T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[Chris24Main]

I really find it difficult to rationalise what is happening.

Join the club...!
It is complex for sure, but at least understand that it's not 100% about what you eat. Cortisol and other hormones are trying to regulate your blood glucose - and if you have just stopped Metformin, your liver will be suddenly much more able to generate Glucose.

 

[Chris24Main]

Not sure about nitrite maybe should be nitrate?

I did wonder if you would let me get away with that
So, yes, nitrate in the water, but will slowly break down into nitride

 

[Wilbach]

Not sure about nitrite maybe should be nitrate?

Potassium nitrate - Wikipedia

en.wikipedia.org

Some sites mention nitrite but I always thought of it as nitrate.
Could be either or historically perhaps.

Long, long time ago inorganic and organic chemistry was my best and favourite subject, had my own collection of chemicals that I should not have had and did experiments I should have not attempted eg distillation of aqua regia from conc nitric and sulphuric acid in the garage! Life was fun then!

 

[Wilbach]

I really find it difficult to rationalise what is happening. Sudden peak not gradual as I roll over and get out of bed. Exercise cutting trees down, spikes both times to over 11. Consistently high during fasting 10+ in mild + ketosis but that is from urine not blood. I am taking no drugs or supplements at the moment.View attachment 70359View attachment 70360View attachment 70361

Amazing, my wife, clinically obese, COPD, ME, heart problems, same diet, I do the cooking! Ie low carb/ keto her blood glucose this morning was 5.3! Mine 11.7 depressing, checked my glucose levels with a new contour blood glucose monitor / my libre2, basically identical!

 

[Wilbach]

Not sure about nitrite maybe should be nitrate?

Potassium nitrate - Wikipedia

en.wikipedia.org

Some sites mention nitrite but I always thought of it as nitrate.
Could be either or historically perhaps.

Dietary Nitrates, Nitrites, and Nitrosamines Intake and the Risk of Gastric Cancer: A Meta-Analysis - PMC

The potential associations between dietary consumption of nitrates, nitrites, and nitrosamines and gastric cancer risk have been investigated by several studies, but yielded inconclusive results. We conducted a meta-analysis to provide a ...

pmc.ncbi.nlm.nih.gov

Funded by China!
Most learned articles say more research is needed!

 

[Chris24Main]

For what it's worth - this was a plot I saved because I was so fed up with not understanding what was going on first thing in the morning (this was before I had even come onto this forum) about a year ago.

Time isn't shown, but this was essentially my morning spike.

Now, while much of what lead to that (for me) won't be relevant to you @Wilbach, however, I do get the sense of frustration...

These days - I'm generally around 5.5 though I can't say what happens over the first couple of hours, because I'm not measuring. I do have a couple of spare CGMs though, and if the next blood test goes well, I may wear one just to see what's going on these days.

For me, the big thing was obviously fasting and cutting carbs in the very short term, but in the medium term - recognising that by definition I was insulin resistant - this whole thing is caused by an imbalance of hormones, mainly insulin, and having needed too much of it, I had lost much of the ability to react to the effects it is supposed to have. My body's control mechanisms were swinging wildly about, producing extreme reactions.

I needed to settle in for the longer term, do things a certain way for a couple of months, and allow my body to regain the sensitivity it needs to control things more subtly. (ie, think of lowering carbs as a means of lowering insulin in the long term, not so much about lowering glucose in the short term).

Ironically, one of the things that really helped was a video from Dr Robert Cywes, who calls himself "the carb addiction doc" - who was talking about this very topic; and mentioned that it may take 18 months to 2 years to fully regain sensitivity to insulin.

I have zero way of knowing whether he is on the money - but at the very least it allowed me to not stress about whether I could truly achieve everything I wanted in a matter of weeks - that was clearly unrealistic.

I don't know if that helps, but if you really are reducing carbs, you are giving your pancreas less to do (the main stimulus for insulin is sugars from the gut) - so over time, everything is helping, even if it feels like day to day it doesn't make sense.

 

[Bcgirl]

Amazing, my wife, clinically obese, COPD, ME, heart problems, same diet, I do the cooking! Ie low carb/ keto her blood glucose this morning was 5.3! Mine 11.7 depressing, checked my glucose levels with a new contour blood glucose monitor / my libre2, basically identical!

Ah, you’re not the only one who,uses their spouse for testing purposes!
those numbers must drive you crazy and certainly not deserved. Hang tough. I’m surprised you can’t get your c peptide and/or fasting insulin….it could give you so much information! Push hard…offer to pay. Wishing you well.

 

[Bcgirl]

Well, I got some results back from my tests.
My fasting insulin showed up this morning. Two years ago, upon diagnosis, it was 28pmol/L (4.0mU/L). It is now 41pmol/L (5.9mU/L)….still low normal. My HOMA-IR is now 1.7 (anything under two is ok and shows I am not insulin resistant). HOMA-IR is a ratio of fasting glucose (mine was 6.4) and fasting insulin. HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance.
waiting on my c peptide. For some reason it’s sent to a main database first and then I get it sent to me later, takes about a week.

 

[Wilbach]

For what it's worth - this was a plot I saved because I was so fed up with not understanding what was going on first thing in the morning (this was before I had even come onto this forum) about a year ago.
View attachment 70391

Time isn't shown, but this was essentially my morning spike.

Now, while much of what lead to that (for me) won't be relevant to you @Wilbach, however, I do get the sense of frustration...

These days - I'm generally around 5.5 though I can't say what happens over the first couple of hours, because I'm not measuring. I do have a couple of spare CGMs though, and if the next blood test goes well, I may wear one just to see what's going on these days.

For me, the big thing was obviously fasting and cutting carbs in the very short term, but in the medium term - recognising that by definition I was insulin resistant - this whole thing is caused by an imbalance of hormones, mainly insulin, and having needed too much of it, I had lost much of the ability to react to the effects it is supposed to have. My body's control mechanisms were swinging wildly about, producing extreme reactions.

I needed to settle in for the longer term, do things a certain way for a couple of months, and allow my body to regain the sensitivity it needs to control things more subtly. (ie, think of lowering carbs as a means of lowering insulin in the long term, not so much about lowering glucose in the short term).

Ironically, one of the things that really helped was a video from Dr Robert Cywes, who calls himself "the carb addiction doc" - who was talking about this very topic; and mentioned that it may take 18 months to 2 years to fully regain sensitivity to insulin.

I have zero way of knowing whether he is on the money - but at the very least it allowed me to not stress about whether I could truly achieve everything I wanted in a matter of weeks - that was clearly unrealistic.

I don't know if that helps, but if you really are reducing carbs, you are giving your pancreas less to do (the main stimulus for insulin is sugars from the gut) - so over time, everything is helping, even if it feels like day to day it doesn't make sense.

I do not have the test strips for keto in the blood but I test my urine each morning. It shows a reasonably high level showing that I am in ketosis. Very few carbs are consumed, diet is mostly fat and protein.

As you say reducing carbs must have an effect giving my pancreas a chance. The good news is that I am going to Dublin on Wednesday to a company called city test.ie who do the c peptide and fasting insulin tests, 72 hour turnaround. They do not interpret the results but at least I will have results. My doctor has said that he will not accept them as a consultant has to decide.
What a crazy world.
What is the joke ‘what is the difference between doctors and God, God does not think he is a doctor.’ I have some very good doctors in my life but these now. Ironically the best here are the young ones in A&E. Some are superb but most move onto better jobs in Australia, Canada etc!
One of the other problems is that I am 76, maybe young at heart but and two years for things to settle is a long time in relation to my remaining lifespan. I have listened to many of Robert Cywes videos. He rambles a bit but has good points. I have had some help and input from a Low Carb Down under doctor, fair play to her and she has given me some solid advice and she is a very pro keto person.
To confuse things further and is interesting, my libre 2 CGM is coming to the end of its life, so I have now a sinocare CGM . I know the question of blood levels is a can of worms, my countour next gives one reading, all the others are different! A lot 10.6 libre, sinocare 8.5, finger prick 11.5! Which one do I accept. Oh dear, what a mess.

 

[Wilbach]

Ah, you’re not the only one who,uses their spouse for testing purposes!
those numbers must drive you crazy and certainly not deserved. Hang tough. I’m surprised you can’t get your c peptide and/or fasting insulin….it could give you so much information! Push hard…offer to pay. Wishing you well.

Thanks for your kind words, hopefully on Wednesday I will have the c peptide and insulin tests done in a walk in private company in Dublin city test.ie, 72 hour turnaround, 75€ including hb1ac. My doctor will not accept it, it has to be done through a consultant! Crazy World, but at least, I will be able to have an idea of what my pancreas is doing. It is almost as if the medical profession wants to keep you ill!
BC one of my favourite fishing places in the World, fishing on the Vedder for coho first light, sitting in the darkness, listening to beavers busy chomping away! Magic. The Fraser for sturgeon, Vancouver Island rivers and way up in Terrace. Wonderful country, people and fishing! A place close to my heart.

 

[Antje77]

the c peptide and fasting insulin tests, 72 hour turnaround. They do not interpret the results but at least I will have results. My doctor has said that he will not accept them as a consultant has to decide.

If your doctor is a GP, they're likely very wise to refuse to interpret the results from your tests and leave it to a specialist.
GP's don't have the specialist knowledge to correctly interpret.

Make sure your blood glucose is tested alongside the C-peptide, it's relevant for the interpretation. If it isn't included in the lab test, do a fingerprick test yourself right before or after the blood draw.

 

[Wilbach]

If your doctor is a GP, they're likely very wise to refuse to interpret the results from your tests and leave it to a specialist.
GP's don't have the specialist knowledge to correctly interpret.

Make sure your blood glucose is tested alongside the C-peptide, it's relevant for the interpretation. If it isn't included in the lab test, do a fingerprick test yourself right before or after the blood draw.

Very useful information, very many thanks, just checked diabetes status panel includes glucose, HbA1c, insulin, c-peptide, so should be alright hopefully.
thanks so much for this,
william

 

[Wilbach]

Very interesting! William

 

[Bcgirl]

Well, I got some results back from my tests.
My fasting insulin showed up this morning. Two years ago, upon diagnosis, it was 28pmol/L (4.0mU/L). It is now 41pmol/L (5.9mU/L)….still low normal. My HOMA-IR is now 1.7 (anything under two is ok and shows I am not insulin resistant). HOMA-IR is a ratio of fasting glucose (mine was 6.4) and fasting insulin. HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance.
waiting on my c peptide. For some reason it’s sent to a main database first and then I get it sent to me later, takes about a week.

I’m quick update, just got my c peptide results. Now it’s at 508 pmol/L, down from 636 last time (year ago) and 668 at diagnosis. I find it interesting that it has gone down while my fasting insulin went up.

 

[Wilbach]

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I’m quick update, just got my c peptide results. Now it’s at [emoji6][emoji[emoji6][emoji6]][emoji[emoji6]] pmol/L, down from [emoji6][emoji6] last time (year ago) and [emoji6][emoji6][emoji[emoji6]] at diagnosis. I find it interesting that it has gone down while my fasting insulin went up.

Well done!

 

[AloeSvea]

@Melgar - the pain you are describing (radiating up into the back) - is spookily similar to what my wife struggled with before having a major episode, and having her gall bladder removed.

(I may be thinking the same thing as @Antje77 - maybe not).

At the time, we were confused - how could she have a gall stone? she hardly eats fat.. but it seems that not eating fat means that the gall bladder is not regularly flushed out - it's a storage for bile to break down fat after all - so it isn't people who eat too much fat who get gallstones, it's people who don't eat enough.

Usual caveats - not making a diagnosis -

I agree wholeheartedly and with much experience of above. Ditto the usual caveats.

 

[AloeSvea]

Amazing, my wife, clinically obese, COPD, ME, heart problems, same diet, I do the cooking! Ie low carb/ keto her blood glucose this morning was 5.3! Mine 11.7 depressing, checked my glucose levels with a new contour blood glucose monitor / my libre2, basically identical!

Such indeed is what having mucked up blood glucose regulation is all about, aka - diabetes! I hear you there, Wilbach.

 

[Chris24Main]

I’m quick update, just got my c peptide results. Now it’s at 508 pmol/L, down from 636 last time (year ago) and 668 at diagnosis. I find it interesting that it has gone down while my fasting insulin went up.

Hi @Bcgirl - I find that interesting too - particularly if it really is the case that C-Peptide is measuring the "left-over" part of naturally produced insulin in the Pancreas - that kind of has to mean that on a minute-to-minute basis, the level of insulin and the level of C-peptide can only vary by the rate at which either insulin is being used (ie, is attaching to insulin receptors in cells around your body) or broken down - or I suppose that there has to be a mechanism that recycles the peptide as well.

It's probably in the long grass though, and none of this suggests a problem for you... so probably not worth the effort in trying to understand.

 

[Peanut234]

As is so often the case.. it's a little more complicated than that. I was just thinking.. hang on.. insulin doesn't have a shelf life at all.. that sounds like something a doctor would say...

Human, self produced, insulin is made in three parts, an A chain, B chain and a middle C chain which joins the two (chains of amino acids) together. When you finally have what we know as insulin.. the C chain is discarded.. all three amino acid chains are peptides.. so what you have is the C-Peptide being left over, and thus that's what we test for.

As far as I understand it.. there are then other hormones who's job it is to break down insulin.. but thinking in terms of shelf life is unhelpful because it doesn't just happen by itself... you need to understand what it is that degrades the insulin and why. (I forget for the moment.. I'll put it on my list).

I still think that what's underneath everything for you @Melgar is something akin to an overstimulated liver, that keeps pumping out glucose (from protein probably), in gluconeogenesis, under influence of glucagon... something along the lines of an opposite to ketoacidosis, and nowhere near so toxic. You don't eat or have available much fat, but you consume loads of energy, so your liver has no fat to burn and must generate glucose for energy.. but this glucose doesn't impact the pancreas in the same way as dietary glucose, so doesn't trigger corresponding insulin to balance the glucacon, so it just makes more than you really need.

I only really offer that because I've found myself talking about the pancreas as a kind if 'glucose thermostat' a lot recently, but that's only with glucose absorbed via the gut. The liver will just keep on acting under the influence of glucagon (break down fats, break down glycogen, create glucose, suppress insulin) until there is a reason to change.

I even wonder if you might find that (counter intuitively) something sweet might LOWER your blood glucose, by triggering that insulin response, which would then suppress the glucagon..

Bet you didn't expect that...!

A couple of comments which people might find interesting:

I echo the something sweet lowering blood sugar. It does my head in but if I have not eaten all morning, particularly if I have exercised, eating with a bit of carb will lower my bloodsugar. ( although this will probably not help in the liver emptying department...)

I have experienced (although as a 3c), variability in pancreas function in both the digestive and insulin producing functions. I still have some function for both, and its a factor that I am trying to adjust to, but some days things get a bit squirrely and so I assume that because of this, that the c peptide test is just a picture in time - like a finger prick, and that a more longitudinal measurement like a cgm would give better answers although I assume that tech doesn't exist yet. In my experience more likely to be less functional when sick.

I recently saw, and cannot find again, that the pancreas has its own internal clock, and generally produces differing amounts of insulin at various points in the day. I assume from the study that it was based on the general public ( and i'm sorry I cannot find it again, I would have searched something like pancreas, circadian rhythm) But I wonder if this natural variation is still present in diabetes and changes our 'potential max' insulin at each point in the day. I also wonder if this is part of the increased insulin resistance at breakfast and in the evening as rather than just insulin resistance changing over the day, there may also be this 'potential max' variation contributing too.

Also on Metformin:
My experience was a bit different to the norm.
After one week on a low dose my liver numbers went wild, and I was immediately taken off it (and put onto insulin unfortunately, but necessarily)
After some research I assumed initially that my liver was just completely full, and was not on board with metformin mechanism of action in blocking it trying to empty itself. The Dr was also perplexed because liver issues with metformin is 'not a thing' apparantly.

After more investigation I have learned that there is some quite recent research about certain medications blocking the main Thiamine transporter. At this stage the research is in its earlier stages, but comes from an initial failed medical trial for a medication which accidentally blocked the transporter completely and had some incredible and fast effects on the trial partipants. They figured if it happened in that medication, what about others, and they went from there. I was already (unknowingly) on one of the medications which are on the 'could be a significant problem list' (and have thiamine deficiency) Metformin was also on the list to be investigated further. I emphasise that that this is very new research - 2020 onwards, and that many people round the world are using metformin without issue, so don't use this as a reason to come off it!, (talk to your dr first!) just something to be aware of. I suspect that in me it may have been the addition of another medication potentially doing the same thing that caused an issue.
Although this seems a bit weird for me to be bringing this up, the pancreas is a very hungry user of thiamine in the body, and deficiency reduces function of the Acinar and beta cells. So for the odd person a 'perfect storm' of medications and pancreas interaction could theoretically occur.

I am coming off the original medication slowly, and with some additional weight loss, hope that down the track that metformin may be an option to reduce insulin needs etc. I also would like to take advantage of its potential protective effects when it comes to pancreatic cancer etc.

 

[Peanut234]

You are right @Bcgirl I live in BC, the Lower Mainland. Thanks for the info, good to know. My other Dr refused, like it was coming out of her own pocket. She’s retired now. My new Dr is much softer and nicer. I didn’t know Life Labs do private tests. I’d sourced a lab in Alberta, but if I can get it done at Life Labs I’ll definitely go there. I will ask my Dr. I’ll have to make an appointment anyways because of these episodes. It’s catching them when they happen. I’m hoping it is Gall Stones and not my pancreas. They come out of the blue, no warning.

Sorry your Dr is retiring. It’s a nightmare trying to get a new one. I hope you are able to get one soon.

@Melgar I second...3rd, whatever, the gallbladder situation. If your blood sugars are affected it can show that things are significant and would probably make accident and emergency jumpy if you presented like this next time due to the possibility of gallbladder infection or pancreas involvement. I know from experience that the attacks are horrible, and affect ones quality of life. But worth dealing with in order to potentially prevent pancreas damage.

a couple of things to keep on your radar, and may be of interest to others:
The liver and pancreas share a valve - the sphincter of oddi - which can close/spasm and create the same pain, inflammation and or pancreas/liver issues.
The assumption will be that you have standard pancreas plumbing - you may not - pancreas divisum, which can contribute to issues and can sometimes be picked up on an MRCP (a pancreas MRI for lack of a better description) its actually quite common, although generally doesn't cause issues. But every now and then...
Gastroparesis/stomach valve spasm can happen particularly if the gallbladder/pancreas/sphincter of oddi are happening. I have been prescribed a muscle relaxant which helps significantly when this happens. - I bring this up, because this gastroparesis etc could contribute to/help explain unexpected changes in your digestive system eg digestive enzymes not getting to the stomach, and preventing food being absorbed and processed properly, which could affect blood sugar etc.
The first line though is generally getting the gallbladder out, although its worth getting a pancreas enzymes+liver enzymes+CRP blood test next time this happens in case it is pancreatitis. Definitely worth trying to protect Pancreas' where possible!

When you are further down the track and have more info - there are medications down the track than can help.
GTN spray ( normally used for Angina) can help open/relax the sphincter of oddi and help the pancreas eject its enzymes rather then eating itself...
Also a new one worth talking to a dr about down the track if needed is Losartan. Its normally a blood pressure medication, and its now being used to prevent adhesions after surgery- BUT has massively helped my pancreas. Its mechanism interrupts one of the inflammation pathways and has been amazing.
Apologies if this sounds preachy - (and of course discuss with medical professionals) I very rarely feel I can contribute from a solid place of knowledge, and unfortunately here I can. If it is helpful, feel free to ask questions