I lost 20 lbs. 12% of body weight, so why did my A1C go up again?

I have been doing some form of keto for years, when I turned 53 I found it harder to stay on the diet and had to go on farxiga after I learned I was getting protein in my urine. My a1c was slipping. 5.4 to 5.6 to 6.1 . I've had to give up keto due to the med and now I'm trying to eat whole, low processed foods (no seed oils, etc). I'm really curious how my numbers will respond next blood / urine test. I was told that many T2 eventually stop insulin production and become like T1's.

Hi @annewoodmayo -- I'm agreeing with windyshores here about using a meter and the 3 month A1c not giving specific info. What I have found even more helpful in determining foods that cause a rise in blood sugar is the LibreFreeStyle 14 day monitor. There are other brands and a Libre 2 version that I didn't like due to much less accurate and alarms going off all the time. No annoying alarms with the original 14 day system shown below.

Your doctor needs to write a prescription for it, but the insurance won't cover it. With the the free GoodRx discount (be sure to confirm the price in advance), it's about $75 for a two pack so lasts 28 days. It doesn't hurt at all to apply to the back of your arm and I don't feel it while I'm wearing it. Just have to be careful not to knock it off while washing in the shower. You load a free app (need iPhone 7 or above -- not sure about other phone brand requirements). Then you can just tap your phone to the sensor anytime and it gives you a glucose reading. It also keeps a graph record so you can monitor what is happening even while sleeping. Be sure to tap at least every 8 hours to keep the graph going. I've compared the sensor reading to my finger sticks and it's always within 10 points so it seems pretty accurate.

Even if you only buy this once, it's great for testing everything you eat to see how it impacts your blood sugar. I find it worth the investment even if you only do it one month. I was drinking a lot of high protein breakfast drinks (that also had sugar and stevia) due to a food aspiration issue and discovered those were raising my blood sugar more than candy bars. Who knew? I thought the protein would balance it out. My blood sugar went to 240 after drinking that 8 oz. drink. The 14 day sensor system is so easy to use and no finger sticks. Due to my neuropathy, those finger sticks really smart!

I also recommend seeing an endocrinologist who may even have a free sensor sample to give you. Although mine gave me a free sample of the newer Libre 2 system that I didn't like or find accurate. Endocrinologists are much better at diagnosing blood tests, ratios, related hormone conditions, etc. Best of luck to you.

My A1c does not seem to vary with weight changes.

Thanks, everyone, for your helpful ideas and your kindness in taking time to reply to me!

I'm feeling a little overwhelmed...Should I start with trying to get off the duloxetine? Is my A1C high enough (6) for an endocrinologist to pay attention?

I'm pretty sure that my rheumatologist checked my thyroid blood test within the last year or so, and it was normal. Thanks for that lead!

I'm thinking that I should start with the medication change (duloxetine), since I've done a lot with my diet and the A1C still went up.

I already met with a nutritionist several times and she helped me lose the weight. I haven't been able to implement all of her suggestions but I have reduced sugar and some other carbs and added more protein.

Frankly, food has become such a monster for me that I have been skipping meals (breakfast and lunch mostly). It's too hard to decide what to eat and we probably don't have it in the house. I haven't been able to food shop myself for a couple of years because of long covid on top of my autoimmune disease. If I eat another freaking nut, I'm going to turn into a squirrel.

Based on what Tinamaria said about her endocrinologist (not concerned because her A1C was under 6): Since my A1C is at 6, will an endocrinologist help me or dismiss me? Is 6 some kind of threshold for treatment?

Does blood cholesterol matter in T2 ?

Thank you all again for your help! I'm really looking forward to your input/ ideas/ hard-won wisdom!

I read about duloxetine and it is used for diabetic nerve pain. Are you thinking it is raising your blood sugars? Did someone tell you that?

Personally I would not go by the A1C since it is an average. I would test when you wake up, before a meal, and every hour after a meal until blood sugar goes down- to see the pattern in one day. Then test randomly for a week. Keep a record and see the pattern.

The endo cannot tell you much without more info. IEditing to add that @californiazebra is up to date with technology and that Libre suggestion sounds great!.

Maybe meet with a nutritionist but try not to let this ruin food for you!

I am having erratic blood sugars myself these days so I get it. I'll be posting with my A1C next week! But seeing my daughter deal with type 1 for 29 years puts a lot in perspective.

How do you feel about whole-grain? I've read good things about oatmeal, and it is almost the only grain I eat on a daily basis. I eat it plain or with vegetables. No bread or pasta except on special occasions.

For reference, my A1c was higher than I'd like when I got it tested about 5 months ago, at 5.5; I'm approaching 50year and my BMI is just barely still in the 'normal' range.

I have two big weaknesses: fruit (especially dried fruit) and overeating. I started using a free website myfooddata.com and using the 'recipe nutrition calculator' under 'tools' in order to add up all my food for the day as if it were one 'recipe'. This way I saw that my sugar intake was kind of high, even though I don't eat baked goods, just from all the fruit and also, surprisingly the cooked carrots I enjoy. I still eat those things, but I'm trying to cut back and be more balanced about my diet.

This next thing probably doesn't apply to your situation, but another thing that can have a very slight impact on A1c is anemia. As I understand it, A1c measures how much glucose is attached to red blood cells, so if you have less RBC, the glucose is not spread out as much (with fewer RBC, each RBC will carry more sugar) and the reading will be higher, if that makes sense.

Oh, I just read about your not being able to shop for yourself. That is a big, big problem! Who shops for you?

Someone I met who is very interested in alternative and preventative medicine told me that fasting insulin is as important as glucose levels. She said the way it was explained to her is that your glucose can be okay, but it may be because your pancreas is working overtime to pump out enough insulin to keep it that way, but sooner or later, your pancreas will start to wear out, can't keep up, and that's when the glucose goes up.
https://headsuphealth.com/blog/self-tracking/low-carb-lab-testing-part-3-homa-ir/#:~:text=Ideally%2C%20the%20doctor%20will%20create%20a%20lab%20order,to%20consider%20ordering%20this%20test%20on%20your%20own

If you do decide to get off the duloxetine, it may not be an easy road.
Stories like this make me even more wary than I already am about psychoactive prescription stuff that they hand out like candy, it seems. I feel like most health practitioners prescribing this stuff really truly have no idea what they are handling! https://www.painnewsnetwork.org/stories/2015/3/19/patients-deserve-to-know-the-truth-about-cymbalta#:~:text=The%20withdrawal%20symptoms%20from%20Cymbalta%20were%20hell.%20Less,my%20brain%20was%20being%2C%20well%2C%20zapped%20by%20electricity
https://mentalhealthdaily.com/2014/04/22/cymbalta-duloxetine-withdrawal-symptoms-my-personal-experience/
There are some comments at the bottom of this one that are informative also.

I glanced at the abstract that @rhubymama linked to and saw that 12 weeks at 60mg raised A1c by an average of 0.5 which is less than what you've had, so perhaps your other efforts have helped cancel it out to some degree.

Hi, everyone!
I can't thank you enough for your ideas. Keep 'em coming! : )
I'm still all of the information processing information, while dealing with Covid and insurance and other disease-- so I'm kinda extra slow on the uptake of information.
Thank you all again!

Hi Scolio,
My husband does the shopping and cooking. He is pretty overwhelmed right now (his mom, my health, new job).

I really appreciate your taking the time to reply to me!
Thanks!