Type 1, Type 2 - no idea

Hi Everybody

I got off the meds within 2 months of being diagnosed as diabetic 18 months ago. I had a Hb1Ac of 115 and finger prick of 26. Max dosage of Gliclazide, lots of research and a low carb, good fat diet got me down to 58 and am now down to 35. So all good you say? Well no, even on the diet and controlling what I eat and Fit Bit scales that tells me my percentage body fat is 22.8 I am very very slowly putting the weight back on. (I lost 2.5 stone though keto acidosis - great for weight loss - shame about the body)

The question that's really bugging me is if a try the 5:2 diet or similar i.e. calorie restrict for a couple of days a week in order to get traction on the weight loss, I end up with the shakes and a capillary blood glucose which typically shows 3.5 to 3.8. which is not good. (Below four, drop the floor as the nurse would say.)

What I don't understand, is how can I get so low without meds (I have never been on Insulin - although was threatened with it due to the high Hb1Ac and its 12 months since I took the Gliclazide)?

The medics don't know whether I have some type of Type 1 or a severe Type 2. I have a BMI of 26, am reasonably fit (just spent the a week chasing my adult kids round a mountain skis and so not completely past it). Through the good fat low carb diet my own cholesterol meter shows me at 3.6.

It would really help if I could do 500 calories for a couple of days a week as I am sure it would nail the gradual weight gain.

Has anybody else come across this?

Your help is much appreciated.

Many thanks

Peter

Hi Peter, these folks are much cleverer than me, not sure about the technical stuff, but wanted to welcome you and say nice job on the efforts and progress with your numbers, I'm not sure about the below 4 rules, I can happily function around 3.7 without any issues, I would be unaware if not testing at the time of the lows, anyway, welcome! And I hope these folks can help

Andy

Many thanks - I must admit I struggle below 4 with shakes and needing to eat. From the various FB groups I am in, it seems every body is different.

Many thanks for the welcome, its much appreciated as its great to have other people who are facing the same battles to bounce ideas off

All the best

Peter

Hi and welcome Peter, sorry to be so tardy with response to your post

Think you can rule out being Type 1 as without injected insulin you would be rapidly losing weight, with the blood glucose levels that you quoted it's clear you are producing your own insulin

Clarifying the keto acidosis which can cause DKA in Type 1  your confusing that with ketosis see the explanation from the dietdoctor here https://www.dietdoctor.com/low-carb/ketosis

Cheers 
Graham

I used to get "reactive hypoglyemia" due to a lack of Phase 1 insulin but still a good Phase 2 response, which meant that after eating my dietician-approved carbs my BG would shoot up mostly to 8 - 10 but seldom higher, then the insulin would turn up late and shoot me rapidly back down to 4 or less.

In my case, as for most RH sufferers, stopping the spikes stopped the lows.

It looks from over here as if you have something else going on. Had your thyroid checked for example? Do you have your trigs or HDL numbers?

Its a while since they tested for Trigs and HDL - I think my kit can test for trigs. My thyroid hasn't been checked. Throughout my life I have had this but didn't have the kit to test BG. However, over my life (I am 57 now) I have slowly been reducing the amount of sugar to the point at 50 I stopped eating cakes and sweet things. My specialist diagnosed me as type 1 but I can't be a full on type 1 otherwise I would need insulin. Suspect there is an autoimmune issue going on as my daughter has autoimmune issues with gluten and dairy. Will test for trigs and see if I can test for HDL as the next step I can do. I have a hospital appointment with the endocrinology team so hopefully can get them to do the full test.

Many thanks for your thoughts

Welcome Peter and well done in getting the HbA1C down.
As far as type 1 or type 2, there is a test you can ask for called GAD test. I won't bore you here but you can Google it. That will tell you if you have the autoimmune type ( 1 or insulin dependant ) or severe type 2.
As for the weight loss/gain, that's not an easy one. I do know it's tough to lose and very easy to put on, especially over a period of time. An excess of 200-300 calories a day will soon creep up on you.
Keep us updated with your progress.
Mo

Mo

Very many thanks, I will check that out and ask the specialist when I see him

Best wishes

Peter

Just wanted to say hello and welcome to the Forum Peter ...

Reading through the thread it seems that you have things to check out.
Hope your next hospital appointment goes well, and as Mo has said do please keep us posted.

All the best Jan

Trigs/HDL ratio is a good thing to keep an eye on, it correlates to insulin resistance. 1.3 or less is "normal". Mine was nearly seven and now is generally 1 or less.

It actually sounds as if you are producing *too much* insulin. Or to look at the other side of the equation (Roger Unger) not enough glucagon, something you might ask about.

Agree the GAD would be a good test. If you can persuade them, insulin levels would also be indicative. Gold standard would be an Insulin Assay a la Joseph Kraft, but I very much doubt the NHS would even consider that.

https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/

Might also be worth poking around here

http://www.diabetesgenes.org

there are other weird and probably genetic forms which are similar but not technically MODY, such as what runs in one specific line of my family, mainly but not exclusively in males - other people with similar symptoms may have it predominantly in females or balanced between (among?) the sexes.

Chris

Brilliant - some really good pointers for me to research. Interesting you say you have been reactive hypoglycemic for 50 years. From what little I have read so far this seems to fit with my own bodies over reaction - with the testing kit I have definitely shown I can go sub 4.0 on occasions which until now has not made any sense.

I have asked my question on a number of forums and the response I am getting is way better than anywhere else.

Very many thanks

Peter

Hi Peter and a late welcome from me. For what my opinion is worth no way are you a type 1 diabetic. If you was a type one no way could you be holding non diabetic numbers with no injected insulin. Also, it appears to me you are a very long way from being a "bog standard" type two diabetic. Most type two's have to work hard to keep BG down, very low BG numbers (no meds) is almost unheard of. Clearly something unusual is going on in your case. This info could be of interest   http://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

I read an earlier post where you said you done away with sweet things cakes etc. If it's not impertinent of me, what is you average carb content per meal and day. Are you eating at regular meal times and consuming similar meals regarding fat, protein and carbs content.

Kind regards

Eddie

Very many thanks, all help us appreciated.

I agree with you regarding your comments hence asking the question as the medics don't have the time or will to really figure what is wrong.

In terms of diet, I eat protein, above ground veg, no caffeine, good fat ( nut based breakfast, avocado, olives, full fat whatever and coconut and almond flour based recipes) minimal dairy.

I am starting to weigh protein although am getting conflicting advice in terms of grams of protein and so have opted for approx 50-70g per day.

So hopefully under 10g of carb per meal but I need to be more accurate and measure more.

I do 3 meals per day; 7:00, 12:30 and 19:00 (due to collecting partner from the station) I then try to not eat until breakfast the next day in order to achieve a BG of less than 6.00 the following morning.

Weight management is still an issue and if I go to low on the calories during the day I can easily achieve a BG less than 4:00 by 18:00. (No carbs to cause an insulin spike and so doesn't make sense.)

I will look at the reactive hypo material as it may have some clues

I am a diabetic as if I eat something that has hidden sugars I can hit 7.00 or above without trying

Again, very many thanks for all the brilliant responses

Best wishes

Peter

Hi Peter

"I am starting to weigh protein although am getting conflicting advice in terms of grams of protein and so have opted for approx 50-70g per day"

This may be of use to you and others.


Back in the early days of becoming a diabetic, nine years ago this month, I kept a very strict food diary. I logged and weighed everything I ate, calculating protein intake I made a big mistake. I was weighing the raw meat to check calories and did not know at the time, how high the water contend of meat is, even after cooking. My calculations on protein intake were around 50% out. One thing is for sure, we pay a lot of money for that water, and of course, there are no calories in water.

"Meat and poultry are composed of naturally occurring water, muscle, connective tissue, fat, and bone. People eat meat for the muscle. The muscle is approximately 75% water (although different cuts may have more or less water) and 20% protein, with the remaining 5% representing a combination of fat, carbohydrate, and minerals. The percentage of naturally occurring water in meat varies with the type of muscle, the kind of meat, the season of the year, and the pH of the meat. Fat in meat is found both between muscles and within muscles. In both locations, fat contributes to overall flavor and juiciness in meats"


Information from here  https://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/meat-preparation/water-in-meat-and-poultry/ct_index

Eddie

Brilliant, very many thanks for sharing

Best wishes

Peter

This was my salvation

http://loraldiabetes.blogspot.co.uk/2009/04/test-test-test.html

of course I was specifically told by my doctor NOT to use a meter, as most people aren't.

It quickly showed that my fasting was usually around normal but could go high or low especially after a prolonged fast, like for blood tests. My two hour postprandials were generally around normal too. My 1 hour numbers were generally high, and depending how high they went the three - four hour postprandials would go low. I've described it as the insulin turning up late to the party and then hanging around after all the glucose had gone home.

Trigs/HDL ratio was nearly 7, which rapidly reduced to around and usually below 1, so I nailed my IR.

The most important thing I discovered was a massive change in carb tolerance over the day. Initially I was limited to around 15g at breakfast and around 30g by evening. After low carbing for a while (plus getting older!) the morning number dropped to around 10g carbs but by evening I could get away with 50 - 80g and sometimes over 100g without spiking too badly. Not that I DO, but I CAN. Mostly I aim at around 50g carbs with most in the evening. Cutting out wheat completely helped with a load of other symptoms too, it soon became apparent that it spiked my BG even worse than sugar, and the only thing worse was wheat mixed with other carbs. I suspect wheat germ agglutinin rather than gluten - it affects insulin receptors.

The controversial bit is that I gave up bothering to test when most of my numbers were between 4 - 6 and occasionally 7 or so. I've been principally dependent on fats and ketones since then and my current "test" is to sniff my early morning pee. If it smells of ketones but not so much during the rest of the day then I reckon I am using them at around the same rate I am generating them. As a result since I am no longer dependent on glucose even when it drops it no longer gives me symptoms.

Like most people I spent (wasted) my life dutifully eating "low fat" with what fat I did eat being "vegetable oils" ie. high Omega 6. I never gained weight until AFTER I met a dietician, who insisted on deleting even avocados and nuts and replacing them with even more carbs. I always used to get starving hungry ("hangry") every two to four hours, which I now know to result from the rapid BG drops, and the dietician left me constantly hungry and semipermanently exhausted, and my lipids got worse and my BP climbed inexorably, so naturally I was accused of "failing to comply" with the diet.

When I actually DID fail to comply with the diet I improved rapidly. Now I eat a thickly buttered oatcake with smoked salmon for breakfast - just enough to tell my liver that my throat hasn't been cut - then I routinely go 5 - 8 hours and often 10 hours or more without getting hungry, and I don't bother to eat until I am. Often I only have one "meal" any time between late afternoon and late evening. Sometimes (more often in winter or the day after I've been active) I eat two smaller meals. I often don't snack but sometimes I may have nuts or even another buttered oatcake with salmon or ham, or cheese. I had one with cheese just now!

Does any of this sound familiar at all? Not necessarily suggesting the same will work for you, but that if you test and stick at it you will probably find your own "sweet spot".

Chris

Very many thanks for sharing.

As an engineer/scientist and love of technology, I enjoy the collection of the data and so I test, have the BG meter hooked up to my PC so that I can download the data and produce charts and graphs. (It is what allowed me to convince the specialist I could do this without drugs - as the drugs seemed worse than the original problem.) I also have a FitBit and FitBit scales so I can measure heart rate, theoretical energy used, exercise and weight and body fat density. It is also all recorded so I don't have to write it down. I also have a cholesterol meter that measures Total and Trigycerides (couldn't find one to do HDL). (Which are 4.0 and 0.8 respectively.)

I used to regularly experience "hangry" before diagnosis and the new diet. I rarely do now - just feeling hungry which I am cool with - however the low BG and the shakes mean I have to then eat. I normally go 5-6 hours between meals but struggle above that but not always.

I suspect I need to lower my carb intake further in order for my fat burning metabolism to work properly and then I think that would help with my morning BG readings as they can be about 5.5 if I am sufficiently rested during the night otherwise they are low 6s.

You have given me some really good pointers as I suspect our diabetic challenges are similar. I have dug out my Ketones testing strips (I had ketoacidosis for awhile - great diet, shame about the affects ) and so will test for ketones to see if the fat is being metabolised (no sense of smell).

Chris, thanks again, knowing somebody else is having similar trials is comforting especially as I seem to be following your path and getting similar results.

Best wishes

Peter

Engineers make the best patients - and some of the best doctors! (Bernstein, Michael Eades).

Since you may be overgenerating insulin, or more likely not producing enough glucagon, I'd try tweaking your protein up so you have extra from which to generate glucose. Protein increases insulin but also increases glucagon to compensate - the two are very closely matched in "nondiabetics" - becoming the minority of the current population. I know enough diabetics who have tested friends and family and found just like Bernstein (who used to test meter salesmen) that truly normal people have BG VERY closely controlled around 4.5 - 5 even after eating a hundred or two grams of carb or running a marathon.

There may be insulin resistance between the beta cells (insulin) and the alpha cells (glucagon) so they lose this ability to track properly. When Joslin looked at some of their long term well controlled Type 1s they found they still produced tiny but measurable quantities of insulin even after 50+ years of diabetes. Theory is because this was generated in close proximity to the alpha cells it was sufficient to better control the glucagon, which releases glucose from store as glycogen in the liver.

Basically you have the tech and the ability to try some tweaking and see what results. Best of luck!

Chris, very many thanks for that.

I have been watching a bunch of videos by Dr Eric Berg on YouTube - some really interesting stuff and he is good at explaining human biology in a way that is easily understood.

Best wishes

Peter

Some hugely technical stuff

http://eprints.nottingham.ac.uk/33792/1/art%253A10.1007%252Fs11538-016-0181-1.pdf

gives you some idea of the complexity involved.

Some people who get high morning BG find a late night snack helps control it. One favours a glass of wine and some nuts. Another uses a biscuit and cheese - the fat slows the metabolism of the carbs down so when the liver takes a peek in the early morning it realises it doesn't have to dump a load of glucose, which often overshoots the insulin.

The main problem is that some of the body's responses shift quickly but some may take a lot longer to adapt, hence your tweaks may need to change over time. Certainly I have become much more predictable. After years of blatting myself with far too many carbs I obviously lost metabolic flexibility

http://www.gnolls.org/3637/what-is-metabolic-flexibility-and-why-is-it-important-j-stantons-ahs-2013-presentation-including-slides/

after a few years I have regained it to the extent I can eat crap occasionally, drop out of ketosis and then go straight back in. Something HCLF breaks even in "nondiabetics".

I'd say it's unlikely you are Type 1 - but there are many variations. A child will generally go from normal to "die without insulin" in a matter of days. Some adult onset Type 1/LADA may take months or even more than a year - I've seen some Type 2s progress faster. Dunno how common but some people have an autoimmune reaction not attacking the beta cells but actually attacking the insulin itself. Then the insulin receptors may be affected - I suspect that's where my overreaction to wheat comes in, and since it's far from uncommon you might try total wheat elimination - same for your relatives - NOT just gluten-free as the gluten may not be the (only) culprit.

Some of this obscure stuff I learned from an engineer (so no surprise there then) who like many was originally diagnosed as Type 2 but turned out to be Type 1, so had a good grounding in knowledge of both types which sadly many Type 1s take pride in lacking.

Jenny

http://www.phlaunt.com/diabetes/

has a strange genetic MODY type, Alan

http://loraldiabetes.blogspot.co.uk

is a fairly typical obese Type 2 - or was! Yup another engineer who soon gained excellent control.

Chris

Love the article of using differential equations to determine how to model the connection between the body having a constant requirement for energy, the discontinuous supply of energy to feed that requirement and the ability for the body to switch between our dual fuel cell storage of carbs and fat. In between the really clever stuff is some interesting info.

I have sussed why I sometimes get raised BG values in the morning. If I test immediately after waking I get solid readings sub 5.5. If I shower and shave first I get raised levels and from research it because the body kicks in some hormones to get the body going after waking which includes producing some glucagon to raise sugars to get the body going hence the higher reading.

My mission now is to reduce the insulin resistance and get my body to flip easily between the different sources of fuel. I can see the importance of the fasting state and will look at keto type diets to help the body get used to working in both modes.

I suspect I have some autoimmune issues but I think I need to discount those for awhile whilst I get what I have working better. I suspect I have/had severe type 2 initially but think am making progress at resetting my metabolism with the low carb, good fat diet. Weight management, exercise and de-stressing are all work in progress.

I will look at the other links later and keep you posted but the help I have received so far from you and the other forum members has really moved my understanding forward and I hope there is something in here for others struggling to figure out the best way forward for them.

Best wishes

Peter

Yes, Dawn Phenomenon. What used to happen to me is if I fasted overnight for blood tests (14+ hours) I could never be sure if I'd be low or high in the morning, and sometimes I'd be low before going to the surgery and high by the time I got back. Now my BG is, well not exactly rock solid but close enough for jazz.

I knew a Type 1 engineer who'd written a computer programme to calculate his insulin doses. It included not only carbs but protein intake, time of day, phase of the moon (not really), exercise etc. and worked on a multicompartment basis between digestive tract, blood and tissue levels.

Ted Naiman has some excellent stuff and puts it into graphic form

https://twitter.com/tednaiman/status/607784775701569536

as one example. He has loads on insulin resistance and the way it is behind so many of the "diseases of civilisation". Some of his dietary advice is a hoot.

Chris, very many thanks. I thought I would show the group what is possible on a low carb diet as I have now got my blood machine talking with my computer again (you have to love the automatic upgrade to Windows 10 whether you like it or not!)



The recent spike to 8.4 was my attempt at making a low carb diabetic christmas pudding. Also, I have removed a lot of variability by taking my BG immediately on getting up - so rocking and rolling now hopefully or least until the next hiccup!

Hi Peter

Butting in on your conversation with Chris ...

As you know I'm not diabetic but do live the LCHF lifestyle ...

I just wondered 'low carb diabetic christmas pudding' what recipe you may have used?

All the best Jan

Jan

No problem joining the conversation. I have no qualifications in this area - this is me reading through recipes and trying to pull things together and then testing myself the next day.

I can't find the original recipe but this is the next version I am going to try, its very similar but with a reduced amount of currents in and no sultanas and raisins which was too much dried fruit. I might also switch round the parsnip and almond, so 200g almond and 100g parsnip.

Spotted Dick / Christmas Pudding
INGREDIENTS
• 50g melted coconut oil
• 100g ground almonds
• 200g grated parsnip
• Lemon zest
• Orange zest
• 1 egg
• 75ml dry red wine
• 2 scoops protein powder
• 2 scoops vita powder
• ¼ tsp ground nutmeg
• 1 tsp ground mixed spice
• ½ tsp ground cinnamon
• 75g currents

METHOD

Mix all the dry ingredients together. Pour in the wine and coconut oil and then mix in the egg. Give it all a good stir and transfer into to pint bowl.

Cover in baking paper and tie with string.

Place in a steamer and steam for 1 hour.