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tloffman

A1C falling, but FBG rising?

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tloffman

Two years ago (July, 2016) my A1C was 5.9 and my fasting glucose was 92. I was concerned about the A1C number because it was on the rise, so I bought some liquid sucralose and cut out honey as a sweetener. I also increased my protein intake and did everything I could to eliminate sugar from my diet - so, high protein, low sugar, a common dietary regimen these days.

 

However, over the past two years my A1C has been steadily falling and is now 5.3 - very happy about that. However, my fasting glucose keeps rising - latest was 113. These aren't just odd values, as the graphs show steady trends. 

 

This odd divergence seems to exactly coincide with my use of the sucralose - may be a coincidence. I am now going to cut back on sucralose as an experiment and reintroduce a little honey into my diet. 

 

Just wondering if this sucralose connection is real or not. And, why would the FG be going up while the A1C is steadily falling? I exercise, my weight is great for my height, and all of my other readings are excellent - cholesterol, triglycerides, blood pressure etc. 

 

I am a male, 71 years old and very fit, 6.1" tall and 185 pounds. 

 

I have eliminated almost all carbs from my meals, so there isn't much more I can do.

 

Thanks for any feedback.

 

Tom

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Kit

Hi Tom, welcome to the group.

 

Look up Dawn Phenomena.

 

In the early morning hours, our livers release stored glucose.  It does this to provide us energy needed in order to start the day.  For a T2 diabetic, we also release insulin in order to process that glucose.  But, since we have issues, its not as effective as it should be.

 

In the early says I'd easily see a 20-30 point rise between a reading taken directly before bed and the next morning.  Through some testing I discovered that my numbers would start rising at around 3am, almost 8 hours after I had last eaten.

 

So, you could certainly be seeing a dawn phenomena.

 

My liver will also do a glucose dump if I wait too long before eating breakfast in the morning.  Another case where I can easily see a 20 point rise with no food what so ever.

 

Another possibility would be the sweetener.  What form are you using?  I ask because powdered forms, such as Splenda, also contain things like maltodextrin, which is full of carbs and is easily metabolized by the body.  I've yet to try a granular or powdered sweetener which doesn't cause my numbers to jump.  I've read that erythritol is pretty safe but haven't tried and tested it myself.  I have not run into issues with any of the liquid sweeteners I have tried such as liquid sucralose or liquid stevia.

\

And another could be your high protein diet.  Excess protein (that not needed to build, maintain, and repair muscle mass) can get converted by our livers into glucose.  You may want to reevaluate your protein intake to make sure you're not consuming large excess.  The interesting part about this is its not fast.  You won't see it at 1 or 2 hours but instead 3 or 4 hours later.  It takes more time for the body to convert protein into glucose, so it shows up later.

 

Also, can you define eliminating almost all carbs from your diet?  I ask this because it often means different things to different things to different people.  Some might say it, but include things like beets, sweet potatoes, whole wheat breads, oatmeal, milk, and similar.  On the other side, I aim for about 30g total carbs per day which I get almost exclusively from low carb vegetables.

 

I personally would setup a testing schedule for a few days.  More testing after meals (you don't mention if you do this), right before bed, and then a few times over the course of the night.  Yes it sucks as it means interrupted sleep, but its worth while to identify the exact behavior.  Once you get a feeling for the behavior, you can better come up with a plan for how to approach it.

 

If you fear you really are becoming insulin resistant, I really really don't recommend going back to honey.  The stress on the body is just not worth it IMO.

 

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dowling gram

Kit has given you good advice so I won't add much to it. I just want to say that honey has as many carbs as sugar and I use granular splenda and it has never spiked my blood glucose.

 

Some here say that eating something before bed helps with dawn phenomena. I don't have it so I can't say for sure it will work.

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meyery2k

Tom - Welcome!  The A1C is great and would suggest that, overall, your glucose level is lower.  You may indeed be experiencing Dawn Phenomenon.  I find if I eat too much protein, I will have somewhat higher morning readings but not much change to my A1C.

 

If you can get the strips, you might find it useful to try a few days as mentioned and observe what is happening throughout the day.

 

There are some interesting ideas about that while we certainly need to watch our glucose, excess insulin may also not be good for us.  Those of us that are insulin resistant try to maintain a diet that doesn't promote the release of any more insulin than necessary.  I would have to agree that honey would not be a good idea if this is your goal.

 

Liquid SF sweeteners or syrups might prove to work better for you.  The granulated sweetener, as explained, uses dextrose and maltodextrin which you may cause you to spike if you use enough of it.

 

Quoted from Wikipedia (Splenda) - The energy content of a single-serving (1 g packet) of Splenda is 3.36 kcal, which is 31% of a single-serving (2.8 g packet) of granulated sugar (10.8 kcal).[9] In the United States, it is legally labelled "zero calories";[9] U.S. FDA regulations allow this "if the food contains less than 5 Calories per reference amount customarily consumed and per labeled serving".[10]Further, Splenda contains a relatively small amount of sucralose, little of which is metabolized; virtually all of Splenda's caloric content derives from the dextrose or highly fluffed maltodextrin "bulking agents" that give Splenda its volume. Like other carbohydrates, dextrose and maltodextrin have 3.75 kcal per gram.

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tloffman

Kit,

 

Thank you for your reply! It's certainly possible that my high protein, low carb regimen is an issue here. 

 

The Dawn Phenomena might be part of what's going on, but the fasting glucose numbers have been on a steady upward trend for two years - a slow trend, but the trend is clear. Here's how I "fast" for the test: I eat dinner about 9-10pm. Then I only drink water until I go in for testing about 12 hours later. I am awake and walking around for at least a couple of hours before the test. 

 

About the sweeteners: I have been using two types of sweeteners. The first is Stevia with erythritol and the second is liquid sucralose. I noticed that the Stevia is mostly erythritol and has about 3g of carbs per package, so I just stopped that. Last year there was a study that came out indicating that artificial sweeteners can raise fasting glucose due to changes in "gut bacteria". Other articles I read said this isn't true. so I don't know what to believe. I will be cutting back on the sucralose to as little as possible, but I do have to have something sweet. 

 

Another issue that started a few weeks ago is a version of "restless leg syndrome". After I eat my dinner,  a big salad, my legs feel flushed with energy and want to contract and move. This feeling goes on for about an hour. Prior to a few weeks ago, after my salad, I was having a small bowl of mixed fruit as a dessert, but now I have stopped that as it seemed to really kick this "restless leg" issue into high gear. Stopping the fruit calmed down the "restless leg" issue, but it's not completely eliminated. 

 

Thank you again for your comments - very, very helpful.

 

Tom

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Kit
27 minutes ago, tloffman said:

 

The Dawn Phenomena might be part of what's going on, but the fasting glucose numbers have been on a steady upward trend for two years - a slow trend, but the trend is clear. Here's how I "fast" for the test: I eat dinner about 9-10pm. Then I only drink water until I go in for testing about 12 hours later. I am awake and walking around for at least a couple of hours before the test. 

 

If that's the case, you've been up and moving around for a while before the test, it might just be a liver dump like I get if I don't eat or delay breakfast in the morning.

 

Funny enough, that morning fasting reading is usually one of the last places to show a problem and one of the last spots to go back down once you start taking control.  It was so frustrating to me to be in the 80s to low low 100s all day, go to bed in the 80s and wake up near 120.  That eventually calmed down.  I'm really not sure how or why that happened.  Now I usually wake up somewhere near where I was when I went to bed.

 

Getting a meter and some strips and spending some time testing yourself at different times will help you better to identify where and when that is coming from.  If its just a liver dump because of a delayed/skipped breakfast, then it really isn't a major deal except for when you have to extend your fast for blood tests.

 

I guess I was lucky as I wasn't a huge sweets person to start with so I don't use much in the way of sweeteners.  I bought a small bottle of liquid stevia 4 years ago and still have ha;f a bottle left.  I bought 4 large bottles of Davinci SF syrups (like what you use in coffees like at Starbucks) around the same time and still have them all.  I periodically get on a one minute muffin kick and use then for both a little sweetness and some additional flavor.

 

But I have had total crap luck with the powdered sweeteners.  They just don't play nice with my body so I have just given up.  As I don't do a lot of baking, which might be a major reason to want granular over liquid, its not been a big deal for me.

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tloffman

Kit,

 

"Also, can you define eliminating almost all carbs from your diet?  I ask this because it often means different things to different things to different people.  Some might say it, but include things like beets, sweet potatoes, whole wheat breads, oatmeal, milk, and similar."

 

About two years ago I went on a label search for sugars - looked at the grams of sugars and grams of protein. I found that sugars are in almost everything that has a label, so I began to change my eating habits to reduce the amount of sugar to a minimum. I cut back and almost eliminated bread. My wife loves cookies so I had to either give them up or only eat a half of one. I do have a little rice with my midday meal. I was eating a dessert of fruit after my dinner, but I have now eliminated that as well. We are surrounded by carbs so it's really tough to say no. Perhaps, adding the protein is raising my fasting glucose. I have been consuming whey protein powder and high protein drinks, so will have to cut back on that. 

 

The only testing I have ever done is the standard blood tests every three months. I have never tested myself at home. 

 

Tom

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TX_Clint

Best recheck the carbs in Stevia. 3g of carbs is more than a packet weighs. The 3g of carbs you see must be for a whole box of 100. I use stevia and it has zero effect on my blood glucose. I also use erythritol for some things and it has no effect on my bg. 

The information I’ve seen says Stevia has 5g of carbs per 100g. If you are putting 100g of stevia in your drink you’ll need a 🥄.

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Kit

I know exactly what you mean in regards to sugar and carbs.  Once I started really reading labels and ingredient lists, it was utterly shocking on what all shows up there and how much sugar is in things you would never imagine.

 

This doesn't mean you have to go without.  If you or your wife enjoy cooking, there are numerous recipes out there for low carb desserts, cakes, cookies, pies, brownies, etc.  I've actually been looking at a few cookie recipes that I might try once fall comes around and I'm in the mood.

 

https://www.ketoconnect.net/recipe/keto-shortbread-cookies

https://www.ketoconnect.net/recipe/gluten-free-sugar-free-cookies/

 

They also have a gingerbread recipe that I might actually make for my winter holiday dessert this year.

 

Poke around on a lot of the low carb and keto recipe sites.  There are a lot of great ideas which will open up more possibilities for you.  :)

 

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Fraser

I would start testing at home to see what different foods do to your BG, rather than assuming  it is called eating to your meter.  

 

I  had what I thought was restless leg syndrome, but it really was closer to neuropathy caused by high sugar spikes. 

Fruit can spike you BG something awful.  Your WOE is fine if your body can handle it, but to me it is not really low carb . 

 

FYI the leg issues went away when I had my BG well controlled. 

 

I would recomend just starting over with your diabetes learning.  

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tloffman

TX_Clint,

 

I just rechecked the ingredients of 1 packet of Truvia (not raw Stevia) online in several places - it says 3g of carbs from sugar alcohol. So, if I have a couple of packets in the morning, then a couple more in the afternoon, and a couple in the evening - let's say a total of 6 or 7 packets - that would come to 18-21g of carbs. 

http://www.calorieking.com/foods/calories-in-sugar-substitutes-sugar-substitute-packets-or-spoonable-erythritol_f-ZmlkPTIwOTg5MA.html

I hope I am wrong about this, but I have eliminated this from my diet now. 

 

Tom

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tloffman

Fraser,

 

"Your WOE is fine if your body can handle it, but to me it is not really low carb . " I am new here - what is WOE?

 

Thanks, 

 

Tom

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TX_Clint
7 minutes ago, tloffman said:

TX_Clint,

 

I just rechecked the ingredients of 1 packet of Truvia (not raw Stevia) online in several places - it says 3g of carbs from sugar alcohol. So, if I have a couple of packets in the morning, then a couple more in the afternoon, and a couple in the evening - let's say a total of 6 or 7 packets - that would come to 18-21g of carbs. 

http://www.calorieking.com/foods/calories-in-sugar-substitutes-sugar-substitute-packets-or-spoonable-erythritol_f-ZmlkPTIwOTg5MA.html

I hope I am wrong about this, but I have eliminated this from my diet now. 

 

Tom

It’s a bit more complicated. Those carbs per packet is sugar alcohol which is what it is and not counted like like other carbs. Mmmmm.,, let me lookup the comparison chart and come back.

WOE is way of eating

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meyery2k

Yeah - Sugar alcohol is kind of grey.  Maltitol is used in many SF ice creams.  Some people spike and some don't.  I have to be careful not to eat too much myself.  My meter and testing helped me establish that 1/4 cup is OK but not 1/2 cup or more.

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TX_Clint

I couldn’t find the chart but here is a quick quote.

Out of all the sugar alcohols, erythritol seems to be the clear winner.

It has almost no calories, no effect on blood sugar and causes significantly less digestive problems than the others. 

It is also good for your teeth, and won't end up harming your dog.

Plus, it tastes pretty awesome. It's basically just like sugar without the calories.

also read

https://en.m.wikipedia.org/wiki/Sugar_alcohol

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Fraser

way of eating. 

 

FYI I am 72 and active still “run”  5-10 185 # could be thinner,  A1C for the last 7 years  between 5.7 and 5.9. Typical wake up BG mid to upper 90

no diabetes medication.  

I am a diabetic because I cant consume more than 25 carbs a day, I count every thing I eat, and exercise 5 to 7 days a week 

every food choice, quantity and eating  time is base on the effect on my BG.   Don’t do a fasting from the lab, it is not that useful.

now if I wasn’t a diabetic, I could stop have a burger with fries, and a milkshake for lunch 😜

 

My point if you need to control you eatin, carb in take etc to keep your BG in the norm range, that is the definition of a diabetic, 

 

 

 

 

 

 

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Kit
2 minutes ago, TX_Clint said:

It’s a bit more complicated. Those carbs per packet is sugar alcohol which is what it is and not counted like like other carbs. Mmmmm.,, let me lookup the comparison chart and come back.

WOE is way of eating

 

Actually that depends on the type of sugar alcohols.

 

There are a number of these out there, but they went through and did BG and ketone testing with the various alternative sweeteners out there.  Two young, healthy, non diabetics. 

 

 

There really are a few good reasons to avoid maltitol.  :)

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tloffman

Fraser,

 

So, I started this thread because I have been working hard to reduce my intake of sugar and processed carbs and my A1C has fallen from 5.9 to 5.3 in two years, but I am having trouble getting my FG down. It just keeps creeping up, while the A1C keeps going down. 

 

So, my take from what you are saying is that I will have to do my own glucose monitoring by getting a kit and strips. Something is keeping my FG above 100 in these lab tests and it doesn't seem like anything I am doing is helping. Perhaps it's just that my FG is higher in the few hours after I wake up and go to the lab. Another idea is that my high protein/low carb regimen is keeping the FG up. I initially thought my sucralose use was the problem, because my FG started moving up when I started using liquid sucralose, and this appears to verify the study that came out last year that said that artificial sweeteners can raise FG - and by quite a lot. It's also possible that this is genetic - perhaps my FG "set point" is higher. 

 

Thanks for the ideas...

 

Tom

 

 

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Kit
58 minutes ago, meyery2k said:

To see non-diabetic responses was interesting since I can't find anyone to experiment on lol...

 

While I don't necessarily take it on faith that if they don't react badly to something that I won't.  But I feel pretty assured that if they react to something that its going to be worse for me.

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Fraser

Just to interject a concept. Now I started with an A1c of 12🙀

now that I am in the 5.0s  I find going lower upsets the balance.  Makes my morning numbers higher. Omg

i decided that I need to listen to my body. 

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meyery2k

I found the sugar response interesting.  So it would appear that we all spike but their presumed insulin response would be expected to bring that down to near "normal" quickly where we would just sit there at 130 or whatever for a while longer.

 

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Kit
23 minutes ago, meyery2k said:

I found the sugar response interesting.  So it would appear that we all spike but their presumed insulin response would be expected to bring that down to near "normal" quickly where we would just sit there at 130 or whatever for a while longer.

 

 

From my experience with how I react, that is pretty much the case.  While a non diabetic might drop quickly (they were testing at 30 minutes), I will go higher and stay there a lot longer.  And in the mean time I'm stressing my body out by making it struggle to bring the number down.

 

Now you could say that if non diabetics will spike like this, then those are ok goal numbers for diabetics.  For me personally I look at it as do I really want to model a healthy diet after how someone reacts to eating 2 tablespoons of pure sugar in one go?

 

@tloffman , basically yes.  Seeing one reading once every three months doesn't give a great picture.  While your lower A1C definitely shows you have made some good improvements, it doesn't tell the whole picture.

 

For example, an A1C of 5.3 is an estimated average BG of 105.

Now that could mean that you spend most of your time somewhere evenly between 95 and 115. It could also mean that you spend most of your time evenly spread between 50 and 160.

 

Some strategic testing will help fill in missing puzzle pieces and get a better idea of how your body is reacting.  Once you have that, you can make a more informed decision on what steps you may need to take in order to resolve the issue.

 

testing yourself before and two hours after meals will also give you a better idea of how you react to the foods you choose to eat.  This will help you better tweak your diet to your needs.  As said above, we call this eating to your meter.

 

Oh and I highly recommend going with a cheap meter with inexpensive strips.  Meter manufacturers pretty much give their meters away.  The strips however can cost an arm, a leg, and your first born child.  There are some inexpensive optiosn out there.  I personally use the ReliOn Prime from Walmart.  The meter is around $20 if I remember right and the strips at $9 for 50.  I believe CVS also has a meter and strips with compatible pricing.

 

You'll also want a lancing device (to poke your finger with) and lancets.  I personally use the Delica, but there are a lot of options out there.  None of this requires a prescription and your pharmacist is a great resource to help you get everything you need.  You can usually also find some really good tutorials on Youtube.

 

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tloffman

Kit,

 

So, basically, if I really want to figure out what's going on I will have to start testing myself. Got it. 

 

Now, here's another idea: I have been reading a number of articles that indicate that cinnamon is a natural way to lower blood glucose. I had forgotten about cinnamon. I was reading a review of one of the glucose test meters on Amazon and one of the reviewers said he drinks cinnamon dissolved in water.  Some of the cinnamon articles I read were quite positive and some not so much. It certainly is an inexpensive experiment. 

 

I started my cinnamon drink yesterday, and last evening did not get my usual restless leg syndrome after dinner. That was good. Would be interested in your response about the cinnamon or other natural supplements to reduce the FBG. 

 

Tom

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