OSA and Sugar - Oh My!!!

[Goofproof]

Goof Proof, out of curiosity, what type of diabetes do you have--I, 1.5 (LADA), or II?

I was told its type II, never did the sugar test, went to the dr (A Quack I no longer use) in his office my sugar was too high for the strips to read, he called the hospital for a room, I told him I'd be 40 miles away in two hours at work. He wanted to know where to send the ambulance. He started the pills, but as I said they gave me little control, I was probably drinking 3 gal of water a day. I had many of the signs, a friends meter was the last test.

Diabetes is in my genes, also Agent Orange exposure made it much sooner and worse. Jim

[Goofproof]

I think my apnea is pretty well controlled - I use my PAP every time I sleep, and my AHI is consistently less than 5 and usually less than 3, and sometimes less than 1. My leaks are good and within range.

They haven't told me to increase my carbs, but rather to cut back on the med to once a day. For the first 1.5 years on Metformin my normal blood glucose was less than 120 - usually between 105 and 115. Then I began having high readings in the morning (fasting), but within 30 minutes to an hour back down to normal. The highest my A1c ever got was 6.4. This last test I referenced is the first time anyone has checked insulin. While the doc didn't make it sound like this level was an immediate threat, he was concerned (normal should be below 10). He also said that high insulin could be causing several of my other health issues.

Increasing the carbs is stupid, except as a emergency correction for lows.

I use Reese Cups for a quick recovery, or slower cookies, but the result is panic and I end up too high. ( the yo-yo effect) When I get in the 80 to 90 range I feel pretty bad 65 and I'm shaking. Unless you are under weight, cutting the meds would be the best option, as will as tracking how fast certain foods digest, and adjusting portion size. Jim

[Janknitz]

Goof, 80 to 90 is NORMAL blood sugar, not hypoglycemia. That's where your blood sugar SHOULD be at fasting, and return to that by about 2 hours after a meal. The fact that you feel so terrible at that blood sugar means that you normally hang out at a much higher level most of the time, despite your insulin. High blood sugars, just like untreated apnea, cause organ damage bit by bit, but it all adds up.

A peanutbutter cup or cookie overshoots by a lot. There's so much sugar in them! You only need about 2 gm for a mild hypo, which you can get in 5 tiny Smartie candies. (Use your BG meter to see where you are). Thst should avoid the yoyo effect. Plus, they are much more portable and don't melt in your pocket. See http://www.phlaunt.com/diabetes/14047370.php.

As a matter of fact, you may find that entire website, known as Diabetes 101, very helpful. http://www.phlaunt.com/diabetes/index.php. Start with "Read This First".

Unfortunately the standard approach to diabetes has been "eat up and shoot up". Sounds like if you could tweak your diet toward lower carb you might be able to stabilize your blood sugar and reduce the insulin.

The other thing to consider is to ask to be tested for LADA, Latent Autoimmune Diabetes in Adults. It might be that you are more similar to a type I than a type II because of this, and there are more considerations for how to treat it, but a reduced carb diet will still be very helpful in either case.

[JohnBFisher]

I'm going to jump in on this as an insulin dependent, Type II diabetic, whose doctor considers me well managed with an A1c consistently at about 6.5 to 6.7.

Janknitz, you noted:

... 80 to 90 is NORMAL blood sugar, not hypoglycemia. That's where your blood sugar SHOULD be at fasting, and return to that by about 2 hours after a meal. The fact that you feel so terrible at that blood sugar means that you normally hang out at a much higher level most of the time, despite your insulin. ...

While what you are saying is true, trust me when I tell you that for a Type 2 diabetic, it can be very difficult - even with a low carbohydrate diet - to maintain a blood glucose level that is lower than 100. Additionally, the "feel so terrible" feeling generally comes from the RATE of decline of the blood glucose level - not the actual level. Unless you have gone through several bouts of hypoglycemia, you do NOT know what you are talking about. You might think book knowledge is good enough, but you simply do NOT know how it feels unless you've had a sudden deep crash of your blood glucose numbers.

... A peanutbutter cup or cookie overshoots by a lot. There's so much sugar in them! You only need about 2 gm for a mild hypo, which you can get in 5 tiny Smartie candies. (Use your BG meter to see where you are). Thst should avoid the yoyo effect. Plus, they are much more portable and don't melt in your pocket. ...

NO! Endocrinologists and diabetes educators ALL recommend a 15/15 rule. Test your blood glucose level. If it's low and clearly falling (trust me, go through a hypoglycemic event and you will not have any doubt about that) and then take about 15 grams of fast acting carbohydrates and wait 15 minutes. Test again. Repeat if needed. And believe it or not, sometimes you need to repeat it. Any number of factors (stress, coffee, improper dosing, not eating on schedule, etc) can cause the insulin to suddenly dry up your glucose levels. When this happens you must work to keep at a safe level. A hypoglycemic event can be DEADLY.

You - without a severely messed up metabolic system - should only take about 2 grams of carbohydrates and tackle your "low". But someone with a severely messed up metabolic system should follow the advice of their endocrinologist ... 15/15 ... That's easy enough to remember, and if your numbers are dropping quickly, it's enough to save your life. Two grams of carbohydrates could kill an insulin dependent diabetic who faces hypoglycemia.

... Unfortunately the standard approach to diabetes has been "eat up and shoot up". Sounds like if you could tweak your diet toward lower carb you might be able to stabilize your blood sugar and reduce the insulin. ...

Janknitz, I normally respect your posts. But you are WAY off base with this post. I seriously doubt if you know the situation for Goofproof (or others). Nor can someone with a normal metabolic system truly understand how insulin resistance can impact someone. I eat what's considered a fairly low carb diet.

According to the Institute of Medicine, children and adults should consume 45 to 65 percent of their calorie intake as carbohydrates, and at least 130 grams of carbs per day.

For me, a HIGH carbohydrate day is about 90. That's WELL below the recommended MINIMUM. Yet, my blood glucose levels - even well controlled - hang around 120. And with an A1c of 6.6, I *know* that my blood glucose is well controlled. And I test regularly (four to five times per day). How often do you test?

As an example, what do you have for breakfast? I have NO carbohydrates. Why? ANY carbohydrates in the morning will drive my blood glucose level up to about 200!!!! A single slice of toast will do that. Cereal is out of the question. So, my insulin resistance is time of day dependent. I know this. My endocrinologist agrees. Because I TEST.

Have you LIVED with insulin resistance? Unless you have, you have NO RIGHT to blame the patient!!!

... The other thing to consider is to ask to be tested for LADA, Latent Autoimmune Diabetes in Adults. It might be that you are more similar to a type I than a type II because of this, and there are more considerations for how to treat it, but a reduced carb diet will still be very helpful in either case.

It's possible LADA might be something to consider. But don't assume he has a high carbohydrate diet!

Sorry if I'm being a bit miffed, but unless you've lived in his shoes and know his circumstances, it is just down right bigoted to blame the patient.

Here's one doctor, who finally realized "What if blaming the obese is blaming the victims?":
https://www.youtube.com/watch?v=U3oI104STzs

[Todzo]

As we can see things get very interesting when the energy control systems are warped by OSA and diet and an inactive lifestyle!! Once the damage is done things get complecated indeed!!!!!!!!!!!!!!!

What I hoped to do with this post is keep those who would from falling into the traps that the holiday season contains.

I feel very fortunate to have found Dr. Lustig's book PRIOR to the holiday season.

Please read and use well!

Todzo

So I am reading an article in the Journal Sleep. “Intermittent Hypoxia Impairs Glucose Homeostasis”. The first statement is “Obstructive sleep apnea is associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus”.

Then, under Conclusions:
“ Intermittent hypoxia induces insulin resistance, impairs beta cell function, enhances hepatocyte glucose output, and increases oxidative stress in the pancreas. Cessation of the hypoxic exposure does not fully reverse the observed changes in glucose metabolism. ”

I recently finished reading “Fat Chance” by Dr. Lustig (see: http://www.amazon.com/Fat-Chance-Beatin ... 159463100X ). So it is now clear to me that eating much sugar for those with or even treated for OSA is not wise.

Please be careful this holiday season!

Take care!

Todzo

[Goofproof]

No doubt I eat to many carbs, if I removed comfort foods I would have nothing left to live for, so I don't. I have given up all I am going to at this point in life.

That being said I,ve gotten to a weight that my health can nl longer support, can't breath. So I have to make changes, and I have. I have been eating less, it's hard to loose weight when your heart won't let you move to burn any fuel, that's most of the problem, when I could no longer more the weight piled on. For 30 years I maintained 200 lb @ 5, 000 to 6, 000 cal a day due to the physical work I was doing, I know you think those level of cal are craze, and no doubt living like that damaged my insulin production ability. But the concern at the time was doing the job and securing the medical my family needed. Its what a responsible person does, whatever is necessary at the time. It wasn't to have the latest car or swimming pool, just to keep the wolf from the door, its a priceI gladly pay.

I retired early for health reasons, the job was dangerious, and with failing health we let the younger take over, we miss being active and our fellow workers, but it was really the effects of diabetes that ended it.

We thought it was time to finally enjoy life, they lied, its not the good old years for many. We find life is filled with lies.

So I am cutting back even more on food, I eat before bed and shoot up, but in reducing the amount of food and insulin is getting hard to figure out. Last night was a point in fact, tested 150 had 1/2 Cup chili 3 crackers toffie bar, shot up 40 unit fast, 15 slow at 4 am to bed, woke up at 8 am feeling bad, tested 55.

Had toffie bar, 3 reese cups, yes I should have did less and waited longer, but I tend go panic and error to the high side, and I did got up 2pm tested 150, ate nothing shot up 40 hot 15 normal, that will hold until supper.

Supper and later watching tv, I use 50 hot and 35 normal, doesn't quite cover the load, been cutting down on tv snacks. Now that I am trying to cut back, I find the way the insulin reacts to be not as predictable, I like predictable.

Life goes on! Jim

[Janknitz]

John, I do have insulin resistance with severe reactive hypoglycemia and used to live all the time on the "blood glucose roller coaster" too. I have significant metabolic issues, but I've been fortunate to have great success with altering my diet to stop the progress toward diabetes and reverse many of the problems. I totally get that some people have other factors that diet alone can't cure. Some people absolutely do need insulin. But I also believe--yes from my reading--that optimizing your diet can minimize the need for insulin by stabilizing the blood sugar, and the outcome can be much better health.

We can get into a whole debate about what works or doesn't, but as you point out, everyone is individual, and what works for you may not work for me, and vice versa. What I pointed to is a very well-researched and knowledgeable site by someone who has LADA herself, she has published well-received books on the topic, and she bases her approach on Dr. Richard Bernstein's approach--he is a Type I whose self-treatment and approach has been highly effective for thousands of diabetics and individuals with insulin resistance. Whether this is the best approach for you I cannot answer.

I don't mean to put GP on the spot, but as you can see what I guessed is correct. A lot of carbs at night, (with other contributors like not much sleep) and he wakes up low, then corrects with a lot of sugar (3 Reeses and a toffie bar are way more than your 15/15). And so the roller coaster continues. He knows his diet contributes to his issues, but he fears feeling hungry and hypo all the time if he takes things out of his diet. There may be a better way that won't leave him hungry and hypo all the time. . .

[Todzo]

John, I do have insulin resistance with severe reactive hypoglycemia and used to live all the time on the "blood glucose roller coaster" too. ... A lot of carbs at night, (with other contributors like not much sleep) and he wakes up low, then corrects with a lot of sugar (3 Reeses and a toffie bar are way more than your 15/15). And so the roller coaster continues. He knows his diet contributes to his issues, but he fears feeling hungry and hypo all the time if he takes things out of his diet. There may be a better way that won't leave him hungry and hypo all the time. . .

What works for me is to focus on what I DO need. In this case I need fiber!! Lots and lots of good fiber. So breakfast today was a few nuts and strawberries without added sugar. Then a bit later a stalk of celery. It is not like these will be the only things I eat rather that if I take the time to eat the good stuff then I am much less attracted to the bad stuff.

Why fiber works so well is well explained in Dr. Lustig's book - http://www.amazon.com/Fat-Chance-Beatin ... 159463100X

[JohnBFisher]

Janknitz, thank you for staying patient with me. I recognize that my tone was more strident than I prefer.

I've just had too many people tell me that my Type II Diabetes is all my fault. Never mind that it runs in my family. Never mind that I had untreated central sleep apnea (I could not get doctors to pay attention to it) until it resulted in permanent kidney damage. Never mind that movement is not something that's not very difficult for me due to my neurological issues.

While I do not closely follow Dr. Richard Bernstein's, I do monitor and try to limit my carbohydrate intake. And you are correct that managing the intake is part of the key to avoiding the "yo yo" roller coaster. But even so, it's generally easier said than done. I *know*. I do know FROM TESTING that going without carbohydrates does NOT work for me. I need a balanced diet. In comparison most Americans, we eat almost no salt. We have more fiber and vegetables than most Americans. And we tend to have much leaner meat than most. And where possible we have lots of fiber. Tonight's meal will be a salad with turkey. I might add a slice of bread. That will be it. And that's pretty normal for me.

So, again, my thanks for not taking offense at my strident tone. And my apologies that I did so!

[Goofproof]

Last night was a extreme case for me, due to the normal progression of the disease, and me changing my nighttime habits. I don't get hungry much, I eat more from habit and attempting to follow a plan to keep the A1C as low as possible. I believe the reason I require such a high sugar level to feel normal is the result of levels being sohigh for so long, they have moved what you would call the normal set point. At 100 I feel weak, at 90 it affects motor control, at 80 things get serious, weak and shaking, below that it's panic time. It use to be at 100, I would see a yelloew circle of light in my vision, I can't count on that anymore, it still happens but some times it happens sooner than low. Up until I started to cut back and play around with my levels, I'd only go low 1 to 2 times a month, now as i'm trying to keep closer to normal, it's easier to crash. Last night was a extreme, I try to overt. I'm changing my rules, and learning to live with the results. It's just a learning curve, I will master it. Its been years since I had my A1C under 7, my goal is low 7 or under, and to lose some of the weight. Jim

[Todzo]

I've just had too many people tell me that my Type II Diabetes is all my fault.

I am happy to tell you that Dr. Lustig agrees with you!! He sees us a victims of a food production system gone wrong.

It is not an easy read but well worth it: http://www.amazon.com/Fat-Chance-Beatin ... 159463100X

[Todzo]

From: http://www.amazon.com/Fat-Chance-Beatin ... 159463100X

“Food is beyond necessity; it is also a commodity, and it has been reformulated to be an addictive substance.” @2%

“To blame obesity on the obese is the easy answer, but it is the wrong answer. The current formulation of gluttony and sloth, diet and exercise, while accepted by virtually everyone is based on faulty premises and myths that have taken hold in the world's consciousness. Obesity is not a behavioral aberration, a character flaw, or an error of commission. When we think about the ravages of obesity, our minds often go first to adults. But what about the kids? One quarter of U.S. children are now obese; even infants are tipping the scales! Children don't choose to be obese. They are victims, not perpetrators. Once you understand the science, you realize what applies to children also applies to grown-ups.” @3%

[49er]

And I am sure all the antipsychotics that kids are getting isn't helping their health and is putting them a great risk for diabetes.

http://online.wsj.com/news/articles/SB1 ... 0977618320

49er

[2flamingos]

I won't say my diet is perfect - by ANY stretch of the imagination, but it is also not horrific. While I love carbs (don't we all), I have learned that white rice IS my worst enemy. I avoid it, but sometimes I allow myself a "treat" and have it. I don't eat much bread or pasta, but when I do it is whole grain. As for fiber - I eat beans, veggies (raw and cooked).

My diet did not change much from when my blood sugar was doing so good to when the morning numbers went wacko. There may have been a bit more stress in my life - but there is always stress.

Since my med change, and then going to one pill a day, things are looking much better on BG readings - I just hope it is also bringing the insulin levels down. 4.5 times the high normal is not good.

I just want to know what happened - and why - to make the numbers so screwy.

[Janknitz]

My 12 year old daughter is severely insulin resistant. She has acanthosis nigracans(dark patches of skin from high insulin levels), very high androgen levels, high cholesterol, and PCOS (yes, already diagnosed despite the young age). And her body weight is . . .

NORMAL. 50th percentile, normal BMI. Not an extra ounce of fat on that body.

We eat a healthy diet, organic and pastured, very few processed foods, very little junk.

Yet she is already on the road to diabetes.

There is NOTHING she did or we did to cause this. She inherited rotten genes from my side of the family, my mother and I have this too.

People are quick to blame obesity and poor diet for diabetes, but sometimes the chicken comes before the egg. In our experience (I was very insulin resistant and very thin until we started messing with my hormones trying to have children), the insulin resistance causes the obesity and not the other way around.

Another thing my mom, my daughter,and I share is a genetic disorder that includes a very narrow airway, so we all probably have sleep apnea (daughter has not been tested yet, mom snored like a freight train). So maybe that's a contributor too?


People (including doctors) are quick to blame diabetes on obesity, what will they tell my daughter?

(Wait, I know the answer to that. One urgent care pedi we had to see for an acute Illness told me my daughter can't have PCOS because she's not fat. WRONG!)