Why I've Been Quiet

I've been quiet for most of the week; haven't even posted much to Facebook. I apologize, and feel like I owe you all an explanation.

Those of you who have listened to this week's podcast know that Dr. Andry, the doctor who diagnosed me with PCOS in the late winter, put me on a new blood sugar drug, Victoza, a week ago this past Wednesday. It seems to be doing the job, though the verdict is not yet in. My morning, fasting blood sugar numbers are sporadically looking better; the question is will that become a constant thing?

(For those of you who missed it, Dr. Andry explained that my fasting blood sugar is high because of the same high nighttime cortisol levels that screw up my sleep patterns -- they also stimulate my liver to make too much sugar. Most of the day my blood sugar is fine, and my A1C levels have always been stone normal.)

However, one of the side effects of Victoza has been fatigue, sometimes pretty severe fatigue. For over a week, I went through my day yawning, having a hard time thinking enough to write. I looked it up, and this side effect passes for most people by the end of the first month, and indeed today I feel fine.

Another side effect is a dramatic reduction in appetite, and -- at least early on -- stomach upset, especially queasiness. My appetite has, indeed, been dramatically reduced. Some days I've practically had to force myself to eat. I have had more than a few moments of queasiness, though I've never actually been sick to my stomach. There are also moments where I can feel that my stomach is empty, but can't think of anything that sounds good.

This is a very strange place for a cookbook author to be. I'm not entirely certain who I am when I'm not interested in food, when food is merely something I do because my body requires it.

It's early days yet. Just as my fatigue has apparently passed, I am hopeful that the reduced appetite will persist, but that as the queasiness subsides I will once again be interested in food, if in smaller quantity.

Too, Victoza is very expensive. Right now I'm working my way through the sample Dr. Andry gave me, but I do not know if my insurance company will agree to cover it. I guess we'll find out if the stuff starts to result in consistently normal fasting blood sugar readings. If my insurance company will not cover it, I'm not at all certain I can afford to continue to take Victoza, regardless of how well it works.

Anyway, that strange limbo of fatigue, queasiness, and a truly bizarre lack of interest in food is why I've been so quiet recently. I will strive to do better in the coming week.

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Victoza

I have also started using Victoza........for about a week now. I have noticed that I am still extremely tired after waking up from a full night's sleep, even though I just started using a CPAP.

I usually take it in the morning along with my Lantus, etc. Since that is when I take it I'm beginning to think that the fatigue comes near the end of the drug's effectiveness, so I'm going to start taking it in the evening and see if it will aid in helping me fall asleep and stay asleep. What the heck, it's worth a try!

BTW-Since taking Victoza my fasting glucose has dropped from over 200 each morning to a range of 113-140!

Victoza

I'm actually not on any blood sugar meds at this point, and my morning sugar is generally in the 80s. I do take cinnamon, which is supposed to be one of the most effective hypoglycemic herbals. But I think the big thing is that I'm eating less protein and more fat -- I actually aim for roughly 80-85% of my calories from fat. My blood sugar seems to really like it. :-D

Blood sugar

From everything I have read, one VERY important thing to do for controlling blood sugar is eating every few hours (to be determined by a 5-hour glucose tolerance test that you can do at home with your blood sugar monitor. You can find instructions online). Based on when your blood sugar drops, you then make sure to have at least a couple bites of something including fat, protein AND some carbs at least 30 minutes before your blood sugar would be dropping. For some people, this is every 1.5 hours, for others it is every 3 hours, etc. Just depends. Some people end up not eating "meals" at all but rather 2-3 bites of something every few hours. As others have said, a snack before bed with protein, fat, AND some carbs (but they can be good veggie carbs or seeds or something) can help with overnight blood sugar issues as well as with insomnia/cortisol.

You post often that you eat a huge breakfast and then don't eat for hours and hours. This could be wreaking silent havoc with your blood sugar and your hormones. There is a great book about blood sugar called "Hypoglycemia: The Disease Your Doctor Won't Treat" by Jeraldine Saunders that might help.

I Love Victoza-you can, too

One strength doesn't fit all with Victoza. I have been on it a while and when you think of the money saved on snacks and meds I could drop, plus grief with type 2 diabetes overactive liver glucogenesis, it's been worth the money. I had to tweek it a little and hope my experience will help you.
1)Because you are on a low-carb diet, you may not need the 0.6 or 1.2 setting and the pen can be set for another setting. The 1.2 setting was way too high for me and 0.8 is where I found the best setting for me after slowly moving up. I am only 5'1" in stature and have also been on a restricted carb diet for a while, so this setting felt best. 2)I also tend to forget to eat lunch till 2pm sometimes so set my cell phone to remind me. I make favorite meals ahead to freeze for days when I don't feel like eating and microwave them(mini quiches).3) The side effects you mentioned happen to me, so I take my shot in the evening when I feel the cravings most and helps with sleep, since I also feel "fatigue" after but feels more like a tryptophan-like sleepiness I feel after Thanksgiving!!
I hope this helps. Feel free to email me if you need a fellow low-carber to commiserate with. It's truly an amazing medicine-just give it time and it can help you with your symptoms. Low-carb diets tend to preserve most people's natural level of GLP1 which some believe help them keep cravings at bay, but with metabolic problems, we may need more and Victoza is closer to our natural hormone than the others out there.

Your drug

Hi. I too am on a very expensive drug. It I buy it through my insurance company it's $1000 for a 3 months supply. So I ventured to the word of Canada Pharmacy. I'm not an employee - I'm not advertising it - but now my drug is $90 for a 30 day supply of Generic and $100 per month for brand name. Investigate for yourself - there are other companies out there. This company exists to sell drugs at a lower cost to America. Some of the generics I get are better than others. But it's allowed me to stay on my medication. I hope this helps you and others in similar situations.

fasting glucose

I'm no diabetologist, and maybe no one knows the answer to this question, but what population are "normal" fasting glucose values based upon? I can't help but hazard a guess that the population is eating the standard American diet, or something close to it. Are these values generalizable to those who are eating low carb? I too have heard again and again, that low-carbers' fasting glucose tends to run "high". I did some sleuthing on the internet and came up with this article in PubMed: ADA 2009: Expert Committee Recommends Use of Hemoglobin A1C for Diagnosis of Diabetes. http://www.medscape.com/viewarticle/704021
The committee argues that HgA1C is a much better indicator of whether a person's blood glucose is abnormal because it is based on an average of blood glucose over two or three months, rather than on random samples which, as you can see from personal experience, Dana, vary quite a bit from day to day. I don't know if this recommendation has been codified, but it makes me think that if your A1C is normal, there is no need to worry about fasting glucose.

Do you read Diabetes Update?

Do you read Diabetes Update? The author is a diabetic who spends the majority of her time studying the latest diabetes related news and research. I find she's a really good source for information about diabetes drugs, in particular. Here's what she had to say about Victoza (short version, she's not a fan):

http://diabetesupdate.blogspot.com/2010/01/victoza-new-competitor-for-byetta.html

High fbg on low carb

I keep reading that fasting blood glucose runs high when you're eating very low carb. I also have normal daytime glucose readings, and normal A1c, but morning glucose readings are creeping up, as high as 118 some days. What's up with that?

Similar issue and a question

Hi Dana,

Diagnosed with PCOS over 10 years ago, I have been on Metformin for years and I think it has helped me in some ways... I have a period at least, and my endocrinologist says it has helped me keep diabetes at bay. I started low carbing at the end of Feb (mostly due to YOU and Gary Taubes... thank you!!) and for the first time I feel better and have had unprecedented weight loss for me! Over 30 pounds! I love all your recipes and have purchased several of your cookbooks and your original book. I have also turned several folks onto your podcast, blog and books and they are also in love!

However - I am having the same issue with morning BG... ALWAYS higher than when I went to bed at night. I will test at night and it will be 85-100 tops but then in the morning between 100-130... once 141! I emailed my endocrinologist about this to see if I should take my vitamins and/or metformin in the morning instead of at night like I have consistently done. His response... "What you are observing is not unusual, but not due to the vitamins or metformin at night. In fact, taking more metformin (I already take 2000mg) at night might lead to lower numbers in the AM. Liver production of glucose is mostly done overnight and metformin helps to suppress this action." He also said that if the numbers keep up we will have to add "another agent to improve control".

I do find that if I happen to eat dinner later at night than usual, my morning BG is lower (closer to the 100-110 mark), so maybe Kate is on to something... I intend on trying this as well.

I have my appointment a week from today, so I am curious and nervous for the outcome of all my levels. First because I really do not want to take additional medicine and second because of what is happening with my husband.

The reason I am nervous about the results is that while I know we are metabolically different, my husband started low carbing the same time, has lost more than 25 pounds and decided to go for a three month (post starting low carbing) check up of his levels. His cholesterol was a bit high pre-February. Well his numbers, according to his doc, are so bad now that his doc wants him to go on statins ASAP. I said that I had heard and read that it takes more than 3 months to get your body acclimated to a new way of eating and I plan on asking my endocrinologist about this next week. I know I heard in one of your podcasts (which I cannot find now) that if your HDLs are low, then your LDLs will most likely be higher than the doctor would like. His levels are as follows...

September:
Total: 217
Triglycerides: 313
LDL: 119
HDL: 35

June (low carb started in Feb):
Total: 278
Triglycerides: 108
LDL: 220
HDL: 36

Anyway, I will be curious to see what doc says, but all so confusing at times. We both feel GREAT, have loads of energy and look better than we have in years! We already own "Why we are Fat", but in his panic to discover what the heck is happening with his levels he just bought "Good Calories, Bad Calories" as well.

Thank you again for your continued support thru your blog, books and podcasts!
Lisa

Higher readings on lab tests

As a clinical laboratory scientist (read Lab Rat), I just want to warn folks to be careful and question lab results at times. A lot may depend on the type of analyzer used to perform testing, the type of specimen obtained, the actual collection process and testing process. Some waived testing devices used in physician offices and health screens can have some seriously skewed results. One of the areas I monitor uses an instrument for employee health screens (Total Cholesterol, Triglycerides, LDL, HDL, glucose) occasionally has really high results. The person has a a venous specimen drawn and tested in the hospital lab and finds their values are totally normal.

Each test system has limitations. For example, the example I'm referring to can give elevated levels due to glycerol in hand lotion (we now require all folks to wash with soap and water first).

Not to say all results should be questioned but if you suspect something isn't right, ask questions about where the testing is done and perhaps get a second test performed at another lab to verify.

Blood fat ratios

Actually, it's triglycerides that tend to go inverse to LDL. LDL is not directly measured, but rather calculated with something called the Friedewald Equation: LDL= Total Cholesterol - (HDL + Trigs/5) You can see that lowering the triglycerides would result in a higher LDL in this equation.

A bigger concern, to my mind, is his HDL, which should be coming up on a high-fat/low carb diet. That it's not says to me that something is off.

Personally, I wouldn't take statins if my TC was over 300. I consider them highly dangerous; take a look at the work of Duane Graveline. Too, I'm unconvinced that high cholesterol, in and of it self, is in any way dangerous. Still, it might be a good idea for your DH to ask for a VAP -- the test that looks at the particle size of the LDL. Turns out that big, fluffy LDL particles aren't dangerous, it's the small, dense LDL that seems to do mischief, and low carb diets tend to slant production to big, fluffy LDL.

Thanks

Thanks so much for your response. That clarifies my confusion a bit. My DH and I are both very leery of statins in general. I will check out Graveline's work.

Good luck with your recent issue - hopefully your fatigue lessens and you start feeling better soon!

Going through that myself...

Hi Dana, sorry to hear about your PCOS woes. I have gone through the same thing myself, having been diagnosed with PCOS in the spring. Like you, my fasting glucose is elevated, but my hba1c is normal. My random glucose tests throughout the day are normal. I just wanted to say that I've been there.

I haven't been taking Victoza, though. I've been taking low doses of metformin (glucophage) at night, and I've seen an improvement in fasting blood sugar. Metformin is cheap and widely used for PCOS and insulin resistance-related issues. I'm not sure if you've tried or can't take it for some reason, but just wanted to let you know that Metformin can make a difference.

Also, I've noticed that having a snack with carbs and fat right before bed can make a difference. I like two ritz crackers with a tablespoon of peanut butter or cream cheese in between, or 1/4 cup of raspberries in a few tablespoons of heavy cream, or an ounce of cashews. No idea why this works, but it may be worth a try.

Good luck!

Kate
getfitkatie.blogspot.com

PCOS

Yes, I've been taking Metformin, that's the first thing we tried. Hasn't been sufficient to get my morning BG down into the normal range. It's weird, because my "high" BG isn't that high -- the highest I've seen it has been 125.

Hmm. I'll try that with the snack. I don't want to eat Ritz crackers, but I could do cashews, or some berries or something. Thanks!

Victoza blues

You have certainly been missed! I do hope the Victoza side effects relent soon -- except for the desire to consume less food, of course. Checked out the Victoza website: naturally, the people advertising the drug look a lot more jolly than you are feeling right now. No surprise.