[LithiumSunset]

Originally Posted by sachinayak

Folks,
A quick question - I was told earlier to specifically test for my Fasting Insulin levels (in addition to my HbA1c levels) but unfortunatley, I do not have a scale of what is good and what is bad.

In my last blood test (yesterday), my results were not great (this is post a 15 hour fast)
1. FBS: 114
2. HbA1C: 7
3. Fasting Insulin: 4.2

While I have been off any medication for some time, and my HbA1c has dropped from 7.5 to 7.1 to 7 (now, over a period of 6 months), i was hoping for better.

Any pointers on the fasting insulin levels?

Sachin, you are the first one to obliquely raise an important issue that no one has touched.

While there is a lot of talk about insulin and insulin resistance but there has been no mention on the need to measure insulin levels on this thread so far.

"Any pointers to Fasting Insulin levels?"

Your test result paper may mention the safe range to be between 2 to 25. But it should be less than 5 (and perhaps closer to 2!). So a fasting insulin level of 4.2 is OK. (Ideally if your body has consumed all of the glucose in the blood then FI should be near zero! But the body is not a simple machine, there is basal secretion and there is a bolus on meals, but I would not go into these details here).

However, I'm sure you are aware that your A1c of 7% puts you firmly in the diabetic range. Why did you stop your medication? What else are you doing for control?

Your HOMA IR index is 1.18 (114mg/dl x 4.2 uU/ml / 405). Anything above 1 should be worked on. Interestingly the Homeostasis Model Assessment - (estimated) Insulin Resistance - HOMA IR model uses two parameters Fasting Glucose and Fasting Insulin. You will now appreciate why FI of 25 is a bad idea and even 10 is not good. At 5 one's fasting glucose should not be more than 80mg/dl to be out of the woods. Some people argue that an HOMA IR of 1.5 is also OK, so this might give some leeway.

Since Insulin is not in our direct control we can only reduce carb intake to reduce glucose uptake, therefore in your case you need to cut down on carbs a lot more and follow other lifestyle changes including IF.

I 'discovered' Insulin 4 years ago and have been on IF since. I was able to bring down my HbA1c from 5.6 to 4.9 and my Fasting Insulin from 8.7 to 5.1 in 3 months. My weight is at the target of 23 BMI. With regular walking (roughly 4 to 5 km. in 40-50 minutes 5 days a week) I no longer need BP medication. I am close to completing 6 decades on the planet.

I have keen interest on this subject and have researched a lot about it and have helped many of my friends pull back their dependence on medication.

Many popular Youtube doctors have been mentioned here and I would like to add a few of my favourites : Dr. Sten Ekberg, Dr. Robert Lustig and Dr. Pradip Jamnadas. The first is prolific. the other two far less so but have excellent videos.

[sachinayak]

Thanks for the wonderful insight. This certainly adds more perspective.

Originally Posted by LithiumSunset

However, I'm sure you are aware that your A1c of 7% puts you firmly in the diabetic range. Why did you stop your medication? What else are you doing for control?

I have been diabetic for 10+ years, but I wanted to get out of external medication. So I wanted to check the impact of lifestyle changes on my sugar levels. This meant
1. Cutting down intake of processed food/direct sugar.
2. Active lifestyle (18K steps daily plus 5km runs post 12hour fasting twice a week).
3. Intermittent fasting (of 16 hours at least twice a week).

Post this, my HbA1c has been on a constant decline. While it is still higher than I would want, I am told it is "within acceptable range" considering that I am off medicine. I need to target to get it below 6.5 levels. Additionally, I was detected with fatty liver earlier and now this is no longer the case. My weight is fine, and my BMI is 23.0. Since the trajectory was in the right direction, my doc asked me to continue the steps I am doing.

Cutting down on refined carbs and strength training would be the logical next steps, I guess.

[NetfreakBombay]

Originally Posted by LithiumSunset

Dr. Sten Ekberg

He is not a "medical" doctor. His advice should be considered accordingly.

[GTO]

Originally Posted by alpha1

Pizza's base would require some kind of flour: perhaps something like Almond flour?

Bang on! Almond flour.

How does it taste compared with refined flour or whole wheat? Texture and mouth feel?

If I give a regular white bread pizza a 10/10, I will give this almond base pizza from Yodeli a 7.5 / 10. It's a fair compromise. We fill the pizza up with nice cheese & lots of fresh veggies (including jalapenos, mushrooms) & paneer. It is absolutely yum! Once you get used to it, you don't miss the real thing at all.

Ditto for the Keto rotis. 7.5 / 10 versus a 10 / 10 to proper rotis.

[LithiumSunset]

Originally Posted by sachinayak

Thanks for the wonderful insight. This certainly adds more perspective.



I have been diabetic for 10+ years, but I wanted to get out of external medication. So I wanted to check the impact of lifestyle changes on my sugar levels. This meant
1. Cutting down intake of processed food/direct sugar.
2. Active lifestyle (18K steps daily plus 5km runs post 12hour fasting twice a week).
3. Intermittent fasting (of 16 hours at least twice a week).

Post this, my HbA1c has been on a constant decline. While it is still higher than I would want, I am told it is "within acceptable range" considering that I am off medicine. I need to target to get it below 6.5 levels. Additionally, I was detected with fatty liver earlier and now this is no longer the case. My weight is fine, and my BMI is 23.0. Since the trajectory was in the right direction, my doc asked me to continue the steps I am doing.

Cutting down on refined carbs and strength training would be the logical next steps, I guess.

May I suggest you up the 2 day IF to everyday and throw in an OMAD once in a while. This alone will help you a lot more along with cutting down on refined carbs and strength training. If possible cut out fruits too, they are not particularly good anyway (and ALL forms of sugar).

I've been on a strict 2 meal no snacking IF 364 days a year for 4 years. Once you get used to it the third meal actually disturbs your system! :-)

[LithiumSunset]

Originally Posted by NetfreakBombay

He is not a "medical" doctor. His advice should be considered accordingly.

Agreed, nor is Dr. Eric Berg.

However the information they give is independently verifiable.

Fung, Lustig and Jamnadas are proper doctors and they have been saying the same thing.

For those interested look up Dr. Joseph Kraft who linked IR to CVD almost 45 years ago.

[sachinayak]

Originally Posted by LithiumSunset

May I suggest you up the 2 day IF to everyday.

My bad, I do IF not twice a week but at least 4-5 times a week. It fits perfectly into my day-to-day routine on weekdays. But I find it very difficult to sustain on weekends. When I have my dinner at 5pm, I do feel hungry around 9:00-9:30pm if I am not busy at work. Hence weekdays are easy - as work is a good distraction. Weekends are tough, when my mind and I are both chilling. Am a hardcore foodie, so thats an additional challenge.

With respect to fruits - my fruit intake is quite low and if I have fruilts I only have seasonal one (in the right season).

But all points are valid, and will try to incorporate them step-by-step into my lifestyle.

[ashokabs]

I am responding to some of the things I read in this thread. I have been following a no or very low carb diet for almost 2 years. It is easy to follow even when you are travelling. Eat plenty of vegetables and in India a good source of protein is dal. You can also eat meat to supplement protein. My HbA1C dropped from 5.8 to 5.1 over 4 months. This included an average of 6 km walking and intermittent running. My BMI is 21.6. it used to be 23.

Another interesting research that is ongoing is to find out whether the livers function of clearing excess insulin from the blood is defective leaving to a build up of Insulin. So far it was believed that it's the high insulin that impairs the livers clearing function. Which is the cause and which the effect? If the cause is genetic then cure could be around in 10 years time.

[NPV]

Here is a great watch for such an important and relevant topic for this thread - "Insulin Resistance" by Dr Benjamin Bikman.

https://youtu.be/hUeV9RwBQv8

[rajesh1868]

I was able to source insulin pen cartridges from my hometown in Kerala with a discount in the range of 30 - 40% as that of the market price.

Does anyone know medical shops in Bangalore (Indiranagar, CV Raman Nagar, New Thipppasandra, or nearby areas) where I can get insulin at a discounted price? Apollo, I think gives 10%. I am looking at a better offer if possible.

[Everlearner]

I think both medplus and Apollo give you 20% discount if you purchase more than Rs.1000 worth of medicines.

[vinit.merchant]

January 2022 I was asked to get sugar test done.

Fasting - 250
Post breakfast - 490
HbA1c - 12.x

I had no clue what this meant. Was advised to visit a physician.
I was in for a rude shock of my life. I was in denial all through the first month of medication that I had diabetes.

They started me with Glimepiride 1mg / 500 Metformin before BF + Metformind
500 mg after lunch + Teneligliptin 20 / 500 metformin after dinner

So net net, I was on heavy medication to control the sugar levels.

Every couple of months, I would request the Dr to reduce dosage after having sugar reports at normal levels.
Eventually by September, the second HbA1c came in at 5.4 and I pushed even more for reducing dosage. So the dosage was finally reduced to simply Teneligliptin 20 / 500 Metformin once after meal.
I was doing regular brisk walks and was happy with the progress and hoped I would be rid of the meds soon if I continued the same lifestyle.

But now my sugar levels started climbing again. And when I had my HbA1C in Feb, it climbed up to 6.4.
So he added metformin 500 mg tabs, but the levels continued to rise and next month out of curiosity I again did hte HbA1c and it came to 6.7.

This time i was started with Sitagliptin in place of Teneligliptin, and this helped the levels.

So far, I stayed away from researching about it on you tube, thinking I should let the Dr do his job.

But now I started reading & seeing videos. Realized my ignorance that cutting out sweet is not enough, and that the rest of my diet was the culprit.
Now I also came to know the reason why a simple plate of Poha for BF shot my levels to 180 even with meds and left me perplexed.

Now I am practicing IF (18:6 or 17:7) + LCHF diet.
Completely cut rotis + rice + potatoes from meal.
Started having salads + subji/curry + daal/sambar + ghee + cheese slices.
Am a vegetarian to will have to be content with this.

4-5 days into this diet but also continuing with the meds, I once felt a little faintish at office and realized the meds would be reducing the levels too low.

Since 12 days I stopped meds, continuously monitoring the levels.
After lunch levels without meds come around 160s for most days, and when I tend to overeat, reach 180-190. This is till good as these were the levels earlier with jsut a plate of poha + medication.
Rest of the day level remains between 100-105, including fasting. Assuming this is my body releasing the extra glucose stored within.

For the cheat days, I usually have alcohol but with the healthy stuff like mushrooms or baby corn or paneer. This is once or max twice a week.

After shifting to Low cards no grains diet,
- Realized that now my tummy feels full a lot sooner as compared to how much I used to eat earlier
- I dont miss my rotis or rice too much
- I do miss the wada pavs & sandwiches at times, and will have to find some alternative for those cravings
- Am losing weight

Wish I had read/searched for this sooner.

I am not sure if this is a good idea, but I have kept the unused of Sitagliptin+metformin combo for those cheat days where I feel like eating my wadapavs / burgers / or when I am on vacation. So far not even once indulged in this though. Members views on this?

[sachinayak]

Originally Posted by sachinayak

In my last blood test (yesterday), my results were
1. FBS: 114
2. HbA1C: 7
3. Fasting Insulin: 4.2

Originally Posted by LithiumSunset

Your test result paper may mention the safe range to be between 2 to 25. But it should be less than 5 (and perhaps closer to 2!).
...
However, I'm sure you are aware that your A1c of 7% puts you firmly in the diabetic range. Why did you stop your medication? What else are you doing for control?
...
Your HOMA IR index is 1.18 (114mg/dl x 4.2 uU/ml / 405). Anything above 1 should be worked on.

Did my blood test again today

1. FBS: 111 mg/dL (from 114 earlier)
2. HbA1C: 6.6% (from 7.0% earlier)
3. Fasting Insulin: 3.36 mU/L (from 4.2 earlier)

With this, my Homa IR index is 0.92, which seems to be in the acceptable territory, so keeping fingers crossed.

I have been off medication since October 2021, so almost 18 months now.

Lifestyle changes to support this

1. 16 hour Intermittent Fasting 5 days every week.
2. Physical activity (16-18K steps daily, 5K runs twice a week, yoga twice a week)
3. On my IF days, have reduced processed food including bread/cheese. Prefer to have a dosa instead of bread, there is batter at home all the time.
4. While my beer intake frequency has more-or-less remained the same (on weekends) the quantity has reduced.
5. I normally do not take too much stress (home or work)
6. I have not made a concentrated effort to reduce my carb intake (except anything that has maida). I am a foodie, so will leave that as my last option. However eating out has reduced.

Intermittent fasting has been the key as most other aspects have been relatively constant in my life. I have not been very fond of sugar/sweets anyways. This forum (this thread and the IF thread) has been extremely helpful, to understand the problem and then help me explore the options/workarounds to get better. Hopefully can keep up the trend.

[LithiumSunset]

Originally Posted by sachinayak

Did my blood test again today

1. FBS: 111 mg/dL (from 114 earlier)
2. HbA1C: 6.6% (from 7.0% earlier)
3. Fasting Insulin: 3.36 mU/L (from 4.2 earlier)

With this, my Homa IR index is 0.92, which seems to be in the acceptable territory, so keeping fingers crossed.

I have been off medication since October 2021, so almost 18 months now.

Lifestyle changes to support this

1. 16 hour Intermittent Fasting 5 days every week.
2. Physical activity (16-18K steps daily, 5K runs twice a week, yoga twice a week)
3. On my IF days, have reduced processed food including bread/cheese. Prefer to have a dosa instead of bread, there is batter at home all the time.
4. While my beer intake frequency has more-or-less remained the same (on weekends) the quantity has reduced.
5. I normally do not take too much stress (home or work)
6. I have not made a concentrated effort to reduce my carb intake (except anything that has maida). I am a foodie, so will leave that as my last option. However eating out has reduced.

Intermittent fasting has been the key as most other aspects have been relatively constant in my life. I have not been very fond of sugar/sweets anyways. This forum (this thread and the IF thread) has been extremely helpful, to understand the problem and then help me explore the options/workarounds to get better. Hopefully can keep up the trend.

Good that this is working. I offer two more things that will make dramatic changes to your sugar levels:

1. Avoid all Milk and dairy derived food including ghee and butter. Hopefully you are already vegetarian - so no meat or eggs at all either.
2. Reduce oil in your food as much as possible.

I can add a lot more but for now see how much difference this alone makes.

[graaja]

Originally Posted by LithiumSunset

Good that this is working. I offer two more things that will make dramatic changes to your sugar levels:

1. Avoid all Milk and dairy derived food including ghee and butter. Hopefully you are already vegetarian - so no meat or eggs at all either.
2. Reduce oil in your food as much as possible.

I beg to differ. Fat is not a contributor to diabetes. Carbs are.

Only dairy product that need to be avoided for diabetes is milk in its natural form which has lactose which is a form of sugar. But all other derivatives like curd, butter, ghee, paneer etc do not have this lactose and are fine to have from diabetes point of view, unless someone is alergic to dairy products. And if @sachinayak is a vegetarian, he does not have many good sources of protein. Cutting off paneer from diet would be a bad idea.

Same about oil as well. In general oil has no relevance to diabetes in particular as it does not affect glucose levels or insulin response. But for other reasons, it is better to avoid seed based oils and replace with healthy fats like butter, ghee, coconut oil etc. More has been discussed about this in the "Weight Loss" thread.

This is my opinion on dairy and oil related to diabetes.

I would very much like to understand your view on why you consider avoiding dairy and oils better for diabetes.