As I thought about what was happening with the "Dawn Effect" (if in fact that was what was going on) I was curious about the impact it would have on my HbA1c. I could conceive of ways that it might rise a bit and of other ways it could drop. My inclination is it would drop. It had been a month since I had checked my HbA1c and a lot of medical professionals will say you don't need to check that often because the A1c test reflects blood sugar levels over the past 2 to 3 months.
Well, I disagree - saying the A1c test reflects the past 2-3 months is just a piece of the truth. The test measures how much of a glycolated protein there is on a person's red blood cells. Red blood cells can live up to 3 months, hence the medical (and insurance) profession's comments. In reality, most of them are shorter lived and HbA1c can change significantly in just a month. So I retested using the Bayer home test and the result was 5.5%, which is an excellent reading (borderline normal).
As I keep studying the data, I am beginning to believe it takes the body 3 weeks or more after stopping a drug to remove the drug and its metabolites and stabilize again without the drug. I've seen this now with Actos, Metformin, and Exforge (a blood pressure drug). Most of the literature you'll find speaks of a half-life that is much shorter, measured in hours or days and never weeks. The may be true at some level if you're measuring blood chemistry. When you look at the time it takes the body to clear a drug AND return to normal, my experience is 2-1/2 to 4 weeks seems to be what it takes.
So the summary to date after 17 weeks of eating for nutrition and exercising both aerobically 3 times/wk (for about 12 wks) and anaerobically 3 time/wk times (starting July 5) are:
38 pounds lost.
45 mg/d of Actos eliminated
All other meds cut by 50%
Blood pressure typically runs 125/70 or less
Total cholesterol: 125
Fast blood sugars are current running 127 mg/dl (and appear to be dropping at 4 mg/dl per week)
My current fasting blood sugar readings are 51 points lower than when I started the program. If I add in the estimated reduction that the Actos and metformin were doing my blood sugar drop is probably between 80 and 100 mg/dl lower than when I started.
I've got 37 more pounds to lose. If the trend lines continue I should be able to control my diabetes with diet alone comfortably in another 10 to 12 weeks (estimate); maybe a bit less. There is no doubt in my mind that I could be "diet controlled" and meet the FAA's requirements for passing a flight physical (HbA1c <9.0). The trouble is, there's too much data that says keeping your A1c low reduces complications from diabetes. The popular simplistic value is 40% fewer complications for every 1% reduction.
When my fasting blood sugar readings are less than 115 and stable, I'll drop my metformin dosage to 500 mg/d. Then I wait and see what happens. I'd like to see my fasting blood sugar under 110 to quit taking metformin. Ideally, I would like to see this happen when I weigh between 205 and 210. Given the current trend line, this seems plausible. Time will tell.
Saturday, July 23, 2011
Wednesday, July 20, 2011
First Stumble
Since the end of March I have been losing between 1.5 and 3.4 pounds per week, every week and averaging a 2.3 pound/week loss. My goal was and continues to be 2.0 pounds per week. There has be a constant but variable drop in blood sugar along the way. The only exception to the drop in blood sugar was when I went off Actos and there was a moderate (15-10 mg/dl) rise. Last week my fasting blood sugar levels started to rise without apparent cause. Two weeks ago my weekly average fasting blood sugar was 117 and dropping 3 to 4 mg/dl every week. Last week my fasting blood sugar was 131.
When I looked for an explanation there were no obvious causes. The change in eating habits was bringing me in line with my ideal weight (i.e., I was losing weight). My exercise plan which seemingly was accelerating the loss a bit was steady, ongoing and seeming to work both building new muscle and increasing stamina. I noticed I had a little congestion. It could have been pretty much anything - an allergy to rising pollen counts or perhaps a summer cold starting up.
I didn't expect the numbers to stay up for very long. About 10 days later they seem to be coming down slowly but I may have discovered the issue. I say "may" because I'm not certain. I have checked my blood sugar during the night and it seems to be between 112-118 until 4:00 or 5:00 am when it starts to rise a little. This is called the "Dawn Effect" and apparently your body is getting ready for you to become active again. Part of the process involves the liver releasing glycogen, which becomes two glucose molecules in the blood. This is energy that's waiting for the body to start to work.
If I've nailed the problem down, I'm not too concerned. My HbA1c will continue to drop but my baseline for evaluating my progress has changed. This is a mixed blessing - it might be good or it might be bad. I'm looking at it as a way to get my fasting blood sugar levels even lower and will monitor my "rising blood sugar" - meaning both when I rise and the fact that the level has risen above the fasting level. My goals remains the same: I want my morning blood sugars under 100 as soon as possible and then I want them under 89. Ideally these numbers will be without medicine.
If there was a way to get my body to extend the low fasting blood sugar levels that would be great. I'm looking to see if there is a way that isn't 'trickery', like having a high carb snack late at night. Building new muscle should increase my metabolism and might reduce my insulin resistance. Logically, this should lower my fasting blood sugar levels. Aerobic exercise burns fat which improves insulin efficiency and this too should lower my fasting blood sugar levels. Good nutrition seems to help and perhaps over time as the body renews itself, my liver and pancreas can improve their insulin sensitivity and production, too.
When I looked for an explanation there were no obvious causes. The change in eating habits was bringing me in line with my ideal weight (i.e., I was losing weight). My exercise plan which seemingly was accelerating the loss a bit was steady, ongoing and seeming to work both building new muscle and increasing stamina. I noticed I had a little congestion. It could have been pretty much anything - an allergy to rising pollen counts or perhaps a summer cold starting up.
I didn't expect the numbers to stay up for very long. About 10 days later they seem to be coming down slowly but I may have discovered the issue. I say "may" because I'm not certain. I have checked my blood sugar during the night and it seems to be between 112-118 until 4:00 or 5:00 am when it starts to rise a little. This is called the "Dawn Effect" and apparently your body is getting ready for you to become active again. Part of the process involves the liver releasing glycogen, which becomes two glucose molecules in the blood. This is energy that's waiting for the body to start to work.
If I've nailed the problem down, I'm not too concerned. My HbA1c will continue to drop but my baseline for evaluating my progress has changed. This is a mixed blessing - it might be good or it might be bad. I'm looking at it as a way to get my fasting blood sugar levels even lower and will monitor my "rising blood sugar" - meaning both when I rise and the fact that the level has risen above the fasting level. My goals remains the same: I want my morning blood sugars under 100 as soon as possible and then I want them under 89. Ideally these numbers will be without medicine.
If there was a way to get my body to extend the low fasting blood sugar levels that would be great. I'm looking to see if there is a way that isn't 'trickery', like having a high carb snack late at night. Building new muscle should increase my metabolism and might reduce my insulin resistance. Logically, this should lower my fasting blood sugar levels. Aerobic exercise burns fat which improves insulin efficiency and this too should lower my fasting blood sugar levels. Good nutrition seems to help and perhaps over time as the body renews itself, my liver and pancreas can improve their insulin sensitivity and production, too.
Saturday, July 9, 2011
Weekly Assessments
It's Saturday and this is the day I evaluate my progress. It is also a full week (8 days actually) on a 50% in metformin. I figured I should be seeing the impact of taking less medicine to control my blood sugar.
So, before I get into the numbers, let me explain what numbers I track and how I track them...and maybe a bit about why I track them. The "how" piece is actually important, and I think a bit interesting - feel free to disagree.
Every morning when I get up (and the time does vary by a few hours some days) I check my fasting blood sugar and my weight. The fluctuate from day to day so trends are not always clear. I try to check my blood sugar before lunch and dinner and 2 hours after eating as well as before I go to bed. My blood sugar meter automatically calculates 14 and 30 day averages for all of the readings I collect. The fact is I have 3 meters and only one of them does the averaging. One meter is at work and the other is near where I eat.
My fasting blood sugar and three or four other readings are generally taken on the averaging meter. My methodology is not terribly consistent and therefore may not be scientifically reproducible but the trend line for both the 14 day and the 30 day readings has been steadily down. The 14 day and 30 day averages were 178 and 165 respectively in late March. They were 122 and 125 this morning. Considering I'm off Actos and only using half the metformin I once was using, this seems like real progress.
Like I said, the daily weight and fasting blood sugar levels fluctuate some and make trends hard to follow. I have "fixed" this by collecting the daily readings and paying attention but not worrying about them. What I "worry" about are the actual trends and these I can find by averaging every weeks data. For instance, my starting weight was 161.5 pounds and every week since the end of March I have lost between 1.5 and 3.4 pounds and have averaged a loss of 2.3 pounds per week. My goal was 2 pounds per week. The daily weight readings may fluctuate but the weekly average really does reveal what's going on.
In terms of weekly average blood sugar readings, a chart shows the trend more clearly. I seem to be dropping my fasting blood sugar readings by about 4 points per week. The most I have dropped in a week is 7 points and for the four weeks after stopping the Actos the trend went up a few points. I think the averages missed the peak of about 15 points. For the past three weeks I have been down 4, 4, and 3 points respectively. Exercise may have helped restore this trend. It is hard to say.
I am not rushing to stop taking metformin. Since I passed my Class 3 flight physical I don't need to be re-examined for another year (or close to it, actually) to keep flying. This gives me the flexibility to go off the metformin whenever I want to prior to my next physical. My first goal is my health and flying is a secondary (but important) goal. My estimated A1c based on both my monitoring and past tests is 6.0 to 6.5. These meet AACE recommendations and exceed ADA recommendations. My goal is to get it to 5.5 or less.
So what I am trying now is to keep the blood sugar coming down. If the 4 points per week decrease continues (on average) I should have a weekly average fasting blood sugar of under 100 in five weeks. At that point I should be another 10 pounds lighter, more or less and I may either quit metformin or cut it to 500 mg/d. I'm inclined to do the latter. It seems that the effect of metformin on blood sugar is related to how over-weight you are. The more over-weight the greater the effect. If this effect applies to me (each person is a rule unto themselves), then it's possible I will be able to quit the last 500 mg of metformin with little or no effect, if I wait until I'm under 200 pounds, which I am estimating will occur sometime in October.
Alternatively, if I see as little effect in reducing my daily dose from 500 mg 2 times per day to 1 time per day as I did with I decreased the dose form 1000 mg 2 times per day to 500 mg 2 time per day, which is to say there was no perceptible change, I may go off the metformin sooner.
My ultimate goal is to have my fasting blood sugars under 89 mg/dl consistently. That is roughly 28 more points to loose and to do it without taking any medicines. By my estimation I have dropped my blood sugar by between 80 and 100 mg/dl, if I had not reduced the drugs I was taking. I am not quite halfway to my weight goal and if the second half of my weight loss/improved nutrition and exercise program holds even one-third the promise of the first half of the program, I should be readily diet controlled, if not "cured" of my diabetes.
Time will tell.
So, before I get into the numbers, let me explain what numbers I track and how I track them...and maybe a bit about why I track them. The "how" piece is actually important, and I think a bit interesting - feel free to disagree.
Every morning when I get up (and the time does vary by a few hours some days) I check my fasting blood sugar and my weight. The fluctuate from day to day so trends are not always clear. I try to check my blood sugar before lunch and dinner and 2 hours after eating as well as before I go to bed. My blood sugar meter automatically calculates 14 and 30 day averages for all of the readings I collect. The fact is I have 3 meters and only one of them does the averaging. One meter is at work and the other is near where I eat.
My fasting blood sugar and three or four other readings are generally taken on the averaging meter. My methodology is not terribly consistent and therefore may not be scientifically reproducible but the trend line for both the 14 day and the 30 day readings has been steadily down. The 14 day and 30 day averages were 178 and 165 respectively in late March. They were 122 and 125 this morning. Considering I'm off Actos and only using half the metformin I once was using, this seems like real progress.
Like I said, the daily weight and fasting blood sugar levels fluctuate some and make trends hard to follow. I have "fixed" this by collecting the daily readings and paying attention but not worrying about them. What I "worry" about are the actual trends and these I can find by averaging every weeks data. For instance, my starting weight was 161.5 pounds and every week since the end of March I have lost between 1.5 and 3.4 pounds and have averaged a loss of 2.3 pounds per week. My goal was 2 pounds per week. The daily weight readings may fluctuate but the weekly average really does reveal what's going on.
In terms of weekly average blood sugar readings, a chart shows the trend more clearly. I seem to be dropping my fasting blood sugar readings by about 4 points per week. The most I have dropped in a week is 7 points and for the four weeks after stopping the Actos the trend went up a few points. I think the averages missed the peak of about 15 points. For the past three weeks I have been down 4, 4, and 3 points respectively. Exercise may have helped restore this trend. It is hard to say.
I am not rushing to stop taking metformin. Since I passed my Class 3 flight physical I don't need to be re-examined for another year (or close to it, actually) to keep flying. This gives me the flexibility to go off the metformin whenever I want to prior to my next physical. My first goal is my health and flying is a secondary (but important) goal. My estimated A1c based on both my monitoring and past tests is 6.0 to 6.5. These meet AACE recommendations and exceed ADA recommendations. My goal is to get it to 5.5 or less.
So what I am trying now is to keep the blood sugar coming down. If the 4 points per week decrease continues (on average) I should have a weekly average fasting blood sugar of under 100 in five weeks. At that point I should be another 10 pounds lighter, more or less and I may either quit metformin or cut it to 500 mg/d. I'm inclined to do the latter. It seems that the effect of metformin on blood sugar is related to how over-weight you are. The more over-weight the greater the effect. If this effect applies to me (each person is a rule unto themselves), then it's possible I will be able to quit the last 500 mg of metformin with little or no effect, if I wait until I'm under 200 pounds, which I am estimating will occur sometime in October.
Alternatively, if I see as little effect in reducing my daily dose from 500 mg 2 times per day to 1 time per day as I did with I decreased the dose form 1000 mg 2 times per day to 500 mg 2 time per day, which is to say there was no perceptible change, I may go off the metformin sooner.
My ultimate goal is to have my fasting blood sugars under 89 mg/dl consistently. That is roughly 28 more points to loose and to do it without taking any medicines. By my estimation I have dropped my blood sugar by between 80 and 100 mg/dl, if I had not reduced the drugs I was taking. I am not quite halfway to my weight goal and if the second half of my weight loss/improved nutrition and exercise program holds even one-third the promise of the first half of the program, I should be readily diet controlled, if not "cured" of my diabetes.
Time will tell.
Wednesday, July 6, 2011
More Progress
Last Thursday (6/30/11) I saw my family doctor for a routine diabetes check. On his scales I'd lost more than 35 pounds since March. I was off Actos, using a quarter of the blood pressure medicine I was in March and half the cholesterol medicine, and my total cholesterol was 125. All of my numbers looked good. He agreed I should cut back on metformin and suggested reducing my dosage from 1000 mg twice per day to 500 mg twice per day. We also discussed getting off medicines and fasting (a topic for a post of its own).
For the past 8 weeks my weekly average fasting blood sugar had been in the 120's for 6 of the 8 weeks. One week it was 115 and that was when I quit Actos and the following week it was 131. To me it seemed like I had stalled in my progress on dropping my blood sugar. I had been dropping 6 points per week and then nada. Last week I hit 120 and this week it looks like I'll beat that. So what's different besides I'm taking less medicine?
I "accidentally" discovered a couple of things. One discovery is exercising briefly (20 min) in the morning and again in the afternoon or evening has a noticeable affect on lowering blood sugar throughout the day. I can't be positive but it seemed like it also reduced the impact of starchy foods a bit.
The other discovery is mostly an answer to a question I had. What, if any, are the benefits of anaerobic exercise on blood sugar? It is well documented, and easy to measure personally, the beneficial effect of aerobic exercise on blood sugar levels. There's nothing like 30 minutes of walking or time on the Nordic Track to lower blood sugar after a meal. Gardening and yard work are more practical ways to experience both better blood sugar and a nicer yard. I have not found much on anaerobic exercise and it's effect on blood sugar.
Coincidentally a Bowflex came up for sale on Craigslist for $150 and I bought it. After two workouts, its a bit early to say much with certainty but my fasting blood sugar is clearly dropping. Not only that but this morning it was 101 mg/dl; 19 points better than it averaged last week. It could be a fluke reading. Or, it could be that anaerobic exercise is building muscle, perhaps less insulin resistant muscle, and the added muscle is burning a little more sugar overnight. This is the basis for the idea that exercise will raise your metabolism. For a diabetic, a higher metabolism means lower blood sugar if everything else stays the same.
One thing I'm not sure of if how long it takes the body to build new muscle and how energy intensive the process is. The lower blood sugar could be a result of the temporary responses to exercise and not new muscle mass. Either way, lower blood sugar is good and I'll keep working out on the Bowflex to see how far I can take this. A nearly 20 point reduction in blood sugar in just a few days is huge and holds a lot of promise.
My goal for my fasting blood sugar is to get it under 89 mg/dl. This goal now seems to be in reach. I have 40 or so pounds of fat to lose, the possibility of adding an unknown amount of muscle, and making other changes that will affect what genes are active and which ones are passive. Any one of these could take me to my goal. All of them together make the goal seem like it is not just achievable but also, not too far off.
For the past 8 weeks my weekly average fasting blood sugar had been in the 120's for 6 of the 8 weeks. One week it was 115 and that was when I quit Actos and the following week it was 131. To me it seemed like I had stalled in my progress on dropping my blood sugar. I had been dropping 6 points per week and then nada. Last week I hit 120 and this week it looks like I'll beat that. So what's different besides I'm taking less medicine?
I "accidentally" discovered a couple of things. One discovery is exercising briefly (20 min) in the morning and again in the afternoon or evening has a noticeable affect on lowering blood sugar throughout the day. I can't be positive but it seemed like it also reduced the impact of starchy foods a bit.
The other discovery is mostly an answer to a question I had. What, if any, are the benefits of anaerobic exercise on blood sugar? It is well documented, and easy to measure personally, the beneficial effect of aerobic exercise on blood sugar levels. There's nothing like 30 minutes of walking or time on the Nordic Track to lower blood sugar after a meal. Gardening and yard work are more practical ways to experience both better blood sugar and a nicer yard. I have not found much on anaerobic exercise and it's effect on blood sugar.
Coincidentally a Bowflex came up for sale on Craigslist for $150 and I bought it. After two workouts, its a bit early to say much with certainty but my fasting blood sugar is clearly dropping. Not only that but this morning it was 101 mg/dl; 19 points better than it averaged last week. It could be a fluke reading. Or, it could be that anaerobic exercise is building muscle, perhaps less insulin resistant muscle, and the added muscle is burning a little more sugar overnight. This is the basis for the idea that exercise will raise your metabolism. For a diabetic, a higher metabolism means lower blood sugar if everything else stays the same.
One thing I'm not sure of if how long it takes the body to build new muscle and how energy intensive the process is. The lower blood sugar could be a result of the temporary responses to exercise and not new muscle mass. Either way, lower blood sugar is good and I'll keep working out on the Bowflex to see how far I can take this. A nearly 20 point reduction in blood sugar in just a few days is huge and holds a lot of promise.
My goal for my fasting blood sugar is to get it under 89 mg/dl. This goal now seems to be in reach. I have 40 or so pounds of fat to lose, the possibility of adding an unknown amount of muscle, and making other changes that will affect what genes are active and which ones are passive. Any one of these could take me to my goal. All of them together make the goal seem like it is not just achievable but also, not too far off.
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