How has Elisabeth been doing in the first month of her diabetes remission journey? Has she had any challenges or struggles? What has she learned so far?
To recap, on April 21, 2024 we made the first post about Elisabeth, 69, who lives in Victoria and was diagnosed with type 2 diabetes in late March 2024 with an HbA1C of 6.4%. She has decided to embark on a low-carb, whole foods way of eating and has invited us to follow her progress and experiences over the coming year.
Elisabeth is focusing on getting good sources of protein at every meal, such as eggs, tofu, chicken, fish, beef, Greek yogurt. She is eating as many vegetables and leafy greens as she wants and adding healthy sources of fat like avocado, olive oil, cheese, and butter. As a treat she enjoys plain Greek yogurt with fresh berries, especially blueberries for nutrients, fibre, and that “pop of sweetness."
“I think my key takeaway of the first month is that I haven’t found it hard to change my diet and stick to it. And that I am feeling just great,” she said. "And I've already lost five pounds."
What was she concerned about when she started?
“I was worried it would feel restrictive and that I would have a lot of cravings like I've had with diets in the past. But I am so happy that I am not feeling hungry or deprived. Instead, I’m finding this way of eating to be very simple and freeing. It is all foods I like, which makes if feel easy. But an added bonus is that I am buying less food and eating less and really enjoying what I do eat. It feels like I can eat this way for life.”
What about her physical health?
“It’s amazing. The weight loss is an immediate bonus. But within a few days of starting, I could feel I had way more energy. And I was so surprised that my joint pain rapidly got much better. I noticed it in my hands first. But, in general, I now ache less, all over, which I think indicates my inflammation is going down."
Trying a continuous glucose monitor
Elisabeth likes to track health measures and so she wanted to see how her dietary changes were impacting her blood sugar. She decided to try using a continuous glucose monitor, or CGM. These are sensors that are applied to the back of your arm and paired with an app on your phone to do real-time tracking of blood glucose levels 24 hours a day and learn how specific foods impact your readings. No finger pricking is needed for a drop of blood to test. (Elisabeth is checking her CGM blood glucose in the top photo.)
Her doctor gave her a prescription, which helps claim the CGM expense on extended benefit plans. But CGMs can also be bought in Canada by anyone without a prescription by asking for it behind the pharmacy counter.
Elisabeth first tried the Dexcom G6, but the sensor for her only lasted 10 days (rather than the 14 days advertised) and she did not find the app interface particularly intuitive or helpful. (Both of us were unaware at the time that the Dexcom G6 could be paired with another app, Clarity, to generate more graphs and trend data over time.)
Then Elisabeth tried the Freestyle Libre 2 CGM and has kept with it. “I love this one. I found it fascinating to explore all the data it provides.”
The Freestyle Libre CGM includes colorful daily graphs, time-in-range stats, estimated A1C results, an easy to use food logbook, and more. After collecting two weeks of daily stats, the app was able to estimate her likely HbA1C, the measure of how much glucose was sticking to her blood cells over time. To her delight it was estimating a new HbA1C of 5.4% - down a full 10 percentage points from her type 2 diabetes diagnosis of 6 weeks earlier and out of the type 2 diabetes range.
“My doctor tells me that I should take that sensor HbA1C estimate with a grain of salt, as the device can underestimate the true number, still it is very encouraging,” Elisabeth said. She will confirm the blood sugar results in a three month lab-test ordered by her doctor this summer.
The CGM did reveal two interesting lessons:
1. Seemingly small sources of sugar can still have a big impact on her glucose levels. Elisabeth had a jar of sour cherries in syrup in her fridge, that she did not want to throw out. One night, she ate just five and dranks about 1/3 cup of the sweet cherry syrup, but shortly after had her largest glucose spike, rapidly up to 8.9 mmol/L and then falling rapidly after eating them. And she could feel that spike and fall. “It was really interesting to see on the CGM. It was delicious, but I will think twice about doing that again. It will be a taste memory that sustains me during the odd temptations to break keto." (The cherries and juice are the last spike and fall in her CGM chart for Sunda May 5.)
2. Stress can be a potent source of blood sugar rises, especially for her morning fasting blood sugar. The past month has been stressful for Elisabeth as she navigates all the administration and tasks of the potential sale of her long-term family lot in Victoria and contemplates buying a new residence, or finding other living arrangements. “My highest morning blood sugar (6.6 mmol/L) came after a night of worry and fretful sleep.” That's because stress releases cortisol, with the liver making more glucose for sudden “fight or flight” energy needs, in a process called gluconeogenesis. Said Elisabeth: “It made me realize I have to pay attention not only to what I eat, but also to how I handle stress and to do stress-reduction techniques like meditation and mindfulness.”
Another lesson Elisbeth learned this month was to pay more attention to food labels, especially looking for hidden carbs and sugars in unsuspecting items like condiments, salad dressing, kefir, and packaged goods. “There are hidden sugars everywhere!”
Elisabeth is feeling so good, she is now planning to add back into her life more exercise and physical activity.
“When I started, I felt so tired I couldn’t contemplate adding in exercise, but now I have so much energy I feel ready to take it on.”
Next month we will update her other health measures. Stay tuned.
If you have any questions for Elisabeth or the team at diabetesremission.ca send them to contact@diabetesremission.ca
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