1. What are some reasons that the body would produce so much of its own glucose?
The body produces glucose for many different reasons. It uses a series of feedback loops in order to retrieve information on when and how much glucose to produce. In the context of metabolic syndrome/diabetes this process is always over and under expressed. This means too much glucose is produced when not needed and too little is produced when needed. This makes sense as all of the metabolic hormones that control blood glucose are functioning poorly, and the feedback loops are broken.
In metabolic syndrome/diabetes the biggest influences for unregulated blood glucose production are:
- To counteract insulin. High insulin, low insulin, poorly functioning insulin all contribute to excess or not enough glucose production.
- To counteract the inability to burn fat for energy. It is very difficult to burn fat for fuel when leptin is not working properly, and this causes for more short-term energy (glucose) to be released into the blood stream instead. This is typically why overweight/obese people have a hard time "keeping their energy up" regardless of how much short-term energy they produce.
- To counteract starvation. Metabolic syndrome and all of its pathologies from overweight/obesity to diabetes are adaptations to starvation. The best way to stop starvation is to release enormous amounts of blood glucose into the bloodstream, not only for fuel but to increase fat mass at the expense of muscle mass.
Other things also influence and contribute to this glucose production like certain common deficiencies seen in people with metabolic problems and imbalances in electrolytes which is also common in metabolic conditions.
2. Should I hire a "low carb/fasting coach"?
There is no such thing. Low carb is simply keeping your carb intake to less than 100 grams per day and fasting simply means not eating anything. You don't need a "coach" to do that. You would need a coach to help you exercise but not to keep you from eating carbs or food.
Now you can go ahead and hire one if you want but you should do so knowing that you are wasting your money. You're basically giving away money to have someone hold your hand through something you should be doing all on your own by determination, will and need alone. The minute someone tells me they need a "coach" to follow a simple diet, I become leery in believing they are serious about anything.
3. I drink a lot of bubbly water. I buy the kind that has zero of everything. Zero sweeteners, calories and caffeine. I'm sure you are familiar with them as they have sprung up everywhere and are very popular with low carb/"keto" dieting. Anyway, I was wondering if their taste has anything to do with my recent weight gain but even more strangely, my recent high blood glucose.
I have discussed before that constantly tasting anything, especially things on the sweet side, will further disrupt your already damaged hypothalamic/pituitary/adrenal axis (HPA). I have also discussed how carbonated drinks effect ghrelin, the hunger hormone. Any of these two effects, on their own, can contribute to weight gain and it's why all of these "zero of everything" drinks haven't done a thing to curb obesity. They have had zero success, aside from zero of everything else. This is why the only thing you should be drinking is water.
But in your case, you aren't only experiencing weight gain but also a rise in blood glucose to boot, which takes us now into an entirely different direction.
CO2, the stuff that makes these waters "bubbly", is acidic. High acidity lowers potassium. Low potassium makes less insulin. Less insulin increases blood glucose. Increased blood glucose contributes to obesity. Imbalances in electrolytes always cause stress in the body and stress always makes more glucose. These waters not only have zero sweeteners, calories, caffeine and success but they also have zero electrolytes, unless it's Perrier which contains some minerals.
Stop drinking like you are at an endless birthday party. Bubbly, fizzy, carbonated, whatever you want to call it, drinks are party novelties. Drink what you were intended to drink in nature - plain water.
4. My blood glucose is fine when I wake up but then it starts rising as time passes. Is this "Dawn Phenomenon" (DP) and how do I stop it?
High blood glucose upon waking is DP which is basically an adverse reaction to the overnight fast. Rising blood glucose later is caused by a secondary spike in cortisol, which is dysregulated in people with metabolic syndrome/diabetes.
You can go out for a walk to lower your blood glucose but the main thing that will prevent this from happening is eating breakfast. Eating when you wake up helps that second cortisol spike to be much lower.
If you're on medications like insulin, you should speak with your doctor as they can adjust it for you to better control this as well.
5. Why does the American Diabetes Association (ADA) target an HbA1C of 7 for diabetics? Isn't that too high?
I've spoken about this before, but I'll quickly recap here.
This has to do with blood glucose lowering medications, which include insulin. Insulin dependent diabetics are extremely susceptible to deadly hypoglycemia. For this reason, it is recommended that their blood glucose remains higher than it would be if they were healthy, so that if their medications cause a blood glucose drop, it won't drop to deadly levels. A drop from an average blood glucose of 170 mg/dl is much safer than a drop from a blood glucose of 85 mg/dl.
So, the goal for this stage of diabetes is to try to keep blood glucose lower (not necessarily normal or low) and stable, which is more important than just "low". Remember diabetes is not a disease of high blood glucose. There are genetic abnormalities that cause for certain people to sustain higher than normal blood glucose and they have none of the complications that diabetics develop over time.
Diabetes is a multifactorial syndrome of which insulin resistance is at the core. Insulin resistance abnormalizes the function of multiple glucoregulatory/metabolic systems which end in the pathologies associated with diabetes and its ultimate morbidity. High blood glucose is only one of those pathologies. It's not the end all/be all. This is why diabetes is still a chronic and progressive condition, even with well controlled low blood glucose and at an HbA1C much lower than 7. The "disease" continues onward.
I really get a kick of low carb advocates who are so focused on blood glucose that they miss the forest for the trees and are always hung up over the ADA. I have said before how the ADA, despite its misgivings, knows way more about the mechanism of diabetes than these low carb people do. These low carb advocates only see one thing - high blood glucose from diet. Well, that's only a very myopic viewpoint of what this complicated syndrome really is. It's not the high blood glucose, it's the blood glucose roller coaster of ups and downs, with large disparities between the two, that is the root of the condition.
6. Is it true that a diabetic can stop their use of insulin if they follow low carb?
It has been shown that about 50% of diabetics can reduce or completely eliminate their need for exogenous insulin if they follow a low carb diet. This shouldn't be surprising as going low carb eliminates a significant load of exogenous glucose from the blood stream depending on how many carbs, and from what sources, are being consumed. So, the highest carb consumers will see the most benefits from going low carb.
But the reality is that once you get to that level of carb consumption, any change in the diet which lowers carbs, including reduction of overall calories, would make an impact on insulin requirements. This is because most of the insulin these people are taking is to control exogenous glucose from their dietary choices.
When you're diabetic at any stage, you already have an excess amount of glucose being produced by your own body, so you certainly don't need more exogenous glucose adding to it. This is why low cab would be the way to go. But the real magic in low carb is the halting of erratic large disparities in blood glucose that occur from the high postprandial blood glucose carbs cause and then the ensuing chronic release of insulin which drives fasting blood glucose to drop too low. That's the engine that drives the metabolic adaptation known as metabolic syndrome/diabetes and results in insulin resistance.
In that sense low carb is powerful indeed but having said that, you have to remember that any diet is only palliative for diabetes. Diet works really well at the beginning stages of the condition and then not so much. This is because the middle and end stages are being driven by other factors which aren't diet specific.
Reducing or eliminating the need for insulin does not mean you aren't diabetic. There are many diabetics who do not require insulin. In fact, most don't. As you can see, once they put you on insulin, you are pretty far along into the "disease" and low carb will only get you so far.
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