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  1. Finally had the Italian holiday we paid for three years ago. However, being Italy, there was a question to be answered about how (and whether) to handle my current keto-level carb intake. I thought I might be able to handle a more relaxed low-ish carb level that would be a compromise. I had 150g/day in mind. This involved allowing myself some pasta, beer (2/3 per day) and a very small amount of bread while continuing to avoid pizza, chips/potatoes, pastry, and puddings, as they do my BG the most damage. There was also a marked rise in my alcohol intake over the week, particularly grappa. In the end I permitted myself one gelato. I didn't struggle to find plenty of choice on menus.

    The other factor was that we spent hours every day walking - I think the least was four hours and the most eight. That alone would normally keep my readings in the 4s without any trouble.

    The results were interesting. There was very little impact on my pre- and post- meal readings. I didn't have a single reading out of range all week, although several +2hr results were the top end of the 6s - to be expected given those followed spaghetti and beer. My morning readings rose immediately (a week later they're returning to the level I expect) so it looks like the last thing to come down is the first thing to go back up.

    Went back to 20g/day once we got home. A week further on and everything has settled back the way it was. So I guess this is do-able (for me, currently) for a week, but I'm not sure if I could stretch it to two weeks. I'm not recommending this for anyone else, just reporting my experiences.
  2. No surprises. A1c at 37, around where it's been for two years or so: BP down a bit at 125/80; and my weight is down to 95kg. First time I've been under 100kg in maybe ten years.

    Not much else of note really. Onwards.
  3. As part of our relaunch of Low-carb Skipton we're talking to some of the local media. This case study (me) might be used. Thought it worth putting here too.

    I’m 64, and for as long as I can remember I had always tried to eat the recommended diet and take enough exercise – this is what the NHS tells you to do, isn’t it? However, about twelve years ago things started to go wrong. I began to gain weight rapidly and other symptoms appeared – kidney problems, swollen legs, sleep apnea. Cuts and scratches wouldn’t heal. I wasn’t eating any more than I had been and was still active.

    I was told I didn’t have Type2 diabetes: my blood sugar levels weren’t then high enough. However, I was having classic diabetic symptoms and they were getting worse. My weight gain eventually meant I could no longer exercise the way I had been doing. I seemed to get injured a lot. By 2019 I was diagnosed diabetic.

    I decided to switch to a Low Carb diet.

    I now eat a lot of what we’re usually lectured NOT to eat – meat, fish, eggs, above ground vegetables, and dairy – mainly cheese. I limit my carb intake to about 20 or 25 grams a day – that’s the equivalent of one apple. I don’t eat pasta, rice, bread, pastry, fruit, or sugar.

    I got my blood sugar levels back to normal within four months and was recognized as “in remission” a year later. In the last two years I’ve also lost at least 40lbs and reduced my waist size by six inches.

    My overall health has improved dramatically, and I’ve even started playing football again in the last few weeks. My blood pressure is down, and my cholesterol is NOT going up. My diabetes symptoms have gone almost completely, and I’ve never been hungry once. As Low Carb doesn’t depend on restricting calories, it means you don’t have to starve.

    Finally, I have managed to drop all the medication I was taking – it’s not needed anymore.

    Edit - link to article as it appeared.
  4. 9 December.
    Two years since diagnosis, and two years on low-carb. In the next year, I want to:
    • Get back to playing some form of football: it might only be old blokes five a side or walking football but it will scratch an itch
    • Stay on my standard 20-25g carbs/day
    • Have to start thinking about not losing any more weight
    All achievable.
  5. I realized recently that I had almost forgotten a lot of the T2 symptoms I've had. Probably this is because we have natural abilities to forget unpleasant experiences and not dwell on them: but for the sake of the record I thought I'd try to write as many down as I can remember, and in some sort of date order. I think I've got them all, but can't be sure. They range from the trivial but unusual to the painful and upsetting.

    The interesting thing is that my blood glucose was only officially at diabetic levels for at most a few months in late 2019 and early 2020: no new symptoms emerged during that time. This means that the entire range of diabetic symptoms I've experienced have been experienced while I've not (officially) been diabetic. I suspect that we each have an IR threshold above which our systems rapidly go out of whack: it looks like mine may be a lot lower than most. I also suspect that there's not an immediate linkage between system changes and symptoms: it looks for me like symptoms might lag changes by at least some months.

    Anyway: I was diagnosed in December 2019 with an HbA1c of 50. I know my A1c was 45 in 2015 and 47 in 2017, but don't have earlier A1c data. On a countback, and matching against symptoms, I guess that I might have moved out of normal BG ranges around 2010 or 2011, which means that my IR started some time before that.

    • Tinnitus - I've had tinnitus most of my adult life. I hadn't noticed it getting worse, but it's definitely improved since 2020.
    • Hunger - from 2011. Always hungry and eating constantly. Stopped in December 2019.
    • Fatigue - from 2011. Tired all the time. Put it down to stressful job. Went in early 2020.
    • Irritability - from 2011. Worked (sometimes) to my benefit in the job I was doing, but I'm glad it's gone.
    • Blurred vision - from 2011. Worst part of this was my prescription constantly changing. It seems to have settled down completely since early 2020.
    • Oedema/foot swelling - 2011 onwards. Largely gone by 2021. Edit Feb 22: oedema plus bullae returned in one leg, not as bad as before. No idea why.
    • Weight gain - started in 2011. No change in exercise or diet but I began to gain weight very easily. Weight gain and associated soft tissue injuries meant I had to give up sports in 2017. Weight gain stopped and reversed when I went low carb in December 2019.
    • Sleep apnoea - diagnosed 2012. Probably an indirect consequence of T2 via weight gain. Has improved a great deal since 2020 but still using CPAP. More work required.
    • Kidney function - not much urine being produced - 2012 onwards. Gone by mid 2020.
    • Inflammation - general pain, particularly at old injury sites, from about 2012. I am not sure this is a diabetic thing but it has faded as my BG has returned to normal, so it's here as a possible.
    • Cuts/bruises not healing - as it says. From around 2013. Gone in early 2020.
    • Frequent infections - particularly in my mouth and teeth. From around 2013. Nothing since 2020.
    • Blistering - diabetic bullae - blistering, fluid under skin and leaking through skin. My skin was like tissue paper and I leaked quantities of fluid from my lower legs. From about 2014 onwards - gone in early 2020. Edit Feb 22: mild return in one leg plus oedema.
    • Heavy sweating - from around 2015 I had occasional episodes of extreme night sweats. These never amounted to much, and I don't recall any pattern. However in September/October/November 2020 and September/October/November 2021, I had two six to eight week periods where it happened every night. It seems to be significantly fading at the time of writing (Nov 2021). I don't understand this, and am going to try a Libre for a couple of weeks to see if something odd is happening overnight. Edit Jan 2022: the night sweats continue off and on. Using the Libre (which was a bit unsatisfactory) showed that my sweating episodes correlate with a drop in my blood glucose around 4-6am, This is a sudden drop into "real hypo" levels with readings in the threes, followed by an equally quick rise in BG (the dawn phenomenon) which can continue for hours. I presume my liver is up to something here with the abrupt fall, but what? Edit Feb 22: three weeks now with no sweats,,,,fingers crossed. Edit March 22...they're back.
    • Neuropathy - burning feet, from around 2015. Bad enough to prevent sleep or wake me up. I still have it a bit but it's more of a very mild tingle/ warmth now (late 2021).
    • Red lower legs - from 2015 - odd one, not at all painful but combined with the oedema and blistering made me look like I'd been standing in boiling water. Nearly completely gone.
    • Constipation - 2015 to around late 2020. Fortunately now gone.
    • Gout - three severe attacks in 2017, and several "threatened" in 2018 and 2019, seen off with Naproxen. Nothing since.
    • Xerostomia "sticky mouth" - this appeared in late 2020 only after my BG was back in normal range. I had a two week spell where every morning my mouth was gummed up and I had to ease it open, First time it happened I managed to rip skin off. Fortunately this is looking like a one-off.

    Hope I don't have to add to this. I trust it might be useful to anyone in the early stages. So many things are affected by diabetes, and by its symptoms. One of the things I think it's important to add is that for many of these symptoms I went to my GP. At no point did anyone suggest or confirm that they might be diabetic symptoms, although my google searches were indicating exactly that. Instead I was firmly told that I wasn't diabetic, as, despite the symptoms, my blood sugar level wasn't high enough. While intervening when blood sugar levels rise out of normal levels is sensible, and should be done long before the arbitrary 49 is reached, I think failing to diagnose, purely on the basis of an under-49 HbA1c reading, is a real problem. Certainly was for me.
  6. I was lucky enough to find a copy of the 4th edition of Bilous' Handbook of Diabetes in a charity shop recently. In the fiction section (!) and only £1. Over £50 new. As the 5th edition came out a year or two ago, I assume someone got rid of the older 2011 edition. It's an interesting read. These comments are from my T2 perspective.

    Being a medical textbook there is, as you might expect, lots about biochemistry and endocrinology. There is next to nothing - half a page or so - about diet and lifestyle. There's a lot of discussion about the late stage complications of diabetes and the usual number of photos of the dreadful things that high blood glucose can do to the human body given enough time. And there's lots about medication. Some of this is very interesting - I learnt that they don't actually know how metformin works - it works, yes, and it helps to lower blood glucose by inhibiting glucose production in the liver...but not how that inhibition happens.

    Given that this handbook focuses so much on medication and appears to assume that all T2s will steadily progress towards insulin and amputations it's probably not surprising that many of us have had the experiences with blinkered clinical professionals that we've had. Medication as the first step. No advice about reducing carbs, changing lifestyle factors etc. Being told to follow the "healthy" Eatwell approach and base all meals around "starchy carbohydrates". In short, the approach becomes self-fulfilling - get T2s to keep on eating carbohydrates, and then wonder why people's conditions get worse.

    Having this book has helped me understand more of what I read in published research papers. It also is a really clear statement about the medical approach to "managing" T2 diabetes, and therefore also why it fails. Maybe the 5th edition has a bit more about avoiding raised blood glucose in the first place, not basing diets around carbs (for the insulin resistant at least) and starting off with the assumption that high blood glucose can easily be reduced relatively simply without drugs. I hope so, but I don't think there's any money in it.
  7. This below is what helped me in the first year after diagnosis. It's a retrospective - I wasn't conscious of these at the time, and it's only been in recent weeks that I've been able to analyze what worked and what didn't. Another poster - @jjraak - suggested separating the ideas like this. I think it works.

    The forum is full of lots of good advice, see https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html.... and very occasionally some bad advice. Established members can invariably be trusted...

    Anyway, this worked and works for me.


    1. You need to unlearn all the standard NHS healthy eating advice, all the assumptions made by the media, your family and friends about what's healthy and what's not. I do mean all.

    2. As Type 2 diabetics we are not, by definition, good at handling carbohydrates. Some of us are better than others at it but we all have the same problem. Eating carbohydrates causes our blood glucose to rise out of control and that causes us physical damage.

    3. Eating carbohydrates, of any kind, is therefore potentially going to cause us a problem as Type 2s.

    4. Just how big of a problem depends on the individual.

    5. Test your blood glucose and record your results to find out what your pattern and tolerances are. Then cut the things that cause the unacceptable rises. This will be carbohydrate, of course.

    6. Nobody will do this for you. Only you can do this.
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