I am feeling very frustrated. I must be doing something wrong, but I can’t figure out what it is.
I’m a complete newbie to being diabetic. I’ve been reading everything I can get my hands on that supports low carbohydrate dieting for Type 2 diabetes. Everyone says that it will bring BG down to normal, or close, and that it’s fairly simple to write down what one eats and notice how it affects BG. Okay.
I was diagnosed 3 weeks ago with a HbA1c of 13.1. I had already been on a low-carb diet for two weeks at that point. Low carb has always the best way for me to lose weight in the past and I’d decided that it was time, once and for all, to get my weight under control. I want to lose 50 pounds.
When the blood tests showed that I’m diabetic, I’d already been on the low-carb diet, so it wasn’t as difficult to accept that I’m going to be eating this way for the rest of my life. In a way, I’m actually relieved about it because I’m hoping that keeping track of my BG and counting carbs will help me avoid gaining weight again once my weight is where it should be.
I’ve lost 20 pounds in the last five weeks. I’m not hungry. I feel terrific. I look a lot better. I have every reason to feel successful but I don’t understand why my BG doesn’t stabilize.
I’m doing readings before meals and at one and two hours afterward as well as at bedtime. I’ve written down everything I’ve eaten and carefully calculated the carbs. It’s rare for me to eat more than 20g a day. I start out with only 5-6, maximum, for breakfast, and then divided the rest evenly between lunch and dinner. I’ve only had one day in the last 5 weeks where I ate close to 30g of carbs, which is what Dr. Bernstein recommends.
My BG hovers between 6.1 and 8.0. For the last 3 days, it’s been between 6.7 and 7.8, until today. The fluctuations don’t seem to be related to what I eat, though.
This morning, my BG was 6.8 when I got up. I cooked sausages for breakfast and had no other carbohydrate. Total carbs: 6. An hour later, my BG was 9.4! It hasn’t been that high in two weeks. An hour after that, it had come down to 6.8. I decided to skip lunch. Maybe I simply need to eat less, not only in terms of carbohydrate, but volume.
Eight and a half hours after breakfast, I decided to do the “Big Blue Test.” My BG was 6.3. I walked the dog for 2 miles. When we got home, my BG was 7.1! I thought it might be a mistake. I waited 15 minutes, washed my hands again and tested again. 7.2. But two hours later–5.8!
I decided that I could have dinner because of the 5.8 reading. I had some cold meat and some cheddar cheese, 6g carbohydrate. An hour later, BG was 6.2. An hour after that, 6.8. Two hours later–that’s four hours after dinner–7.4, the highest all day.
I really have only eaten 12g of carbs–honest! I’ve eaten more on other days and had lower BG, but even so, the numbers are all over the place. I’m not dehydrated–I’ve been drinking water and herbal tea today.
Three weeks ago, I started out taking 250 mg of Metformin twice a day. My doctor said I could increase it if it was helpful, and so I am now taking 500 mg at breakfast, dinner and at bedtime. I’d hoped that this dosing pattern would help with the nausea and horrible diarrhea. However, because I’m having to take so much loperadine to deal with the diarrhea, I’m very irregular: constipated or an explosive faucet in the evenings. I don’t go out in the evening because I never know if it will be a good or a bad evening. However, I do have to go out tomorrow night so I’m just not going to eat anything again until I get back late tomorrow night because I know that I won’t be anywhere close to a bathroom in the evening.
I see the endocrinologist on December 2nd. I’m seeing the dietician that day, too. I don’t know anything about the endo. I already know that the hospital diabetes clinic only recommends a high carb diet, according to the diabetes education nurse I saw 10 days ago. She was good, but perplexed when I declined the offer to attend the formal education workshop. It focuses on the importance of 150-200g of mostly “complex” carbs every day and keeping fat low. I honestly haven’t eaten that much carbohydrate in decades and, back then, I was riding horses every day.
This has turned into a whiny, depressed post! That’s not what I’d intended, at all. I want to be optimistic about my health. The thing that worries me most is that I don’t see a regular pattern in my BG numbers. They’re slowly going down, but even that isn’t making much sense to me.
Maybe 20g of carbs is too much for me? Should I try to stay with less? Maybe I should cut back to 12?
Stymied, you are eating too little carbs and your liver is releasing glucose in its place. You are in a state of glucotoxicity and probably need insulin at this time. I’m sorry you have to wait so long to see an endo, but maybe you can ask your primary care provider to check for insulin antibodies, a c-peptide and insulin level, and GAD65. You might have type 1 diabetes or latent autoimmune diabetes of adults (LADA) based on what you are describing.
You are very hard on yourself. Eating a low carb diet can and “has” brought your blood sugar down dramatically.
Think about it, your HbA1c was 13.1, corresponding to an average blood sugar of 18 mmol/l (330 mg/dl). With your diet, you have brought it down to within 6-8 mmol/l (100 - 140 mg/dl). You are trying to reach “unreasonable” goals.
After I was diagnosed, I dropped my carbs, then I adopted a low carb diet. After six months, I could still not reach my blood sugar targets, so I started Bernstein. It took me more than 9 months to get consistently on target. And you are doing better than I did at the end of 9 months. So stop whining and walk into the bathroom and look yourself in the mirror and congratulate yourself for your accomplishment. If you actually are a T2, over time, your blood sugar will actually “normalize” and you will probably see better numbers, but it just takes time. Don’t go reducing your carbs further, you are doing fine.
And remind yourself. This is a marathon, not a sprint.
ps. And you will need to defend yourself against advice that you need a high carb diet. I do not agree me IrisSanchesCDE that low carb diets causes glucotoxicity. High blood sugars cause glucotoxicity.
pps. And many diabetics find that our blood sugars are affected by things other than food. My blood sugar often rose to over 12 mmol/l (200 mg/dl) from exercise.
I totally agree with BSC. I average about 29 carbs a day, and haven’t found that going lower makes much difference. Don’t beat yourself up - you’ve come so far already! Your body is adjusting, your insulin production may be different at times. I would not change anything… see what happens over the next couple of weeks. I suspect that you’ll see even more improvement - even if you only achieve stability, that’s a battle won. Then look at changing one thing at a time if needed.
Remember, too, that protein/fat will increase your BG, but takes longer to do so.
BSC, I did not mean to convey that carbs cause glucotoxicity. I was trying to describe glucotoxicity as a state in which the body needs insulin. I hope this clarifies the statement I typed
Hi Ann: I agree with Iris–have you considered the possibility that you have slow-onset Type 1 diabetes/LADA? In my opinion, I think you should discuss with your doctors the possibility that you have slow-onset Type 1 diabetes or LADA; you should ask for the full suite of antibody tests (GAD, ICA, IA-2) and a c-peptide test. I have written several blogs on misdiagnosis, including the most recent one on misdiagnosis of insulin deficient diabetes. Check it out and see if you relate. Best of luck to you!