Hi Zack! I’d like to second the suggestion someone else made about testing at two and three hours after eating. I tend to have my peaks somewhat later, and for that reason I’m starting to suspect I have the beginnings of gastroparesis. If I only tested at 45 minutes or an hour I typically wouldn’t catch the peak. If you are having symptoms of long term damage, gastroparesis might be one of them. Perhaps someone with more knowledge about that will chime in.
Also, the meals you posted are relatively low in carbs for a typical Western diet, but not very low in carbs. You might think about doing a few weeks of ultra low carb (under 20g per day) and seeing if that helps you feel any better. It isn’t something you have to do forever, but as a test it might be helpful.
I hope you get some answers and feel better very soon!
OK, thanks for clarification, Jim. Do we recommend he get a 2nd A1c in case the lab sample got confused? In the US, we can do that at some Walgreens pharmacies.
If the a1c is high, there should be high BG values there somewhere - try testing when you are thirsty. Keep testing blood sugars. What the heck!?!?!?
Jules, I second both of your comments. Like you, I suffer from mild gastroparesis. I no longer test 1 hour after eating because I am likely to see a nice low figure then, only to see a much higher one 3 or even 4 hours later. For example, on a good day I might see 5.5 before a very low carb meal, 4.9 1 hour after, and in the high 5s/ or 6s 3-4 hours after. A drop like that after eating is a dead giveaway.
However Zack, I believe you used a Libre for a while? This should have given you an idea of how quickly your bg rises and falls, even though the actual numbers are not always very reliable on Libres.
I am trying to keep to a very low carb diet, under 30g carbs daily, and I would not even look at cereal, fruit or lattes, to mention a few items on Zack’s menu. (Black coffee + double cream has far fewer carbs). I find that many people who believe they are eating low or even zero carb don’t realise the sad fact that carbs crop up in almost all foods, even the least calorific ones such as spinach, celery, cucumber. Of course some foods are much lower in carbs than others, but it’s annoying how fast those grammes of carb do add up.
I strongly recommend consulting Dr Bernstein’s “Diabetes Solution” on: (1) Gastroparesis (2) Foods to eat and foods to avoid and (3) what bg levels are needed to avoid diabetic complications. A lot of his book is available free here:
He has also a long series of Youtube videos.
Dr B contends that the bg numbers considered “normal” by endos. are far too high for health. I am convinced by his arguments, and by the fact that although my A1c is considered pre-diabetic in the US and not even quite pre-diabetic in the UK, I had already accumulated a number of complications before I was made aware of it.
My suggestions for you, Zack: (1) Read Dr B - he’s more expert than any of us will even be. (2) Try eating truly low carb and test exhaustively perhaps over a weekend when you aren’t working. (3) I see you test on waking, then go for a walk fasting and feel dizzy. You could try eating something straight away instead, and then walking. Personally, if I tried to exercise straight after an overnight fast, I’d feel like death!!! (4) Since getting a diabetes diagnosis is such a tricky business, why not just provisionally consider yourself “carb intolerant” and experiment with eating accordingly? Your body may thank you. But NB health problems caused by raised bg levels can take a while to reverse.
Thanks so much for the many thoughtful replies. Lots to think about. At the very least I know something is going on and it’s sugar related. I’ll monitor longer and also 3-4 hours after eating and assume (as I have already) there’s something going
on and truly restrict my diet. Even though what might look low carb on the surface (smoothie, etc) - it’s not when trying to reduce carbs. Reading the Dr Bernstein’s looks like it will provide some very useful guidance as well. It’s still a mystery why the
A1c is so high still - I run long distance ultras so pretty fit at 55 and when I’d did learn about the high A1c (two years ago this month) I cut back sugars carbs by 90% with no change in A1c.
Thanks so much everyone. I know I’ve kind of signed off before as I don’t want to exhaust my welcome as a new member. I will take all of your comments and suggestions into account and use much of this to develop a solid plan. I’m a teacher and
good at expecting others to plan well so it’s my turn to do some good planning. Take care and thanks.
Dont worry about it, Zack. We are all bored and hungry for some good diabetes questions. Whats your heritage? Is he a LADA? Ladas trace, genetically, to the Faeroe Islands. So, if your Nordic, sometimes patterns emerge like this. I’m Finnish ancestry (highest incidence of type 1 in the world, but the Saudis aren’t far behind).
Just one other comment… I know it is counterintuitive, but exercise can cause your BGs to rise dramatically, especially once you stop. Just as an example, my BG could be 70 at end of run, and within 20 minutes I could be at 200! Worse, I often will then shoot down shortly after that and could be at 40! So it can be a real rollercoaster if I do nothing to manage it, even if I do something to manage at times, too! I would recommend that you test before running, immediately at end of run, then a number of times over the next few hours, maybe even every 20 minutes if you can manage.
I’m not sure about my heritage but what little I know it’s likely Germanic on one side and a fair dose of everything UK region on the other. So maybe some Nordic.
In Canada the public typically doesn’t have the ability or option to order blood work. This would be strictly enforced for the duration of the self-isolation and rigid protocols now being used at labs that remain open.
Irrespective, none of us are doctors and don’t have access to his complete file / history, so I don’t feel I’m in a position to offer any advice beyond what’s been given.
I have no idea what type of diet Zack is on, but if I had a BG of 160 after eating bread & butter I’d certainly wonder why.
The morning dizziness isn’t caused by an AM bloodsugar of 90-110. Perhaps something else is going on (dehydration or orthostatic hypotension)? Are you on a diuretic or blood pressure meds Zack?
Talk about coincidence. After reading your post in TuDiabetes forum email, scrolliing down I found an article on the Wayne Variant. Sounds just like what you are presenting with. Same sort of thing, high A1C, visits to Endo’s and good bg’s by and large. Hopefully you can find the same thing on the TuD forum site.
Jim is right. Check your blood pressure when you feel dizzy.
He is suggesting that you check your bloop pressure 3 times - once while lying down, once while sitting, and once while standing. He’s worried that there might be a big change in BP while assuming different positions.
I would still say that in the end, blood sugar readings are more informative than A1cs, especially if you have used a CGM (like the Libre) for an extended period of time. A1cs are merely an indirect method of estimating blood glucose over a long period of time by measuring something that blood glucose levels fairly reliably (but not perfectly) have an impact on. I agree with folks suggesting testing at different time points after eating, but if you can eat a decent amount of carbs and have ok readings at 1, 2, 3, 4 hours afterward (basically you could do a home version of a glucose tolerance test), it still seems really unlikely that your A1c is a valid indicator of your blood glucose levels. If it were me, I’d probably try that a few different times, before bothering to make any major adjustments to my diet. If you do that and you do indeed have a spike at 3 hours say, maybe it is, and your testing is missing that (though should have showed up on the CGM), and going low carb etc would make sense.
I also agree re checking for orthostatic changes in blood pressure, but also heart rate when you do it, since postural orthostatic tachycardia (elevated heart rate) will also make a person dizzy and sometimes a person has both but sometimes just one (I primarily have tachycardia). If either of those are in play, increasing fluid and electrolyte intake by a lot helps a ton (I drink tons of gatorade zero). Meds can also be an option (I take a beta blocker, since my issue is more on the tachycardia side). It’s worth noting that if a person does have one of these issues, going to an ultra low carb diet can exacerbate the situation, because keto-type diets tend to dramatically further increase need for fluids/electrolytes.
Oh and also the way to do a rough check for postural orthostatic effects on blood pressure and heart rate is to lie down for a bit (at least 5-10 min), check, then stand up right away, and check in 2, 5, and 10 min again while you stay standing. For hypotension, I believe you’re checking whether you’re having a drop in the range of about 20/10 or more. For tachycardia, you’re looking for is whether there is a dramatic change (at least 30 bpm) that is sustained while you keep standing (an immediate change is normal but it should regulate quickly in someone not having difficulties). The gold standard for diagnosing either as a more chronic problem is a tilt-table test, but you can’t do that at home, and this should give a decent estimate of if there may be an issue.
I would recommend that you test before running, immediately at end of run, then a number of times over the next few hours, maybe even every 20 minutes if you can manage.