Type 2 Type 2 Newbie Questions

[andyslowrider]

Hi,

Firstly, sorry if this is the wrong thread to post my questions in - I wasn't sure if I should post here or in the T2 forums.

I've recently, about 5 weeks ago, been diagnosed with T2 with an initial blood sugar reading of 19mmol/l and HbA1C of 74 mmol/mol when tested in hospital, rising to 84 when tested at my GP's about a week later. Since then I've spent many hours reading through these and other forums trying to absorb as much information as possible. These forums really are a credit to all of you - they've helped me so much already.

Anyway, I've bought a Contour Next One meter and am having great fun testing, logging and interrogating my data and, whilst I feel I'm making some progress, there are still some things I don't understand and would appreciate your thoughts on.

Firstly, blood sugar readings after meals. I understand (hopefully correctly) that within 2 hours of starting my meal my blood glucose should be no more than 2 mmol/l higher than my before meal reading. Because I'm curious, and impatient, and don't have enough holes in my fingers, I sometimes also test 1 hour after eating - is there any guidance on what increase I should be seeing at this time, or is it just a wasted test? For instance, tonight my before meal reading was 6.4 mmol/l, 1 hour after was 8.7 and 2 hours after (during which I rode my bike gently for 30 minutes) it was 6.0.

Secondly, after my evening meal, and before I do my 2 hour test, I try to do between 30 and 60 minutes exercise, either a brisk walk or a gentle ride on an indoor cycle trainer. Exercise obviously burns energy, presumably at least some of which derives from blood sugar, so I imagine that this helps to lower my blood sugar readings. Does this in any way affect the validity of my after meal readings?

Finally, for now, I'm trying to adopt a LCHF diet. It's been a huge change for me but it's not been as bad as I feared. I'm certainly not feeling as constantly hungry as I expected. I'm a huge coffee addict and apart from a small latte with breakfast tend to drink double espresso with no milk or cream (although do enjoy it with either). I notice that some of you recommend cream in your coffee. Is this purely to help with satiety or does the cream also serve another purpose? As I'm trying to lose weight, and am not feeling particularly hungry, would I be better skipping the cream and the calories that it adds, or will adding it provide other benefits? I think my cardiologist would recommend giving the cream a miss, but I'm more concerned about about getting my T2 under control than heart health at the moment.

Sorry for a long winded post and thanks in advance for any responses.

 

[Stephen Lewis]

Welcome andyslowrider.

To quote a current over-popular phrase that I really dislike but does apply to us,"We are all in this together." And an even worse phrase welcome to our "new normal."

To answer your questions as it worked for me, firstly I was told only to test (also with a Contour Next) just before a meal and I should be in a range of 5.0 to 7.0. This would be 4 or five hours after the meal and as I discovered later is a meaningless measurement except when relates to tests at 1 and 2 hours after a meal. This is how you discover the affect of different foods on you personally. I will repeat a phrase we use here a lot - we all react differently to the same types of foods. I started testing when I was put on insulin in February 2018. This was a health disaster but luckily someone mentioned this forum in the June and I started on a low carb diet. Still following the suggested testing times/ With the diet, where I had a reducing target of carb intake finally down to about 50 gms per day, with the help from this forum, with regular heavy weight-lifting at the gym and occasional prayer at church, I was able to get off insulin in the December and have my other medications cut or removed.

At that point I was able to get the Freestyle Libre that does a continuous monitoring of the glucose (CGM) levels in the interstitial fluid. Luckily I am now able to have this covered on a private health insurance that comes with my pension. I did try pricking my finger about 13 times a day for a few weeks and the pain was worthwhile as the insurance company realized that paying 70% of the sensor cost (about $100 here in Canada) was cheaper than the cost of the Contour test strips. The FL really shows the results on bg of different foods in my system. With some foods the level will spike over 9.0 in less than an hour and then drop below 5.0 at 2 hours. The spike is not good but does not show on pre-timed finger testing.
With the diet and the ability to see what is happening I have managed to get my bg under control with my last A1c tests being below the pre-diabetic range. This after well over 12 years on medication.

So your exercise is good and how much you need will depend on you. On my diet I have manged to lose about 40 lbs and most of this is from around my waist that is 8 inches smaller. I believe this fat is used by the liver to do a glucose 'dump' when the pancreas senses a potentially dangerous drop in bg. Again it is my impression that on a 'normal' high carb, low fat diet my body uses the carbs for energy, changes the unused carbs to fat (close to the liver?) and leaves the fat floating around with the known bad results on heart and arteries. On a low carb diet, the body switches to using the fats for energy and so very little is left floating. Many years ago when first diagnosed as pre-diabetic I was automatically put on Metformin and a statin. A year ago after being on the low carb diet for about 9 months all my blood fat measurements were below the range considered normal but I am fitter and more alert! My statin dose was also cut in half. I expect this medication will also end soon.

Drink the coffee and I put a heavy cream in my coffee as it helps my fat intake though I am not specifically trying a high fat diet. But most importantly do what works for your health. Depending on what is you real type of diabetes - have heard of 5 or 6 T2 - you may be able to go into remission or like me you may be able to take control so that this disease does not control you.

So I have done a more long-windier (is that a word) post and I hope it helps but keep coming back with more questions and make the answers work for you.

 

[andyslowrider]

Welcome andyslowrider.

To quote a current over-popular phrase that I really dislike but does apply to us,"We are all in this together." And an even worse phrase welcome to our "new normal."

To answer your questions as it worked for me, firstly I was told only to test (also with a Contour Next) just before a meal and I should be in a range of 5.0 to 7.0. This would be 4 or five hours after the meal and as I discovered later is a meaningless measurement except when relates to tests at 1 and 2 hours after a meal. This is how you discover the affect of different foods on you personally. I will repeat a phrase we use here a lot - we all react differently to the same types of foods. I started testing when I was put on insulin in February 2018. This was a health disaster but luckily someone mentioned this forum in the June and I started on a low carb diet. Still following the suggested testing times/ With the diet, where I had a reducing target of carb intake finally down to about 50 gms per day, with the help from this forum, with regular heavy weight-lifting at the gym and occasional prayer at church, I was able to get off insulin in the December and have my other medications cut or removed.

At that point I was able to get the Freestyle Libre that does a continuous monitoring of the glucose (CGM) levels in the interstitial fluid. Luckily I am now able to have this covered on a private health insurance that comes with my pension. I did try pricking my finger about 13 times a day for a few weeks and the pain was worthwhile as the insurance company realized that paying 70% of the sensor cost (about $100 here in Canada) was cheaper than the cost of the Contour test strips. The FL really shows the results on bg of different foods in my system. With some foods the level will spike over 9.0 in less than an hour and then drop below 5.0 at 2 hours. The spike is not good but does not show on pre-timed finger testing.
With the diet and the ability to see what is happening I have managed to get my bg under control with my last A1c tests being below the pre-diabetic range. This after well over 12 years on medication.

So your exercise is good and how much you need will depend on you. On my diet I have manged to lose about 40 lbs and most of this is from around my waist that is 8 inches smaller. I believe this fat is used by the liver to do a glucose 'dump' when the pancreas senses a potentially dangerous drop in bg. Again it is my impression that on a 'normal' high carb, low fat diet my body uses the carbs for energy, changes the unused carbs to fat (close to the liver?) and leaves the fat floating around with the known bad results on heart and arteries. On a low carb diet, the body switches to using the fats for energy and so very little is left floating. Many years ago when first diagnosed as pre-diabetic I was automatically put on Metformin and a statin. A year ago after being on the low carb diet for about 9 months all my blood fat measurements were below the range considered normal but I am fitter and more alert! My statin dose was also cut in half. I expect this medication will also end soon.

Drink the coffee and I put a heavy cream in my coffee as it helps my fat intake though I am not specifically trying a high fat diet. But most importantly do what works for your health. Depending on what is you real type of diabetes - have heard of 5 or 6 T2 - you may be able to go into remission or like me you may be able to take control so that this disease does not control you.

So I have done a more long-windier (is that a word) post and I hope it helps but keep coming back with more questions and make the answers work for you.

Many thanks for your reply, and congratulations on your progress.

 

[HSSS]

Re the test at 1 hr. some people do this. And hope to keep to a certain limit. I’m unsure on what basis they set that limit. My thoughts for what they are worth - This https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html says a non diabetic random test (ie at any time) should be below 11. So that would be my absolute highest acceptable limit at any time. It’s also widely acknowledged that damage can occur about 7.8mmol. So Alternatively that too could be my highest limit but accepting that non diabetics can and will go above this at times briefly.

With regards to exercise before the 2hrs are up. Undoubtedly it’s a good thing to do post meal. Personally I’d find this confusing when trying to assess which foods work and which don’t, unless exercise was identical in form and exertion etc every time. Otherwise how will you know what was the food and what was the exercise. Until and unless I already understood that particular meal then I’d delay the exercise until after the post prandial test, and maybe add in post exercise tests if I wasn’t poked enough that day to get data on that too!!

As far as I am aware the cream is for taste and satiety. If you don’t need it then, again personally, I wouldn’t have it unless weight maintenance or gain was desired.

 

[andyslowrider]

Many thanks Stephen Lewis and HSSS for your replies above, both were helpful and informative.

The further I get into this, the more questions I have...

I know that everone's different and react differently to different food items, but anyone offer their thoughts and experiences with the following?

Milk Vs Yoghurt - I read in lots of posts that yoghurt, particularly full fat greek yoghurt, is recommended as a food yet I've also read that milk is best avoided. Why is this? Looking in my fridge, my Tesco full fat greek yoghurt has a slightly higher carb and sugar content than my semi-skimmed milk. As a newbie this makes milk look more attractive than yoghurt from a lchf perspective - is it just that it's easier to consume large quantities of milk than yoghurt?

How many carbs are too many? When looking at the nutritional information panel on a food product, at what point do you decide that it contains too many carbs per 100 grams? Also, how many carbs do you consider to be too many per portion of a given product? How many carbs per portion do you find it takes to spike your BG?

 

[Mike d]

No milk ... full cream will be far better

 

[andyslowrider]

No milk ... full cream will be far better

Why?

 

[Mike d]

High fats. ALWAYS high fats

 

[andyslowrider]

High fats. ALWAYS high fats

Thanks. I understand that fats can help manage hunger, but as I'm not particularly hungry and am trying to lose weight do I need to increase my fat intake, especially as I also have heart health issues to consider?

My question partially relates to breakfast- sometimes I have bowl of full fat Greek yogurt with a handful of mixed nuts. Given that the carb and sugar content is virtually identical, how is this better than a glass of milk and a handful of nuts? And would nuts and double cream be better and, if so, why?

 

[Mike d]

Too late here for me to respond. @Goonergal @bulkbiker ... can you guys take this one over.

thanks

 

[bulkbiker]

Thanks. I understand that fats can help manage hunger, but as I'm not particularly hungry and am trying to lose weight do I need to increase my fat intake, especially as I also have heart health issues to consider?

My question partially relates to breakfast- sometimes I have bowl of full fat Greek yogurt with a handful of mixed nuts. Given that the carb and sugar content is virtually identical, how is this better than a glass of milk and a handful of nuts? And would nuts and double cream be better and, if so, why?

I replaced breakfast with coffee and cream almost as soon as I got my diagnosis and I think have had about 10 breakfast meals over the past 4 1/2 years.
If you can get by with 100ml glass of milk and a handful of nuts instead of full fat greek yoghurt and still feel as full then go for it. The carb amount will be about the same the satiety effect likely a lot less for the milk (and the carb amount slightly higher depending on your yoghurt).
Heart health issues is a whole other thing but in my view there is little to no strong evidence that animal foods are not heart healthy. Fats are great for satiety which may lead to you eating "less often" which would be great as you'd be triggering insulin production less frequently. Your blood sugar should become more stable and your HbA1c lower until you get into remission.

 

[Stephen Lewis]

Many thanks Stephen Lewis and HSSS for your replies above, both were helpful and informative.

Milk Vs Yoghurt - I read in lots of posts that yoghurt, particularly full fat greek yoghurt, is recommended as a food yet I've also read that milk is best avoided.

I don't avoid milk I just never drink it. I will use a high fat cream (18%) in my coffee and on those few occasions I have oatmeal or fresh fruit. My big issue with milk is that whole milk almost does not exist in North America. The milk manufacturers (not the cows) convinced everyone that milk had to be homogenized. I believe this was so that the absence of cream would not be noticed. Cream provides a much higher profit in butter, cheese, 'coffee cream' and other value added (for the producer) products so it is creamed off (pun intentional). My rant but I strongly believe that the lack of cream in milk is a major cause of irritable bowel syndrome. Now Canada has dropped milk as an essential food group replaced with water, necessary but with absolutely no food value.

All yoghurts seem to have an excessive % of sugars and will cause me an immediate but short lived spike in my bg. Unless people are testing at least 1 and 2 hours after eating yoghurt this may not be seen. I believe the sugar in yoghurt is lactose and my body seems to deal with it quickly. I have seen studies that show that fructose is changed almost immediately into fat so perhaps my body does the same with yoghurt. So I only have yoghurt either as a treat on rare occasions, if I feel my weight has dropped too low or if there does not seem to be enough of a liver boost to bg in the morning or after exercise.

As before, find out what works for you but I suggest being very careful with yoghurt. The fats are a good replacement for carbs but keep away from low fat as the sugars may be a higher proportion of the portion.

 

[Goonergal]

Hi @andyslowrider

I’m another one who doesn’t eat breakfast - that wasn’t an immediate thing for me, but overtime I was less hungry and wanted to experiment with intermittent fasting to improve insulin sensitivity and speed up weight loss.

Don’t be afraid of fat - it helps you to feel full and also to reduce your carb count - low fat usually equates to more sugar, whether added or in the form of lactose or other ‘natural’ sugars.

 

[Mike d]

@bulkbiker @Goonergal ... thanks you two It was 2300 my time so I had to bail