I was diagnosed type 2 diabete on this May. The fasting blood glucose was 330 and my HbA1c was 11,3%. I’ve started with a diabetologist that has started with a lot of fast and basal insuline + metformin.
After one month, with blood sugar levels going back to “normal”, he has changed the medication with a GLP-1 medicine, Trulicity. After getting the shot I’ve been very sick with pain in the stomach, nausea and I was totally inappetent. I’ve eaten half apple in 2 days and could not digest it. The diabetologist has not one word about my diet.
Then I’ve decided to change diabetologist and to try to solve my diabetes without medications for some days, just to test if I could. I’ve started a low carb diet eliminating bread and spaghetti (I’m Italian). I’m 1.86. I was 102 KGs (with a top weight of 110 some years ago) and in 2 months I’ve lost some KGs and now I’m 82 KG.
My glucose level has gone down with acceptable levels of <140 post-prandial. The fasting glucose still high and sometimes over 120. I do exercise almost any day of the week with running (6/10 KM per day) and kayak (2 hours 3 days per week).
My latest HbA1c, after 50 days from the diagnosis, was already 8.5% and my continuous glucose monitor says that in my last 7 days my HbA1c should be 5.5%.
I had fasting glucose levels above 300 and my HbA1c was over 11% so I’m technically a diabetic. But now my HbA1c seems to be on the “prediabetic” stage going to the “normal” values. Am I a diabetic, a well treated diabetic, a pre-diabetic that had a bad moment, a person with a metabolic momentary disfunction?
My new diabetologist (I’ve seen him only once and I’ll visit him after summer) said that he’s does not agree to go without any medication and would suggest metformin while, he said, “it’s a noble medication”. I don’t know what he means with it but my question is. Not using Metformin is damaging me or is anyway slowing my path to a better glucose management?
I had recently ordered a CGM, FreeStyle Libre and I’m experimenting on what works and not works to better lower my glucose levels. One of that experiments was to do running in the morning without having breakfast before. I’ve read that fasting moderate exercises could improve insuline resistance. In my experience, when wake up my glucose is under 90. Just after opening my eyes it goes to about 100/110. When I run it stays under 120. The moment I stop running it spikes up to 180 before having breakfast. The interesting part is breakfast, even with some carbs (fruits) does not contribute to any further spikes. Instead, it goes very quickly down to less then 95 in minutes (and stays very low for many hours). What this behaviour suggest to you? In my theory, I just produce glucose from stored fats and when I stop exercising my muscles stop using energy and so I have a spike. Could be this? And why my body doesn’t react sooner then getting 180? Do I am insuline resistant or I produce a little amount of it or it’s just normal? Is running without eating?
Sorry for the long post bu I would like to give the community some data.
Congratulations on taking ownership of your diabetes health! Welcome to TuD. Your lifestyle choices, a lower carb way of eating, plenty of exercise, and persistent glucose checks have all exerted a dramatically beneficial effect on your glucose levels.
Your improved lifestyle choices have given you non-diabetic sugar levels but you must remember that these tactics are treatments for high glucose, not a cure for diabetes. If you return to eating lots of highly processed carbohydrate foods, your diabetic level glucose levels will certainly come back. I would conclude that you are well-treated diabetic.
Metformin does have beneficial effects in treating diabetes and it’s been used for decades and shown to be safe. I don’t think that it’s absolutely necessary for every diabetic to use, but it can be helpful for minimizing the liver’s inappropriate release of glycogen (glucose) following a meal. It’s primary unintended effect is indigestion and diarrhea. If you are happy with the post-meal glucose excursions (<140 sixty minutes after eating, falling to <120 at 120 minutes), then you may not need Metformin.
A CGM is a an essential tool to help you untangle your morning blood sugar puzzle. Morning is difficult, blood-sugar-wise, for almost all diabetics. The body is responding to circadian rhythms that cause a release of cortisol and other glucose counter-regulatory hormones that can drive up glucose levels.
I highly recommend your getting and wearing a CGM. You will learn more from careful observation of your glucose data stream than you could from any other source. While your fingerstick practice appears robust, a continuous glucose data stream will give you a much better representation of your glucose metabolism and the interaction with food and exercise.
I believe you are on a good track to improve your health. Your attention to detail and curiosity bode well for restoring your glucose to healthier levels. You should be able to treat this well, but don’t think for a minute that you could resume your old ways of eating without significant and unhealthy glucose elevations. Good luck!
@Terry4 Thank you so much for your answer. It’s informative and has been written by a beautiful soul: thank you!
Actually I’m wearing a CGM! After using it for one week I wonder WHY no doctors prescribe to T2 non insulin dependent this tool. It’ essential, as you stated, to better understand what is happening.
I would also like to share with you a standard path. Is my BG path acceptable?
Ok - I’m not a doctor nor am I a T2D. Here’s my opinion as a person who has wrestled with abnormal glucose for several decades. I don’t think this is a healthy pattern to accept as “normal.” If I were you, I would be interested in experimenting with some Metorfmin to see if it’s possible to mitigate that “morning running on fasting” spike. Another experiment could be moving the morning run to later in the day.
Your second graph looks like a 14-day AGP or ambulatory glucose profile. (Please excuse my monolingualism!) Ideally, your glucose median (the black line) should fall mostly under 100. Your glucose does not fall to these levels until a few hours in the early morning .
Welcome, @Wintersome. You have a very good attitude toward self-management. Doctors seem not to give much information to diabetics. In addition to what you are doing and what Terry suggests, I suggest you be tested for GAD65 antibodies as well as some of the others. Your story and numbers could be early advent of T1 LADA.
Thank you @Willow4 ! What brings you to think that could be an early advent of T1 LADA? I’ll soon make the antibodies test but just curious to understand your point of view. Just want to add that my familiarity about diabetes is high while both my grandparents were diabetic and also both my parents but no one had T1.
@Wintersome, doctors in general don’t seem to think that adults can develop T1. What makes me suspect that you may be T1 LADA are your high numbers and high A1c at diagnosis. Also, the fact that you are losing weight. Even a c-peptide in the middle of normal range can indicate T1 because T2s usually run a c-peptide in the high normal to abnormally high ranges.
On my morning group ride a physician friend and I were discussing her non-compliant patients and the benefits of constant glucose monitors to give near instant blood glucose feedback to any type diabetic patient of how medications, foods, activities and stress will affect the BG control
I don’t know about other countries, but in the USA, medical insurance is not prone to allow them to be prescribed. So, in the US it is not stubborn doctors but insurance companies.
I am retired and on Medicare. The requirments for a CGM is testing 4 or more times per day and injecting insulin 3 or more times.
My friend would love to have all of her type 2 DM patients on a CGM so they could see what’s happening.
@Luis3 the cost of a single sensor that you can read with your cellular phone is about € 50 in Italy and lasts 14 days. I would suggest even to use once every 6 months just for 14 days. It educate yourself to have a vision of what is happening. With normal glucose meters and the rule of “2 hours after lunchtime” you can’t understand how it really works. For example pure sugar tends to fade away in 2 hours while some slow carbs like lentils gives a prolonged BS without a peak. After 2 hours the sugar would probably give a better result. Also, for T2 diabete I find less important to use it everyday but it helps you a lot to create a good diet/exercise routine that, once structured, you can apply without the sensor.
@willow4 I had high values because I stayed at computer desk for two years of COVID lockdown without any physical exercise and I’ve started drinking something like 5 Cokes per day. While I’ve lost something like 5 KGs before I knew I was diabetic, after the diagnosis I’ve lost another 15KG but because I’ve started a low carb diet and I do 1 to 2 hours of medium to intense running / fitness. I must say that I’m in a excellent shape with a better muscular tone. I don’t feel I’m loosing weight for diabete depletion.
Welcome to the group. I have taken metformin for 30 years. I also take a basal insulin. If you do not eat before you run ,your body is looking glucose for energy. Thus it puts out extra glucose. Good luck,Nancy
@Wintersome A lot of good information has been given to you but I just want to add that hard exercise can cause an increase in glucose levels, especially when you haven’t eaten.
I am a type 1, but I was experiencing a huge surge in my BG level when I swam for 2-3 hours. I wouldn’t eat beforehand because mornings are difficult for me to control my Bg levels. It was pointed out that I was not providing fuel to swim so my liver was trying to help and dumping glucose into my system for fuel. The rise would happen at about the 1 1/2 hours after I started and continue after I stopped.
The cure was to eat about 2 hours before I swam, it worked in helping my BG levels while I swam, but then for me I had to deal with that morning eating problem. So now I have switched to providing some fuel while I swim. I am still experimenting!
Hard exercise can increase Bg levels anyway, but it does help later with controlling BG levels. Cardio exercise usually helps lower or hold your BG level. But what caught my eye is you saying you were fasting before your runs. You might try to eat something to provide some fuel to see if it helps stop your spike.
