PART I — I know how thyroid hormones (TH) raise blood glucose.
— In liver, TH increases expression of GLUT2 -->increase in both gluconeogenesis and glycogenolysis.
—In liver, T3 increases gluconeogenesis by increasing activity of phosphoenolpyruvate carboxykinase (PEPCK)
—the TH stimulated glycogenolysis & gluconeogenesis --> hyperinsulinemia and glucose intolerance, resulting in peripheral insulin resistance.
—In adipose tissue, TH increases lipolysis, resulting in an increase in free fatty acid that stimulates hepatic gluconeogenesis
Diabetes Metab J. 2022 Mar; 46(2): 239–256. Published online 2022 Mar 24. doi: 10.4093/dmj.2022.0013
PART II - Based on what I read yesterday (above), I decided to forego even a low-carb breakfast to see if I get the glucose spike. Nope.
It would seem taking a dose of thyroid meds at 4:00 AM which results in gluconeogenesis and glycogenolysis from the liver AND eating breakfast is what puts me over the edge, resulting in the huge spike.
I normally 3 meals per day based on the research of Dr. Don Layman (to preserve muscle mass / reduce risk of sarcopenia) so I will need to work out a different schedule for taking my thyroid meds.
Currently taking:
4:00 AM : 37.5 mcg T4 plus 4 mcg T3
10:00 AM: 4 mcg T3
4:00 PM: 4 mcg T3
10:00 PM: 37.5 mcg T4
Suggestion on better med schedule / (low carc) breakfast time so as not to spike glucose so much.
Getting new thyroid and nutrient labs later this week
Thanks.
Written by
Joyya
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Hi Joyya. While I haven’t done the breadth reading you’ve done (at least not recently!) I do remember reading about how diabetics newly on thyroid hormones do find that they need to adjust their meds.
But also, I’ve dabbled lots with low carb diets over the years. And that’s how I know about a thing commonly dubbed the “Dawn Phenomenon”. It’s common for most people to have a spike in blood sugar around dawn in fact, even when on a very low carb diet. mayoclinic.org/diseases-con...
I expect you may already have come across this but on the off-chance you haven’t I thought I’d throw it into the mix.
Edited to add—should have read your last post and the replies first—you do indeed know all about this! Far more than me!
Sorry! I’ll leave this reply here though cos I do find all this stuff fascinating. 🙂
Dawn Phenomenon occurs between 2 AM and 8 AM and I do have this even though I have been in remission (non-diabetic ranges) for 2 years. For example, today at 2 AM my FBG was 5.2 mmol/L and rose to 5.5 mmol/l at 4:00 AM just before my first med dose.
My spikes have been occurring at 10:00-10:30 AM and jump to 9-10 mmol/L 2 hours after a low carb breakfast, so it must be the combo of gluconeogenesis and glycogenolysis from the meds and the few carbs from breakfast setting me that high.
I have heard from someone who is T1D that they had to increase their bolus insulin on synthetic T4 /T3 and switched to Armour and have no problems.
Erfa (equivalent of Armour) here in Canada is an option, but much more expensive than what I'm doing (not covered by insurance).
I am looking for ideas about timing my first dose of meds (T4 & T3) vis a vis timing of breakfast to minimize the blood glucose rise. Today I just fasted, and it only went up to 6.3 mmol/L which is just from gluconeogenesis and glycogenolysis from the thyroid hormones and some gluconeogenesis from ketones.
You’ll obviously get mixed opinions but there are quite a few folk here who don’t split their thyroid hormone dosage and take it all in one go.
Or as a halfway house, just stick to twice a day - 37.5mcg levo and 8mcg T3 each time. That might give you the leeway to experiment with the best time to take it and avoid the glucose spike?
I completely understand the expense issue—I’m on Armour and it’s very expensive to get hold of. If indeed I can still get hold of it (I fear my latest order is stuck in Customs and not sure if it will stay stuck there…).
I used to take my 3 grains all at once but switched to dividing it half and half but I find I don’t need to be too precious about timing.
I have considered taking it in two doses, but it may result in a significantly greater glucose spike from liver induced gluconeogenesis and glycogenolysis.
Fascinating post and something I am giving a lot more thought to as well - especially the link between avoiding blood sugar spikes and weight loss. Can you not do some yoga, indoor exercises or go for some sort of run/walk early in the day having taken the medicines in one go? Just a thought …
I’m honestly not sure why I started doing it. 🙂 It must have seemed a good idea at the time. I think I went through a phase of trying to reduce my dosage a bit and decided the best way to cope with that would be to divide the dose.
Well, I've decided to try this! Thanks for the suggestion. I was going to do 6AM and 2PM based on the timings Dr. Theodore Friedman uses for T4 /T3 combo, but decided since I felt much better taking the T4 at bedtime, to keep half my meds then, and the other half at 2 PM. Certainly more convenient timing, and if I do some exercise right after breakfast that should help!
Thank you very much for the suggestion. I'll keep you posted.
Thanks @Jazzw. Wow, it's after 8:00 PM and I was able to go out for dinner and don't feel ready for bed!
I had trouble falling asleep and staying asleep last night , so I will take the first dose at 6AM and keep the second at 2:00 PM.
The weird thing is I get much more of a glucose spike with the first dose than with the second, and I assume the is because the gluconeogenesis and glycogenolysis plus food (even low carb) is too much. I am going to try the 6AM meds and a walk/indoor exercise and see if that helps.
Thank you! I feel much better med wise with two doses, rather than three.
Your post is very interesting. I take Armour thyroid because I had part of my thyroid gland removed due to having cancer. I am also diabetic and I’ve noticed recently that my morning bloods are jumping very high. I take my Armour at approximately 6am and then I test my bloods 2 hours later when I have my breakfast. Recently, my bloods are high even though I know I’ve had a diabetic hypo. I had all the hypo symptoms this morning (without testing my blood) so, I waited for it to pass and then my blood sugars were over 10. This has been happening since I had laser eye surgery 3 weeks ago and I’ve attributed it to that but, maybe it’s not after reading your post. My GP agreed with me about the Dawn phenomenon many years ago as I thought this was my problem and I’m wondering if it’s happening again now. Any advices will be appreciated and, can you send me a link to your source?
Your symptoms and blood work mirrors mine but something I didn't mention is that I had dental surgery on Tuesday!You can't diagnose Dawn Phenomenon based on what your blood work is 2 hours after you eat. Dawn Phenomenon occurs between 2 AM and 8 AM. so I would recommend doing your bloods at 6 AM when you wake.
You can test again 2 hours after you eat to know your glycemic response to the Meal.
I'm sorry, I don't have a resource. This is something I know as the result of my post graduate studies in human nutrition and my profession.
In terms of my glycemic response, I am experimenting with different med timing which should remove the combination rise from both the thyroid meds and post meal glucose response. I am splitting my dose because before bed and 2 PM. This is the first night, and three hours after my evening meds, and my blood glucose is 5.0 mmol (which is amazing). I have resumed eating very low carb.
I do suffer from the Dawn phenomenon at the times you stated. I took my insulin at bedtime with my snack, and I don't usually test my blood in the night but I did on Saturday night and it was through the roof! It should have been coming down and not going up. This morning I awoke to take my Armour thyroid and I had all the symptoms of a diabetic hypo so, I just went back to sleep because I had to take my Armour thyroid and I cannot eat with the tablets. Then when I checked my blood before breakfast it was high at 10.7. This isn't usual for me and it has been doing this for about a month now. I'm not sure if my body is responding to having had laser eye surgery or something else. It gets so frustrating and upsetting!
TT xx.😐
Have you listed to the Zoe podcast on blood glucose? They talk about how the order in which you eat your food can reduce your BG spikes as well as simply bouncing your knees after eating.
Excellent information Joyya! Thank you for sharing this. I always gain weight on T3. Anecdotally T4 seems to have less of an impact on blood glucose and resulting hyperinsulinemia.
It seems from what I've read in the literature so far is that the synthetic T3 has more impact. Once I get my new lab tests done, I will consider my options.
Hi Joyya thanks for sharing it's really interesting. I'm on T3 only taken 3 times a day. For the past couple of months I've been on the ZOE program. It starts with a detailed tracking of blood sugar and blood fat metabolism. Results for me were that I have fantastic blood sugar control but terrible fat processing metabolism. I think the poor fat thing is very common in hypothyroidism. Not sure if the T3 is responsible for the good blood sugar results but the variations could be very individual and not necessarily down to when we take meds.
Hi there, it’s a healthy eating program that tests your blood sugar and fat processing ability and checks your gut microbiome then scores food and meals and gives you a teaching programme on an app to help you learn to eat meals that your body will respond to best based on your individual scores. So for example my results suggest I process blood sugar very effectively but not so much for fat so paleo or Keto would not be metabolically great for me whereas a wholefood moderate fat mostly plant based diet is better for me. For someone else it might be the opposite. The whole idea is the scoring is very personal. So I like museli and yoghurt for breakfast, so a museli made up of barley flakes, seeds, some oats, nuts with banana, berries and low fat Greek yoghurt is perfect for my blood sugar, fat control and for gut health. For someone else that same meal might cause a big blood sugar spike and they’d be better with full fat yoghurt or an omelette. If you are interested you can check on Professor Tim Spectors book, Food for life or gooogle ZOE health. You could also ask Hidden as I think they follow it. It’s expensive and felt like a steep learning curve but now I really like it and feel good eating this way. I’ve lost weight but that wasn’t the aim and it isn’t a weight loss diet. Hope that helps.
Ahhh, THAT Zoe! Yes, I am familiar with Dr. Spector and his research! Your explanation is excellent. Question? Isn't his approach for those who have never had type 2 diabetes?
I don't know to be honest. It might be worth contacting them directly to find out. But yes, their disclaimer says,
"ZOE is a nutritional science company. We are not able to diagnose any medical conditions or advise on what this means for your healthcare. If you are under care for chronic medical conditions (including type 1 diabetes, or type 2 diabetes), you should consult with your physician for appropriate ranges specific to you."
Hi Joyya, thought you might want to consider the fact that all types of food (carbs, proteins and fats) end up being converted into glucose by our digestive system, as such, even if you eat low carb diet eventually you will need insulin to get the resulting glucose from your blood stream into your cells. However, it will take much longer for the low carb meal to be converted into glucose (2-6 hours) than eating simple carbs (1-2 hours absorption time) or even complex carbs (2-3 hours absorption time) .
As Type 1 Diabetic, I inject insulin for 100% of carbs in any given meal and only 50% of the weight of proteins and fats consumed over a much longer period of time.
So, your blood glucose level spike 2-3 hours after low carb breakfast is due to the proteins and fats in your meal having been digested and converted into glucose. Having said that, the glucose level rise should not be as much of a spike as it would have been had you eaten carbohydrates rich meal.
Most meals are a mix of all three elements and will take from 1-6 hours to fully digest and the glucose spike will occur between 1-3 hours later. This happens even if you are not diabetic, though the glucose spike is not as dramatic.
Your insight as someone with T1D is very helpful, thank you. I was guessing that the spike was due to the protein content, as carb count was low and protein content was 30-45g protein per meal, but couldn't figure out the timing of the spike, but what you said makes sense. In low carb intake, the protein and fat are used for gluconeogenesis and the T4 and T3 meds are already increasing gluconeogenesis. All that glucose production is what's doing it.
I will play with limiting my protein to 30g per meal and not adding extra fat besides what comes with the whole food. Perhaps adding a little bit more slowly metabolized carbs to prevent the need for protein to be used for energy will help too.
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