At what point will a gp say...

[Sutherlandlass]

Hi folks, at the moment my gp says my type 2 can be managed by diet and exercise. However, I find exercise pretty painful (during and after) due to limited mobility caused by acute fibromyalgia symptoms. I have lost 3 stone since May 2014, slow.. but sure, but I am still morbidly obese bmi at 47
I am still very slowly losing weight, my fasting bloods range from 8.8 in the morning, the lowest so far was 6.4, seems to average around 7.7
Before bed it averages around 8.4, highest so far 9.4
My hbA1c was 52 in December.
My gp says that I am doing well, but then I read other folks posts and it really makes me wonder if I am?
I don't have any caffeine, don't smoke, don't drink alcohol, cut my carbs down but occasionally, 120 at most, I try and get out of my chair at least once an hour, often more for loo trips
So... my main concerns are: if I can't lose enough weight quickly enough, how soon will it be before my gp says " it's time for some kind of meds"? Are there limits to your blood glucose levels, where a gp will say this?
Is there anyone else that has been or is in a similar situation, that can help me make more informed changes to improve things?
Would the first med be metformin?
I am on simvastatin 10mg at the moment, which causes increased muscle pains, especially in my legs. GP initially prescribed 40mg but with having fibromyalgia, I seem to be so sensitive to a lot of meds, I managed to convince my gp to start me on a lower dose. I am glad I did too! Don't fancy the idea of having to increase the dosage of that, I would much rather take plant sterols, which I take alongside anyway. Seeing my gp on 11th February, and going to see if he says about testing my cholesterol again. It was 6.1 in December, ratio of 6.6
Gp convinced me to start the statins, he said it would reduce my chance of a stroke or heart attack by 20%
My hypertension is under control with perindopril, bendroflumethiazide and doxazosin. 131/63 onJanuary 13th.
Just realized that I have rambled on a bit... sorry folks, but I thought it a good idea to give yous as much information as possible, so if there's anyone who can associate with this situation, I look forward to hearing your observations.

 

[Bluetit1802]

Hello,
Each doctor seems to have his own ideas of when to start type 2s on medication. Metformin is the first line of attack. Perhaps you should discuss Metformin with him because this drug tends to help people with a lot of weight to lose better than it does those with less excess weight. I believe the reason for this is because it is an appetite suppressant, so can help you eat less. It doesn't do much to help with blood sugar levels. If he does prescribe it for you, ask for the slow release version, which is kinder on the tummy.

Your levels are OK but not brilliant. Do you test before and after meals? If not, I suggest you start doing this because I have a feeling you are eating too many carbs on a regular basis. Going to bed in the 8's isn't good any more than seeing 8's on fasting. The NICE guidelines for Type 2's is under 7 fasting and before meals, and under 8.5 at least 90 minutes after a meal, but many of us here think this is too generous and try to stick to non-diabetic levels of under 6 fasting and before meals, and under 7.8 at least 90 minutes after meals.

Try testing immediately before you eat, then 2 hours after your first bite. Look at the rise. It should be as low as possible, certainly under 2mmol/l and preferably around 1mmol/l. Any more than that and there are too many carbs in that meal. Keep a record of these levels alongside a food diary and very soon patterns will emerge telling you what you should be cutting out or seriously reducing in quantity.
Do have a good read round the forums and consider lowering those carbs. Good luck.

 

[Squire Fulwood]

Many GP's give out everything they can as soon as they can. My original levels were pre-diabetic but I left the surgery with a prescription for three different kinds of pills. In short, I am surprised he hasn't mentioned medication already.

 

[Sutherlandlass]

Hello,
Each doctor seems to have his own ideas of when to start type 2s on medication. Metformin is the first line of attack. Perhaps you should discuss Metformin with him because this drug tends to help people with a lot of weight to lose better than it does those with less excess weight. I believe the reason for this is because it is an appetite suppressant, so can help you eat less. It doesn't do much to help with blood sugar levels. If he does prescribe it for you, ask for the slow release version, which is kinder on the tummy.

Your levels are OK but not brilliant. Do you test before and after meals? If not, I suggest you start doing this because I have a feeling you are eating too many carbs on a regular basis. Going to bed in the 8's isn't good any more than seeing 8's on fasting. The NICE guidelines for Type 2's is under 7 fasting and before meals, and under 8.5 at least 90 minutes after a meal, but many of us here think this is too generous and try to stick to non-diabetic levels of under 6 fasting and before meals, and under 7.8 at least 90 minutes after meals.

Try testing immediately before you eat, then 2 hours after your first bite. Look at the rise. It should be as low as possible, certainly under 2mmol/l and preferably around 1mmol/l. Any more than that and there are too many carbs in that meal. Keep a record of these levels alongside a food diary and very soon patterns will emerge telling you what you should be cutting out or seriously reducing in quantity.
Do have a good read round the forums and consider lowering those carbs. Good luck.

Thank you for your reply ☺ at my first appt after diagnosis, he said that"I might" need to go on tablets after about 12 months"! But thanks to the information provided by you lovely folks, I will definitely be talking to him about this next wee, during my appt.
I had also wondered about going lower with the carbs too! I read somewhere that you shouldn't go much lower than 120? But I also see that some folks are at around 40-50 a day? I am sure this is possible but is it hard to get used to such a low carb intake?
I do keep a food diary, I started using carbs and cals app and book about a week ago, which really helps me to keep an eye on the numbers. However, when setting it up and telling it that I want to lose 2lbs/week it allows me 1385 cals/day and automatically sets the values for carbs,protein, etc., so I presumed that that was acceptable?! I am sure that I have fatty liver and wonder if a higher protein diet would be the right way to go or not?

 

[Sutherlandlass]

Many GP's give out everything they can as soon as they can. My original levels were pre-diabetic but I left the surgery with a prescription for three different kinds of pills. In short, I am surprised he hasn't mentioned medication already.

I think my gp practice like to only spend money on their patients when they feel it's" a must!" Although I was very grateful to my gp, for allowing me to have a meter etc., prescription immediately, but then he'd already warned me that my anxiety problems wouldn't be helping my blood glucose levels. I do feel more relaxed in the sense that I feel more in control of my diabetes. Especially with the support of all you good folks here! ☺

 

[Bluetit1802]

Thank you for your reply ☺ at my first appt after diagnosis, he said that"I might" need to go on tablets after about 12 months"! But thanks to the information provided by you lovely folks, I will definitely be talking to him about this next wee, during my appt.
I had also wondered about going lower with the carbs too! I read somewhere that you shouldn't go much lower than 120? But I also see that some folks are at around 40-50 a day? I am sure this is possible but is it hard to get used to such a low carb intake?
I do keep a food diary, I started using carbs and cals app and book about a week ago, which really helps me to keep an eye on the numbers. However, when setting it up and telling it that I want to lose 2lbs/week it allows me 1385 cals/day and automatically sets the values for carbs,protein, etc., so I presumed that that was acceptable?! I am sure that I have fatty liver and wonder if a higher protein diet would be the right way to go or not?

First of all, these apps that tell you how many carbs/cals/protein etc to eat are based on non-diabetics and are for calorie controlled diets, not carb control diets, so you can ignore the advice. The calorie advice may be correct, so to make up the lost calories by eating far less carbs, you need to up certainly the fats and maybe also protein.

Secondly, the advice that you need 120g carbs is rubbish. We don't need any carbs to function healthily. Our bodies will burn fats if it is starved of carbs. The 120g comes from the notion that our brains use up 120g carbs. However, our brains will also use fats when starved of carbs. So fats are important when you reduce carbs.

We each have our own carb thresholds. Some people manage their blood sugars on a higher carb intake than others. For me personally, to maintain normal blood sugars I can't manage more than 30g a day. I have learnt this by testing, testing, testing. I started at 120g but that was too many, I reduced to 90g. Still too many. Then over a period I reduced gradually till I found my personal limit, 30g. Your personal limit may be more. Or less. Only testing will tell you this.

Then of course, not all carbs are equal. I had one plum the other day immediately after a fry up meal that never raises my levels. That one plum sent my levels rocketing to the 9's. I rarely see a 7, never mind a 9. I have known a long time that fruit half kills me so I avoid it. However, I can eat a couple of new potatoes with no damage done, and I can also eat a few home made deep fried chips with no effect at all. What I am trying to say is, our bodies are unique to us, so you need to discover what your body can/can't cope with.

 

[Sutherlandlass]

First of all, these apps that tell you how many carbs/cals/protein etc to eat are based on non-diabetics and are for calorie controlled diets, not carb control diets, so you can ignore the advice. The calorie advice may be correct, so to make up the lost calories by eating far less carbs, you need to up certainly the fats and maybe also protein.

Secondly, the advice that you need 120g carbs is rubbish. We don't need any carbs to function healthily. Our bodies will burn fats if it is starved of carbs. The 120g comes from the notion that our brains use up 120g carbs. However, our brains will also use fats when starved of carbs. So fats are important when you reduce carbs.

We each have our own carb thresholds. Some people manage their blood sugars on a higher carb intake than others. For me personally, to maintain normal blood sugars I can't manage more than 30g a day. I have learnt this by testing, testing, testing. I started at 120g but that was too many, I reduced to 90g. Still too many. Then over a period I reduced gradually till I found my personal limit, 30g. Your personal limit may be more. Or less. Only testing will tell you this.

Then of course, not all carbs are equal. I had one plum the other day immediately after a fry up meal that never raises my levels. That one plum sent my levels rocketing to the 9's. I rarely see a 7, never mind a 9. I have known a long time that fruit half kills me so I avoid it. However, I can eat a couple of new potatoes with no damage done, and I can also eat a few home made deep fried chips with no effect at all. What I am trying to say is, our bodies are unique to us, so you need to discover what your body can/can't cope with.

Thanks again... I will certainly be lowering the carbs drastically from now on and see how it works for me ☺ I am desperate to be in total control of my diabetes, not have it in control of me. Everything you have said makes so much sense to me. I live in a very remote area of the Highlands, and there's been no offer of any educational programs available. I am so grateful for this community and the excellent amount of knowledge available here. I would be extremely anxious without the support that I have received so far from you folks on here! Thanks again, it's great to be able to talk to folks who understand and empathise with each other! ☺