal which has been really successful as I don’t eat again until my sugars are around 6.
I was gestationally diabetic with a BIG genetic predisposition (father, grandmother, great grandmother, 1st cousins on insulin) and they predicted I’d be on insulin after my daughter was born - that was 19 years ago BUT I’m still managing to bat it from my door. Consultant has suggested semaglutide next if my levels haven’t altered when I next squeak to him in June. I have spent 24 years battling blood sugars and am happy to keep battling against medication if I can.
All help and advice gladly received - even if it is to recommend an increase in medication!

68 to 50 in four months is a substantial drop, and if you continue there's every possibility that you'll see a further drop next time.

My morning fasting levels were the last to come down and were still elevated (for me) long after my A1c was in normal scores. If it was me - I'd use the time, keep on what you're doing, and see where you are in June. No point in taking meds that you don't actually need.

 

[jem1]

At 50 they want a second line medication? I’m surprised as that’s not within the standard guidance. I’m also surprised you have a consultant as most type 2 don’t. Would he consider a cpeptide test to see what state your insulin production is in before adding more meds as it could help decide the best direction to go (insulin resistance or lack of insulin needs different approaches).

Morning fasting can be stubbornly high if properly low carb due to adapative glucose sparing and it’s not pathological. Or you need to go lower than you are. How low carb are you currently? What carbs are you eating still?

I’ve been keeping my carbs to below 80g per day, the majority of those coming from two slices of wholemeal bread (one at breakfast and one with lunch). I tried keeping them to below 40g but found I was really hungry after school (I teach infant children so I’m on the go and on my feet all day) and was more inclined to snack. At 80g I find it sustainable and has worked well …. apart from my morning readings.

I have a thyroid/endocrine consultant as I have thyroid/parathyroid issues. He discusses my diabetic status as part of my thyroid consultations. I think the further medication was if my HBA1C didn’t drop from 68. I’ll ask about the cpeptide test when I next speak with him.

 

[HSSS]

I’ve been keeping my carbs to below 80g per day, the majority of those coming from two slices of wholemeal bread (one at breakfast and one with lunch). I tried keeping them to below 40g but found I was really hungry after school (I teach infant children so I’m on the go and on my feet all day) and was more inclined to snack. At 80g I find it sustainable and has worked well …. apart from my morning readings.

I have a thyroid/endocrine consultant as I have thyroid/parathyroid issues. He discusses my diabetic status as part of my thyroid consultations. I think the further medication was if my HBA1C didn’t drop from 68. I’ll ask about the cpeptide test when I next speak with him.

At 80g I struggle too. It’s still a fair amount for those of us with a lot of insulin resistance for whatever reason. Many find they need less than that, although others manage ok there. if you are hungry at 40g it means you need more filling meals with more fats and proteins to keep you going to the next meal. The fact that morning is still high suggests you haven’t got the balance quite right yet, unless of course you simply don’t produce normal amounts when discussing insulin it’s important to differentiate it producing enough full stop from not producing enough to overcome resistance even though the amounts are normal/quite high.

The fact that family members are on insulin could relate to shared/ learned eating patterns and choice of management strategy as much as how “bad” the family genetics are

How long ago were you diagnosed? You say battling it for a couple of decades as in waiting for it after GD or actually having issues?

 

[jem1]

I was diagnosed a year after my daughter was born (2004) and they predicted I’d be on insulin within 5 years. She’s now 19 and I’m only just on Alogliptin since November. My glucose figures have risen steadily over the years but diet and exercise have kept me from medication - until now. I’d love to get back off it but I think my morning readings are going to keep me on it ?

How would you recommend I get the right balance between carbs/fat/protein ? Trial and error or is there a good formula to start with ?

 

[jem1]

Sounds like you’re in control and doing well. Morning levels are stubborn, aren’t they? There may be a free trial available for a Libre - it’s only one but a fortnight of continuous data might shed some light on what’s happening.

I’ve tried, without success, to register for this today but it just consists gives me ‘Failure Message’ when I submit the form. I am a new customer, so will try again tomorrow. I also tried to do the love chat and got to being 1st in the queue twice - at which point the ‘agent’ went offline Tomorrow is another day. Thank you for the suggestion

 

[HSSS]

I was diagnosed a year after my daughter was born (2004) and they predicted I’d be on insulin within 5 years. She’s now 19 and I’m only just on Alogliptin since November. My glucose figures have risen steadily over the years but diet and exercise have kept me from medication - until now. I’d love to get back off it but I think my morning readings are going to keep me on it ?

How would you recommend I get the right balance between carbs/fat/protein ? Trial and error or is there a good formula to start with ?

Alogliptin increases your own production of insulin. If you already have high levels caused by trying to overcome insulin resistance, adding even more of it will be actually adding to resistance in the long term, even whilst it short term reduce blood glucose levels. Same as many type 2 medications, and why we gradually get worse with time using drugs to control symptoms rather than increasing insulin sensitivity

Using a meter to test meals would be my suggestion Pre and 2hrs post eating aiming for a rise of less than 2mmol and (under 7.8mmol afterwards ideally) works pretty well for most people that try it. If you’re over the post meal goals then reduce carbs in that meal next time. If you’re hungry afterwards increase fats/proteins next time.

NOTE If you reduce carbs on hypo causing meds like yours make sure you are aware of impending lows with regular testing and know what do do about them. As the goal is to reduce or eliminate the meds there will come a point when you’ll need to reduce or eliminate them, with your dr, when numbers drop to a point where this could happen as they become stronger than you’ll then need. It might happen quicker than you expect.

 

[JoKalsbeek]

Through low carbing and exercise I have lowered my HBA1C from 68 to 50 over 4 months (which I’m delighted about) and have dropped nearly a stone and a half in weight. I’m on one dose Alogliptin daily. However much I low carb/don’t eat after 6pm/5 Pilates classes a week/swim 500m every morning at 0630 - my fasting glucose is consistently above 8.5 (to around 9.5). I’ve requested a CGM but I don’t qualify and have lowered my HBA1C by finger prick monitoring before and after every meal which has been really successful as I don’t eat again until my sugars are around 6.
I was gestationally diabetic with a BIG genetic predisposition (father, grandmother, great grandmother, 1st cousins on insulin) and they predicted I’d be on insulin after my daughter was born - that was 19 years ago BUT I’m still managing to bat it from my door. Consultant has suggested semaglutide next if my levels haven’t altered when I next squeak to him in June. I have spent 24 years battling blood sugars and am happy to keep battling against medication if I can.
All help and advice gladly received - even if it is to recommend an increase in medication!

Another question here; do you do your pilates & swim while fasting? Because that could trigger a liver dump of glucose. Just a thought. A long walk might give better results, being less strenuous and dump-triggering.

I wouldn't be able to deal with 80 grams of carbs a day, personally. Maybe ditch the bread and fill up on something fatty/protein rich instead, like some ham & cheese slices rolled up, maybe with butter? Maybe some extra eggs? If you feel hungry, weak or peckish, you likely just need to up the other macro's some to compensate for the lack of carbs.

Just some stuff to mull over. You're doing an excellent job of it already, really...!

 

[jem1]

Alogliptin increases your own production of insulin. If you already have high levels caused by trying to overcome insulin resistance, adding even more of it will be actually adding to resistance in the long term, even whilst it short term reduce blood glucose levels. Same as many type 2 medications, and why we gradually get worse with time using drugs to control symptoms rather than increasing insulin sensitivity

Using a meter to test meals would be my suggestion Pre and 2hrs post eating aiming for a rise of less than 2mmol and (under 7.8mmol afterwards ideally) works pretty well for most people that try it. If you’re over the post meal goals then reduce carbs in that meal next time. If you’re hungry afterwards increase fats/proteins next time.

NOTE If you reduce carbs on hypo causing meds like yours make sure you are aware of impending lows with regular testing and know what do do about them. As the goal is to reduce or eliminate the meds there will come a point when you’ll need to reduce or eliminate them, with your dr, when numbers drop to a point where this could happen as they become stronger than you’ll then need. It might happen quicker than you expect.

Thank you for your advice and guidance. I already test before and after every meal which is how I’ve managed to drop from 68 to 50, however, I never get below 7.8mmol post meal. Sounds like I need to drop my carbs even further if I have any chance of ditching the Alogliptin and best I start carrying a snack with me!

What do you keep your daily carbs at ?

 

[jem1]

Another question here; do you do your pilates & swim while fasting? Because that could trigger a liver dump of glucose. Just a thought. A long walk might give better results, being less strenuous and dump-triggering.

I wouldn't be able to deal with 80 grams of carbs a day, personally. Maybe ditch the bread and fill up on something fatty/protein rich instead, like some ham & cheese slices rolled up, maybe with butter? Maybe some extra eggs? If you feel hungry, weak or peckish, you likely just need to up the other macro's some to compensate for the lack of carbs.

Just some stuff to mull over. You're doing an excellent job of it already, really...!

Thank you! Having come this far I’m just really frustrated I can’t get my levels that wee bit lower to get off the meds but sounds like I need to ditch even more carbs.

I swim at 0630 which is during fasting and just after my first test of the day which is always above 8mmol. I’d read that exercise should help to reduce the reading but that definitely hasn’t been the case with me as I test after my swim and am usually even higher (still fasting). What you say about the liver dump would make sense here. Pilates is in the evening after dinner but, again, I don’t see a drop when I test afterwards.

 

[catinahat]

sounds like I need to ditch even more carbs.

When deciding how many carb should be in your diet, start from the fact that we don't need any.
We can function perfectly well without them, what small amount of glucose our body needs, it can manufacture for itself
If you are concerned about getting enough fibre, there is plenty in things like green veg, salads, avocado, chia/flax seeds, all of them have a much lower carb count than wholemeal bread.
If I were you I would be asking for a c-peptide test. If you are producing plenty of insulin and it's your insulin resistance causing the problem. Then using drugs to force your already overworked pancreas to produce more is just treating the symptom not the problem.
Squeezing more insulin out of your pancreas can only make your insulin resistance worse and force your pancreas into early retirement.
On the other hand if your pancreas is already failing and not producing enough insulin, then low carb isn't going to cut it and the drugs are needed.
Unless your Dr has second sight or a crystal ball, how can he know what the best treatment is without doing the tests.

 

[HSSS]

Thank you for your advice and guidance. I already test before and after every meal which is how I’ve managed to drop from 68 to 50, however, I never get below 7.8mmol post meal. Sounds like I need to drop my carbs even further if I have any chance of ditching the Alogliptin and best I start carrying a snack with me!

What do you keep your daily carbs at ?

When I’m getting the results I want around 40 ish but it’s highly personal what the right number is so yours might be different.

Do try and get the c peptide if you can though as it will hopefully take the guesswork out of what’s going on and provide reassurance you’re taking the most effective actions.

I wish we could all get it done as it would prevent so much trouble and identify which problem someone has much earlier and more accurately than relying solely on blood glucose. People heading towards type 2 as yet unseen in blood glucose, those highly resistant making things worse with more insulin and those underproducing needing medicinal assistance getting the right drugs at the right time rather than struggling for years.

 

[jem1]

Sounds like you’re in control and doing well. Morning levels are stubborn, aren’t they? There may be a free trial available for a Libre - it’s only one but a fortnight of continuous data might shed some light on what’s happening.

My trial Freestyle Libre is finally on its way Thank you for bringing this to my attention My GP has already said he’d be interested in the data it provides !

 

[jem1]

At 50 they want a second line medication? I’m surprised as that’s not within the standard guidance. I’m also surprised you have a consultant as most type 2 don’t. Would he consider a cpeptide test to see what state your insulin production is in before adding more meds as it could help decide the best direction to go (insulin resistance or lack of insulin needs different approaches).

Morning fasting can be stubbornly high if properly low carb due to adapative glucose sparing and it’s not pathological. Or you need to go lower than you are. How low carb are you currently? What carbs are you eating still?

My GP has given me the go-ahead to get a C-Peptide test In fact, he thought it was a great idea !!!!!!!! He doesn’t know if it’s accessible through Primary Care under NHS Scotland but says we can but try. If unsuccessful he will contact my endo to access it that way. Thank you for making me aware of this

 

[HSSS]

My GP has given me the go-ahead to get a C-Peptide test In fact, he thought it was a great idea !!!!!!!! He doesn’t know if it’s accessible through Primary Care under NHS Scotland but says we can but try. If unsuccessful he will contact my endo to access it that way. Thank you for making me aware of this

That’s a great GP.