Surgery! (Wed. August 3, 2011)

Tuesday was a normal day with pretty normal results.

However, Wednesday I had surgery to correct a deviated septum, remove part of the turbinate, etc. Should make it much easier to breathe through my nose (eventually, not today!).

This meant a couple things. Diet not normal at all today and, because I'm a singer, the anesthesiologist used a little steroid to keep swelling of the vocal cords down (I had full anesthesia). One of the problems for diabetics using steroids is that they cause your blood sugar to rise.

All went well and I felt better than they advertised today, not much pain, only one of the prescribed pain pills, then naproxen after that. Also, not much draining. I'll see the Doc again tomorrow and see how things have progressed. Very little sleep last night (bed late and very early rise, since we had to be at the hospital at 6 AM) or today (just not sleepy) and the whole day in my recliner (and sleeping there tonight, too) since I have to keep my head higher than the rest of my body so any drainage goes the right direction!

I was supposed to eat rather bland, soft food (post-anesthia and with a slightly sore throat from the tube), so I did two protein drinks today, some cheese, about 3 sugar-free jellos and 3 sugar-free puddings (but not carb-free--about 13 grams of carbs). Also later, when it became clear I could handle some nuts, about 3 oz. of almonds over the evening. This means my carbs are NOT at my normal level, probably 100 grams or more instead of 30-35. I suspect my weight on Saturday will reflect that, although I should be able to get back on track by Friday and perhaps tomorrow. I'm also doing NO exercise or movement (lots of TV, though), where lately I have been walking most days for at least 30 minutes.

Blood sugar reflected stress from the surgery, more carbs and the steroid: 146 when I got back from the hospital around 2 (oh yeah, I had 6 oz. of Sprite in the recovery room, but of course hadn't eaten or drank anything since about 10:30 the previous evening), 134, 141, and then finally, at 1 AM, back to 107.

All-in-all, not a bad day, compared to what the Doc warned it could be (headaches, feeling stuffed up like a very bad cold, lots of drainage, etc.). But more symptoms could show up tomorrow!

When to measure blood sugar

Dr. William Davis' Heart Scan Blog is one of the better ones (I need to get a blogroll here soon).

I was wondering if measuring my blood sugar two hours later (as the ADA and the makers of my glucose monitor say) was correct--I hadn't gone back to check Dr. Bernstein's book, but remembered one hour as the significant time (and that's how I've been testing).

And so, along comes a post on Dr. Davis' site: "One hour blood sugar: Key to carbohydrate control and reversing diabetes." Just what I needed!

A bit of what he says:

Diabetics are instructed to monitor blood glucose first thing in the morning and two hours after eating. This helps determine whether blood sugar is controlled with medications like metformin, Januvia, Byetta injections, or insulin.

But that’s not how you use blood sugar to prevent or reverse diabetes. Two-hour blood sugars are also of no help in deciding whether you have halted glycation, or glucose modification of proteins the process that leads to cataracts, brittle cartilage and arthritis, oxidation of small LDL particles, atherosclerosis, kidney disease, etc.

So the key is to check one-hour after-eating (postprandial) blood sugars, a time when blood glucose peaks after consumption of carbohydrates.

Perfect for me right now.

He also mentions building your own peaking curve by testing every 15 minutes. I may try that a few times to see if my peak is different than just one hour.

But this is incredibly helpful.

As does Bernstein, he forcefully questions allowing blood sugar to go high:

I reject the insane notion that after-eating blood sugars of less than 200 mg/dl are acceptable, the value accepted widely as the cutoff for health. Blood sugars this high occurring with any regularity ensure cataracts, arthritis, and all the other consequences of cumulative glycation. I therefore aim to keep one-hour after-eating glucoses 100 mg/dl or less. If you start in a pre-diabetic or diabetic range of, say, 120 mg/dl, then I advise people to not allow blood glucose to go any higher. A pre-meal blood glucose of 120 mg/dl would therefore be followed by an after-eating blood glucose of no higher than 120 mg/dl.

More important advice for me to reinforce that I need to keep truly tight control over blood sugar, not what the ADA calls "tight" control!

Next three days and further experiment

So, I'm continuing to see drops in blood glucose:
Saturday - 97, 82, 105
Sunday - 98, 81
Monday - 86, 86, 85

More significant was an experiment done twice with protein drinks, but now with 2 scoops of Designer Whey, one of BCCA, 1 tbl coconut oil, 2 tbl heavy cream, 1 raw egg. The first day I followed one hour later with BG of 81, the next day of 86.

This is very helpful for me, since I tend to get tired of meat if I eat it too often (strange that I can eat chips, burgers, tacos, and drink cokes day after day with no let up!).

On the other hand, doing this rather than real food may lead to slightly slower weight loss, but it's worth it if I can be more successful at keeping on the diet.

Week 3 results

Thursday and Friday, some experiments:

Thursday: Protein drink (1 scoop Designer Whey, 1 scoop BCCA, 2 tbl coconut oil, 1 tbl cream); pre-breakfast blood sugar 93, 1 hour pp 129 (!), 1 hour later 108 -- this tells me that at this point, a protein drink gets converted to blood sugar too quickly for me --  :-(   (I like the variation from eggs or meat, so too bad)
- took a walk at the mall (hey, it's 100 degrees around here!)
- beef broth
- snapper, green beans, tomato/avocado salad, a few strawberries - before 91, after 94 - a good experiment, since the strawberries (at least in this quantity) didn't bother my glucose level!

Friday: 94; eggs, bacon, strawberries; 108
- beef broth
- walk
- steak, gn beans, 1/2 small avocado, cole slaw; 95

So, blood glucose doing well with the exception of the protein drink. Both days took a walk. Energy coming up. Because of when I got up, only did two meals each day, not three.

Weight:

Body fat:

So, doing fine. 5 days on a much restricted carb count. Lost 12.5 pounds in 3 weeks, essentially 7 of that this week--i.e., the intervention levels of carbs (no more than 30 g. or so/day) caused a lot of water loss. I've been ingesting plenty of sodium (salt on food, salt in beef or chicken broth) plus supplemental potassium (tablets) and magnesium (Calm brand drink most evenings) to replace minerals lost, so electrolytes should be good. A note, however: even with this amount of sodium (I salt most things I eat--mostly use Real Salt or Maldon Sea Salt) I'm probably eating less sodium than before, when I ate lots of processed (chips, for example) and restaurant foods . . . and in much larger amounts.

The challenge will be staying on this kind of restrictive diet long-term, but given my compromised metabolic system, keeping my blood sugar low will be a very good thing!

I will continue with experiments to see how different foods and amounts effect my glucose levels. It will also be interesting to see if my insulin resistance changes as I get more fit (increase exercise and amount of lean muscle) and (eventually) less and less visceral body fat (which has direct effects on hormones). Also, I suppose, to see if my battered beta cells (that produce insulin) are able to heal when not so much is being asked of them. In other words, can I become metabolically healthier--probably not normal, but at least to the point where my body can handle a higher level of carb and not kick my blood sugar above the desired levels.

I expect the weight loss to go back to normal next week. There's only so much fluid to lose!

Wednesday, 7-27-11

Breakfast: 3 scrambled eggs - 104
Lunch: 2 oz. cheese, 1/2 avocado, 93
Dinner: Chicken, salad, 1 tbl. coconut oil, 1 oz. macademias, 93

Blood sugars getting more consistent

Going much lower carb

I've already said that I'm a carboholic. But after re-reading Richard Bernstein's Diabetes Solution I decided I need to take carbs lower (at least for now) and closely track my blood sugar. He makes the point that normal blood sugar readings should be 80/85-100. Mine have been sometimes in that range, but post-prandial (after a meal) up to 150-170 after a lot of carbs (or a really big meal). Not good.

Consequently, I decided to follow Bernstein's guidelines, which are quite restrictive: 6 g carb for breakfast, 12 each for lunch and dinner (i.e. 30 g/day). Atkins "induction" is 20, the Eades recommend an induction of no more than 7-10 g/meal and less than 40/day. The Eades recommend staying at that level until metabolic issues have resolved themselves and weight is normal (some time away for me). That's what I have to do.

This means (for me) meat/fish/eggs/cheese plus salads and/or non-starchy veggies (green beans, etc.). No fruit, no nuts for now. I need to do this for at least 4 weeks or so to get a good baseline of food, how it affects me, and blood sugars. After that, I can experiment gradually (measuring blood sugar always!), adding (one at a time) low carb fruits (such as berries) or nuts (tough part here is to limit them!). Then I can know if I can stay within guidelines for carbs with fruit or nuts, but not blow my blood sugars.

I started on Monday. Following my colonoscopy on Friday, I relaxed on carbs over the weekend (partly because I knew I was going to go very low Monday!) with mostly moderate blood sugar, but one at 172 (yeah, I had soft drinks--NOT good).

Bernstein convinced me that I need to keep blood sugar in the correct range ALL the time. That for someone like me, metabolically compromised, allowing the larger numbers is NOT a good idea. Damage is constantly being done to blood vessels and nerves (which is why you see diabetics who are blind or have amputations--we had a colleague with both of those problems).

The American Diabetes Association says for tight control:

Tight control means getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 70 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin (A1C) level less than 7 percent.

For Bernstein this isn't even close to "tight" control. I want to move closer to his range, rather than the ADA's.

Here's where I am for the first two days:
Monday: waking 109; 1 hour after (normal post-prandial measurement) breakfast (3 eggs fried in butter, 5 cherry tomatoes) 115; chicken broth (remember, this is recommended when you start with this low carb content to replace sodium); dinner: steak, salad (forgot to measure after)
Tuesday: waking 95; breakfast: left over steak, 6 tbl coconut oil (supposed to help get into ketosis); pp 120; lunch: chicken (left over from a roast chicken we bought for dinner over the weekend), celery, cherry tomatoes, 1/2 avocado; 102; beef broth; dinner: 2 brats, sugar free jello; 98

This is a challenging diet for someone who loves bread, pasta, chips, and all manner of sweet things! It will be a challenge to stay with this, but I have to think about where I want to be, health-wise, for the rest of my life.

Picture of lunch below (very good, really!):

Week 2

Interesting week . . .

Colonoscopy on Friday, so weight went through the following changes:
Before prep (Thursday AM):

After MoviPrep (which empties you out, and after a day of clear liquids (in my case, homemade chicken broth, lots of water, and some soft drinks):

And then this AM (Saturday), after colonoscopy (all OK, by the way), then non-low-carb day (breakfast: 

2 eggs, bacon, hashbrowns, strawberries; dinner/Mexican restaurant: some chips and salsa, steak, 4 small nachos, ca. 1/2 avocado, beans, rice; and some nuts (pistachios) and 1/2 Jones cream soda:

And bodyfat:

Whatever water/fecal weight lost in the colonoscopy prep all regained a day later, probably to be expected (although I ate a high carb, large meal for dinner--had I eaten low carb, might have been different). Probably would have been healthier.

So, 6.5 pounds in the first two weeks. Plenty satisfying. 

Now back to lower carb!