Diabetes Talking

Question:

I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed.

Being overweight is not necessary to be Type II. It just helps. You could be Type I but it seems that you are under enouygh control that Ttpe I might be doubtfull. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this?

How long are you exercising? How heavily are you exercising. I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal?

1500 is a relatively small dose. It is starting to get up there, but it is still small. Any help is appreciated.

Do you trust your doctor? If not get a new doctor. If so then trust your doctor.

Response:

Why is my glucose level always high in the morning regardless of how low it is the night before?

Dawn phenomenon, which is extremely common.  Everybody’s liver puts out extra glucose while they’re sleeping, since otherwise the brain would run out of fuel.  In many type 2 diabetics, though, the liver misses the signals that tell it to stop doing this, and as a result they wake up high. My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs?

It’s not fully known at this point.  However, non-diabetics hardly ever go much higher than 140 at the one-hour mark, and it’s commonly believed (though the evidence is still sketchy) that going above 180 (some would say 160) for any length of time can do some damage.  Going into the 300s isn’t good in any case.  However, if you were just diagnosed, it’s likely that you’re still in a state of glucose toxicity, where you blood glucose is so high that it actually interferes with your body’s attempts to control it.  In this state, practically anything will spike you hard.  At this stage I’d focus on your 2-hour numbers; once the glucose toxicity starts to let up, then you can worry about the 1-hour values.  Right now, just look for trends (hopefully downward) in your 1-hour levels. I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system.

You can’t hurt your kidneys by drinking too much water; the only danger from drinking too much water is from lowering the sodium level in your blood, and you aren’t drinking anywhere near enough water to cause that (it usually only happens in people who experience severe losses of both water and salt as a result of sweating from hot weather exercise and then replace only the water losses, or in schizophrenics who have a pathological compulsion to consume huge amounts of water and also have a hormonal abnormality that restricts the rate at which they can excrete water).  Note that the kidneys only excrete glucose when your blood glucose is over the value known as your renal threshold, which for most people is around 200; once you gain a little bit of control, you’ll be spending little if any time in that range. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed.

It’s possible you might be a late-onset T1 (LADA), but it’s too early to tell. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this?

Your liver putting out glucose.  Although common sense would seem to say you shouldn’t eat when your BG is high, in reality skipping meals or going too long without eating just makes your liver put out extra glucose. I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal?

How long have you been taking the Glucophage?  It usually takes at least two weeks to start having a major effect.  If you’re in glucose toxicity, then your carb tolerance is going to be way down.  In my personal opinion, the first thing to do is start spreading your carbs over several small meals a day rather than a few big meals, with most of them at times other than breakfast.  If that doesn’t make much difference, start slowly decreasing the amount of carbs you consume, replacing each gram of carb with a half a gram of monounsaturated fat, such as found in olive oil and nuts (the reason for the ratio is to keep the number of calories you’re consuming constant). Others will tell you to cut nearly all the carbs out of your diet and try to get at least two-thirds of your calories from fat.  I personally don’t think that’s the first thing you should try, but that’s just my opinion.   Suffice it to say that it’s an issue that people approach with almost religious fervor on both sides. Regardless of how much carbohydrate you choose to consume, almost everybody here will agree that you should get most of it from whole grains and non-starchy vegetables and little of it from sources like pasta, white bread, potatoes, rice, dry breakfast cereal (every few weeks we get someone here who describes how they improved their control by eliminating Cheerios from their breakfast), or fruit juices.  Those sources tend to hit you really hard because the carbohydrates are absorbed as glucose almost instantly.  The better sources take a while to digest, so they don’t hit you all at once.  You might want to go to <http://www.mendosa.com and look at Rick Mendosa’s list of "glycemic loads" per serving of various foods; that will probably help you choose foods that don’t spike you so much.

Response:

Why is my glucose level always high in the morning regardless of how low it is the night before? My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs? I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this? I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal? Any help is appreciated. Paul

Response:

Why is my glucose level always high in the morning regardless of how low it is the night before?

It’s called the ‘dawn effect’.  It’s believed to have something to do with the necessity of having extra energy to start up in the morning, when our ancestors went out to hunt the saber-toothed rabbit. My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs?

Spiking happens.  I would ask the Dr. Those spikes would be high for me, but everybody is different.  If you don’t like the Dr’s explanation, get a second opinion. I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system.

Extra water is in general good for the kidneys.  I don’t think it would hurt anything else, unless you did something really stupid, like trying to drink a gallon at one time.  You can die from doing things like that. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed.

It’s possible.  There is a test for an antibody that is usually definitive.  The usually accepted definition of type I is that the body makes little (usually no) insulin. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this?

One theory is that exercise will stimulate the liver to produce more glucose.  Everybody is different.  I can’t outguess your body. I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal?

Well, you have to face the fact that having diabetes as both of us do is not exactly normal.  Glucophage is supposed to work by slowing the release of glucose from the liver.  It is not the only type of drug available for type 2s.  I would give it a try for a couple of weeks at least, and if it doesn’t seem to be helping you, talk to your Dr. I can’t give you medical advice, for obvious reasons. Any help is appreciated. Paul

Speaking only for myself, Joe Durusau

Response:

Why is my glucose level always high in the morning regardless of how low it is the night before?

This isn’t unusual. My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs?

This isn’t normal. Keep a record of what you eat and what your numbers are and show it to your doctor. (Include quantities, especially of carbs) I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed.

It’s certainly possible that you have Type 1.I get the impression that a lot of doctors diagnose adult onset T1 by letting you fail on standard treatment for T2. Ask your doctor this question. If  you don’t like the answer, get a referral to an endocrinologist. If you do have T1, it will take a while for your pancreas to give up totally, so some of the T2 medications will kind of, sort or work. For a while. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this?

AF — "it’s good to know that this country hasn’t lost touch with its founding values and principles:  freedom for all, a government of the people, for the people and by the people and a personal relationship with Loki." — sam h shares his vision of the American Dream

Response:

Eric, Thank you so much for your omments.  I’m newly diagnosed Type II and your discussion about carbs were particularly helpful. Chet Wilkinson – Hide quoted text — Show quoted text – Why is my glucose level always high in the morning regardless of how low it is the night before? Dawn phenomenon, which is extremely common.  Everybody’s liver puts out extra glucose while they’re sleeping, since otherwise the brain would run out of fuel.  In many type 2 diabetics, though, the liver misses the signals that tell it to stop doing this, and as a result they wake up high. My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs? It’s not fully known at this point.  However, non-diabetics hardly ever go much higher than 140 at the one-hour mark, and it’s commonly believed (though the evidence is still sketchy) that going above 180 (some would say 160) for any length of time can do some damage.  Going into the 300s isn’t good in any case.  However, if you were just diagnosed, it’s likely that you’re still in a state of glucose toxicity, where you blood glucose is so high that it actually interferes with your body’s attempts to control it.  In this state, practically anything will spike you hard.  At this stage I’d focus on your 2-hour numbers; once the glucose toxicity starts to let up, then you can worry about the 1-hour values.  Right now, just look for trends (hopefully downward) in your 1-hour levels. I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system. You can’t hurt your kidneys by drinking too much water; the only danger from drinking too much water is from lowering the sodium level in your blood, and you aren’t drinking anywhere near enough water to cause that (it usually only happens in people who experience severe losses of both water and salt as a result of sweating from hot weather exercise and then replace only the water losses, or in schizophrenics who have a pathological compulsion to consume huge amounts of water and also have a hormonal abnormality that restricts the rate at which they can excrete water).  Note that the kidneys only excrete glucose when your blood glucose is over the value known as your renal threshold, which for most people is around 200; once you gain a little bit of control, you’ll be spending little if any time in that range. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed. It’s possible you might be a late-onset T1 (LADA), but it’s too early to tell. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this? Your liver putting out glucose.  Although common sense would seem to say you shouldn’t eat when your BG is high, in reality skipping meals or going too long without eating just makes your liver put out extra glucose. I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal? How long have you been taking the Glucophage?  It usually takes at least two weeks to start having a major effect.  If you’re in glucose toxicity, then your carb tolerance is going to be way down.  In my personal opinion, the first thing to do is start spreading your carbs over several small meals a day rather than a few big meals, with most of them at times other than breakfast.  If that doesn’t make much difference, start slowly decreasing the amount of carbs you consume, replacing each gram of carb with a half a gram of monounsaturated fat, such as found in olive oil and nuts (the reason for the ratio is to keep the number of calories you’re consuming constant). Others will tell you to cut nearly all the carbs out of your diet and try to get at least two-thirds of your calories from fat.  I personally don’t think that’s the first thing you should try, but that’s just my opinion.   Suffice it to say that it’s an issue that people approach with almost religious fervor on both sides. Regardless of how much carbohydrate you choose to consume, almost everybody here will agree that you should get most of it from whole grains and non-starchy vegetables and little of it from sources like pasta, white bread, potatoes, rice, dry breakfast cereal (every few weeks we get someone here who describes how they improved their control by eliminating Cheerios from their breakfast), or fruit juices.  Those sources tend to hit you really hard because the carbohydrates are absorbed as glucose almost instantly.  The better sources take a while to digest, so they don’t hit you all at once.  You might want to go to <http://www.mendosa.com and look at Rick Mendosa’s list of "glycemic loads" per serving of various foods; that will probably help you choose foods that don’t spike you so much.

Response:

Why is my glucose level always high in the morning regardless of how low it is the night before? My doctor says to check 2 hrs after eating, and it should be below 140. If is often below 140 2 hrs after eating but can spike to 300 if I check 30 minutes or an hour after eating. Is this normal? Will these spikes damage my organs?

This is not surprising. I drink at least 64 oz of water every day but not because of thirst. Is this helpful for my diabetes? Is this bad for my kidneys? I know that when my glucose level is high, my kidneys will help bring it down using water in my system. I was diagnosed with type II, but I am not overweight. 6 ft 165 lbs. Could I actually have type I? I am 33 and have just been diagnosed.

Doctors have a really bard time typing your diabetes.  There is no real litmus test. Exercising brings my glucose level down. But after I stop exercising sometimes it goes back up even when I haven’t eaten anything since exercising? Why is this? I am taking 1500 mg of Glucophage XR per day and I barely can tolerate any carbs.  Is this normal?

All right.  You have done everything you can with control with diet alone.  You have already done everything you can with oral meds alone.  Assuming that you have exhausted these two remedies for a type 2, your next step is insulin, and this may be on a large scale.  Before you go any further, you have to be sure that these last two steps have been exhausted. If so, this is a natural course of events.  I wish you the best of luck. Michel – Hide quoted text — Show quoted text – Any help is appreciated. Paul

Response: