Newbie - Medication Quandary

DJS05

Newbie
Messages
3
Hey All,

I have been visiting the website and forum since this Summer with this being my first post.

My GP diagnosed me with suspected type 2 diabetes back in July 2021 following a blood test which indicated a HbA1c of 93.

It was a complete surprise as I am in my mid thirties, have no family history of any form of diabetes and my diet, while too high in carbohydrate, did not consist of regular confectionery or sugary drinks.

It hit me hard and I have been trying to educate myself ever since.

Initially I refused any form of medication; the GP wanted to start me on Metformin immediately. I am still not currently taking any medication (hence this post).

I switched to a strict Ketogenic diet straight away and purchased the Abbott Freestyle Libre sensors to monitor my blood sugar level.

Based on the sensor data, in the last 30 days my average blood sugar is 5.8 mmol/L. However, despite not eating or drinking anything (other than water) within four hours of going to bed, my average blood sugar in the first few hours of waking, and before eating (I have never ate breakfast) is 6.9 mmol/L.

I understand what is happening i.e. Dawn Phenomenon but I am still trying to get my head around what I can do about it. Further weight loss and incorporate intermittent fasting? Medication?

I decided to see what would happen to my blood sugar if I broke from the Ketogenic diet for a festive snack.

I had a festive mince pie knowing the amount of sugar in it. Immediately before biting into the pie my blood sugar was 5.9 mmol/L. Within 30 minutes my blood sugar was 7.8 mmol/L, within 60 minutes it was 10.1 mmol/L, within 90 minutes 8.1 mmol/L and within 120 minutes it was 6.3 mmol/L.

It has fluctuated, without further food or drink intake (except water) since rising to 7.3 mmol/L and then steadily dropping to 6.0 mmol/L currently.

I am doubting my initial decision to refuse medication and questioning whether to start the Metformin.

There is a large part of me questioning and blaming myself given no family history etc. so subconsciously I think there is a bit of “you must have done this to yourself so you need to address it without being a burden” etc. etc. I know it’s the wrong mindset but nevertheless it is my mindset.

Since the diagnosis, I haven’t been able to have a follow up with my GP (either in person or on the phone) despite trying to get an appointment on several occasions to arrange further blood tests, discuss my records and discuss options. It’s rather frustrating but that’s another matter.

Not expecting medical advice but I would appreciate the opinion of fellow type 2 people as to whether Metformin is something they would take in my position.

I am planning to incorporate intermittent fasting into my regime as a New Year resolution in the form of a 48 hour weekly fast and can’t be sure how this will effect my blood sugar.

KR
DJS05
 

Rachox

Oracle
Retired Moderator
Messages
15,885
Type of diabetes
I reversed my Type 2
Treatment type
Tablets (oral)
As you appreciate we can’t give medical advice, however I don’t think you can make a decision about medication with out another HbA1c test to see where you are now.
Nice guidelines are HbA1c initially every 3 - 6 months so you are quite with in your rights to ask for a blood test now
https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management
In your position I would email the Practice Manager to get a repeat blood test organised.

Edit to add, where are my manners, sorry! Welcome to the forum!
 
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Resurgam

Expert
Messages
9,867
Type of diabetes
Treatment type
Diet only
You are probably going to get back into the normal range before long, and in a few years you could see remission - but there are a lot of carbs in an ordinary mince pie.
I tend to use the spices associated with Christmas and use them and a small amount of high carb but highly flavoured foods to evoke the spirit of the season rather than eating the standard recipes.
In time you might be able to indulge, if you still have any longings and have not built up a recipe book of your own. I am 5 years from diagnosis and if I do eat carbs these days the evidence is around my waist, not on the glucose meter.
 
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catinahat

Well-Known Member
Messages
3,405
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Reality tv
I understand what is happening i.e. Dawn Phenomenon but I am still trying to get my head around what I can do about it. Further weight loss and incorporate intermittent fasting? Medication?

The dawn phenomenon, a strange name for something that can happen at any time and is in fact your body reacting to the release of certain hormones in exactly the way it should do, so not a phenomenon just a natural bodily function.
What can you do about it. Well you will certainly have a hard time trying to stop something we have evolved to do. But as you improve your insulin resistance your ability to deal with a release of stored glucose will also improve.
I think you are already doing what you need to, your keto diet will get you there eventually especially if you throw intermittent fasting into the mix. The only other thing I would advise is patience, you were diagnosed 5 months ago, it's taken your whole life to get T2 you can't fix it in 5 months.
 
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Seacrow

Well-Known Member
Messages
496
Type of diabetes
LADA
Regarding your family history, you have no record of diabetes, but this doesn't mean your diabetes isn't down to your inherited genes. One generation back, people did more physical exercise and ate a different diet. Two generations back, unless you actually went into dka, you'd probably never be diagnosed. Diabetes might be something you were always going to have an inherited weakness to.

I see your mince pie numbers with envy. If I ate half a mince pie with no insulin, my bg would go up to 20 and stay there for hours. Your insulin response is a bit slower than non-diabetic, but it's there and it's bringing you back down to an 'acceptable' range within two hours. Based on this, and other stuff you've said, you sound like a good candidate to get your diabetes into remission.

Metformin. My personal opinion would be get that evil stuff away from me. It does nothing for my HbA1c, and causes nasty gastric problems. BUT if you can tolerate it, then it is supposed to provide numerous benefits. Totally a personal choice. I would recommend waiting to start any new diabetic drug until after your next HbA1c, that way you know what is because of your diet change, and what is because of the meds.
 
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ianf0ster

Moderator
Staff Member
Messages
2,423
Type of diabetes
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Diet only
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exercise, phone calls
As has been pointed out, your body copes with a single mince pie admirably well. But this doesn't mean it could cope with a whole festive meal!

Since you appear to be doing well without Metformin, why would you consider taking it? Are you impatient? Do you think there is a cure, rather than just remission?

Diabetes isn't something that suddenly strikes us out of the blue, it develops over time (sometimes 10yr or more). Likewise (in my opinion) t isn't fixed/cured in an instant - though I have seen some claim they cured it within 6 months and mock me for feeling I need to continue eating Low Carb. However I've heard from others who thought they were cured and then realised that it's merely remission and so going back to their unhealthy ways of eating eventually makes them unhealthy again (surprise , surprise).
 
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Craigmartin

Well-Known Member
Messages
182
Type of diabetes
Treatment type
Tablets (oral)
It was April 2020 when I was diagnosed and its only really the last couple of months my morning readings are in line with the rest of the day. This will impact your hbA1c. I'm not as knowledgeable as others who have posted on this but id say you are doing very well
 
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Ronancastled

Well-Known Member
Messages
1,235
Type of diabetes
Type 2
Treatment type
Diet only
I decided to see what would happen to my blood sugar if I broke from the Ketogenic diet for a festive snack.

I had a festive mince pie knowing the amount of sugar in it. Immediately before biting into the pie my blood sugar was 5.9 mmol/L. Within 30 minutes my blood sugar was 7.8 mmol/L, within 60 minutes it was 10.1 mmol/L, within 90 minutes 8.1 mmol/L and within 120 minutes it was 6.3 mmol/L.

First of all eating a high carb food while on a Keto diet will spike a non-diabetic, pancreatic beta cells will go into a dormant mode & make take several days of re-carbing to wake up.

Even with that your response wasn't too bad which shows you have a lot to work with here.
My advice would be for you to continue on your Keto track for now, IF is probably not a bad idea.
Your FBG will come down but that may take months, it's a long game.

With an average BG of 5.8 your next A1c is going to be amazing

aac.PNG
 
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DJS05

Newbie
Messages
3
Thank you for the responses.

I will continue to try and get in contact with my GP to arrange for another blood test; no joy again this morning.

I will post my latest HbA1c once received and let you know what I decide.

If there is solid improvement since the last test then I am siding with continuing to try and manage this disease with diet and lifestyle changes.

Thanks again.
 
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DJS05

Newbie
Messages
3
As has been pointed out, your body copes with a single mince pie admirably well. But this doesn't mean it could cope with a whole festive meal!

Since you appear to be doing well without Metformin, why would you consider taking it? Are you impatient? Do you think there is a cure, rather than just remission?

Diabetes isn't something that suddenly strikes us out of the blue, it develops over time (sometimes 10yr or more). Likewise (in my opinion) t isn't fixed/cured in an instant - though I have seen some claim they cured it within 6 months and mock me for feeling I need to continue eating Low Carb. However I've heard from others who thought they were cured and then realised that it's merely remission and so going back to their unhealthy ways of eating eventually makes them unhealthy again (surprise , surprise).

Patience is not a skill I have in abundance so will certainly be a factor.

But I suppose the main consideration is being driven by being told by family and friends, some of whom work in the medical profession, that I should not be eating a high fat diet as its unhealthy and will lead to heart disease and liver damage (and in any event cannot live on such a diet long term) and that diabetes is progressive and requires controlling.

Lots of conflicting information. But taking a lot of positives from peoples results on this forum that have addressed by diet and lifestyle changes. Can’t all be wrong…
 

ianf0ster

Moderator
Staff Member
Messages
2,423
Type of diabetes
Treatment type
Diet only
Dislikes
exercise, phone calls
@DJS05 I didn't see any mention of weight or BMI.
If you are a more typical T2 than me (I've always been slim) then it's unlikely that Keto or Low Carb way of eating will make any of your lipid figures or liver health markers any worse than before. In fact it's likely to improve them if it makes any change at all. Thus taken together with an improved BG and HbA1C it should be obvious to any of your medics close to you that the changes are all beneficial.
And if the changes are beneficial that makes it much more sustainable.

Keto has been used to treat epilepsy in children for around 100yrs now (and still is). It doesn't have to be High Fat just higher than we are currently used to seeing advised. Dr Atkins showed that the Low Carb High Protein approach was safe and sustainable for adults in the late 1900's. There are some who falsely claim he died from his diet, when the truth is he was walking outdoors in winter, slipped on ice and sustained a brain injury from which de died.
 

Resurgam

Expert
Messages
9,867
Type of diabetes
Treatment type
Diet only
Patience is not a skill I have in abundance so will certainly be a factor.

But I suppose the main consideration is being driven by being told by family and friends, some of whom work in the medical profession, that I should not be eating a high fat diet as its unhealthy and will lead to heart disease and liver damage (and in any event cannot live on such a diet long term) and that diabetes is progressive and requires controlling.

Lots of conflicting information. But taking a lot of positives from peoples results on this forum that have addressed by diet and lifestyle changes. Can’t all be wrong…
There is a problem with getting the information into the records - I have found that anything which goes against the accepted dogma is not put into my files when I experience it - my reduced cholesterol was assumed to be due to weightloss, but the timeline disproves it. The weightloss came after the reduction in blood glucose levels, but cause and effect are reversed in the thinking of my HCPs. My reduced intake of food is assumed to be my obeying accepted reasoning and forcing my gluttonous self to accept that starvation is my punishment - actually no - not at all - but I can't get over to them how it works because they seem not to listen, and not to be at all bothered when I smile and shake my head at them when they get it wrong.
I eat natural foods with the normal fat which comes with them. Very little fat is added - other than butter into eggs because I don't spend out for low fat options. I also tend to cook meat and then put it and the juices into the fridge overnight, then I collect the solidified fat before starting to cook next day. I might be using less fat in cooking than someone going for low fat and pouring fat or oil away
 

MrsA2

Expert
Messages
5,642
Type of diabetes
Type 2
Treatment type
Diet only
I prefer the term Low Carb Healthy Fat.
Healthy includes both the quantity and the quality of the fat.
High fat makes people think of an overabundance of fat (and can include all the bad man made produced cheap fats such as seed oils and margarine), whereas Healthy Fats are good, natural fats eaten in only enough quantity to satisfy, such as butter, full fat yoghurt and fats found in good meat.

People think of high fat diets as eating things like doughnuts and chips fried in processed seed oils. These have no place in a Healthy fats diet, like the ideas they tried to introduce in the so called Mediterranean diet using olive oil and butter
 
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bulkbiker

BANNED
Messages
19,575
Type of diabetes
Type 2
Treatment type
Diet only
I should not be eating a high fat diet as its unhealthy and will lead to heart disease and liver damage (and in any event cannot live on such a diet long term) and that diabetes is progressive and requires controlling.

All complete cobblers... but I think you know that really.

Well T2 can be progressive if not addressed by precisely what you are doing.
 
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Dandelade

Well-Known Member
Messages
221
Hi @DJS05 welcome to the forums. At the start of my journey I was really concerned about the dawn phenomenon- I could see my levels were pretty good the rest of the time but had hours of raised levels in the morning. So I can totally understand why someone would consider metformin to reduce the liver dump.

I knew I could flatten them with a high protein breakfast but it made me feel sick eating that early. I also knew that the dump was either stores from the liver or broken down fats, so wasn’t sure whether actually it’s a good thing?

In the end I listened to my body and skipped breakfast (or intermittent fasting for an actual name fir it), let the dawn phenomenon do its thing, continue with low carb lunch and evening meal.

I really wasn’t sure it was the right thing to do at the time but I’ve lost 8 inches from my waist and 24 pounds. Insulin resistance seems to have decreased massively (I’m guessing from my body’s reactions I don’t know). I’m putting the improved insulin response down to weight loss in which case dp was good thing? @ianf0ster tagging you to say thank for your advice at the time!

Anyway back to you. I suppose it depends on which part of your journey you’re at. If you’re looking to reduce hba1c then yeah I’d consider metformin. If you’ve weight to lose and looking to reduce insulin resistance then don’t worry about dp. I’m definitely no expert but I’d give low carb/ keto a few months without metformin and not worry about dawn phenomenon personally.
 

Hotglove

Member
Messages
20
I use a Personal Trainer and find that she looks at a bigger picture than I do. I might consider diet and exercise while she is considering stress, quality of sleep, use of blue screens and so on, I have come to believe that any of these considerations will make difference to health and wellbeing, but their sum is greater than their whole. PTs don’t come cheap, but there are other ways to find support from individuals and groups, debating on this forum is one of them, has been a big help to me and, hopefully, will be a big help to you.
 

ClairedeMort

Member
Messages
12
Given your young woth no risk factors for T2DM I would be asking your GP about LAte Onset (insulin dependent/T1) diabetes.
These tests can’t usually be done on the community so they would need to ref you to the diabetes team.
and I’d be asking:looking at your liver function.

Hope you’re ok.
 

simo_M

Active Member
Messages
36
Type of diabetes
Type 2
Treatment type
Other
Hello and welcome to the forum. I was diagnosed about a year earlier than you with hba1c in the 90s and have been eating low carb, often keto, for the last 15 months.

Normally my first reading of the day is the highest (6.x) but I'm still trying to reduce it.
I have found that intermittent fasting can help as can avoiding eating dinner late and or exercising after dinner. Unfortunately I rarely put this into practice due to working hours and an attempt to be sociable.

I suspect that my body may work best on a single meal a day in mid afternoon.
 

simo_M

Active Member
Messages
36
Type of diabetes
Type 2
Treatment type
Other
Meant to add that I started on Metformin, halved the dose after 10 months and will likely stop in the next quarter. I haven't had problems with it (unlike some) but have a general aversion to taking things if I don't need to.
When I halved my dose it had no effect on hba1 c (went from 40 to 39).