Dawn phenomon - first thing to go?

[Jock Coats]

I kind of hesitate to put this in the "weight loss" board because to me the Newcastle/8-wee blood sugar diet is not about *absolute* weight loss as it is about specifically getting rid of fat in the liver and pancreas to stimulate insulin tolerance and production, but I've been doing it was nearly a week now having seen a lecture by Roy Taylor last Monday night after a day of 5:2 fasting and decided to just carry on.

But I just wanted to run something past people that I've noticed straight away. In Taylor's charts he shows that fasting blood glucose seems to drop to a near "normal" range very quickly - within that first week for most of his subjects. Now I've been wearing a Freestyle Libre sensor for some months now and even when under the best control I have achieved with medication, I experienced an inexorable rise from about the middle of the night - 4 or 5am (and sometimes earlier) from a low point of between about 3.5 and 4.5 to 6 or more before I wake and 7 or 8 regardless of whether I have breakfast by about 9am.

I thought this was what is known as "dawn phenomenon" and it has been quite difficult to reduce. I can limit the rise by exercise just after I wake, but not prevent the rise while I sleep. But just a few days into this low calorie system I have noticed that it appears to have all but disappeared. My blood glucose with a prick test has been around 5.1% shortly after waking and remains pretty stable until after I have breakfast. I'm wondering if this might indicate that even after only six days my system is reacting better to glaucagon production with either more insulin or better sensitivity to insulin.

I might have noticed it the day after each of my previous "5:2" fast days but less obviously. I literally now seem to "flatline" right through he night instead of beginning to rise from right in the dead middle of my sleep. Thoughts?

 

[trophywench]

My thoughts are just 'Wow! - that sounds phenomenal!' Jock.

DP is one of the trickiest things to bring any control over - so I'm impressed.

 

[Ljc]

I’m impressed too, for the same reason as Jenny.

 

[Jock Coats]

It may be illusory! And five days hardly makes a long term trend. But since DP is not related directly to eating, I'd be slightly surprised if it was just because I am tending to go to bed with lower glucose levels anyway owing to the low calorie diet. In fact if your body needed it surely it would try and create more out of fat stores. I first noticed it the day after I first did a 5:2 fasting day. It *could* be the darker mornings I suppose. But then you'd think it would have been apparent for a bit longer that just these five days. Nevertheless it look unmistakeable. One image is the 90 day pattern and the other is the past seven days:

 

[Radders]

Is it possible that on a very low carb diet, the liver’s stores are so depleted that there’s nothing there to release?
It’s a genuine question and one I have been wondering about for a while since I noticed that when I have low carb days my basal requirements overnight are reduced.

 

[Jock Coats]

I certainly think that's a possibility. I would just have thought with my history I would have had bigger stores 🙂 Though I did find it remarkable on Roy Taylor's presentation that people on his diet dropped from "20" (whatever unit that was of liver fat content) to "2" seemingly very quickly and wondered if this was evidence. The idea that you only need to lose one gram of pancreatic fat to kickstart insulin production seems to suggest we are not talking about a lot. It would have been interesting to see it on the MRI scanner 🙂

Of course it may be a preservation strategy too - I'm not giving up so much of my stores if I'm not being replenished as much as I'm used to.

 

[Flakie]

I may be going slightly off topic here but I was interested in the charts that Jock put up here. Is there a way of roughly calculating your HbA1c score by using the data of your early morning tests, or those during the day? How many would you need to make some sort of prediction? I’m probably due one in about six weeks if they do them 3 monthly but would love to get a heads up now! Sorry if I’ve hijacked the thread but it made it easier to refer.

 

[grovesy]

The app mySugr does an estimate it needs at least 3 readings for a week.

 

[Amigo]

I may be going slightly off topic here but I was interested in the charts that Jock put up here. Is there a way of roughly calculating your HbA1c score by using the data of your early morning tests, or those during the day? How many would you need to make some sort of prediction? I’m probably due one in about six weeks if they do them 3 monthly but would love to get a heads up now! Sorry if I’ve hijacked the thread but it made it easier to refer.

Flakie, much depends on how many times a day you test to reflect an accurate b/g level. There needs to be levels after food too. Do you know what your average level is over 7/14/30 days?

 

[Robin]

I may be going slightly off topic here but I was interested in the charts that Jock put up here. Is there a way of roughly calculating your HbA1c score by using the data of your early morning tests, or those during the day? How many would you need to make some sort of prediction? I’m probably due one in about six weeks if they do them 3 monthly but would love to get a heads up now! Sorry if I’ve hijacked the thread but it made it easier to refer.

There is an estimate of HbA1c from finger prick tests, but it would only be accurate if you had done tests at every part of the day, ie when your blood glucose is at it's highest, as well as when it is at its lowest. Just basing an estimate on the morning readings would be misleading as it wouldn't take account of any spikes you get after eating.
Edit. Amigo, you beat me to it, must learn to type faster!

 

[Jock Coats]

I'm not sure how they estimate it. It wasn't too far out when I had my last lot done. It was a little on the low side, but then I had had a few sensors not working that produced several days of 2mmol/l which skewed it. I was very sceptical about it to start with but pleased at how reasonably accurate it appeared in the outcome.

I actually usually use some different software, called DiabetesPal (no space!) but it doesn't produce such presentable charts and it too makes an estimate.

I imagine it's quite a blunt tool. Taking the moving average over 12 weeks and doing something like this: https://www.glucosetracker.net/blog/how-to-calculate-your-a1c/

 

[Jock Coats]

Of course, you'll probably find it more difficult to get any sort of average with point-in-time finger prick tests. A benefit of the Libre is that it is constantly recording, albeit ISF rather than plasma, glucose so can come up with reasonable averages over whole days/weeks/months.

 

[Flakie]

Thanks for the advice. I test where I can but sometimes I’m just not in two hours after lunch or brekkie for instance so may not be too accurate. Will try harder!

 

[Jock Coats]

But it has undoubtedly helped me to see that average to know what my general trend is. For instance when I had my last test at 5.2% I kind of let up a little with my low LCHF diet and a little with my exercise. And while the doc told me to stay on 1g metformin "for now" I actually tried to see what I could do without, and over the past eight weeks or so, until I tried intermittent fasting, its prediction was rising by about 1mmol/mol a week so I decided to try something different (i.e. the intermittent fasting, and now the Newcastle/Mosely diet).

 

[Jock Coats]

Thanks for the advice. I test where I can but sometimes I’m just not in two hours after lunch or brekkie for instance so may not be too accurate. Will try harder!

But remember the "average" it is taking includes all the data from low periods too, when you won't feel much of a need to test, not just your after meal "spikes". So if you test then it's likely to be much higher than your actual average over a day. I think it might be difficult to predict with confidence with that "continuous" monitoring.

 

[Amigo]

This is a good conversion tool;

http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

 

[Radders]

I certainly think that's a possibility. I would just have thought with my history I would have had bigger stores 🙂 Though I did find it remarkable on Roy Taylor's presentation that people on his diet dropped from "20" (whatever unit that was of liver fat content) to "2" seemingly very quickly and wondered if this was evidence. The idea that you only need to lose one gram of pancreatic fat to kickstart insulin production seems to suggest we are not talking about a lot. It would have been interesting to see it on the MRI scanner 🙂

Of course it may be a preservation strategy too - I'm not giving up so much of my stores if I'm not being replenished as much as I'm used to.

I was thinking more of the liver’s stores of glucose rather than fat, I’m not sure if you’re referring to the fat in the liver?

 

[Jock Coats]

I was thinking more of the liver’s stores of glucose rather than fat, I’m not sure if you’re referring to the fat in the liver?

Oh yes. I see what you mean now. And its stores of glycogen are not large. SO that might be the case. I rather assumed that if it wanted to it would make some from fat stores too 🙂

 

[Radders]

Oh yes. I see what you mean now. And its stores of glycogen are not large. SO that might be the case. I rather assumed that if it wanted to it would make some from fat stores too 🙂

Is that even possible, do you know?

 

[Jock Coats]

Is that even possible, do you know?

No, I don't know. But I rather assumed that that was the mechanism by which you burned fat - that the liver asked for it when energy was demanded and it broke it down to short chain carbohydrates before sending it round your system? Is there another mechanism for "burning fat" in the normal course of diet/exercise etc? I'll try and find out 🙂
EDIT: or is all fat burning "ketosis"?