Chronic Afib, diabetes, numbers

I'm in chronic afib since last March with bloodwork numbers suggesting diabetes.
I'm tall, thin (too thin), have low BP and have lost weight in the last 6 or 8 years.
I'm seeing an endocrinologist.
Aug 16, she told me to aim for 10% carbs.
I'm using Cronometer, keeping track since then (carbs 20%) and am down to 12%, (my trend for last 7 days). Really great site!
When I saw her Sept 13, she ignored this effort, said no to perhaps resorting to a glucometer and on the basis of my new bloodwork mentioned Metformin and even insulin. (I've already found Metformin is worrisome for peripheral neuropathy, which I have, but which has started slowly subsiding. I'm guessing this is from the magnesium and/or acupuncture, as could be a L5S1 lumbar spine issue.)
I'm reading Rosedale, Mendosa, etc. and the forum of course.
Numbers:
March 2015: Fasting Glucose 94 mg/dl / HbA1C 6.1% / HbA1C in IFCC units: 43 mmol/mol
April 2016: Fasting Glucose 110 mg/dl (no HbA1C)
Sept 2016: Fasting Glucose 108 mg/dl / HbA1C 6.4% / HbA1C in IFCC units: 46 mmol/mol
Fasting Insulin: 4.4 ul/ml

Daily I take:
Acetyl L-Carnitine 500 mg, 2 x day
Ubiquinol, 100 mg, 2 x day
D-Ribose, 3g 2 x day
Mg aspartate, 300 mg
Mg Bisglycinate, 200 mg
Mega EPA/DHA, 3g (Life Extension)
Evening Primrose Oil
Vitamin C (Nutrilite AC plus) 250 mg 2 x day

I'm walking a fine line with this MD taking some of what she gives me, when I find the supporting info in this forum, but other suggestions I think I'll ignore, case of Metformin and Vit D2 (I'm low: 16.0 ng/ml). Will start Vit D3.
She suggested I *not* take carnitine, mentioning something about it being excitatory, I'm not listening.
I'm feeling weaker, not sure if this is the drop in carbs. I'm out of breath in a different way to what I can attribute to afib.
Questions:
How long to notice improvement in Fasting Glucose and/or HbA1C numbers or are they volatile like all the other numbers seem to be.
Which numbers are more important, the relatively high Fasting Glucose and A1C or the Fasting Insulin?
Can this weakness be from the drop in carbs. Seems not a big drop, I'm not a McDonald's junk food addict type person, much to the contrary, been eating organic for years. I haven't made *really* big changes. Dropped beets, chickpeas, a morsel a day of a brownie, nothing drastic.
What to do with protein numbers as I'm thin, too thin.
Last 7 days trend is 21%.
Endocrinologist wants 35-40%, wants me to take Whey Protein, but how would I start burning Fat (fatty liver)?

Thanks!

Hi Ginny - just a couple thoughts... do you have high stress.?.. (other than the stress of the chronic AF) Often that will cause interferences with glucose metabolism... and you'll see a gradual increase in the A1C due to insulin resistance. . With insulin resistance, the insulin receptors are no longer able to respond to insulin and glucose levels rise because blood sugar can't enter cells. Typically, those with insulin resistance start to gain weight... so that's not descriptive for you... but the stress issue can underlie the beginnings of IR. Proper cortisol testing can reveal a lot and is connected to both thyroid and adrenal gland function. This all goes together. Fixing the insulin resistance is the first priority. Metformin helps lower the glucose but doesn't address the core issue.

You'll also want to know from your thyroid profile panel if you are trending toward 'hyper'-thyroidism which would account for your inability to maintain or gain weight... plus perpetuates arrhythmia.

Your 25 OH D level is very low so once your number is at least in the 50-60 range, you should start to feel less weak. When I was initially tested, mine was 18 and I felt terrible. Fortunately, these days, most doctors are testing for vitamin D levels routinely compared to back then and are aggressively treating.

You may need to consult with a practitioner who has expertise in functional endocrinology. I saw three endocrinologists before I found my current Family Medicine MD who did the proper tests and prescribed protocols to normalize adrenal and thyroid function. Although my case was much different than yours, I was insulin resistant caused by beta blockers for the AF. Once I stopped those, the AlC normalized and then we could work on adrenal fatigue and hypothyroidism.

This is by no means a diagnosis of your situation,but rather just offering some insight as to avenues that may be helpful to evaluate.

I certainly wish you well and I empathize because of my extremely frustrating struggle with all this in addition to the AFib.

Kind regards,
Jackie

Thank you!! Jackie!! Always to the rescue. Amazing. Always so careful or cautious (I'm at a loss for the right words) in your replies.
You really help me with this reply, in spite of the obvious differences (beta blockers), because I actually refused to take beta blockers when initially diagnosed with AF by a cardiologist.
Also, this type of reply is what helps me face my endocrinologist, the only "reasonable" professional I have available, as she actually recommended Life Extensions' Mega EPA/DHA for the blood situation.

A question about Vitamin D and the D2 / D3 issue.
She prescribed Roemmers Vitamin D2 daily oral drops, 10 drops x day. (100 ml. = 164 mg D2). I checked the forum and found your references to the D2/D3 issue.
I live in Buenos Aires, (Argentina), went out to find Vit D3, I could not find "Health Food section" type Vit D3.
All I can find is a local pharmaceutical company's Cholecalciferol Oral ampule 100,000 UI/2ml, the pharmacist says it's a single monthly dose, OTC.
Any opinions on that as an alternative to the Roemmers D2?
I'm guessing it's preferable, but the issue is that in *both* cases the small print "cautions" mention congestive heart failure issue.

Many many thanks!

Hi Ginny - I'll respond to your questions soon... I'm out of the house for the rest of the day.

I'm pleased that your endocrinologist recognizes the value of a source such as Life Extension... and that could be a source for you to order in supplements. I'll do some research on the D2 option you mention. I seem to recall that the single high dose has some risk factors as you mention but I want to check that in detail. It is imperative that you get your D levels up so you can start feeling "human" again. At the very least, you could begin trying to get mild, short duration natural sun exposure when the weather is favorable. I'll send you a PM soon on sunshine tips since it was part of my "dilemma" for almost 2 years before I began to get relief.

I'm sorry I didn't remember you lived in Argentina... so I understand the limitations on "functional" type practitioners... but that doesn't mean we can explore areas for you to bring up with your doctor.

Back soon.
Best to you,
Jackie

Ginny

"March 2015: Fasting Glucose 94 mg/dl / HbA1C 6.1% / HbA1C in IFCC units: 43 mmol/mol
April 2016: Fasting Glucose 110 mg/dl (no HbA1C)
Sept 2016: Fasting Glucose 108 mg/dl / HbA1C 6.4% / HbA1C in IFCC units: 46 mmol/mol
Fasting Insulin: 4.4 ul/ml "

Didn't have time to read everything, but the above stuck out. If you are lowering your carb intake and everything is getting worse, it could be LADA diabetes (late adult onset) or type 1.5. In my limited knowledge, this is autoimmune based. Your beta cells are loosing their ability to produce insulin. A low carb diet is certainly the way to go. For the blood sugar part, the best reference I know of is Richard Bernstein MD <[www.diabetes-book.com] You can read some online: <[www.diabetes-book.com] He is not focused on helping the autoimmune part of this. I follow a very strict autoimmune protocol and can give more info if you are interested.

George

Thank you, George!
I appreciate an earlier answer of yours suggesting a glucometer, which I made to the MD and was brushed off, twice actually.
You say,
"If you are lowering your carb intake and everything is getting worse".
My question is about a time frame for seeing changes, for a drop in Fasting Glucose, when aiming at 10% carbs (which I've only done for a month).
Fasting Insulin: it's the first time, I have nothing to compare with.
I'm aware of your posts on your strict protocol and appreciate your offer!

Ginny,

A1C measures glycated hemoglobin (red blood cells). Glucose will glycate these cells and the more glucose the more glycation. When A1C is correlated with average glucose, one of the assumptions is the life of the cells. From memory, this is usually 6-8 weeks. So to completely see the result of a diet change in A1C will take this long. You don't have a close (in time) test. I certainly don't know that you have LADA, it just is a possibility. You have a low fasting insulin for fairly high glucose, which is a bit suspicious that your pancreas isn't up to the task of cranking out enough insulin.

If it is LADA, it would pay to work at it very hard (keeping glucose under control). This might mean insulin, but a low carb diet is still in order to minimize how much is needed. This will help by taking the load off the pancreas. I know some LADA's who have managed to stay in the "honeymoon" phase for 10+ years. This means that their pancreas is still working - not as well as others without the condition, but they end up with much better blood sugar control than T1's with no insulin production. Weight loss can also be indicative of low insulin, as you need insulin to use your fuel.

There are other tests that can be run to help figure out if this is your problem <[www.diabetesforecast.org]

I am one for testing "endpoints." A glucometer would be very useful. Don't know why that idea was brushed aside. The doc maybe thinking is is only to see if an insulin dose is needed for someone taking insulin. My thought is to use it in a very different way: as feedback as to what different eating styles do to your glucose. The idea is to act as a scientist with your body. If you go very low carb, say <20g/day and then see what happens, or by fasting for various periods of time. Not that you have to measure all the time like someone on insulin would.

So the possibilities are that you have insulin resistance and you are overproducing insulin, but still have relatively high A1C, though not yet to Type II (though really just a matter of degree) OR you are not making enough insulin (though people who don't make enough and also be resistant at the same time - guessing this isn't your problem as you are losing weight).

I'm not a doc, just giving my opinion.

George

And again, George, thank you.
It's slowly beginning to make a little sense.
Again I appreciate your suggestion, of a *different* quality, regarding the use of a glucometer.
I particularly appreciate this post of yours for the detail.
Thanks!

Jackie,

I have seen my A1c shoot up since being on beta blockers. Are there beta blockers that do not create the insulin resistance that metoprolol does? Calcium channel blockers have not agreed with me in the past.