Blood Glucose Levels Over the last Three Months

Here are my blood glucose numbers over the past three months. I have been fasting the last week so the number are lower during the fast. This is an average of 113, and a HbA1c of 5.7. The normal range for level for hemoglobin A1c is less than 6%. Note that I am still taking Metformin. I am also doing High Carb, Healthy Fats plus Intermittent Fasting.

Another fast so soon?

I started a new fast on Sunday so I am at day 4 now. So far it is going very well. Not very hungry and not too grouchy (that I can tell). I’ve dropped off half the weight I regained over the four days of eating.

Stopped taking Metformin on the third day of this fast. My blood sugar numbers are up a bit but still on the low end. By dinner time last night my Blood Sugar was 88.

Considering starting up some exercise. Not for weight loss, it might in fact hinder some weight loss. More to work on my Blood Pressure. I have had a nice mountain bike since 2007 but I rarely ever ride the bike. So I bought a trainer which is attaches to the rear tire and turns the bike into a stationary bike.

40-5838-whi-angle

One of my Keto/fasting heros, Tom, uses an ap called Kinomap. It lets you ride in different places in the world where people have recorded videos of their rides.

I pulled the bike out of the basement, cleaned it off and pumped up the tires. Hopefully I will be in riding shape by Spring. There’s a great bike trail very near to here,

GREAT ALLEGHENY PASSAGE ®

150 miles of biking and hiking from Cumberland, MD to Pittsburgh, PA

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Remission of pre-diabetes

Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: randomized control trial

Results After 6 months on the HP diet, 100% of the subjects had remission of their pre-diabetes to normal glucose tolerance, whereas only 33.3% of subjects on the HC diet had remission of their pre-diabetes. The HP diet group exhibited significant improvement in (1) insulin sensitivity (p=0.001), (2) cardiovascular risk factors (p=0.04), (3) inflammatory cytokines (p=0.001), (4) oxidative stress (p=0.001), (5) increased percent lean body mass (p=0.001) compared with the HC diet at 6 months.

Thoughts on Fasting

I just finished something that most people would consider unthinkable. I just did a ten day fast and it was really easy. Here’s some thoughts on why it was so easy.

1 – Coffee.
2 – I am still 60+ lbs overweight.
3 – I am a meat eater so eating my own body (which is what fasting is) is easy for me.
4 – I have been on a ketogenic diet for 4 months now and am constantly in ketosis the whole time.
5 – I am a Type 2 diabetic who never got below 72 for blood sugar during the fast. Typical number was more like 85.

 

Low Carb and the “Authorities”

From the American Diabetics Association 2008 (Nutrition Recommendations and Interventions for Diabetes):

ENERGY BALANCE, OVERWEIGHT, AND OBESITY

Recommendations

  • In overweight and obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance. Thus, weight loss is recommended for all such individuals who have or are at risk for diabetes. (A)

  • For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year). (A)

  • For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

Wow. Back when I was a newly diagnosed T2D (in 2003) they were saying LC is bad. Now it is one of the recommended diets for Diabetics. Reading on…

The optimal macronutrient distribution of weight loss diets has not been established. Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets (19,20). Another study of overweight women randomized to one of four diets showed significantly more weight loss at 12 months with the Atkins low-carbohydrate diet than with higher-carbohydrate diets (20a). However, at 1 year, the difference in weight loss between the low-carbohydrate and low-fat diets was not significant and weight loss was modest with both diets. Changes in serum triglyceride and HDL cholesterol were more favorable with the low-carbohydrate diets. In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1C with a low-carbohydrate diet than with a low-fat diet (20). A recent meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (21).

So everything (except LDL) was better with LC. And they did not differentiate between the various LDL (small particle size vs large).

 

Coffee and Insulin Resistance

Wasn’t too sure about what the title of this article should be. I was tempted to make it Coffee and Blood Sugar but I really need to adjust my thinking since Blood Sugar isn’t the problem, but insulin levels are.

The general concept that lowering Insulin levels also lowers Insulin resistance in the cells makes good sense. The problem is that there’s no available instrument I can use to determine Insulin levels. The only measurement I can do easily is blood sugar levels. Insulin kicks in when blood sugar levels rise. Carbs cause blood sugar to rise and Insulin to kick in. That’s the advantage a Low Carb diet brings to Insulin Resistance.

So why coffee? I have not been a fan of coffee. My preferred drink of choice is Diet Mountain Dew. Lots of caffeine and a taste that I used to like. It now tastes too sweet to me since I have gone LCHF. To replace the caffeine I have taken to drinking coffee. It started innocently enough. Drank some of the horrible coffee at work. Spotted a jar of instant coffee at Trader Joe’s and it was better than the stuff at work. Researched through a friend at work K-cup machine and actually purchased a Bella Single Cup brewstation.

Took this to the next level and actually started adding Ghee to coffee. Not too much, maybe a half teaspoon. I drink 2 mugs (12 oz each) of coffee a day. I’m adding maybe 50 calories to my day during what was previously a fast time. But since those calories are fat rather than carbs it’s not affecting my ketosis.

But all of this begs the question. Have I done myself a favor by trading something I like for something I am just beginning to learn to tolerate? Certainly it’s a more grown up thing to drink coffee but is it a more healthy choice?

By my own testing with my blood sugar meter Diet Mountain Dew really didn’t drive my blood sugar one way or the other. But there’s the question of what it was doing to my Insulin levels.

But, what does coffee do to blood sugar and Insulin? I see a small rise in my blood sugar when I drink my black coffee. And that’s what the literature says happens (Associations between the intake of caffeinated and decaffeinated coffee and measures of insulin sensitivity and beta cell function).

There is some evidence as well that the effect on Insulin Sensitivity is a temporary effect and that the longer term effect of coffee on Insulin Sensitivity is in fact a good effect (Caffeinated Coffee, Decaffeinated Coffee, and Caffeine in Relation to Plasma C-Peptide Levels, a Marker of Insulin Secretion, in U.S. Women):

Intakes of caffeinated and decaffeinated coffee and caffeine in 1990 were each inversely associated with C-peptide concentration in age-adjusted, BMI-adjusted, and multivariable-adjusted analyses. In multivariable analysis, concentrations of C-peptide were 16% less in women who drank >4 cups/day of caffeinated or decaffeinated coffee compared with nondrinkers (P < 0.005 for each). Women in the highest quintile compared with the lowest quintile of caffeine intake had 10% lower C-peptide levels (P = 0.02). We did not find any association between tea and C-peptide. The inverse association between caffeinated coffee and C-peptide was considerably stronger in obese (27% reduction) and overweight women (20% reduction) than in normal weight women (11% reduction) (P = 0.005).

C-peptide is proportional to Insulin although it has a longer half life. It looks as if this may be part of the reason that coffee is a good choice for diabetics. It may raise blood sugar in the short term but lower insulin resistance in the longer term.

 

Food and the Heart

A newly published study (Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries).

The results of our study show that high-glycaemic carbohydrates or a high overall proportion of carbohydrates in the diet are the key ecological correlates of CVD risk. These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs (1, 32–34). The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products (Supplementary Table 2), which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.

And…

The role of the high glycaemic index/load can be explained by the hypothesis linking CVD risk to inflammation resulting from the excessive spikes of blood glucose (‘post-prandial hyperglycaemia’) (35). Furthermore, multiple clinical trials have demonstrated that when compared with low-carbohydrate diets, a low-fat diet increases plasma triglyceride levels and decreases total cholesterol and HDL-cholesterol, which generally indicates a higher CVD risk (36, 37). Simultaneously, LDL-cholesterol decreases as well and the number of dense, small LDL particles increases at the expense of less dense, large LDL particles, which also indicates increased CVD risk (27). These findings are mirrored even in the present study because cereals and carbohydrates in general emerge as the strongest correlates of low cholesterol levels.

 

Is Insulin Effective for Type 2 Diabetics?

Interesting study (Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials). The study reviewed:

A systematic literature review (Pubmed, Embase, Cochrane Library) including all randomised clinical trials (RCT) analysing insulin vs. hypoglycaemic drugs or diet/placebo, published between 1950 and 2013, was performed.

Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed:

The study looked at:

We included all RCTs reporting effects on all-cause mortality, cardiovascular mortality, death by cancer, cardiovascular morbidity, microvascular complications and hypoglycaemia in adults ≥ 18 years with T2D.

The conclusion was:

There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia.

 

Daily Status – 2016-08-29

Today is the third day I have been off Metformin. My Blood Glucose numbers have tended up but not horribly. About 10 increase. I am no longer seeing numbers from 95-115 and am now seeing numbers from 105-125 instead. Not too bad really. If the upward trend continues I will add back in Metformin. If it flattens out I will stick with removing Metformin. If Metformin reduces gluconeogensis by 33%, I really don’t see it in my own numbers. I should be seeing numbers that are 33% higher not 10% higher.

Work scale shows I am down 23 lbs since Aug 5th. I started about July 31 (four weeks now). Not sure what my initial weight was but my guess is that I am down about 30 lbs so far.

I am going out for dinner with the kiddos tonight so it will be out to somewhere that I can do LCHF easily. We have done Jimmy John’s (order the lettuce wrap and the JJ Gargantuan) as well as Five Guys Burgers and Fries (skip the fries and order the burger “bunless”). Harder to find suitable choices at places like Applebee’s.

Still doing the Intermittent Fasting (IF). Yesterday I ate from 5 PM to 6:30 PM with a final snack at 8:30 PM of some ParmCrisps.

 

Are Chicken Wings a LC Choice?

I was eating a lot of chicken wings thinking they are Low Carb. And when it comes to carbs, they are. Well, sorta. Here is the nutritional information for chicken wings. Note they took away the skin which has fat.

Nutr-Wings

A wing without skin has 43 calories where 24 of the calories come from Protein. 15 Calories come from Fat. That’s only 35% of calories from fat. Not LCHF at all. That’s LCHP, not the goal for a diabetic.

What happens with the Protein? Suppose you have 6 wings. That’s 36 grams of Protein. But half of that gets converted to Glucose. That’s 18 grams of carbs (equivalent).

Leaving the skin on helps quite a bit. It is the best part after all. Here’s the wing with the skin.

Nutr-WingsWSkin

Fat is 5.4*9=48.6 calories from fat = 60%
Protein is 29.8 calories from protein = 37%

A half dozen whole wings is 44 grams of protein with the glucose equivalent of 22 grams of carbs. No wonder I used to need to pump under such a protein load. It wasn’t spread out like my carb load was. It would last around twice as long. But it still had a load for Insulin response.