1. I ate potatoes and some hours later my blood glucose was 78 mg/dL. It’s never been under 100 mg/dL. I am a diabetic on Metformin.
One blood glucose reading in isolation is not enough to determine what happened. Blood glucose readings are meant to detect patterns in metabolic function so multiple readings should be taken, across a span of time, in order to get a more complete picture of how the body is regulating its blood glucose. It would have been nice to know what your blood glucose was an hour and then two hours, after your meal, for example.
We can only guess why your blood glucose dropped to such low levels without you having done a very long fast. Usually, blood glucose will drop into the 70's mg/dL, for people with metabolic syndrome/diabetes after fasts of more than 18 hours. Blood glucose should never drop this low though as the body always keeps its blood glucose around 84 mg/dL, if it’s healthy.
Your blood glucose most likely went up high after eating the potatoes and this flood of extra insulin, plus the Metformin, dropped your blood glucose into the 70's mg/dL while fasting. That's why people on blood glucose medications are told to eat regularly and not fast for long periods.
2. I have been on "keto" for some years. I have been able to keep my blood glucose pretty stable, even though I am a diabetic on Metformin. Since I have heard "keto" people say that this diet can "cure" diabetes, I decided to give it a test and see if it "cured" me. I checked my blood glucose before eating at 10:45 am and it was 113 mg/dL. I ate a plain boiled potato and an hour later it was 193 mg/dL. Two hours later it was 250 mg/dL. It's 3 pm now and it's dropped to 97 mg/dL. I didn't eat anything else since, because I feel full and not hungry at all. It doesn't seem like I have been "cured".
You are correct. The reason it seems like you haven't been cured is because you haven't been "cured". Worse, you have been lied to. There is no known cure for diabetes as of this post. I get a lot of people asking me these types of question because of the quacks online who have fed them lies. "Keto" is not a cure for diabetes. All diets are only palliative treatments for the syndrome known as diabetes. What you are experiencing is diabetes. Diabetes is the inability to regulate blood glucose properly.
The problem is that when you are a diabetic, any glucose from diet, including glucose in the form of starch in potatoes, causes for blood glucose regulation to deteriorate. This can never be "cured". You can only manage your blood glucose with diet and medications. It will only remain managed as long as you don't veer from either. You want to keep your diabetes under control because it is chronic and will progress if not treated properly.
The goal is to prevent your blood glucose from taking these swings up and down. It's these large disparities in highs and lows that will worsen your condition and eventually lead to the complications of diabetes.
Stay away from carbs. Not because staying away from them will "cure" you or keep your blood glucose low, but because staying away from them will help minimize these erratic ups and downs in blood glucose which will eventually ruin your health and end in death.
As far as feeling full and not hungry is concerned, that's called "starvation mode". It's just like when you become less and less hungry, the longer you extend your fast. Contrary to popular belief, the potato didn't simply fill you up, keeping you satiated, so you eat less calories during the day. It actually disrupted your blood glucose homeostasis and your body simply interpreted that as starvation. Your metabolic rate dropped and your leptin under expressed, sparing your fat mass further. There is no need to be hungry if energy is being conserved. Inability to burn fat signals starvation. You are getting fatter as I write this.
You can't solve this by eating fat, like these "keto" people claim. That only hides the problem and makes you even doubly fat because there is nothing worse than consuming fat with poor leptin expression. You will store it all and then some. You need to eat a proper meal, even if you aren't hungry, to see if you can stabilize your blood glucose and halt this starvation mode. When you start getting your appetite back, then it's because you are headed in the right direction.
3. I was told by "keto" people that when you have metabolic syndrome/diabetes, it means that your insulin "doesn't work".
If your insulin "didn't work", you would have the same symptoms as a Type I diabetic. The insulin of Type II diabetics is "working" just fine. There are studies that even show that the "lock and key" mechanism between insulin and cells is working properly and not "broken", as it was once thought to be.
The problem is that insulin doesn't just do one thing. It is a hormone that is responsible for many processes in the body and basically, it's these processes that are not functioning properly. They aren't responding to insulin as they should, hence the term "insulin resistance". So, it's not that insulin "doesn't work", it's that diabetics have poor insulin function (release/expression) as a whole. They require more and more insulin to get the job done.
The mechanism behind this is very complicated and involves multiple metabolic systems that have deteriorated in the diabetic. So, to avoid complexity, which won't solve anything, let's just say that the body already has too much glucose and it's no longer able to control it, so it is no longer accepting more. That at least will help you target something, like not putting any more glucose in and getting what you have out.
4. How can my HbA1C have dropped to 5.2 from 5.9 but I checked my postprandial blood glucose, and it was 190 mg/dL. My fasting blood glucose never drops below 100 mg/dL. I have been on Metformin for about 8 months.
Because if your blood glucose drops very low during fasting, your HbA1C lowers but you still aren't regulating your blood glucose properly. HbA1C is a measurement of average blood glucose during a three-month period. You can have a seemingly normal HbA1C if your very high blood glucose readings cancel out your very low blood glucose readings. Basically, large disparities in highs and lows can still produce a lower HbA1C but you are getting sicker with time. In fact, HbA1C has the tendency to be the last marker to finally become abnormal. Your doctor will notice your high fasting blood glucose before he notices a high HbA1C. This is why lowering of HbA1C has not been shown to be very beneficial to diabetics in the long run and they still succumb to the progression of the "disease".
The same goes for low fasting blood glucose. If your blood glucose is 80 mg/dL while fasting, that's fantastic but if it rises to 200 mg/dL postprandial, you will eventually get diabetes, and if you already have it, those readings show you don't have it under control. That's really the crux of the problem. While a diabetic puts all of his focus on low fasting blood glucose and a lowering of their HbA1C, their blood glucose regulation continues to deteriorate.
Diabetes is not a disease of high blood glucose nor of a high HbA1C, though those are the diagnostic tools used to determine if you are diabetic or not. The syndrome itself is large disparities between highs and lows in blood glucose of which the lows drive the condition's progression. That's the engine driving all of the associated pathologies called diabetes, including overweight/obesity. You must avoid large disparities in blood glucose because that's the "disease". These disparities only deteriorate your insulin function and exacerbate overweight/obesity through a "starvation adaptation". Continuing to be overweight/obese does not improve diabetes outcomes. It only worsens them. High body fat is fertilizer for diabetes.
5. A person can have poor blood glucose regulation and not be diabetic. This poor blood glucose regulation will not cause overweight/obesity.
Diabetes is a syndrome which is the result of end stage metabolic dysfunction. Diabetes is not the beginning of your problems. It is the end.
A person can be in a perpetual state of appearing "healthy" while still having pathological metabolic function, for years, until they eventually succumb to diabetes. Remember, the engine that drives the syndrome known as diabetes are large disparities between blood glucose highs and lows. This disparity does not ever have to go into a "diabetic range". For example, a low fasting blood glucose of 70 mg/dL and a postprandial blood glucose of 150 mg/dL will eventually cause overweight/obesity and diabetes. This person will pass all of their annual blood work. They will have a normal HbA1C and a normal fasting blood glucose, all while slowly putting on body fat and having undetected, erratic blood glucose regulation. This is why diabetes is a syndrome that can take decades to develop.
The culprit is most commonly diet. It is these high postprandial blood glucose readings that drop fasting blood glucose to very low levels. It is then the low fasting blood glucose levels that push the body towards a starvation adaptation which spares body fat and deteriorates insulin function causing an "energy crises" in certain tissues and an "energy toxicity" at the fat mass. This occurs over a long period of time. It is actually mostly occurring while the person is seemingly still considered "healthy".
I once had an acquaintance who was in pretty good health. They had only put on a few pounds, through the years, and had recently started developing a bit of high blood pressure. All of their other health markers were prefect and their doctor was not concerned. Normally, the person will assume that these common and insignificant health issues are simply the normal result of getting older. Well, my blood glucose meter proved otherwise. Their postprandial blood glucose clocked in at 176 mg/dL. This was the result of eating two slices of pizza, three hours before.
This abnormality would have gone undetected, for decades, if it hadn't been for them wanting to check their blood glucose at that moment. Two seemingly benign slices of pizza were enough to cause havoc on metabolism and why not? It shouldn't be surprising, as pizza is the world's most obesogenic food. Pizza is a very high carb food, that is also very high in fat, and poor in protein. Pizza is the embodiment of the Standard American Diet (SAD). You can also see how watching calories would not prevent weight gain or diabetes. Two slices of pizza would fit a daily calorie budget, while still taking you towards obesity and diabetes through blood glucose dysregulation.
All diabetes usually begins at the mouth, and it ends everywhere else on the body. You can still control it at the mouth stage, but once it metastasizes from there, it's a roll of the dice whether it can be put into remission or not. This is why following a healthy diet, that keeps blood glucose stable and under control, is of vital importance because all of these seemingly "healthy" people, who believe they are immune to eating pizza, are simply not. No one is.
6. If my diet is under control, overweight/obesity should not worsen my diabetes. Diabetes solely a diet induced disease.
Diabetes is a lifestyle choice because multiple lifestyle factors, including behavior, activity level and diet, contribute to it. So how does overweight/obesity factor into this? Why would it make diabetes worse or even cause it?
Overweight/obesity is the right hand of diabetes and is usually the first stage of it. Overweight/obesity further deteriorates insulin function over time. High body fat (overweight/obesity) puts a high insulin demand on the body because it takes a lot of insulin to keep fat trapped in fat cells. So, once again we get that "compounding" effect where one thing piles on top of another and collapses metabolic function:
- A bad diet that interrupts the proper regulation of blood glucose, deteriorates insulin function plus,
- Overweight/obesity puts a high insulin demand on the body, further deteriorating blood glucose control and insulin function.
As you can see, diabetes and overweight/obesity work hand in hand, in a vicious circle, to progress the condition. If diet doesn't topple your health fast enough, overweight/obesity will finish the job. It's a double assault.
This is why diet is not enough. Diet is only palliative. It will never address the root cause of the syndrome. Diet was only the root, at the beginning stages of the syndrome, but not once the ball gets rolling. Now the ball has momentum and needs no further dietary assistance to keep rolling downhill. It has all the glucose it needs, coming from the inside, to continue the progression of the condition. Once you finally get diabetes, and make no mistake you most likely will, the condition itself will make it doubly hard for you to get rid of body fat, when you most need to, as diabetes is a fat sparing mechanism and makes it very difficult to regain blood glucose homeostasis enough to allow body fat loss to begin with. Again, diabetes is the right hand of overweight/obesity.
So, you can't be fooled by these "keto" people who weigh 500 pounds and think they are doing just fine because their insulin happens to be low. That's pure quackery and has no scientific foundation. That's simply someone who can't lose body fat and doesn't want the diet they are promoting to be blamed for it.
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