A Dietitian’s Journey – the 25 week breakthrough

Finally!  Like anyone else who’s been working long and hard towards achieving their health goals, I’m so excited that I’ve finally made a significant ‘breakthrough‘! I didn’t think it would take this long, but when I think that it has taken me close to 20 years to become this insulin resistant, it only makes sense that it is going to take some time to become insulin sensitive again!

Last night, for the first time since I was diagnosed with Type 2 Diabetes (T2D) ten years ago, my 2 hour post-prandial blood glucose (i.e. two hours after a meal) was 5.8 mmol/L (105 mg/dl).

To put that in context for someone without Diabetes, blood glucose taken two hours after meals should be less than 7.8 mmol/L (140 mg/dl) – so my blood sugar after supper was not only in the non-Diabetic range, it was much better than that!

This means that the delaying the time between meals that I have been doing each weekday is starting to have its effect.

‘Hearing’ for the first time

When insulin was released after I ate dinner last night, my cells responded to insulin’s signal and took up the glucose from my blood, into my cells! This is what is supposed to happen, but from years and years of eating a diet that had far to many carbs (mostly as “healthy” fruit and milk), my cells had become non-responsive to insulin’s signal. The glucose (the blood sugar produced after food is digested) would stay at high levels in my blood because even though sufficient insulin was being produced and released by the βeta-cells of my pancreas, my cells had become insensitive to its signal. My cells had become insulin resistant – they were ‘deaf’ to insulin’s signal.

Last night, for the first time that I’ve observed, my cells responded to insulin properly!  Like a hearing-impaired person hearing for the first time, my cells could ‘hear’!

Still “hearing-impaired”

My cells aren’t yet ‘healed’. They and my liver are still insulin resistant which is evidenced by the fact that even though I haven’t eaten anything since dinner last night, my blood glucose is high.

As it is supposed to do in response to both a low-carb diet and intermittent fasting, my body is breaking down my fat stores for energy (lipolysis) and the free fatty acids that are released are being used to produce glucose for my blood (in a process called gluconeogenesis) and ketones for my other organs, including my brain.

My blood glucose should increase from the gluconeogenesis, but it shouldn’t stay high! 

In a perfect world, my blood glucose should be maintained around 4.0 mmol/L (72 mg/dl) when I am intermittent fasting, but it is much higher than that.  The VERY good news is, it is falling to these ideal levels earlier and earlier each day, as I continue to intermittently fast Monday to Friday.

Intermittent Fasting – the missing ‘key’

It used to be late in the afternoon before my blood glucose would finally fall to 3.9 – 4.2 mmol/L, but over the six days it has been falling to these levels earlier and earlier each day.

blood glucose readings July 25 – August 23, 2017

 

Last Thursday, while checking my blood glucose every 2 hours, it dropped to 3.2 mmol/L at 1:55 PM and I immediately ate some carb-containing food, but the next day, late in the afternoon it only reached 4.8 mmol/L at 4:00 PM, despite me delaying the time between meals, both days. As someone with Type 2 Diabetes, I have to monitor my blood sugars every few hours when I am delaying meals, to be sure my blood sugar is being maintained by my body breaking down fat.

Monday, my blood glucose was 3.7 mmol/L (67 mg/dl) at 4:00 PM and yes, I ate something immediately.

Tuesday it was 4.6 mmol/L (83 mg/dl) at 2:30 PM

Today (Wednesday) it was 4.5 mmol/L (81 mg/dl) at noon!

Best of all was that last night, 2 hours after eating, my blood glucose was only 5.8 mmol/L (105 mg/dl) – not just ‘normal’, but well below the non-Diabetic cutoffs! This is what I have been waiting for!

Tracking Ketosis

Ketones (also called ‘ketone bodies’) are naturally occurring molecules (acetoacetateβeta-hydroxybutyrate, and their spontaneous breakdown product, acetone) that are produced for energy while people are sleeping, or when they haven’t eaten for a while. Ketone production is natural and normal and occurs to everyone – otherwise we would need to get up at night to eat!

Ketones are picked up the body’s tissues and converted into something called ‘acetyl-CoA’ which then enters the citric acid cycle and is burned in the cell’s mitochondria (the ‘powerhouse’ of each cell) for energy. When we are sleeping, or are eating low-carb high health fat or simply not eating for a while, this is what our body uses as fuel instead of glucose. When eating low carb over an extended period of time, the body makes the little bit of glucose it needs for our brain and blood from fat and uses ketones for the rest.

A Ketostix® urine test strip (from several weeks ago)

Ketones can be easily  and inexpensively detected in urine using a test strip, such as Ketostix®.

When people are at a low level of ketosis, they produce both acetoacetate and βeta-hydroxybutyrate in approximately equal quantities. These ketones are used by the muscle cells for energy. Ketostix® only measures the amount of acetoacetate in the urine.

For those that choose to eat very low carb and remain in ketosis for a while, their body’s will take the acetoacetate and convert it to βeta-hydroxybutyrate. Since Ketostix® only measures acetoacetate, the strips may become lighter and lighter because there is less acetoacetate in then urine. This is when blood ketone strips becomes helpful.

Abbott Laboratories® produce a small serum monitoring system that can test either blood glucose levels or serum β-ketone levels, using different test strips. The glucose strips cost about the same as glucose test strips used with other glucometers, but the β-ketone test strips are quite costly, costing between $3-$5 each, depending on where they are purchased.  I don’t use them very often – only to make sure I don’t let my ketones get too high.

Note: I take a rather conservative approach to low carb eating and don't see any need to lower carbs to such a point as people are producing large amounts of ketones. I encourage insulin-resistant clients who are eating low carb to monitor both their blood sugar and ketone production often and to discuss their results with their doctors.

The β-ketone test strips measure the amount of βeta-hydroxybutyrate in the blood.

β-Ketone test strip, measures βeta-hydroxybutyrate in blood sample

This morning, about an hour after I measured my fasting blood glucose at 7.8 mmol/L, I measured my fasting β-ketones (which measures the amount of βeta-hyroxybuterate in my blood) at 1.6 mmol/L.

A low level of serum βeta-hyroxybuterate is considered 0.34 mmol/L and a mid-range level of serum βeta-hyroxybuterate  is considered 2.36 mmol/L, so I was in the low-mid range level, which is the highest level that I go. I am also monitoring my blood sugar every two hours to make sure that my blood sugar level is being maintained adequately.

Note: as they say on TV "don't try this at home".  Be sure to discuss following a low carb diet with your doctor first and also discuss whether there are any health reasons to avoid remaining in mild ketosis for any period of time.

At these levels, my body is happily breaking down my own fat stores for energy and the free fatty acids that are being released are being used to produce glucose for my blood (via gluconeogenesis). This is evident by my blood glucose being 7.8 mmol/L around 9:30 AM today.

This morning’s workout ‘selfie’

My body produces ketones (as evident by my βeta-hyroxybuterate being 1.6 mmol/L) an hour later and these ketones are being picked up my body’s tissues and are being converted into acetyl-CoA, which is being burned by my cells mitochondria for energy.  These ketones not only fuel my brain, so I can work, they also fuel my body so I can exercise.

Yes! I aim to do some kind of exercise for 30-45 minutes most days.

This is the BIG difference between “starving” and “fasting”. I’m fat-adapted and I have plenty of fat stores to burn, so my body is really quite happy burning my own fat stores for energy while maintaining my blood sugar using the carbs in my diet and the glucose synthesized from my fat.

‘Getting moving’ and occasionally ‘breaking a sweat’

When I speak of ‘exercise’, it’s not crazy intense, but it is my getting my body ‘moving’.

All my morning walks (with and without Nordic poles) – from the very first one 5 1/2 months ago, have been done fasting.

Yesterday I did 15 minutes of aerobic exercise and 30 minutes of lower body resistance training – not in a gym, but at home. I was fasting…and continued to fast until late in the afternoon. Remember, my body is breaking down my fat stores for energy and I have plenty of those!

all the “gym” I need!

I’m not a member of a gym.

I have a corner of one room set up with my Nordic Track ski-machine, a few free-weights (2#, 5#, 10# and for the future 20#), a floor mat, 3 levels of resistance bands, and a “step“.

If I use my Nordic Track, I listen to music while I work out, and have a water bottle with homemade club soda (seltzer) close at hand. I have a Sodastream® machine, so I always have a steady supply.

I am using the “step” or doing aerobics of some kind, I use some videos I found on You-Tube of a TV show I used to exercise to years ago. I always liked them because they gave lots of instructions so that only one muscle group at a time is being worked.  That way, only one part of my body needs to recover, and I can work other parts the following day.

If I am doing my free weights, I follow the routine I learned from a kinesiologist friend, when I took off the first part of the weight 5 years ago.

I keep it simple and simply make part of every day doing something that requires me to ‘get moving‘ and 3 times a week I aim to make that activity something that ‘breaks a sweat‘.

I don’t exercise to ‘lose weight’ – I’m active because it’s part of a healthy lifestyle.  It’s good for my heart, for reducing stress and to increase muscle tone – and it makes me feel terrific.

Sure, I still have a long way to go but a each week and each month passes, I am closer to my goal that I was the week or month before.  I am certainly closer than had I never started!

Here’s some more proof…

These three photos were taken on this date (August 23) in 2015, shortly after I had heard about low carb high fat eating from a retired physician-friend, last year in 2016 and today 2017. While there isn’t a huge difference weight-wise between last year and this year (14 pounds), the difference one can’t see is becoming evident.

Me – August 23 2015, 2016 and today 2017

Yes, the progress it is painfully slow and it would be easy to get discouraged except that I have read the studies and seen the results that other clinicians have obtained with their patients. It’s twenty-five weeks since I started – just about 1/2 a year, but my hard work and determination to ‘stick with it’ is paying off.  Last night, for the first time since I was diagnosed as having Type 2 Diabetes, my cells provided evidence that they are beginning to respond to the signals from insulin the way they are supposed to.

This afternoon, they did it all again!  

This was my blood glucose 3 hours after lunch (which I decided to eat today, because I felt hungry). As mentioned above, 4.5 mmol/L (81 mg/dl) is well below the ‘normal’, non-Diabetic post prandial glucose level of 7.8 mmol/L (140 mg/dl)

This was even better than after dinner, yesterday!

It took longer than I expect, but it’s happening!

So, one day at a time, one week at time, the weeks add up to months and the months to half a year and in half a year, I have measurable progress!

Oh, did I forget to mention that my weight is down again?  I am seeing “numbers” I haven’t seen since I gave birth to my children!

Slow, yes – but very sure.

Now let’s see what I’ll accomplish in the second half of this year!

Have questions?

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

To our good health!

Joy


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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