Friday, January 24, 2020

Retrospective #343: My “No-Cheat” Week

My doctor’s appointment was coming up soon, so I decided to do a “no-cheat” week. Doctors know that patients try to be on their best behavior before their appointment (while “cheating” the rest of the time). That has to be one of the reasons that the Standard of Care transitioned a few years ago from the Fasting Blood Sugar to the Hemoglobin A1c as a diagnostic tool for Pre-diabetes and Type 2 Diabetes. The main reason, though, was that A1c also includes post-prandial (after meal) spikes and measures blood sugar 24/7 over roughly 3 months.
I decided to “go straight” because my average Fasting Blood Sugars for the three previous weeks had been 104, 107 and 106mg/dl. Your doctor would probably tell you that these averages, which are low on the Pre-diabetes scale (100-125mg/dl), are okay. Your doctor will probably tell you he or she will continue to monitor your blood sugar periodically, but they’ll not be very concerned for you, in order to relieve your anxiety. They should be, though.
Also driving my “no-cheat” motivation was the change in my Metformin prescription. Early in 2016 I had requested that my prescription for Metformin be increased from 500mg daily to 1,500mg daily. I had been on 500mg since 2002, within a week of starting to eat Very Low Carb. Before that I had been on a maximum dose of Metformin (2000mg), plus a maximum dose (20mg) of Glyburide, a Sulfonylurea, and I had just started on Avandia, in a drug class later associated with increased heart attacks. I had to stop taking these other 2 anti-diabetes oral meds completely to avoid “hypos” (hypoglycemia, a dangerously low blood sugar).
I asked to have my Metformin increased because I had just attended a conference on Metabolic Therapeutics at which many normoglycemic attendees (body builders and fitness buffs, mostly) were eating low carb and taking maximum doses of Metformin to induce ketosis and fat-burning. Metformin does this by suppressing hepatic gluconeogenesis and improving cellular glucose uptake, thus lowering serum insulin. With both low blood sugar and low blood insulin, fat burning is activated.
So, seeing no harm or stigma from increasing Metformin, and to get the unrealized benefits, I wanted to try taking more Metformin. Wow! Was I surprised with the result! My blood sugar control, as measured by a daily fasting blood glucose, improved overnight and very dramatically. All of a sudden, my fasting blood sugars were all in the 70s and 80s, with two concurrent weekly averages of 79mg/dl. THIS WAS VERY LIBERATING. My editor suggested I do a follow-up column in a few months. She didn’t say why, but I said I would.
I thought about the follow-up, though, and two reasons came to mind: 1) the body will adjust to the meds and the effect, over time, will wear off; 2) the “liberating” effect will result in my becoming less stringent in following my Very Low Carb Way of Eating. I would become a “libertine,” taking advantage of the benefit accorded me by the higher level of medication to eat more carbs. In other words, to cheat more often! So, that is the reason that I have decided to have a no-cheat week now, coincident with my upcoming doctor’s appointment next week.
Result: My fasting blood sugar the day before I started the no-cheat week was 111 (weekly average 106, range 100 to 119). The next 7 days were: 93, 82, 88, 79, 85, 83, 100; Weekly average: 87mg/dl. (The last reading was a morning after a restaurant dinner.) So, did the metformin effect wear off over time? It did, a little. (87mg/dl vs. 79mg/dl). Did the higher dose have a liberating effect? Definitely! I cheated a little every day, and my weekly averages rose to 104, 107 and 106mg/dl. When I didn’t cheat, my FBGs were mostly in the healthy 80s, considered normal for young, non-insulin resistant, NON-DIABETIC people. It is definitely the best place to be for both my diabetic and general health.
The choice is mine, of course. How much risk to my general and diabetic health should I take? Do I want to live on the edge? Or do I want to continue to reap the benefits of a low blood sugar? And if I only eat when hungry, and remain at all other times in a mild state of ketosis, will I lose weight (which I still need to do)? Can I do it? The answer is TBD (to be determined). If I stick to the maxim espoused in Retrospective #342, “Is Cheating Okay?” I think I can. I must simply ask myself, “Am I hungry?” If the answer is “no,” that is almost always sufficient to not eat.

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