Question about my CGM and carnivore experience

cgm
(Susan) #1

Type II diabetic here. I hit a 6 month stall on keto so I’m now a 6 weeks into strict non-dairy carnivore and trying to see what I can add back into my diet. I’ve lost 10 lbs. I put on a CGM a few days ago and my blood sugar levels have been an almost straight line between 55 and 70. The ‘low sugar’ alarm starts at 60 and I’ve turned that off, but the ‘urgent low glucose’ alarm starts at 55. I’ve set it off a few times, twice in the middle of the night. I’m. now turning the app off when I sleep so it doesn’t wake me up. I feel fine and continue to exercise. My energy levels aren’t low, but they aren’t high either. My guess is that even though the blood glucose is low, I’ve got enough ketones to keep me going. Does that sound reasonable? I don’t know if this makes a difference, but I’m also on Mounjaro (Tirzepatide).

So far I’ve added back the thing I missed most on strict carnivore - sweeteners. The CGM didn’t budge for 2 days with various sweeteners. Today I’m going to add back a little cream cheese and see what happens. Then I’ll add either HWC or hard cheese and hope I can continue with slow steady weight loss. After that comes nuts and coconut flour.

(Bob M) #2

I think if you tested your blood ketones, they would be quite high.

If you use allulose, your blood sugar might go down. I’ve had some blood sugar effect by using it (though I don’t have a CGM yet to verify, just if I eat allulose at night, I get lower morning blood sugar).

I don’t know how Mounjaro effects anything, though.

Most of the food you listed shouldn’t have much effect on blood sugar. Weather they cause you to gain weight or not is a different story.

(Susan) #3

@ctviggen Thanks. My ketones were 2.3 part way into the carnivore journey and I haven’t measured them since. I didn’t feel a need to and don’t have many test strips left. I’ve included allulose and not had any noticeable glitches in the blood glucose. If you look at it with a magnifying glass, it did go down the the hour after I had a fair amount of allulose, but I didn’t notice that until you pointed it out. By the next morning I was back to 65 from a low overnight of 55.

(John) #4

Hey Susan. I have a few thoughts to offer on this:

On low BG… Just FYI, when I eat a solid amount of protein my blood sugar goes up more than yours seems to. That makes me wonder if you might just be eating on the low side for protein or total calories, which could be part of why your line is so flat. You’re probably right that ketones are covering you, especially on strict carnivore, but running at 55–60 on a diabetes med probably isn’t something to ignore. Feeling fine doesn’t always mean it’s automatically safe if you know what I mean.

Also, the Tirzepatide lowers blood sugar and improves insulin sensitivity, so it can absolutely be part of why your numbers are low and super steady. On top of a strict low‑carb diet, it can push glucose even lower than you’re used to. I’m not medical professional here but I’d be cautious about turning off the low BG alarm since you’re bordering on hypoglycemic levels.

One more thing… I totally get the excitement that your CGM doesn’t move with sweeteners, but CGM only shows glucose, not insulin. It’s still possible the sweeteners are nudging insulin up a bit in the background even if your blood sugar looks flat, so I’d treat them as ‘probably kinda ok in moderation’ rather than totally neutral. I don’t know what your overall goals are but, along with a few other adverse effects, elevated insulin is an inhibitor to fat burning.

#5

A few things, 6mo isn’t a stall, that’s just what you’re doing isn’t working. Being carnivore makes it very easy to rack up massive cals very easily, are you tracking?

Going below 55 isn’t great, even low carb. How long have you been on the Tirz and have you been upping it like the normal dose progression? If so, stop upping it, You’re not the “normal” person that dosing progression was made for.

Also, if you’re averaging between 55-70, you don’t sound diabetic. Were you around there before the Tirz was in the mix? Are you taking if to wipe out appetite, or for the blood sugar control?

I wouldn’t worry about the artificial sweeteners or the dairy, the despite the internet fad, most people tolerate them just fine.

That said, if you’re not tracking, track. It makes no sense to worry about nutrition, cut out certain foods, wear a CGM, try to lose weight, while not tracking how much you’re eating. That’s a pretty huge whole in information to work with.

(Susan) #6

@JDR I should have mentioned that I’ve been keto 6 years, my A1c is 5.0 and I’m off all meds except Mounjaro. You’re very right if I was on diabetes meds I should be really concerned.
I’ve been eating between 115 and 160g of protein daily - I’ve been tracking it and aiming for the higher end. I’m doing resistance exercise and doing my best not to lose muscle mass on Mounjaro.
The low glucose alarm is going to be turned off only while I’m asleep. Waking me up to say it’s 55 isn’t useful. I’ll keep the alarm on during waking hours. If I could change the cut off point to 50, I’d turn it back on, but you can’t alter that alarm.
Just some background. I initially lost the water weight you lose when starting keto, but in the long run was mostly stable with a 5 lb. weight loss before finding out about Ozempic. I managed to gain 5 lbs on Ozempic and have now lost 45 lbs on keto and Mounjaro. I stalled for 6 months and went to carnivore. Now I’m down another 10 lbs on 6 weeks of carnivore. If I stall again, I’ll go back to no sweeteners, no dairy carnivore.
I calculate my protein with the equation of 0.7 to 1 g of protein per pound of ideal body weight. I put my ideal body weight at 160.

(Susan) #7

@lfod14 I think we were both writing our responses at the same time. Yes, I’m tracking everything I eat. I’ve been on tirzepatide for a year. I wasn’t tracking in the beginning of the tirzepatide but I think that a number of days a week I was only eating about 900 calories. I lost 45 lbs but also lost about 3/4 of my hair. I started tracking, started eating a lot more, especially protein, and stopped losing weight when it clicked that the hair loss was probably under nutrition. I didn’t restart losing weight until I switched to carnivore.

I’ve had diabetes for about 3 decades but have been keto for 6 years. In the last 6 years on keto, my A1c has been between 5.9 and 5.0. If I went back to the SAD, I’d have my diabetes back in a heart beat. When I used a CGM about a year and a half ago, I was routinely between 80 and 110. I wish I’d had more CGMs in between these two trials. Now I have 2 changes, both the tirzepatide and the carnivore. I’ve been carnivore for 6 weeks and on the CGM for only 3 days. I can’t sort out if which of the changes is responsible for the low glucose (maybe both?). I’m sure my metabolism went down while not eating much on the tirzepatide and hopefully I’ve convinced it I’m getting enough food now and it can go back up. I’ve been taking the tirz every 9 or 10 days since the hair loss and figuring out how little I was eating. My appetite is down for 3-4 days and then I’ve got a higher calorie intake for the rest of the 9-10 days. I’m taking the tirz for appetite control.

#8

OUCH! Ya, that’s starvation alright. Tirz is the only one that can take people like me and do that, that’s why I went back to Semaglutide. I said I wanted that and that I’d rather force feed myself because then I’d stop when I hit what I needed…easier said than done though!

If you’re tracking with something like MacroFactor, then the math is being done for you, if Cronometer or anything like it, do a TDEE Calculation on yourself, takes a week or so to start really getting it down, but then you have the real number to work with rather than a guess one based on a joke of a “Statistical average”, which isn’t so average after all.

This is one of the few non hideous ones, just give it your goals and daily cals and weight, and it starts doing the math.

To make it a little more realistic, you can get an app that does trend weights, weigh daily, but give the spreadsheet your daily trend weight and not your actual day to day scale weight which will be much smoother, won’t hyper react to temporary weight swings, and still get you in the right place. The hairloss is also a good sign your Thyroid when into hibernation over that one. If you’ve never done a full panel on it, you should. Don’t expect a doc to do it, they won’t. Maybe a TSH and if they think they’re trying they may do T4, which is useless in isolation.

(Edith) #9

Something to think about since you are doing resistance training: It is possible to gain muscle and lose fat at the same time, so it might look like you are not losing weight, but your body fat percentage could actually be decreasing. Don’t just go by the scale, but how your clothes are fitting.

(John) #10

“I can’t sort out if which of the changes is responsible for the low glucose (maybe both?)”

I’m not doc but, while you’re right that it’s probably both, I think the meds are a big factor, right? I’m a 150lb guy eating strictly carnivore for about 5 or 6 years and my BG is typically around 70 or so, spiking up to 100 only after a big meal of protein. With the double whammy from the meds - lower glucagon/baseline BG, and increased insulin sensitivity after a meal, I think we’d expect to see yours quite a few points lower.

(Bob M) #11

You get a 30 point rise in blood sugar by eating protein?

(Bob M) #12

This is why I find it unlikely that protein causes a blood sugar rise:

He shows this:

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The protein curves are basically flat, and the “available glucose” is what they thought would happen (which is that half the protein would turn into glucose).

This has been my experience – high protein causes no blood sugar rise.

Here’s part 2:

If you are getting a 30 point rise in glucose after eating just meat, I honestly have no idea what could cause that. My guess is glucagon, with lowered insulin, but I don’t know why this would be. Maybe a very low fasting insulin/insulin response combined with “too much” glucagon?

(Susan) #13

@lfod14 I had looked at a TDEE and it was similar to the Gym Geek one you recommend. I think I’m not losing as much as it expects because I lowered my metabolism. That’s why I’m trying to get more calories in about half the time, even though that continues to mean two steps forward and two steps back over the week. I’m using Carb Manager for calculating my calories and macros. It was recommended by Kelly Hogan (My Zero Carb Life).

What else is in a 'full thyroid panel besides T3, T4 and TSH?

Here’s hoping you’re right! The clothes are looser. I’m not very concerned with the scale. I eat (as Dr. Ken Berry recommends) until I’m comfortably full. I have trouble falling asleep in general, and huge problems if I’m hungry, so my intermittent fasting is skipping breakfast and eating later in the day, despite the recommendations to do the opposite. I follow my hunger more than the exact calories or weight. I record the calories and weight, but don’t obsess over them.

@ctviggen Thanks for the videos on protein. I’ll watch them later today or tomorrow. My CGM isn’t budging even after 15 oz of steak. For some reason I got a 15 point swing about 2 hours before I ate that steak, but I was intermittent fasting and there was nothing obvious to cause it. No food and no exercise. Just normal variation I think.