Started cycloset and metformin one week ago today and I thought I would share my experience so far. First, I am a long time low carber and have been mostly paleo for a year. My FBG has been rising slowly over the last several years but when I asked my PCP about it she said don't worry, because my HbA1c was "good" at 5.5 % or a little less. Of course that was totally due to diet...hard to have blood sugar spikes if you are eating 40 g or less of carb per day. So, recently my FBG has been topping 120 (120-125), but my post prandial (after a meal) is never higher than 130. On the other hand, it never drops below 105 either. Much of the problem may be connected to sleep apnea, which I've had for years. Apparently it disorders glucose metabolism independent of body weight.



So after telling my PCP that it was time to treat this and bringing her references on cycloset and giving her a short version of Jack's ideas about circadian cycles, the epi-paleo diet and hormone balancing, she agreed that cycloset and metformin would be a reasonable next step.



To make this a bit shorter, my FBG is down to around 100-103 after a week. Good so far, but I have to say this has not been easy. The downside for me is a bad tummy and baaaad sleep. I am finding most foods nauseating and seafood particularly so, so eating according to the leptin rx and epi-paleo has been a real challenge!



Ok. My sleep was really getting better after the leptin rx and working on dhea and CT and I was having nights where I got 8 whole, entire hours! Wow, it makes a difference. However, after I started the cycloset and metformin, bang! Bad sleep again. I have gone to bed by 10:30 the last 6 nights and every night like clockwork, I wake up at 2:30 am. The worst part is that I am not able to get back to sleep at all. So, 4 hours per night for the last 6 nights. I am really exhausted and I am hoping this cycle will end soon (to be honest it was a bit better last night, I slept a bit over 5 hours).



Even though I have cut back quite a bit on the amount I was eating due to the nausea, I'm still trying to follow the guidelines as closely as I can. I'm also making sure I get at least two servings of fermented veggies per day, hoping that it will settle my stomach a bit.



I am sure other people will react differently than me. I just thought there might be some value in letting people know what my experience with these drugs has been so far. I'm hanging in there and will post again when things change.

 

This is the OSA battling the cycloset......I'd tell you to give it some time to work itself through. If sleep is still an issue You may want to increase DHEA to help foster sleep. The cycloset can cause an upset stomach because of how it dramatically alters the gut flora because of the acute changes in cortisol and dopamine in the brain and the gut.



Remember the cycloset is made for increasing AM cortisol......Works awesome and is a great way to stop taking hydrocortisone in LR states or in Adrenal fatigue. Lots of educational consultants are hearing about how I might consider to use it now.



Cortisol is a stress hormone that is linked with dopamine production in the brain. Levels of cortisol in the bloodstream are highest during rising in the AM, which in turn leads to higher dopamine levels during daytime. Dopamine, a neurotransmitter, is directly responsible for a number of important functions in the brain, including attention and learning when we rise.



Recent studies have suggested that the circadian neuroendocrine rhythm mediated by dopamine and serotonin plays a large role in insulin sensitivity. In people without diabetes, the postmeal state causes a decline in endogenous glucose production due to suppression of glucagon and inhibition of lipolysis. In individuals with T2D, a drop in dopamine levels is thought to lead to an inadequate hypothalamus response, resulting in elevated levels of blood glucose, free fatty acids (FFA), and triglycerides (TG), which contribute to insulin resistance, visceral adiposity, and beta-cell dysfunction. Clinical studies suggest that bromocriptine-QR administered in the morning (within 2 hours of waking) mimics the normal peak of dopamine in the central nervous system, consequently thought to reset this circadian rhythm. The main target organ of bromocriptine is the brain.



However, subsequent effects have been observed in adipose tissue (due to decreased levels of glucose, FFAs, and TGs) and the liver (reduced hepatic gluconeogenesis due to reduced cortisol levels in response to dopamine). Higher brain dopamine levels will reduce the cortisol spikes seen in Leptin resistant states like T2D or IR.



1. Meier A, Cincotta A. Circadian rhythms regulate the expression of the thrifty genotype/phenotype. Diabetes Rev. 1996;4:464-487.

 

Thank you for posting this update, and Jack, thank you for posting the additional info about cycloset. I am on standby, trying to learn more about it, and which lab markers indicate a person may benefit from its use. How low does am cortisol need to be to see an improvement? How about FBG levels?

 

Its not just about your cortisol.....its about a lot of context. IR, PG/E2 ratio/ FBG/Sleep/ and other related hormones like DHEA/melatonin/IGF1

 

You still haven't made decision about doctoring?

 

Hi Jack. Thanks for the encouraging words. Can you explain what you mean by "OSA battling the cycloset"? I kinda thought the nausea was caused by mucosal serotonin release leading to stimulation of vagal afferent input to the vomiting center and CRTZ (chemoreceptor trigger zone). Or are we saying the same thing?



I'm feeling a bit better today. I got about six hours of sleep last night and the nausea doesn't seem quite as intense. No vomiting today and I was actually sort of hungry for lunch. So it seems that this may work itself out...at least I hope so.



FBG was 115 this morning. I'm sure it's normal for it to go up and down for a while.

 

I've been on the cycloset for 2 wks now - the first week I did have the night wakeups, FBG all over the place (its still kinda in that scattered pattern) but I'm seeing improvements... suddenly this week I can't eat my BAB (I now start to get nausea when I eat too much)... and I'm waking up well before my alarm goes off...

 

KATHYLU OSA causes low AM cortisol.......cycloset does the exact opposite......it is the bettle of wills and your gut and brain are trying to make sense of what the hell just happened. Your brain's normal pattern is radically altered.......so give it time to adjust to its new reset. I hope this makes some sense. Cycloset is like a decorator coming into your home and changing the furniture and the floor plan in 4 hours and you coming home and expecting that you know where everything is now........#notgonnahappen. Change is not linear like your thought process.

 

I did today in clinic.......but I have to run it by a few folks first.

 

I'm ready when you are!

 

I guess I can hold on. Its not like it makes any sense knocking on doors. I don't even think we can tell our story in a rational way.

 

still trying to figure out the budget for what we can afford (I'm looking at bringing the whole family)

 

Another update....FBG this morning was 115. The intense nausea has stopped, now I just feel mildly nauseous most of the day. I really get that cycloset may be affecting my gut flora because I am having detox like symptoms. Brain fog, fatigue and a little sinus pain. My tummy hurts mildly and I'm weirdly "aware" of my GI tract. Constipation has increased too. So, I'm really hitting the probiotic fermented veggies with each meal and I'm drinking kevita and no-salt sauerkraut juice several times per day. Sleep is better, but not good yet. I have increased my DHEA to 100 mg per day and I think it's helping the sleep issue a bit.



I'm irritated at Georgetown University Hospital. I called to make an appointment for a sleep study and was told they can't talk to me until they see a referral. So I have faxed it to them 3 times this past week and no call back yet. OMG, I guess they just have so many patients they can't bother to get back to me...*laugh*



Hanging in there and waiting for the miracle!

 

Kathylu,

How long have you been on the cycloset? I've had two sleep studies and had to drink coffee to drive myself to them. It was such a stupid scam. The whole thing was geared for 8 hour shifts. Gotta love CA. Fingers crossed for your miracle. I bet this is the perfect thing. You can do everything right, but your gut flora can act like parasites of convenience. I guess that's why fasting when you travel allegedly resets the clock. Maybe it does for some.

 

who's your sleep doc? I see eliott alpher in DC. he's great...

 

Wow! After 2 weeks on cycloset and metformin, my FBG was 97 this morning. My blood glucose hasn't been under 100 in years! The nausea is slowly fading away, I was actually able to eat my HAB this morning...tuna burgers with a layer of fish roe on top. Sleep is still less than optimal though, only about six hours. At least that's enough for me to function.



I notice that I'm eating less overall, I feel full most of the time. No cravings either (what a relief!). So, I haven't been adding coconut oil to anything, except for a little to cook with. I'm thinking that as some of my issues correct themselves, I'll need less calories and still be quite comfortable. I remember Jack saying that as you become leptin sensitive "calorie restriction becomes easy and natural". Maybe I'm starting to get there...

 

Thanks for the recommendation. I really don't have a sleep doc per se, although someone reviews my test results and writes a report. I was referred for treatment for OSA by my pulmonologist at Georgetown. She was treating me for asthma during my pregnancy. Of course, since I started the leptin rx and corrected my vitamin D level, the asthma has disappeared, so I don't need the pulmonologist any longer. I'll check out your sleep doc.

 

Whoot that's awesome. I'm still bouncing around yesterday FbG was 75 mg/dl. This am 91mg/dl.

 

I have. We will send out an email about it and I will talk about it during this months Webinar.

 

not maybe........you just need the last push.....of giving your brain dopamine it lost because of chronic leptin resistance. The dopamine tracts are outflow only tracts from the leptin receptors. Cycloset resets them.