Pre-diabetic and getting worse? Crazy to want to start insulin?

[sorka]

Two years ago, my GP said I might be pre-diabetic. I'd had a few fasting BGs in the 110 range. Bought a One Touch Ultra and started tracking it. Also, whenever I did a fasting lab, I always do my own test to compare BG with the labs. Those Lifecan's are amazingly accurate.

I tracked it over several months and most mornings it was in the 70s or 80s, but occasionally it would be over 100 like maybe once a week.

At that time, A1C was 5.9. I was 230 lbs. I'm 6' 5".

I started exercising and dramatically changed diet and lifestyle. I lost 55 lbs and am now 175. It took about 15 months to lose the weight. I never did see an improvement in BGs, but A1Cs dropped to 5.5 about.

Then I noticed about 4 months ago my FBGs going up. Now they are always over 100 and for the first time ever, post prandials have taken a huge jump from always being below 100 at 2 hours to sometimes being as high as 120 two hours later.

I obtained some Metformin from a friend to try it out. Worked up to 750 mg / day. Within a few weeks, fasting BGs were back in the 80s.

I stopped the Metformin and decided I needed to see an endo which I did several months later. He did an OGTT. I used my meter every 15 minutes to get additional readings and calibrate against the blood draws. I peaked at 174 at one hour. 164 at two hours. It tooked 3 hours to get back down to 95. The lab goofed part of the test though. They were supposed to take the 2 hours insulin but only did the fasting insulin.

It was low, 4.0 while my BG was 105. So I'm not insulin resistant, but since Glucophage suppresses liver glucose production, this was likely the effect.


Oddly enough, the same lab did my A1C at the same time. It came back 5.0 with the lab range of 4.5 to 6.0 being normal. This must be a mistake. I'd only been on the metformin for about a month and it had been several months since I'd taken it. It couldn't have lowered my A1Cs that much.

The endo suggested that I lose more weight. He said I could lose another 10 lbs before going into the underweight range on BMI.

The problem is I've got no fat left. Just muscle. I'm at about 3% now. My waist is 28 inches. You can see the muscle fiber under my skin on my lower abs. I've only got muscle left to lose. My wife thinks I look very strange with a 28 inch wast at 6' 5". My chest size is 46 inches.

She says the endo is crazy for wanting me to lose more weight.

I feel helpless because my BG control is worsening. I'm ultra careful with my diet. I never have sugar or foods with white flour. Only meat, veggies, and some grain as long as it's whole.

Other facts:

I've been tested for most of the common antibodies that cause LADA and all were negative.

What does that leave? Genetic defects that cause pre-mature beta cell destruction? Other autoimmune diseases.

Also, several years ago, right after being diagnosed as possibly pre-diabetic(which there is no doubt I am now), I had some unusual symptoms. My eyes completely dried out. Tear production stopped. I had to use gel drops every hour and through the night. My saliva production stopped. I wasn't thirsty. Just dry mouth. I also had joint pain which turned out to be a lack of synovial fluid in my joints. You could actually hear the finger joints squeak in the morning if you listened carefully. I had a tear production test and it was through the floor. The ophthalmologist mentioned that if I was a woman, they'd suspect sjogren's, but since I was a guy, they didn't think so. I went to see a rheumatologist and they did a bunch of antibody tests and said that it wasn't sjogren's, However, in my own research on the internet, it appears men are less likely to show positive for typical sjogren's antibodies. Should I have asked for a lip biopsy?

Several months later, my bodily fluid production returned mostly to normal. I no longer have to use eye drops daily and my mouth is no longer dry and my joints don't squeak or hurt, but it sure has left me wondering.

I sent my endo a question through their online system and asked if there were any other immune issues to check and mentioned my worry about sjogren's, His response was that I might want to seek counseling for anxiety. Didn't answer the questions, just simply told me I was worrying too much.

Yes I have anxiety. I know from research what even slightly elevated BGs can do over the long run.

Ironically, I think I'm worse off than someone who is well controlled on insulin because I don't have any more tools in my box for BG control. I'd almost rather be on a slow acting once a day insulin to take the stress off of whatever beta cell production I have left so that my body can regain metabolic control of my glucose.

The endo did say that if the 10 lbs didn't make a difference, he'd prescribe Metformin since it appeared to help, but it obviously wasn't because of insulin resistance.

OK, I know that was long, but I've never posted in a forum about this before and I'm at my whits end.

I'd really like to find a doctor who can tell me what's going on and can be aggressive.

This current endo and my own GP both think it's fine because I'm only pre-diabetic. They're so used to dealing with patients that are out of control with a1Cs above 7 or 8.

[princesslinda]

Welcome Sorka, glad you found the forums.

With the blood sugar levels you mention, I don't think there would be any need for you to start insulin at this point.

I think you'd do well to keep an eye on your blood sugars, continue with a good healthy diet and exercise, and have your A1C checked once or twice a year.

If your blood sugars start to get out of control, then you'd definitely want to look into different options. I'd save these options though until your blood sugars show a bit more elevation.

Also, i'd encourage you NOT to take medications that haven't been prescribed for your specific condition. There are medications that could cause an unsafe drop in blood sugars, and you don't want that to happen.

[foxl]

You can have insulin resistance without obesity. In which case metformin would work.

You also could have no beta cell mass in reserve. A c-peptide would help to indicate that.

You also could have antibodies that would indicate autoimmune diabetes, Type 1. Antibody testing would indicate that.

Could be MODY ... could be any number of things. Did your Endo mention any of those things? (mine did not).

[sorka]

MODY usually shows up younger than I am and has a much stronger genetic link than other conditions. Forgot to mention I'm 41. Most LADA typical antibodies have been ruled out that I know of. Have not ruled out more systemic autoimmune diseases although antibody testing suggests no Lupis or RA. My mom is on Ebrel for excess TNF, but she's considerably overweight, doesn't eat well, and doesn't exercise which are prime ingredients for excess TNF.

I was willing to try Metformin on my own given it's excellent safety record. A previous version of this had been linked to lactic acidosis but only in those with compromised kidney function mine are so far perfect. Metformin is also increasingly being linked to decrease in an P53 gene defect based cancers which is about 55% of all cancer types.

Also, the dose I was on was very small.


Other tests I've had done recently:

HS-CRP was negative.
ALT and AST were 7 and 15.
LDL 100.
HDL was 51.
Lactic acid I think was 5.5. It was in the middle of the normal range.
Blood pressure at rest is typically 100/50....slightly on the low side.

Also, have no family history of diabetes except my great grandfather who was told he was slightly diabetic at 80. He lived to 90 with normal blood sugar control after losing weight.

Also, since my fasting insulin was so low, it really kind of rules out insulin resistance unless I'm misinformed?

[Ronin]

Hi Sorka!

When I read through your posts, I could feel the panic. As a fellow Pre-D I know the feeling and the underlying emotions well.

You mention your FBG levels but what about post-prandial readings? There are legitimate reasons for an FBG to be high, particularly if you are severely restricting your eating as you may be forcing an early morning liver dump (a.k.a., Dawn Phenomenon) simply because you don't have sufficient energy when you awake. (FWIW: I've been watching myself for some time and have noted that if I skip the evening meal my FBG is always above 100 -- why? because I am over hungry and my body is screaming for energy.)

Also, self medication, even with a "safe" drug is dangerous.

Finally, I have the sense that you are highly motivated to avoid the onset of Diabetes, but you are becoming frustrated and simply want it to be over and start medications. I've been there and had the same feelings. My sense is that you have probably over-compensated and may be driving your FBGS higher by under-eating and driving your anxiety/stress levels to the max. None of that behavior is good for you.

It is time to take a basic assessment of yourself. You are not overweight, it appears that you are not Insuling Resistant, and other than an FBG above 100 you don't have any problems. If your two-hour post prandials are in the "normal" range and your HbA1c levels are in the normal range -- take heart and know that what you have done is working. Reduce the stress/anxiety, eat sensibly, and relax.

[sorka]

Hi Sorka!
Also, self medication, even with a "safe" drug is dangerous.



Thanks for the reply Ronin. I'm certainly not condoning it even though I did it for myself. I was desperate to see if it made a difference and once I knew it did, I stopped and made it a data point for future discussions with an endo.

I did talk about my post prandials in the first post. I often see 120s two hours after a small low carb 400 calorie or less meal. Two years ago when I was faced with the occasional high fasting BG, my two hour post prandials were always below 100.

The post prandials are what I'm most concerned with as they've risen quite quickly.

I've taken to eating meals over a very long time. Today, I had a spinach salad with chicken, tomatoes, mixed nuts, avacodo, and olive oil. I ate it over the course of an hour. This is the only way now that I can keep my BGs from spiking above 120, so yes, that is one more tool that I can use to keep the spikes down. But at some point I'll have to start grazing all day long without eating any lump sum meals.

It's starting to interfere with family meal times now. My wife is sure cooking a lot better. Last night we had baked lemon chicken mixed vegitables(barely cooked for slower glycemic load) and garlic. No grains. Even then, my BG was in the 120s.

I experimented a lot with dinner time. It seems my best morning results come if I eat around 8 PM when going to sleep at 11 or 11:30.

[sorka]

I messaged my endo and he ordered a C-Peptide. Asked me to eat as big of a carb meal as I would normally do and then get drawn at 1 hour postprandial.

Since I've been low carbing it for the last few months, more than I normally do, should I try change my diet for some period before the test? I was also low carbing it more than usual prior to my fasting insulin test of 4.0. I read that low carbing can artificially lower c-peptide even more.

One thing I forgot to mention is the morning of my OGTT, I woke up with a BG of 90, one of the few times it had been below a 100 in a while.

By the time I got to the lab and got started which was about 2 hours later, it had risen to 105. Obviously my liver was dumping glucose. I'm wondering if there was a chance that my liver dumped glucose and that my blood was drawn before my pancreas responded.

Hopefully my C-Pep won't be on the low side, but given my thinness, it probably will be :(

[Ronin]

Hi Sorka!

I assumed you knew that taking someone else's medications isn't the best thing to do. However, it does go to your desperation.

I'm surprsed that the lab didn't do C-Peptides along with the OGTT, that is a much more telling test as it shows exactly how your pancreas reacts to a high stress glucose load over time.

I have to ask a politically sensitive question: have you been reading anything by Dr. Bernstein? I know that he has a certain popularity but I also know that he is more than a bit of a fanatic when it comes to the definition of "normal" BG levels. Much of his opinion on what constitutes "normal" is based on a single study done on a particularly small sample of very fit young scandanavian people on a very low carb diet.

Your two-hour post prandials at 120 are well within normal limits. You also need to realize that "normal" people spike if they over-indulge (much to the chagrin of Dr. Bernstein - who then claims that they are now diabetics).

As to grazing -- it works, as does the Atkins diet. I know I've tried them all. The problem is that most of these approaches are not sustainable over the long term.

As to your C-Peptide. There really isn't anyting to worry about. All you will learn is your levels. If they are low, that simply means that you have low output and if/when your BG levels get compeltly out of control insulin will help but Type-2 meds will not. If the C-Peptide is high that means that you are developing IR. And, most probably, if the C-Peptide is in the normal range it means that you are doing the right things and your pancreas is working.

IMHO: you need to relax. Your life is more than just a number from a blood test or meter. Yes, you should eat a healthy diet, exercise, and most of all enjoy your life. I've been exactly where you are today -- darn near tore my marriage apart and drove eveyone around me crazy. Your numbers are not all that bad. Give yourself a break, as well as all those people who love you.

[sorka]

I'm in a vulnerable state right now where I perceive something has changed but don't yet have enough information.

I was a little miffed when the lab didn't even do the two hour insulin. I asked and they said it wasn't on the test. I asked them to double check. The woman came back 5 minutes later and said no 2 hour insulin. The endo said the following week that it was on the lab order and he showed me.

Grazing is unsustainable for sure. I don't do it now. My current diet is just fine. I haven't read any diet books and am not following any particular diet. My diet is particularly high in certain foods because I enjoy eating them and do so now in higher quantities. Yes I enjoy things like donuts and pizza but simply don't touch them any more. Haven't for over two years now.

My diet is very high in greens like broccoli, spinach, tomatoes, cauliflower, avocados(yes high in fat, but I put them on every salad), carrots, onions, garlic cloves both raw and sauteed, and the list goes on. I don't eat potatoes.

Snack on mixed nuts and cheese.

Oh, love Pesto. I put it on nearly everything. Cook with pretty much only olive oil because I love the taste.

Boneless skinless chicken breasts :)

Lots of soups. Love Minestrone. Tend to eat that more than any other soup.

I know you said those numbers are normal, but they're higher than they've ever been before for me. Prior to a bout 4 months ago, my post prandials at two hours were almost always below 100.

It's not about the current absolute numbers, it's more about where they're going.

BTW, in case you haven't figured it out, I'm completely neurotic. It tends to serve me well as a software engineer because those behavioral traits are needed for detail work. But by the same token, since i'm an engineer, I tend to want to conquer problems whether they be in work or my personal life.

My wife doesn't know how I managed to lose 55 lbs. I tell her it was easy. I just changed what I ate, ate less, and stuck to it and did it in a way that I like.

[genie86333]

Hi!

Yes, you've seen an upward trend & it is important to know that. However...if you're not insulin resistant (as you stated above) even a *tiny* dose of insulin may be too much for you because your numbers are not very high.

If your numbers were better with the Metformin, I'd go with that. Prescribed *for you* by your doctor. Did you know that Met can cause serious problems with some medical tests? What if you'd been in an accident & were unable to tell medical professionals that you were taking it?

Yes, desperation causes us to do things that are not good for us, but your bg levels are NOT dangerously high. Yes, they're higher than they were, but they're not so high that you should be that desperate. Perhaps you need to talk to your doctor about anxiety issues as well as metformin.

[Ronin]

Hi Sorka!

Yeah, I know about those feelings as I've had them all myself.

As an engineer you already know that information is powerful and necessary in making any decision. What you are looking at is trending. Biological systems go through cycles and I've noted that my own personal cycles seem to coorelate to the seasons. That may be the result of more or less activity in bicycling/tandeming with the resultant increase in FBG levels, or it may simply be my biological response to shorter daylight hours. However the trend is noted.

You might want to look at establishing an acceptable range for readings for yourself, with a consult with the folks here and your medical professionals, and then allow yourself to stay within range without getting worried about daily changes.

In the current thread you have written a lot about your diet but not mentioned any exercise. What, if anything, do you do as exercise?

[sorka]

I have a full gym in my house. It was installed several years ago and was instrumental in my losing weight. I work out about 4 days a week now with some cardio as a warm up but mostly weights.

I tend to not work out on the weekends because I'm doing some sort of landscaping or outdoor project on the weekends which is usually takes most of the daylight hours every weekend. I recently planted 70 redwood trees as a screen. Dug all the holes myself and planted every one by hand. They were in 15 gallon containers and ranged from 8 to 11 feet in height.

I'm pretty much always busy and always active. Even after meals, if I'm not working out, an hour after eating, I'm either walking or doing something moderately physical.

[sorka]

Checked my BG this morning around 7:00 AM. It was 70. First time I've ever seen a reading like that.

Wonder if I had reactive hypo? Maybe this happends a lot and I just don't realize it.

It would explain the low A1c's even though my readings are typically high when I'm actually taking them. Perhaps I'm spending a lot of time at low BG in the middle of the night?

[fgummett]

70mg/dl is at the lower end of the normal range... it is not hypo :)

I'd take an increasing FBG as a wake up call... I believe that Pre-D should be treated more aggressively than it is but I'd add my concern to that expressed above regarding self-medication.

I suggest that the best approach is to focus on real whole foods and daily activity.

Choose mostly foods that are natural, preferably local and in season, raised/grown on nutrient rich soil... not processed or packaged and avoid anything with refined/concentrated carbohydrates.

Activity can range from a daily 30 minutes brisk walk, and parking further away... to gym, weights, cycling etc... if you enjoy that kind of thing.

[sorka]

I suggest that the best approach is to focus on real whole foods and daily activity.

Thanks. Pretty much been my focus for the last few years :)

[fgummett]

If your FBG is still creeping up despite the real whole foods and daily activity, then is the time to seek medical intervention... tests like A1C, OGTT, possibly C-Peptide, GAD etc... and possibly medication.

It can be difficult to determine what a normal BG is as there is conflicting evidence out there... my personal understanding is that a truly normal, healthy, non-diabetic BG range is 4-7mmol/l (70-125mg/dl) no matter what you eat, or how soon after eating you test. Any study which shows normal people spiking higher than that would do well to follow up on those same people some years later and see how many of them were already on the road to D.

[sorka]

Thanks. Had them all done. Discussed in detail above :)

[fgummett]

Yes, I did read the thread before I posted in it :)

I'm suggesting that your current routine seems to be managing decent BGs... IF things start to get worse then further intervention including the possibility of medication should be discussed with a Doctor... at that time the above tests would need to be repeated.

[sorka]

Ahh. I see. Well the current plan is the endo wants me to lose 10 more lbs. I'm 5 lbs into that at about 1 lb a week. He said since Metformin seemed to help, that if getting down to 170 doesn't make a difference, he's willing to try that.

Since then, I've convinced him to check C-Peptide which I'll be doing today which should give better indication of my true insulin production and if I'm headed toward type 1.5 or by some miracle have some insulin resistance.

Since Sulfonylureas can still lower fasting BGs in those that have no IR via hepatic glucose suppression, this may have been the mechanism at work.

I'm hoping for a normal or high C-Peptide but I'm sure it will be quite low :(

One thing I'm wondering though is if my recent diet could throw off the test. Since I'm low carbing it AND eating 500 fewer calories a day for a 1lb a week weight loss, I'm hoping this doesn't cause the pancrease to produce less when demanded during meals.

The endo wants me to eat a largish meal and then get the blood drawn when my BGs start to go down after peaking.

I'm going to have to eat, then drive to the lab and sit there taking my BGs every 15 minutes to see when that happens.

[genie86333]

Hi, Sorka.

2 things - #1, a 500-calorie-a-day diet is *WAY* too little for someone who is 6'5" and 175 pounds & will probably throw your body into starvation mode, which means your body will slow your metabolism (meaning you won't lose weight & since you are at the low-range of normal weight already, (from what I've read) you may lose lean mass from organs such as your heart!

I've very concerned about that - did your doctor actually tell you "you need to lose 10 more pounds" because the way you worded it in your 1st post "He said I could lose another 10 lbs before going into the underweight range on BMI." means you're NORMAL weight now & if you lost 11 pounds you'd actually be underweight. I don't understand why a doctor would tell you to lose so much weight that you are almost underweight when your weight is normal now.

#2 You mentioned a few posts back that your 7 a.m. bg was 70 & wondered if it was a reactive hypo.

First of all, a 70 is normal, not hypo. It's the low-end of normal, but still normal. Secondly, was that a fasting bg or had you eaten a significant amount of carbs THAT MORNING?

I'm asking because a reactive hypo will be relatively soon after eating carbs - you eat the carbs, have a sudden spike which causes your pancreas to to overract with too much insulin & force your bg to go low...but unless you're an extremely early riser, I can't see you having a reactive low that early.
If that was your fasting number, it's a great #...that's what you want to see every morning!

[sorka]

I said 500 calories a day FEWER. I'm eating about 1500 to 1600 a day right now.

I did not suggest to the endo that I wanted to lose more weight. He suggested to me that I SHOULD lose more weight. His reasoning is that he says he's seen just 10 lbs make a big difference in fasting BGs.

He apparantly doesn't understand that I'm at about 3% body fat right now. Any weight I am losing now is most likely muscle, not fat.



The 70 was fasting in the morning. I'd not eaten anything since the night before.

[Dan Gato]

Sorka,
Congratulations on your proactive approach to D.:top:

I would say that you have good bg's readings.
Wait for your C-peptide test.
After that get an A1C every 3 months. & as Ronin said try to relax, you have great numbers.
Have you read any of Dr. Bernstein's writings? If you already answered, I missed it.

[sorka]

No. Haven't read his work. Should I?

[genie86333]

I said 500 calories a day FEWER. I'm eating about 1500 to 1600 a day right now.

I did not suggest to the endo that I wanted to lose more weight. He suggested to me that I SHOULD lose more weight. His reasoning is that he says he's seen just 10 lbs make a big difference in fasting BGs.

Ah, ok...I must have missed the word FEWER! That had me very worred. Thanks for replying.

And yes, losing 10 lbs can make a difference, however, since you've already *done* that (plus 45 more!) I'd be telling the Endo that it's his turn now to chip in with some help, especially if you are already only at 3% body flat.

[tealas]

MODY usually shows up younger than I am and has a much stronger genetic link than other conditions. Forgot to mention I'm 41. Most LADA typical antibodies have been ruled out that I know of. Have not ruled out more systemic autoimmune diseases although antibody testing suggests no Lupis or RA. My mom is on Ebrel for excess TNF, but she's considerably overweight, doesn't eat well, and doesn't exercise which are prime ingredients for excess TNF.

I was willing to try Metformin on my own given it's excellent safety record. A previous version of this had been linked to lactic acidosis but only in those with compromised kidney function mine are so far perfect. Metformin is also increasingly being linked to decrease in an P53 gene defect based cancers which is about 55% of all cancer types.

Also, the dose I was on was very small.


Other tests I've had done recently:

HS-CRP was negative.
ALT and AST were 7 and 15.
LDL 100.
HDL was 51.
Lactic acid I think was 5.5. It was in the middle of the normal range.
Blood pressure at rest is typically 100/50....slightly on the low side.

Also, have no family history of diabetes except my great grandfather who was told he was slightly diabetic at 80. He lived to 90 with normal blood sugar control after losing weight.

Also, since my fasting insulin was so low, it really kind of rules out insulin resistance unless I'm misinformed?

Sorka,

I've read this thread with interest, as your determination is very papable! You've received so much good advice I'm just going to add a few things that might be relevant.

MODY forms of diabetes do not have to express in youth. Say for MODY3 I think the current stats are that 98% of genetic carriers express by age 55. But that being said your family history doesn't seem consistent with an autosomal dominant gene inheritance. Based on your higher fasting readings and the mild level of elevations - MODY2 would be the most likely if you were indeed some form of MODY. Depending on your insurance/available income, and other family members that may have died fairly young of cardiovascular events (with potentially undiagnosed MODY) - you might still want to screen for the most common forms of MODY to rule them out.

Given all my years in doctors offices as an "atypical" diabetic before they knew what the heck MODY even was, I landed up using Traditional Chinese Medicine (TCM) to get an alternate window into which systems of my body were out of balance and how to address them. From a TCM stantpoint - those symptoms you describe (dry eyes, joint issues) would likely be considered liver system imbalances. Also interesting that metformin apparently also acts on the liver to reduce gylcogen conversion to glucose. The thing about general forms of Type 2 is that they most certainly have a genetic basis, it is just that they aren't as severe and monogenic like a MODY, so harder to sequence the genes. This is sort of fuzzy logic, but it sounds like you may have some genetic tendency towards diabetes that could be involved with liver metabolism.

I live with my elderly father - he's had a brain anuerysm and many other health issues. He often jokes with me, "There is no getting out of here alive." I'm also a computer engineer, and I can understand that kind of attention to detail and strength of will to make things happen. But the body can and does change with age. It is good to be proactive, but I think it best done with a spiritual awareness of "impermanence" as they say in Buddhism. We do the best we can with what information we have, with diet changes, the best medications and daily activity. And then I think we need to hold the rest of it in wisdom and serenity (hence my title).

That said, I think your Endo is unconsciously capitalizing on your determination and willingness toward extreme dietary measures! Given what you are writing, it seems unlikely that the metabolic mechanism in play for you is primarliy with obesity triggered insulin resistance. Losing that weight may or may not make a difference - or as other's have pointed out it may stress your liver towards dawn phenomemon.

In my own searches for better health, I came to realize that I was not keeping my post-meal spikes under good enough control with insulin. This spring I stumbled into using a higher percentage of raw foods and using Paleolithic diet (and to some extent the "Blood Type Diet") food choices. I've also found that green smoothies (ala Victoria Boutenko) really help shift my fbg's lower. For instance if I eat a heavier lunch, and have a green smoothie as a light dinner, I wake up in the 70's. If you are interested I could email you my blood sugar charts from before I was eating raw foods (with spikes) and what they look like now! Significant difference in both fbg's and post-meal spikes. You can look at cooking as the original form of "processing" food, and from that standpoint eating 50%-75% (or more) raw foods may help keep some of these genetic weaknesses at bay. I mean if you are willing to jump through diet hoops, you might want to consider the raw angle!

Here is my typical green smoothie receipe. I usually have about 2 cups of this for breakfast, and then another 1-2 cups of this for afternoon snack, or dinner.

2-3 cups filtered water
2-3 cups packed organic baby spinach (or 1-2 cups chopped dinosaur kale)
1 ripe pear
1/2 - 1 bannana
1/4 tsp cardamom
2 tsp Chia seeds
Blend for about 2 minutes in VitaMix (or other high powered blender)

If you decide to consider incorporating more raw foods into your diet, I have a couple of books I would recommend:

1) Natalia Rose's: "The Raw Food Detox Diet: The Five-Step plan..." (on amazon)
2) Victoria Boutenko's books on Green Smoothies
3) Google searches on Paleolithic Diet and Blood Type Diet to at least consider the concepts

[Josselyn]

From your posting:
"Lots of soups. Love Minestrone. Tend to eat that more than any other soup."

Ummm...canned or home-made?
I had a small can of minnestrone soup a few months ago, shortly after Dx, and my BG 90 minutes pp was in the 190s!
I tested three times to make sure it wasn't an error.

Pasta, potatoes, flour, and sugar substances abound in canned soups. My reaction was disproportional to the nutrition info on the can.
Never again.

Just offering up a possible area to address.

[sorka]

Mostly home made but occasionally, a few times a month, Progresso Minestrone. It hasn't caused spike for me prior to a few months ago.