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I am a Type II diabetic and have been on a low-to-zero carb diet for approximately 2 years and am experiencing high blood glucose levels. Why?

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Updated about 21 hours ago
Created July 09, 2014 at 7:14 PM

I eat probably less than 1000 calories per day on average, occasionally up to 1500; abundant healthy fats such as coconut oil, grassfed butter, raw olive oil, avocado oil, bacon, etc. I eat two eggs almost daily, a little meat. I drink 8-12 oz. raw sprouted almond milk daily and I have coffee with heavy cream in the morning. Greens, other non-starchy veggies, occasional glass of red wine in the evening before bed,and that pretty much is my standard dietary intake..

I have been in ketosis for about two years. I am not losing weight. I have managed to get my diabetes medications (metformin and glipizide) down to once per day, usually before supper and my numbers have been hovering around 130-180. Last week they spiked and I am now frequently in the mid-200's and am having to take my medications twice/day. Still I am not losing weight (am currently 170-174lbs but had gotten down to 156 until weight started to climb again over the last year or so).

I have no explanation for my high glucose levels and my inability to lose weight. Literally, the only thing that I consume on occasion that deviates from this diet is an occasional sugar-free (so, Splenda, probably) blended coffee drink from Peet's. This would be once or twice a week. Could this have something to do with it?

Help. I'm lost!

Ae9864a6f35302d9dad69303c181a75c
0 · July 12, 2014 at 4:25 PM

Thank you, rht. I had not heard of the Bernstein Diabetes Forum before, and it sounds like that might be a good place to pose my some of these questions. I did not think I could be the only diabetic with these issues, but I sure hadn't met anyone else with them, so I was at a complete loss as to how to proceed. This sounds like a good place to go from here! Thanks again.

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942 · July 12, 2014 at 4:01 AM

Alcohol helps you go to sleep but disrupts your sleep. You get poorer quality sleep.

Medium avatar
10234 · July 11, 2014 at 2:15 PM

Here's the methodology I used to control T2 7 years ago, per my doctor.

https://www.novomedlink.com/content/dam/novonordis...

Carb exchange counting targets high glycemic carbs. But it is also restrictive of fats and overall calories. I think in my case that it took restriction of all three to recover insulin sensitivity, though I cannot prove it.

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 6:04 AM

Thanks, Harry. Yes, I will look into my dairy consumption as well. None of the dairy I consume is sweetened, and most is cultured. But what you say is interesting, so I think I will do a little snooping around myself to see if this could be an issue.

I'm curious about why a glass of wine before bedtime is not a good idea. It's useful to help me sleep, but is it better with food? Tell me what you know about that.

Bad68cda06fa2c32f8a8d01e75d10926
10 · July 11, 2014 at 2:44 AM

I hope it works!

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 2:27 AM

Two great comments in a row! Now we're getting somewhere. The commenter above yours suggested trying a middle-ground 1500 calories. Sometimes too much of a good thing...isn't, to repeat a tired cliche. I will follow the link you provided. Thanks, Jake.

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 2:24 AM

O.K., so that could make sense. Maybe I just missed the sweet spot going from 2000 calories/day down to around 1000. Maybe 1500 would be worth a try. Thanks NerdFaerie!

Ae9864a6f35302d9dad69303c181a75c
0 · July 10, 2014 at 5:07 PM

Please re-read initial post. Usually under 1000 but occasionally up to 1500. And listen Matt, it may even go above that sometimes. I went to a 4th of July B-B-Q and had corn-on-the-cob and a little potato salad. I have a life. All I really want you to take away from this is that my normal day-to-day cal. intake is under 1000. I am not counting calories so much as eating very conservative amounts of very healthy foods. Many of my staples (such as raw almond milk) are low in calories. Yesterday I probably consumed less than 700. Today it might be 1600. Either way, the average hovers around 1000

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41544 · July 10, 2014 at 3:55 PM

Gotta cover the basics first, I'm still hesitant to buy your calorie totals. You go from less than 1000 calories to exactly 1418 calories.

Ae9864a6f35302d9dad69303c181a75c
0 · July 10, 2014 at 3:39 PM

My mother was a type II diabetic and was insulin-dependent for many years. I was diagnosed 12 years ago but have been able to manage it (with varying degrees of success) with diet/medication, but my goal in practicing this extreme diet is to one day get off the meds entirely.

Fortunately, all the usual corollary symptoms (like foot ulcers, failing eyesight, etc.) are completely absent--one of the things my doctor scratches her head about. I would be willing to increase calories if it would improve my results. This low-cal thing is just an experiment because the 2000 cal./day wasn't working.

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10234 · July 10, 2014 at 2:17 PM

As far as increasing the calories, if you're on the verge of starvation you may be forcing the overproduction of glucose for basic body needs. Most LC Paleos pride themselves on eating a high calorie diet without weight gain. Given your level of activity I'm a little surprised that you're eating near-starvation rations.

Medium avatar
10234 · July 10, 2014 at 2:08 PM

I mentioned age because I was diagnosed at age 54, with both high A1C and fasting blood glucose. I felt just fine, but it was only a matter of time before the diabetes took its toll. I'm not sure age had as much to do with it as obesity, but our metabolism slows with age (possibly thyroid, possibly less activity) and we can't continue to eat like teenagers without getting fat. Do you have ulcers on your feet?

Ae9864a6f35302d9dad69303c181a75c
0 · July 10, 2014 at 3:58 AM

Thanks, Bob. You're right, I should have included more details from the outset. I was trying to avoid a long, rambling post, but ended up rambling anyway.

Yes, you have it all right. Missing info: 5'6 and 43" at my fattest part. I have never learned to figure my bmi. I am smallish everywhere but my gut: a true apple.

In the interest of disclosing all the details, there is one other odd thing. In the last week or so my urine has taken on an odd smell. Like asparagus, but I haven't had any in at least a month. Not ammonia-like at all. I googled this, but came up empty.

Now I think you have it all.

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690 · July 10, 2014 at 2:52 AM

@deblongley

You're making us work too hard for the data.... here's what I've gleaned

Female, 55, current 170-174 but as low as 156

Hard physical labor, appear to be eating clean.

Important stuff I have not found, height, waist (where the sideways bend occurs), est bodyfat %

Appears you're not a standard T2. I have read about cases were people on very restrictive diets (relative to caloric expenditures) did not lose weight. Instrumented they burned fewer calories compared to "normal" poeple putting out the same effort. ??? yeah puzzling

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41544 · July 09, 2014 at 10:10 PM

Did you measure it? Or eyeball it? If you haven't been trained to measure things by eye, you are seriously under-estimating your intake. Your menu yesterday could easily push 2000+ calories.

As you say, something doesn't add up, and somebody who isn't measuring intake likely is wrongly estimating intake. Particularly when you say "abundant healthy fats"… sorry it sounds harsh, but you are not the first person to not lose weight on the internet.

Your high blood sugar very likely could be physiological insulin resistance (coupled with Type II diabetes), no carb is not better than ketosis.

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10 Answers

13c5a9f1678d75b93f269cdcf69f14d5
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2329 · July 12, 2014 at 12:12 PM

  • You might consider asking this question over at the Bernstein Diabetes Forum. Bernstein's approach is compatible with Paleo, but the experience level with T2 is much higher.
  • One possible reason for the higher BG levels is a hidden dental infection. Another possibility is histamine intolerance, which can cause inflammation, leading to higher BG levels. Paleo can be higher in histamines and everyone's tolerance level is different. That tolerance level can also vary seasonally and there are hormonal variations for women to consider, which may be less of an issue for you at 55, but perhaps not.

Ae9864a6f35302d9dad69303c181a75c
0 · July 12, 2014 at 4:25 PM

Thank you, rht. I had not heard of the Bernstein Diabetes Forum before, and it sounds like that might be a good place to pose my some of these questions. I did not think I could be the only diabetic with these issues, but I sure hadn't met anyone else with them, so I was at a complete loss as to how to proceed. This sounds like a good place to go from here! Thanks again.

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942 · July 11, 2014 at 5:37 AM

I have had a recent experience similar to yours. Reasonable glucose level for 7 years on Metformin. A couple of months ago, it shot up to 250 or more.

I had two courses of anti-biotics earlier in the year. I had had a long-term sinus infection so I gave in and took them. I normally refuse. I started eating yogurt thinking it would be good for me. (local, organic, whole milk, pastured, lightly sweetened) Not the best idea but I love yogurt and convinced myself it was the right thing to do.

I was told by a nephrologist that I could eat the many, many healthy high oxalate foods if I got calcium AT THE SAME TIME. He said Tums but I started eating even more dairy. I am Primal and my ancestors are all from the British Isles. I do dairy. But I was probably getting too much. I could chug a pint of heavy cream. not a good idea, although I don't buy the conventional wisdom about cholesterol and saturated fat.

When my glucose shot up, I responded by trying to go lower carb. (<50 g/day, sometimes 35) The doc also increased my Metformin.

It was pointed out to me that fat makes cells insulin resistant. Cutting back on fat, especially dairy fat, brought my glucose down to a reasonable level, not great yet but much better. I'm probably getting around 75 g/day carb of heathy veg. More than that DOES increase my glucose. I still believe in Mark's carb curve.

I sometimes have a bit of red wine with dinner. Having it at bedtime is probably a mistake.

I'm not sure if any of this will be useful to you, deblongley, but maybe to someone.

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 6:04 AM

Thanks, Harry. Yes, I will look into my dairy consumption as well. None of the dairy I consume is sweetened, and most is cultured. But what you say is interesting, so I think I will do a little snooping around myself to see if this could be an issue.

I'm curious about why a glass of wine before bedtime is not a good idea. It's useful to help me sleep, but is it better with food? Tell me what you know about that.

Ffc7e0ecad8e8831b528c5d4921377cc
942 · July 12, 2014 at 4:01 AM

Alcohol helps you go to sleep but disrupts your sleep. You get poorer quality sleep.

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2391 · July 11, 2014 at 1:35 AM

Paul Jaminet would say that too little glucose can produce the symptoms you describe. His explanation (and someone correct me if I'm wrong) is that too little glucose in the diet results in the body becoming insulin-resistant, because it's trying to conserve glucose for the interior tissues of the brain, where ketone molecules are too big to penetrate. Second, too little insulin causes functional hypothyroidsim, which interferes with fat loss. If you go to perfecthealthdiet.com, you'll find a series of articles on the long-term effects of very-low-carb diets.

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 2:27 AM

Two great comments in a row! Now we're getting somewhere. The commenter above yours suggested trying a middle-ground 1500 calories. Sometimes too much of a good thing...isn't, to repeat a tired cliche. I will follow the link you provided. Thanks, Jake.

Medium avatar
10234 · July 11, 2014 at 2:15 PM

Here's the methodology I used to control T2 7 years ago, per my doctor.

https://www.novomedlink.com/content/dam/novonordis...

Carb exchange counting targets high glycemic carbs. But it is also restrictive of fats and overall calories. I think in my case that it took restriction of all three to recover insulin sensitivity, though I cannot prove it.

Bad68cda06fa2c32f8a8d01e75d10926
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10 · July 11, 2014 at 12:31 AM

My mom eats in a similar fashion and I really think she can't lose weight because she eats too little. I mean, at a certain point, your body is going to hold on to every cell of fat it can because it's starving. If anything, I would try to increase your calories. That little amount of food is not healthy for anyone. Eat a minimum of 1500 calories a day. Also, are you doing any strength exercises? If not, try to add some to your daily routine. Building muscle will help burn calories all the time, not just while you exercise. And they're generally a lot easier to do than cardio (in case you have trouble exercise for longer periods of time). Easy to fit five or ten minutes or a few exercises in here or there during the day. Though I'd imagine that if you're tending a garden, milking goats, etc. you already get quite a workout!

Ae9864a6f35302d9dad69303c181a75c
0 · July 11, 2014 at 2:24 AM

O.K., so that could make sense. Maybe I just missed the sweet spot going from 2000 calories/day down to around 1000. Maybe 1500 would be worth a try. Thanks NerdFaerie!

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690 · July 10, 2014 at 4:44 AM

@deblongley

I'm not a proponent of BMI, imo it's nearly useless.

It's a ridiculously simple model based on two easy to measure attributes. It makes no attempt to model "shape". Here's a better model because it makes a crude attempt at shape. It's probably decent for people not too skinny or not too fat. In the text of the webpage there is a reference to some fitness correlation work that a USAF captain did. Target waist should be in the 50%-ish of height or so.

http://home.fuse.net/clymer/bmi/

You're situation is beyond what I can probably intelligently comment on. But I have read accounts of a couple women who calorie restricted compared to physical work done and still had trouble losing fat & not gaining more. A hormonal thing...cortisol, thyroid plus the excessive body fat acting as a hormone producer too. Maybe your fat is keeping you from losing fat. :(

I think you need a very experienced & specialized health care professional.

I had it easy, I lost fat (220 to 190, 6') by cleaning up my diet alone.

This shows how BMI is more than a bit flawed, your BMI=27.5, my BMI=26.5

My waist is 36" , 50% of my height Your waist is 43", 65% of your height

Our BMI's put me in the marginally overweight & you in the overweight range but I think that's not accurate.

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0 · July 10, 2014 at 2:20 AM

Thanks, thhq. Not sure about thyroid function yet. I have scheduled a checkup with the doc because of these recent bg levels. This is one thing I would like to have checked. She'll do an A1C and all the usual battery of tests to see if anything turns up. As for excercise, I live an active life and do physical work much of the day (including heavy earthmoving and pick and shovel in the hot sun--I have gotten dehydrated that way, simply forgetting to drink because, oddly enough, I'm not only not too hungry, but I also often don't get thirsty either), also taking care of livestock. But as for the treadmill or the bicycle--not too much in the summertime. Maybe I will try that and see if it makes a difference.

I'm 55 years old, have never smoked, have excellent blood pressure, good energy even with the low caloric intake, generally feel great. On the other hand, even when my glucose levels are sky-high, I still feel great--no symptoms whatever. I switched to this diet two years ago when I almost killed myself by taking myself off my medication, thinking that if I wasn't eating carbs and was eating all the right things, I would be just fine. But here's the stupid part: I didn't tell my doctor, and I was out of test strips. I visited my parents one day and my dad tested me just on a hunch and I was at 456. Should have been in a hospital or in a coma or both, but I still felt great. This is a problem, because I rarely have symptoms. My doctor is also puzzled with all of this. I just don't seem to fit the diabetic norm at all.

As for the 2000 calories/day, I used to do that. I did a little research a few months ago, because I was having some of these same questions (why isn't the weight just falling off me, why is my diabetes out of control) and read about something called a calorie-restricted ketogenic diet. Couldn't get a lot of details about a specific diet plan, so I just started to try and figure it out for myself. I knew I wanted to stay with the high-fat/moderate-protein/low carb model, and I know all the essential things to keep in my diet, so I just basically reduced intake of all of those things (some things I did eliminate entirely, but not many). Still don't understand why that isn't doing the trick. What is your thinking about increasing calories? I'm curious now.

Thanks for your input. This has given me some things to chew on (yeah, a pun--I have no self-control).

--Deb

Medium avatar
10234 · July 10, 2014 at 2:17 PM

As far as increasing the calories, if you're on the verge of starvation you may be forcing the overproduction of glucose for basic body needs. Most LC Paleos pride themselves on eating a high calorie diet without weight gain. Given your level of activity I'm a little surprised that you're eating near-starvation rations.

Medium avatar
10234 · July 10, 2014 at 2:08 PM

I mentioned age because I was diagnosed at age 54, with both high A1C and fasting blood glucose. I felt just fine, but it was only a matter of time before the diabetes took its toll. I'm not sure age had as much to do with it as obesity, but our metabolism slows with age (possibly thyroid, possibly less activity) and we can't continue to eat like teenagers without getting fat. Do you have ulcers on your feet?

Medium avatar
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10234 · July 10, 2014 at 12:16 AM

I was type 2 and got rid of the glucose spikes by reducing carbs short term and losing weight long term. I have never been in ketosis, so cannot say what this would do to you over two years. This is baffling to me...you sound like a glucogenesis factory. Your weight is not terribly high, and this doesn't sound like it's driven by obesity. like Here are some thoughts and questions.

How's your thyroid function?

Do you exercise very much? For me exercise is an easy way to burn up blood sugar.

How are your trigs and A1C?

Are you getting glucose spikes post prandial or are you maintaining high fasting levels?

How old are you?

Have you tried eating 2000 calories a day for a week or more?

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0 · July 09, 2014 at 10:58 PM

1418 calories for the day. Like I said, I've been doing this for awhile. I eat this avocado/tomato/bacon salad probably 5 times/week. It is 764 calories, give or take. I would be happy to give you the breakdown if you'd like. The cream in my coffee is probably around 200. Duck eggs are 130 each. Kefir is about 150 (no lactose, since it's cultured). And my daily raw sprouted almond milk is only about 40-60 calories, depending on how much I pour.

And, I'm not losing weight "on the internet." I am attempting to lose weight at home with home-grown veggies, fresh milk from my goats, pastured eggs from my chickens, and tweeking my diet by observing what seems to be happening (or not) with my metabolism. I have never posted a question on any forum prior to this (in part because I have seen the rude and presumptuous replies that other honest questioners have received for their trouble), but I am really at the end of my own knowledge about any of this, so I am reaching out to see if anyone has any ideas about what I might be doing wrong.

Incidentally, I left out a huge category of food that I eat: fermented and cultured foods. I drink home-brewed raw goat milk kefir and kombucha and eat homemade sauerkraut several times a week.

Just to be clear: none of this is a whim for me. I have been experimenting with this ketogenic diet for two years now. It's not perfect (obviously, or it would be working better). But I am doing it consciously and I am recording everything, every single day. I am wondering if my diabetes is the actual monkey-wrench in the works. Sometimes a condition (like diabetes in my case) causes the body to respond differently than it would in someone else. Just a thought.

Thanks for engaging, but now I would like for you to believe what I am telling you about what I have been doing and see if you can come up with something I haven't already thought of.

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41544 · July 10, 2014 at 3:55 PM

Gotta cover the basics first, I'm still hesitant to buy your calorie totals. You go from less than 1000 calories to exactly 1418 calories.

Ae9864a6f35302d9dad69303c181a75c
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0 · July 09, 2014 at 9:11 PM

Well, just typed a long response that did not seem to post, so apologies if this you get this twice.

Here's the thing, Matt 11. It wouldn't do me a whole lot of good if I was posing a sincere question while being insincere about everything else. Right? I keep a detailed daily log of everything that goes down my gullet, so here we go: today, so far nothing (after my morning coffee with cream). Yesterday, coffee with cream at 7:45, two hardboiled duck eggs and a glass of raw almond milk @ 2:45, a tomato/avocado/romain/cuke/broccoli sprout salad topped with lemon juice, balsamic vinegar, olive oil, raw pepitas and sunflower seeds and bacon @ 7:45 and a glass of raw goat milk kefir at 9:00. The day before: coffee w/cream at 8:00am, raw almond milk at 3:00pm and a 2-egg chicken/green bean omelette at 7:00pm.

Shall I go on? Now, while you may be correct that I am consuming more calories than I think I am, it is not going vastly more. It could be somewhat more. But not, I think enough to give me the kind of results I'm getting--or not getting. The three days above are typical (I will eat something later today to get some calories on the board) and I have been doing this for a long time so I am used to it and don't really have much of an appetite anymore.

But maybe you have missed my point. I am at near-starvation levels. I am having trouble losing pounds. I am experiencing higher than normal blood sugar levels. These things do not add up. I mean, you can see that, right? So, not "bullplop." This is really the crux of my whole problem. Doing what I think I should be, and things are still going in the wrong direction.

I suspect there is something going on that is not self-evident. Maybe there are unintended consequences from eating too few carbs, or calories, or eating too much protein (although I try to keep my protein levels moderate, but that can be hard to gauge). Some chemical reaction to all this dietary austerity. So frankly, I find it rather simplistic of you to answer my question by assuming I am being untruthful. Let's move on, shall we?

I am looking for an actual answer. Something useful that I could try. Something that I should stop doing. Something I should do more of. You see what I am looking for?

Thanks.

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41544 · July 09, 2014 at 10:10 PM

Did you measure it? Or eyeball it? If you haven't been trained to measure things by eye, you are seriously under-estimating your intake. Your menu yesterday could easily push 2000+ calories.

As you say, something doesn't add up, and somebody who isn't measuring intake likely is wrongly estimating intake. Particularly when you say "abundant healthy fats"… sorry it sounds harsh, but you are not the first person to not lose weight on the internet.

Your high blood sugar very likely could be physiological insulin resistance (coupled with Type II diabetes), no carb is not better than ketosis.

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41544 · July 09, 2014 at 8:00 PM

Probably eat less than 1000 calories a day? Bullplop. Show me the food logs. Sub-1000 calories is starvation, you will lose weight. You're likely consuming a lot more than you think you are.

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