More insulin/glucose questions

[theprez]

Hi everyone,
I've just finished the Bredesen book and will be doing 23andme. I've been reading the threads in this "Getting Started" and I have not found exactly what I'm wanting to know. Your opinions will be appreceated.
I've been a Type II Diabetic for around 30 years now. I read all of the recommendations here for lowering FSG and A1C, and they are exactly what I've already been doing for the last 10-15 years.
I've lost 75 pounds over that span, I eat a vegetarian, anti-inflamatory diet with lots of greens, vegetables, nuts, seeds, good fats and only sprouted whole grains. Very small amounts of dairy, no animal fats, etc. I also exercise twice daily, have a BMI below 25, haven't smoked in 40 years, drink a half glass of red wine with dinner and that's it.
I have managed to keep my A1C in the 6s with this lifestyle plus Metformin alone for a long time, but now I'm finding that my numbers are rising and I have been taking a Sulfonylurea with dinner. I do have "Dawn Phenomenon" so without the Glimeperide, my FSG has been too high.
I am concerned that by poking my pancreas each evening, I am creating a bigger problem with the increased insulin. I just don't know what is worse at this point, the higher insulin or the higher blood sugar.
What do you folks suggest?

[Stavia]

hi theprez!
This is an excellent question.
I suspect that your pancreas may be producing insufficient insulin after decades of T2DM.
The bottom line IMO is the question - is the sulphonylurea producing a physiological or supra-physiological level of insulin and for how long?
I'm not acquainted with your particular sulphonylurea so am unsure of its halflife.

I guess one could get creative with some insulin testing with a dose at a large lunch as likely no lab will be happy to draw blood at 10pm!

My gut feeling is that a dose of a sulphonylurea sufficient to reduce post prandial and fasting glucose to an acceptable range is likely to produce a near physiological insulin level.

Another thought is to reduce your carbohydrates to as little as possible, this reducing the need for pancreatic insulin.

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[Jan]

Hi, theprez, so glad you found the site. I'm not medically-trained, so was glad to see Stavia's response. Just out of curiosity, does the red wine (even if a small amount) not interact with your medications?

[JML]

Hi theprez, and welcome to the forum. You are asking some good questions about insulin/glucose. Although I cannot answer your question, I do want to make sure you are aware of the Search function on the site (if you haven't already found it, it can make finding posts within threads much easier).

To use the Search function, click on the three vertical dots in the upper right corner of the screen (under the word "Donate" and next to your name). Click on "Search" and you can enter your keyword(s).

Good health to you

[theprez]

Thanks for the responses.
Glimeperide is a tier two Sulfonylurea, considered to be among the "least harmful",certainly an improvement over the older orals, but I am still concerned about insulin levels as it relates to cognitive issues down the road.
My last C-Peptide (1.18) was, as they say, "within range" (though on the lower side). This should indicate that my pancreas is still producing. The big problem as I see it is the Dawn Effect. For anyone not familiar, it is the not uncommon condition where over night, the liver cranks out glucose in the pre-dawn hours. In my case, it seems to start around 4-5 AM.
I feel like I've been doing everything recommended to decrease my insulin resistance, but after reading Dr. Bredesen's book, I've decided to add more zinc and magnesium to my supplement regimen. I posted here because I hoped I might find others with similar concerns who may have additional recommendations.
As for carbs, my intake is already pretty low, and primarily whole and sprouted. I know you can drop all carbs and eliminate DM with a diet of nothing but proteins, but I think you just trade one disease for another if you don't eat a healthy, balanced diet.

[Grace]

Hi theprez,

Have you tried intermittent fasting? I encourage you to read The Obesity Code by Jason Fung and look into his work on fasting. His center up in Canada has had considerable success getting diabetics, even severe diabetics, off their meds and normalizing blood glucose using intensive dietary management with longer fasts. It can work wonders for elevated glucose.

[theprez]

I have not read that particular book, but there is so much discussion of fasting these days. I am currently following Dr. Valter Longo's advice re: 2-3 day, 2-3 times a month of extremely low calorie "fast" days with minimal intake of primarily good fats and vegetables only. I also have been maintaining the 12 hour, Bredesen fast each night, with the minimum 3 hours of no food between dinner and bedtime. I'll have a look at The Obesity Code (though it's been years since anyone could have called me obese )
Thanks

[Stavia]

"healthy balanced diet"
That's the nubbin of it - in my view nobody has successfully defined a universal absolute version. I read every single post here every day and in succession I have just read member A's post, who said they were unwell on a vegan diet and improved on LCHF and then I read member B's post, where they felt healthier on a low fat, high carb vegan diet.
Everyone has their version of what constitutes a healthy diet and it certainly isn't consistent.
Balance - now who decides where the fulcrum is? Again I posit that it's individual and there is no absolute fulcrum.

Which leads me to believe the concept of a perfect diet does not exist.
Rather, a range of possibilities that may or may not suit different people.
I keep being reminded of Akira Kurosawa's movie Rashomon. Four versions of an event. All valid. The absence of an absolute truth.

Not specifically talking about your insulin and diet theprez, just a general comment sparked by the posts tonight.

I hear you that you are hesitant about going lower carb. This isnt a diabetes group so I'm probably the only doctor member who has actually treated many diabetics in active practice over decades. What specifically are your concerns? I'm very interested in learning

[theprez]

I hear you that you are hesitant about going lower carb..... What specifically are your concerns? I'm very interested in learning

I am already extremely low on my consumption of the so called "bad" carbs, meaning that I eat very little simple, processed or refined. On a typical day I will have 1/2 of a sprouted whole grain muffin, or a small apple with my breakfast nuts and seeds, and I do eat a fair amount of tofu and beans, but the majority of my carbs are from vegetables. I eat no meat, but plenty of good quality fats from olives. olive oil, avocados, coconut oil, and the aforementioned nuts and seeds. I'm well aware that a mostly protein "Atkins" style diet is effective for DM, but I believe it is way too hard on the kidneys. Protein leakage from the kidneys is a common enough problem for diabetics as it is. I've also noticed that many who eat this mostly protein and fat diet will rationalize a lot of additionally harmful food just because they're hungry and "it has no carbs".
I think the answer I'm still after is: While I'm transitioning to the recode protocol, which should be my bigger concern: Too high blood glucose or too high insulin? In other words, do I drop the evening Glimeperide and accept the higher FSG?

[Stavia]

Theprez, I truly don't think anyone can give you a true answer. The data just isnt there amd anyone will be guessing. I still think if you could actually measure your insulin at the peak of action of your sulphonylurea it would give you more data to work with.

My gut feeling is to prioritise the glycaemic control because this is where the data is in terms of diabetic complications , and sustained high glucose levels for a significant time will in turn drive increasing insulin resistance.

Thank you for your explanation re your diet. Nobody here that I am aware of is following the old-fashioned Atkins type high protein. Many of us limit our protein to less than 1gm/kg or even much lower. For many reasons, amongst which mTOR is prominent.

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