Author: Dr. Ada Ozoh

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Pain in the legs in diabetes (diabetic nerve damage)

Diabetic leg and foot pain can be excruciating. It is often caused by diabetic nerve damage (neuropathy). This is a type of damage that is peculiar to people with diabetes. It is one of the most common complications of diabetes. Pain in the legs can affect up to half of people with type 1 or type 2 diabetes.

This nerve damage may be mild initially, but gradually it gets worse. The pain in the feet may become so bad that it gets in the way of everyday activities.

Nerves are specialised tissues that do several things in the body.

  • They send information back to the brain about things going on around you through your senses like sight, smell and touch.
  • They transmit signals from the brain to other parts of the body. This tells them what to do, for example, to wiggle your fingers.
  • Through the nerves, the brain controls your body functions like your heartbeat and digestion that you can’t control directly.

What causes neuropathic pain in the legs in diabetes?

Over time, uncontrolled and persistent high blood sugar causes damage to the nerves. They malfunction and stop firing the way they should.

High blood sugar, over a long period, damages the blood vessels that feed the nerves. How do you feel when you haven’t eaten? You feel hungry, irritable and you can’t function efficiently. That is exactly what happens to your nerves. They become nutrient-deficient, hungry and irritable.

Different types of neuropathy

Peripheral neuropathy

Peripheral neuropathy usually affects the legs and feet but may also affect the hands.

It is the most common type of diabetic neuropathy. It is usually accompanied by:

  • sharp pains,
  • numbness,
  • tingling/burning,
  • electric shock sensation and
  • increased sensitivity to touch.

Peripheral neuropathy is usually worse at night, although it can occur at any time of day.

Autonomic neuropathy

Autonomic neuropathy affects the internal organs – the heart, stomach, intestines and sex organs. Damage to nerves in these areas can lead to:

  • painful swallowing,
  • nausea, vomiting and loss of appetite,
  • diarrhoea, constipation and faecal incontinence,
  • persistent first heartbeat (tachycardia),
  • dizziness and fainting when you change position/stand-up (postural hypotension) and
  • problems with urination.

Proximal neuropathy

Proximal neuropathy affects the nerves in the buttocks and legs. It can lead to:

  • severe pain,
  • weakness of the muscles,
  • shrinking of the muscles and
  • difficulty in rising from a sitting position.

Mono neuropathy

Mono neuropathy affects a single nerve and can occur anywhere in the body. It may manifest as:

  • aching behind one eye,
  • double vision,
  • paralysis of one side of the face and
  • weakness of the hands, which may make you drop things frequently.

Risk factors for developing pain in the legs in diabetes

Prolonged, uncontrolled high blood sugar is the biggest risk factor for developing diabetic leg and foot pain.

The longer you have diabetes, the more likely you are to develop nerve damage.

If you have kidney disease, you are at a high risk of developing neuropathy. Being overweight, drinking a lot of alcohol, or smoking puts you at a higher risk.

High blood pressure or high cholesterol increases your risk of developing diabetic nerve damage.

Complications of diabetic nerve damage

Some of the complications of diabetic nerve damage can be worse than the neuropathy itself.

These may include:

  • fainting and falls – sometimes these falls can lead to death,
  • amputation of the toes all feet from infected diabetic sores on the feet,
  • urinary incontinence,
  • urinary tract infections,
  • digestive problems and
  • sexual dysfunction, including difficulty with arousal and erectile dysfunction.

Treatment of foot pain in diabetic nerve damage

In the early stages, you can reverse diabetic nerve damage. This process is excruciatingly slow, but it is possible.

The longer you have had the neuropathy, the worse it becomes. And the harder it is to treat and reverse.

The number one way to slow down the progression of diabetic nerve damage is to bring down and regulate blood sugar.

You’ll need to avoid drastic fluctuations in your blood sugar. Your blood glucose should not be swinging up and down continuously throughout the day, which can also make the pain of nerve damage even worse.

Put some effort into treating the insulin resistance aspect of diabetes and don’t just focus on your blood sugar numbers.

You will need to change the type of food you eat and when you eat. Work on developing good exercise and sleep habits. These and other lifestyle changes will bring down your blood sugar.

Drugs for pain in the legs in diabetics due to nerve damage

Drugs used to treat depression and convulsions can also help with the pain of diabetic neuropathy:

  • Anti-seizure drugs – Pregabalin (Lyrica) and gabapentin (Gralise, Neurontin) are used to treat epilepsy. Side effects may include drowsiness, dizziness and swelling.
  • Tricyclic antidepressants – These include amitriptyline, desipramine (Norpramin) and imipramine (Tofranil). Side effects may include dry mouth and drowsines.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Duloxetine (Cymbalta) and venlafaxine (Effexor XR) are used commonly. Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.

But these drugs do not actually reverse the nerve damage.

Supplements for diabetic foot pain and nerve damage

Many supplements can help with pain in the legs in diabetes. They may also create an environment that heals the nerves.

Benfotiamine

Benfotiamine is a fat-soluble version of thiamine (vitamin B1). It is better absorbed than thiamine because it is fat-soluble. Therefore, it does a better job of penetrating the fatty myelin sheath that surrounds the nerves.

What does vitamin B1 do? It helps the mitochondria clear glucose from the cell.

Vitamin B12

Vitamin B12 can also help with nerve pain and nerve damage. The methylated form of vitamin B12, known as methylcobalamin, is more effective in non-methylators. Some people cannot methylate cobalamin, so they must take methylcobalamin.

Antioxidants 

Antioxidants can be very useful in managing diabetic nerve pain and damage. 

  • Alpha-lipoic acid exists in two forms – the r-fraction is the one that is active in the body. It is a powerful antioxidant. 
  • Pycnogenol – this helps with neuropathy but is also necessary for a healthy heart and healthy blood vessels. It is helpful for hypertension and for managing blood sugar.

Magnesium

The cells use magnesium to process glucose, which helps blood sugar control. Magnesium also helps brain and nerve function. You need it for heart function and maintaining normal blood pressure.

There are many different forms of magnesium, some of which are more effective than others. Deficiency in magnesium can worsen blood sugar control and nerve pain.

Acetyl L-carnitine

Acetyl L-carnitine is a fat-soluble nutrient, so it can pass easily into the nerves where others cannot. It helps to protect the nerves from damage and may also help to reduce pain.

All these supplements work in slightly different ways to help with diabetic nerve pain and diabetic nerve damage.

Of course, you should consult your doctor before taking any supplement, no matter how safe it claims to be.

And once again, these supplements will be most effective when you combine them with lifestyle changes that bring down your blood sugar and treat your insulin resistance.

Have you experienced diabetic nerve pain? Have you used any of the supplements I mentioned above? Let me know in the comments. 

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Are eggs good for diabetics?

I am often asked if eggs are good for diabetics, and this question is usually phrased in different ways.

  • Should I avoid eggs if I have high blood sugar? 
  • Will eggs give me a heart attack?
  • How many eggs should I eat?
eggs for diabetes

Eggs are full of nutrients which diabetics need

The yolk

Eggs are one of the most nutritious foods that you can eat. They are a superfood, a nature’s multivitamin. They contain lots of vitamins including vitamins A, B2, B5 and B12.

Eggs are a good source of selenium. They also contain smaller amounts of lots of other nutrients like potassium, iron, manganese and folate.

Eggs are one of the best sources of choline. Choline is converted into a compound that helps to transmit messages around the body through the nerves. It is also necessary for memory, brain function and contraction of muscles.

Eggs are rich in the antioxidants lutein and zeaxanthin. These are concentrated in the eye and help to protect your eyes from harmful sunlight. This, in turn, helps to prevent cataracts and macular degeneration, which can lead to blindness.

All these nutrients I’ve mentioned are in the yolk. So if you don’t eat the yolk of the egg, then you’re missing out.

Are all these nutrients in eggs good for diabetics? Yes, definitely!

The white

The white of the egg is mostly protein, a very high-quality protein. It’s a complete protein because it contains the whole spectrum of amino acids your body needs to function properly.

There are some amino acids that you can’t produce that you have to eat. These are “essential” amino acids, and you will find them in the white of the egg.

You can cook eggs in lots of different ways. You can eat them virtually any time of the day – morning, afternoon and night.

Eggs for weight loss

When you eat eggs for breakfast, it can help you lose weight.

This works because eggs are fill you up. So you find that if you eat eggs in the morning, you don’t feel that need to nibble and pick at things all through the day. Because you feel full.

You are naturally, without hunger, reducing the number of calories that you’re consuming in a day. Which can help you to lose weight. Many diabetics need to lose weight, so in this scenario, eggs are good for diabetes.

Eggs are great – even in diabetes

Now the next question is going to be, “What about the cholesterol? Eggs are high in cholesterol, and cholesterol is bad for you.”

If you have high blood sugar, you most likely have high cholesterol levels as well.

Over the years, the media and some health bodies have brain-washed us into thinking that we shouldn’t eat cholesterol because it will kill us.

The cholesterol that you eat does not automatically equal cholesterol in your blood.

Cholesterol is vital for our existence

You make cholesterol

Cholesterol is so crucial that you cannot live without it. Your body produces cholesterol, so if you don’t eat enough, your body will make it.

Let’s assume that you need 1000mg of cholesterol in a day. If you consume maybe 300mg in your diet, your body will produce 700mg of cholesterol to make up the difference. If you eat 600mg, then your body will produce 400 mg to make up the difference.

Your body needs a certain amount of cholesterol every day, and if you don’t give it to your body, it will make it by itself. That is how vital cholesterol is to human life.

Eggs are great for brain function and hormone production in diabetics

Believe it or not, about 75% of your brain is fat, so your brain is mainly fat. One-quarter of that fat is cholesterol. That shows that you need cholesterol to make sure that your brain functions the way that it should.

Your body uses cholesterol to produce hormones. These are messengers that move around telling different cells what to do and when to do it. These include the sex hormones progesterone, estrogen and testosterone. Eggs are great for diabetics who need to make sure they are producing enough of these hormones.

The body also produces the stress hormone cortisol from cholesterol.

The cell membrane that holds the cell together is made from cholesterol.

Cholesterol is found in bile, which is secreted into your intestines to help you break down the fat in your food.

So you can see that cholesterol is essential. You can’t do without it.

I’m going to say it one more time – the cholesterol you eat does not equal cholesterol in your blood.

Where did the cholesterol come from? Not from the eggs!

With all the press about the dangers of eating cholesterol, you may have been avoiding it for some time. You may have been taking the skin off your chicken or avoiding red meat and eggs.

And yet, you still have high cholesterol. So, where did that cholesterol come from?

Cholesterol is only found in animals and foods that originate from animals, like dairy products. Vegans do not eat any animal products, and yet some vegans have high blood cholesterol. Where did the cholesterol come from?

This means that there’s something wrong in the body that’s making it produce excessive amounts of cholesterol. And it doesn’t matter what you put in your mouth. 

US dietary guidelines on cholesterol and eggs

The older US dietary guidelines told people to eat less than 300mg of cholesterol a day. An average large egg contains about 200 milligrams of cholesterol. So basically, they were saying that you should eat no more than one and a half eggs or the equivalent a day. 

There was a lot of fanfare, and it was heavily publicized, “Oh no, don’t eat more than 300mg of cholesterol a day – it’s bad for you.” etc. etc. etc.

In their more recent guidelines, they quietly removed that 300mg limit. With all the noise that was made about this 300mg/day limit, when this limit was removed, we should have heard something.

Instead, what did we get? Crickets!

Unfortunately, some people still haven’t gotten the memo.

They’re still sharing the outdated idea that you should limit your cholesterol to less than 300mg/day. And they are dishing this out as advice to people who don’t know any better.

Meanwhile, this advice never had any scientific basis from the start. As human beings, we’ve been eating eggs for eons, for generations, and we never had any problems.

What is really raising your cholesterol?

Perhaps we should take a closer look at the foods that we eat with the eggs. 

What about the toast, orange juice, breakfast cereal and honey (which is supposed to be a healthier alternative to sugar)? Could these be giving eggs a bad reputation?

Eggs are not going to give you a heart attack. People with heart disease can eat a couple of eggs a week – some suggest up to six eggs a week are okay.

This whole egg discussion is a huge distraction. There are so many other things that you could be doing that would have an enormous impact on your health:

  • cutting out processed food,
  • eating more vegetables
  • getting up and moving around a bit more instead of sitting in one place all the time.

These are a much better use of your time and your mental energy than obsessing about how many eggs you can or can’t eat.

These two newer studies add merit to the landmark review(This link opens in a new window) published in 2017 in the Canadian Journal of Diabetes, in which researchers reviewed 10 studies on egg intake for people with diabetes. They found that eating six to 12 eggs per week had no impact on cholesterol, triglycerides, fasting glucose or insulin levels for people with diabetes.

How many eggs do you eat a week? Let me know in the comments.

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What are normal A1c levels?

normal Hb A1c levels

Normal A1c levels can be difficult to achieve in long-standing diabetes. But using the HbA1c is not always the best way to measure success or failure of diabetic treatments.

The hemoglobin A1c test is a blood test used to diagnose diabetes mellitus. You can also use it to monitor the progress and success of treatment.

It gives an average of your blood sugar levels over the past 3 to 4 months.

What is hemoglobin (haemoglobin)

Hemoglobin is a protein found in your red blood cells. It carries oxygen from the lungs to the cells. It also takes carbon dioxide from the cells to the lungs to be breathed out into the atmosphere.

Sugar in the blood attaches to hemoglobin to form glycated hemoglobin, which is commonly known as HbA1c.

The higher the sugar levels in the blood, the more of it binds to the hemoglobin, the higher the HbA1c levels.

Once sugar attaches to the hemoglobin, you cannot remove it. 

The only way to get rid of this sugar is to destroy the red blood cell. The average lifespan of a red blood cell is 3 to 4 months. So once it is formed, the a1c (glycated hemoglobin) will remain in the blood to be measured for 3 to 4 months.

The HbA1c is often described as a percentage: 

glycated haemoglobin/ total haemoglobin x 100.

How is the HbA1c test done?

You must have a blood sample to check the HbA1c levels. You don’t need any special preparation. That means you can have your blood drawn any time, day or night.

Everybody has some a1c (glycated haemoglobin) circulating in their blood. Your blood sugar cannot be zero or else you’d be dead! In the same way, your HbA1c cannot be zero because you must always have some sugar circulating in your blood.

Normal A1c Levels

  • less than 5.7% is normal
  • 5.7 – 6.5 is the prediabetic level
  • more than 6.5 suggests a diagnosis of diabetes.

Estimated average glucose level (EAG) and abnormal A1c levels

Below is a table that gives the HbA1c equivalents in units you will be more familiar with.

A1cEAG (mg/dl) EAG (mmol/l)
61267
6.51407.8
71548.6
7.51699.4
818310.1
8.519710.9
921211.8
9.522612.6
1024013.4
The relationship between A1c and EAG (estimated average glucose levels)

eAG (estimated average glucose levels) = 28.7 X A1C – 46.7

If you don’t want to do the maths, here is a handy calculator you can use to calculate your estimated average glucose levels based on your HbA1c.

Treatment goals for diabetes using A1c

Generally speaking, the treatment goal in diabetes is an HbA1c below 7%. However, this depends on age and other coexisting health conditions. Younger people have lower goals, to help them avoid the complications of having high blood sugar over time.

  • less than 6.5% – young patients
  • less than 7% – general population
  • less than 7.5%-patients
  • less than 8.0%-very sick, elderly or frail patients.

For every drop of 1% in the HbA1c, the risk of diabetic complications reduces by about 30%.

Your aim should be to keep your HbA1c level as low as possible without having frequent blood sugar crashes (hypos). Hypos have their own set of complications and can lead to death. You must avoid very aggressive treatment of diabetes to bring the HbA1c level down to a particular number.

How accurate is the A1c test?

The HbA1c test is not a perfect one. Many things can affect the accuracy of this test one way or another.

Blood disorders:

  • Blood disorders like sickle-cell anaemia and haemolytic anaemia can lead to a very low HbA1c. They are conditions in which the blood cells are destroyed prematurely, so they don’t survive for up to 3 to 4 months. These result in an abnormally low A1c number.
  • Iron deficiency anaemia – In this kind of anaemia, the blood cells live for longer than 3 to 4 months which means that there are more blood cells in circulation at any given time. This leads to a markedly increased HbA1c. The same can be said for any condition where red blood cells live longer than 3 to 4 months.

Diseases of the major organs:

  • Kidney disease can affect HbA1c. 
  • Advanced liver disease can also influence the A1c.

Recent blood loss and recent blood transfusions can also skew the estimated A1c levels. 

Disadvantages of the HbA1c test to monitor progression and treatment of diabetes

Measured HbA1c levels can vary from lab to lab, even using the same blood sample. To make sure you have consistent results, you should get your HbA1c test done at the same lab each time.

Another problem is that anything that tampers with the haemoglobin in the red blood cells over the red blood cells themselves can affect the accuracy of the test.

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Why blood sugar is high in the morning and what you can do about it

Why blood sugar is high in the morning

Why is my blood sugar high in the morning even when I haven’t eaten anything? This is a question you may be asking yourself. Believe me, you are not alone. In diabetes or pre-diabetes it is common to wake up with blood sugar levels higher than the night before.

Fasting blood sugar

The fasting blood sugar (blood glucose) is the most common test used to assess the blood sugar levels. You would usually do this in the morning before breakfast. It is easy to do at home with a personal blood glucose monitor which most people with diabetes have.

You usually check your fasting blood sugar after fasting over night. This means you don’t eat or drink anything except water for at least 8 hours before you do the test.

Naturally you would expect the following pattern. You eat dinner, perhaps you check your blood sugar an hour or two after eating. Then you would fast overnight and check your blood sugar before breakfast.

You would expect your morning fasting blood sugar number to be lower than what you had before you slept.

It doesn’t always work that way!

Much to your frustration, you find that your blood sugar isn’t lower! In fact, it’s even higher. There are a couple of reasons why you may be having this problem. I’ll go through them all and explain what’s happening and what you can do about it.

If you have diabetes, you’ll find it more difficult to regulate the levels of sugar in your blood. In type 1 diabetes the body is not able to produce enough insulin. There is an absolute lack of insulin in the body.

In type 2 diabetes the body produces insulin and initially very large amounts. But the body cannot use the insulin effectively. This is insulin resistance. Insulin is the hormone that helps the body cells to take up sugar from the blood. The cells use this sugar for energy.

Normal blood sugar levels

The main symptom of all types of diabetes mellitus is high blood sugar. Diabetes is diagnosed with a fasting blood sugar over 125mg/dl or a random blood sugar above 200mg/dl. The aim of most diabetic treatment in non-pregnant adults is to maintain a fasting blood sugar within certain levels:

  • between 70 and 130 mg/dl and
  • 2-hour postprandial (2 hours after eating) blood sugar level under 180mg/dl.

In pregnant diabetic women:

  • the fasting blood sugar should not be above 90 mg/dl,
  • the 1 hour postprandial blood sugar should not be above 140mg/dl
  • the 2-hour postprandial blood sugar should be less than 120mg/dl.

The dawn phenomenon (and extended dawn phenomenon)

By far, the most common cause of very high morning fasting blood sugar levels is the dawn phenomenon.

The dawn phenomenon refers to recurring high blood sugar occurring in the early morning before breakfast. Sometimes it may extend into the late morning after breakfast. This is an extended dawn phenomenon.

The body has a circadian rhythm. During this daily cycle the body is programmed to do certain things at certain times of the day. For example in the evening your body starts to wind down. This prepares you to gradually become less active and eventually to go to sleep.

In the early morning, changes take place in your body. These changes prepare you to tackle a day of activity and challenges. This happens in every normal human being.

Insulin secretion goes down in the early hours of the morning. This allows for secretion of insulin antagonist hormones which raise the blood sugar.

Hormones that work to raise the blood sugar

From around 4 a.m. to 8 a.m. the body starts to release certain hormones. They tell it to wake up and be alert. These are the hormones that help you to get out of bed in the morning.

Hormones are chemicals which travel around the body telling different cells and organs what to do. These hormones that are released in the morning include;

  • cortisol which is a stress hormone 
  • growth hormone 
  • glucagon 
  • thyroid hormone
  • adrenaline or epinephrine

Under the influence of these hormones, in the early morning hours the liver starts to break down stored glycogen. This releases glucose into the blood. The liver also increases production of glucose from other sources like stored fat.

This leads to a rise in blood sugar. If you don’t have diabetes the body responds by producing more insulin. So as the blood sugar goes up the insulin levels go up as well. This tells the liver to stop producing and releasing more glucose into the blood. It also tells the cells to take up glucose from the blood.

Some diabetics do not have this response to the early morning rise in blood sugar. The blood sugar continues to go up to abnormal levels. There is no increase in the production of insulin. The liver just keeps producing and dumping in glucose into the blood, even as the blood sugar levels are rising higher and higher.

Who has high blood sugars in the morning?

The dawn phenomenon occurs in both type 1 and type 2 diabetics and can also occur in pre-diabetics.

If you are a type 2 diabetics who have dawn phenomenon you may have problems with your pancreatic beta cells. When the liver is dumping glucose into the blood, the pancreas does not produce insulin. It cannot respond to the high blood sugar levels.

In type 1 diabetics, the dawn phenomenon occurs when the insulin you injected the previous day is not enough to compensate for the early morning rise in blood sugar. This means that:

  • basal insulin injections are too low or
  • the intermediate acting insulin dose injected the night before is not high enough to compensate for the morning rise in blood sugar. The effects of the injected insulin start to wear off at about the same time as the release of the hormones. This raises blood sugar and opposes the effects of insulin.

About 50% of people with type 1 and type 2 diabetes may experience the dawn phenomenon. Recurring morning hyperglycemia (very high blood sugar levels) can cause insulin resistance. This can lead to a worsening of glucose tolerance and make the disease worse.

The Extended Dawn Phenomenon

If the morning glucose remains high until mid-morning you may have the Extended Dawn Phenomenon.  

Possible causes of the extended dawn phenomenon include:

  • eating too many carbohydrates for breakfast and
  • abnormal growth hormone secretion.

Growth hormone is normally released into the blood which raises the blood sugar. The levels gradually come down as the morning progresses. But some people with diabetes have an abnormal pattern of growth hormone production. The growth hormone continues to be produced even when insulin has been secreted which keeps the blood sugar high. 

Insulin

Insulin acts as a kind of gatekeeper to many hormones. Hormones produced early in the morning that contribute to the dawn phenomenon cannot be released in the presence of high insulin levels. So the low insulin requirements during the night allows these hormones to be secreted.

When you eat, the insulin level rises and then comes down again. Seeing as you’re not eating during the night, the pancreas does not produce much insulin. During the night when you’re not eating the insulin level drops quite low. This reduction in insulin allows the other hormones like growth hormone, epinephrine, cortisol and thyroid hormone to be released into the blood. These hormones work as antagonist to insulin. They raise the blood sugar while insulin brings down the blood sugar.

Tests for the dawn phenomenon 

Both the dawn phenomenon and the Somogyi effect can be a reasons why blood sugar is high in the morning. So you need to be able to tell them apart because the treatment for them is different.

There are two ways to do this:

  • Test the blood sugar between 3 and 4 a.m. for several days. In the dawn phenomenon the blood sugar should be normal or high at this time. In the presence of the Somogyi effect the blood sugar will be low.
  • Check the blood sugar levels with a continuous glucose monitor (CGM). This is a small machine that you attach to the skin to detect changes in blood sugar levels throughout the day. A computer processes and interprets the information. This will show whether the blood sugar is low normal or high between 3 and 4 a.m. This helps differentiate between the dawn phenomenon and the Somogyi effect.

Treatment and prevention of the dawn phenomenon

You can bring down high morning blood sugar levels over time in several ways.

Exercise

Engage in some physical activity after your evening meal. Go for a brisk walk or do something you find enjoyable but not too exciting (as this may stop you from falling asleep).

This activates your muscles so that they can take up glucose from the blood. Physical activity after your evening meal actually helps with blood glucose control throughout the whole of the next day. It is something that you should try.

Change what and when you eat

  • Eat a meal that’s high in protein and low in carbohydrates.
  • Have more fish, meat, eggs, chicken etc. with your meals.
  • Eat less starchy foods like pasta and bread. It’s also best to avoid processed and packaged food and to eat natural whole foods as much as possible.
  • Eat dinner earlier in the day. Instead of eating around 8 p.m., eat your dinner before 6 p.m.. You may find this difficult to pull off depending on how and where you work and how you structure your day. It may also not work for you if you have a family and you like to eat dinner together. But it is definitely something you should consider if you can make it work.
  • Take a tablespoon of apple cider vinegar in half a glass of water after your evening meal. It helps to reduce the absorption of carbohydrates into the blood from the intestines.

Medication

  • Increase your morning dose of diabetes medication
  • Switch to an insulin pump and program it to release more insulin in the morning

Why blood sugar is high in the morning – The Somogyi effect

Another way you can describe this is rebound hyperglycemia. This is another reason why blood sugar is high in the morning. The Somogyi effect is named after the doctor who first put forward the idea.

It occurs in type 1 diabetics and only in type 2 diabetics who are on insulin. The Somogyi effect refers to a situation in which there is very low blood sugar during the night followed by high blood sugar in the morning. This is your body trying to save you from the dangers of having a blood sugar that’s too low. In the body’s attempt to raise the blood sugar and prevent the complications of having a very low blood sugar, the blood sugar levels overshoot and become very high in the morning.

Your body tries to keep you alive by producing hormones that raise the blood sugar. These hormones tell the liver to release glucose into the blood. In a diabetic the system does not work efficiently and the liver releases more sugar than the body needs. This leads to a very high blood sugar in the morning.

Signs that you may be having very low blood sugar during the night

Signs that your blood sugar may be dropping very low during the night include:

  • waking up with a headache,
  • sweating profusely during the night,
  • having nightmares.

Why blood sugar is high in the morning – dawn phenomenon vs Somogyi

In both the dawn phenomenon and the Somogyi effect, the main symptom is very high blood sugar in the morning. So it’s important to be able to tell them apart to make sure the right kind of treatment is given. Once again the blood sugar should be measured between 3 and 4 a.m.. If it is very low repeatedly over several night this suggests that you’re suffering from the Somogyi effect.

How to prevent the Somogyi effect

You can prevent the Somogyi effect by making changes to what you eat. You can also adjust your medication.

  • Eat more protein and less carbohydrate with your evening meal.
  • Adjust your insulin regimen with your doctor’s help to make sure that you’re not having too much insulin or to reduce your insulin. Change your dosage to make sure that you don’t have hypoglycemia during the night.
  • Use an insulin pump to administer your insulin. Program it to give you a higher dose of insulin in the morning. 
  • Eat a carbohydrate snack before going to bed.
  • If you exercise in the evening do it earlier in the day.

Problems you may have when blood sugar is persistently high in the morning

You may start experiencing the dawn phenomenon early on when you develop diabetes. If it is not treated it can lead to a worsening of diabetes. It can also increase your chances of developing cardiovascular disease (problems with your heart and blood vessels) and problems with your nerves (neuropathy).

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Intermittent fasting for health and fat loss – a beginner’s guide

Want to know how intermittent fasting can transform your health? How it can help you lose weight fast even without exercising? How it can help you lower you blood sugar and lower your blood pressure? Yes? Then keep reading. This is not hype, it’s not theory, it’s real.

Sooner or later, everything old is new again.

– Stephen King

Fasting is not some new, mind-boggling discovery, it’s been around forever. I’m not sure there is any Nigerian who hasn’t heard about fasting. Most of us know about it in a religious context. In the bible, Jesus fasted for 40 days and 40 nights in the wilderness. Major religions the world over encourage their adherents to fast for spiritual benefits.

But people don’t really think about fasting in terms of health benefits. I have been doing intermittent fasting (IF) for a few years now and it has been wonderful for my health. I’ve lost weight and kept it off. I have more energy, I feel more alert and awake during the day and I sleep better at night. Intermittent fasting has become my default daily setting.

What is intermittent fasting?

Intermittent fasting means choosing not to eat or drink anything containing calories for several hours or days. It is not starvation, it is not a diet but a way of eating (or not eating 😉 ). The main focus of intermittent fasting is on when to eat . For years there’s been mountains of advice about what you should be eating, most of it heavily influenced by big food producers in the United States, but that’s a story for another day!

There hasn’t been much talk about when you should eat. What you eat is also important in intermittent fasting, more so for some people than others. Assuming you eat dinner at 8pm and you don’t eat again until 8am the next day, you have fasted for 12 hours. After all, what is breakfast? It’s the morning meal that breaks your nightly fast. So you can see that (unless you’re a midnight-snacker) most of us fast for a good number of hours every day without even thinking about it.

How does intermittent fasting work for weight (fat) loss?

Every time you eat or drink your body produces a hormone (chemical messenger) called insulin. Insulin’s job is to push the food you have eaten into your cells as fast as possible, to be used as fuel or to be used for other bodily functions. Any food you don’t use immediately is converted to fat and stored.

If you’re not eating, your body does not produce much insulin so there is no fat storage. To survive, your body release 2 other hormones called growth hormone and glucagon. These messengers tell the body to use the fat that is already stored in your body and burn it for energy. Yippee! That’s what we all want isn’t it? Yes it is.

Intermittent fasting for insulin resistance

One of the most damaging states your body can be in is one of insulin resistance. Many of the chronic diseases we suffer from in the modern world have been linked to insulin resistance. This includes:

  • type 2 diabetes (the end point of insulin resistance)
  • heart disease
  • high blood pressure
  • Alzheimer’s dementia – (Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.)

Intermittent fasting can help increase your body’s sensitivity to insulin.

But you have to keep eating and drinking to keep your energy levels up

Ummmm…. not really.

As long as our eyes are open, our mouths are open.

-Dr. Sachin Panda, renowned circadian rhythm researcher

Each time you eat, especially if it’s sugary, processed or very starchy food, your body releases lots of insulin. The idea is to get the food out of your blood stream as quickly as possible and into your cells.

Seeing as you’re not going to use all that food immediately, your body stores it as fat, ready for when you need it. Your blood sugar crashes and you start feeling irritable and uncomfortable and hungry again. Then you start looking for something else to eat and the cycle starts all over again.

Because you’re eating constantly, your body never gets a chance to use up the energy that’s already stored away as fat. You just keep adding to your fat stores. Intermittent fasting helps you to break that cycle. Not eating allows your body to use the fat that you have stored away for energy.

What are the advantages of intermittent fasting?

Intermittent fasting is FREE.

intermittent fasting saves money

In fact it may even save you money. If you eat fewer meals you may end up spending less money on food. If you are on a tight budget you may be able to spend the same amount of money on food while increasing the quality of your food.

This may include being able to buy more nutritious food like meat and vegetables. Cutting out the numerous snacks during the day – buns, puff puff, groundnuts, biscuits, sweets, chocolates, soft drinks e.t.c. will definitely save you money. Also you don’t need to buy any special shakes, pills or supplements.

Intermittent fasting is simple

Really. Don’t eat. How much simpler can it get? You can drink water, tea or coffee without sugar or milk. Some people drink bone broth. Technically speaking, bone broth does break a fast, but it can help you initially to adjust to fasting.

Intermittent fasting is flexible

You can start when you want and stop whenever you choose. Fasting can fit into your lifestyle and around your commitments. You can choose not to fast if you’re going for a party or if it’s your child’s birthday or you’re going out with friends.

Fasting is useful if you’re travelling (avoid traveller’s diarrhoea and having to poop in the bushes!).You can fast through the day and then eat with your family in the evening. You can fast and still enjoy your family and have a social life. What works for you will be different from what works for someone else. You choose.

Intermittent fasting saves time

You spend less time planning and thinking about what to eat. You spend less time shopping for food and less time cooking it. The time you spend eating can be put to good use elsewhere. If you’re not cooking and eating then there’s no mess to clear up.

You will be more productive

Pleasurable as it is, food can be a huge distraction. After the initial adjustments, you may find that you get more done in your everyday life when you’re fasting. I have been known to clean the house when I’m fasting. I also get more done on this blog when I’m fasting.

But breakfast is the most important meal of the day!

No need to eat breakfast while intermittent fasting
You don’t have to eat breakfast.

Is it really? I confess. I used to be a breakfast evangelist myself, but not anymore. Personally, I rarely eat breakfast. We’ve become almost brainwashed into thinking that:

  • We must eat 3 meals a day.
  • We have to snack throughout the day to keep up our energy levels.
  • Skipping meals is dangerous.

Says who? You don’t have to start eating the moment you roll out of bed. If you are a breakfast person, I have good news for you. You can still do intermittent fasting. You can choose to have breakfast and skip dinner. See what I mean about intermittent fasting being flexible?

Why not eat less and exercise more?

Let’s be honest. I’ve tried that, you’ve tried that. How did it work out? Not well I’m guessing. Otherwise you probably wouldn’t be reading this. And I would still be drinking fat-free milk (yuck!)… trying to count calories instead of making delicious, full fat yoghurt. And living in tracksuit bottoms…because I was working out for about 2 hours every day!

Trying to eat small low-fat meals and exercise a lot may work for a little while. Then it stops working. Your body adapts to survive. You’re hungry all the time and you don’t have the energy to exercise. You put all the weight back on and a little bit more.

Maybe I’m supposed to be this big, you tell yourself. After all, it’s normal to “have body” (i.e. to be plump) in your 40’s. This is too much stress. And you give up. And dive into a tub of your favourite ice cream or a packet of double chocolate chip cookies (my preferred poison in those days).

Health benefits of intermittent fasting

3 popular ways to do intermittent fasting

Intermittent fasting is a cycle of eating and not eating. The period during which you eat is called your feeding window. There are many different regimens (or protocols) for intermittent fasting. These are 3 of the most popular.

16:8 intermittent fasting (Time-restricted eating (TRE))

Intermittent fasting eating window
You have an 8 hour feeding window.

Here you fast for 16 hours of the day. Then you have a feeding window of 8 hours during which you eat. Anything which you eat or drink must be taken during your 8 hour feeding window, apart from permitted fluids like water.

The hours you sleep during the night can also count towards the 16 hours of fasting. Some people still eat 3 meals during the 8 hour eating window but it is more common to eat less food than usual during the feeding window. Time restricted eating is possibly the most popular form of fasting. Many people skip breakfast and start eating around lunch time.

One meal a day (OMAD) intermittent fasting (23:1)

Some people may call this a 24 hour fast. Strictly speaking you fast for less than 24 hours. In OMAD fasting, you basically….eat one meal a day. This means you’re fasting for about 23 hours each day. You have about 1 hour to eat. It is difficult to eat 3 meals in this small eating window. So you would naturally be eating less food.

Alternate day intermittent fasting

Here you eat one day then fast the next day and eat the day after. This usually gives you at least 36 hours of fasting depending on what time of the day you eat.

The great thing about intermittent fasting is that it is very flexible. You can always try different types to see which one gives you the results that you want. Have you heard of intermittent fasting for weight loss and better health? Have you tried it? What has been your experience? Please let me know in the comments.

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What is Metformin & what are Metformin side effects

metformin
metformin

Millions of people all over the world use metformin. What does it do? What are the advantages and disadvantages of taking this drug?

Metformin is an oral medication, that is a medicine that you take by mouth. It is used to lower blood sugar, particularly in type 2 diabetes. The generic name is metformin but you may know it better by the brand name of Glucophage.

How does it work?

It works in three ways:

  • In the intestines it reduces the absorption of sugar from the food that you eat.
  • It stops the liver from breaking down glycogen into glucose and releasing this into the blood.
  • It makes your body more sensitive to insulin.

All these work together to bring down your blood sugar.

When do you use metformin?

It is used in several conditions:

  • To treat prediabetes,
  • To treat type 2 diabetes,
  • In type 1 diabetics to make injected insulin more effective.
  • It is also sometimes used in PCOS as well as in infertility.

In type I diabetes the body does not produce insulin in the pancreas. Insulin is a hormone that triggers cells to take up sugar out of the blood. Seeing as the body is not making insulin, type I diabetics have to inject insulin.

Type 2 diabetics have very high insulin, especially in the early stages of the disease.

There is a difference when you’re using metformin in type 1 compared to type 2 diabetes. In type 1, you’re taking it to make the body more sensitive to the insulin you are injecting. In type 2 diabetes, you’re using it to make the cells more sensitive to the insulin that your body is already producing.

How do you take it?

Metformin comes in 500 mg, 850 mg, and 1000 mg tablets. You can take it up to 3 times a day. The maximum dose is about 2500 mg a day. However, this may vary according to the formulation that you are using. It is also available in an extended-release form which you would usually take this only once a day.

It is often combined with other diabetes drugs to enhance their effects.

What should you monitor while you’re taking metformin?

  • Fasting blood sugar/fasting blood glucose
  • HbA1c gives a picture of what your average blood sugar has been over the previous three months.
  • Kidney function is important because metformin should not be used in severe kidney disease.
  • Complete blood count may show signs of anaemia.
  • Vitamin B12 and folic acid levels – long-term use of metformin can lead to a deficiency of vitamin B12 and folic acid, which can also be detected in the complete blood count if it is severe enough.

Advantages of metformin

  • It is affordable.
  • It is available all over the world.
  • It’s an oral drug. There is no need for needles and other things that go with injecting medication.
  • It does not cause weight gain which other diabetic medications may cause. On the contrary, many people lose a little bit of weight when they start taking metformin.
  • It is not likely to cause hypoglycaemia which is common with other diabetes drugs.

Disadvantages of using metformin

Ithas some serious side effects. These may be so bad that some people stop taking it altogether.

  • If you have severe kidney disease you should not use metformin.
  • You must limit your alcohol intake to avoid dangerous side effects.
  • While the regular version is very affordable, the extended-release version is quite expensive.

Interactions of metformin

There are some drugs that you have to use with care when you’re taking metformin.
The most common ones include:

  • Beta-blockers-These are used to treat high blood pressure and other problems of the heart and blood vessels. One example is propranolol. They may cause a lowering of blood sugar which can be dangerous. This is even worse when you combine it with the loweringof the blood sugar that metformin causes.
  • Cimetidine – this is used to treat peptic ulcers. Taking cimetidine can increase the amount of metformin in the system.
  • Cephalexin – this is an antibiotic that can increase metformin levels
  • Quinolone antibiotics – these includes drugs like ciprofloxacin. These can cause an increase in blood sugar.

If you need these drugs to treat related medical problems while taking metformin you can still take them. However to your healthcare provider would be aware of the possible interactions and would need to monitor you very closely.

Metformin side effects

Metformin is a drug used by millions of people all over the world. It is the first-line drug in treating type 2 diabetes which is now at epidemic levels worldwide. And yet, many people are placed on this drug without any formal guidance or advice. Get ready to learn everything you need to know about metformin, its side effects and how you can avoid them.

All drugs have side effects, without exception. When a doctor prescribes any form of medication, she weighs the benefits of that drug against the potential side effects.
For example, daily aspirin tablets are often prescribed for people with heart disease even though they can cause bleeding. So you would need to weigh the benefits of aspirin in preventing blood clots against the risk of uncontrolled bleeding. If the benefits are more than the risks, you go ahead and use the drug. If the risks appear to be higher than the potential benefits, you need to find an alternative.

Metformin has many side effects. Some of these are very common, while others are rare.


Commonest metformin side effects

These include general side-effects like:

  • weakness
  • dizziness which may lead to falls
  • low blood sugar-especially if metformin is used together with insulin
  • muscle pain
  • chills
  • lactic acidosis
  • low vitamin B12 levels
  • lowered folic acid levels
  • low calcium levels

Gastrointestinal side effects

These include:

  • unusual taste in the mouth,
  • loss of appetite,
  • gas,
  • diarrhoea,
  • abdominal pain,
  • nausea,
  • vomiting,
  • bloating with abdominal distension
  • heartburn and
  • constipation.

Respiratory side effects

  • Chest pain
  • upper respiratory tract infection
  • persistent cough

Out of these side-effects, the most common are:

  • weakness
  • dizziness
  • gastrointestinal side effects like nausea and vomitin

Virtually any drug that you take by mouth has the potential to cause problems in the stomach and intestines. As usual, side effects vary from one person to another. Just because there are so many adverse effects, it doesn’t mean that you will have all of them. You may not have any at all. In some people, the side effects are so severe that they have to stop taking metformin altogether.

How do you avoid the side effects of metformin?

The best way to avoid metformin side effects is to ease into taking it. You should start on 500 mg once a day, preferably at night (so you can see through any discomfort you may experience).

You should take this for a week or two. If you’re not experiencing huge problems, then you can start taking 500 mg in the morning. Then you can add 500 mg in the evening for another week or two. If you need more metformin to control your blood sugar, then you can add 500 mg every one or two weeks. You can do this until you reach the maximum recommended dosage.

Another option for reducing the side effects of metformin is to use a different form of metformin. Once you’ve swallowed it, the regular metformin starts being released immediately into the stomach. There is another form of metformin known as extended-release metformin. With this preparation, metformin is released gradually throughout the day. It minimises the side effects, especially the gastrointestinal ones. Usually, you would take this once a day in the evening.

A simple way to avoid metformin side effects is never to take metformin on an empty stomach. Wait for about 15 minutes after you eat, then take the metformin. That will make a huge difference, especially in preventing gastrointestinal side effects like nausea, vomiting, heartburn et cetera.

Metformin decreases the absorption of vitamin B12 and folate from the intestines, which can lead to anaemia. Supplementing with vitamin B12 and folic acid helps with this complication.

Lactic acidosis

A rare, but life-threatening side effect of metformin is a condition known as lactic acidosis, which can lead to death.
symptoms and signs of lactic acidosis
these include:

  • abdominal pain
  • nausea, vomiting and diarrhoea
  • fatigue
  • muscle pain
  • altered mental state
  • shallow breathing

Who is at risk of developing lactic acidosis?

  • the elderly
  • using high dose of metformin
  • If you have decreased kidney function, this increases the risk.
  • dehydration
  • If you’re actively taking alcohol while taking metformin, this will increase your chances of developing lactic acidosis.Infection can increase your chances of developing lactic acidosis while you are taking metformin.

Lactic acidosis is a medical emergency that requires immediate medical attention.

Metformin, x-rays and CT scans

Another area where you need to be careful with metformin is when you’re doing some types of radiological tests. Some x-rays and CT scans may require the injection of iodine-containing contrast medium to help highlight particular areas of the body.
If you have decreased kidney function (with an estimated GFR of less than 30 ml per minute), you need to stop taking metformin before doing the test. Remember that this problem with metformin also applies to drug combinations that include metformin.

The combination of decreased kidney function and the contrast medium used to do the test plus the metformin greatly increases the risk of lactic acidosis.

After 48 hours, if the doctor has assessed your kidney function and found it to be okay, then you would be able to start the metformin again.

I’ve talked about the fact that many people all over the world take metformin to bring down their blood sugar in type II diabetes. It has lots of side effects, the commonest ones being the gastrointestinal side effects. Also, remember that you can greatly reduce the side effects of metformin by starting with the lowest dose possible. You can increase the dosage gradually. Remember to take metformin with meals.

Have you taken metformin before? Did you have any side effects? If you did, how bad were they? Let me know in the comments.