Normal blood sugar after decades of insulin resistance?

askdrandreaseenfeld

What are your thoughts on my blood markers after one month on keto? How long could it take to get my blood sugar back to normal after decades of insulin resistance? And, could keto help ease arthritis?

Get the answers to these and other questions in this week’s Q&A with me:

Why are my blood markers off the charts after a month on keto?

Hi Doctor,

After a month on keto which I got into primarily to alter my type 2 diabetes, these are my observations:

I was on 56 units of insulin (30% fast & 70% long-acting), 5 mg Saxagliptin, 10mg Empagliflozin, 120 mg Gliclazide & 2 gm of Metformin per day. On starting keto, I was off insulin the very next day & was off all other medication after 3 days. I intermittently had 500 mg Metformin & my sugars were very much in control. But after 30 days on Keto lets look at my other parameters:

  • HS-CRP went up from 3.4 to 8.9 mg/L
  • Blood ketone went up from 0.3 to 7.16 mg/dL
  • Fructosamine came down from 331.5 to 297 micromol/L
  • SGOT came down from 31 to 23.7 U/I
  • SGPT came down from 63 to 46.3 U/I
  • GGT came down from 65 to 45.9 U/I
  • TCL went up from 195 to 297
  • HDL came DOWN from 33 to 30
  • LDL went up from 105 to 118
  • Triglycerides skyrocketed from 360 to 713
  • TC/HDL ratio went up from 6 to 9.8
  • LDL/HDL ratio went up from 3.2 to 3.9
  • VLDL went up from 71 to 142.6
  • Non HDL went up from 162 to 266.2
  • Uric Acid went up from 4.96 to 7.81
  • HbA1c came down from 11.2 to 9,2
  • ABG came down from 275 to 217
  • Hemoglobin came down from 17.8 to 15.7

I would love to hear your impression on the above parameters. If you do not have the time to answer an individual query, then I hope that you can use the above readings as a test case & I am prepared to take further blood tests to help in any way I can if you need the data.

Thank You,
Anand

 
Hi Anand!

I can’t offer personalized medical advice here, for advice on your blood markers tailored to your medical situation, you’ll have to discuss with you doctor.

On a more general level, HbA1c going down (despite being off medication!) is absolutely great. If trigs go up, could it be that you were not fasting? It’s common for trigs to go down in the fasted state on keto.

I think it would be reasonable to discuss this with your doctor and if appropriate, continue and follow up on the values. The A1c and medication situation is extremely encouraging! :)

Best,
Andreas Eenfeldt, MD


If I was insulin resistant for decades – how long should it take to get my blood sugar back to normal?

I am fit 63 years old. Was 80 kg, 178 cm. I had full blood tests done four months ago and my HbA1c was 6.2. Cholesterol 230 (TG-35, HDL-49, LDL-C 167). I had CAC and came out 240. So I was concerned and made a change to strict ketogenic diet and HIIT, and intermittent fasting. Had my tests repeated and my HbA1c dropped to 5.3, Cholesterol 240 (TG-51, HDL-57, LDL-C 176).

My main concern and question are that my blood sugar checked before and after every event (meal, exercise, supplement) stays in the 105-115 range. This only drops to the 80 range if I stay 24 hours fasting. My fasting Insulin is 7 IU/ml. My plan is to do bulletproof coffee in the morning and dinner with no cheating. But my blood sugar stays above 100.

Question: is this normal and how long do I have to stay on this fat fasting protocol to see my BG levels drop to the 80 range? Or in my case, do I have to go to one meal per day without bulletproof coffee, which would be hard for me?

Thank you,
Edwin

 

Edwin,

If your A1c is 5.3, your average blood glucose is normal, so it should not be a major concern if it never gets really low.

Keto, HIIT and intermittent fasting are probably great. However, I would not recommend bulletproof coffee daily for reversing IR, regular coffee would likely be better, and larger meals if necessary.

Best,
Andreas Eenfeldt, MD


Arthritis and keto


I’m 34 and I got diagnosed with RA. The dr told me that i need to watch what I eat, but he didnt give me a list of what to eat or not. He didnt prescribe me any medications. The pain eventually went away with a months supply of meds he gave me. If I start this diet will help me with my RA?

Luna

 
Luna,
There’s no good evidence for that – no studies have ever tested this question, to the best of my knowledge.

However, some anecdotal reports suggest that avoiding excess carbs and gluten might be helpful.

Best,
Andreas Eenfeldt, MD


Nausea

I’ve been following the Low carb diets for almost two months now. I regularly have an upset stomach (nausea) and diarrhea. Is there something I am missing?

Sarita

 
Sarita,
Sometimes stomach upset and diarrhea happens in the beginning when starting a keto diet, but two months is a long time.

If it’s a big issue, and you don’t necessarily need a strict low-carb diet, perhaps you can try a more liberal version, e.g. 75 grams of carbs per day? That could make the issue go away, possibly.

You could also try to reduce the amount of fat you eat per meal, perhaps dividing your intake into more daily meals, until the situation improves. It can take weeks or months for the gut to adapt to a new diet.

Best,
Andreas Eenfeldt

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