Next stop insulin...... Apparently

Hi all,

I've been going to a foot clinic since last October after trying to take up running.
I'm 20st or there abouts and this time last year I was combining intermittent fasting, low(ish) carb and exercise to try and reduce my BG.

By late September I was getting fitter and decided to start couch to 5k but after the 3rd run I felt some pain in my feet and woke up the next day to find the whole ball of my left foot to be covered in blisters.
Fast forward a month and they didn't clear up fast and I went to my GP who quickly diagnosed two ulcers (under callous skin).
I was referred to the diabetes centre and have been going there almost every week since.

I haven't exercised since then and have barely moved but I have kept my weight off!
The ulcers healed after a couple of months but just as they were done healing my right foot started playing up and I was (eventually) diagnosed with having Charcot in the big toe and 2bd toe region and also had Osteomyelitis. Overall I've had probably 14 weeks on big doses of antibiotics on and off but included 6 straight weeks to treat the osteomyelitis.

This time last year my Hba1c was 110 and by the time of me trying running it was down to 72!

I know those numbers aren't great but they were good for me.
I've been diagnosed for 14 years now.
I'm currently on 2g Metformin, Ramipril and Victoza 1.8mg daily.

Upon my now routine appointment with the consultant who runs the foot clinic, he declared today that my last Hba1c was 84 and that I need to start insulin ASAP.

I don't know the exact name but it is the once a day slow acting one??

Anyway, he warned me that I might gain weight which seems so counter productive to me.

Despite the feet, I'm actually feeling pretty good and still working on my health despite not exercising at all. In fact, my feet are getting to the point where I believe I might be able to start cycling again and some light walking.

Going on insulin terrifies me.

I have been told that I've been on everything they're willing to try apart from insulin.

I've been doing intermittent fasting for a while now and feel great after fasting for 16 hours. I eat a generally low carb diet but certainly not to the keto level.

I don't take any supplements.

I've been thinking of signing up for the low carb program and in advance of that I bought the cook book.

Is there anything I can be doing better?

The consultant is concerned that my daily fasting BG is usually one of the highest according to my meter and by mid late afternoon it can be around 6 - 9 depending on what I've eaten.

He doesn't like the fact that after a 16 hour fast my BG is 10 or more.

Am I doomed to going on insulin?

Sorry for the long post!

Cheers

Bluetit1802 said:

Have you tried fasting for longer than your 16 hours?

What foods and drinks do you have in a typical day? You say you are lowish carb, but how low is lowish?

Do you count your carbs and measure your portions?

Do you test before each meal and again 2 hours after first bite to see what your food choices are doing to you?

A high fasting level is often a symptom of severe insulin resistance. If you do have severe insulin resistance, taking even more through injections will be counter productive. Insulin resistance means we need more and more insulin to clear the glucose from meals, but, and it is a big but, the more insulin we have floating about makes the insulin resistance worse. It is a vicious circle.

Do you snack between meals?

Exercise helps with general health and with insulin resistance, but the saying goes that you cannot outrun a bad diet - a suitable diet is the key, not exercise.

Click to expand...

Thanks for the reply.

I have done a few 24 hours fasts in the past and apart from a brief 'rough feeling' at the 20 hour mark I've felt great.
I did a 36 hour fast but timed the last 12 hours very well (not) to coincide with a sickness but my children had!

I mainly stick to low carb foods in the sense that I avoid bread, pasta and the other usual stuff. What hurt the most was fruit!

However, I do have periods where I 'forget' to be low carb.
Honestly up until I started low carbing and fasting I was very bad with my diet and it was mostly the same over the decade before.

My weight is now lower than when I was diagnosed 14 years ago.

Cheers

Flora123 said:

I’m sure someone more experienced will be along soon for some expert advice. However in the meantime I’d say if you’ve been on antibiotics for such a long time your gut flora will have been ‘nuked’ so worth adding probiotics (good quality) fibre from green leafy veg and if you like it, live sauerkraut or such to build it back up.

Also can you tell us your typical eating habits, foods you like etc etc? Good luck.

Click to expand...

I hadn't thought of that! I'll get on with doing some good. I did start having apple cider vinegar whilst I was on them, perhaps I'll start doing that again.

Cheers

Antje77 said:

I'm sorry to hear of your troubles, @ElNevera .
Is there a specific reason why insulin scares you more than high blood sugars? I think the stuff is wonderful, as it saves me from nasty complications.
Good luck!

Click to expand...

Honestly it is the threat of weight gain and it's always felt like a last resort type of option to me.

I feel like gaining weight would undo the good work I've been doing but I do understand the numbers don't look good to the docs.

Just for some info.
I do 16/8 fasting Monday to Friday and on a weekend I like to eat with the family but with two young children I face temptation quite a lot. For example, I was making my son a sandwich and caved and had 2 slices of bread and butter this past Saturday.
I knew instantly it was a mistake, I started getting hot and sweating and my mood changed and I became quite grumpy.

Finding out how food effects my mood has been a recent discovery to me, that and the high bloods.

Monday to Friday I'll have some combination of meat and eggs for breakfast and meat or fish and salad or veg for a late lunch and start fasting.

I try not to fast but if I do it now consists of nuts or fruit.
Sometimes I'll swap the eggs for Greek yoghurt and nuts, seeds and raspberries.

On a weekend I'm more relaxed but do try for example on Sunday I made the family fajitas but I had mine wrapped up in lettuce leaves rather than the tortilla.

I don't carb count as I really thought I could mentally be sub 100g Monday to Friday just with my standard choices.

I guess if I went total keto I'd have to as sub 20g would be harder to be sure.

ert said:

I'm sorry you're working so hard, and still not getting the results you need to see. Have you read Dr Jason Fung's The Diabetes Code? I recommend it. Hopefully, you can find some answers for decreasing your insulin resistance and lowering your blood sugars into the normal range. In the meantime, I suggest testing your blood sugars before eating and two hours afterwards to assess what's really happening when you eat different foods.

Click to expand...

I've just ordered it from Amazon. Thanks for the tip.
I think it was Jason Fung's YouTube vids that got me going down the low carb route, albeit my lazy half assed approach. :/

Also, I do test my bloods every day but have not seen a a fasting level below 9 in a very long time.

Flora123 said:

I meant to add earlier that a good brisk walk after a meal has a more favourable outcome for my BG than a run. Just in case you don’t want to resume the Couch to 5K once you are fully recovered.

Click to expand...

Yeah, I have issues with my feet anyway (hammer toes) and fairly severe neuropathy but I do like walking (haven't done a decent walk since October!)

Running might not be for me but I'm hoping biking esp MTB is going to be a big part of my future.

ert said:

And what have your before and two-hour after meal results been like?

Click to expand...

I've not been doing the 2 hour past food testing but I'll start doing it.

Insulin resistance seems like a big issue of mine but medical staff seem to disregard it.

Is there a blood test that can identify resistance?

ert said:

You can calculate insulin resistance (IR) using the HOMA formula. There is a calculator you can download: https://www.dtu.ox.ac.uk/homacalculator/download.php The calculator does the IR calculation for you.
You will need your fasting glucose and c-peptide blood test results to enter them. You may have to have them done privately as c-peptide is usually ordered by a specialist.

Click to expand...

Thank you for the link.
Is my GP likely to agree to doing the c-peptide test? By fasting glucose is that a hba1c taken from the same blood sample?