Newly diagnosed T2- LCHF 14 years

[L1ncslass]

Hi

Getting over the shock of this diagnosis having LC for 14 yrs due to migraines [which it cured] plus some weight loss too [but not enough] AC1 was 84, Cholestrol [non fasting] LDL they couldn't measure TC 7.5 Tri 7, HDL 0.6, only positive kidney function was fine!

Prescribed Metformin told to take one after breakfast and to increase to 4 in next 4 weeks. Got over most of the symptoms other than they raise my pulse! Practice nurse refused to prescribe a BG meter so I've bought my own, testing morning fasting, before eating and 90 mins afterwards [and a couple of bedtime readings]. attached file with readings

Observations
1. Blueberries in my mock danish at breakfast [cream cheese, eggs and almonds cooked like a cake] caused a 8 point spike [first change] now get 0.8-1 rise.
2. Dinner time food higher in fat meant a drop in BG levels so when home made Chicken soup 1.1 rise added a spoonful of cream next day 1.1 LOWER!
3. Dawn effect BG higher readings than bedtime night before around 11.4 ish. Slightly lower this morning 10.9 tho last night had a small packet of peanuts, a diet coke at the pub and then a piece of cheese before bedtime.

So taking Metformin in the morning, would it not be better at night? I really want to 'fix' this with LC diet and not pills, so reluctantly I've taken one

Original ailment was Gall Bladder or pancreas issues so been for a scan and told they are ok [symptoms have gone may have been a virus] BUT a bright fatty liver mentioned [waiting results been sent back to Dr]

Any help advice welcome

 

[kokhongw]

Getting over the shock of this diagnosis having LC for 14 yrs

What is your typical meal like?

 

[Resurgam]

The Metformin doesn't reduce blood sugars, so you can take it at any time. The effects can take a while to build up and to go away again if you stop taking it.
As you have a meter now the best way to use it is to test yourself before and after eating and try to keep the increase down - usually two whole numbers is thought to work best.
I set out to stay under 8mmol/l after eating, and once I found the things I could eat and the amounts I stuck to that and saw my numbers going down. I did not need to test for every meal after a while, and now hardly test at all as I can eat more carbs and not spike high - though I still tend to keep to under 60 gm of carbs a day most of the time.
If you know Atkins I am doing OWL and am at the alcohol level - which I only take very occasionally, which is where I have been for decades except when encouraged by doctors to eat more carbs because low carb is 'not healthy'.

 

[ringi]

Metformin lasts in the body for a long time, hence the time of day does not make much difference, buts lots of people split the dose, so as to reduce the side effects.

Given how much insulin resistance you have, you may find intermittent fasting helpful, I found the book "The Complete Guide To Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting" very helpful.

I expect that LC have delayed you getting Type2, however, your BG response to Blueberries you seem to very sensitive to even a low level of carbs and therefore you may also be sensitive to how much protein you eat. The dietdoctor website has lots of contents about Keto diets, you may need to get below 10g of carbs a day.

 

[L1ncslass]

What is your typical meal like?

Bfast Mock Danish [cream cheese, eggs almonds, cooked then cream]
Lunch Mackerel Pate with celery/cucumber/red peppers [normally 2 veggies] Homemade soup, such as chicken, beef or mushroom base made with leek, celery, carrot, mushrooms
Dinner Moussaka [aubergines no spuds], Fish pie [leek and cheese sauce] chicken thai green curry and coconut milk, with green salad [watercress, lambs lettuce, baby leaves etc]

All are homemade, LC recipes ie Gia Tomato puree, unsweetened cocnut milk,

 

[NoCrbs4Me]

Have they ruled out MODY?

MODY: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363133/

 

[kokhongw]

Have you been losing weight?

 

[ringi]

With that diet, I am also questioning if the issue is Type2. I think it will be worth getting your GP to send you to a consultant as well as testing how much insulin your body is making. (Maybe go private if you can afford it, the consultant can then refer you back to the correct NHS service.)

The high Trigs are often due to many carbs or eating too much food, but from what you are saying they are not, hence another reason for an expert investigation.

PS what do you drink?

 

[L1ncslass]

Have they ruled out MODY?

As far as I know I'm the first in the family to diagnosed with diabetes, tho my Dad died at 55 [misadventure] and mum 67 [pancreatic cancer] maternal grandparents live to their 80's and paternal grandmother died of a stroke before I was born and grandfather in hos 70's something to do with his liver

Have you been losing weight?

I wish!! I lost 3 stone when I first LC a bit of carb creep but have been very faithful to LC

With that diet, I am also questioning if the issue is Type2. I think it will be worth getting your GP to send you to a consultant as well as testing how much insulin your body is making. (Maybe go private if you can afford it, the consultant can then refer you back to the correct NHS service.)

The high Trigs are often due to many carbs or eating too much food, but from what you are saying they are not, hence another reason for an expert investigation.

PS what do you drink?

Before diagnosis, I'd often eat cheese and nuts at Lunch and at the weekend only breakfast and an evening meal [not always hungry] Sunday we have a cooked breakfast and Sunday lunch about 5ish. However thought I'd better eat at mid day as well,

Drinks are Coffee x2 Bfast and after evening meal, water at all other meals and in between [dropped the Low Sugar squashes at the min], a diet coke when out at the pub and very little alcohol, probably once a month a few Bacardis and diet coke, and as I don't trust the pumps the past few months asked for diet coke bottled.

 

[Grateful]

I wish!! I lost 3 stone when I first LC a bit of carb creep but have been very faithful to LC.

Good for you! If I may ask, have you worked out how many grams of carbs you have per day?

 

[NoCrbs4Me]

As far as I know I'm the first in the family to diagnosed with diabetes, tho my Dad died at 55 [misadventure] and mum 67 [pancreatic cancer] maternal grandparents live to their 80's and paternal grandmother died of a stroke before I was born and grandfather in hos 70's something to do with his liver

I don't think that would rule out MODY.

 

[L1ncslass]

Good for you! If I may ask, have you worked out how many grams of carbs you have per day?

My original goal was about 25 carbs a day 7 carbs per meal plus a little for snacks [tho I rarely do] but once I got used to LC, I stopped counting,, Tho hubby has taken over cooking [change in my working hours] and we've had several heated debates over him swapping items, changing recipes!!

It's something I ought to check, better get the scales & calculator out!!

Is your 3 miles walking a day? I can do a lot of walking at work in busy periods 12K steps, so days I don't hit the target going for a walk in the park to boost my step count!

 

[Grateful]

My original goal was about 25 carbs a day 7 carbs per meal plus a little for snacks

You do mean grams, right? I'm only asking because here in America, and perhaps also in the UK, there is an alternative system to count nutrients (linked with the "plate-of-food method") and that system has nothing to do with grams. Each of those "units" is quite a few grams.

I make no attempt to equalize the carbs per meal. Mine is something like 15g breakfast, 0g lunch and 10g dinner, plus another 5g for snacks and red wine. This is pretty extreme. I admire you for having done LC for 14 years.

You said you had stopped counting. I do a bit of both. Some meals (lunch) are nearly always prepared using ingredients that I already know are zero-carb, so no need to count. Others (breakfast) are the same every day, so I only had to calculate once. Dinner is probably the only one that I sometimes have to calculate anew, but that would be if we are cooking a new recipe.

Yes, I walk 3 miles per day (at least) which is about 50 minutes. Then, 30 minutes of home exercises, mainly for lower-body strength -- I broke my hip playing tennis 12 years ago. It was fixed up, rather than being replaced with an artificial one, and I want to try to keep my original "repaired" hip for the rest of my life! (So far, so good.)

I would like to add resistance training soon, in an effort to turn fat into muscle. This has the double benefit of (1) hopefully putting on a little weight, since apparently muscle weighs a bit more than the fat it replaces, and (2) I've been told that more muscle and less fat can be good for managing diabetes (I have forgotten the exact mechanism of that). Also, even though I am borderline underweight, I still have a small paunch left over from my heavier days and I'm vain enough to want to do something about it.

 

[L1ncslass]

Update :-When changes made to diet, given a few days to note if any change to BG levels

Week 1
Used a blood glucose meter from work at first, yellow square is when I changed to my own bought one, which I will continue with.

Changes cut out blueberries at breakfast due to high BG spike also noted mid-day meals, blood glucose rose less when the meal had a higher fat content, so started adding cream to home-made soups.

By the end of the week realise I have the Dawn Phenomenon, with BG levels rising in the night, so I eat a piece of cheese and maybe some nuts before bed and added in a BG test before bed.

Week 2
Noted alcohol lowers BG levels in the morning, stops the DP issue, a bit of research led me to the statement that woman who are t-total increase their risk of T2 diabetes by 40% hmm as I hardly ever drink am I one of the 40%. Don't think it would do my liver much good in the long term if I became a heavy drinker!!

Changes, towards the end of the second week I began to monitor LC diet more closely dropping intake below 20g a day closer 10-15 if possible.

Now the complacency of taking tablets sets in as I forgot to take Metformin twice in the morning [blue square] and as I'd had a Dr's appointment re scan [outcome fatty liver tho nothing made of this] I asked about moving tablets to the evening hoping it would help with DP problem Still no positive support from Dr's re lifestyle change to combat T2 diabetes or a LC diet!

Also swapped my 2 cups of coffee a day for hot water and lemon, might add coffee back in!

Week 3
Had a drink on 2 consecutive nights, BG readings for next 3 days were a lot better with the 3rd day the best I've had since testing.

I'm still only taking one Metformin tablet I should be on three now if I followed the nurse practitioners advice. I know it takes 2 weeks to deplete the livers glucose stores [Atkins] and my two weeks for the lower and monitored LC diet won't be reached for a couple more days. So if I continue with DP issue [if it wasn't for this I think my daytime BG's would be 'normal'] I will consider taking a second tablet in the evening.

I've also upped my walking try at minimum 1hr a day but try to do 10K steps every day [abt 120mins of walking]

My BG results are showing a downwards trend

WK1 BG AVG 9.80/WK2 BG 9.12 /WK3 BG AVG 8.52 [daily results attached by week]

 

[ringi]

You are thinking about the right things

Alcohol can be turned into fat by the liver, and the fat often remains in the liver. Therefore limit your alcohol, however, one small glass of red wine has been shown to have benefits.

"fatty liver" normally responds well to low carb, but as you have been low carb for the last 14 year you may need to do more like 23hr fasts, or "8 weeks blood sugar diet". (Most people doing what you are doing now should totally ace their Type2)

 

[kokhongw]

Given the high fasting readings, I would consider skipping dinner or having it much ealier...give the liver more time to deplete its glycogen store.

https://idmprogram.com/dawn-phenomenon-t2d-8/

 

[L1ncslass]

Week 4 update, Many thanks for your comments & support, I'm really pleased with this weeks results [see attached] DP still an issue.The better result coincide with the 2 weeks of keeping carb levels under review.

I'm keeping up my 10K steps a day and the past few days have taken to walking to work [can't always do this as often need to go out for supplies] I''m hoping the walk between breakfast will help 'burn' off some BG and reduce the continued morning rise.

Although I've LC for 14 years maybe there has been a bit of drift upwards! I think it will take some time to 'cure' the fatty liver therefore the DP problem but my weekly morning average and post breakfast jump are coming down tho for fasting BG needs to come down a lot further. I don't intend to become a heavy drinker as the alcohol I guess will do the same as the drugs and keep the glucose stuffed in the liver it has to come out for it to stop the DP problem.

I can go from breakfast till 3-5pm without eating especially when I'm not at work, which I did prior to the diagnosis 4 weeks ago. I have noticed I've felt hungry the past few days dropped my carb content to around 10-12 gms a day. I've added more fat into the diet to help combat the hunger and higher fat content also helps keep post dinner BG results down!!

I'm thinking of eating more cooked breakfast to see if that helps bring the morning highs down too.

 

[L1ncslass]

Showdown with Dr today due to lack of 'support' re T2 diagnosis and management, 2nd HbA1c test now 50, taken off Metformin. I said I'd take the last 28 tablets still got DP but waking BG now mid to low 7's, tho the choice was mine I could stop today :
Hooray got prescribed one pack of test strips oh hum, told only to test every few days, erm nope will continue as is until HbA1c under 42, and DP lower. The glucose meter has taught me well about my diet.
Treat the cause not the symptoms