Newly Diagnosed T2

[LaurenceJB]

Hi everyone. Although I was first diagnosed as glucose intolerant 11 years ago I have - despite my battle over the years to keep blood glucose under control - recently been diagnosed as T2 diabetic with an HBA1c reading of 49. Apologies for the length of this message but I have a number of questions that hopefully someone can help with.
First, I am a third generation diabetic - my grandfather, father(and uncle) were all T2. My diabetes is clearly genetic. I have never been overweight and when I received the reading of 49 a few weeks ago my weight was 10 stone 4 lbs and my BMI 22. I have been active over the past two years since retirement (I am 67 this month) running 5k two or three times a week, gardening, hillwalking and generally keeping active. I have watched my diet over the last decade (hence my BMI) but it seems that none of this has been sufficient to keep the diagnosis of T2 at bay. Since receiving that news I have lost 17 lbs and I now weigh 9 stone 1 lb and my BMI is just 19.9. When I spoke to my practice Diabetic Nurse her first words were “Medication”. When I told her of my current weight and weight loss she agreed to give me another 4 months to turn things around, saying I was an extreme case of skinny diabetes and must feel a “deep sense of injustice” which was not exactly the encouragement that I was hoping for.
I currently carry a foot injury (from running) but am able to ride my racing cycle and ride very hard, almost to exhaustion, most days. I still garden, walk, and watch my diet even more closely than before. I limit the amount of carbs I eat, I try to focus on protein, have virtually foresworn alcohol- not that I drank heavily before - and generally am very fit. My VO2 Max is 48, which puts me in the top 5% for my age. My blood pressure, heart rate and cholesterol are all very good.
My questions, really, are these:

1. Is my diabetes reversible (I am aware of Prof Roy Taylor’s recent Re-Tune study into normal weight diabetics - which gives some hope for the future) - but my pre- diabetes BMI of 22 was still lower than what a number of participants have achieved to reverse their condition. It is now 19.9 but my fasting readings are usually still too high at 6/7 + first thing in the morning.

2. Am I exercising too hard? Am I pushing up my blood sugar too high as a result? Would more moderate exercise be better? Again I am aware of the reported benefits of HIIT but some experts seem to suggest that moderate exercise would be better. Confused!

3. Are there any diabetics out there with a weight of 9 stone 1 lb or BMI of 19/20? If so, I would love to hear from you!

4. How far should I limit my carbs each day? I usually have around 60 grams of sourdough with veg soup for lunch - which is really very little - and egg omelette for breakfast. Supper is usually chicken or fish - again with little or no carbs. I am hungry most of the time but feel I have no alternative if I am to reverse my diagnosis. I am really not sure how much more weight I can lose.

Any help or advice would be greatly appreciated. Apologies again for the length of this message.

 

[MrsA2]

Do you have a meter to test your bg? That really is the only way to see what affects your bg. We are all individuals with individual results

 

[LaurenceJB]

Hi. Thanks for your reply. Yes, I do. I tend to test my bg around three times a week - usually a fasting test in the morning around 7.00am. The results seem to vary for little or no reason. I think I will have to start testing before and after meals to see what effect it is having. As you say, we are all individuals.

 

[MrsA2]

Yes, before and then 2 hours after each meal should give you lots of info.
You may find going even lower carb but increasing the healthy fats helps get rid of what is probably fatty liver (not caused by dietary fats btw).
There's no need to be hungry on low carb.
Eat filling meals based on protein (meat, fish, eggs) above ground veg, add nuts, seeds, olive oil, some dairy and cheese. Eat until full, then stop.

I'm no expert on exercise, some people find better results with weights, some with Hitt, some with steady walking. Your meter will tell you.
It's worth sore fingers for a couple of months to find out.
Or you could try cgm like libre, but that's about £50 a fortnight

 

[LaurenceJB]

Thanks very much. I will give these ideas a try. I think I will have to use my meter a lot more than I have been doing.

 

[Ronancastled]

I am aware of Prof Roy Taylor’s recent Re-Tune study into normal weight diabetics .

That was the first resource I was going to point you towards, I was pleased to see you've read up already.
Honestly it seems like you've done your homework, eat to your meter is the only thing to add.

 

[LaurenceJB]

Thanks very much. Yes - I need to use my meter much more. Starting today!

 

[ianf0ster]

In my opinion everybody who is using low Carb to control/reverse their T2D should use a meter . And use it to test every meal at first, until they can predict the BG result from most meals. Then just test unusual meals or just test periodic meals to ensure they don't suffer from 'carb creep'.

You seem currently to be trying to eat Low Fat and use intensive exercise to burn off calories, so effectively low calorie as well. Many wise medics say that 'You can't outrun a poor diet' - and this appear to be what you are trying. The combination of Low Fat and high Exercise almost always results in tears for a T2 diabetic, because it means punishing your body whilst also mildly starving it. Your willpower is then under constant strain.

Why do people do this to themselves? A 30 min brisk walk (or equivalent) 5 times per week is enough aerobic exercise (unless you enjoy more), after that you can add in some resistance exercise (such as weights) to build muscle which acts as a safe store for glucose.

Don't fear natural fat (fat that comes packaged with traditional real foods (butter, bacon, cheese, eggs etc,). Fat in food provides energy and when mixed with protein makes you feel fuller for longer. What it doesn't do is make you fatter (unless eaten with carbohydrates or eaten in large excess).

Be kinder to your body and it will respond better.

 

[LaurenceJB]

Thanks for this. In fact I don’t fear fat - I eat a lot of eggs, butter and some cheese, nuts, etc as a substitute for carbs. I do, however, exercise hard when I can. I understood that HIIT was particularly helpful in lowering blood sugar but I also know that some experts, and yourself, obviously, think that moderate exercise is better. I will give it a try and see what my meter says. I really want to try to get my diabetes into remission if I possibly can and it is this, I think, that drives me to push my body hard.
Thanks again for your response.

 

[LaurenceJB]

In my opinion everybody who is using low Carb to control/reverse their T2D should use a meter . And use it to test every meal at first, until they can predict the BG result from most meals. Then just test unusual meals or just test periodic meals to ensure they don't suffer from 'carb creep'.

You seem currently to be trying to eat Low Fat and use intensive exercise to burn off calories, so effectively low calorie as well. Many wise medics say that 'You can't outrun a poor diet' - and this appear to be what you are trying. The combination of Low Fat and high Exercise almost always results in tears for a T2 diabetic, because it means punishing your body whilst also mildly starving it. Your willpower is then under constant strain.

Why do people do this to themselves? A 30 min brisk walk (or equivalent) 5 times per week is enough aerobic exercise (unless you enjoy more), after that you can add in some resistance exercise (such as weights) to build muscle which acts as a safe store for glucose.

Don't fear natural fat (fat that comes packaged with traditional real foods (butter, bacon, cheese, eggs etc,). Fat in food provides energy and when mixed with protein makes you feel fuller for longer. What it doesn't do is make you fatter (unless eaten with carbohydrates or eaten in large excess).

Be kinder to your body and it will respond better.

 

[LaurenceJB]

Hi again Ian. Since your very helpful reply I have looked at a few studies into moderate v vigorous exercise for lowering blood glucose and there certainly seems to be strong evidence that regular, moderate exercise is better. I wonder whether that is where I have been going wrong over the last couple of years? I will certainly put your suggestion into practice for the next few weeks and see how things go.
Thanks once again. Finally, I have to say what a wonderful resource this forum is and how helpful everyone is. I have already learned quite a lot and it is nice to know that I am not alone in my struggles.

 

[HSSS]

Hi again Ian. Since your very helpful reply I have looked at a few studies into moderate v vigorous exercise for lowering blood glucose and there certainly seems to be strong evidence that regular, moderate exercise is better. I wonder whether that is where I have been going wrong over the last couple of years? I will certainly put your suggestion into practice for the next few weeks and see how things go.
Thanks once again. Finally, I have to say what a wonderful resource this forum is and how helpful everyone is. I have already learned quite a lot and it is nice to know that I am not alone in my struggles.

There’s also a significant argument that resistance/weight/muscle building exercise is particularly helpful. I think it’s about increasing insulin receptors and the ability to safely store glucose ready for use without it circulating/turning to fat increasing resistance

 

[LaurenceJB]

Thanks very much. I will look into this - it might be an idea to buy some weights or join a gym.

 

[Lupf]

Hi @LaurenceJB, welcome to the forum, People here have lots of knowledge and are happy to share their knowledge, but this is your body, we are individuals and so you will have to find out what works and what not for yourself. All that said, here is my two cents worth:
Let me start with saying that being fit as you are and exercising a lot has many benefits, but these are not necessarily correlated with diabetes. We can debate the merit of HIIT over regular exercise for our hearts, but I wouldn't worry about having done it wrongly over the past years as it cannot be changed anyways. I haven't seen the studies you and HSSS refer to and can't comment on these. From what you've said you have a lot of stuff going for you. An HbA1c of 49 is just above threshold for being diabetic. This is not a bad start to be diagnosed compared to some of us, who, including myself, had an initial HbA1c of over 100. You are losing weight and this often correlates with lowering blood sugar, so I would not be surprised if your next HbA1c test comes back below 48.
Regarding weight loss, until 3 years ago, I only knew diets that failed and now I understand why: our bodies are not combustion engines but hormonal machines; and a calorie is not a calorie. Let me illustrate this: If you eat less of the same every day, you will lose weight, but then your metabolic base rate will go down, from say 1800 calories to 1300 calories i.e. you will burn fewer calories per day, At that stage you will not lose any more weight or even gain it back, but you will always feel hungry and miserable and at some point you will give up and join the huge number of yoyo dieters in the world. So our weight depends less on how much, but more on what and when you eat. A better method of losing weight is intermittent fasting: Three years ago I lost 10 kg by 5+2 intermittent fasting, i.e. on two days of the week I ate only 600 calories, so no bread, pasta, rice, mainly vegetables, salad, soup, eggs, yogurt, a bit of chicken fish. I ate normally on the other five days. By doing this the metabolic rate stayed high, so I lost weight. In my experience intermittent fasting works, most likely for evolutionary reason: when our ancestor did not have success hunting they have to live from foraging which was not enough and they were burning fat.
T2s like you and me do not tolerate carbs as we have become insulin resistant. By reducing their carb intake many in this forum have been able to reduce their blood sugar levels and some are now in remission, i.e. have been below 42 for at least a year. But to do this sustainably you have to replace the carbs to not feel hungry, mostly with fat, but also proteins, so cheese and bacon and olive oil is good for T2s. I refuse to eat anything that has a low fat label on it. By doing this, we feel satiated after a meal and don't feel hungry all the time. The low carb days during my intermittent fast also led me to reduce my HbA1c to below 48 and get off metformin. A good book to read about all this is "The Diabetes Code" by Jason Fung, which explains this and much more. Note also that diabetes control is a marathon, not a sprint, so measures that are not sustainable won't work in the long run. But your the answer to your Q1 is: yes, diabetes can be put in remission. How far you have to reduce your carb intake you will have to find out yourself by testing.

 

[LaurenceJB]

Hi Lupf - what a helpful and encouraging message! You have done incredibly well to get your A1c down from over 100 to 48. Truly inspirational! I will have a look at the Jason Fung book and try to put some of your ideas into practice.
Thanks once again!