Disappointing blood results
 

I just got my annual bloodwork results back and am beyond disappointed.

My A1c last year was 5.3, not bad, but having idiopathic small fiber neuropathy and reactive hypoglycemia, I concluded it was time to start treating myself like a diabetic.

I completely overhauled my diet which had been VERY "healthy-carb" laden. The mainstays of my diet were whole grain carbs....pasta, bread, rice, cereal, etc... For the past 8 months, I've been eating low carb/high fat. My carb intake is between 20g and 60g most days. I also eat to my meter. Anything that takes my post-prandial blood sugar over 140 is off the menu.

So what happens to my A1c? It goes up. It came in at 5.6. My heart sank when I saw that. How can that be? Is a process started that I can't stop?

I'd always been tested by Quest before, and this year had to switch to Lab Corp. Can testing techniques be different between labs?

Hi, I just looked at last year's labs and my glucose came in a 99, HbA1c at 5.4 and report says Optimal. Last year my A1c was 5.6. My insulin says 11 (intermediate risk). Last year insulin was 5.

Why all these change as they do we just don't know and can drive ourselves nuts.

You did a good thing by changing diet and I've changed a lot too but I'm not perfect and I weaken with some sweets....

Maybe taking 250mg G.S.E. a couple times per day. I think I read on one of my sites about taking 300+mg two times per day for diabetic issues.

Keep up with the healing nutrition.

PS: I do all my labs non-fasting...just can't get to the doc's office early in the morning, so gotta take that into account.

All this glucose testing can drive you mad.

There are things to take into account. Surely the other lab could be calibrated slightly differently. Lab testing is never 100% accurate.

When you eat less glucose the liver makes more. And the liver is not a very accurate organ for this, and tends to make more than you need. The old saying of "you need to eat to lower glucose or lose weight" is true.

Those A1C numbers are not the end all ...anyway. They are only a marker. And tend to increase with age too. All of them, the charts and everything were made up as best guesses. With time we may see some changes there too.

Thank you for this, MrsD.

Of course as soon as I get this news, I went into "figure it out" mode. I just couldn't understand how this could possibly happen.

The liver thing makes sense. I don't understand the process well, but I understand weird things can happen when you drastically change your diet. One thing I definitely saw was that my FBG went up initially. I was consistently over 90 whereas I'd been mostly low 80s. I read somewhere this sometimes happens because your body is shocked by the lower carb intake and allows your BG to drift higher. It's back down to the mid 80s now.

I also read this article which is interesting regarding the life of red blood cells. Not knowing any better, it makes sense to me. I guess.

http://chriskresser.com/why-hemoglob...liable-marker/

Thanks again.

I had my annual physical yesterday, and after grilling me on what I was eating and drinking to make sure I was doing things right, my doctor had no explanation for why my A1c didn't drop. As you'd mentioned, MrsD, some diabetics I consulted with said that if I'm eating too much protein, my liver will convert excess into glucose. That's not something I'm monitoring at all, so I'll have look at how much I should be getting, and compare it to the reality. I'm definitely much heavier on the protein than I ever have been.

As I expected, there was a discussion about both my LDL and triglycerides which increased significantly from last year. The triglycerides were still within normal reference range, but I still need to try to understand why they more than doubled. I know they're very sensitive to what you've eaten in the week prior, but I don't remember eating anything hateful before this blood draw.

We had the discussion about bad LDL and benign LDL which I initiated, and she asked if I wanted to get the more refined test to check my LDL particle count to distinguish between the two. I think it will run about $100, and am still trying to decide whether I want to do that or not. I know I can bring my LDL down by just backing off on the saturated fat which would be the path of least resistance, and then just re-check the regular panel in 6 months.

She did at one point ask, "Do you want to take something to bring it down?" She knows I'm not a pill-popper and would decline, but I got the feeling she was obligated to ask. I'm sure "offered and refused" went into her notes.

I wish I had asked for her honest opinion on statins. It would have been interesting to hear her answer.

I-SFN & Pre-Diabetes
 

[QUOTE=janieg;1155632]I had my annual physical yesterday, and after grilling me on what I was eating and drinking to make sure I was doing things right, my doctor had no explanation for why my A1C didn't drop. As you'd mentioned, MrsD, some diabetics I consulted with said that if I'm eating too much protein, my liver will convert excess into glucose. That's not something I'm monitoring at all, so I'll have look at how much I should be getting, and compare it to the reality. I'm definitely much heavier on the protein than I ever have been.

As I expected, there was a discussion about both my LDL and triglycerides which increased significantly from last year. The triglycerides were still within normal reference range, but I still need to try to understand why they more than doubled. I know they're very sensitive to what you've eaten in the week prior, but I don't remember eating anything hateful before this blood draw.

We had the discussion about bad LDL and benign LDL which I initiated, and she asked if I wanted to get the more refined test to check my LDL particle count to distinguish between the two. I think it will run about $100, and am still trying to decide whether I want to do that or not. I know I can bring my LDL down by just backing off on the saturated fat which would be the path of least resistance, and then just re-check the regular panel in 6 months.

She did at one point ask, "Do you want to take something to bring it down?" She knows I'm not a pill-popper and would decline, but I got the feeling she was obligated to ask. I'm sure "offered and refused" went into her notes.

I wish I had asked for her honest opinion on statins. It would have been interesting to hear her answer.

Hi Jan
I hope this finds you doing "ok".. I read you have Idiopathic small fiber Neuropathy. I also suffer with I-Sfn and my first A1C was 5.7. My BS fasting average around 83. I was told I am pre-diabetic. Like you I changed my diet and eat like I am a diabetic. I eat low carb and very little red meat. I get my protein mostly from chicken, fish , vegs and legumes. Lots of avocado, peanut butter, olive oil and walnuts. My A1C did go down to 5.3.
My (2) Endo Docs do not believe my Pre-Diabetes is related to the I-SFN!. My Neurologists "thinks" there may be a correlation between the sfn and pre-diabetes. Its all so frustrating, to think these "Specialists" do not understand any of this...
I did my own research and read studies show even early stage (pre-diabetes) can cause harm to the small fibers and cause neuropathic pain! I am interested in knowing how your sfn started and what kind of "symptoms" or pain your suffern with.
I see you take mostly natural supplements. Do you take anything else for your pain? Mine all started in early 2011 with pins & needles in my calves and burning under both feet. Its been 4 years and it spread to all over my body. Mainly painful pins and needles, roaring tinnitus with surging buzzing and burning. I take 300 mgs Lyrica, and Tramadol as needed. Neither one of these meds help with this type of pain. I take Klonopin for anxiety. I dont know what else to do or who to talk too. I tried all the "first-line" meds, including Gabapentin, Cymbalta and Elavil, nothing worked. What do you take , if anything and how are you coping?
Sorry this response is not an answer to your question or concerns. I felt the need to respond to you because of your I-sfn & Pre-diabetes.
Feeling alone and isolated with pain. Any comments or suggestions would be greatly appreciated. If you like, you can private message me and we can talk further. I think that would be good..
Marie :hug:

Your increased Omega-3's should bring down the triglycerides.

Thanks.

I was really surprised my triglycerides went up at all. I need to learn more about them.

I'm thinking for my 6 month check up that I'll spring for the more advanced NMR Lipid Panel that will show LDL particle size as well. Having read what I've read, I can't believe that's not standard operating procedure now.

Hi Marie,

I've not had the blood sugar discussion with my neuro yet, but two other docs I've seen were completely non-committal on whether my mild sugar problems could be responsible for my SFN.

I did not have typical diabetic-SFN onset. I've had paresthesia in my left leg for 30 years since I was in my mid-20s. Docs could never figure out what caused it, and I was left with a diagnosis of "nerve root irritation." Whether or not that has anything at all to do with what I'm dealing with now, I doubt, but it could.

Without going into all the gory details leading up to it, on Nov. 10, 2013 I woke up feeling like I had electric current running through my body. My left leg symptoms were now in my right leg, and I felt odd things all over. They included mild paresthesia in my arms and hands, and really bizarre sensations in my temple areas. At its worst, I would feel electric current running up through my temple and down under my right eye. It was hitting whatever nerve that was. I have a really bad neck, and I somewhat suspect this SFN is "opportunistic" and wherever you have some kind of nerve insult, it magnifies it.

Also at its worst, I'd wake up feeling like my bed was vibrating, or like I was plugged into an electrical socket. My lower legs also twitched like crazy. I'd had that twitching in my left leg all along, but it was now worse, and also my right leg joined the party. (I definitely think the Mag64 I'm taking helped with the twitching.)

Other symptoms are extreme sensitivity to cold and "referred sensation." The latter seems like a unique symptom to me. No one else here has reported it. If I touch my body anywhere from my armpits on down, the constant sensation in my feet gets stronger. So if I touch my left torso anywhere, I "feel it" in my left foot. Very weird.

I don't know how old you are, but you might want to check the "Progesterone Therapy" thread here which is kind of mis-labeled at this point. I strongly suspect that there's a hormonal component to my SFN. (I'm perimenopausal.) That thread will also lead you to another thread MrsD started about neuropathy research. I think the findings out of UC Davis are very interesting. It's that research that has lead me to increase my omega 3s and ALA intake, and I'm also going to go on estradiol to see what that does. As it is right now, I'm feeling better than I have in 20 months. My symptoms are definitely dialed back, and I have no pain. The weird sensations are all still there, but no pain. :)

My neuro prescribed gabapentin early on, but I no longer take it (by choice). I'm not sure the dosage I was taking, 300 mg at night, was enough to help, so when facing the choice of increasing the dosage, I opted not to. I just didn't want to go down that path if I didn't have to. My discomfort wasn't horrible everyday, but my flares were pretty unpleasant. I would use lidocaine patches and epsom salt lotion to help. And just last month, I got some kratom for the really bad days, but I haven't had to use it (or anything else) in the past couple of weeks.

I'm not supplementing B12 in any form, and my B12 just came back at 835 (normal).

Have to run now. I decided to reply publicly in case it would help anyone else, but feel free to message me anytime.

Janie



[QUOTE=Marie33;1155801]

Janieg, adding to what mrsD wrote;

"When you eat less glucose the liver makes more. And the liver is not a very accurate organ for this, and tends to make more than you need."

I guess that you have Type 2 (not Type 1) diabetes.

If so, metformin is a medication which is worth considering. It stops the liver from making too much glucose.

Like all medications metformin has both potential benefits and risks - this is something that your clinical care team should be able to tell you about.

I actually don't have diabetes, but I have some level of Impaired Glucose Tolerance. Both my A1c and FBG are normal, but they won't be if I don't watch my diet. I can see my glucose spiking too high with home monitoring when I eat carbohydrates.

Hope you don't mind my asking, but something you just posted made me wonder... wouldn't that happen for everyone after high carb meal?

janieg, have you tested an hour after the carbs and again 2 hrs after the carbs? I'm curious if it settles after the 2 hr mark or stays high?

It does spike for everyone, but it's a matter of how high. Mine goes higher than normal, and stays elevated for too long. It seems to peak at the 90 minute mark or so, and it can take upwards of 5 - 6 hours to get it back down to under 100. I've seen mine spike as high as 190, and apparently a completely normal person would never go above 140 no matter what they eat.

This is a good explanation using some of the graphs that have been on various other sites over the years. This topic seems to get new addresses often.

http://bananapoop.com/health/hypogly...rance-test.php

This link is one I am more familiar with:
http://www.rajeun.net/gtt.html

In a glucose tolerance test --pure glucose is measured. One cannot say what a normal should be if it were food instead of pure glucose. The various types of impairment are compared to each other, but not to potential test results if food which needs to be digested are measured for the same time period.

Hi janie,

Being Diabetic and just having started monitoring at home, I am surprised at the frequency at which you are testing. I also would like to know who told you your 'magic number' was below 100. According to all advice I have been given by GPs, Diabetic friends and Diabetes sites you should test just before you eat and then 2 hours after the start of the meal, not straight after or 90 minutes after.

My A1c this year has risen to 7.1, but I am being retested in a week hoping my diet and weight loss will have brought the number down. My fasting numbers are between 110 - 120, except for a minor episode of 66. My +2 hour numbers reach 173, but if I can consistently keep them below 180 and my A1c trends downwards from now on, I can stay off the Metformin and try to control my Diabetes by diet alone.

Please be aware that all the experts agree too much self testing is counter-productive, as is setting unrealistic goals. Remember, as has been pointed out, your liver will produce glucose so it is not simply a dietary issue.

Dave.

Thanks for the links. Very helpful.

This graph in particular shows my impairment:

http://bananapoop.com/health/hypogly...est.php#curve1


After a very high carb meal of pasta and bread...

30 minutes post-meal: 166
1 hour post-meal: 162
2 hours post-meal: 166
3 hours post-meal: 148
4 hours post-meal: 128
6 hours post-meal: 82


This was a test I did to see if apple cider vinegar helped. These were virtually identical meals of "pauper's pasta." (Onions sauteed in olive oil over whole grain pasta).

6:30 94 pre-meal (no vinegar)
7:15 131 (45 min after eating)
8:05 149 (95 min)
8:50 131 (2 hrs 20 min)
9:33 159 (3 hrs) retest a minute later 154
10:05 141 (3 1/2 hrs)
10:35 122 (4 hrs)
11:00 133 (4 1/2 hrs)

5:51 86 pre-meal then took 2 Tbsp vinegar
6:36 118 (45 min)
7:26 129 (95 min)
7:51 112 (120 min)
8:11 119 (2 hrs 20 min)
9:01 121 (3 hrs 10 min)
9:51 126 (4 hrs)


Last week I really splurged and had a high carb meal AND dessert. At the 90 minute mark, I was at 190. I immediately got on the exercise bike. :eek:

I will go weeks without testing at all. This is not something I do all the time.

I test when I eat something new with carbs to see what effect it has on my BG. If it does really bad things, I don't eat it anymore.

Dave,

Keep testing even after you level off. After I dropped 20 pounds late 2012 I severed ties with my gp who was unresponsive to my then newish and growing neuropathy issue. I didn't rush to fill my metformin, instead cutting my dose to once daily until off for a few months.

I kept monitoring and right before I found a new gp I found wild swings taking place. I went back on metformin and have been on since. I may reconsider again, as I am further down in weight exponentially and even better a1c wise, but I thought it was a useful anecdote.

Janie,

I can tell by now what is good or bad, but test still. I do a day, 8-12 or more tests, at least once a week. I like to see the flow of my day, through activity, though lately more inactivity than anything.

I hope you have found some relief through this process. Mine would be the unknown variety, as in how much worse could this be. I imagine lots.

Yes, that's where I am. The only thing I know for sure with regard to my neuropathy and watching my glucose is that I'm at least not doing any additional damage which I certainly could have been doing before.

I've been doing some testing on the effects of exercise on your glucose levels, and it's pretty profound. When I saw I was in the 190s last week after a really bad meal, I immediately hopped on the exercise bike. 20 minutes later it was 106, but it went back up over 140 when I stopped and was continuing to digest.

Hi Jon,

I should have been more clear, I'm expecting my A1c to trend down NOW but still be up from previous years. I have definitely reached a new low (high?) in my Diabetes progression.

I am currently still in the 'collecting baseline data' stage of testing and already notice wild, unexplained differences in numbers, so I have no intention of stopping.

My GPs are VERY supportive, especially with my taking control of my weight problem and losing 25lbs in 9 weeks - much more to go. I will be seeing my PM Team about the onset of additional excruciating needle stab pains in my limbs at my next appt. They are the most supportive Team I could wish for.

Dave.

Sorry to see your post. Hope things turn around very soon. You have my positive thoughts and best wishes.