[tbach]

Sorry - I mistakenly used the "reply" button instead of "new thread" button.

okay - the short version. Finally found a decent endo after a search of almost 3 years. I am 69 year old male, and my main reason for trying to locate a good endo was to assist with ongoing testosterone replacement therapy after a long distance move from So. California (where I coudn't find a decent endo either!).

I have charted my bloodtest results for the last 8 years on an easy to read spreadsheet - most doctors chuckle when I hand it to them, but see it's value quickly. On the basis of our initial office visit, my bloodtest history, and the fact that I have apnea and low test, he suspects that I am insulin resistant and prescribed MetforminER - 1000mg with dinner daily. After the shocked reactions I got on this forum, from other medical practicioners (cardiac rehab nurse/physical therapist), and from my daughter, who is diabetic - controlled with diet and oral meds - I called my endo's office and requested a glucometer.

For the most part, glucometer readings have been very pedestrian. I check upon waking (105), before intense daily exercise (usually within an hour after breakfast - oatmeal, banana, trail mix and fresh fruit) (123) and about 2 hours afterward when my exercise is completed (108). I check regularly about 2 hours after dinner, too (109). The surprise came when I checked blood level mid-afternoon (about 2 hours after lunch). This is the time I often suffer what I call a "crash," when it takes terrific effort to stay awake. My lunch is usually 1/2 bagel with small amount of tofutti "cream cheese" and 1/2oz smoked salmon - also an egg white omelet with basil and 1 small piece of canadian bacon diced. When I have done mid-afternoon check (a couple of times I was prompted to do so because I could feel the "crash" upon me), my level has been consistently in the high 150's . . . even after an intense 1hour bike ride. I spend 30-45 minutes on a bicycle training setup in my garage - usually 3 hours after dinner, and after that exercise session, my level has averaged 86.

How do my levels increase from low 86 to 104 while I'm sleeping?

Why are my highest readings in mid-afternoon after what I consider a light lunch and often after intense exercise?

Do higher levels cause excessive sleepiness? This problem has plagued me for a couple of years. Almost as bad as it was before I started using CPAP at night - just had new sleep study and using better mask and high pressure. So Apnea may be a consideration, but not the whole picture.

Thanks for any enlightenment. My saving grace for the past 3 years with Testosterone Replacement Therapy has been an online forum, and I suspect that the same great support and info will be available here.

[DCaplinger]

Lots of questions were asked... I'll break them down individually.

1) Levels increas while sleeping... could be a problem we refer to as the Dawn Phenomenon. This is a very common occurance. You'll see it abbreviated here as DP.

2) Intense Exercise causing highs... Yup... that's a normal reaction in some people to exercise. Exercise is a stimulating event, even if it wears us out. In order for the exercise to occur, our body has to dump hormones like adrenaline. The increase in adrenaline often signals an overrelease of sugar from the liver, resulting in a hyper reading.

Another thing to think about... the bagel. That's a food that's almost pure carbs. It's not always about how many carbs you eat, but the type. Some types of carb sources absorb quicker than others. For example, carbs from breads absorb very quickly in me. The carbs from chocolate, however, take much longer and cause much lower spikes for me.

3) Do high levels cause sleepiness? Actually, that's my first clue to test. I get very tired when I go high. I also suffer from sleep apnea, however I sleep very well since I got the CPAP.

Hope that helps!

Regards,

D

[tbach]

Thanks for your help - will start research on DP. Also need to find out how to counteract (if indeed I actually need to) the effect that exercise seems to have on my blood levels mid-afternoon. Exercising less is not an option . . . it's my addiction (replacing food, for the most part), and although it started because of health when I suffered two heart attacks in 2002 and had a stent implant, it has grown way beyond "health." Instead of that package of m&m's or brick of cheese, I get my endorphines from exercise and elevated heart rate.

Thanks again, and welcome to the CPAPies club. It's amazing what a good night's sleep can do!

Do you have any suggestions for sites that offer nutritional tips to diabetics/pre-diabetics?

Ted

[EeyoreButterfly]

Welcome to the prediabetes club! (Not that you want to be a member). Your fastings combined with the multiple 150 readings are definitely prediabetes. Metformin in some studies has been shown to help delay the onset of diabetes and is the only drug approved for prediabetes, so it sounds like the endo made the right call.

There are some wonderful sites out there, although I encourage you to not take what one says as gospel. There are many approaches:

1.) The ADA has good general advice but their eating plan is too high carb for most people

2.)Diabetes Daily has forums and general diabetes advice and blogs from people who have diabetes.

3.)DLife has forums, articles, and even a small store.

4.) Healthy Outcomes is a site that has a lot of educational material, games, even surveys. The best part is that for each thing you do, you earn points that can be redeemd for free items. Quite a few of us have used it and absolutely love it!

There are also some books I want to recommend:

1.) The Forever Young Diet and Lifestyle. It's what my amazing Endo recommended. It not only gives you a way to eat, it tells you why we eat the way we do from an evolutionary perspective, and addresses multiple issues (psychological, spiritual, physical).

2.) Many people recommend Gretchen Becker's books including the one about your first year with type 2 (of which prediabetes is the precursor).

3.) A book on the glycemic index might also be helpful.

Now that you have know you are pre-D it is time to start counting carbs. You want no more than 2-3 servings a day which is about 30-45 grams. What you do eat, the rule of thumb I was given is 3 grams of fiber per 100 calories and to try to make it whole grain whenever possible.

[genie86333]

One other thing to consider that I haven't seen any posters mention is that a readings of 86 & 104 can actually be the same. Meters have a 20% variance - If your blood sugar is 100 it could actually read 80.

That being said, your blood sugar may be increasing a bit in the morning, but you are still within very safe levels.

And regarding the carbs - as someone else posted Bagels are VERY high in carbs - you may want to eliminate them. Best thing to do is change one thing at a time when you're trying to eliminate a cause for a spike - you say you don't want to change the exercise, so try eliminating the bagel first & see if that makes a difference.

Another option is *pausing* during your exercise to test (every 15-30 minutes) & having a small snack if you're getting low to prevent your liver from dumping glucose into your system.