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

[Chris24Main]

@zand - sure, and I certainly do not want to minimise your conditions.
I suppose I have to put myself in the position of messenger to be shot, because I'm badly summarising.
She spent much more time talking about dimming light in the evening - using warm bulbs or even blue filter glasses after the sun goes down, and definitely being wary about blue light screens - much more time on that than about "not wearing your sunnies" during the day, and to be fair, even then, it was about regularly getting some natural light so that your body could gauge the time - it was not about spending lots of time in bright sunlight. In fact - brightness has nothing to do with it, it's the wavelength you are responding to, you can do that in the shade, just not indoors.

@Melgar - a big part of this for me is discovering just how complex and amazing fat cells are .. but the analogy works better if you think about a central clock, and a messaging system for when the alarm goes off, like in an office building.. so that everyone hears at the same time, and does the right thing - at least that's the way I read it.

 

[zand]

@Chris24Main
This thread is brilliant. It has summed up in a very short time what took me years of 'living it' to discover.

Circadian rhythms. Yes, agree totally how important these are. Like @Outlier I never used to get jet lag due to years of messed up sleep patterns. Experiences as a child necessitated sleeping with a light on in the landing. Without the light I didn't sleep. A few years before T2 diagnosis, worried about my ever increasing weight, I tried hard to break the habit. I eventually won that battle and have slept in the dark for around 18 - 20 years now.

Adrenaline and cortisol. A few years after this I realised that due to those childhood experiences (which didn't fully come to light until I was in my 40s) I was always on high alert. This was normal for me so I didn't know it was wrong. As a child and teenager I used to know there was someone coming to the door before the family dog's hackles rose. Mine rose first. My parents would say 'Don't be silly, the dog can't hear it, there's no-one there '. Then the dog would react. Then the visitor knocked on the door. This happened with every dog they ever owned.

I thought the nervousness when out of the home was normal. My mum used to buy me a pack of crisps every time we went out. These crisps became a sign of safety, of being loved. Not surprising then that crisps remain my problem snack 60 years on.

When I realised the damage excess cortisol was doing to my body I bought a book about resetting the adrenal glands as I figured mine were in really bad shape. Since completing the recommendations in it I now get jetlag! I feel a little bit more normal, but it was a bit of a shock at first as I had thought my family were wimps not being able to cope with the change in time zones.

Leptin resistance. Yes, I realised pre diagnosis this was a problem for me. Low carbing helped.

Did you watch Irresistible: Why We Can't Stop Eating on BBC 2 last night? I found the statements by the food industry at the end to be rather telling.

I'm sure there other areas you have touched on which have been what I have experienced too but I'm currently ill so don't have the energy to type more now. Thanks so much for starting this thread and letting it flow where it will.

 

[Chris24Main]

Much appreciated @zand - as it happens I've just been watching that in my lunch break - I read Chris Van Tullekens' book "ultra processed people" - and that treads a lot of the same ground. Also "the case against sugar" by Gary Taubes and Nina Tiecholz (sp?) "the big fat surprise" -

in particular, the interweaving of the sugar and tobacco industry is fascinating.

When you start to dig, its shocking that so much of the food industry that we love ... turns out to have been bought by the old tobacco firms..

then you dig deeper, and realise actually it was the sugar industry all along... they just took a detour into tobacco for a while..

I was thinking about taking a dive into the sympathetic nervous system next - so Adrenaline and Cortisol primarily; you've convinced me that this is the next logical place - but I don't have enough to be able to speak to it yet.

 

[zand]

There were 2 things pre T2 diagnosis that I really had to work hard on to achieve. One I have mentioned already, sleeping in the dark. The second was addiction, not to food particularly, but to diet drinks. I read various articles that said that diet drinks increased insulin resistance and made you fat. It took a very long time, maybe 3 or 4 years, to get over the cravings for diet coke/pepsi. One slip when I was out and I was addicted again. I wish I had never made the switch to diet drinks, at least with sugary ones you (and your body) knew where you were. I dread to think of the effect artificial sweeteners are having on todays youngsters.

 

[Chris24Main]

It's a pretty complicated story with artificial sweeteners - and I think there is a hugely personal level to it as well, which you may be able to speak to @zand . I think this is one of the things where genetic expression plays a huge part. Ie, you may genetically be predisposed to react to some sweeteners.

What the hell does that mean ?

Some people are clearly driven to want more (I'm ...lucky?... in that regard, just don't like the taste of any artificial sweetener, never have) - so you drink a diet coke - among other things, the signalling to your brain is a consequence of, if you like, your genetic sensitivity to the mechanisms that underpin that signalling (translation factors - it's like .. some people may have a broadband connection between their stomach and brain for that particular signal - others work on dial-up). The reaction in your pleasure/ reward centre, how much dopamine and your sensitivity to dopamine then play a part. It becomes a spiral with dopamine too, needing more and more for the same "fix".

The point being that genetics plays a part, but the genetics alone may make no difference unless you are exposed to the thing that makes that genetic material express something.

Then, independently, the same thing applies to the hormonal reaction to the sweetener. It may just taste sweet, or your whole system may go "right - we're due to deal with a whole bunch of sugar in a minute - best roll out the insulin carpet..." - which of course is where the connection to insulin resistance comes in, and the elevated insulin locking you in energy storage, thus the "makes you fat" comment. But - how you personally react to the specific sweetener will depend on what your body is used to - in some cases literally (the emotional connection to the reaction to that sweetener), but also physiologically, some directly have effects in the gut and pancreas and some don't.

I always kind of felt as a kid that you were better off with the sugar. I'm not sure I 100% agree with that now - I think I see it as the same kind of relationship as heroin and methadone; if you are using one to reduce the other, that's one thing, but you can get hooked on either.

The history of these kind of drinks is really fascinating - and I speak as someone who would pack away 5 Cokes or Sprites or Fantas easily every day in the Seventies growing up in the tropics. 5 minimum. Every day.

Coke in particular started off as a "tonic" packed with wine, cocaine and sugar. The wine was removed and nobody noticed. The cocaine was removed and nobody noticed. The sugar was reduced and people rioted...

 

[Chris24Main]

It's funny how sometimes, when you are looking for something, it can elude you for ages, then several things can coalesce at once.

All roads seem to lead back to the mitochondria, if they are healthy, you are healthy. There is a good case that everything we stress about on this forum (at least on the type 2 side of the fence) is all downstream consequences of mitochondrial disruption, but one thing that I've kind of been fascinated about for years, is "what the hell are mitochondria anyway and where did they come from?"

They live, they multiply and they die - they have what seems to be a completely separate existence to "us" - yet they form a critical part of all complex animals. Are they actually aliens? - are they like George Lucas's Midichlorians, the things that make Jedis force-sensitive?

and over the weekend, a couple of things popped out of sources I'm into at the moment, that just blew the question apart - the answer is actually quite easy to pin down, but no less amazing for it.

So - it all started about two and a half billion years ago, when bacteria ruled the world. As far as it goes, this is all fact - none of this is contentious anyway. Essentially, there were enough bacteria doing their thing, getting jiggy with it, and spewing out oxygen; such that the atmosphere started to change and become more like what we think of as normal now - with a significant percentage of oxygen.

The problem was - nothing could cope with all that explosive oxygen - this period of time was referred to as "the Great Oxygen Catastrophe" - it was the biggest mass-extinction event that the planet has ever seen; more impactful than ice, or meteor, or anything - just oxygen doing the business of oxidisation ... everything literally just went "bang".

Until, a class of bacteria evolved that could cope with the explosive power of oxygen, by managing lots of little bangs, where energy is passed from one reaction to another in a slow enough way that the thing didn't just pop in the process.

That bacteria is what we know now as mitochondria. Somehow (in another rabbit hole that I need to jump down) - these bacteria were wrapped up in larger cells, providing them with the much more efficient energy supply in exchange for safe passage. It's this symbiosis that allowed life to take that next big step, and form more complex life, as the cells began to specialise into different kinds of function.

Part of this came from one source, the other from Dr Robert Lustig talking about something altogether different (topic for another day) - but mentioned in passing - "because of course, mitochondria are just re-purposed bacteria" - and it was one of those moments ...

If the real purpose of all of this is to figure out how to be healthy (as opposed to not having any disease) then the answer has to involve healthy mitochondria, because they supply the energy for literally everything, when it comes down to it. If you don't have enough energy in some part of your body, it malfunctions and that we call chronic disease. If it's all getting less and less efficient, we call that old age, and if the balance goes the wrong way in the whole body - if it takes more energy than can be made; we call that dying of old age.

Seen like this, mitochondrial health has to be something we take seriously. For now though, this revelation just impressed me so much I had to get it out...

 

[zand]

It's a pretty complicated story with artificial sweeteners - and I think there is a hugely personal level to it as well, which you may be able to speak to @zand . I think this is one of the things where genetic expression plays a huge part. Ie, you may genetically be predisposed to react to some sweeteners.

What the hell does that mean ?

Some people are clearly driven to want more (I'm ...lucky?... in that regard, just don't like the taste of any artificial sweetener, never have) - so you drink a diet coke - among other things, the signalling to your brain is a consequence of, if you like, your genetic sensitivity to the mechanisms that underpin that signalling (translation factors - it's like .. some people may have a broadband connection between their stomach and brain for that particular signal - others work on dial-up). The reaction in your pleasure/ reward centre, how much dopamine and your sensitivity to dopamine then play a part. It becomes a spiral with dopamine too, needing more and more for the same "fix".

The point being that genetics plays a part, but the genetics alone may make no difference unless you are exposed to the thing that makes that genetic material express something.

Then, independently, the same thing applies to the hormonal reaction to the sweetener. It may just taste sweet, or your whole system may go "right - we're due to deal with a whole bunch of sugar in a minute - best roll out the insulin carpet..." - which of course is where the connection to insulin resistance comes in, and the elevated insulin locking you in energy storage, thus the "makes you fat" comment. But - how you personally react to the specific sweetener will depend on what your body is used to - in some cases literally (the emotional connection to the reaction to that sweetener), but also physiologically, some directly have effects in the gut and pancreas and some don't.

I always kind of felt as a kid that you were better off with the sugar. I'm not sure I 100% agree with that now - I think I see it as the same kind of relationship as heroin and methadone; if you are using one to reduce the other, that's one thing, but you can get hooked on either.

The history of these kind of drinks is really fascinating - and I speak as someone who would pack away 5 Cokes or Sprites or Fantas easily every day in the Seventies growing up in the tropics. 5 minimum. Every day.

Coke in particular started off as a "tonic" packed with wine, cocaine and sugar. The wine was removed and nobody noticed. The cocaine was removed and nobody noticed. The sugar was reduced and people rioted...

Some background info then. As a child I had sugary fizzy drinks every day. I had no weight problems at all until I started taking the contraceptive pill before I got married aged 24. Looking back, I should have just stopped taking it but instead, 4 months after taking the pill, I found I had gained almost two stones. I had never put on more than half a stone before and had always lost it naturally and easily through not feeling so hungry when I was more plump. This time, I cut calories by switching to diet colas and cutting out desserts. I used a sweetener in tea. This was easy for me to do so I can't say I found sugar to be at all addictive. It didn't even take a lot of willpower, just a decision to not have added sugar anymore. I would have had hidden sugars in things like ketchup, but that was all. My hubby needed to lose a few pounds a couple of years ago. I asked him if he found sugar to be addictive and he didn't either. I did read years ago that breast milk is sweet and it's natural for babies and children to have a sweet tooth that can be habit forming, but that's just habit, not addiction.

The reason I think sugar is the safer alternative is that you see the results of too many calories very quickly. It's easy to spot weight going up and it appears obvious that you need to eat less and move more. Sugar is the obvious thing to ditch as there's no nutritional value to it, just empty calories.

With sweeteners the damage can take many years to manifest. By then your metabolism is messed up and reducing calories and moving more no longer cut it. However when I said diet drinks were addictive I was wrong. I believe I was addicted to colas (any brand), and as I always drank diet ones I erroneously blamed artificial sweeteners. I found the black coloured diet fizzy drinks very much harder to give up than other flavours like orange or lemonade. I drank diet colas to feel full when I wasn't consuming enough calories to satiate. I wouldn't have done that with sugary ones. And yes for me artificial sweeteners were the main cause of my insulin resistance.

Oh and I hated the taste of diet drinks at first too, but I was desperate to lose weight so got used to them. Just like when I stopped adding a sweetener to my cup of tea. The tea tasted awful for a couple of weeks but now I hate having sweetened tea.

 

[Chris24Main]

I was planning on something along the lines of "let's talk about all the non-food ways that the liver is affected to alter our blood glucose" - because I think that really helps to get free of the idea that you have a plate of food, and then you can easily predict what is going to happen to your blood glucose as a result, because .. liver.

But - it occurred to me that I need to start a little before that, and look at all the things the liver does - so... I present the liver for dummies - I promise no jargon and no diagrams :-

The liver is sitting more or less as the centre of all our major systems - in terms of blood, it's directly connected to the heart, stomach, and intestines. All of that 'piping' is connected to the lymphatic system. As for the electrics; it has a hot-line to the brain in the form of the vagus nerve, and is directly connected to the sympathetic nervous system (fight or flight) so can be directly controlled by "stress".

As for the jobs the liver has on it's plate: (with apologies for the circular metaphor)

It produces the bile we need to break down fats
It regulates blood plasma and regulates blood clotting, and is heavily involved in the immune response and for removing bacteria from the blood.
It produces haemoglobin to store iron (all iron storage is in the liver - the liver acts as storage for most minerals)
It's the major "clearance house" for toxins, with a three stage process for identifying, capturing and expelling toxins
It regulates blood levels of amino acids and produces cholesterol as a starting point for the sex hormones, Vitamin D, skin and cell lining repair and nerve padding amongst other things (your brain makes it's own cholesterol, and many other tissues also, but the liver does the lions share)
It manages the conversion of ammonia (end product of protein metabolism) to urea.
It's intimately connected to the kidney, which acts as the filter for all the things it's trying to get rid of

It does around 500 other jobs related to managing overall metabolism,

It exclusively deals with the metabolism of alcohol and fructose (generally into fat that it first stores itself)

and, it converts excess glucose into glycogen or triglycerides and back again, or creates new glucose - depending on what other systems are telling it the body needs (pancreas and brain mainly) via a cocktail of hormones, most obviously insulin.

It's quite the list, and yet - for me anyway - I would have said it's one job was regulating blood glucose, and it doesn't even do that.

 

[Chris24Main]

Of course, I immediately caught Ben Bikman's latest metabolic classroom, which talks about the thyroid, thyroid hormone signalling ... effect on insulin signalling and glucose transport and realised that I hadn't even mentioned the thyroid... though to be fair, that is about glucose control and not liver function, so maybe I can give myself a pass on that...

 

[Chris24Main]

Going to verge into dangerous waters again. I've fallen foul here before, so I'm going to be super careful.
Hypothesis: men and women are not identical.

<peeks up over the table>

Right - a little more context: anyone still reading this thread will be aware that I tend to go on about the three layers of biology- you have to consider how any topic affects:
The whole person (which is wider than saying the whole body)
The various organs - the same input can have very different effects, and one organ can affect another.
Cell metabolism - every cell needs energy to do anything, and the availability of energy, in what form, and how easily the cell can produce energy (which really means how healthy the mitochondria are) will have a huge effect on health, and most forms of disease can fundamentally be explained as mitochondrial problems (though it's fearsomely complicated down at this level).

So - on a cellular basis, men and women are equal. There is no such thing as a female mitochondria. You can talk about DNA, of course, and Y chromosomes, but that's more about why a fertilised egg goes down one path or another, not about health as people.

On a whole person level - Well, there are clearly some possible differences, but I'm not really interested in that - in any population there are differences between groups of men, between groups of women, and there are differences between groups of people. As individuals, we all have possibilities, and we are all equally valuable humans. Let me stress, I'm not even nudging toward the concept of "better".

However - when we think about organs - that's a different story. Now there are certain parts of certain societies that tie themselves in knots about "what is a woman" - but let me put it this way - Men do not have ovaries.

Now, let me take a little detour. Like many men, I have to confess to zoning out a little when it comes to "women's issues" - it's a man thing, it's sometimes a coping mechanism, and mostly; it's - "this doesn't tell me anything I need to know about me". So - I'm acknowledging my ignorance, and lack of credibility or right to talk to anything specifically relating to women. But...

Why are the ovaries important thinking about metabolic health? because ovaries are factories for a particular Oestrogen. Oestradiol, to be precise, or E2 - (when we say "Oestrogen" - that isn't biologically correct; there are a family of hormones called Oestrogens, just like only one of the Androgens is Testosterone)

Oestradiol has a primary function of regulating the menstrual cycle, but it also directly improves sensitivity to insulin (through pretty complicated signalling pathway affects which I'll spare you) - I recall reading this a while ago, and it going over my head, but I can now follow some (most? .. no, some) of the detail, and it makes a big difference to insulin resistance at the cellular level, throughout the body.

Menopause, the shutting down of the ovaries, switches production of E2 back to other cells (most notably the adipose or fat storage cells, which is where men make this hormone) and the sudden drop of availability of E2 is what gives rise to many of the common menopause symptoms, and what HRT is aiming to replace (there is more to it than that, of course).

In fact - (sorry, I'm regurgitating from others, and thus can only say - in my opinion) it's the best explanation as to why women live longer than men statistically speaking - simply that by the time the menopause comes around, women will have had less aging effect due to glycation because of better insulin sensitivity up until that point. (There is more to that as well, and it isn't limited to insulin function, E2 affects fat metabolism, and inflammation all over the body in a positive way)

That's a statistical hypothesis - so, you know, it only makes sense at the population level - I'm not at all making any connection to any individual person, so if you feel your hackles raising at this outrageous mansplaining, I'm only really saying that:

1. Women tend to live longer than men. If you disagree with that, take it up with your nearest actuary.
2. Women tend to have more ovaries than men. If you disagree with that, well, there's nothing I can do....
3. Ovary-derived E2 directly improves insulin functioning, (this you can look into yourself, but it makes sense to me)

Moreover - if you're with me so far, this would make me think twice about advice generated from studies made on middle aged men, and that all of these hormones - androgens and oestrogens alike, are steroid hormones, made from cholestrerol - and I think I should leave it there... one step further and I'm into opinion...

 

[Outlier]

Sensitively put.

When I started to research cholesterol because I was being put under huge pressure to take statins, I discovered that all but the most recent research was entirely conducted on men (and rabbits). Up-to-date research paints a way different picture in any case, but once women were added to the research (who would have thought that would be necessary?) some sufficiently interesting anomalies appeared, to the extend that earlier theories were blown out of the water. Of course this hasn't yet reached those who are under pressure to make everyone's cholesterol equal and as low as possible. This here is a diabetic forum, so I'll leave cholesterol there but - who is to say that similar issues aren't also ready to be discovered for a whole raft of illnesses?

 

[Bcgirl]

Interesting for sure. I was taking HRT for many years, I was then diagnosed with early stage breast cancer, estrogen positive. Told to immediately stop my estrogen and told I needed to take tamoxifen (estrogen blocker)for five years. I fought that hard but ultimately felt pressured into taking it. That lasted two months….thats when I was diagnosed with diabetes. My diet had not changed, I was sugar free and keto for over a year before diagnosis. Seems it’s quite a common side effect with tamoxifen, hidden deep in the side effects page…..

 

[Chris24Main]

Just done a quick read up of Tamoxifen - funnily enough, even the NIH just talks about "estrogen" as if it's a single thing. I can see some dots to join up, but really, I'm definitely out of my depth and shouldn't speculate - I'd be just as guilty of making unsafe assertions as the people feeding those rabbits the equivalent of a thousand cheeseburgers and then being all surprised at how unwell they were.

 

[Chris24Main]

So, I now have an appointment next Thursday for a session on health and wellbeing at my local surgery. I told my wife, and she immediately said "now, be nice..." - and so I will, but I am curious what the general advice will be - I'll report back here of course, but to be clear, I am engaging with an open mind and in a positive spirit. My local surgery is just fantastic, and I've had an amazing experience, throughout the twenty years or so I've been using them.

One thing I thought I could do to prepare, though: I have kept a couple of CGMs from back when I was mis-diagnosed as type 1 and needed to wear them. I figure; I'm monitoring my fasting blood glucose and ketones, but despite what I think is going on, I really have no data to back any of it up, except for first thing in the morning - now would be a great time to use one of those monitors, and also track what's really going on during a 36hour fast (as opposed to what was going on right at the start, when my blood glucose was still high).

Primarily, as I understand more and more just how many non-food stimuli there are for the various hormones (including obviously insulin) that affect blood glucose, what is really going on for me now, in between meals, and during the time we refer to as the "dawn phenomenon".

 

[MrsA2]

So, I now have an appointment next Thursday for a session on health and wellbeing at my local surgery. I told my wife, and she immediately said "now, be nice.

That's exactly what my husband said when I had mine last week!!!
In the event anything I raised she just said "you'll have to contact the doctor about that".
She did take a full set of bloods (whereas hubby only had finger pricks for sugar and cholesterol). I'm getting full lipids, hba1c and liver function. She refused to write me up for thyroid (I only have half a one and think that may be at the root of some of my problems)
Once she'd found I was of normal weight, BP, low alcohol and active there wasn’t much else she could advise on.
Dotn expect too much but it was nice to feel I had 30 minutes of someone's time, even if she couldn't do much.
So, yes be nice but keep expectations realistic. We do know more then they do!

 

[MrsA2]

Oh, and I chose not to use the words keto or low carb or monitoring. She didn't even notice I was wearing a libre in the arm she did BP on 3 times. I didn't want to be labelled hypochondriac or anxious or awkward, not yet anyway.

 

[Outlier]

Nice bit of management technique there, @MrsA2.

 

[Chris24Main]

Yeah - I'm not expecting much of a welcome if I go in all armed with my "ketones vs fasting glucose" chart, demanding better cell membrane construction for all!!

And to be totally clear, I'm really not going in with anything other than curiosity. I may be surprised, and I`ve no doubt that the people laying it on are doing so with the very best intentions. No-one likes a smart ass...

In fact, I think one of the great tragedies was that there really was this golden opportunity in the seventies and eighties, where there was a recognition that diet was important, and that if all of society pulled together, we could collectively improve our health. All sorts of independent bodies over many countries were co-ordinated in a truly amazing way, and it's made a huge impact on behaviour across the world - totally measurable and real.

Except, that the levels of chronic disease have steadily gotten worse, and part of that very optimism and public spirit is what makes it so difficult to offer a view of "well, maybe those original guidelines were a bit short of the mark"

 

[Chris24Main]

Consider this a peg in the sand, or something I can judge myself against in a fortnight or so, but I thought I should make some predictions.
I'm wearing a CGM again, and while I realise better now how much there is to learn about metabolism, I do know more than I did when I was last wearing one. I find myself repeatedly saying variations along the lines of "don't worry so much about what your blood glucose and food - there are more things going on than food".

I would personally go one step beyond that; reversing T2DM is specific, but beyond that, I'm thinking more and more that the balance of hormones that we think of as metabolic homeostasis, has less to do with food, and more to do with energy provision - or put another way, a healthy metabolism is concerned more with providing you energy on demand to do things, not reacting to the food you eat.

We spend so much of our lives forcing our metabolism to react to food, that it loses track of it's true nature. That's my take on "modern chronic disease" of all types, though I do stress, this is a work in progress, and I reserve the right to confess my ignorance at some future point. I very much do not state this as fact. [full disclosure, please do not listen to anything I say, I'm only learning like the rest of us, just masochistically doing it in public as much as possible].

So - I think then that my CGM traces over the next couple of weeks should show very little variation, they will be low-ish (I am in remission, so my HbA1c is low) and there will be more variation based on non-food events than what we typically call sugar spikes - there should be zero of those.

My dawn phenomenon should be lower than at the start of the year, but some reaction is a good sign of a strong circadian rhythm, so I still expect to see some rise early in the morning.

Couple of initial results;

First - this is my "daily fasting glucose and ketones" - you can see since the summer that the red line (average glucose first thing in the morning) is gradually settling on a number around 5.5 - I don't expect it to get lower than that.
The blue line is still increasing, and increasing faster - this is the average morning ketones; they will be low in the morning, but I'm using it as a kind of proxy for fat-adaptation - it doesn't show a large amount of ketones (I'm not really that interested in level of ketosis for what it's worth) but the more my body has "on hand" in the morning, the more it shows that I'm able to produce ketones, meaning that insulin has been low, meaning that my body fat can be unlocked and used for fuel (you cannot measure that directly, but if you think of ketones being a "relief valve" for fat burning, you can see that this should hold).

All of that should say that, as I go deeper, the less (bizarrely) I should be interested in blood glucose levels - they shouldn't really change... but of course they will, because there is more to this than food.

So Day 1:

Big morning spike - except it isn't - the small raise at 9:30 and 2:00 are breakfast and lunch, and dinner was about 5:45 - you can't even see any reaction to that. The morning raise was during a paddleboard run, and you can see that the glucose level drops as soon as I get off the water.

Day 2:

Even flatter - the slight raises around 7 and 8 are simply me getting up and doing things... (I had a sunrise walk, so you can see the end of that first thing)

Then - over night;

Somehow, I cropped off the time, but this is from evening through to morning. Much more variation, yet clearly, I'm asleep all the way through.
I think this is all about the brain. Your brain can be just as active through the night as during the day - it has a lot to get done while you sleep, but I think your liver will be slower to produce glucose (this is something I need to look into ... I'm speculating) so the control is not so good.

It is an interesting point though - many people talk about exercise as a way of burning off (fat, but often I think for most people fat just will not be accessible because of insulin, so it's about stored glycogen; but let's say fuel) - when what is really going on is the body providing fuel to keep up with the exercise - that is more subtle. If you want to look at what simply burns off energy - the brain does much more of that, and just "takes". So - if you exercise and run low on energy, you can feel good, but if you are consuming energy in your brain, and run low, you feel stressed and bad.

Anyway - that's enough for now - I'll report at the end of this sensor and declare whether my predictions were worth the time to write this, or not...

 

[Chris24Main]

A thought that's been buzzing around my head - so I thought I would try to expunge it here... (you're welcome)

In various places around the forum, and in society in general, we trip over ourselves with the baggage that comes with the words we use when describing the way that we eat, and do things during the time we are not eating.

I want to be totally clear - this is really only applicable to Type 2 - classic type 2 who has developing insulin resistance which tips over into diagnosable T2DM when the pancreas loses the fight to keep up with the increased demand.

(but also this applies to nearly everyone, understanding that the goalposts for "pre-diabetes" were moved not long ago, and under the previous definition, the majority of the population has some level of insulin resistance)

There are various ways of describing "ways of eating as treatment" - and there are lots of different names - Keto, carnivore, low-carb high-fat, but it seems to me that they all have weaknesses - some people react to the word "fat" - and you can generate ketones by eating a stick of butter a day, but it's not very healthy, so I've been curious as to what is a better term..

but also trying to figure out myself what it is I'm trying to do.. what is this all about?

and it seems to me that the answer to both is the same - it's about reversing insulin resistance, but let's be positive and call it an "insulin sensitising way of eating" - because then it wraps up all the things I think are important (very me-centric, but it's my thread...)

1. Control Carbs (mainly sugar and starch)
2. Prioritise Protein (eat with fat together in real food)
3. Don't fear Fat (but stay away from seed oils)
4. Don't snack - be satisfied between meals
5. Fast intermittently - whatever you can do
6. Enjoy your food - cooking and eating should be a pleasure
7. Social connection is important too; don't let it get in the way
8. Stress needs to be considered - practice something to reduce
9. Sleep hygiene cannot be ignored - do what you can
10. Let your body work at it's own pace - change takes time

I don't mean to be all - "this is the answer!!" - it's just a list of the things I have come to think of as important in this phase of really focusing on reversing insulin resistance.

I have a feeling that reducing blood pressure is the next phase, but that can really only become a priority once you are insulin sensitive. (and since insulin resistance is one of the biggest drivers of blood pressure, it still makes sense to focus on that first).