MalcToy said:
Hi All
Last ApriI I was diagnosed Type 2 following a visit to my Heal Centre for a 'Well Man' clinic. The subsequent Glucose test along with an HbA1c showed my level at 63.0 mmol.mol. On a retinal scan traces of diabetes were found but only level R1.
Since then through diet and limiting/reducing my sugar intake I have lost about 6/7kg in weight and my average blood sugar level has been reduced from 6.23 last April to 5.57 at the end of August. This was established using Free Style Lite Testing Strips which I used once each day before meals varying each day between pre-breakfast, pre-lunch and pre-dinner.
This week I had a second HbA1c test which confirmed my level at 56 mmol.mol which, according to the information I have sobtained online, in non-diabetic.
That said, my GP who specialises in diabetes recommends that I start taking one metformin tablet each day to further reduce my HbA1c level ideally to 50.
Unless it is necessary, I don't really wish to start taking continual medication and would prefer control being by diet and excercise.
My question is, should I follow my GP's advice ?
I would really appreciate peoples thoughts.
Many thanks from a Newbie Diabetic !
Firstly, congratulations on reducing both your weight and HBA1c. :clap: However, there's room for improvement on your HBA1c.
For more information on what your HBA1c result means, go to
http://www.diabetes.co.uk/what-is-hba1c.html
HbA1c can be expressed as a percentage (DCCT unit) or as a value in mmol/mol (IFCC unit). Since 2009, mmol/mol has been the default unit to use in the UK.
On diagnosis, your HBA1c was 63 mmol/mol - 7.9% (DCCT) which is an average BGL (Blood Glucose Level) of 10.0 mmol/l
Your latest HBA1c of 56 mmol/mol equates to 7.3% (DCCT) actually shows that you have reduced your average BGL to 9.0 mmol/l
Note that the HbA1c value, which is measured in mmol/mol, should not be confused with a blood glucose level (BGL) which is measured in mmol/l.
Use this converter tool to calculate your average BGL from your HBA1c result.
http://www.diabetes.co.uk/hba1c-units-converter.html
You said that you had reduced your average BGL to 5.57 at the end of August. You came to this figure by testing once each day before meals varying each day between pre-breakfast, pre-lunch and pre-dinner. Unfortunately, as you can see from the figures above, testing only pre-meal does not give a true picture of your average BGL, and as important, is how much your BGL rises AFTER eating.
To get a more accurate picture you need to test pre-meal and 2 hrs after you finish eating that meal to see the effect of the food you have eaten on your BGL. Your BGL will start to rise the minute you start eating. If you want to see how high your BGL might spike after eating, try testing at 1hr after you finish eating. At +2 hrs you want to aim for a similar value to your pre-meal value. If it's not of a similar level, then you likely consumed too much carbohydrate in that meal.
Make a note of what was in that meal, and the effect on your BGL, and if all's well and you're back to pre-meal levels at +2hrs, then you know that you can keep that meal or food in your diet as it's good for you. If your BGL rises higher than you would like at +1hr or +2hrs, or is still high at +3hrs, then you know to adjust portion size, or in extremis, exclude that meal or ingredient from your diet. Fats, & proteins have neglible effect on BGLs, what you really need to take notice of is the carbohydrates you eat.
As well as cutting sugar, you may want to look at reducing the carbohydrates in your diet, especially the refined carbohydrates which can push up your BGL quickly - things like, white bread, potatoes (especially mashed), cakes, pastries obviously, pasta, white rice etc., Some people advocate cutting these things entirely from their diet, but if you find this difficult, reducing carbohydrate portion sizes may also produce results. I would recommend weighing everything at first, so that you can learn appropriate portion sizes - you might be surprised by how much you eat and what might be an appropriate portion size.
At the same time, I would recommend increasing the amount of vegetables you eat, especially those grown above the ground - i.e. green leafy stuff
like broccoli, cabbage, spinach, cauliflower etc., Eat root veg. in moderation (carrots, turnip etc.,)
Another tactic is to eat low-GI carbohydrates which have higher levels of fibre and which don't provoke such an instant rise in BGLs as their refined counterparts. You might consider, wholewheat pasta or noodles, brown basmati rice, barley, wholewheat bread etc., Be careful of the sugar in fruits, berries are best, as they are high in fibre, and lower in sugar than other fruits.
Most diabetics find that they can improve control by testing before and after each meal, until they get a good idea of what works for them. Everybody's tolerances are different, so there is no one-size-fits-all formula. You have to find out the foods which will work for you, to lower and maintain your BGLs and to reduce your risk of complications. Be adventurous, and find what suits you best. Learn to love what you CAN eat, making it as tasty, healthy and interesting as possible. This has to be a way of eating that you can sustain, and enjoy for life, or you may be tempted to "fall off the wagon". You can still have treats, but they should be just that, not the norm. IMO, they are best factored into what you plan to eat for the day, not EXTRA. You want a treat? - compensate by having less pasta or rice...
Your GP will likely tell you not to test, as their agenda is to reduce costs and they don't want to have to prescribe expensive test strips. But ask any diabetic and they will tell you that testing is vital. so TEST, TEST, TEST is the best advice I can give. Once you know what foods work for you , you will be able to reduce or eliminate testing as you see fit.
If you are overweight, reducing your weight will reduce your insulin resistance, which in turn will reduce your BGLs.
Exercise will also help with insulin resistance, even 30 minutes fast walking 5 times a week; take the stairs instead of the lift or escalator; join a gym, go swimming. Exercising regularly can improve your cholesterol profile, reducing the total, and increasing the HDL (so-called good cholesterol) and reduce triglycerides. Can't recommend it highly enough!
It's really up to you whether you take metformin or not. I don't personally take it, but many folks do, and it works for them. I believe some of the benefits, might be reduction of CVD risk, and it assists with weight loss. It does have its downsides too - something delicately called "gastric upset". Metformin doesn't help hugely with BGL levels. It supposedly helps with insulin resistance, but losing weight can be just as effective, if not more so, IMO. Only you can decide if it's worth it to you.
I would recommend that you browse other areas of this site, not just the forum, for information on all aspects of diabetes, diet and medication to help you decide the best way forward for you. It's an excellent resource, that I've found invaluable.
Whatever you decide, I wish you the very best of luck!