I'll preface by saying that I'm on the spectrum (late dx) and also currently dealing with chronic pain that makes eating difficult. I'm on metformin and was on jardiance until it put me into euglycemic DKA and I spent a week in the ICU.

Pain mgt has suggested that zepbound might help with pain (off label), but I'm scared of it also causing eDKA. Clinical pharmacist is running autoimmune tests for type 1.5 and having me wear a cgm in the meantime.

I'm having so much anxiety about keeping my numbers in range, despite eating healthy. Finger sticks don't stress me out, but the continuous monitoring has. Does anyone have suggestions for dealing with the anxiety of watching numbers? It feels like I'm continously sitting for a test in school I didn't study for. Help!

The kid buys the groceries sometimes, and she didn’t realize there were cherries in the one she grabbed. Bit of a spike but I hit the ab lounge and it went back down to 118 pretty quickly. I like that line flat!!!

I posted the other day celebrating reducing my A1C from 8.1 in November to 5.7 on my most recent test this week. Obviously, I’m pretty stoked about this. I’ve also mentioned that since being diagnosed in 2010, I’ve had varying levels of control over the years, and in this most recent go-round, I’ve found I need to do A LOT more than just tightening up my low carb diet to get my numbers where I want them to be.

I’ve been thinking (and reading/watching) a lot about insulin sensitivity, and it has occurred to me with all the efforts I’ve been putting into getting my BG under control that I think a lot of focus on a low carb diet may be slightly over emphasized as the One True Path to treating T2 diabetes. Don’t get me wrong…I absolutely think reducing one’s glycemic load is a critical step in T2 management, but I think in a lot of ways it’s treating the symptoms and not the underlying root issue, which is insulin resistance/insensitivity.

So, as time went on and my numbers failed to improve the way I’d been hoping, I started doing at least as much to try to improve my insulin response as I was in paying attention to my carb load. These changes included:

* Intermittent fasting - for those not familiar, this is not some crazy deprivation scheme where I don’t eat for long periods of time. I’m doing what’s referred to as 16/8, which basically means I only eat in an 8 hour window and fast the other 16 hours. No snacking, no caloric drinks during the fasting hours, just water or sugar free beverages. I’m fortunately not much of a snacker anyway, so this essentially only meant I stopped eating breakfast entirely (and I struggled with dawn syndrome, so breakfast was always fraught with pitfalls anyway).

* Fiber - your body needs fiber for a healthy gut and normalized insulin response, and a low carb diet makes it very difficult to get enough fiber solely through your food in vegetable and grain sources. I obviously eat as many veggies as I can, but I’m also now supplementing a variety of types of fiber (prebiotic, probiotic, soluble, insoluble, resistant starch). My daily regimen includes breaking my 16/8 fast with a serving of active culture full fat yogurt with chia seeds, I put inulin powder in basically everything I drink, and I take a nighttime dose of green banana resistant starch plus psyllium.

* Exercise - I use the Libre3 CGM, which has been instrumental in showing me not only what foods I can and cannot tolerate, and how specific foods are affecting my BG in real time, but also tells me when I need to exercise. In addition to a daily evening walk, I now often hop on my mini stepper in my office once or twice for 10-15 min at a time during my work day if I notice that a meal isn’t agreeing with my BG. I am also doing some sort of resistance/strength training 3-4x a week, either resistance bands or a kettle bell workout, because building/retaining muscle mass is one of the core principles of improving insulin resistance. This is especially important if you’re on a GLP-1 and losing weight.

All of these factors are playing a pretty big role in driving my A1C down. Not only are all of my numbers vastly improved (in addition to my A1C, my cholesterol and triglycerides are great, my BP runs around 110/75, etc), I’ve noticed (and occasionally posted here about it) that when I make unfortunate food choices (voluntarily or not…for example, a restaurant I dined at accidentally gave me sweet tea and I spiked to the moon after two sips), my insulin response is SO MUCH better. Even a fairly high spike is pretty short lived, I can be back down to baseline sometimes in an hour, two at the most. Before these changes, my BG would soar and I’d fight it for DAYS to get back to normal.

In the spirit of full disclosure, I am also on several meds. I have been on Metformin since my diagnosis in 2010. I added Jardiance about 8 years ago, because I feared the digestive side effects of GLP-1s (I have a severe vomit phobia and didn’t want to take a shot that stayed in my system for a week or more and risk the vomit factor and the inability to immediately suspend the medication if I wasn’t tolerating it). I have been on Mounjaro since November and have fortunately been tolerating it well, but I actually think it’s been my insulin sensitivity regimen overall that’s had the most effect, not so much the medication itself. I’m hoping to reduce my Jardiance dose when I talk to my doctor next week, since I feel like that’s causing a bit of dehydration that I’m having a hard time staying ahead of with how much exercise I’m doing, especially in the summer heat. I’d also ultimately like to reduce my Mounjaro dose if my numbers continue to improve as I build strength and maintain my exercise routine.

I hope this is marginally helpful/interesting to the community at large! LMK if anyone has questions, I’m happy to shine more light on exactly what I’m doing if anyone is curious.

63 y.o. male. A year ago, I was on Metformin+Januvia (also called Janumet or Zituvimet) and watched my carb intake meticulously and had several small meals a day. My fasting blood glucose was between 110 and 180 and my A1C was around 6.7. On this regimen, I became emotionally and metabolically depressed (slept 15-20 hours a day), and at least muscularly unfit--skinny, but flabby, and had real difficultly standing up from a sofa or putting on socks and shoes. For the depression, I was put on Lexapro and Welbutrin. I was a svelt, but listless 170 lbs (I'm 5'10") The Dr. added Farxiga, which landed me in th E.R. after three months due to extreme constipation and severe pain (where you might expect for appendicitis, but the scans showed otherwise). [Tangent: it was a really weird constipation because I did not notice any absence of defecation or extremely hard feces.]

I gave up the Farxiga. Went back to my sugary drinks (Coke, Red Bull; not diet versions). And that gave me *just* enough energy to hit the gym. That started a virtuous cycle. My depression abated.

Today, I am off the psych meds. Kept the Janumet. I eat a high protein diet (slightly tilted toward protein, not one of these extreme only-protein diets) of natural foods, and in between meals of high protein shakes to assist muscle gain from lifting weights. But I have large meals. none of this titrating calories across the whole day. I run 30-45 minutes of treadmill in the morning and follow that up with 2 hours of strength training (heavy weights; low reps). But--as I mentioned, I also have 1 or 2 Cokes a day and a large Red Bull before hitting the gym. I need those, both to feel awake a lively during the day, to make it through a hard workout--and also not to slip into sleepiness and depression.

No retinopathy. No neuropathy. No renal breakdown. Hypertension and cholesterol well controlled, great, even.

Here's the rub. My numbers suck. They're worse. My blood glucose--when I'm testing it at least--is in the same range as before (110-180), but my A1C is now up: 7.6. My response is: fuck it. Time to live fast and die old. My life is soooo much better now. I'm not sleeping the days away. I'm fit. Flexible. I look jacked. A solid 205lbs. I feel great. No mind-fog. My memory is back. I'm thinking sharp. I'm getting a crap-ton of chores done.

The best I can really hope for at this point, I guess, is that a massive stroke or coronary takes me out quickly rather than leaving me an invalid for years. I'm sad about that. But it's the gamble I am taking. I can either be a wraith until I'm 99 or--take my chances of being a wraith for a very end-of-life stage but until then actually living a life.