I've got the D

[Twisticles]

Hi all,
I was diagnosed T2 a week ago. Male, 46.
Firstly, I'm glad I found you. I've been reading everything I can. Resources here in Hong Kong are limited, or in Chinese. So as an expat Brit this feels like the place to be.

My tale starts a year ago with extreme fatigue, constant headaches and an insuppressible appetite. I put on 25kg in the last 20 months, so firmly in the obese category. FBG in September '17 was 6.2 and ultimately I was diagnosed with sleep apnea and put on CPAP. That helped; I stopped falling asleep at work and the headaches went. But the fatigue persisted.

In August 18 I was put on Antibiotics for a skin infection and got thrush. I learned this might be a side effect of high blood sugar, so I bought a meter and randomly tested myself a few times - nothing outside the ranges published here.

Next came the stinky urine around October time and a few more self-tests were going as high as 14. I finally went to my Doc a couple of weeks ago and shared my concerns - a heap of blood tests, ECGs, X-Ray etc and the Doctor was happy that my ECG, Chest and blood pressure are text book perfect! Sadly, my HB1AC was 88 and my triglycerides are elevated. Is it usual for T2 to manifest in just a couple of months?

Doc has put me on 250mg Metformin twice a day which I seem to be tolerating, as well as Fenofibrate for the Trigs. Told me to come back in three months and didn't give much advice, which is about par for HK. Wondering how long Metformin takes to have an effect on BG.

I signed up for a low-carb meal service a month or so back (for weight loss) but that also seems like a good direction as treatment. Postprandial readings for <30g carbs are around 10. Wondering if I need more adjustment time or lower carbs? Daily intake is less than 70g carbs per day over the last week (except the weekend dinners).Appetite is a little more controlled now.

On the weekend I found that bread and potatoes send my BG through the roof, pasta not so much. But aiming to avoid all the starches in the future.

A week ago my FBG was 22.6, now is hovering around 12. Yesterday evening my pre-dinner was 7.5 and post-dinner 2hr was 9.5. This morning FBG was 13.3, not sure why it went up so much overnight.

No need to tag daisy1, I've read that post a million times.
Also, when signing up to this site, the Accu-Chek Guide isn't an option as a meter to select, doesn't appear to be available in the UK but it the latest Accu-Check meter over here.

 

[kokhongw]

A week ago my FBG was 22.6, now is hovering around 12. Yesterday evening my pre-dinner was 7.5 and post-dinner 2hr was 9.5. This morning FBG was 13.3, not sure why it went up so much overnight.

You are progressing well...

The morning rise is due to the Dawn Phenomenon, where our insulin resistant liver don't respond to the background insulin to hold back the glucose. I find that having light early dinner or just skipping dinner to be most helpful when dealing with rising FBG.

 

[JoKalsbeek]

Hi all,
I was diagnosed T2 a week ago. Male, 46.
Firstly, I'm glad I found you. I've been reading everything I can. Resources here in Hong Kong are limited, or in Chinese. So as an expat Brit this feels like the place to be.

My tale starts a year ago with extreme fatigue, constant headaches and an insuppressible appetite. I put on 25kg in the last 20 months, so firmly in the obese category. FBG in September '17 was 6.2 and ultimately I was diagnosed with sleep apnea and put on CPAP. That helped; I stopped falling asleep at work and the headaches went. But the fatigue persisted.

In August 18 I was put on Antibiotics for a skin infection and got thrush. I learned this might be a side effect of high blood sugar, so I bought a meter and randomly tested myself a few times - nothing outside the ranges published here.

Next came the stinky urine around October time and a few more self-tests were going as high as 14. I finally went to my Doc a couple of weeks ago and shared my concerns - a heap of blood tests, ECGs, X-Ray etc and the Doctor was happy that my ECG, Chest and blood pressure are text book perfect! Sadly, my HB1AC was 88 and my triglycerides are elevated. Is it usual for T2 to manifest in just a couple of months?

Doc has put me on 250mg Metformin twice a day which I seem to be tolerating, as well as Fenofibrate for the Trigs. Told me to come back in three months and didn't give much advice, which is about par for HK. Wondering how long Metformin takes to have an effect on BG.

I signed up for a low-carb meal service a month or so back (for weight loss) but that also seems like a good direction as treatment. Postprandial readings for <30g carbs are around 10. Wondering if I need more adjustment time or lower carbs? Daily intake is less than 70g carbs per day over the last week (except the weekend dinners).Appetite is a little more controlled now.

On the weekend I found that bread and potatoes send my BG through the roof, pasta not so much. But aiming to avoid all the starches in the future.

A week ago my FBG was 22.6, now is hovering around 12. Yesterday evening my pre-dinner was 7.5 and post-dinner 2hr was 9.5. This morning FBG was 13.3, not sure why it went up so much overnight.

No need to tag daisy1, I've read that post a million times.
Also, when signing up to this site, the Accu-Chek Guide isn't an option as a meter to select, doesn't appear to be available in the UK but it the latest Accu-Check meter over here.

Hi, welcome!

The T2 didn't just appear in a couple of months: when you started putting on weight, that was most likely because you were gradually becoming more insulin resistant. It wouldn't show up as high bloodglucose, but your pancreas was pumping out insulin in insane amounts to keep your BG in the normal range, making you insensitive to it in the long run. As practically all carbs turn to glucose, your body started storing that glucose in fat cells. Which is why 90% of T2's are (often morbidly) obese. Still, we're often told one causes the other, while it's the other way around.
Your HbA1c would probably benefit from cutting carbs further. As you yourself noted, 30 grams in a meal caused a spike up to 10, though I wonder what your readings were before that meal, as yesterday's numbers were better. After all, if your body is used to high bloodsugars, your liver might be dumping glucose to get you back to what was normal for you for a long time, and it'll be a little while before it clues in. (Which is also why your BG goes up in the morning; it thinks it's helping you get energy to start the day) Test before and 2 hours after the first bite, if it went up more than 2.0 mmol/l, that meal was carbier than you could handle. I'm down to 20 grams of carbs a day or less, (with the meter you tend to find out what works for you, so you might be at 45 grams, or 60, or...?) which also impacted my non-alcoholic liver disease, which is part & parcel with T2, more often than not. Metabolic syndrome is worth a google. Also tackled my high cholesterol, my weight (dropped 25 kilo's), and my T2: I'm now in the normal range with a HbA1c of 34. So it can be done, just don't count too much on the metformin. It can help with supressing appetite, and it'll tell your liver to dial it down a notch with the sugar dumping, but it doesn't do all that much about ingested carbs.
You're off to a flying start, so well done, you!
Jo

 

[Brunneria]

Hi and welcome @Twisticles

Sorry to hear about your diagnosis, but it looks like you are tackling things head on. Well done for that. Sometimes it takes people much longer to get their heads around things.

You asked if T2 can develop in a matter of a couple of months.

Yes, it can. At least the symptoms can appear rapidly. There may have been other issues that went un noticed for quite some time.
Have a look at the www.bloodsugar101.com website
It is full of very useful information on how and why T2 develops and different approaches and studies on the subject. Very informative for any T2, and especially someone with a new diagnosis, and it explains the different ways that T2 can creep up on us.

Having said that, T2 is not the only kind of diabetes that can develop at varying speeds, so I have to ask, have you had the requisite tests to eliminate T1 as a possiblity? These tests would probably have been called GAD and c-peptide, but may be known by different names in Hong Kong. They test for insulin production levels and antibodies, and would give a clearer indication as to whether you may be T1. If you have a google on both tests, then you will see what I mean.

In my opinion, you would be better making doubly sure that you get the correct diagnosis confirmed at this stage, rather than battling with blood glucose by T2 methods until someone comes along and says 'um... maybe we should check you for T1...'

Hope that helps!

 

[Member496333]

Two things you can do to mitigate dawn phenomenon. Firstly do plenty of mild exercise in order to keep glycogen levels low (glycogen is glucose stored in your liver and muscles). Training with weights both depletes glycogen and sucks up lots of glucose. Secondly don’t replace the carbohydrate with excess protein. You must replace the carbs with fat. Natural fats and oils...not seed or vegetable oils.

Excess protein is the most common mistake that diabetics make when embarking on low carb. The body has no mechanism by which it can store amino acids, so if you consume excess dietary protein then it has no choice but to convert those amino acids into glucose. It won’t result in spikes, but will make your numbers creep up above where they could be, and will most certainly give your body ammunition with which to manufacture glucose in the early hours of the morning.

Hope that made sense

 

[bulkbiker]

Excess protein is the most common mistake that diabetics make when embarking on low carb. The body has no mechanism by which it can store amino acids, so if you consume excess dietary protein then it has no choice but to convert those amino acids into glucose.

Hmm and here may be the first time we disagree... There is quite some evidence that GNG is demand driven.. so excess protein is not necessarily turned into glucose.
Have you checked out the work of Dr Ben Bikman he expresses it very well in this video

https://www.youtube.com/channel/UCF2Oy5c7T1R_4s1skNO0TwQ

At least I'm pretty sure it's that one...

 

[Member496333]

Hmm and here may be the first time we disagree... There is quite some evidence that GNG is demand driven.. so excess protein is not necessarily turned into glucose.
Have you checked out the work of Dr Ben Bikman he expresses it very well in this video

https://www.youtube.com/channel/UCF2Oy5c7T1R_4s1skNO0TwQ

At least I'm pretty sure it's that one...

Thanks. I’ll take a look. I had read about the excess amino acid thing, applied it to my own diet and saw my fasting glucose numbers plummet. Always open to new learning, though

Also worth noting that non diabetics won’t manifest this as any issue, because they’re not insulin resistant, so their liver doesn’t run away with itself in the mornings.

 

[bulkbiker]

Enjoy.. I found it enlightening on just abut everything.. I have a lot of respect for Ben..

 

[Bluetit1802]

Thanks. I’ll take a look. I had read about the excess amino acid thing, applied it to my own diet and saw my fasting glucose numbers plummet. Always open to new learning, though

Also worth noting that non diabetics won’t manifest this as any issue, because they’re not insulin resistant, so their liver doesn’t run away with itself in the mornings.

I found this blog explained it simply.
http://www.tuitnutrition.com/2017/07/gluconeogenesis.html

 

[Member496333]

I found this blog explained it simply.
http://www.tuitnutrition.com/2017/07/gluconeogenesis.html

Thanks but I’ll stick with my own experience

For me personally, excess protein does contribute to GNG. I’ve tried and tested it several times with complete repeatability. Obviously we all vary somewhat though.

Put another way, I can predict with absolute certainty that if I eat too much protein today, I will have slightly elevated glucose all day tomorrow. So it may not be true for everyone, but it’s definitely not a “myth”

 

[Bluetit1802]

Thanks but I’ll stick with my own experience

For me personally, excess protein does contribute to GNG. I’ve tried and tested it several times with complete repeatability. Obviously we all vary somewhat though.

Yes indeed, we all react differently to just about everything we put in our stomachs. However, maybe you should make it clear in your posts that protein needs moderating is just your n=1 experience and not the experience of many other Type 2s. Protein is important for us all, and particularly important for older people, and also for those with no weight to lose who wish to eat low carb.

 

[Member496333]

Yes indeed, we all react differently to just about everything we put in our stomachs. However, maybe you should make it clear in your posts that protein needs moderating is just your n=1 experience and not the experience of many other Type 2s. Protein is important for us all, and particularly important for older people, and also for those with no weight to lose who wish to eat low carb.

Yes. Point taken and fair enough.

I did state “excess “ protein, mind you. That which is over and above what the body needs to build and repair. I found my required level and have proven that anything over and above this level turns to glucose. I’m not alone in having this experience with protein, and don’t necessarily think that I need to qualify every statement as being my own personal experience, but I do generally try to do so anyway.

My point is that it’s not a “myth” as some like to assert just because it doesn’t happen to them

EDIT:

Just to add further. I was talking specifically about a properly formulated LCHF dietary strategy on the whole. Protein requirements are largely the same across any diet plan. It should be used almost entirely for building and repairing the body, not as a source of energy. In someone who has drastically cut their carbohydrate content, then assuming that their protein intake was already sufficient, the carbohydrate should be displaced with dietary fat, not excessive protein.

This is my view and my experience only

 

[Twisticles]

Hi and welcome @Twisticles

Sorry to hear about your diagnosis, but it looks like you are tackling things head on. Well done for that. Sometimes it takes people much longer to get their heads around things.



Having said that, T2 is not the only kind of diabetes that can develop at varying speeds, so I have to ask, have you had the requisite tests to eliminate T1 as a possiblity? These tests would probably have been called GAD and c-peptide, but may be known by different names in Hong Kong.

Hope that helps!

It does help thanks. I will request those tests on my next visit, just to be sure. Diabetes care is a little behind the times here, so Doc probably just saw a fat guy and decided T2!

 

[kokhongw]

It does help thanks. I will request those tests on my next visit, just to be sure. Diabetes care is a little behind the times here, so Doc probably just saw a fat guy and decided T2!

Frankly if we are overweight, we can be quite assured that our pancreas is still able to crank out loads of insulin...

 

[Twisticles]

Hi, welcome!


Your HbA1c would probably benefit from cutting carbs further. As you yourself noted, 30 grams in a meal caused a spike up to 10, though I wonder what your readings were before that meal, as yesterday's numbers were better.
You're off to a flying start, so well done, you!
Jo

Thanks for the advice.
Before the meal was 8.3.
Yesterday was better: 7.5 and 9.5. My first reading below 8 since I was diagnosed! Deviations are all trending to 2 or less...but my first bite readings are higher in the morning and get lower with later meals. All I can think is its the FBG levels taking time to come down?

 

[Twisticles]

Two things you can do to mitigate dawn phenomenon. Firstly do plenty of mild exercise in order to keep glycogen levels low (glycogen is glucose stored in your liver and muscles). Training with weights both depletes glycogen and sucks up lots of glucose. Secondly don’t replace the carbohydrate with excess protein. You must replace the carbs with fat. Natural fats and oils...not seed or vegetable oils.

(snip)

Hope that made sense

Thanks. Certainly exercise would be good...I walk around 8,000-10,000 steps per day but its hardly aerobic. May be time to dust off the hiking boots...HK has some wonderful hills!

 

[JoKalsbeek]

Thanks for the advice.
Before the meal was 8.3.
Yesterday was better: 7.5 and 9.5. My first reading below 8 since I was diagnosed! Deviations are all trending to 2 or less...but my first bite readings are higher in the morning and get lower with later meals. All I can think is its the FBG levels taking time to come down?

FBG is the last to come down. There's so much stored on and around the liver, it'll be a while, add to that it thinks it's helping by upping your levels for energy to start the day (Dawn Phenomenon)... My FBG didn't come down properly until about a year in, and it's the first thing to go back up if I'm even slightly ill or have a little insomnia. So if you want to focus on anything, keep an eye on what your rises after food look like. If they're 2.0 mmol/l or less, you're all good, and the rest will gradually follow. From what I understand, anyway... You've got this.

 

[bulkbiker]

I was talking specifically about a properly formulated LCHF dietary strategy on the whole.

I thought that you personally followed a ketogenic way of eating? Have you tried higher protein eating that way rather than LCHF?
I eat virtually no carbs (mainly carnivore at the moment) and monitor my blood sugars closely.. no rises from me and I eat way over my protein macro every day. Well I don't actually have any "macros" as such but I do record everything that goes in just don't really change it to fit some random "calculator".

 

[Member496333]

I thought that you personally followed a ketogenic way of eating? Have you tried higher protein eating that way rather than LCHF?
I eat virtually no carbs (mainly carnivore at the moment) and monitor my blood sugars closely.. no rises from me and I eat way over my protein macro every day. Well I don't actually have any "macros" as such but I do record everything that goes in just don't really change it to fit some random "calculator".

No. Sorry, I probably didn’t explain myself properly. I incorrectly tend to put ketosis and LCHF under the same umbrella. I’m most definitely ketogenic. Last time I checked my blood I was 5.4mmol/L (ketones not glucose!). I’m virtually zero carb also. Green overground vegetables and a few squares of 100% cocoa chocolate aside.

We all react differently and we all certainly have different levels of insulin sensitivity. For me, personally, more protein than my body needs in order to maintain itself manifests in upward creeping glucose numbers. Not huge, but noticeable to me. I’d never wake up in the 4.* mmol/L glucose range every day if I was consuming excess protein. I know I’m not alone in experiencing this because it was reading other people’s advice that alerted me to it. Incidentally I also don’t count macros. I’m just “zero” carb, moderate protein, fat to satiety.

Anyway it’s fun sharing our experiences. Ultimately it’s all about what works for the individual, and the more information that’s out there, the more people can choose what to listen to and formulate a strategy that may work for them

 

[Bluetit1802]

Anyway it’s fun sharing our experiences. Ultimately it’s all about what works for the individual, and the more information that’s out there, the more people can choose what to listen to and formulate a strategy that may work for them

I agree. I say to newcomers over and over again, it is all trial and error. One size never can fit all.