Fasting and exercise

[Northerner]

Sounds like an excellent plan to me Brian, the best of luck and do let us know if you have any questions or concerns 🙂

 

[bellx15]

It has gone back up again overnight, although I haven't consumed anything.

How does that happen?

 

[mcdonagh47]

It has gone back up again overnight, although I haven't consumed anything.

How does that happen?

Its probably the Dawn Phenomenon (DP) - the body releases glucose at or just before dawn to give a burst of energy for starting the day ahead - great if you are a Caveman. That's no problem for non-diabetics, a bit of a hassle for Diabetics. And the DP can be quite powerful in some cases and run on into mid-morning.
There are various ways of tackling the DP with varying success - e.g. a small snack of long lasting carb or protein before bed.
The Dp has been the subject of ongoing discussion and experimetation by Rick Mendosa ( a major Type 2 blogger ) ....search his site on it ...
http://www.mendosa.com/diabetes.htm

e.g. http://www.mendosa.com/blog/?p=232

 

[bellx15]

I see. It isn't simple, is it.

Could I also be seeing a reaction to my sudden exercise and diet over the past couple of days? Would I be producing more glucose to compensate?

I assume I need to press on with my regime, anyway. It's a bit discouraging when there are no measurable benefits.

 

[mcdonagh47]

I see. It isn't simple, is it.

I assume I need to press on with my regime, anyway. It's a bit discouraging when there are no measurable benefits.

you will see the measurable benefit of taking control in your HbA1c ( the medium term blood test) . If you haven't had one of those already I assume a baseline HbA1c is one of the tests your Gp has put you down for in the next few weeks. If not demand one.

 

[Northerner]

I see. It isn't simple, is it.

Could I also be seeing a reaction to my sudden exercise and diet over the past couple of days? Would I be producing more glucose to compensate?

I assume I need to press on with my regime, anyway. It's a bit discouraging when there are no measurable benefits.

No, I'm afraid it's not simple, especially in the early days when you are still learning and adapting. But you are benefiting already - you already know much more than you did a week ago, and it is this knowledge and experience that will help you in the future 🙂 One of the reasons why some GPs say you shouldn't/don't need to test is because they don't want you to be discouraged by confusing or unexpectedly high readings, but you will quickly learn to see patterns in your testing and associate the highs with particular meals or events - or some may just be one-offs with no discernible explanation. Treat each reading you take as a learning experience and, if possible, record it along with your thoughts about why it might be at the level it is. In time, it will become more intuitive and you will have fewer reasons to test. 🙂

 

[bellx15]

Yes, I am down for that test whenever I choose to get my blood sampled next - in two or three weeks time. I don't think that test was done the first time around.

What pattern do you think I might expect to see with my daily morning fasting glucose measurements, if I carry on exercising and dieting?

 

[bellx15]

I've been on a restricted diet and daily exercise regime since Monday evening, and really not much change yet. My FBG seems to be stuck in the 11s. My weight hasn't dropped more than about three pounds, though. Maybe once the weight starts falling away I'll see better readings. I have no idea how Gareth managed to lose ten pounds in the first week!

I need some glimmer of a change to stay motivated here. I think I'll stick for now with the hypothesis that FBG is only going to follow weight. So I'll try to get a few more pounds off and see what that does.

Of course, I have cut the drinking 'cold turkey', so perhaps that is having an effect too. Any sudden changes in diet or other habits, I believe, is going to evoke compensatory reactions from the body.

BTW - what is the thing about diet shakes? Would a normal but reduced quantity diet be OK? Just to get the weight down, burn some abdominal fat off, and see the results?

 

[Northerner]

I think the idea behind the diet shakes is that they provide you with all the necessary nutrients and vitamins your body needs, at the lowest calorie (or a specific calorie) intake. Creating your own restricted diet may leave out some things you hadn't considered or weren't aware of - certain trace elementsm for example.

I always find that it takes around 5 days to a week after stopping after a period of regular drinking before I start to notice benefits in my weight and blood sugar levels, so going cold turkey may be the reason for a slow start for you. Stick with it, be patient 🙂

 

[bellx15]

Ok, thanks for the reassurance. I'll stick with it.


[Later today]

Well well! I just thought I'd try doing a test this evening to compare with the morning reading (of 11.6).

It is 6.7 !!! And that is 4-5 hours after a meal.

Anyone understand what is going on here?

 

[Mark T]

Nice result 🙂

It's difficult to figure out how the readings relate. It depends on what you ate and how active you were.

Might be worth you doing some readings just as you go to be and some when you wake up, that might give an indication if your body is doing the dreaded dawn phenomenon,

 

[Northerner]

Ok, thanks for the reassurance. I'll stick with it.


[Later today]

Well well! I just thought I'd try doing a test this evening to compare with the morning reading (of 11.6).

It is 6.7 !!! And that is 4-5 hours after a meal.

Anyone understand what is going on here?

You will have been active during the day, so your sensitivity to the insulin you are producing will have helped bring your levels down 🙂 Insulin resistance tends to be greatest in the morning, plus there is the problem of Dawn Phenomenon whereby your liver dumps extra glucose into your blood as you wake. Your meal would normally be fully digested by 4-5 hours 🙂 You need to be comparing like for like i.e. morning readings with morning readings, bedtime with bedtime etc.

 

[bellx15]

Right - but for me the point here is that the high morning readings don't necessarily indicate high all-day readings. I was assuming the FBG reading would be the lowest, but obviously it isn't.

If I am something like 6.7 in the daytime, that's not so bad.

 

[Mark T]

Right - but for me the point here is that the high morning readings don't necessarily indicate high all-day readings. I was assuming the FBG reading would be the lowest, but obviously it isn't.

If I am something like 6.7 in the daytime, that's not so bad.

Not at all, for me my FBG is usually one of my higher (pre-food) readings.

From what I understand there are a lot of hormones and chemicals floating around your body first think in the morning (hang over from caveman days) and they mostly make your readings higher in the morning. For the same reason you are at your most insulin resistant first thing in the morning.

I think quite a few of the type 1's have different carb/insulin ratios in the morning compared with the rest of the day.

 

[bellx15]

Sorry Mark -

[edited]

You mean it is not the lowest value in a day. So how bad is it if my average daytime value turns out to be something like 6.7?

I am still full of questions, so apologies in advance. One is:

If the test to take notice of is the HbA1c, which indicates an average value over two or three months, how important is it (for health) to also measure the short-term peaks? Is diabetes diagnosed on the basis of the HbA1c alone, on spot checks alone, or what?

Thanks!

 

[Northerner]

Sorry Mark -

[edited]

You mean it is not the lowest value in a day. So how bad is it if my average daytime value turns out to be something like 6.7?

I am still full of questions, so apologies in advance. One is:

If the test to take notice of is the HbA1c, which indicates an average value over two or three months, how important is it (for health) to also measure the short-term peaks? Is diabetes diagnosed on the basis of the HbA1c alone, on spot checks alone, or what?

Thanks!

Hi Brian, taking a couple of tests (or more) during the day won't really give you a daytime average as they are all 'moments in time' - snapshots of how your levels are at that particular moment. From minute to minute your levels are affected by many factors so can be quite different according to these factors (things like food eaten/when eaten, activity levels) - if you are not taking readings at the times when your levels are likely to be at their peaks then your average will be non-representative. You can, however, get a rough guide of your average daily levels if you are prepared to test more (the more tests, the closer to reality the average will be) - tests on waking, pre-meal, post-meal (1 and 2 hour) and pre-bedtime.

Health care professionals (HCPs) will take account of both the meter readings and the HbA1c as they tell different stories. The HbA1c is an average over the previous 6-12 weeks, but this may be comprised of quite widely varying levels day by day, so whilst it gives an indication of general control, it won't tell you when you ate something that spiked your levels up or when your levels dropped unusually low like a fingerprick test will.

As I discovered when I was diagnosed, the human body is an incredibly complex thing with all sorts of influences, and diabetes really gets to the heart of this as it is all about food and energy, how the body uses and processes it, and it affects every part of the body as an imbalance of glucose in the blood will impinge on everything. I often think HCPs oversimplify things by suggesting it is a case of 'eat this, do this and your diabetes will be controlled' - you need a much deeper knowledge and sustained effort to keep things on the straight and narrow. Once you have found the right balance then things do become easier and more instinctive, but there are no quick fixes.

 

[Mark T]

Difficult to cross reference when I'm posting from a smart phone. But the bloog sugar 101 website references a number of studies that relate the 2 hour postprandial levels to cardio events and thus mortality.

I think the HbA1c being an average is limited. Your levels might be ok but you could still be damaging yourself by going very high or very low.

6.7 would be high for my personal targets, but would probavly be within the general nhs targets that I have seen.

 

[bellx15]

Thanks again for the further info.

Update: It looks as though I have pretty dire glucose intolerance - just about to conduct the 2-hr test after food. So far, I had a 6.0 prior to eating two smallish potatoes, a piece of bread and a blob of jam. One hour later it was 14.8!! After two hours it was still up at 13.0

So I am preparing myself for going back to the GP to accept that medication seems to be unavoidable, at least for now. Two questions:

1. Is there a medication specifically for controlling post-meal surges? I can keep my general level down to 6ish just with diet and exercise, it seems.

2. Can this medication be used on a temporary basis, while I continue with my attempt to get my glucose tolerance back by diet and exercise? I don't relish committing to medication if there is no escape from it for the rest of my life. I still hope to be able to recover my health by natural means.

Thanks!

 

[mcdonagh47]

If the test to take notice of is the HbA1c, which indicates an average value over two or three months, how important is it (for health) to also measure the short-term peaks? Is diabetes diagnosed on the basis of the HbA1c alone, on spot checks alone, or what?

Thanks!

Recent research suggests that Post prandial Spikes in BGs are just as indicative of future complications as high HbA1cs.
But the major study of Type Diabetes in the 1990s, which still informs medical strategies ( The UKPDS), showed that high HbA1cs ( over 6.5) were
dangerous in terms of future complications so that is set in stone.
In general the medics want to macro-manage your Type 2 via medium term measures like the A1c, you need to micro-manage it to reduce post prandial spikes. That's the clash of strategies that's at the root of the disputes over Test Strip allocations and Docs telling new T2s that they don't need to test.

Micro managing your bgs will of course bring a good HbA1c inter alia but the medics don't seem to grasp that.

BTW the HbA1c is not a measure of average BGs, it measures something else entirely ( Glycosulated Haemoglobin) but it is a good measure of average control.

 

[bellx15]

"Micro managing your bgs will of course bring a good HbA1c inter alia but the medics don't seem to grasp that."

Maybe they just don't like splashing out on prescription test strips?


OK - so I will have to continue with diet and exercise (which is pretty enjoyable in this weather!) and also try to organise a Low Glycemic Index regime. I'll check my reactions in a few days time, and then get back to the doc with my findings.

I am relieved to see that such a diet is possible without making me lose the will to go on; also that I can still have moderate quantities of alcohol. 🙂

I have to say again: The weird thing for me is that I get absolutely no symptoms of high BG - apart from fuzzy vision in the morning.