A Dietitian’s Journey – 5 month update

It’s been 5 months since I began my own weight-loss journey, following a low carb high healthy fat diet and here is a short update. 

Fasting Blood Glucose

When I began this journey at the beginning of March, my fasting blood glucose was averaging 12 mmol/L. Four months into eating low carb high fat, my fasting blood sugar was averaging 8.5 mmol/L. 

July 25th, it was measured at the lab and on my home glucometer as 8.0 mmol/L – still way above the cutoffs for those with Type 2 Diabetes of 6.0 mmol/L, and way above the normal levels of 4.5-5.5 mmol/L.  

It is highest is in the morning, I believe due to cortisol’s effect (see 4 month update, for details).

2 hour Post-Prandial Blood Glucose

I’ve been tracking my blood glucose regularly since I started implementing the dietary and lifestyle changes 5 months ago, and my 2 hr post prandial (after a meal) glucose had been averaging ~7.2 mmol/L, which is much better than the 7.7 – 8.6 mmol/L which is what it was at the beginning of March, but still no where good enough!

…but I noticed that after I go for my brisk 3-4 km each morning, it is 5.4 mmol/L. This gave me an idea (see below).

Blood Glucose through the night – effects of Cortisol

For about a week, I measured my blood glucose at 1 AM and 4 AM and 6 AM (in the interest of science, of course!) with a brand new glucometer that I standardized at the lab, when I had my fasting blood glucose and fasting insulin done on July 25th. My morning fasting blood glucose would rise to ~6.6 – 6.8 mmol/L (119 – 123 mg/dl) from the 5.4 mmol/L it was when I went to bed, even though I hadn’t eating or had anything to drink.  This had to be the effect of cortisol!

Fasting Cortisol

I had my fasting cortisol assessed the same day that I had my fasting blood glucose assessed (July 25 2017) and it was, as I suspected, high421 (125-536) nmol/L 

…and this is with walking 4 km / day and sleeping 8 hours (restful sleep). 

I need to come up with some additional strategies for lowering stress.

Fasting Insulin & Calculating Insulin Resistance

I also had my fasting insulin assessed the same day that I had my fasting blood glucose and fasting cortisol assessed (July 25 2017).

Based on the July 25th lab work, I calculated my Insulin Resistance using both Matthews (1985) Equations (HOMA1-IR), as well as using Oxford University Center for Diabetes, Endocrinology and Metabolism  homeostasis model assessment (HOMA2-IR)  calculator (2013).

From when my fasting insulin and fasting blood glucose was last tested 2 years ago in August 10, 2015, my insulin resistance  calculated by HOMA2-IR had gone down from 3.06 to 2.77, but it’s still too high because my fasting blood glucose remains high.

Average Insulin Resistance – in the normal population

One study reported that the average HOMA2-IR in the general (non-Diabetic) population is 2.1 +/- 2.2 (Diabetes Care, Volume 24, Number 3, March 2001), so I am guessing that a HOMA2-IR of 1.00 would be a healthy target – one that will likely take me a year to approximate.

Whether that will be possible with diet and lifestyle change alone, has yet to be seen.

That is my goal.

High Morning Glucose – assessing the problem

I believe the reason that my blood glucose remains high in the morning is due to a combination of residual hepatic (liver) insulin resistance (from years of eating way too many carbs) and high cortisol that is stimulating an overproduction of waking glucose.

Effect of Walking

The last 5 months, my fasting blood glucose has been consistently high at 8.0 – 8.5 mmol/L (144 – 153 mg/dl) and my 2 hour postprandial is fine for a Type 2 Diabetic at ~7.2 mmol/L – but a far cry from the non-Diabetic range I am seeking.

…but I noticed that after I go for my brisk 3-4 km walk each morning, my fasting blood glucose is 5.4 mmol/L (yes, I go fasting).

The effect of moderate exercise seems substantial, so I decided to see what effect there would be on my early morning fasting blood glucose levels if if I took a short walk after dinner.

The results were dramatic!

For the last week and a half, my blood glucose drops to ~5.2 – 5.4 mmol/L (94-97 mg/dl) after a very leisurely 15-20 minute walk around my neighbourhood.

High Morning Glucose – assessing the solution

Based on my high fasting blood glucose of 8.0 mmol/L on July 25th, my physician’s colleague naturally recommended that I go on Metformin, but I have decided to hold off on introducing it for 3 months provided that;

(1) I continue the dietary and lifestyle changes I have been doing for the last 5 months and…

(2) I add a 20-minute walk after dinner.

Plan to Reassess in Three Months

I am requesting that my physician provide me with a requisition to have my fasting insulin and FBG re-run in October, when I update my HbA1c, so I can recalculate my HOMA2-IR again and see how much less insulin resistant I am by then.

I want to know the magnitude of the insulin levels dropping, not just the fasting blood glucose, which I expect, will drop…after all, the goal is to lower the very high levels of insulin. High blood glucose is a symptom – the cause is too much insulin being released, due to insulin resistance.

Blood Pressure

As mentioned previously, I asked to be started on a very low dose of Ramipril (Altace) about 6 weeks ago, as my blood pressure had begun to creep up again. When I saw 160/90 mmHg two days in a row, I went to see my doctor.

10% of the time I am ≤ 119 / 79 mmHg, considered normal blood pressure

64% of the time I am ≤ 120/80 mmHg, categorized as “Prehypertension”.

…and 26% of the time, measured before I take my medication, I am ≤ 138/90 mmHg, categorized as “Stage 1 Hypertension”.

I will continue to take the blood pressure medication as a temporary measure to offer some protection against heart attack, stroke and kidney damage until I lose some more weight, and my blood pressure stays down on its own.

Weight

Overall, in the last 5 months, I have lost 12 pounds and ~3 inches off my waist. I’ve lost about the same number of inches off my neck circumference  (3 inches) which has had a dramatic effect on how I look.  I have a neck and ONE chin.

I’ve lost overall about an inch off my mid-arm, an inch off on my thighs (gaining muscle and losing fat, at the same time) and lost around an inch off my chest.

Lowering Stress, Lowering Insulin

I need to get my cortisol levels down, as these are driving my high morning fasting blood glucose levels. Walking in the morning has been good, adding the short evening walk even better. Now I am adding (on alternate days from my 3-4 km walks) a workout with 5 and 10 pound weights and other forms of resistance training. I am even jumping rope (which has gotten much harder since when I last did it at around age 16!).

The goal is to get my insulin levels down, and I am already doing everything that needs to happen for that; eating only the carbs necessary to have a nutritious diet, with no excess protein and extending the time between meals (intermittent fasting) a few days per week.

It is going to take time

Over the next 3-6 months, I expect fasting insulin will keep falling.

My goal over the next year is to reach a ‘normal’ 2 hour postprandial peak of 60 mIU/L (430.5 pmol/L) as determined by Dr. Kraft’s Insulin Response curves, which should be an Insulin Resistance (HOMA2-IR) of between 1.0 and 2.0.

Over time, the fat in my liver (“hepatic adiposity“) will continue to decrease, and the derangement which took time to develop will resolve.

While the rate of resolution to for me to achieve normal insulin metabolism is unknown, I know if I keep doing what I am doing, it should happen. It doesn’t always occur, but I won’t know if I don’t try.

Have questions?

Want to know how I can help you achieve your health and weight goals? Why not send me a note using the “Contact Us” form, above.

To our good health!

Joy


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Note: I am a "sample-set of 1" - meaning that my results may or may not be like any others who follow a similar lifestyle. If you are considering eating "low carb" and are taking medication to control your blood sugar or blood pressure, please discuss it with your doctor, first.

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