So, one year ago today I was given my Diabetes Type II diagnosis. I don't know an exact date for when my Diabetes developed, but I know that it was sometime between April 2010 (had bloodwork done & my numbers were normal at that time) and January 2011 ( had bloodwork done & my numbers were not normal). And based on symptoms I can even narrow that down a little more. We took our grandkids to Disney World in late May 2010 and I had no symptoms but by Thanksgiving I was experiencing hypoglycemic lows. So I have it narrowed down to a five month span of time. I'm going to lean closer to the end of that 5 month span since my symptoms are probably a good indicator. So we could say Fall 2010.
So much has changed in this past year with regards to my health and diet. I now know a lot of numbers regarding glucose, cholesterol, blood pressure and the likes that I had no clue about before my diagnosis. I was already on blood pressure medicine, but I just took the pill every day - no real knowledge or concern what the numbers were or meant. I was also on meds for my triglycerides. And again, I was just taking the pill - let the pill take care of the number. But once I was told I had Diabetes I realized that any and all of the health issues I was taking meds for would all become more important simply because Diabetes tends to complicate most health issues.
I also now know how, when and why to test my glucose. Who would have thought that pricking my finger daily would become such a non-event? But after the first few weeks it pretty much became a non- event. I do it almost without thought now. In fact, my 7 year old grand-daughter does the finger prick for me when she is here. For some reason she loves helping me with my Diabetes - be it fthe finger prick or reminding me that I can't eat sugar (not that I do anymore, but she will ask for a snack and tell me she would like a Kit Kat Candy Bar end then say "But you can't have it cause it has sugar, right?").
And, when first diagnosed, my BG and A1C were both so high that I was immediately put on Metformin and Insulin injections. And while the injections never became a non-event, it did get easier before it got better. Initially I had a herder time injecting myself so I had my husband do my injections, but God love him, I know he cared and I know he meant well, but I think he became too complacent after a few weeks and I started feeling the injections more than I thought I should. I knew that I needed to tough-up and do this myself. It wasn't all that bad and I actually got pretty good at it. But fortunately I was also making major changes to my diet and exercise and was able to get my blood glucose numbers into control well enough that I came off the insulin completely.
With continued diet modification (I can't say continued exercise since that has more or less fallen to the way-side - but honestly, who wants to stand in their den and do exercises all alone day after day - it is just so uninspiring and un-motivating to me.), but anyway, with continued diet I have managed to keep my BG controlled well enough that I eventually came off the Metformin also. Coming off Metformin was primarily to address major hair loss I was experiencing. I was shedding worse than a sheep dog in the dead of summer in South Alabama. I could walk from my bedroom to my kitchen and drop no less than 10 hairs on the way - and that is a short stroll in my tiny house. And, having now been off Metformin for a few months my hair loss has subsided. If ever my BG becomes too hard to control without meds I will address the hair loss issue at that time. But until then, I will stay the course and hope my diet keeps my glucose in good control for a long long time.
So, that brings me to my One Year Diaversary - and I now consider my Diabetes to be a non-event. It is a fact of life and a pert of who I am, but all in all it is currently just the impetus behind my diet choices. I will never eat sugar as I once did and I will forever choose diet drinks over regular drinks (something I wanted no part of prior to my diagnosis) and I will be selective and limiting in regard to carb foods.
My next goal is to reach my 5 year Diaversary without having to get back on any Diabetes meds. Here's to the next five years being non-events! (clink clink)
I don't expect to have to update this blog for five more years, so, until then, Goodnight Moon. :D
by Jim Hartmann
One of the most frustrating things that diabetics deal with is an unexpected rise in blood glucose overnight. You go to bed with a BG of 100 mg/dL (5.6 mmol/L), and wake up with a BG of 130 (7.2)! You didn’t eat, so what happened?
This results from two distinctly different processes: Dawn Phenomenon and Somogyi Effect. Here are some basics.
Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies’ circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a woolly behemoth for breakfast.
Since most of us fast while sleeping, with teenagers a possible exception, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy.
The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis.
Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally “the creation of new glucose”.
So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream.
Dawn Phenomenon, and its associated increase in insulin resistance, is the reason most diabetics are far more sensitive to carbs in the morning.
Dealing with Dawn Phenomenon
There are many ways of defeating Dawn Phenomenon. You will have to experiment with the following suggestions to see what works for you.
- Try eating no food after dinner. This works for people whose Dawn Phenomenon isn’t very strong. Basically, it lowers their baseline BG, so that when DP does hit them, the increase keeps them below a certain level, usually 120 (6.7).
- Try eating a small snack of fat and protein before bed. Most find that a tablespoon of peanut butter, or some cheese and deli meat are effective. The theory here is that the slow-digesting fat and protein holds their BG high enough overnight to avoid Somogyi Effect (see below).
- Eventually, you will learn how the two disparate approaches above work for you. Hopefully, you will set personal targets to guide you, eg., if my BG is below XXX (insert your target here), I need a snack. If my BG is over XXX, I don’t need a snack.
- The prescription medication Metformin HCl (Glucophage) is often very effective in limiting Dawn Phenomenon for Type-2s and insulin resistant Type-1s. Of course, Type-1s can adjust their basal (slow) insulin regimen to account for Dawn Phenomenon.
- Lastly, EAT BREAKFAST. The resulting increase in blood glucose from food will often turn off the continued rise. If you don’t, some diabetics will continue to rise until 10-11 am.
Somogyi Effect, named for Dr. Robert Somogyi, its discoverer, is a high morning BG due to a low overnight. It is most commonly seen with insulin using diabetics, but is also seen with overnight reactive hypoglycemics.
The mechanism is a low overnight, which causes the body to react by releasing many of the same hormones seen in DP. The strongest blood glucose increasing hormone, glucagon, plays an important role. It tells your liver to start glycogenolysis and gluconeogenesis to provide enough glucose for your body to survive. This is sometimes referred to as a Liver Dump. Often, this mechanism over-produces, and you wake to a significantly higher BG.
Setting your bedtime BG target a bit higher, will usually prevent you from having a hypoglycemic event overnight.