Elevated blood sugar...help

(KM) #21

I’ve also noticed something frustrating: I vetted foods for their appropriateness and then bought in bulk to save $. But I find that when I have a lot of something available, my portion size / how many I eat goes up. It’s not rational, but I guess my mind sees half a cabbage as a reasonable portion if I’ve got four of them!

(Rossi Luo) #22

Hi Paul, my typical food is:
I don’t eat breakfast and lunch since months ago on Monday to Friday, drinking lots of water and green tea only during the day.
Dinner:
100 g ~ 200 g meat (usually fried pork, beef, lamb or chicken, using extra virgin olive oil to fry, made in spain, Im not sure if it’s really extra virgin, but it must be olive oil. And salt and pepper on the meat)
Around 100 g greens (kale, broccoli and purple cabbage every meal, topped with chia seeds or sesame seed, a little Chinese soy sauce to give it flavor, the greens are not cooked, I eat them in raw cold)
2 capsule of fish oil after dinner
2 capsule of choline after dinner
1 capsule of multiple Vitamin B
Cheating Food Sometimes, I do cheating, maybe a piece of bread or 3 or 4 sweet candy for Children. Maybe once or twice a week, but the amount was little.

And I am quite sure I have been in Ketosis all the time, because I use strips to test my urine ketones, it’s always very high in purple color, and I don’t feel hunger in fasting.
My mom, my mom’s mom, my mom’s sister all have type 2 diabetes. I didn’t have diabetes before keto, and now I am not sure if I am diabetes. And I have fatty liver for 7+ years, that’s why I came into keto diet.

(Rossi Luo) #23
Date & Time Blood Sugar#1 Blood Sugar#2 Blood Sugar#3 Blood Sugar#4
27 March 8:15 AM (13 hours fasting with water, red tea) 8.1 mmol/L 7.3 mmol/L
27 March 12:10 AM (17 hours fasting with water, red tea, green tea, 2 cigarette) 6.3 mmol/L 7.0 mmol/L 5.8 mmol/L 6.1 mmol/L

I have done more testing on my blood sugar in the noon on different fingers, the blood sugar level is dropping, the device is not very accurate, it fluctuates. I will do more testing in the up coming days, see what will happen.
By the way, my last dinner yesterday was a piece of beef steak and broccoli, kale, purple cabbage and a half of fried egg left by my kid.

(Bacon is a many-splendoured thing) #24

If you are eating only one meal a day, and that meal is only 100-200 g of meat and100 g of greens, then you are eating far too little. That’s 25-50 g of protein which, unless you are very small, is likely not nearly enough. And 100 g of greens, being mostly indigestible fibre, is not going to provide nearly enough energy to meet your daily needs. You need more protein and plenty more fat.

Now, as for the blood sugar readings you provided in your later post, it is clear that what you are experiencing is something doctors call the “dawn phenomenon,” in which serum glucose is higher in the mornings when we wake. It appears to be an evolutionary mechanism intended to help us chase the sabre-tooth tiger out of the cave before it eats anyone (I’m joshing, but you get the idea).

The eight o’clock readings are indeed quite high. However, I suspect that if you start eating more, and especially if you include more saturated and mono-unsaturated fat in your diet, you will still see a dawn phenomenon, but the readings will be much more reasonable, and your readings later in the day will go down.

(Rossi Luo) #25

Hi Paul, yes, I know the dawn phenomenon, but like you said, my dawn phenomenon is not reasonable, it’s too high. Yesterday dinner, I removed the greens (broccoli, purple cabbage and kale) out of my dinner, and this morning, I found that my blood sugar was lower than yesterday morning. I will do more experiment and testing, and I believe your judgement that I had too little fat, because I want to burn my liver fat.

Date & Time Blood Sugar#1 Blood Sugar#2 Blood Sugar#3 Blood Sugar#4
27 March 8:15 AM (13 hours fasting with water, red tea) 8.1 mmol/L 7.3 mmol/L
12:10 AM (17 hours fasting with water, red tea, green tea, 2 cigarette) 6.3 mmol/L 7.0 mmol/L 5.8 mmol/L 6.1 mmol/L
6:15 PM (23 hours fasting with water, red tea, green tea, 4 cigarette) 4.8 mmol/L
6:30 PM (Dinner: fried pork with garlic sprout (leaves)) ------------- --------------- -------------- --------------
8:35 PM (2 hours after dinner) 5.8 mmol/L
9:15 PM (around 90g dry chickpea) ------------- --------------- -------------- --------------
28 March 8:15 AM (11 hours fasting with water) 6.3 mmol/L 7.0 mmol/L 6.4 mmol/L
(Bacon is a many-splendoured thing) #26

Well, I hope I’m right, and that extra fat will help. Let us know how you progress.

(Bob M) #27

Those seem like wildly varying blood sugars, 86 to 113. The problem is that pin prick monitors have a variance of plus/minus 15 or 20%. If you have an average blood sugar of 100, you can get those.

I wouldn’t be worried, personally.

(Rossi Luo) #28

Yeah, I know that monitors are not accurate, even the device in the hospital is not accurate all the time. Actually I worked for a instrument producing company in UK as an engineer, so I know instrument is not accurate, it can be affected by many factors.

What ever, after removing the greens (kale, broccoli and purple cabbage) out of my dinner, my blood sugar in the morning has lowered down! Interesting, I know greens have carbs, but the amount I ate is so little. I will do more experiment to see what’s happening.

Date & Time Blood Sugar#1 Blood Sugar#2 Blood Sugar#3 Blood Sugar#4
27 March 8:15 AM (13 hours fasting with water, red tea) 8.1 mmol/L 7.3 mmol/L
12:10 AM (17 hours fasting with water, red tea, green tea, 2 cigarette) 6.3 mmol/L 7.0 mmol/L 5.8 mmol/L 6.1 mmol/L
6:15 PM (23 hours fasting with water, red tea, green tea, 4 cigarette) 4.8 mmol/L
6:30 PM (Dinner: fried pork with garlic sprout (leaves)) ------------- --------------- -------------- --------------
8:35 PM (2 hours after dinner) 5.8 mmol/L
9:15 PM (around 90g dry chickpea) ------------- --------------- -------------- --------------
------------------- ------------- --------------- -------------- --------------
28 March 8:15 AM (11 hours fasting with water) 6.3 mmol/L 7.0 mmol/L 6.4 mmol/L
28 March 12:15 PM (15 hours fasting with water) 5.8 mmol/L 5.9 mmol/L
------------------- ------------- --------------- -------------- --------------
29 March 8:20 AM (13 hours fasting with water) 6.0 mmol/L 5.4 mmol/L 5.3 mmol/L
(Bacon is a many-splendoured thing) #29

Wow! That is some difference. Carry on as you are, then. Wow!

Have you had an oral glucose tolerance test recently? The test is labour-intensive and therefore expensive, so doctors don’t like to prescribe it and the NHS doesn’t like paying for it, but if you could persuade your doctor, or if there’s some private laboratory that will do the test on your say-so and for a reasonable price, it would be valuable information.

There is also some kind of index called HOMA-IR that is supposed to provide a measure of a patient’s insulin-resistance. It is calculated off values measured in normal blood work, so that might be a less-costly alternative.

I mention it, because it’s possible that you are more highly insulin-resistant that most people, and therefore have poorer glucose control. If that is the case, you can expect to regain insulin sensitivity over time, but it’s a slow process.

(Rossi Luo) #30

No, this is the first time I heard about this. I have googled about it, I think I can do it myself, it’s quite simple, just drink 300 ml glucose liquid, and measure the blood sugar at 0.5, 1, 2, 3 hours after the drink. I will try to find what glucose drink I should use.

(Bacon is a many-splendoured thing) #31

Actually, the measurement needs to include insulin as well, and that, unfortunately, requires a radioassay that can only be done in a laboratory. It is important to be able to compare the glucose curve with the insulin curve. The late Dr. Joseph Kraft, a noted diabetologist, identified five different patterns of insulin and glucose response, only one of which was normal. Follow-up indicated that the patients with one of the other four patterns were later diagnosed as Type II diabetics. Dr. Kraft believed that an OGTT could identify diabetics up to twenty years in advance of diagnosis, which relies on glucose getting out of control, instead of on the insulin response.

(Rossi Luo) #32

Hi Paul, thanks for your information, then I can’t test the insulin level. I will test the blood sugar first to see if my body can deal with the glucose in 3 hours. I have bought some glucose (75g) minutes ago, and I will do the testing when I get it.

(Bacon is a many-splendoured thing) #33

Another way to measure insulin resistance is your HOMA-IR score. It might actually appear in your latest lab results, or you might be able to figure out how to calculate it. I’m sure the formula is somewhere on the Web. I have the impression that HOMA-IR isn’t quite as accurate as an OGTT, but it should be close enough for your needs.

(Bob M) #34

I don’t think HOMA-IR is accurate at all, for those of us with glucose sparing in the morning. Maybe for carb-burners, it’s accurate. But not for us.

What you want is a Kraft test, which is OGTT + insulin.

Here are my results from a 2 hour Kraft test, where they were supposed to also take readings at 1 hour but did not (the “Glucose” column lists the lab’s results):

image
image.png726×117 3.64 KB

According to that info above, my starting insulin is slightly above where they want (10.3 instead of <10), but everything else was OK. (NOTE: my blood sugar skyrocketed, because I was keto beforehand, but came down to what is a normal reading for this test in 2 hours.)

My HOMA-IR was 2.52, though, which supposedly indicates some insulin resistance.

https://www.omnicalculator.com/health/homa-ir

(Jane) #35

I was able to get my HOMA-IR score when I paid for my fasting insuling myself using an online service that hires a doctor to issue the lab order so it is “legal”. I also had my fasting glucose and a1c measured while I was at it. The HOMA-IR showed I was no longer insuling resistant after 9 months of keto. I don’t have a starting score but all other indications were I was insuin resistant.

I only had my a1c measured years ago was was pre-diabetic then. Since my fasting glucose is never over 100 no doctor since then has ordered it, so I was curious. It came back 5.2 so was happy with that.

That was back in 2018 - haven’t retested since then. I was working in Ft Worth a lot then so I could swing by a Labcorp and have my blood drawn on my way to work. There are no labs where I live to draw blood that use the online lab requests.

I have a couple of longer trips to Houston this year for a project I am working on - 2 weeks in June and 3 weeks in October so will probably pay for the tests again and compare, just for grins.

(Bacon is a many-splendoured thing) #36

Ah. You’ve looked into this a lot more than I have. Thanks, Bob.

(Rossi Luo) #37

Do you imply that ketogenic diet makes some people (like us with dawn phenomenon) have higher blood glucose after having carbs? But the blood glucose will go down to normal soon?

I didn’t measure my blood glucose today because I had half of a sandwich (egg inside) this morning, it’s my kid’s food, and I ate it…:sweat_smile:

(Bacon is a many-splendoured thing) #38

In people who eat a lot of carbohydrate, the pancreas stores insulin for immediate release as a first-phase response. When we go keto, there is no longer a need for this insulin store. So when we do have a sudden glucose rise, there is no first-phase response. This is perfectly normal, and not a sign of anything wrong.

Also, as Prof. Bikman points out, when we return to eating carbohydrate it takes the pancreas less than 24 hours to recharge the insulin store that it now needs again.

However, this does mean that a ketonian given an oral glucose tolerance test will have what appears to be a diabetic response to the glucose load. It can be hard to convince your doctor that there’s actually nothing wrong, so if you know about the test far enough in advance, a day or two of eating carbs beforehand will make your insulin response look normal.

(Bob M) #39

Yeah, I THINK what happens is that the “height” of the response is higher, but the “width” stays the same. Here’s data from my CGM from my Kraft test:

image
image.png965×138 10.2 KB

Unfortunately, this software only puts a point and value on there when you actually download data using a receiver. I wanted to download at 1 hour into it, but I couldn’t keep my eyes open. I guess 75gm of glucose early Saturday morning doesn’t go well with me. So, I can’t tell the height of the peak. If it was 10, that’s 180 in US units, 11 would be 196. Kinda high.

Most people say that if you want to do a Kraft test, you should eat carbs a few days beforehand to lessen this effect. The woman doctor I had at the time (Kate Shanahan) said I didn’t need to do that, so I didn’t.

As for HOMA-IR, it can work if you don’t have higher morning blood sugar. My morning blood sugar is about 100 in US units, and has been that way for years. I have CGM data with graphs that are separated by 14 months. My blood sugar was exactly the same for those graphs: highest around 10-11 am, then goes down all day, with a nadir at night.

I’d love to know why some people on keto/carnivore have higher morning blood sugar and some don’t. I theorize it has to do with exercise (higher exercise = higher chance of higher morning blood sugar), maybe protein intake (though I’m eating very high animal fat now, and still get 100 this morning), maybe time of eating (later = higher morning blood sugar).

The other way HOMA-IR works is if you have lower insulin, say 5 or below. But mine is mainly around 10, which means to get a “good” score, I’d need to have lower blood sugar…and I don’t.

(Bacon is a many-splendoured thing) #40

She’s right, so long as the doctor knows how to correctly interpret the results. But similar to Dave Feldman’s experience with lipids, there are doctors out there who just don’t understand, and it can save some grief by doing the protocol before the blood draw. Of course, Dave Feldman says never to lie to your doctor . . . :wink: