Looking for Help After Some Disappointing Blood Test Results

hba1c
bloodglucose
(Dawn Comber) #1

Hi everyone… I’ve been a quiet bystander on the forums, liking here and there but this is my first post! First, I appreciate this forum so very much. For background, I have been working on my HbA1c and fasting blood sugars since February. I requested tests from my DR after 6 weeks and I was delighted.

I went from fasting blood sugars of 5.6 to 5.2 and an HbA1c of 5.9 to 5.3… All good news for me. I was pretty satisfied and it gave me the motivation to continue eating low carb/keto.

BUT… new results after 6 months are just in and I am disappointed to say the least. FBG is up to 5.8 and H1c is 5.7. I’ve thought of some strategies:

  • Go back to monitoring daily macros with MyFitnessPal (maybe I eed to reduce protein?). I think I’m pretty strict with carbs but now I am wondering if I am fooling myself.
  • Add some cardio & resistance to my daily 10,000 steps
  • Buy a blood glucose monitor and test, test, test (any advice on testing would be appreciated)
  • Should I add some IF to the mix?

Thanks to all you wonderful Keto-ites for sharing your wisdom.

#2

Hi Dawn. I always fall back on that Keep Calm and Keto On saying, but your strategies sound like good ideas. Tracking carbs can’t hurt, because that is the easiest thing to slip up on in my experience. Do you do net or total carbs? If you’ve been doing net, you could try switching to total carbs. Or, if doing net, make sure you are only doing it for whole foods and not processed foods (keto candy bars etc.). That’s advice I heard on Primal Edge Health’s videos.

I would encourage you to self-monitor your blood glucose. At the very least it will save you from any nasty surprises when you get labs done by the doctor, you will have a better idea what to expect. But most of all it will give you valuable feedback about how you respond to foods you eat, exercise, etc. I am a type 2 diabetic so I test a lot, but I would suggest you pick some consistent times to test each day, such as first thing in the morning (fasted state) and two hours after a meal. Track these in a notebook or on Heads Up Health etc. You can show this log to your doctor too. (I bought my latest monitor at Walmart - ReliOn Prime - because it and the test strips are inexpensive.)

Yes to intermittent fasting. It works hand-in-hand with keto, since the high fat-low carb diet keeps you from feeling hungry as often. Eating less often helps keep your insulin lower, so that will have typically have a good effect on your blood glucose levels.

High-intensity interval training type exercise could be helpful, but can’t speak from experience, I’m not there yet. Dr. Richard Bernstein (diabetes guru) recommends it though.

All the best. Hang in there, you are making great changes. It will pay off.

(Dawn Comber) #3

Thanks for your in-depth response, Darcy. I do total carbs because it just seemed easier.

I will do as you’ve said and consistently self-monitor my blood glucose - including recording the results. Like you said I don’t want nasty surprises. And I will try Heads Up Health.

How did you start with IF beyond the smaller eating windows? I’ve done those but have yet to experiment with the longer fasts.

#4

When I first started fasting, I went for 24 hours or longer from the get-go, because I thought for severe diabetes that was the way to go. For a long time my husband had been doing IF by having a Bulletproof coffee in the morning, skipping lunch, and eating supper. I didn’t really think about IF for myself until I heard Megan Ramos’ talk at Ketofest when she mentioned their advice to their patients. She suggested that on eating days (between longer fasts) they keep their eating to within an 8 hour window, and to limit that eating to two 90-minute periods. This prevents grazing and snacking throughout the day. So I have tried to incorporate this in the past month or so - I would have coffee with heavy cream in the morning, but keep lunch and supper within the 8 hour timeframe… and sometimes I tried to incorporate my coffee in those 8 hours too by having it later in the morning. Last week I tried an experiment where I ate a real meal earlier in the morning, had a full lunch and skipped supper. (Another suggestion from that Primal Edge guy.) I didn’t notice any major changes in my fasting blood glucose so I’m not sure that helped me more than other IF schedules. I am now doing a longer fast (shooting for 5 days) so I will probably try the skipping supper thing again later.

The easiest thing is to have the bulk of your IF hours happen while you’re sleeping, so you might aim to end your eating earlier in the day, or start eating later in the day. You could still have three full meals, or skip a meal, etc.

Whatever schedule you start out with, you eventually will want to change it up, do something different. Maybe you try a multi-day fast in there, and maybe try skipping different meals on eating days. The key is giving your system some break from eating. It seems like it is best when this is a regular practice (a rest from eating) but maybe not on a regular schedule, so your metabolism doesn’t slow down. It’s a huge area for self-experimentation.

(Dawn Comber) #5

Thanks Darcy. Megan (and you) give some sound advice. I guess I have to put my big girl pants on here. :grin:

Looking forward to hearing about your success on the longer fast.

#6

I would say look into how much protein you’re getting, since too much protein turns into glucose. I had a buddy at work that was doing keto and his HbA1C wasn’t going down. Then one day I looked at the communal pork rinds jar and found that each serving had 9 grams of protein. After cutting those out, his hba1c started dropping.

Check and make sure there aren’t any sneaky protein sources.

(VLC.MD) #7

A1c of 5.7 is no biggie.

(Dawn Comber) #8

I guess the upward trend is more disheartening than anything. Certainly not a trend I want to continue and I thought I was going to get better results.

(Dawn Comber) #9

Thanks Powertrix. I wondered whether I might be having too much protein too. Maybe a dexa scan to confirm lean body mass and therefore proteins?

(VLC.MD) #10

I can’t see what you’d gain from micromanaging your already good blood sugars.

If you keto and lose weight, your sugars will be fine.

What is your weight ?

In a Keto / LCHF methodology, if your sugars are too high you …

lower carbs more, increase fat more. and if that doesnt work …
get fat adapted and fast ! either full fasting or IF.

(Dawn Comber) #11

Thanks @VLC.MD.

The goal of micromanaging my blood sugar is achieve levels considered outside of the “at risk” range. According to Dr. Bernstein, my blood sugars aren’t in the “good” range. And I happen to agree with his belief that everyone deserves normal sugars. Currently I seem to be heading in the opposite direction in spite of my attempts at low carb/keto. My weight is 136 lbs.

(VLC.MD) #12

Lower your carbs.
Post some of your meals
Walk more. Stress less.

Can excess protein make your A1c higher ?

Hard to say. Probably only a little. It could stimulate insulin slowly and make weight loss harder.

#13

Listened to a podcast by Tim Ferriss today on the consistency of testing. For example, if you are a young adult and you go out on weekends, you will get a different result on a Monday morning (after a party weekend) than on a Thursday morning. The same if you are stressed because you neighbor’s baby kept you up all night. I realize A1C is supposed to be a 3 month average but maybe they were a very stressful 3 months? Also not everyone’s blood cells last 3 months, some are longer or shorter. I would track your BG and see what it correlates with. While 5.7 is not perfect, I think it is still pretty decent.

Also, are you eating a lot of separate meals? This could cause more raised insulin. Since A1C is an average, if you used to be in an eating window and are not any more (as an example), your A1C will go up even if you do nothing else changes

(Dawn Comber) #14

@Saphire - oh thanks! Hmmm, stressful last 3 months? Could be a factor and I hadn’t thought of that. I’m doubly convinced now about testing. I’m don’t think I am eating a lot of separate meals. Mostly 2-3 per day. Staying inside a 8-12 hr eating window.

#15

Dexa is certainly the best method to find it out, you could also try to estimate it. 136lbs (62kgs) seems like a healthy weight to me, so you might be 10-20% body fat. which would in turn mean you should eat roughly 50-60g of protein if you follow 1g per kg.

You don’t have a lot to work with though; 4 oz of chicken breast has ~35g of protein. Also, don’t forget that cheese also has protein. 1 slice (1oz) of cheddar has ~7g of protein.

(Dawn Comber) #16

Again, thanks for your input @powertrix. I agree that I probably don’t need to shed more weight but the dexa will confirm my body comp and put my mind at ease. You’re right about not having much to work with. I looked back on my proteins for yesterday and my total was right in the middle - 55 gms!

Honestly, just problem solving and sharing has made me feel more hopeful. :grin:

(Ethan) #17

How do you find a place to get a dexa?

(betsy.rome) #18

Wondering what the relative consistency of A1C tests are. Has anyone taken them frequently enough to find out? I’m thinking that a variance of 0.2 - 0.4 would be within testing variation. And last I recall of data science, you need more than one or 2 points of data to establish a trend.

(VLC.MD) #19

And how much are dexa scans ?

(Damon Chance) #20

I just googled “Dexa scan near me” and got several results. I had one done as part of a fancy Executive Physical they used to give us here at work. I assume I could go back to that place and order one too. Another place had them for $115 in my google results.

I think a good place to start looking is Medical Imaging locations near you. It’s an special x-ray procedure so they are usually set up for it.