I am about a week and a half in on the keto diet again.

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I am about a week and a half in on the keto diet again. At this point is where I always get nervous because my fasting glucose is getting higher and not lower. Last week, each day they came down (around 150) and this week they are staying between 180-205. I keep getting into various stages of this way of eating but my numbers never seem to stabilize into a normal healthy area. My last a1c was 6.8. I take metformin xr 500 mg after breakfast and lunch and 1000mg after dinner. Any ideas?

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I am on the same boat as you. But if you have only done keto for 1.5 weeks you need to be more patient. Your diabetes did not materialize over night and it will not go away overnight either. Give it a few months.

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I am concerned you are much sicker than your doctor has led you to believe. I am 100% confident that you must pursue a low carb diet for long term health. I am not so sure if your current medication is sufficient for your needs. From our point of view, we tend to hand-wave short term issues below 200 as part of the healing cycle. I am uncomfortable with your medical management of your glucose control with you able to hit 200 on keto. That is a big deal. For most, the first few weeks are rather unstable, but since you are not EATING carbs, this sugar is coming from DERANGED behavior of liver and pancreas. Add in your 2grams of metformin and I must suggest you discuss with your endo about stepping up to Januvia or another dpp-4 for the short term. I am 100% glad you are here, and again, this keto/lowcarb diet is your best path to healing. The problem is you are pretty sick, more than we can influence with just food.

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I would also suggest that this is likely a temporary situation and within a matter of weeks you would be able to ratchet off the dpp4 and likely cruise on metformin till summer before coming off it completely. This assumes your pancreas is in good working order and you are successful at losing a little weight. Just throwing it out as an idea of timeline to discuss with the doc so you don’t get sucked into meds for longer than you need.

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