Wednesday, July 13, 2016

Monitoring your own health - Blood Glucose

If you asked me what is the one thing I can track myself to monitor my health it would be blood glucose.  This is a measurement of the amount glucose in your blood stream.  Its very simple to do yourself and is cheap.  No fancy blood tests, urine analysis, or scooping poop into a tube.  The simplest measurement is fasting blood glucose.  You simply fast for 12 hours and then measure your fasting glucose.  So eat dinner at 7pm and them measure your fasting blood glucose in the morning at 7am.

I use a ReliOn Prime meter from Walmart.  They are only $10 now and I like them also because the strips and lancets are very cheap, so the cost per reading is very low.

The reference range for blood glucose is 66-99.  However as I've mentioned before the reference range does not stand for optimal range.  Anything over 90 fasting is probably cause for at least more investigation.

The Cleveland Clinic Foundation now uses a fasting blood sugar of 90 mg/dl or higher as a biomarker of coronary heart disease risk. The Cleveland Clinic gets very concerned when they someone with a fasting blood sugar above 90 mg/dl. They try to intervene with exercise, diet and weight control.
Type 2 diabetes isn’t the only disease associated with prediabetes. A meta-analysis that included data from nearly 900,000 people found that those with prediabetes have a 15 percent higher risk of cancer, especially cancers of the liver, stomach, pancreas, breast, and endometrium. 
Fasting Blood glucose of 95 or higher have a more than 3X risk of developing future diabetes than people with a fasting of below 90 
However don't expect your doctor to say anything until you are at least prediabetic.  Diabetes is a very slow developing disease it doesn't just happen overnight.  It takes years to develop the insulin resistance.  Here are my results from a 2014 doctor visit.

As you can see not only am I not even optimal but I'm already slightly above range and not a word from the doctor on this.  A year later I had a result of 113 mg/Dl fasting.  That did finally trigger some comments from my doctor.

Here are the doctor ranges for prediabetic and full blown diabetes.

I think it is much better to take action before you are prediabetic.  Certainly much better than when you have diabetes.  It is much harder to reverse once you are at that point and very insulin resistant although not impossible.

Consider this fictional graph.

This clearly tells a story that your glucose response is getting worse and you are trending in the direction of prediabetes.  However these results are all within range.  The doctor will be more focused on the ranges and if you fall within them.  You need to keep an eye on your trend.  In the above scenario it is highly likely you will get the ok from the doctor but its clearly going to be a problem if you continue on this path.  Use a site like wellnessfx to input all your test results and you can then view them in a nice graph format on their dashboard and look for trends yourself.  I personally don't put my glucose results in there but use a spreadsheet as I have taken so many.  Below is all my data although lately I've haven't been taking many readings.

The blood glucose monitors themselves are not super accurate.  It is not uncommon for them to be off around 10%.   So if you're doing it yourself you will want to take multiple readings over days to get more of a trend than relying on a single entry.  Looking at my own results it certainly appears to be trending in the wrong direction and my results are certainly close to that prediabetic range of 100 - 125.

At least for 2016 YTD I'm trending down so it isn't all bad news.

If you want to get a little more technical and do more analysis above and beyond the fasting number, the next thing to do would be to take your post prandial readings.  Basically it means to take your readings after a meal to see what your glucose response is.  Typically you take it 1, 2 and 3 hours after a meal.  For your post meal 2 hour readings

Normal <140 mg/dL
Prediabetes 140-199 mg/dL
Diabetes >200 mg/dL

These aren't optimal you probably want a 2 hour post prandial < 120 mg/dL.

Here are all my 2 hour post prandial readings, obviously the amount of carbs in the meal is going to greatly effect the results.

So it looks like at least my 2 hour post prandial numbers look pretty decent.  I only have a couple that were above the 120 optimal threshold although I think the vast majority of these meals were pretty low carb.

Here is a closer look at my blood glucose throughout a typical day.  I stay low carb until dinner as you will see.

Breakfast - Coffee & Heavy Cream  (basically fasted)
Lunch - Sardines, Avocado, 3 eggs, Broccoli, Olive Oil, Mayo (avocado oil based)

Lunch Macros

Dinner - Ground Beef, White Rice, Broccoli, Cauliflower, Cabbage, Carrots, Cheese, Sour Cream, Blueberries

Dinner Macros

Here is my blood glucose throughout the day.  I measured it every hour and then every 20 mins for 3 hours after each meal (lunch & dinner).  Yes that is a lot of finger pricks.  I don't normally snack but I did have a spoonful of almond butter at 16:30 as I just wanted to see if there was any response to this type of snack and as I expected there was none.  I think its important to keep the area under the curve (blue area) for the whole day as small as possible.

Here I overlay the 2 post prandial readings so you can clearly see the different responses to meals with carbs and without.  My lunch which is low carb high fat barely even registered but my dinner which has many more carbs particularly from the rice and fruit has a much bigger response.

From the above graph based on my dinner I'm in the not optimal but not in the classic definition of pre diabetes as over 140 after 2 hours.  However it does also spikes back up to almost 140 around 2 hours 20 mins.

Another check is to get your your A1C measured.  Your A1C is basically a 3 month average of your blood glucose.  You can get your doctor to do it or Walmart has home kits for like $20.  For me its kinda of useless since I give blood so often for my Hereidtary Hemochromatosis it messes up my A1C readings.

For A1C
Normal < 6.0%
Prediabetes 6-6.4%
Diabetes > 6.4%

Again these aren't optimal, you probably want an A1C < 5.3%.  Also A1C is not that reliable for some people so it should just be part of an overall snapshot of information, don't use it as your sole data point.

So why do we care about blood glucose readings.  Well the main reason is for prevention of diabetes which is a pretty horrible disease and exploding in developed countries.  Also as mentioned earlier higher blood glucose (even non diabetic ranges) is a marker for heart disease and cancer.  Here are some diabetes numbers according to the CDC  in 2014.

Total:29.1 million people or 9.3% of the population have diabetes.
Diagnosed:21.0 million people.
Undiagnosed:8.1 million people (27.8% of people with diabetes are undiagnosed).

What this looks like over time is an epidemic in diabetes.

So what am I doing to try to improve my insulin resistance and bring my fasting glucose to a normal range?
  • Eating a lowish carb, moderate protein, high fat diet.
  • Saving my carbs for the evening hours
  • No processed sugars or carbs
  • No grains 
  • Very limited fruit, especially fruit that is high in fructose.  I go for more of the dark fruits like blueberries, blackberries etc.  
  • Exercise, weight lifting especially can decrease insulin resistance
  • Intermittent fasting
  • No artificial sweeteners
This is just what I'm doing and with very limited success so far it would seem at least for my fasting number.  I'm taking a wait and see approach as my iron overload from Hereditary Hemochromatosis could be part of the problem.  The liver and pancreas are major players in blood glucose and they both can be affected by iron overload.  Its probably why diabetes is one of the possible outcomes of HH.  This study suggests that iron overload is associated with insulin resistance.  So until my iron is at a normal level I might just be spinning my wheels on this.  I suspect i'll have to get my iron down and then have to reverse the insulin resistance over time.  I'll revisit this once my iron is under control but in the meantime I'll continue to take occasional readings to make sure I'm not slipping in the wrong direction.


If Your Fasting Blood Sugar is Above 90 You Are At Risk of Heart Disease

How To Prevent Diabetes And Heart Disease for $16

Why your “normal” blood sugar isn’t normal (Part 2)

Why Hemoglobin A1C Is not a reliable marker

Peter Attia's Use of a continuous glucose monitor

The Dawn Phenomenon (High Fasting Reading)

'Healthy' foods differ by individual

Physiological insulin resistance

4 Ways to Control Blood Sugar With Exercise

No comments:

Post a Comment