I have an endo appt in two weeks, and since I've been struggling so much lately, I have some questions that I want to post here before seeing him.

1. Does anyone have issues with cooked carbs only? Meaning, I can have an apple or two in a row (or a mango or two in a row) with no problems, but the minute I eat two apple's worth of apple crisp (minus the crisp, just apple baked with splenda brown sugar), I spike.

2. When my endo put me on Januvia last March, I began experiencing a racing heart for about 20 minutes after I ate. I ignored it, figuring it was some weird side effect, and it went away when I stopped taking it...until a month or two later when I started getting highs again. This has been going on and off since about June or July, and it's getting annoying. I DO have a high c-peptide and, though my heart races with or without highs, it's always worse if I'm going to be high. Has anyone had this?

3. Is it "normal" for him to basically have asked me to give up carbs completely? At this point, it seems the only carbs I can eat are fruit and dairy. I know that some people with T2 eat less than 30 carbs a day, but at most, I'm pre-diabetic (latest A1c 5.1). Does this make sense?

4. Has anyone here come up negative for antibodies at first and had them appear later? I was tested for antibodies nearly two years ago (anti-GAD and anti-Islets, nothing else). He'll probably test me for them again if I ask, but is it even worth it? I'm young, active, barely overweight, yet I was 200 an hour and a half after eating about 40 carbs worth of those aforementioned baked apples today. The things that make me wonder the most are that I'm SO extremely sensitive to steroids, even inhaled steroids that aren't supposed to be absorbed past the lungs, and that the highs got SO much worse about a month after stopping the Januvia.

Thanks in advance for your answers! I'm sorry to be bothersome but I've been nearly 4 months with very few carbs and I've been waiting for this appt since I realized how hard this would be (and how it wasn't working as well as we'd hoped) in December.

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Maybe there's some reactivity to gltuen or something going on? A lady I work with, no D, had had that and felt horrible until they dx'ed it and she adjusted her diet.

Rice, sweet potatoes, processed corn products (including homemade popcorn), white potatoes, etc. bother it every bit as much as wheat-based products do.

Originally, my endo thought it might be an enzyme deficiency, but since it's getting worse and encompassing more foods, I'm beginning to think it's something on the D spectrum.

You post several question but they certainly are not bothersome. One of the reasons this community exist is to help with questions.

1 Thats a new one on me but I do know that fruitose is a problem for many. I don't know why cooked friut would be more of a problem unless something is added in preparation.

2 I looked up the side effects of Januvia and increased heart rate was not listed

3 A reduced carb diet is very helpful for people with diabetes(PWD) but 30 grams a day seems extreme. Grains are a problem for most PWD, a better choice is leafy vegetables and proteins. I'm surprised you do so well with fruits and dairy but all diabetics are different. A person can't live without carbs the key is moderation and learning what sets your bg off and limiting those foods.

4 I really don't know about the GAD test but I do know that a lot of LADA type 1's were initially misdiagnosed as type 2. Steriods do cause an increase in BG for most PWD. When you stopped the Januvia did you replace it with something else to help prevent high bg if not you can probally expect more highs.

Thanks!

Two tablespoons of flour and 1/2 cup of Splenda brown sugar (which usually works well for me) were added to 8 thinly sliced apples.

I, too, looked up the side effects of Januvia (great minds think alike, apparently) and I just assumed that I'm weird and I should just live with it. The fact that it continued makes me think it might have something to do with my high c-peptide (my last one was 9.7, I think, where normal is somewhere between 2 and 4).

Oops! My daily intake of carbs is probably somewhere closer to 50, but I've seen some people here talk about the Bernstein Diet, which seems to be 30 grams per day. I can't live with it either way. And correct me if I'm wrong, but aren't whole grains usually okay in moderation? As in, one slice of whole wheat bread balanced with other things that don't annoy BG? That's 15g and it's a whole grain...of course, I can't eat that, but I thought other people can?

About the steroids and the Januvia, well, it's a little long, but I'll try to shorten it.

I was put on inhaled steroids for asthma (which it turns out I don't even have). While on them, I watched my BG go up and up, so I checked out the side effects. None of them even mentioned high blood sugars, even in PWD. The one I was on (Asmanex) the day I called my endo freaking out about being 200 2 hours after one thin slice of whole wheat pizza is supposed to have less than 1% systemic biovailability (meaning it's really not absorbed into the bloodstream). He put me on Januvia until I got off the steroids, at which point I didn't need it anymore. A month or two later, I started getting highs again, even though I'd been off the steroids and hadn't been eating anything crazy.

Getting highs after getting off the Januvia sounds like LADA to me, since it would likely provoke the immune system to attack more beta cells. A lot of this also sounds like LADA, and I've thought about it. The problem is that my antibodies are normal and my c-peptide is sky high. Most endo's don't test adults for antibodies, which is how so many LADAs get diagnosed as T2 initially.

The fiber in raw fruit slows down digestion some. When cooked, the fiber is more digestible, thus higher carb. The carb counts for cooked & raw fruits & vegetables are different.

Do you eat vegetables? Wondering since you mention the only carbs are from dairy & fruit.

Fructose is problematic because it's the only sugar that's metabolized by the liver.

Whatever it takes to keep BG level is the goal, of course. I've been eating 30-40 carbs for over 4.5 years.

Not common, but you could be MODY. There are various MODY forms & MODY doesn't present with positive antibodies. MODY DNA testing is expensive.

Okay, the fiber thing makes sense.

I eat tons of vegetables! I just can't eat any with carbs in them, so no sweet potatoes, etc.

I'm going to ask my endo about MODY, especially since my father also has BG problems, but I don't really fit any of the profiles.

All vegetables have carbs:)

Non-starchy vegetables have very few

If you're counting carbs, it adds up & also depends on quantity. You said you eat lots of vegetables, so you might want to calculate the real amount of carbs you're eating. Foods like tomatoes & onions have quite a few carbs. So do spices for how relatively little is used.

I don't like tomatoes or any of the squashes, and if I use onions, there aren't many. I eat lots of vegetables, but they're usually one serving at a time, at most two. Those meals (or snacks) aren't the ones that bother me, they're the ones with other carbs involved. A typical dinner for me is a serving and a half of a protein and a salad or sauteed zucchini. Even when I have sauteed peppers and onions as a side dish, my BG doesn't go crazy.

Interesting questions. Here is my cut

1. Cooking foods makes them more bioavailable. This is why raw vegan diets may seem to work so well, you essentially get less food. This effect is not surprising.

2. If you have sudden changes in your blood sugar levels, that can lead to surges in hormones and the effect you describe.

3. If you are T1, then you are T1. There is no pre-diabetic, it is only a question of how your diabetes will progress. If you tightly control your blood sugar, you may be able to delay moving to medications and then insulin for some time. Perhaps years. That is why no carbs.

4. Antibodies can come and go, but they are highly associated with T1, 85-90% of T1s tested come up positive. They do occur in other populations at low rates, some suggest that perhaps 15% of T2s test positive and similar rates in the non-diabetic population. But it is not at all clear whether these are simply cases along a spectrum which have not emerged as full blown diabetes. If you are 200 mg/dl 2 hours after eating 75g of carbs (an OGTT), then you have diabetes and that basically seems that is your case.

Don't ask your doctor for more tests, ask him to explain his diagnosis and why be believes it is the right one.

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