New HbAc1 figures up on low carb for last year?

[Caz141]

I’m not sure which way to go with my latest HbAc1 result . A re cap,
I’ve been a diabetic for two years now. I started out at 10 mmol/mol and less than a year later I got it down to 5.5 mmol. My new figure for this year being 6.2 mmol. My bmi is 19.7(if this holds any relevance?). My LDL is at 4.4mmol/l. All my other readings are spot on on the cholesterol panel.
I’ve read up on lean hyper responder, lada, modi, type 1 in the making? I know that some of you are lean mass hyper responders on here and know more than I do on this subject. I’ve Listened through a few talks on you tube on this subject but i find the information hard to understand without the fancy in depth jargon. Sometimes the deeper you go into the rabbit hole, the more confusing it gets.

The first year was a readjustment to my diet and reading/researching on here and all over the internet on the foods I could have and trying to understand what diabetes is.!!. I Cut out all starchy veg, flour, beans, bread, pasta, rice, looked into the GI a little and took on board some of the findings . Put in 30 minutes of brisk walking 5 days a week. Armed myself with a glucose meter. I started a LCHF diet keeping my carbs for the day between 20-35g of carbs. I guess this has kind of held my sugars back for a year. My calories are 1,500 per day. I don’t over eat just overthink. I don’t eat anything from 7pm- 1pm the next day. My morning figures are the only ones that generally are at 7-8mmol on the finger prick test @ foot to the floor time.

I then tried for the last 6 months to have a handful of pecan or walnuts in the morning thinking that fasting might not be my game changer but no different on the glucose meter testing. I’m taking it that I suffer with the dawn phenomenon as i have read that 50% of diabetics do. All my meals through the day keep me below the 2 point rise mark. Most of them only rising 1 point after 2 hrs. It doesn’t fall much through the day though but 90% 0f the time i end the day in the 6’s-7s. I don’t touch much desserts like once a month.

Other than turning my lunch (5g) and dinner(12g carb) around so I’m eating my higher carb meal at lunch or eventually face the metformin?

I’m at a loss, I’m just wondering if there’s anything more I could be doing or I’m missing something more?

It feels at the moment that I’ve worked really hard at changing my lifestyle and it’s just not been enough..I know that the doctors won’t find this figure an issue as it’s still only top end of pre, it’s even often something that has been mentioned on here that by the time the doctors are ready to give you the drugs your in the high figures! so since the beginning of this journey I took it on myself to try and be my own advocate but I’m left at a loss now and my beliefs in low carb deflated some what?

I really don’t want to go on the metformin or the next drug but have i got to that stage of accept???.
I also don’t want to go another year of unknowing if my diet is doing anything right. By this time next year my figures still rising before the doc’s decide to do something about it! Then it being a harder climb to get back in range or a barrage of drugs to combat it.

Do I need to get those morning figures down to know I’m heading in the right direction? This is the only area in the day where i see it high. A year on my morning figures are higher than they were.

I feel there is a part of me that says my body is just failing to handle the insulin no matter what i do but there’s another part that is still willing to go into the ring with this disease.
I just thought I’d put it out there for some other views on this.
Thank you for taking the time to read through this post.
What could i be missing?

 

[Chris24Main]

Hi there @Caz141 - thanks for taking the time to lay out the context in such detail - you're clearly putting a great effort into your health - and I feel the frustration. Hang in there...

A couple of things that may put your mind at rest a little -

Nobody suffers with the dawn phenomenon, it's just the liver doing what the liver does, getting you ready for the day. The only issue is that it "believes" you need more glucose to do that because as your blood glucose was climbing higher - your level of "normal" was also getting higher. It can be brought down again, but don't stress if it takes some time..

Then, insulin is just the lever that your body uses to clear out the glucose. Similarly, your level (as all of us "classic T2") of insulin has crept higher as your body needs more and more to have the same effect (this is what insulin resistance is - or one way to describe it).

All of it can be reversed by keeping your glucose and insulin levels low... but it isn't just about the food you eat, levels of stress and really anything that would affect your immune system can also haven an effect, so don't give up !!
You talk about the amount of carbs in your meals, so I assume you are weighing them - can you describe what you are typically eating? there may be some general advice that we might be able to help with.

 

[Caz141]

Hi @Chris24Main, thanks for the speedy response, I’ve been hooked on your post of a funny thing happened on the way to surgery, it has took me about 2/3 months to catch up on it though. Some information has retained in there from it. I’ve listened to some of the pod casts from it also. It has been interesting. Thank you for that.

I guess as far as insulin levels going up with the new norm i get, i hadn’t thought of it that way or the honeymoon period as I’ve heard mentioned somewhere through this forum. Mine lasted a year. No I’m not willing to give up though, it’s not a choice, i know where that one leads too. But yes a frustrating journey when it don’t give you the lottery figures i wanted at the end of it..

My typical day would be a salad that I’ve started to have as my evening meal with the theory being I’m not running any marathon at night when my insulin def does go into a crawl mode...along with me..

This will be 2 eggs, 70g lettuce, 10g Hellman's mayo, 10g nando lemon herb dressing, 20g mature cheddar cheese then either 50g tinned Mackeral, tuna, ham, or corned beef swapped around on various days. (5g carb). sometimes an omelette on other night.
The vegetables that are my go to are Broc, cauliflower, courgette, mushrooms, cabbage a small amount of french beans (not all in one sitting though), this will average 100-150g of vegetables per meal).

I eat very little fruit in a day and if i do it’s a couple of grapes or blueberries.

I take an iron supplement and d4 supplement that doesn’t have too many nasties in the ingredients. No other meds.
That I’m aware to at present, fairly healthy other than aches of an aging body…or a few clicking joints when my head tells me i can build this walk into a jog before my body starts to laugh at me.

Meat will be 100-150g per meal of chicken, mince or pork chops. Some weeks sausage but not that often. I do various fish fillets in between, no added sauces to these that are not made by myself so i know what goes into it.
My snack through the week go to will be ray gray pork crunch, a handful of pecans or walnuts or cheese with 100% peanut butter (no more than a tablespoon spoon in a day and not every day or baby bell.
My coffee has no sweetened almond milk.
Some weeks i use almond flour if i fancy making my own bread.
My biggest splurge will be a small latte 3 times a week at most but my body seems to handle this. It raises by 1.5 but is back down to nearly the original by the 2 hr mark.
Any food that raises over the 2 mark i don’t have again or will half the amount.

Full fats on all food and double cream but not in excess i don’t think. Another area again not too sure as my LDL as doubled since being on a LCHF way of eating. (I won’t say diet because it’s not what it is or rabbit food as my friend puts it.) it’s hard not having that thought in the back of your head when thats where the social norm has lead you to believe, That low fat is what is needed. I figure even the LDL might have gone up because i became a diabetic even??? After all it seems another thing that goes hand in hand with this disease. This is still another area i seem to find myself reading through the vast information out there wether i can help my body from producing cholesterols or if there even harmful cholesterols in there?

I look at the patterns of my readings over the year and don’t always see why it has gone up so much.
I never really did alot of the morning finger prick readings . I did when i was first diagnosed then started looking at the morning reading in the last month or so because i wasn’t sure if you could do anything about this one. There are times that i think it’s coming down in the right way then it goes back up again. I don’t have problems with sleep or stress really. Even though i might debate that after reading over these ramblings I’ve wrote.

I’ll stop here other wise I’ll ramble on into the night…this is the only space that i feel i can ramble without annoying everyone around me or watching the glazed look come across their face…

 

[Antje77]

My calories are 1,500 per day. I don’t over eat just overthink.

With your calories at around 1500, you're at the lower end of what people generally need, depending on size and activity level.
With your BMI at the low end of normal as well, and doing intermittent fasting with a restricted eating window, are you sure you're eating enough?

You don't fit the 'typical' T2 profile, although there are many thin T2's as well. But not fitting the profile, and your numbers slowly rising despite a very low carb diet may be a reason to get some more tests done and see how much insulin you produce.

 

[Chris24Main]

Ok - another set of amazing info, and of course, love to hear that at least someone is reading my ramblings... and also just to stress, they really are just ramblings - just because I can join up some dots and write my thoughts down doesn't mean that anyone should, you know, listen to anything I have to say..
ahem..

but (ok - one less thing to say - @Antje77 has just said it for me, low-carb high fat does not mean low calorie - if you limit your energy, your body will limit it's use of energy, if you replace carbs with fat, the body will be able to mobilise the reserves and burn them... there is a natural want to "diet" - even if we don't think we are.. for me, I totally stopped counting grams of anything and just eat till I'm full - it's THE ONE BIG benefit of being so strict on the makeup of the food - you really do not need to be hungry, in fact it often does not help). YMMV - and some people seem to work better with hunger than others - I don't much like it.

Then - while the topic is far from being one everyone agrees with (the dreaded Colesterol topic) - there are a few pointers that should be non-controversial. One - there is no such thing as a harmful cholesterol - not in the least - they are very important molecules, and your body needs far more than you can reasonably eat. Every cholesterol molecule can be put to good use. When people talk about good and bad - that only refers to the carrier particles, and there is very muddy water about what any of it really means. Even if you buy the "LDL is bad" hypothesis - a far bigger risk factor is the level of serum triglycerides - literally the level of fat around your liver as visceral fat. Then - there are a couple of reasons why under low carb, your LDL levels may go up. Try not to stress... even if you accept all the stated results - you are statistically likely to have a small increase in risk of heart disease, but mainly if you are a middle aged man, and mainly if you have had a heart attack. Other things are far more "risky" - for example:

The key causal risks of heart disease are high blood glucose, high blood pressure, smoking and high stress hormones.

The key indicators of metabolic syndrome are high blood glucose, high blood pressure, high triglycerides and low HDL.

So - it sounds like you are doing well on those grounds.

More practically - I would say I was eating much as you are for about 6 months, then I really got into looking at ingredients - there are a lot more starch extracts and sugars in things like mayo than you would think - and protien extract - we just cannot deal with protein extracted from Soy or Palm as if it was part of an animal... it's a bit of a minefield once you really start looking.

And - I would thoroughly recommend trialling a CGM - spot checks of your blood glucose don't give you nearly the same amount of information about what your body really is doing with food - and reacting to stress, and feeling hungry, and all of the non-food things that can happen.

If you follow my thread you will know that what works for me is keeping insulin down, and measuring ketones as a way of knowing that insulin is really down. But - you have to find what work for you.. I think you will look back and realise how close you are now...

 

[Caz141]

@ Antje77, thank you for the reply.
When i was first diagnosed i had a test done called insulin antibodies that came back with the results of 5.2.
Is this anything to do with what my body is making on the insulin scale? Or do i need the test for the C PEPTIDE? Or the glucose test which few people seem to get unless going private.
From what i gather this is supposed to be
I remember having to fight with the receptionist and doctor just to get an HbA1c test because i heard those same words, i just was not the right figures to fit the category of diabetes. I think they were shocked when it came back at 10.4% (90mmol). Again Type 1 was mentioned but i went into over drive and drove the figures down with LCHF and walking until now that they are slowly creeping.

I was thinking if I’m making no or little insulin then this would go into TYPE 1 or the other ones out there of LADA/ MODY but then i would then be having either extreme hypos or hypers? My figures rarely go low and keeping the carbs low they may go into higher figures once a week. These are the times I’m experimenting with something new or to see though wishful thinking if i can add some foods back in (i so haven’t become any more insulin sensitive over the year).
It’s just the morning figures that are still in the 6,7 or 8’s. There is no pattern or consistency to this figure. After a year of this way of eating i thought they would be better.

As to the fat i was eating more fat than i do now but my weight was slowly gaining so i then cut back on it over the last month or so and my weight is either stable or moves down by 2 pound. That is what made me think that there was too much fat in my menu with the gradual weight gain?

Then there is the whole thought process that because I’ve got my body to the low carb regime that when i do slightly higher those carbs then my system don’t know what to do with them and goes into the 8’s on the finger prick testing? But it seems it’s not till the next day that this shows up?
And yes i do think my eating is healthy but also un healthy in the same breath but if I’m eating to my metre then that is somewhere around here. Could be really wrong though.

 

[Chris24Main]

One of the things I really struggled with was that it seems like there is some kind of soft boundary between Type 1 and Type 2.
There is not - they are only similar in that they are associated with high blood glucose at diagnosis. Otherwise, they are completely opposite in the mechanism and treatment.

Confusingly, (and the source of some of the confusion)
a Type 1 can develop insulin resistance over time and additionally become type 2.
a person diagnosed Type 2 can in fact be suffering from a failing Pancreas through various forms of injury.

However - these are both relatively rare (a double edged sword) and in either case, there is no ...movement between type 1 and 2 - one is about zero insulin, 2 is about too much insulin.

Then - insulin drives weight gain - it's primary function is all about energy management - so too much of it and you are always storing.. and insulin is driven by starches and sugar - not by eating fat. In fact, eating fat allows the body to be more flexible about whether it is storing or burning fat - this is really the most important thing to me. In some ways I am lucky - due to being misdiagnosed, I was injecting insulin when I probably should not have been - the direct result is that I gained three stone in 7 months. Every doctor and nurse said "with insulin, you expect to put on weight" - and so it is; for me, I do not need to believe or not believe - I've lived it - insulin was high - I put on 3st. Insulin was low - I lost 3st. Simple.

 

[Antje77]

When i was first diagnosed i had a test done called insulin antibodies that came back with the results of 5.2.
Is this anything to do with what my body is making on the insulin scale? Or do i need the test for the C PEPTIDE?

Are you sure it was insulin antibodies that were tested and not the anti GAD ones, or some of the other antibodies associated with T1?
C-peptide is the one you need to see how much insulin you produce. Should that one be on the low side, it may be worth looking into antibody testing.
You are definitely producing insulin or your bg would be very high all the time and you'd be very ill.

T2's often overproduce insulin, so a high C-peptide suggests T2, although it's possible to overproduce in early T1 as well.
T1's (including LADA, LADA is simply T1 that develops slower than classic T1 and is therefore often initially misdiagnosed as T2) produce too little insulin because the immune system slowly kills the insulin producing cells.
This process can take years, and for some it's possible to not need insulin for a long time with dietary changes.

A glucose tolerance test doesn't differentiate between types, it simply show you have diabetes or not.

I was thinking if I’m making no or little insulin then this would go into TYPE 1 or the other ones out there of LADA/ MODY but then i would then be having either extreme hypos or hypers? My figures rarely go low

T1's go low because of medication, not because of diabetes. You wouldn't expect lows with any type of diabetes unless you're on a medication that actively lowers bg, such as insulin or gliclazide.
As long as you still produce an almost sufficient amount of insulin, and don't eat high carb foods, you wouldn't expect extreme hypers either.

In early T1/LADA, it can be hard to diagnose, unless you test positive for antibodies. Testing negative doesn't rule out T1 however. Sometimes it just needs more time to see what happens.

MODY is a completely different type of diabetes, caused by a change in a single gene. There are various types of MODY but the testing for all of them is the same: a genetic test which will clearly rule in/out MODY.
People with MODY usually have a strong family history of diabetics diagnosed with T1 or T2, depending on luck of the draw. Once one of them is diagnosed with MODY it may turn out that those other diabetics in the family have MODY as well and were misdiagnosed.

Then there is the whole thought process that because I’ve got my body to the low carb regime that when i do slightly higher those carbs then my system don’t know what to do with them and goes into the 8’s on the finger prick testing? But it seems it’s not till the next day that this shows up?

Are you testing before eating and two hours after first bite? That's the pattern which should show you how your body handles a particular meal.

Every doctor and nurse said "with insulin, you expect to put on weight" - and so it is; for me, I do not need to believe or not believe - I've lived it - insulin was high - I put on 3st. Insulin was low - I lost 3st. Simple.

While many experience weight gain when first starting insulin, it's often the weight that was lost before diagnosis.
Weight gain is not a given. I haven't gained weight in the 8 years I've been on insulin, and over the past two years I've even lost some. And that's on relatively high doses of insulin.

 

[Melgar]

Your situation is similar to mine @Caz141 . My BMI is around 19, lean and fit and up until I was diagnosed as prediabetic in 2019, I was on a Mediterranean diet. I then became mildely diabetic and was able to drive them down to pre-diabetic. I Rarely if ever ate junk food. I can’t tolerate fats or gluten. None of it made sense given all the information I was reading on the internet, including medical research papers. The way my blood sugars behave seems to run contrary to Classic T2. My blood sugars fluctuate and I can suffer significant lows as well as raised blood sugars, usually around 10-12 mmol/ls but I had a recent spell at 17 mmol/ls. I had my C-peptides tested a couple of years ago and they were low/normal.

This year I have been dealing with gall bladder and pancreas issues. No gall stones were found.

A T2 diagnosis is very broad and anything that is not obviously autoimmune is classified as T2. The trouble is early LADA can present as T2, so to can a damaged pancreas. What this means is that the advice given to treat T2 doesn’t seem to work or if it does work, it doesn’t last or is not that effective. I was unable to lower my blood sugars with a low carb diet, I was on around 35 carbs a day. All that happened was I lost weight I could not afford to lose.
My suggestion to you is to push for a C-peptide test. This will give you and your medical team an idea just how much insulin your pancreas is producing. Insulin autoantibodies, or IAA targets insulin. It is one of four types of autoimmune antibody that can be produced. There are three other types, Glutamic Acid Decarboxylase Autoantibodies or GADA or anti-GAD, these antibodies are produced against a specific enzyme in the insulin-producing pancreatic beta cells, Zinc Transporter 8 (ZnT8Ab) autoantibodies are also produced against a specific enzyme in the beta cells. The other autoantibody is the Islet Cell Cytoplasmic Autoantibodies (ICA)
Islet cells are clusters of cells in the pancreas that produce hormones, including insulin. This test identifies a type of islet cell antibodies present in up to 80 percent of people with T1DM.

To make matters more complex, some people produce autoantibodies and do not go on to develop Type 1 diabetes. My Suggestion, as I said early is to get that C-Peptide test done.

Edited to add a link https://pmc.ncbi.nlm.nih.gov/articles/PMC10298549/

 

[Caz141]

@Chris24Main yes I’m aware that we all have ramblings on here but it’s good reading though a collective of those said rambling and finding glimmers that give an element to another thought and maybe another rabbit hole to dig into. Other times to just realise how green the information in me was expecting something to be true that has you’ve said totally blows that theory out of the window just by saying it out loud. .

I’ve thought about getting the keto pee sticks that just tell me yes or no but I’m fairly sure from reading up on the little knowledge i do have that I’m not in any keto levels. I’ve not done an awful lot of research on this side either. This seems like a whole different ball game that is expensive on the equipment to read the keytones properly. I find it hard enough just reading the sugars and trying to work out how i can change the diet to make a difference or if i even can. i don’t think i could mentally go down this route. You come across as a lot more scientific than i am. Or it takes me a lot longer to digest. Ketones just confuse the hell out of me. Maybe in another year.
I have thought about trialing the CGM though.

@Antje77-you asked -Are you sure it was insulin antibodies that were tested and not the anti GAD ones, or some of the other antibodies associated with T1?


This is taken from my online doctors account from 2 yrs ago when i was first diagnosed with diabetes.
No other explanation with it? I’m thinking this was to do with the diabetes though because it was first thought i was TYPE 1 and this marker was were they seemed to change their mind and out it to TYPE 2? That and the lack of symptoms for TYPe 1.



In answer to the testing, yes i test before and 2 hrs after.

All my meals i have got within the 1-2 mark. Lunch time is generally back to one point above where i started from. Sometimes below where i started but not often.
I seem to be able to come down in the figures until my evening meal. By the end of the day my figures are between 6.5-8.5.
The next day morning figures will be 1 point above this end figure sometimes 2 (no midnight snacks had or any snacks after 7pm.
I’ve never totally looked what happens at night but this is usually the only time I’m out of that range of 7.5. Hence me thinking this is why my HbA1c has risen this year? This is my high time when I’m doing nothing other than sleeping. So thinking it’s coming down to something I’m doing in the day.

Over the week of changing my higher carb meal to lunch time and a salad at night i have seen a slight movement in the figures but i know from this game it is early days yet.

I don’t quite get what the c peptide will give me or how to fight with the doctors to give me this test at the moment. More reading on this one. Like i say i had to fight just to get a HbA1c and from reading this is a relatively cheap test to preform.

My simple understanding, if I’m high then this low carb is doing nothing, if I’m low or normal continue until i am diabetic again?

Thank you for the replies it is giving me helpful thoughts to think about, some information as you can see I’m still trying to process.

Some of my info on cholesterols and fat and not the low cal diet, i need to change my thoughts on i think.
Working progress again.

 

[Melgar]

“I don’t quite get what the c peptide will give me or how to fight with the doctors to give me this test at the moment. More reading on this one. Like i say i had to fight just to get a HbA1c and from reading this is a relatively cheap test to preform.”

@Caz141 C-Peptides are produced by the Pancreas along side Insulin. There is a direct correlation between C-Peptides and Insulin produced. C-Peptides are stable , but Insulin is not as it deteriorates very quickly once outside the body, so measuring it becomes a problem that is why C-Peptides are used instead to determine Insulin secretion.
C-Peptides are used to determine how much insulin the pancreas is producing. If C-Peptides are low, therefore Insulin is low, then your Dr may want to test for autoimmune antibodies. Low C-Peptides along with raised to high blood sugars may indicate autoimmune T1. Your Dr usually asks for further tests to ascertain if autoantibodies are being produced.
Low insulin production may suggest an injured or compromised pancreas, possibly T1
High C-Peptides suggest raised to high insulin resistance which leans towards T2 diabetes.

In short Testing C-Peptides are used, in general, are a first round test to ascertain how much insulin your pancreas producing. I hope that makes sense.

 

[sgm14]

Like i say i had to fight just to get a HbA1c and from reading this is a relatively cheap test to preform.

I don't think you should let this put you off fighting for either the tests to be repeated or different tests, especially if you are worried about the direction your HbA1c is going. You mention that they were surprised at the HbA1c result which can only mean they were pretty sure that you were not diabetic.

I know that the doctors won’t find this figure an issue as it’s still only top end of pre,

I presume this is referring to 6.2% HbA1c. result. If so remember that diabetics are supposed to keep our levels below the diabetic range, so if your figures continue rising it won't be long before the doctors do find your HbA1C an issue and I think you have a right to try to sort this before that happens.

A HbA1c of 6.2% would suggest your average daily blood sugar is over 7 mmol/l, but your post make it sound that you thought it was only over 7 for a short period in the morning. Could this be wrong? It might be worthwhile getting a CGM (even if just for a trial) to see if it spots some-thing you are missing. (For example the dawn phenomenon can sometimes kick in at 4 am so your levels may be higher for a lot longer. You also mention you don't eat anything after 7pm - but for some people their blood glucose will rise unless they eat some carbs at nighttime.)

I don't know how to interpret the results you posted but I know that some of the tests to try to determine the type of diabetics can be inclusive especially during the early stages and it seems that in those cases type 2 is assumed usually until something happens to make them re-evaluate and the thing that usually makes them evaluate is when your HbA1c starts rising. Also when that happens the tests are much more likely to be conclusive. Hence if I was you I would push for another antibodies test.

 

[Caz141]

“I don’t quite get what the c peptide will give me or how to fight with the doctors to give me this test at the moment. More reading on this one. Like i say i had to fight just to get a HbA1c and from reading this is a relatively cheap test to preform.”

@Caz141 C-Peptides are produced by the Pancreas along side Insulin. There is a direct correlation between C-Peptides and Insulin produced. C-Peptides are stable , but Insulin is not as it deteriorates very quickly once outside the body, so measuring it becomes a problem that is why C-Peptides are used instead to determine Insulin secretion.
C-Peptides are used to determine how much insulin the pancreas is producing. If C-Peptides are low, therefore Insulin is low, then your Dr may want to test for autoimmune antibodies. Low C-Peptides along with raised to high blood sugars may indicate autoimmune T1. Your Dr usually asks for further tests to ascertain if autoantibodies are being produced.
Low insulin production may suggest an injured or compromised pancreas, possibly T1
High C-Peptides suggest raised to high insulin resistance which leans towards T2 diabetes.

In short Testing C-Peptides are used, in general, are a first round test to ascertain how much insulin your pancreas producing. I hope that makes sense.

Thank you for that @Melgar, makes perfect sense and something better to go to the doctors with the right wording along with how the low carb diet is not quite cutting it. I don’t want to be back up at those high figures again this time next year. Considering i am doing the finger prick testing i feel like there is something amiss going on. Considering my diet has drastically improved from a year ago as far as the carb cutting and sweet things go in my life for the last year.

Good news that no gull stones were found but must be also frustrating that something is not quite right here either despite the best efforts at being fit and eating healthy.

 

[Ria]

I’m not sure which way to go with my latest HbAc1 result . A re cap,
I’ve been a diabetic for two years now. I started out at 10 mmol/mol and less than a year later I got it down to 5.5 mmol. My new figure for this year being 6.2 mmol. My bmi is 19.7(if this holds any relevance?). My LDL is at 4.4mmol/l. All my other readings are spot on on the cholesterol panel.
I’ve read up on lean hyper responder, lada, modi, type 1 in the making? I know that some of you are lean mass hyper responders on here and know more than I do on this subject. I’ve Listened through a few talks on you tube on this subject but i find the information hard to understand without the fancy in depth jargon. Sometimes the deeper you go into the rabbit hole, the more confusing it gets.

The first year was a readjustment to my diet and reading/researching on here and all over the internet on the foods I could have and trying to understand what diabetes is.!!. I Cut out all starchy veg, flour, beans, bread, pasta, rice, looked into the GI a little and took on board some of the findings . Put in 30 minutes of brisk walking 5 days a week. Armed myself with a glucose meter. I started a LCHF diet keeping my carbs for the day between 20-35g of carbs. I guess this has kind of held my sugars back for a year. My calories are 1,500 per day. I don’t over eat just overthink. I don’t eat anything from 7pm- 1pm the next day. My morning figures are the only ones that generally are at 7-8mmol on the finger prick test @ foot to the floor time.

I then tried for the last 6 months to have a handful of pecan or walnuts in the morning thinking that fasting might not be my game changer but no different on the glucose meter testing. I’m taking it that I suffer with the dawn phenomenon as i have read that 50% of diabetics do. All my meals through the day keep me below the 2 point rise mark. Most of them only rising 1 point after 2 hrs. It doesn’t fall much through the day though but 90% 0f the time i end the day in the 6’s-7s. I don’t touch much desserts like once a month.

Other than turning my lunch (5g) and dinner(12g carb) around so I’m eating my higher carb meal at lunch or eventually face the metformin?

I’m at a loss, I’m just wondering if there’s anything more I could be doing or I’m missing something more?

It feels at the moment that I’ve worked really hard at changing my lifestyle and it’s just not been enough..I know that the doctors won’t find this figure an issue as it’s still only top end of pre, it’s even often something that has been mentioned on here that by the time the doctors are ready to give you the drugs your in the high figures! so since the beginning of this journey I took it on myself to try and be my own advocate but I’m left at a loss now and my beliefs in low carb deflated some what?

I really don’t want to go on the metformin or the next drug but have i got to that stage of accept???.
I also don’t want to go another year of unknowing if my diet is doing anything right. By this time next year my figures still rising before the doc’s decide to do something about it! Then it being a harder climb to get back in range or a barrage of drugs to combat it.

Do I need to get those morning figures down to know I’m heading in the right direction? This is the only area in the day where i see it high. A year on my morning figures are higher than they were.

I feel there is a part of me that says my body is just failing to handle the insulin no matter what i do but there’s another part that is still willing to go into the ring with this disease.
I just thought I’d put it out there for some other views on this.
Thank you for taking the time to read through this post.
What could i be missing?

Looks like you are doing all the right things. To really get an insight into how food affects you try a cgm. Abbots offer you a free one at the moment. Go to their website freestyle.abbott and select the free trial.

 

[Caz141]

I don't think you should let this put you off fighting for either the tests to be repeated or different tests, especially if you are worried about the direction your HbA1c is going. You mention that they were surprised at the HbA1c result which can only mean they were pretty sure that you were not diabetic.

Up until 2020 i was in the range of 5.3/ 5.5% so i guess as them looking at all my other healthy history i was fitting the right boxes of healthy
(wrong 2022 -10.3% not as healthy as 2 years ago)

I presume this is referring to 6.2% HbA1c. result. If so remember that diabetics are supposed to keep our levels below the diabetic range, so if your figures continue rising it won't be long before the doctors do find your HbA1C an issue and I think you have a right to try to sort this before that happens.

A HbA1c of 6.2% would suggest your average daily blood sugar is over 7 mmol/l, but your post make it sound that you thought it was only over 7 for a short period in the morning. Could this be wrong?

I’ve previously tested all my meals in a 2 hr window, from start and finish, anything that got more of a rise i ditched.
My morning figures i tested at the beginning of being diagnosed diabetic and have not been great but enough at that time to give me a 5.5% HbA1c result.

In the year the only 2 things that have changed is my walking time which used to be first thing to now i go in the afternoon /evening and my breakfast which i took out because this was still giving me a high at the time on my readings. Despite taking it from porridge to low carb eggs and almond flour bread or homemade keto porridge.
I’m now thinking it could be my walking that made the difference???
Has the point you raised there is lots going on that I’m really not aware of and a glucose metre or knowing what my insulin levels are or are not producing does not propel me forward with this?

I’ve booked an appointment for the end of the month with the docs
I’ve put my walking back in the mornings. Which on testing over 1 week seems to have bought it down from the mid 7’s to the mid 6’s on the glucose metre.
I’ve swapped my evening meal to my lunch time meal , thought process being my body doesn’t have to work so hard when going into slow evening mode.

It might be worthwhile getting a CGM (even if just for a trial) to see if it spots some-thing you are missing. (For example the dawn phenomenon can sometimes kick in at 4 am so your levels may be higher for a lot longer. You also mention you don't eat anything after 7pm - but for some people their blood glucose will rise unless they eat some carbs at nighttime.)

I get up at 5am and my sugars are already in the 6-7 mark.

I don't know how to interpret the results you posted but I know that some of the tests to try to determine the type of diabetics can be inclusive especially during the early stages and it seems that in those cases type 2 is assumed usually until something happens to make them re-evaluate and the thing that usually makes them evaluate is when your HbA1c starts rising. Also when that happens the tests are much more likely to be conclusive. Hence if I was you I would push for another antibodies test.

Thank you for the insights. I’ve thought about the CGM but always shied away because of reading the graphs or if i will have long enough in 2 weeks to gain any insights from?
but i do think that between
a c peptide test,
Or another test in Hba1c test in 3 months time on the changed routine
Or the CGM might be the answer forwards.

I can see that carrying on on this trajectory would be blindly stupid…

 

[sgm14]

or if i will have long enough in 2 weeks to gain any insights from?

You wouldn't know until you try and if you qualify for a free trial then the only thing you have to lose is that you may get hooked!

Two weeks does not give you much time to make changes and observe the affects, but if your routines and meals are fairly consistent, then I would have thought that two weeks should long enough to tell whether your finger prick tests are telling you the whole story.

 

[Chris24Main]

Absolutely @Caz141 - a CGM is a life saver for a type 1, who needs to wear one continuously, but for a type 2 it can give you real insight as to what is going on. Fingerprick testing is much better at measuring long term trends, but will not tell you anything about short term reaction to foods - it's like looking at a frame of a film and trying to tell what it was about.

@Melgar is spot on with the C-Peptide; it's a byproduct of naturally produced insulin - if you are making insulin, you are making C-peptide. It's primarily of use in the case where a person is also injecting insulin, because you can then tell whether the pancreas is active even on top of the injections... that isn't your situation, and that may be the source of any objection, but if you are unsure; it's perfectly reasonable to ask for this test.

Be aware though, that the standard is often to only look for the anti-bodies (that would be present if your immune system was attacking your pancreas in the case of type 1, or late onset, or gradual onset type 1) - the system will look at your current test results, and the way you describe your glucose levels, and will likely be satisfied that you are type 2. If you are concerned about that, argue that your glucose levels are going up despite low carb, and want to be sure that your pancreas is ok - and that a C-Peptide test is the only way to be sure.

That said, reading through your posts again, it seems to me that your blood glucose is rising as you are taking on less fat. That would be consistent, because you would then be eating mainly protein, some of which your liver will convert into glucose. (understand - that isn't a diagnosis, only reflecting what you have said)

There is such a fear of fat, that it's hard to think in any way other than "whatever I'm doing now, it will be better if I eat less fat" - but low-carb high-fat only works with both sides of that - your body needs energy as well as nutrition, and if you are not eating enough fat, it will create sugar from protein, and lock away any fat you are storing. The purpose of eating fat (as part of reversing insulin resistance) is to help mobilise your body's ability to unlock that fat and use it as fuel.

Any form of fat works for this (I mean, I also would not eat or cook with vegetable oil, but olive oil, avocado, coconut, nut oils, or just nuts, butter, cheese, eggs, or anything with animal fat is all great) - and while I agree with what @Antje77 said above about insulin on it's face - it's more important (as a type 2 reversing insulin resistance) to realise that when insulin is low - your body will allow fat burning, and get more and more used to this over time. It's also very nearly impossible to put on weight when insulin is very low (though there are more things than food that affect this - it's a long game).

A type 1 in good control is only ever injecting just enough insulin to deal with the food they eat. A type 2 is likely producing too much insulin in order to do the same job, and that excess insulin is taking a wrecking ball to their metabolism. The thought process is so different, that it's frankly ridiculous talking about them as types of the same disease - if type 1 was called "immune degraded pancreas" and type 2 "hyper insulinemia with chronic insulin resistance" - it would be much harder to see the treatment being similar.

Put another way - if a type 1 gets low on insulin, for an extended period - they could die. If a type 1 gets low in blood glucose for an extended period, they could die, but in a different way. If a type 2 gets low on insulin and glucose for an extended period, they may improve, to the point of reversing the condition. It couldn't be more different. That of course brings us full circle to being sure about whether you are type 1 or type 2.

 

[Caz141]

@chris77main. You Could be on to something there.
on my fat content Looking back over my last 3 months, prior to my HbA1c of 6.2%

this is my averages per day avg per month
For the month

Fat Protein Mmol/l (FP)
Aug 102g 105g 6.9
Sept 90g 102g 6.8
Oct 95g 98g 7.1
Nov 91g 103g 6.2

I’ve currently set my fat target at 90g, before it was in the range of 115g avg per day.

How much is the recommended that makes this low carb work?

Or are we saying that there is no weight/limit to fat eaten? Just eat until full on healthy fat
(whatever full feels like , i think i turned that switch off a long time ago).
I seem to be in the minority that has OCD weighing everything. I can say that with a smile and a snigger (it is a nuts way of living)
Fat fear sounds about right too!

My fat content when my HbA1c was @10.4 in 2022 was at 58g per day avg.
Which Collaborates with that low fat diet and diabetes epidemic.
Carbs were off the roof at 200g (ish) per day in 2022 also.

It’s kinda not a surprise that my body was struggling!

These were the figure i was working to in 2023 [email protected]

this is my averages per day avg per month
For the month
Fat protein mmol (FP)
July 113 89 6.6
Aug 109 66 6.1
Sept 104 86 5.9
Oct 80 92 5.8

Protein lower but fat higher
Avg mmol definetly better…

Maybe the diet i need to get back to

 

[Chris24Main]

Try this one for size - imagine insulin as an old style train signalman, in a signal box at the outskirts of town (they still exist, our town has one) - and this signalman controls a single track switch - to the countryside or the siding.

If there are no trains, nothing happens, but otherwise, the trains leave town, and either get stuck in the siding or go on to the countryside.

What an abysmal analogy - but this is how insulin works (and this isn't opinion, you'll find this in any good medical textbook)- if insulin is high, and there is sufficient energy, it will cause the fat cells to expand to store the available energy.

So - keeping the carbs very low is the key - if you don't raise insulin, you are not storing energy.
If you have a carby but very low energy meal, there is insufficient energy - that's how most diets work, but you will be hungry, and any stored fat will be kept locked down. It's so much easier to keep insulin down and provide energy with fat.

It's such a powerful phrase - if both things are true - high insulin and sufficient energy - fat storing - if insulin is low - fat burning.
The last piece of the puzzle is that sugars and starches trigger insulin, and also too much gets turned into fat anyway.

The rest kind of doesn't matter - you may know what ketones are, but in many ways they are a relief valve - if insulin is low, your body knows it has enough energy (when you are eating sufficient fat), and starts to make ketones, of which there are three kinds of molecule, in blood, urine and breath. This means you actually start breathing out calories.. imagine that!!

You may also hear lots about Ketones, in almost mystical terms, but there is nothing magical about them, we all come into the world fuelled by ketones, and they are just another form of fuel. If you eat vast amounts of fat, then of course this doesn't hold - you can overwhelm any system, but it's physically difficult to do, because you will be properly engaging parts of your brain designed to tell you that you've had enough.

 

[Caz141]

Hi,
I’m still trying to get some of my ducks in a row (or not) in prep for my 10 minutes of time with the docs.

Since looking at my medical notes online I have learnt that the test I had when first debating if I was type 1 or 2 was the
Insulin antibody level Znt8 and the results were 5.2 mg/L [< 5] outside range

Does this information have any relevance to what is discussed with the doctors. ?

Being just over on the results does it give any more pointers to type 1 or type 1.5 or type 2?

Is it a test worth repeating from 2 years ago or does the c peptide test tell me more or less?

What are the ranges for this test?
How do they relate to type 1/2. Does it go high or low for the different diabetes or is this an over simplified thought?

I have done some searching on the net but as usual there is a lot of conflicting and/or confusing information out there.

I’m guessing this is what my diagnostic is being based on from 2 years ago?