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.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!
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?
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.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.
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.
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 sensitivityI 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 ?
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.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!
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.
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...!
When deciding how many carb should be in your diet, start from the fact that we don't need any.sounds like I need to ditch even more carbs.
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.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 ?
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.
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?
That’s a great GP.My GP has given me the go-ahead to get a C-Peptide testIn 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
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