It can be done!

[RobsterinSheff]

I was diagnosed formally on May 2nd having diagnosed myself in mid March with internet research, clinistix urine glucose testing and Boots one off Blood Glucose test kit.

In late February/ early March I'd suddenly had a MASSIVE thirst (4-5 litres of water per day and an almost comedic amount of visits to the loo). Upon realisation via web search and self-diagnostic tools I also discovered I had lost almost 1.5 stone in 2 months (without any diet or exercise changes) i.e. peeing away glucose to the extent I had unwittingly placed myself on a calorie restricted diet!

I was unable to go to GP till end of April as I had a 6-week work-related sabbatical abroad: but I immediately cut out added and refined sugar based foods and anyhtingderived from white flour- and saw most of my clinistix tests go normal (as opposed to everyone reading 'high'). At the end of April and back in UK I saw GP who promptly ordered a A1c and sent me away for a few days to get it done/ turned around.

Result on May 2nd 2012 was:

* HBA1c of 13.5 (124 in new money).

He instantly diagnosed me as T2D and immediately put me on 2000 of Metformin which I decided to take as two in the morning with breakfast, one with evening meal and one with small late snack about an hour before bed. I also instituted a regime of 150g carb max per day: sometimes I am above that by 30-50g but I then go down to 100-120g the next day so that the 150g level is maintained over time. I cut out all wheat products and started to have small amounts of no-wheat bread from M&S and no wheat spaghetti (once/twice a week savoury treats) and once/ twice a week I also have brown basmati rice. As sweet treats I use 1 Atkins daybreak bar a day (with my SB triple espresso at lunchtime) and 3 Boots diabetic boiled sweets with my evening decaffeinated coffee. If I need another sweet hit I'll have a pink lady/ gala apple or two. Outside of these principles I use typical lo-carb recipes and foodstuff recommendations. I also increased my movement levels- both in everyday life (walking to work/ using stairs not lift etc etc) and bought some dumbbells for short daily use- usually early evening- and started to use my bike for 20-60 minutes a few days a week.

In early May I also had readings of:

* headline cholesterol 7.0; 'good' HDL 1.05; ratio TC/HDL 6.6
* and a liver function ALGT/SGPT number of 67 (he wanted me to go for an MRI to investigate Fatty Liver disease!)

I saw my GP for my 3 month review today and the current readings are:

* HBA1c = 6.4 (46 in new money)
* headline cholesterol 4.4; 'good' HDL 1.29; ratio TC/HDL 3.4
* liver function ALGT/SGPT number of 32

He was over-the-moon and has halved both my metformin and statin with a few to cutting out completely in 3 months time (I've been on 40mg statin for 7 years and number has never been lower than 6.6...): and "no need to look for FLD"

I was SOOOO pessimistic back in May. But to any newbies who are also feeling the strain: you can do it with sensible dietary changes and increasing your movement levels.

NB one interesting intellectual/ treatment point.

My GP said the NHS is currently targeting a range of 48-53 (6.5 to 7.0) for T2D patients: and that there is "a U-shape evidenced in recent research" that suggests that the lower the T2D A1c goes below 6.5 there is an concomitant increase in CvH and stroke instances = similar to being above 7.0 A1C.

One of the reasons he did not argue when I asked to halve my metformin is that he is expecting the next A1c to go up a little (into his preferred range) given the metformin reduction!

 

[sugarmog]

NB one interesting intellectual/ treatment point.

My GP said the NHS is currently targeting a range of 48-53 (6.5 to 7.0) for T2D patients: and that there is "a U-shape evidenced in recent research" that suggests that the lower the T2D A1c goes below 6.5 there is an concomitant increase in CvH and stroke instances = similar to being above 7.0 A1C.

One of the reasons he did not argue when I asked to halve my metformin is that he is expecting the next A1c to go up a little (into his preferred range) given the metformin reduction!

!!! Given that I pretty much eat what the NHS suggests is a healthy diet for diabetics and I now have a HbA1C of 5.5, I would have to over eat carbs and sugar and make myself overweight again to reach that target.

 

[Grazer]

Hi! First of all, really well done on the great results. Super effort.
One thing that concerned me a little though was part of your GP's comment
"my GP said the NHS is currently targeting a range of 48-53 (6.5 to 7.0) for T2D patients: and that there is "a U-shape evidenced in recent research" that suggests that the lower the T2D A1c goes below 6.5 there is an concomitant increase in CvH and stroke instances = similar to being above 7.0 A1C."

The research I'm pretty sure he's referring to is highly flawed. The research showed in fact that reducing HbA1c in the group studied from 7.5 to 7.0 marginally worsened mortality rates. HOWEVER, about 90% of the test group were insulin dependant or on similar meds. The authors of the study stated that the findings did NOT apply to the others in the group (T2s on diet/metformin) so for the GP to apply this to you as a T2 on Metformin is very wrong. Every other study I've ever seen shows that for T2s on diet only or metformin, the nearer you can get to normal HbA1c levels for a non diabetic the better. Cardio vascular risk reduces with every reduction you can achieve. This is why so many of us strive to be in the 5s and some even achieve 4s. PLEASE don't be talked into going higher!

 

[Defren]

Hi! First of all, really well done on the great results. Super effort.
One thing that concerned me a little though was part of your GP's comment
"my GP said the NHS is currently targeting a range of 48-53 (6.5 to 7.0) for T2D patients: and that there is "a U-shape evidenced in recent research" that suggests that the lower the T2D A1c goes below 6.5 there is an concomitant increase in CvH and stroke instances = similar to being above 7.0 A1C."

The research I'm pretty sure he's referring to is highly flawed. The research showed in fact that reducing HbA1c in the group studied from 7.5 to 7.0 marginally worsened mortality rates. HOWEVER, about 90% of the test group were insulin dependant or on similar meds. The authors of the study stated that the findings did NOT apply to the others in the group (T2s on diet/metformin) so for the GP to apply this to you as a T2 on Metformin is very wrong. Every other study I've ever seen shows that for T2s on diet only or metformin, the nearer you can get to normal HbA1c levels for a non diabetic the better. Cardio vascular risk reduces with every reduction you can achieve. This is why so many of us strive to be in the 5s and some even achieve 4s. PLEASE don't be talked into going higher!

I was going to say +1 but better not. :lol: I agree with you absolutely. I and others strive hard to be as low as possible. My last HbA1c was 4.9 my GP was thrilled. No, don't be talked into higher, get as low as you can.

Brilliant results by the way. :clap: :clap: :clap: :clap:

 

[RobsterinSheff]

!!! Given that I pretty much eat what the NHS suggests is a healthy diet for diabetics and I now have a HbA1C of 5.5, I would have to over eat carbs and sugar and make myself overweight again to reach that target

That is what I was thinking. I have absolutely no intention of 'settling' for the current 6.4= I want to be hovering around 5.0 !!

I wonder if others in the community have come across this 'dictum'?

Or perhaps it is a new one and people will come up against it in the coming couple of months with their next GP visits?

It does appear to be linked to the switch to the new numbering system a few months ago.....I asked him to explain and he showed me the 'GP guidelines' that clearly stated treatment should be geared towards T2D patients maintaining a range of 48-53 (6.5 - 7.0). Not above; but not below either !?!

 

[RobsterinSheff]

Brilliant results by the way

Cheers- I am well chuffed.

To the extent that (in the first depressed shell-shocked weeks) I thought control was possible, I was targeting 9 months to get to a "non diabetic" A1c- given the horror of my 13.5 diagnosis HBA1c :crazy:

It means I can now target 5.9 and below for next A1c in 3 months :thumbup:

 

[Grazer]

I really think that GPs haven't read the study and don't KNOW about the "doesn't apply to T2s on diet" bit. My own GP suggested I had a chat with his younger (junior) partner as he specialised in diabetes. I did. He mentioned this "lower can be worse for mortality" bit trying to convince me not to try aiming for better figures. Fortunately, we had just discussed the study which caused the NHS comments on this forum, and I was able to confirm he was referring to that, and then point out that it didn't apply to me or the vast majority of diabetics (who are T2 and diet/metformin). We looked it up together and he was very embarassed and "couldn't comment further"
The cynics might suggest that the NHS revealed the finding of this study to GPs without the caveats because if a higher HbA1c target was established, more diabetics would by definition be achieving it! Miraculously, NHS target achievements improve dramatically! (I think about 70% of diabetics are within 7.5% A1c, but only about 30% within 6.5%A1c.
There would of course also be less moaning patients worried about their figures and bothering doctors if targets were higher.
Interestingly, the study findings were also, I believe, quite misleading for T1s and other insulin dependants, which is why most T1s also seem to strive for lower HbA1c figures.
Interestingly, the American Diabetes Association reccommend T1s should be under 6% "if safe", meaning safe from hypos.

 

[RobsterinSheff]

Hi

do you (or any other poster) have a citation for this study

It would be great to turn up next time with it. He is relatively young- only a GP for a few years and not experienced (until me!!) in T2D management. Instinctively I don't think he is aware of the studies nature as you describe it (lack of relevance to T2D) and I reckon he would accede if confronted wit hard evidence to the contrary.

The practice guidelines will definitely be geared to the notion of achieving targets- so a higher HBA1c target and a associated treatment plan will be right up the PMs alley.

 

[Grazer]

Unfortunately I can't remember the name of the study. I'll have a look when I get the chance, but there was a longish thread on here about it.