Completely confused and nowhere to turn?

[Kiren K]

Hello All,

I am a Type 1 Diabetic - Insulin Independent. My frustration doesn’t lie within myself but with my partner, who is actually Type 2 Diabetic.

He has been Diabetic for 5/6years and to this date still cannot get his HBA1C to come down. He is 33yrs old, vegetarian and lives a pretty active lifestyle, which confuses the hell out of me, as his sugar levels are amazing and are constantly in the one figure stage. We have tired everything like changing his meter, dieticians, GP appointments, I think one year we changed doctors almost 5 times, as the doctors kept giving his slow releasing insulin. Furthermore we finally stayed with a doctor who seemed to WANT to help sort out his issues, however they have now put him on a fast reacting insulin which are now Apidra and Lantus and still nothing is happening? He is also on metaformin and the current nurse has sent him to a dietician, which still hasn’t done anything to help his situation. His insulin seems to working and he claims that it is, however sometimes on lazy days it will react very slow.

Recently he has been experiencing severe chest pains and had to be taken to hospital; after everything was completed such as tests and cardiovascular tests, his heart is perfectly normal. Being Diabetic myself I know that I can’t diagnose him, yet he is feeling more lethargic more and more everyday. I’ve done research stating that poor HBA1C can lead to this type of chronic complications, yet we still can’t get his HBA1C to come down. I am so fed up of tying to go to the doctors to sort it out, as I feel no one is helping him and getting to the bottom of this?

Thank you for reading and if anyone can think of anything that we have missed, please do not hesitate to reply.

 

[EllieM]

He has been Diabetic for 5/6years and to this date still cannot get his HBA1C to come down. He is 33yrs old, vegetarian and lives a pretty active lifestyle, which confuses the hell out of me, as his sugar levels are amazing and are constantly in the one figure stage.

I'd believe the meter rather than the hba1c. There are a number of medical conditions (eg anemia) which can cause an hba1c to be inaccurate. I'd ask for a fructosamine test instead.

And on another note, are you sure he's T2 and not T1/LADA/MODY? 5/6 years seems early to move onto insulin to me....but then I've been reading all the stories from T2s on these forums who've often come off meds altogether by going low carb.

Edited to add. I've just realised this is your first post. Welcome to the forums.

 

[xfieldok]

Welcome to the forum. This is a great place for support.

Can you give us an idea of what your partner eats in a typical day please.

 

[Kiren K]

Welcome to the forum. This is a great place for support.

Can you give us an idea of what your partner eats in a typical day please.

Hello and thank you!!

Yes of course a typical day for him would include:
05:30 - cup of tea (no sugar) & 2 wheatabix
10:00 - homemade soup (no added sugar)
12:30/13:00 - 3 boiled eggs & large salad (cucumber,avocado, tomatoes and lettuce)
15:00 - cup of tea (no sugar) (3) veggie sausage sandwich
18:00 - lentil curry

That’s roughly what he’ll eat - he has to eat early as he gets up early for work as he starts working around 6am.

In between meals he’ll have about 2 banana’s and 3 pears - sometimes if it’s a cheat day he’ll a pack of crisps in replacement to a pear.

I hope that helps

 

[Kiren K]

I'd believe the meter rather than the hba1c. There are a number of medical conditions (eg anemia) which can cause an hba1c to be inaccurate. I'd ask for a fructosamine test instead.

And on another note, are you sure he's T2 and not T1/LADA/MODY? 5/6 years seems early to move onto insulin to me....but then I've been reading all the stories from T2s on these forums who've often come off meds altogether by going low carb.

Edited to add. I've just realised this is your first post. Welcome to the forums.

Hello Ellie,

Thank you for getting back to me, we’ve gone through at least 4 anti-bodies test that CLAIM that he is a definite T2? I’ve never hear of the fructosamine test so will get him to try that.

Well that’s what I thought to begin with, however when he was first diagnosed he’s sugars were completely all over the place - hence why they placed him on insulin maybe only just last year and they’ve come down increasingly but just not the HBA1C - he has tried the low-carb diets too and nothing’s changed within that.

Aww thank you! I’m hoping to get some answers &/or guidance too

 

[xfieldok]

Ok. I suspect he is overdoing the carbohydrates. Bananas are a huge no no for T2s. A huge sugar spike for fast energy which is why tennis players eat them between sets.

Fruit in general is best avoided,except for a few berries with full fat yoghurt. Fruit contains fructose which can only be processed by the liver.

Veggie sausages. Depends upon the ingredients. Least cereals the better.

You say sandwich? What are you using for the sandwich? Bread of any colour is not good.

Wheetabixis very high carb and bad for t2. I have eggs for breakfast, but breakfast can be anything.

Please look at some of the threads on low carb high fat or keto. I am not vegetarian myself, but could point you to some interesting sites.

 

[Mike d]

That is a VERY questionable diet. Bananas pears breads and cereals? Extremely bad for diabetics. Total rethink is required

 

[Kiren K]

Ok. I suspect he is overdoing the carbohydrates. Bananas are a huge no no for T2s. A huge sugar spike for fast energy which is why tennis players eat them between sets.

Fruit in general is best avoided,except for a few berries with full fat yoghurt. Fruit contains fructose which can only be processed by the liver.

Veggie sausages. Depends upon the ingredients. Least cereals the better.

You say sandwich? What are you using for the sandwich? Bread of any colour is not good.

Wheetabixis very high carb and bad for t2. I have eggs for breakfast, but breakfast can be anything.

Please look at some of the threads on low carb high fat or keto. I am not vegetarian myself, but could point you to some interesting sites.

Thank you for that haha
His job is a VERY active job, hence why he needs all that sugar because if he doesn’t have it - he’ll have massive hypo’s throughout the day. So he needs quick acting and slow releasing foods to help him through his job?

 

[Kiren K]

That is a VERY questionable diet. Bananas pears breads and cereals? Extremely bad for diabetics. Total rethink is required

Hi Mike,

thank you for your reply, considering his job is fast-paced would you have any recommendations for his diet?

 

[xfieldok]

T2 is best described as a metabolic disorder in which we cannot process carbohydrates. He DOES NOT need carbohydrates in order to function, this is a falicy. I would also question the lentil curry, I cannot process lentils.

Everyone is different and each T2 whill process carbodydrates differently, which makes recipe books a little difficult to cope with. You say he has tried low carb before, but for how long?

Many of us on this forum (not all) control their T2 numbers using LCHF or keto. If your partner is taking insulin but using bananas and such like to stop having hypos, I dread to think what his graphs would look like/

Download the mysugr app. Record his food and readings before he eats and two hours after. After a few days it will give him an estimated hba1c number. It may not be as accurate as a lab test, but it is close enough and will show you upward or downward trends. I found it highly motivational when I first started.

 

[Mike d]

Hi Mike,

thank you for your reply, considering his job is fast-paced would you have any recommendations for his diet?

Hi @Kiren K ... @xfieldok covered it well enough. Cut out those sugars. The fact he's vegetarian limits his options

 

[Rokaab]

Hi @Kiren K ... @xfieldok covered it well enough. Cut out those sugars. The fact he's vegetarian limits his options

But, since he is taking insulin this should be done very carefully.

 

[Brunneria]

hi and welcome!

I hope you both find the forum helpful and informative

Has Mr K been trained in adjusting his insulin to match his carbs?
If so, he shouldn’t be constantly needing to feed carbs to head off hypos.
If not, then he needs to go back to whoever told him to take so much insulin and ask them to adjust his doses downwards to remove the constant risk of hypos.

typical T2s do not experience hypos unless they are on too strong medication for the carbs they are eating.
In fact, hypos are very rare for T2s, with the main challenge being trying to keep bg low and steady. Of course insulin complicates this.

What range does Mr K's blood glucose vary over during the day? If he swings violently from low to high and back again, that will be affecting his energy levels, his lethargy, and is a big strain on the body.

i totally agree that a fructosamine test is worth asking for - there are a few conditions that case distorted HbA1cs.

has he been tested for MODY? And Haemochromatosis?

 

[EllieM]

Thank you for getting back to me, we’ve gone through at least 4 anti-bodies test that CLAIM that he is a definite T2?

Plenty of T1s don't show up on the antibody tests. I'd get a c-peptide test which will show up how much insulin he is producing. T2s are generally high, while T1/LADAs will be low eventually zero. Of course there are a few folk on here who never get a definite diagnosis, and it doesn't necessarily matter if the treatment they get maintains their blood sugars. But if you know he's definitely T2 then you have low carb as an option to reduce or possibly eliminate the meds, while if T1 then he's going to need insulin eventually whatever you do. And then there's MODY, which is rare and genetic and I don't understand at all....

 

[Mike d]

But, since he is taking insulin this should be done very carefully.

@Rokaab .... you see the conflict between his choice of eating lifestyle and sugars as much as I do.

 

[bulkbiker]

Thank you for that haha
His job is a VERY active job, hence why he needs all that sugar because if he doesn’t have it - he’ll have massive hypo’s throughout the day. So he needs quick acting and slow releasing foods to help him through his job?

He will have massive hypos because he is taking insulin.. if he wasn't then he wouldn't hypo.
If he is a typical insulin overproducing T2 then adding yet more into the mix could well be counterproductive.

The core of his diet seems carbohydrate based which will trigger higher blood sugars and then more insulin demand.

 

[Resurgam]

There might very well be some reason that the low test results are not reflected in the Hba1c results, as there are conditions which affect it.
Would your partner consider eating eggs or cheese? Having so much carbohydrate is not a good idea for a type two diabetic, we simply can't cope with it. There are several people I have read about on the forums who have reduced or given up insulin by cutting down the carbs. They are not an essential food group.

 

[Energize]

@Kiren K

As you are Type 1 and Mr K is Type 2, it is important to appreciate that Type 1 and Type 2 are COMPLETELY DIFFERENT conditions. Might I suggest you get hold of a copy of Jason Fung's book 'The Diabetes Code' (https://www.amazon.co.uk/Diabetes-C...=1574297096&sprefix=jason+fung,aps,181&sr=8-1) which explains very well what Type 2 is about and how carbohydrates affect Type 2. Type 1, as you probably know, is autoimmune and therefore the body does not produce enough/any insulin. Type 2 involves too much insulin - the recommended book explains this brilliantly.

Another thing you could try, should you be in a position to afford it, would be to fund a few Libre sensors (unfortunately, approx £50/2 weeks, so quite considerable pay-out). The Libre system is great in that, apart from other information, shows a graph of the glucose levels during the 2 week period. Many have found this incredibly enlightening as to the spikes/troughs which weren't appreciated when using the Glucometer.

Wishing you the best of luck. It certainly takes a while to get ones head around it all

 

[JoKalsbeek]

Hello All,

I am a Type 1 Diabetic - Insulin Independent. My frustration doesn’t lie within myself but with my partner, who is actually Type 2 Diabetic.

.

Hi @Kiren K ,

And welcome! As others have said, T2 is a completely, absolutely different condition than T1. You don't produce insulin, he does, but so much of it he's insensitive to it. And every time he eats carbs, his bloodsugars shoot up, not because the insulin's not there, but because it's just not effectively working for him. Things'd be easier if he wasn't a vegan, I have to admit, but there are more people on the forum who go that route for ethical or religious reasons, but.... If he wants to get off of insulin, he will have to go low carb. A T2 doesn't need carbs. I have about 20 grams or less a day (keto diet; I am in ketosis, meaning I burn fat for fuel rather than carbohydrates). Haven't toppled over yet. When i read through the usual daily fare I thought, "Well, that's not too bad, few tweaks here and there, and it's a whole lot better." and then you mentioned the fruit. Might as well put him on a sugarwater drip. Thing is, because he's on insulin, going low carb he will 100% hypo when you reduce carbs (all sugars are carbs, not all carbs are sugar, but TURN to sugar once ingested.). I'm just surprised everyone's putting him on an insulin regime....

Okay, so, I wrote something called the Nutritional Thingy, geared to T2's, but half the time the link doesn't work, and I can't get a grip on why it doesn't, so I'm going to put it here. I hope he forgives all the non-vegan foods in there, and doesn't rush righ in with the insulin he's on.... Again, he will crash & burn if he tried this while shooting the good stuff.
THE NUTRITIONAL THINGY
There’s a few things you should know.

1. Practically all carbs turn to glucose once ingested, so not just straight sugars, but starches too. Food doesn’t have to taste sweet to make your blood sugars skyrocket.

2. A meter helps you know what foods agree with you, and which don’t. Test before and 2 hours after the first bite. If you go up more than 2.0 mmol/l, the meal was carbier than you could handle. (It’s easy to remember, as you’re a T2: all 2’s, all over the place!)

3. In case you didn’t know already, this isn’t your fault. It’s genetics, medication, decades of bad dietary advice, and basically all manner of things, but nothing you can actually blame yourself for.

4. Diabetes T2 is a progressive condition, unless you (also) change your diet. So you have options. Diet-only, diet with medication, or medication only. But that last option will most likely mean more medication over the years. (And there is more than just metformin, so if it doesn’t agree with you, there’s lots of others to try). So even if going really low carb isn’t for you, you might consider moderately low carb an option, with meds to assist.

5. Are you overweight? 90% of T2’s are. Yeah, that means 10% are slim and always were.* If you did gain weight, it was the precursor of this metabolic condition. We make loads of insulin, but become insensitive to it. So carbs we eat turn to glucose, and normally, insulin helps us burn that glucose for fuel. When it doesn’t, that glucose is stored in fat cells instead. When those fat stores are full, the glucose remains in our bloodstream, overflowing, into our eyes, tears, urine, saliva… And then we’re T2’s. So weight gain is a symptom, not a cause. This also means that “regular” dietary advice doesn’t work for us. The problem lies in our inability to process carbs. And most diets focus on lowering fats and upping carb intake. Which is the direct opposite of what a T2, or prediabetic, for that matter, needs.

6. There are 3 macro-nutrients. Fats, protein and carbohydrates. Those macro’s mean we get the micro-nutrients we need: that would be vitamins and minerals. So… If you ditch the carbs, you should up another macro-nutrient to compensate, to make sure you don’t get malnourished or vitamin deficient. Carbs make our blood sugars rise. Protein too, but nowhere near as bad as carbs do, so they’re alright in moderation. Fats however… Fats are as good as a glucose-flatline. Better yet, they’ll mitigate the effects of any carbs we do ingest, slowing down their uptake and thus the sugar-spike. Contrary to what we’ve been told for decades; fats are our friends.

7. Worried about cholesterol? On a low carb diet, your cholesterol may rise a little as you start to lose weight. That’s a good thing though. (Believe it or not). What was already there, stored in your body, is starting to head for the exit, and for that it’ll go into your bloodstream first. So when you have lost weight and it stabilises, so will your cholesterol. And it’ll probably be lower than what it was before you started out.

8. You’ll lose weight on a low carb diet. Weight loss will help with your insulin-resistance, and not only that… Going low carb might help with other issues as well, like non-alcoholic fatty liver disease and depression.

9. Always ask for your test results. You don’t know where you’re going, if you don’t know where you’ve been.

10. Last, but certainly not least: If you are on medication that has hypoglycemia listed as a side-effect, like Gliclazide for instance, do NOT attempt a LCHF diet without a meter nor your doctors’ knowledge/assistance. You can drop blood glucose levels too far, too fast, if your dosage isn’t adjusted accordingly. This could mean a lower dose in stages or even stopping medication completely. Never do this without discussing it with your doctor first!


So what raises blood sugars? Aside from the obvious (sugar), starches raise blood glucose too. So bread, and anything made with grain/oats flour, rice, potatoes, pasta, corn, cereals (including all the “healthy choices”, like Weetabix and muesli), most beans and most fruits. So you’ll want to limit your intake, or scratch them altogether.

Which food items remain on the shopping list? Well, meat, fish, poultry, above ground veggies/leafy greens, eggs, cheese, heavy cream, full fat Greek yoghurt, full fat milk, extra dark chocolate (85% Lindt’s is great!), avocado, (whole) tomatoes, berries, olives, nuts, that sort of thing… Meal ideas? Have a couple:

Scrambled eggs with bacon, cheese, mushrooms, tomato, maybe some high meat content sausages?
Eggs with ham, bacon and cheese
Omelet with spinach and/or smoked salmon
Omelet with cream, cinnamon, with some berries and coconut shavings
Full fat Greek yoghurt with nuts and berries
Leafy green salad with a can of tuna (oil, not brine!), mayonnaise, capers, olives and avocado
Leafy green salad with (warmed goat's) cheese and bacon, maybe a nice vinaigrette?
Meat, fish or poultry with veggies. I usually go for cauliflower rice or broccoli rice, with cheese and bacon to bulk it up. Never the same meal twice in a row because of various herbs/spices.

Snacks? Pork scratchings, cheese, olives, extra dark chocolate, nuts.

Of course, there’s loads more on the web, for people more adventurous than I. (Which is pretty much everyone). Just google whatever you want to make and add “keto” to it, and you’ll get a low carb version. There’s a lot of recipes on the diabetes.co.uk website, as well as on www.dietdoctor.com where you’ll also find visual (carb content) guides and videos. And I can wholeheartedly endorse Dr. Jason Fung’s book The Diabetes Code. It’ll help you understand what’s going on in your body and how to tackle it, whilst not being a dry read. Not only that, but you’ll know what to ask your doctor, and you’ll understand the answers, which is, I believe, quite convenient.

*If you can't afford to lose weight, do NOT go for Intermittent Fasting/One Meal A Day. Sticking with three meals a day, 3 snacks a day, all low carb, high fat, moderate protein, should keep your weight up to par while keeping your bloodsugars in check.

And I'm hoping this link will work: https://www.diabetes.co.uk/forum/category/vegetarian-diet-forum.71/
Good luck eh. And tell him to be careful.
Jo

 

[Daibell]

Hi. Can you let us know whether he is overweight which would imply eating too many carbs e.g bananas which are a No-No. You should never eat to match the insulin but adjust the insulin to match the carbs you eat. The only blood test that implies T2 rather than T1 is the C-peptide, otherwise it will probably be guesswork as to T2. Although I understand the points made by other posters that T1 and T2 are completely different, I don't totally agree. Both types when taking too many carbs may gain weight due to the presence of adequate inulin so having a sensibly low-carb diet often makes sense for both types.