How I manage my Type 2 diabetes

[JamesMS]

I was diagnosed with T2 about 18 months ago, after HbA1c of 113. Within a year it was 39 and now 43. I have fasted a few times for 48 to 64 hours, breaking the last one when my BGL kept falling. I couldn't see any benefit to continuing. I am fasting at the moment and will continue until 48 hours. I keep electrolytes topped up when fasting and take vitamin supplements. I also monitor my heartbeat, since I don't like the change to ectopic beats that happens with low electrolytes.
I have lost about 50 pounds over the past 2 years and my diet became lighter on saturated fats and sugary foods. I tried various recommendations for healthy eating, including ancient seeds, nuts, soy milk, almond milk and dark chocolate. Lately, I have severely reduced ancient seeds due to the higher BGL levels for several hours after meals. The same is true of soy milk, dark chocolate and nuts, but I will taper them off more slowly. Instead, I am eating fruit and yogurt with muesli for breakfast. This gives a higher glucose spike, but it drops back more quickly. Out with the almond milk as well, since I think cow's milk is likely better for me. Exercise can get rid of the spike if needed.
I am 68 and weigh 11st 6lb, having been 15st 6lb some years ago. Stopped dapagliflozin and metformin about 6 months ago, since I don't want CGM alarms through the night.
Since exercise can induce rise in stress hormones and consequently rise in BG I refrain from overtraining and my CGM does not then show an unwanted rebound. I sometimes take the CGM down to 3.0, when it alarms, but I am not then having a hypo and my metabolism stabilises my BG a bit higher. During fasting the CGM can be alarming all night, so I turn it off. Fingerstick tests show the Libre2+ is not accurate, but always 1 mmol/l or so different. I don't have hypo symptoms, although I used to several years ago after a breakfast of Scott's Oats.
I am cutting out some slow release complex carbohydrates in favour of those with quicker breakdown to see how my glucose levels change and the effect on HbA1c.

Edited by mods to remove quote

 

[LiSwati]

Hello James. Seems like you’ve tried it all. I am 57, on 1 Metformin 500mg and 1 Dapagliflozin 10mg per day. I also take meds for Cholesterol and BP. I was diagnosed with diabetes 2+ years ago, with extremely high BG levels that put me in hospital for 3 days, and when I came out, I lost 50% of my vision, which came back after 1.5 - 3 months later. It was a scary experience. At the time, I was 20 kg overweight.

From this group, I learnt about the intermittent fasting and low carb and high fat lifestyle, which I have been following for 1 yr 8 months now. I also cut out seed oils, and replaced it with animal fats and coconut oil, and occasionally, use olive oil. For the past year, I also stopped taking sweeteners, but I allow myself the occasional treat, like a biscuit or slice of cake.

I am on the 16/8 intermittent fast, and I break my fast at 11 am with a fruit, which is usual the only fruit I eat per day, and always from the group of fruits recommended for us. At 1 pm, I have a full meal, which is based on the 50/25/25 principal (50% veg, 25% protein & 25% slow-release starch, like Al Dente basmati long grain rice or Al Dente buckwheat noodles). In the mid afternoon, I may have some nuts (but not daily). Then in the evening, around 6:30 pm, I have my last meal, which is usually a salad, or soup, or toast.

This lifestyle, including taking walks, has changed everything for me in a very positive way. My BG is perfectly stable (except when I fall off the wagon for a sweet craving, which thankfully, is short lived), and all my vitals are great, except that I was also diagnosed with CKD a year ago, which is also improving with my new lifestyle. I have since lost 15 kg, so now only have 5 kg remaining to lose.

Some may argue that I am still taking too many carbs (starch), but I personally found it almost impossible to enjoy my meals by cutting out starch altogether. So I rather allow myself to eat some slow-release starch (25% at lunch) rather than trying to cut it out altogether. This system works perfectly for me, as I get to eat all the food I love, and I look and feel healthy. I hope my story helps.

 

[JamesMS]

I haven't fasted for months and decided to try it again last weekend. I started the fast after breakfast at 9:30 and had a salad at 21:30 36 hours later. During the evening my CGM kept falling gently, then alarmed many times through the night, since it read well below the low threshold of 3.8. The next day the CGM remained low and I could tell it would likely alarm the following night, so I had a meal instead. Since the weekend I have had lower CGM readings day and night, with the alarm going off frequently at night. My BGL is okay, but the Libre2 CGM always alarms when there is no need. Fasting now seems very useful and I plan to continue.

 

[Mrs Redboots]

I can't do intermittent fasting - the only time I tried, I nearly passed out long before lunch! I do, however, do (not really intentionally, nor very committedly) overnight fasting - our evening meal is at 19:00, and breakfast not usually much before 09:00, which is 14 hours. But that just happened! I very seldom eat between meals, but if I do, it is often in the late evening. I try to stick to nuts and/or dark chocolate, but there might have been a sneaky hot cross bun the other night. Didn't affect my blood glucose levels, though.

I have been rather in denial about diabetes, and don't modify my diet much; however, the metformin brought my HbAc1 down to pre-diabetic levels last year, and since then, I've also been on oral semaglutide as part of the Ascend Plus trial, and that has been totally transformative - my last HbAc1 was normal, my appetite has halved, and I've lost over 10 kg in this past year (having lost 2 kg the previous year, and am basically down 20 kg from when I started to have regular health checks). In fact, I have only one more kilogramme to lose and my BMI will be in the healthy range!

 

[CarbMaster]

I manage my T2 diabetes with meds (40mg Gliclazide, 1000mg metformin but sometimes I miss a dose of Met as I sometimes get nausea from it), exercise - gym once a week, exercise bike at least twice a week and long distance walking (up to 22 miles) most times once a week sometimes less.

I've been diabetic T2 since 1997 and am 75 years old and whilst my bgs are not where I want them to be (average 6.5) they are ok for the moment.

I weigh around 11st so I wonder if I should drop it down to 10st 8lbs which is where I was in my late twenties.

 

[Mrs Redboots]

I weigh around 11st so I wonder if I should drop it down to 10st 8lbs which is where I was in my late twenties.

If you can lose a little weight, it's always better for one, but don't stress out on it! Life is too short, especially when we are in our 70s!

I haven't had nausea from the Metformin for years - I did at first, quite dreadfully, and when I had to up the dose every three weeks to get to the maximum, but once that subsided, I wouldn't know I'm on it. The oral semaglutide is another story - I don't feel sick any more, but my insides don't always play ball! Plus I now get the occasional hypo, especially when I'm stressed out.

 

[LiSwati]

I can't do intermittent fasting - the only time I tried, I nearly passed out long before lunch! I do, however, do (not really intentionally, nor very committedly) overnight fasting - our evening meal is at 19:00, and breakfast not usually much before 09:00, which is 14 hours. But that just happened! I very seldom eat between meals, but if I do, it is often in the late evening. I try to stick to nuts and/or dark chocolate, but there might have been a sneaky hot cross bun the other night. Didn't affect my blood glucose levels, though.

I have been rather in denial about diabetes, and don't modify my diet much; however, the metformin brought my HbAc1 down to pre-diabetic levels last year, and since then, I've also been on oral semaglutide as part of the Ascend Plus trial, and that has been totally transformative - my last HbAc1 was normal, my appetite has halved, and I've lost over 10 kg in this past year (having lost 2 kg the previous year, and am basically down 20 kg from when I started to have regular health checks). In fact, I have only one more kilogramme to lose and my BMI will be in the healthy range!

I smiled reading your post. It’s much the same for me, as when my numbers become good, I am tempted to enjoy a little more, which sadly leads to more (thus my use of the term - fall off the wagon, from a sugar enjoyment perspective).

I think that this paradox is stopping me from achieving my ultimate goal, which is to came off Meds altogether. This need became ever so real for me when I discovered I was at Stage 3a CKD. Thanks to my kidney specialist who helped adjust my medication and encouraged me to continue on my 16/8 intermittent fast, low carb & high fat lifestyle, including cutting out seed oils, I lost 15 kg in 2 years and was able to reduce my Metformin from 500mg twice a day to 500mg once a day. My CKD is now at the bottom end of Stage 2 (which is truly great).

My medical specialist and I believe that if I can lose the remaining 5kg and be more diligent with what I eat and my exercises, I should able to come off Metformin altogether. Sadly, it’s this constant slippage into allowing myself to occasionally indulge (enjoy those devilish carvings under the self-belief to ‘treat’ myself now and then is okay), that is my kryptonite (the paradox I believe we have in come).

I must overcome this continual slippage by improving my self-discipline, as I cannot afford to wait for another medical emergency for the motivation to do so.

By the way, Ms Redboots (nice name), you are following an intermittent fast routine. By having your last meal at 19:00 and your next meal at 09:00 the next day, is a 14/10 intermittent fast. Now try to not eat until 10 am for the next month (15/9 fast) and thereafter, try not eat until 11 am, making it 16/8 intermittent fast.

Note: Always consult your doctor before trying out this lifestyle, as we are all uniquely different.

Read up more on Intermittent Fasting, as it has done wonders for me. Another thing this group taught me was that we can drink water, tea or coffee during our fasting period, and by adding cream to your tea or coffee, helps alleviate your hunger during the fasting period after sleeping. This is what sustains me from 6 am to 11 am, when after I break my fast with a fruit.

I observed that you sometimes have a snack in the late evenings on nuts or dark chocolate. When you try intermittent fasting again, try not to eat anything after 19:00, unless you work nights, then change your eating schedule according to your sleep routine. Hope my story helps you and everyone else.

 

[JamesMS]

I think that exercise and weight loss combined with occasional fasting and use of a CGM are the keys for me. I finished a 36 hour fast 5 days ago and my BG has been trending lower according to my CGM. I have used fingerstick testing to check, in case the CGM is faulty, but the fingerstick readings have dropped as well.

Yesterday for breakfast I had flaxseed, quinoa, nuts, chicken, egg, tomatoes, sugar snap peas, raspberries, grapes, dark chocolate and coffee with cream. My CGM didn't rise much, reaching 6.6 before dropping to 4.8 just over 2 hours later.

For lunch I had flaxseed, 40g Scott's Oats with 10g mixed ancient seeds, half a pint of semi-skimmed milk, 5 raspberries, 2 strawberries, 1 teaspoon of molasses, 30g dark chocolate and coffee with cream. Some months ago the CGM would rise to about 9.0 after less than this, so this extra breakfast at lunchtime was an experiment. My CGM rose to 7.6, then fell to 3.2 within 3 hours and after a half hour walk, when I did start feeling the beginnings of a hypo.

For dinner I had flaxseed, nuts, chicken curry, dahl, rice, chocolate cheesecake, crisps, coffee with cream and 30ml dry white wine. This was rather heavy in carbohydrates and my CGM rose to 7.8 after what was a staggered meal over 90 minutes. The CGM steadily fell and was at 5.0 when I woke up 3 hours later. Once I had moved around a little the CGM dropped to 2.9. A fingerstick test gave 4.1 and I did not feel hypoglycemic.

I had a few nuts and some green tea with ginger and the CGM has risen to 4.2 before bed. I expect it will go back into the red again once I fall asleep for the night. I exercised less than half my normal today and have eaten considerably more carbohydrate and processed foods than the usual fruit, yogurt, fish and salad over 2 meals early in the day.

This seems a great change for me after HbA1c of 113 18 months ago and coming off metformin and dapagliflozin 6 months ago. No way could I be taking those medications today. I had noticed similar trends after fasting 9 months ago, but after this fast and perhaps being lower in weight with less abdominal fat the glucose lowering effect seems huge. I will see how things go, but fasting for 36 hours works for me. Longer and my BGL drops too low and although I do not feel hungry I start feeling hypoglycemic and know I should eat.

Another change is with my right eye, where my retina appears to be healing and the small area like a scotoma near the macula has become smaller and looks like an area of blurring rather than an opacity. This is changing over months, though, but when my BGL is lower for a few days I can see some improvement. That said, I still have 20/10 vision in both eyes and they remarked on improvement in my vision at my last retinal scan. My mother was diabetic and registered blind at around my current age of 68, hence my focus on keeping my HbA1c lower than the pre-diabetic range.

 

[Mrs Redboots]

I smiled reading your post. It’s much the same for me, as when my numbers become good, I am tempted to enjoy a little more, which sadly leads to more (thus my use of the term - fall off the wagon, from a sugar enjoyment perspective).

I think my sister does intermittent fasting, and she has certainly lost some weight in the past couple of years. I really can't extend my fasting any more, as I would feel really ill if I tried!

The thing about treats is that it's fine if they are just that - a couple of squares of dark chocolate is one thing - half the packet is another!

 

[CarbMaster]

James, this is great stuff and I like your experimental mind and intelligent use of CGM.

I would reckon that you are no longer insulin resistant and that seems to be manifested in your ability to bounce back from small spikes in your BGs.

I'm very insulin resistant so have to follow a very low carb diet. I also go to they gym once a week (sometime less) go on the exercise bike at home at least three times a week and most weeks do long walks of up to 22 miles and sometimes some shorter local walks.

My weight is around 11st which is good for my age and height but there's still work to be done on my BGs. I used to wear CGM but since Apple have upgraded their operating system have stopped as Dexcom doesn't seem to give a **** about people like me who are not that computer savvy. I would have thought they would have offered to take people through the upgrade process step by step but I guess they're too busy making the huge profits they are making to worry about us.

I've dabbled in intermittent fasting in the past so your experiences interest me so I might try it again.

 

[CarbMaster]

I think my sister does intermittent fasting, and she has certainly lost some weight in the past couple of years. I really can't extend my fasting any more, as I would feel really ill if I tried!

The thing about treats is that it's fine if they are just that - a couple of squares of dark chocolate is one thing - half the packet is another!

I eat 100% cocoa solids chocolate which is an acquired taste but there's little fear I'll overeat! But even with 100% it still has 27g of carbs per 100g which I guess is not surprising as the chocolate comes from the cocoa seed.

 

[LiSwati]

Yesterday for breakfast I had flaxseed, quinoa, nuts, chicken, egg, tomatoes, sugar snap peas, raspberries, grapes, dark chocolate and coffee with cream. My CGM didn't rise much, reaching 6.6 before dropping to 4.8 just over 2 hours later.

For lunch I had flaxseed, 40g Scott's Oats with 10g mixed ancient seeds, half a pint of semi-skimmed milk, 5 raspberries, 2 strawberries, 1 teaspoon of molasses, 30g dark chocolate and coffee with cream. Some months ago the CGM would rise to about 9.0 after less than this, so this extra breakfast at lunchtime was an experiment. My CGM rose to 7.6, then fell to 3.2 within 3 hours and after a half hour walk, when I did start feeling the beginnings of a hypo.

For dinner I had flaxseed, nuts, chicken curry, dahl, rice, chocolate cheesecake, crisps, coffee with cream and 30ml dry white wine. This was rather heavy in carbohydrates and my CGM rose to 7.8 after what was a staggered meal over 90 minutes. The CGM steadily fell and was at 5.0 when I woke up 3 hours later. Once I had moved around a little the CGM dropped to 2.9. A fingerstick test gave 4.1 and I did not feel hypoglycemic.

Wow, that’s amazing. I could never be able to eat all that in 1 day. I’d be having hypers & hypos throughout the day. On average, my breakfast is a single apple at 11 am, and my evening meals at 19:00 are very light. Only my lunch at 13:00 is large, but still low in sugar & starch.

Your meal routine is amazing. Are you not concerned with your high and low readings? I find that when my readings are far apart (having a large difference), my eye sight suffers. Consider reducing the rapid spikes.

 

[LiSwati]

The thing about treats is that it's fine if they are just that - a couple of squares of dark chocolate is one thing - half the packet is another!

The problem is the frequency of ‘treats’. When I lose control, I tend to treat myself 1-3 in a day, whereas, I should limit myself to a treat once a week at most. How often do you ‘treat’ yourself?

 

[LiSwati]

I eat 100% cocoa solids chocolate which is an acquired taste but there's little fear I'll overeat! But even with 100% it still has 27g of carbs per 100g which I guess is not surprising as the chocolate comes from the cocoa seed.

I must admit, I love chocolate and eating a high % dark chocolate helps reduce the temptation to eat too much.

I however stopped eating chocolate bars about a year ago, when I stopped taking sweeteners and honey. My taste buds have since changed, allowing me to taste sweetness in fruits and vegetables like never before.

The same with salt, which I also reduced. After a while, you gain an increased sensitivity to salt and sugar in almost everything you eat, but for the better, as my taste buds are now fine-tuned, thus increasing my meal taste sensation and enjoyment.

This said, a slice of melt-in-your-mouth chocolate cake, is a treat I find hard to resist.

 

[CarbMaster]

I must admit, I love chocolate and eating a high % dark chocolate helps reduce the temptation to eat too much.

I however stopped eating chocolate bars about a year ago, when I stopped taking sweeteners and honey. My taste buds have since changed, allowing me to taste sweetness in fruits and vegetables like never before.

The same with salt, which I also reduced. After a while, you gain an increased sensitivity to salt and sugar in almost everything you eat, but for the better, as my taste buds are now fine-tuned, thus increasing my meal taste sensation and enjoyment.

This said, a slice of melt-in-your-mouth chocolate cake, is a treat I find hard to resist.

I found that after getting rid of sugar in tea and coffee I could actually taste the tea or coffee. I still use salt partly because salt is not a problem due I suspect to genetics.

 

[CarbMaster]

The problem is the frequency of ‘treats’. When I lose control, I tend to treat myself 1-3 in a day, whereas, I should limit myself to a treat once a week at most. How often do you ‘treat’ yourself?

That's the problem with treats they can if not careful become wall to wall! I think the trick is to identify trigger foods and avoid them whilst still having some treats. For instance I avoid Lindor chocolate truffles as if I start I end up in a feeding frenzy and get surrounded by sweet wrappers and an empty box.

I don't consciously treat myself any more but sometimes I accidentally get into a situation where I carb binge. In other words occasionally I fall off the wagon and enjoy it but I have noticed that the Law of Diminishing Returns kicks in so after the third piece of naughty food the enjoyment becomes less and less.

 

[LiSwati]

I could actually taste the tea or coffee

So very true. I am actually enjoying to drink black tea now, without any thing added, and I am learning how delicious some teas are.

 

[LiSwati]

occasionally I fall off the wagon and enjoy it but I have noticed that the Law of Diminishing Returns kicks in so after the third piece of naughty food the enjoyment becomes less and less.

This reminds me of my recent trip to Cairo. They are famous for these pure fruit smoothies. On my first night out, I started on 1 (guava) and it was so, so delicious, I had to have another, this time strawberry. Within 2 hours, I had 4 of those delicious drinks (1 mango and another guava), plus deserts.

I couldn’t finish my deserts, as I was having the worst hyper attack I’ve ever experienced (and never want to experience again), which lasted for about 1.5 hours. It was hell.

So your quote of - ‘Law of Diminishing Returns’, is so very true. This was a lesson I’ll never forget.