Type II insulin resistance ?

Hi Brian,

I am not sure if the diet is affecting your insulin resistance, but I can tell you (I am a type 3c diabetic due to pancreatectomy) that rice, potatoes, flour, and bread (specifically white bread, crackers, etc.) are hard on glucose control (they are very simple carbs). Higher fat meals also can also slow digestion and lessen the carb spike (and blood sugar can also rebound later because it slows digestion). I generally try to stay under 150 g of carbs per day to maintain my glucose levels (using about 60 units of insulin per day)

Have you ever considered using a CGM? I can tell you that it is invaluable for me as I can measure the impact of carbs and fats after meals to get a feel for how different foods affect me. I have also used MyFitnessPal to map my carbs per meal per day against the CGM to get an idea of daily carb load.

It also may be worth checking with an endocrinologist to see if insulin would help your control.

Before I had my pancreatectomy, I was a type II diabetic and was taking 500 mg metformin twice a day for control and was eating 60g of carbs or less per day to maintain an A1C of 5.8.

Your diet doesn't sound unreasonable but for a type II, rice, bread, fruits are hard on you. There is only so much your pancreas can overcome with medication. I think counting carbs and a CGM would be very insightful for you to map out your food/glucose graph over time. You might also want to read this article to see if this applies to you as well -> https://www.webmd.com/diabetes/dawn-phenomenon-or-somogyi-effect (which is why I have a snack before bed.) Hope this helps.

Thanks
- Matt

@matt2024

Thanks Matt. I'll look at the app. Brian

I agree about using a cgm. It’s invaluable for most people who have diabetes. You can really see the trends on what is causing higher blood sugars. Also, I wouldn’t blame yourself. From what I read, type 2 has a way of progressing that may be inevitable. Of course, low carb can be helpful, since there’s less carbs to cover. Have you considered newer meds for type 2 like Ozempic? It offers more coverage, kidney protection and weight loss benefits.

I take insulin as a a type 1, so I can cover my carbs with insulin. Still, I stopped eating most carbs on a daily basis. Stopped potatoes, rice, pasta and most bread. One piece of toast per day is about it. I do get most carbs in the form of veggies, fruits, yogurt, etc.

Hi Brian. Several things that you can fiddle with. Let's start with the easiest! Swap out your blueberries for strawberries! Strawberries have much more fisetin, a natural flavonoid like quercetin, but especially helpful for blood glucose control.

Now the snacks. Opinion is split on the benefits of snacks. They don't seem to work for me, quite the opposite. Instead you can raise your carb guidelines for meals.

Exercise. Here's the thing, if you do too MUCH exercise your diabetic liver may not know when you stop so it keeps releasing glycogen for some hours. That's what happens to me, I walk an average of about four miles a day, but if I walk more than about six miles in one walk I find my blood sugar elevated 20-30 points for hours afterwards (I've seldom gone the next step and exercised enough to run out of glycogen and go into ketosis, have to ask someone else about that!). I think it's probably net positive when you exercise "too much" but it will likely raise your next pre-meal reading.

When you have that beef stew for lunch, was this from the refrigerator, left-over stew for a day or three after made for dinner? Do you know about resistant starch? Some normally bad carbs left in the fridge overnight knit themselves tighter, become "resistant", and raise your blood glucose much less, and can even cover for additional carbs you eat at the same time. But I can eat small amounts of white potatoes most times without huge problems. Works for bread, too, hope you keep yours in the fridge.

Why do you need to drop the metformin? You're on a modest dose. I've been taking 1000mg twice a day with the goal of keeping my numbers below "pre-diabetes" ... and also letting me cheat my diet a little at the same time. Actually I'm going to try cutting back the metformin a little, see how that works. Consult your doctor with the Januvia but you might try a little more metformin, fwiw. I take the regular, not the ER.

What else? Well, in my case, it seems that beef and milk fat aggravate my blood glucose, I presume by increasing insulin resistance. Eat more chicken, maybe some salmon. Try eating less cheese. A little whole-milk yogurt now and then is one of my cheats.

About avoiding carbs at dinner to try to address morning reading - doesn't work for me. I too generally have my highest reading in the morning, after generally a twelve-hour fast. Go figure. Many things you eat may take more than twelve hours to digest fully so I think the morning reading (already high from wake-up cortisol or something) depends more on total carbs and balance, not just the last meal.

Let's see, one last thing: Nuts! Now, there is a whole subject of fats, aka essential fatty acids (EFA), you know the omega-6 and omega-3 and omega-9, that you want to keep in balance. There is also short chain and long chain, saturated, mono-unsaturated, and poly-unsaturated. And a few other dimensions. Now there is no simple path from EFAs to blood glucose - but there may be some complex paths. Anyway a few nuts in your diet seem to provide a good mixture of all these features and I believe helps balance out all the blood glucose systems.

You didn't state your A1C level or your later-day blood glucose readings, if any. I test three times per day, before each meal. My pre-lunch is usually lowest, my A1C has varied mostly below but sometimes barely above 5.7. Of course YMMV, diabetes is nothing of not highly variable case to case, behavior to behavior. Best wishes!

@carbcounter

I can't have food with sharp edges. Strawberries etc are a no no for me. I am switching to cantaloupe or honeydew melon. Exercise is 15 min bike ride on the warm up, 45-60 min weights, and walk two miles three days a week.

Stew didn't bother me, seemed to tolerate it well and this surprised me.

Metformin is loosing my stool too much.

I definitely need to up my protein and lower my fat consumption.

I have been having a 1/2 cup walnuts as an afternoon snack.

I was below 7, 6 months ago, but over seven this time. Eating too many protein bars and snacks; which I have cut out, but thought I would go down the rabbit hole and review everything to see what I can do to make it better.

I ordered a Lingo to use for 1 month to help me see what is doing what, and started an account on my fitness pal this morning.

thanks brian

@mchang1 well I understand about the metformin and that's exactly why I'm trying a lower morning dose.

I cut up strawberries, nuke them gently then mix them into the oatmeal along with other magic ingredients, would they still have sharp edges like that? I tried a fisetin supplement early on, they're a little hard to get but there are several out there, and didn't feel that was the same. Actually I'm probably due to try another one. Fisetin is in many/most fruit but in smaller amounts.

Actually, have you tried oatmeal? Organic only of course. Oatmeal seems to be a natural source of resistant starch, oatmeal was considered a "treatment" for diabetes all by itself, back in olden days.

Have you tried cinnamon, and does that work on your diet? It also seems helpful and I recommend it to all. I throw some into the oatmeal, also sprinkle it on a cut-up apple, usually after dinner.

What else? Well, licorice. In small amounts and not too often, but teas that have licorice are common (Trader Joes has a ginger-turmeric tea that also has licorice, same available from others in most supermarkets), just a cup of that two or three times a week seems to claw back a few points pretty reliably!

I think your cutting snacks may help in itself, gives your body more time to turn glucose processing off for a couple of hours.

So I started on my fitness pal tracking food intake. Changed/replaced a couple food items. Last three days for dinner I have had 2 salads and salmon/kale. I can only get my fasting glucose down to 152. Not sure how long to see any result from changes? I do have to much fat in my diet. Not sure what this does? Lower this increase protein?

Not sure how to post totals since I can't paste a snip it or upload an image here?

yesterday:

1700 calories
102 carbs
115 fat
85 protein
and way to much sodium. the sliced turkey is loaded with it , amylu breakfast links and veggies made great egg white muffins.

Thanks. Brian

@matt2024

In the last 6 months my A1C went up over 7. Too many protein bars for snacks. I've signed up for myfitnesspal.com and put on a Lingo CGM for the next month to better track my blood sugar. I cut out the morning blueberries and added 1 cup of melon to lower carbs, changed my lunch sandwich bread from home made brown rice flower/buckwheat combo to almond flour/rice flower combo.

I normally don't have any carbs with dinner. Yesterday at bedtime I was 133 on the lingo. I slept 8-1/2 hours and when I got up my blood sugar was 165? I kept the phone on the nightstand for an accurate reading.

Another issue is when the lingo was reading 133 my glucose meter was reading 156?

Seems lowering my carbs is sending my blood sugar in the wrong direction?

Appreciate any help.

Brian

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@mchang1 Hi Brian. Welcome to Mayo Clinic Connect. I have had diabetes for 50+ years. This is what I know about insulin resistance. It has been associated with Type 2 or Maturity Onset diabetes. The person’s body makes insulin but not enough to keep blood sugar in good control. It is often common for the person to have a problem with weight. There does seem to be a genetic component to it.
You are to be commended on your attention to diet and exercise. If you don’t mind me asking what is the colon condition that requires you to follow a Fodmap diet? When you have more than one condition these things can interact and make blood sugar control & treatment more challenging.
Another question I have for you is what are you using to track and record blood sugars? The members above mentioned Continual Glucose Monitoring (CGM). This can be helpful to identify trends and patterns. But most measure the glucose in your interstitial fluid not what is in your blood. They are related but are not the same. I use a glucometer for finger blood sticks and I also have a CGM. Sometimes the results are vastly different and that bugs me. It is kind of like a rollercoaster and can take awhile for the tail to catch up with the head before it all evens out. The technical support of my CGM told me that it isn’t accurate over 300 or less than 40. They recommended double checking with a meter and finger stick in those situations.
Lastly, for now I want to say that we members here shouldn’t diagnose or prescribe. We tell our own stories to encourage and provide hope to each other who are facing similar struggles. The members here given some great information and ideas of things that have helped them. I would suggest don’t make any big changes without the input of your providers. Also don’t make too many changes at one time. I say this because sometimes changes can conflict with each other and make things worse instead of better. Plus if something works, how do you know what it was? Get a provider to help you develop a plan prioritizing the things you want to work on. Start small and go from there.
Keep us posted on how it is going?