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When low carb/keto doesn’t work

D

DEBBIESCOTT

Well-Known Member
Messages
4,132
Location
Lincolnshire
Type of diabetes
MODY
Treatment type
Tablets (oral)
Stopped gliclazide yet again on 18/10/21 because of the hypos
Since then I’ve logged everything I’ve eaten & drank on mfp and have kept to 20g total carbs (not net carbs as I haven’t deducted the fibre)
Last few days b/s had been rising & yesterday after the gym libre said 13.9 with an upward arrow, had 20mg of gliclazide & it fell quite quickly, down to 4.4 this morning.
This is the 4th time since May I’ve been back on it, seems like my pancreas needs a kick every few weeks.
I’m now being referred to a consultant to be tested for MODY, don’t know if that’s why low carb/keto doesn’t work
Been told to only take gliclazide long enough to stabilise b//s
So fed up
 
Counterintuitively this isn’t actually unheard of. It’s not entirely unusual for the liver to start deflating and pouring glucose out into the blood as insulin levels normalise. With an insulin resistant liver this can go on for a long time. Gliclazide works for you, so we have a pretty good idea that your pancreas is still able to produce and secrete a ton of insulin, even if only under duress. It took me two years of mega hardcore keto before I completely normalised. For you it’s been around two weeks? Keep calm and carry on, but stay vigilant with testing. Personally I think it’s a sage idea to also be testing ketones during a period of transition like this in order to ensure both glucose and ketones aren’t simultaneously skyrocketing.
 
In the US, carbs include fibre and those need to be deducted for net carbs, but over on our side of the pond, that's not an issue. Fibre and carbs are already separated (and thus, "net"), on our nutritional information. (I was so surprised when I got negative figures when deducting fibre from the carbs I was having... That's what I got for reading American literature on the issue. )

So if all you've been eating is 20 grams of carbs a day, with glic in the mix, high numbers and the occasional hypo due to the medication... Then yeah. Good move getting further testing done. It's still early days, but if you can get that ball rolling when it's hard to get anything done at the moment, do! And yes, I can see how you're getting fed up with all this, it'd be nice to know where you stand... You're certainly giving it your best go and not getting anywhere right now, so hopefully getting some proper answers will help with both your blood sugars and the current frustration!

Hugs,
Jo
 
Hi Jo
Thanks for replying
Only take gliclazide when the numbers go up and won’t come down no matter what, managed 24 years on diet only, this seems to be a new thing but so frustrating, never really sure if you should deduct the fibre from things like avocado & vegetables, but I’ve been so careful this time & it still doesn’t work
 
Did anything change lately? I know some people who've had covid had erratic blood sugars for up to a year and beyond, before normalising again... Could that be the matter? Or after a (booster?) jab? If you were fine for so long, something must've changed somewhere. Maybe ask for a pancreatic echo or something when you're at it, if there's nothing you can pinpoint... It's just weird.
 
Doctor seems to think something happens & blood of sugar goes up, bit of gliclazide gets it going again & repeat, being referred to a consultant who knows a lot about MODY, might have to wait months though
 
Jim Lahey said:
Exercise extreme caution mixing your medication with keto.
Thanks, not doing keto at the minute, have to have carbs with every meal while taking the gliclazide, hopefully will be able to stop it again over the weekend
Click to expand...
 
Unfortunately, this way you are adding more glucose into the body that will have to be cleared somehow after you stop taking the medication. The gliclazide will be increasing hyperinsulinemia and won’t help long term. Obviously we are unable to give medical advice as that is between you and your doctor, but I recommend reading The Diabetes Code by Jason Fung if you haven’t already.
 
Thanks, I have read it, but feel at the minute I haven’t got any other choice, at 5ft 4 and 48kg I have no weight to lose so even that’s not an option, just seems to be catch 22,
They don’t think it’s type 2 so don’t even know if eating keto can make any difference
 

I have read your post and tried to fathom why you spike very high then when you take the glic you then drop into near hypo levels. Am I right? And this is happening after exercising?

With my condition, not saying you have RH, but I have discovered that if I did too much exercise, my liver would dump glucose to offset the energy used by the exercise. This liver dump would trigger a reaction and I would spike then hypo. Of course if I had the glic added to the mix, that would see me go hypo quicker and lower.
Add insulin resistance and a low initial insulin response and it would be no surprise that you spike so quickly. Add being carb intolerance and even 50g along with a liver dump, would almost certainly have a dramatic effect on your blood sugar levels.

For my exercise, and I'm close to 70, I walk, which is quite good for blood levels control. And do enough not to trigger a reaction. Walk, walk, walk. Test, test, test.

Keep safe.
 
Hi
its ongoing take gliclazide & hypo, stop taking it & blood sugar fine for so long then just goes up over a couple of days, starts being higher in the morning for a couple of days then goes up & stays up until I have gliclazide again, then it’s back to normal within a couple of hours, had gliclazide yesterday & today, eaten carbs & 2 hypos today already, it goes up whether i exercise or not, I can sit down & it’ll just keep going up, it’s like pancreas goes slow & gliclazide gives it a kick, hopefully when I get an appointment to see a consultant he’ll have some idea, just so frustrating
 

Hi @DEBBIESCOTT,

Hugs. It must be very frustrating what you are going through ... and it's definitely not what most of us T2s experience. So, in this sense it's a good that you've been referred to an endo for further exploration -- as I feel that MODY is a possibility in your case.

Here's a link to Jenny Ruhl's website (https://www.bloodsugar101.com/mody), who's herself been diagnosed with MODY after 7 years of diet control and believing she was a T2.

Maybe some of this sounds familiar (this is an excerpt from her website):

"People with some forms of MODY are not insulin resistant. They will respond to very small doses of insulin or drugs that stimulate insulin production. If misdiagnosed as having Type 1 diabetes and given insulin, they will typically remain using the very low doses used in the so-called "honeymoon" stage of Type 1 diabetes. However, this is not always true of other forms of MODY where high blood sugars apparently cause insulin resistance, though the genetic defect, not the insulin resistance, is thought to be the primary cause of the diabetes." ​

"MODY-1 and MODY-3 respond very well to drugs that stimulate insulin secretion. In these forms of MODY, the genetic defect causes the beta cell to fail to get the signal telling it to secrete insulin when blood sugar starts to rise. A strong response to a very small dose of a sulfonylurea drug or repaglinide may actually be diagnostic of the two forms of MODY that have this characteristic."

"In one common form of MODY, fasting blood sugar is normal, but insulin secretion begins to fail as blood sugars go over 144 mg/dl. ...
​
Hope this info helps a bit.
 
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With respect, I'm not sure that Debbie has a diagnosis of hyperinsulemia (which assumes serious Insulin Resistance).
I may of course have missed this in this/other threads.
@DEBBIESCOTT
Have you had your insulin production checked by CPeptide or similar?
 
DEBBIESCOTT said:
Only take gliclazide when the numbers go up and won’t come down no matter what, managed 24 years on diet only
Click to expand...

Watching this with much interest.
I am only diagnosed for 13.5 years but now can't get my HbA1c below 7% when trying very hard to stay low carbohydrate.
I am considering that I may have to go to the next stage, possibly gliclazide, but your experience goes straight to my concerns.

If I start on gliclazide will I have to up my carbohydrates to avoid hypos?
How long will the drug continue to work.

Your strategy of taking gliclazide for a bit then stopping, then taking again if BG keeps going up is an interesting one.
Timing is the interesting part.
Like making sure you pay the Pied Piper before he steals the children.

I had a private IR test some years back and was diagnosed with mild IR.
My insulin production was low normal, but my fasting BG was above normal so I was not fully utilising the insulin.
Thus I had some IR but was not over producing insulin.
I would be interested to know (if you can find out) what your insulin production level is when you are not taking the gliclazide.

Hope you get a proper diagnosis soon.
 

It’s an assumption on my part based on the information provided. Firstly type 2 is hyperinsulinemia. Even if the pancreas has packed up, the insulin resistance remains, and any added or drug-teased insulin would need to be in high quantities, which is still hyperinsulinemia. You can’t really be a true type 2 and not insulin resistant, and pathological insulin resistance is hyperinsulinemia.

Obviously I’m not a doctor, so not making a diagnosis, but all the above point to hyperinsulinemia. Happy to be wrong but I’m willing to bet 10p I’m not

EDIT: for clarity, yes it’s possible the pancreas has had enough and is on its last legs, but a true type 2 would then need to be adding very large quantities of exogenous just to cover the resistance, which then amounts to exogenous hyperinsulinemia - the same mechanism that can bring about double diabetes in type 1. Hope I’m making sense
 
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Jim Lahey said:
You can’t really be a true type 2 and not insulin resistant, and pathological insulin resistance is hyperinsulinemia.
Click to expand...

So what are you if you only have mild insulin resistance and aren't over producing insulin?

Edit: being told that I am "Not a true T2" is a remarkably offensive approach IMHO.
 
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