Help me understand my blood glucose
 

My docs said that I'm not diabetic. What I learned elsewhere made me wonder. Due to growing up in a dysfunctional and abusive family I found food my only solace. I became a binge eater for most of my life. Lots of junk but really healthy foods too. Like I'd eat pounds of raw organic veggies each day along with the donuts and chips and with everything I'd eat until I was emotionally numb. (did not purge however).

That's the background in a nutshell.

Anyway I've always felt that there would be some dues to pay for such behaviors but even with years of therapy it was only slightly better so I did not stop often or for long. Anyway I'm sure there was plenty of glucose spiking going on even if my insulin still worked.

So I started monitoring myself at home with a Max glucose meter. My first readings while not scary made me wonder. Two hours after food I was around 150-60. That's prediabetic. My fasting glucose was around 140 which sucks IMO.

Fear sucks but lets appreciate its function as a motivator. I quickly quit binge eating and started eating five small meals a day that are all healthy food. Within a few days my numbers came down and the symptoms seemed to abate just a tad and I got cautiously excited.

So my Fasting numbers are now in the 84-90 range which is pretty solid and at two hours it's about 110. Stellar from what I know.

This makes me think I was wrong about the prediabetes. Or is there more to this story that I don't get yet? I'm just getting going on the sugar thing.

Can you help me understand this?

The docs and my search have yet to find a cause of my neuropathy. I have many suspicions but no certainties. I'm sure you can all relate to that.

I think there is glucose intolerance that affects people.

Your numbers as they are now sound great. I know diet has affected mine vastly. I also know pretty quickly when a food is overdone or needs to be eliminated due to how it makes me feel.

Diet is hard to control if you pn affects standing, balance and the litany. I used to cook at least half the time. Now I cook a Sunday meal if I am not worn too thin by the day.

Cooking makes me feel good, but I have to be so careful now. My hands have the feeling of three pair of food service gloves on in regard to sensation and dexterity. Some days are less. Who knew changing fryers would lead to a useful analogy for my hand sensation/lack there of?

My first comment is about your "two hour number." You said you were 150-160 two hours after a meal and now you're 110. Were identical meals involved? You have to compare apples-to-apples. A meal of pasta vs. a meal of meat of non-startch veggies will yield very different two hour results if you have Impaired Glucose Tolerance (IGT).

The diabetics who have been guiding me promote the "eat to your meter" approach to controlling blood sugar. In a nutshell, always eat so that your blood sugar never goes over 140, and preferably 120. I have no trouble doing that as long as I keep carbs to a minimum. This was a page I was referred to:

http://www.phlaunt.com/diabetes/14045621.php

Something as simple as a measured 1 cup bowl of Cheerios with enough milk to cover it sends me to 169. An apple takes me over 140. All this happens with my Fasting Blood Glucose (FBG) being in the low 80s and my A1C in the low 5s....well below pre-diabetic screening criteria.

Most of the diabetics say to ignore your FBG as it's not a good measure of what's going on. Your post-prandial (PP) values tell the story. There's a lot of good information on the website I linked to. Start reading on the home page.

Something like 50- 60% of diabetics will get peripheral neuropathy, so obviously there's a real motivation for someone with neuropathy to keep their blood sugar under control regardless of whether blood sugar is believed to be the cause or not. Will a doctor tell you this? My neuro didn't, but my primary care doc did.

The meals were basically identical day to day but each meal was slightly different but I ate the same the next day so I would have apples to apples comparison.

I've never heard of numbers improving that drastically that quickly, but I'm certainly no expert.

I've been low carb for about 8 months now and have seen no improvement in PP numbers with regard to how I process carbs. When I get my annual physical next month, however, I'm hoping my A1C will be even lower showing the effects of my dietary changes.

If you want an accurate test in a controlled environment to see what going on post-prandrial, I'd request an Oral Glucose Tolerance Test from your doc. It's a two hour ordeal at the lab getting stuck four times, but it will really show what's going on. Some researchers recommend that anyone diagnosed with idiopathic SFN should automatically be given this test.

http://www.jabfm.org/content/17/2/127.full

"Conclusion

Based on the data available in the current medical literature, we suggest that patients presenting with unexplained painful sensory neuropathy should be evaluated for impaired glucose metabolism with a 2-hour OGTT; if the results of the test are abnormal, they should be referred for lifestyle interventions and/or initiation of oral hypoglycemic agents in addition to management of neuropathy symptoms. Improved glycemic control can prevent the development of overt diabetes mellitus and may have some impact on progression of neuropathy in these cases. The association between “idiopathic” painful sensory neuropathy and impaired glucose metabolism argues very strongly for prospective studies in larger populations looking at the cost-effectiveness of this approach."

As I understand
 

My Dr. told me that once you get above 140 on fasting glucose in the morning, you are diabetic. 80-120 is what you want. I am glad you can eat better and get your numbers down. If you test two hrs after eating the number needs to be 180<. I don't think you were wrong about the prediabetes. My backstory may be very similar but my numbers have been bad. I lost 60lbs during muscle wasting acute phase amyotrophy and the diabetes went away until the strength started coming back. Now I'm getting stronger but sweeter too! I have a month to get my numbers into safer range or else the Optometrist is going to do laser surgery on my eyes as they are bleeding on the inside. So please keep on testing. I have in the last week, given up tortillas at breakfast and doubled my Metformin to 2000 mg/d.
Good Luck, Ken in Texas.

< 180 is the post-prandial target for a diabetic as given by the American Diabetes Association which many believe is too high.

Regardless of that, it is WAY too high for a non-diabetic like icelander.


Below is what I've consistently read to be postprandial numbers for a person without issues.

http://clinical.diabetesjournals.org...t/20/2/71.full

"In healthy, nondiabetic subjects, 2-h postprandial blood glucose levels are usually <120 and rarely >140 mg/dl. Glucose levels peak at ∼1 h after the start of the meal and then return to preprandial levels within 2–3 h."


If I eat a high carb meal, I spike into the 170s/180s, and it will take me 4 - 6 hours to return to preprandial levels. This is how I know without a doubt that I have a problem with glucose metabolism. Well that, and the fact that my Oral Glucose Tolerance Test showed reactive hypoglycemia.

_______

My annual reading comes in at 90 or so, and this is non-fasting. Regardless, I would work to keep carbs/sugars to a MINIMUM. I decided about 5-6 yrs ago to get off breads...started buying gluten free but then decided I didn't need to bring breads into my house....my sandwiches are a romaine lettuce wrap, I buy a lot of organics as at this time in my life, my health is too important to put cwap into my body. I was raised on pasta and this time in my life, hardly ever eat it. My health is too important...

I have a friend who deals with skin cancers and she says idiopathic neuropathy, but I believe her issues are sugar....she gets a HIGH when sweets are around her. I've stopped talking to her, does no good. cancer loves sugar environment.

I now eat no sugar, and very rarely grains. I eat small amounts of meat. lots of veggies cooked and raw, whey protein powder, some berries for fruit. That's about it right now.

See this is what I think I've been doing to myself all these years. Spiking over and over and over because of binge eating junk. My insulin still works however and that's why eating like a normal human has brought my glucose into the healthy range. So I might not be pre or diabetic but still have caused my neuropathy with the spiking for all those years. Does that sound like a possible?

I've been doing the same thing all these years, only not with junk food but with "healthy carbs." The effect is the same.

Eating low carb and checking your glucose postprandial BG or fasting BG isn't going to tell you if you still have a problem. To see if you're not metabolizing glucose properly, just emulate the glucose tolerance test at home.

- Take your fasting blood glucose before you eat
- Eat a very high carb meal...like white pasta with garlic bread...really splurge
- Check your BG at the one hour mark after you started eating
- Check your BG at the two hour mark

If you're under 140 at the 2 hour mark, you're fine. Some people would say that to be classified normal, that one hour mark number shouldn't be over 140 either, but I think that might be up for debate.

When I was still in the 160s at the two hour mark, I kept checking on the hour to see how long it would take me to get back down to normal.

Loved your line, "eat to your meter".

That is what works BEST for me and I AM a full fledged diabetic for years.

While I do pay close attention to nutrition labels and the amount of carbs listed, I have found that my meter is the BEST guide of what my body likes and doesn't like as far as its ability to deal with food consumption of various types.

Portion control will also affect my meter readings. I can eat something with almost NO carbs, but if I don't watch the portion (false thinking that I can eat more of it since it has little or no carbs), quantity will also create high post prandial numbers.

The endocrine system is very complex. My meter is my guide.

It sounds like you're doing exactly what the "eat to your meter" people told me to do. Their instructions are below.

I'm using a ton of test strips, but thankfully mine are cheap. Rather than give up some things all together, I'm working on portion size to see if I can reintroduce some things.

From www.diabetesforum.com....

Technique for eating to your meter:.
*edit* per that sites copyright & terms.. ( you may link to the specific post or thread for members)

Great info and I thank you. If I eat a big meal like I used to there I am over 140 and last I checked around 160. I'm assuming I will have to eat very consciously for the rest of my time here.

I have hope my system will normalize, though if I eat too many carbs or an odd occassion of not considering sugar I pay in a myriad of ways.

I am in the prediabetic zone A1C wise, but I have not found any comfort in improvement. I think I have improved my grade of descent, though. A parachute of sorts.

I know I blindly consumed in the past and if not for a conscious decision to do anything reason or unreasonable (though not dangerous) was where I needed to get.

I am leaning toward adding some seafood soon. I have always enjoyed it, though I'm picky. A lot of seafood in the market these days has dubious quality.

No comfort in improvement? Have you at least stabilized at your current pain level?

My numbers getting better have not translated to any improvement in symptoms.

I know I'm speaking the obvious here, but at least you're doing what you need to to prevent further damage. And maybe with more time, you'll start to see improvement.


I found this really good blog article that seems to summarize well what I've read all over the place. I'm excerpting the sections of real importance (with permission by the author):

http://diabetesupdate.blogspot.com/2...ou-can-do.html

"Everything changes when you define "tight control" to mean "Maintaining post-meal blood sugars below the level where neuropathy begins." That level turns out to be 140 mg/dl (7.7 mmol/L). Lower your blood sugar to this level, meal after meal, and your nerves sill start to heal.

This is a good 40 mg/dl lower than the dangerously high 180 mg/dl two hours after eating which the ADA officially defines as "tight control." And when you bring your blood sugars down below 140 mg/dl and keep them there for a few months, your feet will get better. "


"The take-away lesson here is this: It is post meal blood sugars that cause neuropathy. People can get identical A1cs with very different post meal blood sugars which is probably why the research finds there is no clear correlation between A1c and the presence of neuropathy, especially when A1c is below 8%.

Your fasting blood sugar, which is the only blood sugar many out-of-date doctors monitor, is also worthless in evaluating your neuropathy risk, because it is possible to have extremely high post meal blood sugars and completely normal fasting blood sugars. I did that myself years ago when I had fasting blood sugars of 98 mg/dl and post meal blood sugars at every meal over 250 mg/dl.

This 140 mg/dl post meal blood sugar target is very mainstream--the American Association of Clinical Endocrinologists has been recommending it for five years now and I have heard rumors that some of that organization's members would like to see it lowered even further. "

__________

Right. The reason I continue is it is possible and even likely that less control is likely to make it worse.

If I found the approach I am on difficult, I might change. But I don't and I actually feel so much better with lower caloric intake, no matter what sort.

I am prescribed 4 strips a day. I tend to horde them and do 8-12 tests a day tracking a full days progression- before meal, 1 hour and two hours after meal, more if the numbers are funny.

I also test after exertion of a mile walk or so.

I wonder if there is more that a diabetic angle, but I can't ignore it has a place at my table.

That's pretty much where I am. I didn't have typical "slow creep" onset that I think most diabetics have...mine was pretty sudden and acute. Regardless, my postprandial spikes were certainly not helping the situation, so I'm changing my ways for good diet-wise.

But that's not what I asked. Have you at least stabilized?

That's all true IMO. One of the reasons I believe I made it into old age before this occurred was I was gonzo on exercise. I often did 5-15 mile walks with my dogs and then hit the courts for basketball etc. I've never thought of testing after exercise. I shall try out your protocol. Thanks.

Also I agree that eating light feels very good most of the time. I'm so motivated due to pain and my fear of it I don't think sticking to any food regime will be too hard.

Plus I always wonder if it would be worse if I wasn't watching the glucose or anything else for that matter.

I see the reason
 

I have phone coaches that want me to do "paired testing" and gave me the <180 goal. Even if this is too high it is still better than my Dr. that told me to forget about the coaches. I understand his reasoning because I had become lost trying to test so often and so precisely that I had thrown out the baby with the bathwater and was no longer doing anything right. That statement about <140 being the threshold for nerve healing is a pretty fat and juicy carrot to shoot for. Using the analogy of being lost, I need to sit down and look around for the way to proceed. Maybe some of your discipline will rub off onto me. Thanks, Ken in Texas.

Wow I missed this. That means there's a little ray of light for me.:hug: My 2 hr. blood glucose after breakfast this morning was a beautiful 97. No more spikes for this bad boy. Why don't they teach this stuff in school. "You want a good life boy, well money is only a small part of living well".

I think the bottom line is you just need to learn what you can eat without driving your BG above that 140 mark. With me, it's become pretty clear that I can't eat a lot of carbs at all in one sitting without risking that, so I've had to gain a good understanding of the carb content of all the foods I eat.

I rely a lot on Googling to learn the carb content on everything. If that's not your thing, you can order the free Atkins Starter Kit, and they'll send you a little booklet that you can quickly reference for the carb content of various foods. They'll send you other things as well more related to their diet, but that little booklet is the most valuable thing.

http://www.atkins.com/register

Of course once you know and understand the carbs, the next step is developing the discipline. That's where things get interesting, but if I can do it, anyone can. :)

JON. I found this in the blog and thought you might find this of interest.



"If you have been living with much higher blood sugars for a while and have neuropathy that has progressed to numbness, there is one bump in the road you should be aware of. If your nerves are so damaged that they have become numb, when you start to heal them, they may hurt.

Regenerating nerves always hurt, itch or tingle. This is true whether they are regenerating from glucose poisoning or mechanical damage. If your feet start to hurt after you have lowered your blood sugar, remind yourself that this is good not bad. "

Dear Icelander,

Your PN may or may NOT be related to blood sugar swings in the past. While diabetics frequently get "diabetic" neuropathy, all neuropathy is not due to blood sugar levels.

All diabetics do not necessarily get peripheral neuropathies, nor do all peripheral neuropathies originate from blood sugar abnormalities.

Your PN may have nothing to do with your past diet or glucose levels. Maybe yes, maybe no.

And once a person HAS been diagnosed with diabetes, any PN is almost always attributed to diabetes, which may or may not be valid, but it is almost always the assumption made, by most in the medical field.

You may never know if your previous diet has/had anything to do with your PN. The only thing I can say for certain is that improvements made in one's diet are a good thing regardless of whether that improves PN symptoms or not.

One last note. There is no magic number at which a person will or will not develop PN from abnormal blood sugar levels. Every one is different. A person can have POOR control and have NO PN symptoms while another may have tight control and suffer with terrible PN symptoms. It is not cut and dry. No magic levels or numbers to be "safe" from PN.

Bottom line: One can only do their best to control the things they can and that in turn may lessen the risks and degree of PN. It is no guarantee. The better you treat your body, the better it may treat you. Even the person that does everything correct in the manner in which they care for their body is not guaranteed to avoid any problems. We can only lay a good foundation for a good outcome. The rest is up to GOD or chance depending upon one's beliefs.

Just keep up the good work and see what happens. Let us hope that your efforts will be rewarded with better health. Even if improvement is not attained, at least you have done your best and may have prevented it from getting worse.

Sometimes we don't get all the answers we seek. You may never know what the origin of your PN. You may have idiopathic PN.

I've done my homework that far. I know all that you've said is basically true. This is the second piece of possible good news I've gotten here and I see no reason not to be a little hopeful as long as I remain cognisant of the realities.

If it's something else I'll likely never find it as I'm about done with my search as far as cause within the medical profession. I will still use them for some tests to confirm what I'm doing or not but other than that I hope to basically use them as adjunct and selectively. I'm mostly done searching/begging the medical profession for help. This is it and if it's a mistake I'll accept any consequences. I'm going to sink or swim using my own skills and intuition which IMO put me ahead of a medical profession that does not care if I suffer or not as long as the profits come in. That's not a hippocratic oath. It's a hypocritical oath.

So this is my path and I think we might be on to something. And as you said eating well never will make anything worse.

No icelander,

I am progressing along and I wish I could believe it were healing, though to me it is advancing.

I hope to be wrong.

Ok thanks, that's what mine has been doing and I'm looking at everything possible. I'm thinking of trying self-hypnosis and writing affirmations. Affirmations worked well for me at another juncture in the road of life. I figure if diabetes is the issue then it will be a long road to recovery and there will be as much or more pain at times due to the healing process (I remember someone else who got better saying it was a painful process and they often didn't believe they were getting better). If that's the case then being very nutrition and supplement savvy should set me in good stead. If I can speed recovery by feeding myself the right nutrients, becoming very calm and relaxed, and creating a positive attitude without lying to myself then I figure that things could speed up. I saw it happen in the supps industry with customers and friends. So I'll be doing within my own self everything I can and let the rest be damned.

I'll admit this here. The deep breathing and relaxation techniques have helped more than anything so far and I got on to it one night when I was so scared and in pain I wanted to run anywhere or be dead. I stopped myself and saw how my breathing had completely tensed me. So I did some deep breathing and things got a little better. Then over time it really helped, now when I'm scared or confused, lost as to what to do next and frantic because there are so many possibles I stop the internal dialog going on and tell myself the ONLY THING I have to do is breath deeply and relax. That one thing has made a ton of difference for me and I'm just getting started. And it takes all the performance pressure off me as far as grasping at straws just because someone else said I should or I'm terrified. I'm much more relaxed and when in pain deep breathing always helps at least a little and often a lot.

And if nothing ultimately works for the neuropathy, that breathing one has been doing will keep them calm enough to do whatever they feel they need to do to improve the situation.

Hi icelander,

I worry a little when I read that someone is doing deep breathing to relax. Overdoing it leads to carbon dioxide depletion and hyperventilation. There also is rarely a long lasting, positive mental outcome.

The powerful Breathing Meditation I have been taught is to:

Sit comfortably in a peaceful room with no chance of distraction.
Close your eyes half way, facing forward, you are not trying to go to sleep.
Breathe normally, steadily and calmly through your nose.
Concentrate on the feeling of your breath entering and leaving your body, think of nothing else.
Your mind will calm and become clear. Concentrate on that Clarity.
Continue for 10 minutes or so, in which you should achieve 2-3 minutes Clarity of Mind.
If your thoughts wander, concentrate on your breathing again.

As with everything, practice makes achieving Clarity easier.

Dave.

Then you worry unnecessarily. I've studied meditation technique for over 20 years and have practiced intermittently.

Here's my "deep breathing relaxation exercise" . Blow out your air audibly. Then intake to a count of 4, hold for 7 and then out for 8. Do four times only. This can be repeated throughout the day as much as you need. It gets more effective with practice.

I also do the one you just posted. Close enough anyway.

About breathing..........

I don't know about others, but I know that I unknowingly seem to hold my breath when going through a temporary excruciating pain. It is not something I do on purpose, it just happens at the onset of a painful medical procedure. Then I realize I am holding my breath and have tensed up. I know that holding my breath does not eradicate the pain but it is an automatic reaction. When I realize I am doing it, I try to breath normally.

I am just wondering if others have this "automatic" response when undergoing a painful medical procedure.

Do others breath abnormally when going through elevated pain levels?

About the ADA guidelines..............

Just my personal vent. I am not sure how the American Diabetes Association has determined their guidelines and why they change them at times, but, for ME..... I would like my numbers to be "lower" than their guidelines.

I have my own goals which are a little bit lower than the ADA's numbers but it is MY eyesight, MY kidneys, MY limbs, MY pain and suffering that is of more concern to me.

I feel that MY goals are not only realistic goals, but reduce the risks of diabetic complications a little more than those suggested by the ADA.

I do not expect to have "normal" numbers that would equate to those of a non-diabetic, but I would definitely prefer to have an A1C level at 6.5 or below rather than the 7.0 depicted in the ADA guidelines.

At the moment, not meeting either goal levels, but this is a temporary situation.

I heard they are raising their guidelines for fasting blood glucose levels.

Their numbers (guidelines) do not eliminate the complication risks. They do not suffer the consequences.

I am aware that attempting to lower one's numbers too much can also be detrimental so I am setting goals that are lower than the ADA's diabetic guidelines but also realistic for myself.

Some diabetics feel they are "safe" from diabetic complications if they meet the ADA's guidelines and I think that is a false assumption on the part of many patients.

Just MY opinion. May not be the right one for others.

YOUR opinion about the guidelines are warranted, because there is more and more evidence that you can be glucose intolerant or pre-diabetic and still suffer the full range of neuropathy. The standard there is probably set by how much people get symptoms at this glucose lvl. even people with diabetic levels glucose, dont get any symptoms at all. some can have it at lower levels. or some people will only show at very high levels. I can use this analogy with Hiv/cbc, some people wont get AIDS below a certain point. I think its to get your glucose as low as medically possible, without causing some symptoms.

Yes, I get this every month when having a cannula jammed into my vein for my Lidocaine Infusion. All Meditative techniques go out the window. They work for the 5-10 minutes of prodding and slapping my oversensitive hands, trying to find a vein not knackered by overuse and Chemo, but as soon as I feel the pain from the needle touching skin, I stop breathing automatically.

I wonder why.

Dave.

Hi Hopeless
Yes absolutely - for so long I just did the 'grin & bear it' response to pain that holding my breath and tensing became automatic. I suspect this may be part of the reason I developed TMJ (temporomandibular joint disorder). My jaw became sore with clenching from pain - so much that I had to get a bite splint made to relieve it.

Like you, as soon as I realize I'm doing it I try to relax and breath normally.

I'll definitely apply the breathing techniques mentioned here. When I realize I've stopped regular breathing I have a sighish sound that comes out.

I agree Hopeless, any rise in acceptable is unacceptable. I muse that our overly processed food system influences such decisions, along with our continued "frankenfood" approach to our building blocks.

I am no scientist, though.

I was a horribly out of control diabetic for at least a decade (a long time with no insurance and a youthful view toward my health) though I have been out of the A1C zone of diabetic, I recognize feelings of "too much" now as the echos of what took place after that bear claw.

There are a myriad of reasons for betterment. I guess I could throw up my hands, grab a bag of Skittles and go Cookie Monstee on them with the results of symptoms as they are, but I do recognize the good and growth my approach has offered.

I see my hard days would be more difficult and acknowledge any change for the better is likely to come as my symptoms started. Sure, it is 4 AM and neuropathy woke me up. But hey, my A1C to start the day is sub 100 when it often resides 110-120.

I like the Jim Valvano approach to disease, tho' his was cancer-
"Don't give up. Don't ever give up."