A Dietitian’s Journey – update of lab tests and metabolic markers

Recently, my endocrinologist requisitioned a fasted c-peptide and a fasting blood glucose (FBG) lab test which enabled comparison with results done fasted and at the same time of day 4-1/2 years ago. At that point in time, I had been type 2 diabetic for 4 years. This article is an update.

In August 2015, my FBG was 9.7 mmol/L (175 mg/dl) and my c-peptide was 569 nmol/L (1.72 ng/mol).

Using Oxford’s HOMA2-IR calculator, it is easy to see that I was quite as I was well over the 1.00 to be insulin resistant (IR=1.56) and my estimated steady state beta cell function (%B) was only 32.7%.

With my endocrinologist’s encouragement, knowledge and support, I began to implement a low carb dietary approach. Unfortunately, in November of that year, a family matter ended up derailing things, and while I could have (should have!) restarted a therapeutic low carb in January 2016, when I could, I didn’t.  As written about in an early entry to this journal, I was in classic denial as to just how metabolically unwell I was.

It wasn’t until March 5, 2017 when my blood pressure had reached a hypertensive emergency that I changed. At that point, I was obese, had uncontrolled type 2 diabetes and severe hypertension. You can read about this in the first entry to this personal account. My life literally depended on me improving my off-the-chart metabolic markers, and for me sticking with my endocrinologist’s recommendations was essential.

If you’ve read though my “journey”, then you already know how two years later, I had lost over 50 pounds, lost 12 inches off my waist, and brought my HbA1C down to the high end of the normal range, but that I still had moderately high blood pressure. Over the past year, I adopted changes to my daily routine based on the research of circadian biologist, Dr. Sachidananda Panda of Salk Institute’s research, as it had evidence for lowering cortisol and blood pressure. It did. After 3 months, my GP halved my high blood pressure medication and it’s been 3 months since I have been off them completely, with absolutely normal blood pressure. My 3-month glycated hemoglobin (HbA1C) results have remained just about 6.0% for the last year, which is good (i.e. normal for a non-diabetic), but not as good as I would like it. I still have work to do.

As mentioned above, recently my endocrinologist re-ran the above tests and in December 2019, my FBG was 5.2 mmol/L (94 mg/dl) which is normal for someone who is non-diabetic and my c-peptide was was 531 nmol/L  (1.6 ng/mol).

Using Oxford’s HOMA2-IR calculator again, here is the update:

I was almost completely below the threshold of 1.00 definition of being insulin resistant (IR=1.19) and my estimated % beta cell function (%B) had gone up to over 98%. I was encouraged by this update.

Comparing my August 2015 and 2019 update results, my muslin resistance significantly improved, and my steady state beta-cell function did too (from 33% to 98%), while FBG fell to well below the normal cutoff of 5.5 mmol/L (99 mg/dl). This seems to indicate that I regained some beta-cell capacity.  In 2015,  when my FBG was 9.7 mmol/L (175 mg/dl), my pancreas “wanted” to do more, but couldn’t. What this update shows is that at the end of 2019, my pancreas was able to do what was required.

It is reasonable to assume, that in another year or so that when I update these labs again (given I continue to minimize carbs) that my FBG is going to be lower, which could actually make my steady-state beta-cell function lower (yes, lower) because with the improved insulin sensitivity, less insulin will be needed. My pancreas will have to work less hard, leaving more capacity for a second phase  insulin response (which clearly I don’t have yet, from my recent half-a-donut story, available here).

Theoretically, if I wanted to assess my body’s actual insulin response to a carbohydrate load, I could have a 3-hour Kraft Assay performed, which would measure my blood sugar and insulin response at fasting, and every 30 minutes for 3 hours. You can read more about that here. This test is quite costly and I would need to justify the need in order for my endocrinologist to requisition it. As well, since I normally eat low carb in order to manage my blood sugar levels, I likely have what is called “physiological insulin resistance”, which is where the body spares glucose by reducing glucose uptake. This is very different than the “pathological insulin resistance” I referred to above, which is due to the body ignoring insulin’s signals to uptake glucose due to hyperinsulinemia (chronic high levels of circulating insulin) which accompanies uncontrolled type 2 diabetes and pre-diabetes. I have several previous articles about this topic that you can read by searching for “hyperinsulinemia” in the search bar in the lower left hand corner of this web page. In any case, if I wanted to have a 3-hour Kraft Assay to assess my first and second stage insulin response (and by proxy, beta-cell function) I would need to eat between 100 and 130 g of carbohydrate per day for a week or 10 days, in order to lower physiological insulin resistance prior to the Kraft Assay.  At this point in time, this is not something I feel is necessary, but maybe in a year or more, when my FBG and HbA1C comes down even more, it may be interesting to do.

While I have been in partial remission of type 2 diabetes for about 6 months (explained here), my donut adventure clearly indicates that I have not reversed (“cured”) it.

While I many not ever recover my pre-diabetic beta-cell function, being in remission is a very good thing! My symptoms of the disease are gone, lab tests are in the normal (non-diabetic range), and I have lowered my cardiovascular and metabolic risks. Remission, in my option, is the next best thing to reversal.

Some final thoughts…

Critics of a low carb / very low carb (ketogenic) diet say that it is “not sustainable” but for me (and many others too), eating real, whole food is very sustainable! For me, my life and my health depend on me remaining in remission, and that is all the motivation I need.

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To your good health!

Joy

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