New T2

[lazybum]

Hi there,

I was diagnosed a week ago with T2. I'm 36/m, family history of diabetes; my father was diagnosed with T2 in his early 30s. I'm of asian descent, so rice is a staple and hence my diet is quite heavy on carbs. I've also had hyperthyroidism, however this has gone into remission and my GP suspects this is a contributing factor as it caused my metabolism to slow down.

I felt particularly lethargic after a carb heavy day last week, bought myself a BG meter. Had a fasting glucose of 11.8 mmol, dragged myself to the GP and got put on 2000mg/day Metformin ER. A1C came back at 11.1. Tests also showed mild non-alc induced fatty liver.

Since then, I've gone on a mainly LCHF diet and started exercising 45-60 mins per day. I've been on Metformin for exactly 7 days, BG levels have dropped significantly and my fasting glucose over the last 3 mornings (taken right after I get up) have been 5.x mmol.

I've been introducing some carbs and sugars back in and actively monitoring BG to see how much my body can tolerate while keeping BG in check. In most cases postprandial BG is consistently between 6.8-7.8 mmol after 2 hours, even if I take a significant amount of fruits, eg. 300g of mixed melon pieces.

The only thing I've noticed is when taking particularly carb/sugar heavy food, BG takes a while to peak. I had a very sweet cream cheese danish for tea, and BG was as follows:
- 6.0 mmol @ 1 hour before meal
- 10.4 mmol @ 1 hour after first bite
- 12.8 mmol @ 1.5 hours
- 11.4 mmol @ 2 hours
- 8.5 mmol @ 2.5 hours
- 6.0 mmol @ 3 hours

I'm assuming BG in non-Ds aren't likely to peak that high, however is the late BG peak @ 1.5 hours typical of insulin resistance, or just slow digestion?

 

[Sugarlisa]

DCUKMOD

 

[Sugarlisa]

I’m a newbie type 2 been over a month for me and I normally don’t eat carb and sugar unless carb are low

 

[Sugarlisa]

Jokalsbeek might can help u too

 

[ianf0ster]

Hi, The standard post prandial measurement type for us Type 2 diabetics is at 2hrs after 1st bite. Now this varies if you are eating something with high refined carbs ( move it earlier) or eating something with a large amount of Fats (extra tests at 2.5 hrs and 3hrs). This is because refined carbs spike you quickly and fats delay the processing of non-refined carbs.

You say that you are OK with large quantities of Melon, but the problem with fruit is that it contains Fructose as well as Glucose. Fructose doesn't raise your BG, it dose contribute to non-alc fatty liver.

 

[JoKalsbeek]

Hi there,

I was diagnosed a week ago with T2. I'm 36/m, family history of diabetes; my father was diagnosed with T2 in his early 30s. I'm of asian descent, so rice is a staple and hence my diet is quite heavy on carbs. I've also had hyperthyroidism, however this has gone into remission and my GP suspects this is a contributing factor as it caused my metabolism to slow down.

I felt particularly lethargic after a carb heavy day last week, bought myself a BG meter. Had a fasting glucose of 11.8 mmol, dragged myself to the GP and got put on 2000mg/day Metformin ER. A1C came back at 11.1. Tests also showed mild non-alc induced fatty liver.

Since then, I've gone on a mainly LCHF diet and started exercising 45-60 mins per day. I've been on Metformin for exactly 7 days, BG levels have dropped significantly and my fasting glucose over the last 3 mornings (taken right after I get up) have been 5.x mmol.

I've been introducing some carbs and sugars back in and actively monitoring BG to see how much my body can tolerate while keeping BG in check. In most cases postprandial BG is consistently between 6.8-7.8 mmol after 2 hours, even if I take a significant amount of fruits, eg. 300g of mixed melon pieces.

The only thing I've noticed is when taking particularly carb/sugar heavy food, BG takes a while to peak. I had a very sweet cream cheese danish for tea, and BG was as follows:
- 6.0 mmol @ 1 hour before meal
- 10.4 mmol @ 1 hour after first bite
- 12.8 mmol @ 1.5 hours
- 11.4 mmol @ 2 hours
- 8.5 mmol @ 2.5 hours
- 6.0 mmol @ 3 hours

I'm assuming BG in non-Ds aren't likely to peak that high, however is the late BG peak @ 1.5 hours typical of insulin resistance, or just slow digestion?

The numbers you're seeing are thoroughly diabetic, so, no, not slow digestion, just your body trying it's damnedest to deal with what you put in there, and failing miserably. It just can't deal. You're looking for a rise of no more than 2.0 mmol/l between before the meal and 2 hours after the first bite, and you're nowhere near it. So the question becomes: Why in heaven's name are you reintroducing carbs and sugars? Once you're diabetic, that's what you are. I've been in remission for years, but I'll always be a T2. While your tolerance can improve some, and it'll take months if not years for that to happen, the moment one goes back to the old, previously usual carb load, numbers will rise again. You've been diagnosed for a week and you expect miracles? Or is it just a matter of experimenting? I'm all for experiments, but please, do be careful. You only get one body to live in, take care of it. I had non alcoholic fatty liver disease so bad it hurt to breathe, and carbs, and especially fructose, can make it that much worse. Cutting carbs and fruit can fix it, like it did mine.

https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ might help a little, but do yourself a favour and stay away from the Danishes.
Good luck!
Jo

 

[lazybum]

I never said I went back to my old carb load. I'm on significantly less carbs than I was previously, typically <80g a day. I'm also maintaining ketosis with my current carb load.

As I mentioned earlier, most of my readings at 2 hours post meals are under 7.8 mmol. I'm not expecting miracles so please don't lecture me - I'd like to hear what others have experienced and I think it's important to find out what my body can handle.

 

[VashtiB]

Hello and welcome,

I also find your post a bit confusing. You have been diagnosed as a type 2 diabetic at a reasonably young age. You seem to have some understanding that us type 2s can't tolerate carbs but then say after a week that you are introducing some carbs and sugars back into your diet. The levels you post in relation to your blood sugar levels are all higher than I personally like. If I see a 6 I take that as a message to reduce my carbs, try to reduce my stress (easier said than done) and maybe get out for another walk. I am a lot older than you- in my 50s and the reason I take it this seriously is that I don't want to do any more damage to my body and I absolutely do not want to increase my insulin resistance. You as someone much younger than me doesn't seem concerned with the issue of your insulin resistance and that makes me a bit sad.

You will be a diabetic for the rest of your life. That is a fact. You can make a real effort to put it into remission and make it non-symptomatic and try to decrease your insulin resistance or you cantata the path you seem to be on and have levels well into the diabetic range which will increase your insulin resistance and end up having to take insulin. It is your choice.

I sincerely hope you can see how much @JoKalsbeek was trying to help. She is one of the most generous people I have 'met' her link that she posted has helped at least thousands of people. The people here are so generous with their advice and time and as a result of that generosity and advice I like many many others have had my diabetes in remission within three months of diagnosis. I have found that journey difficult as I love carbs and they formed a huge part of my diet pre-diagnosis. The help and support I have been given when complaining about how hard I have found it was amazing.

Good luck with your journey- only you can make the choice about the path you will follow.

 

[EllieM]

Welcome to the forums.

A1C came back at 11.1. Tests also showed mild non-alc induced fatty liver.

That's an average blood sugar of 15 (unless you've got various weirdnesses in your blood such as anaemia). So you've actually done really well to get your levels down so fast (sorry about the rice, I'd be surprised if you can ever go back to eating that). You've bought a meter, dropped the carbs and have increased exercise, all excellent things that should help you immeasurably. (Sorry if that sounds a bit condescending, it's not meant to be. Usually people come on here first and get advised to do all that stuff, so you've bypassed the first stage in the advice for new T2s.)

Given your age and your health conditions you'll be doing your body a huge favour if you can keep your bgs under control by diet. If you go the medication route you'll probably be on insulin in ten years or so, and then you'll have the joy of both insulin resistance and insulin injections, not something I'd wish on anyone. (Speaking from personal experience as a T1 with a T2 father, so I produce no insulin but am definitely slightly insulin resistant. )

So, patience is a virtue. Yes, in the long term you can reintroduce some carbs to test your system, but maybe wait till you've got more normal levels first? And it'll take weeks (or months) of low carb before your results get to normal levels. There's a lot of experience here from people who have gone through what you are enduring now, they are trying to tell you the stuff that they wish they'd known at the beginning of their T2 journey.

Good luck. Unfortunately T2 is massively influenced by genetics, and there's nothing you can do about that. But avoiding carbs should keep your levels OK and mean that you avoid the spiral of increasing blood sugar levels, complications and medication.

Hopefully, in the long run you'll be able to (slightly) increase the amount of carbs in your diet, only time will tell. Sugar is addictive, so low carb does become easier the longer you do it.

 

[EllieM]

@Sugarlisa . For future reference, if you want to send an alert to another member to join the thread you put an @ followed by their name. Then they get a notification that their name has been mentioned in the thread

 

[lazybum]

Again, I'm not 're-introducing' carbs so I can go back to my previous diet before diagnosis. I am also not aiming to have zero carbs, and having a look at some other threads on this forum, I can see there are some who manage 100g of carbs/day and yet maintain normal HbA1C and fasting BG levels. Of course, everyone is different, and similarly I'm trying to see where I stand rather than to take an absolute no-carb approach.

I have seen the blog entry, and I appreciate the wealth of knowledge on this forum, but to jump to a conclusion that I'm not concerned is perhaps a little bit ill-informed. I have been carb counting and my BG levels continue to fall daily. I've just tested my fasting BG at 5.5 mmol.

I see that 'remission' on here is determined by HbA1C and fasting BG in a normal range. However there is very little information available on what a typical day-to-day BG graph should look like, how high/long/when your postprandial BG spikes should be, apart from being under 140mg/dl 2 hours after meals. Is 2 hours supposed to be post peak? Some sources state BG should peak within 30-60 minutes after meals, but this isn't necessarily my experience.

For future reference, if anyone else has similar questions regarding postprandial BGs, PM me - I've found my answers elsewhere.

Anyway, thank you for your concerns - I came here for information, but it seems I've been judged and lectured instead.

 

[lazybum]

Welcome to the forums.



That's an average blood sugar of 15 (unless you've got various weirdnesses in your blood such as anaemia). So you've actually done really well to get your levels down so fast (sorry about the rice, I'd be surprised if you can ever go back to eating that). You've bought a meter, dropped the carbs and have increased exercise, all excellent things that should help you immeasurably. (Sorry if that sounds a bit condescending, it's not meant to be. Usually people come on here first and get advised to do all that stuff, so you've bypassed the first stage in the advice for new T2s.)

Given your age and your health conditions you'll be doing your body a huge favour if you can keep your bgs under control by diet. If you go the medication route you'll probably be on insulin in ten years or so, and then you'll have the joy of both insulin resistance and insulin injections, not something I'd wish on anyone. (Speaking from personal experience as a T1 with a T2 father, so I produce no insulin but am definitely slightly insulin resistant. )

So, patience is a virtue. Yes, in the long term you can reintroduce some carbs to test your system, but maybe wait till you've got more normal levels first? And it'll take weeks (or months) of low carb before your results get to normal levels. There's a lot of experience here from people who have gone through what you are enduring now, they are trying to tell you the stuff that they wish they'd known at the beginning of their T2 journey.

Good luck. Unfortunately T2 is massively influenced by genetics, and there's nothing you can do about that. But avoiding carbs should keep your levels OK and mean that you avoid the spiral of increasing blood sugar levels, complications and medication.

Hopefully, in the long run you'll be able to (slightly) increase the amount of carbs in your diet, only time will tell. Sugar is addictive, so low carb does become easier the longer you do it.

Thank you @EllieM, this is a much more friendly, understanding and informative response that I was looking for.

 

[lazybum]

My fasting BG was 5.5 mmol this morning. This is the 4th day in a row it's been at 5.x after only a week from being diagnosed, so I must be doing something right?

No one has been able to provide any additional information on what a postprandial BG curve should look like other than 'it should be no more than 2.0mmol higher at 2 hours'. It doesn't tell me if 2.0mmol is post peak? It would mean by BG could go from 6 -> 10 -> 7mmol in the span of 2 hours and that would be acceptable being less than 2.0mmol higher @ 2 hours.


[edited my moderator]

 

[lazybum]

I believe the timing and delta of postprandial spikes/peaks are also important.

I can have a small serve of rice, bread or potatoes with my meal and my 2 hour postprandial will be low 7s.

Yet some have the opinion that any amount of carbs are bad and this will lead to insulin dependency in 10 years.


[edited by moderator]

 

[Goonergal]

No one has been able to provide any additional information on what a postprandial BG curve should look like other than 'it should be no more than 2.0mmol higher at 2 hours'. It doesn't tell me if 2.0mmol is post peak? It would mean by BG could go from 6 -> 10 -> 7mmol in the span of 2 hours and that would be acceptable being less than 2.0mmol higher @ 2 hours.

Hi there. I don’t think there is a definitive answer to this. The ‘2 hour rule’ is the one generally used and it’s a very helpful guide as above all when testing and experimenting with food, you need to be consistent in how and when you test so that you get a good picture of what is happening.

The ‘curve’ before and after the 2 hour mark will be affected by many things - your own insulin response; the macronutrient content of what you ate; portion size and so on. For example, if what you eat has a high fat content, the curve, even for a relatively high carb meal, may be ‘lower and slower’ than for a pure carb hit, where the spike may be more pronounced and short-lived.

In my own case, for example, there are things I eat which are not high carb but are considerably more carbs than I’d usually eat (I go for as close to zero as possible), but as they’re high fat content, the initial rise is low, but hours later I’ll see a bigger, prolonged rise and sometimes even a ‘double’ dip, where it goes down and then shoots back up, sometimes higher than the first rise.

 

[Brunneria]

@lazybum

You may find it helpful to consider that it is the 'area under the curve' which is more important than the highest number, which is no more than a snapshot at a set time.

Yes, as @Goonergal mentioned, the actual peak will vary considerably depending on whether you eat just sweet stuff (a steep needlelike graph which may well drop nice and low by the 2 hour mark) or you eat a complex, slow release meal high in carbs, protein and fat where the peak could be anywhere from 3 to 6 hours after eating in which case the graph curve would look like a long low plateau.

In both cases it is the area under the curve that mounts up, once damaging numbers are reached.

Finger prick testing at 2 hours is a fabulously useful tool to help us tailor our way of eating, and to keep track of how well we are managing our condition. However, in order for it to provide us the kind of detail that you are looking for, it would be necessary to finger prick every 15 or 30 minutes, which would kind of take over your life.

If you want to see your blood glucose plotted out on a curve, to see exactly what is going on pre and post meal, when your peaks are, and what happens at night, then you would need a different gadget for blood glucose monitoring. Many here on the forum use the Freestyle Libre for this. It has its faults (all bg monitoring methods do), but it was certainly a revelation when I started using it.

Also, please understand that the people here on the forum are trying to help you. They wouldn't be here, and they wouldn't be posting if they weren't willing to spend their free time and leisure trying to pass on their experiences and help people through what can be a very stressful condition. Especially soon after diagnosis.

What is frustrating to all of us, whether we are newly diagnosed or have been dealing with D for 50 years, is that it is a very multifaceted beast, that can vary from week to week and from hour to hour. There are very few clear cut answers, and the more you learn, the more you discover that worked today, or last week may well not continue to work in months and years to come. I would urge you aim for a period of stability to allow your body to make the best recovery it can - with nice low numbers and regular eating patterns - before you start rocking the boat with experiments to find your upper carb tolerance - cos sure as eggs is eggs, your carb tolerance will change in the next few months.

 

[EllieM]

My fasting BG was 5.5 mmol this morning. This is the 4th day in a row it's been at 5.x after only a week from being diagnosed, so I must be doing something right?

Those results are so good that I'm actually wondering if you suffer from one of those conditions that artificially elevate hba1cs. I mean, you're definitely diabetic, but most T2s that post on here find that their fasting glucose takes months or more to come down.

Could Your Hemoglobin A1C Test Be Wrong? - GoodRx

Look, I'm not going to comment on the ideal glucose spike after meals, I don't think anyone is exactly sure how blood sugars feed into health, different countries have different recommended levels. And most people's bodies behave slightly differently, some people have to go keto to achieve the results than they want, others can potter along on 100g a day (or more). Your meter will teach you. As a T1 I personally find that a large fat content meal can delay carb consumption, which is why pizzas can be difficult for T1s to inject for. Insulin resistance goes down if I go on a long walk, but my blood sugar tends to go up if I do weights at the gym when there's not much active insulin left in my insulin. But I'm not making any insulin at all, so I have to juggle food, exercise and insulin amounts whenever I inject (and I do a lot of injections). As a T2, you can juggle exercise and food to bring your levels down if you need to.

And the insulin in 10 years thing? That apparently is the average time scale of progression for T2s who go the medication route. The problem is that high blood sugars damage your insulin producing cells, so you need to keep on top of your levels if you don't want to end up with damaged production. (I know, it seems crazy, first you produce too much and then you end up producing too little). The NHS certainly used to assume that T2 was inevitably progressive, though I think that there are plenty of T2s posting on these boards who are managing to prove them wrong. And the trouble with not testing your bg levels (NHS advice for T2s in early stages of diabetes, is that your levels end up going too high because you have no idea what they are doing apart from when you have an hba1c test.)

And one final (hopefully unlikely) point. If they haven't done cpeptide and GAD antibody tests (they may not have bothered because of your family history and fatty liver), lots and lots of late onset T1s get misdagnosed as T2s for the first couple of years. T2 is still way more common, but if you go low carb and your levels go up and you progress to insulin fast, then that misdiagnosis becomes likely.

Good luck.

 

[OB87]

I believe the timing and delta of postprandial spikes/peaks are also important.

I can have a small serve of rice, bread or potatoes with my meal and my 2 hour postprandial will be low 7s.

Yet some have the opinion that any amount of carbs are bad and this will lead to insulin dependency in 10 years.


[edited by moderator]

I think it depends on the individual that's why testing is so important. Now my blood sugars are more stable I do eat foods like pasta and potatoes every now and again and it doesnt raise my blood sugars by much. I plan my food diary in advance and will have a lower carb breakfast and lunch on those days and increase exercise. My portion size is a lot smaller than it used it be. I don't eat normal bread as the low carb alternative is really tasty so I haven't needed it. I find rice bland, so swapping to cauliflower rice was easy. Good luck with everything, it gets easier. I was diagnosed 4 months ago age 33 and I was/am devastated but tracking food and blood sugars has given me motivation. There is hope.

 

[Sugarlisa]

@Sugarlisa . For future reference, if you want to send an alert to another member to join the thread you put an @ followed by their name. Then they get a notification that their name has been mentioned in the thread

Thanks

 

[Resurgam]

I think that the 2 hours from starting the meal timing is used as it showed me both my progress and how the meal affected me - but I don't have high carb foods at all so I saw my numbers reducing week by week.