10 months on

Metformin does little in the way of reducing blood glucose. Go back to your GP and ask for the slow release version, it might be kinder on your tummy/bowel. The Metformin is a mild appetite suppressor, helps with liver dumps and is generally regarded as a safe drug but some people just cannot tolerate it.

Start testing your bg before the first bite of food then two hours later, the difference in the two readings should be no more than 2mmol, this will tell you if the foods you have eaten 'spike' your bg too high. Start keeping a diary of your meals and the readings and patterns will soon become apparent. The foods to cut back/avoid are bread, potatoes, rice, pasta and anything made with grains or white flour. Breakfast cereals are usually very high in carbohydrates and most likely will raise your bg too highly though some people can tolerate a small portion. Testing at random times tells you nothing. Hope this helps.

Hi @elmer_dinkley,

If you are okay on one slow-release metformin, you should probably continue with it. Edited to add: You probably should still talk to your doctor about this.

As to the number of carbs per day, this is a very individual thing. Some of us eat only a few carbs (maybe 20g or 30g per day), other low-carbers have significantly more (maybe 100g). You will find out what works for you by testing before and after meals. The rise in blood sugar levels before meals to two hours after you have started eating should be no more than 2 mmol, preferably less.

When deciding how many carbs to eat, also remember that your diet (or maybe better lifestyle) has to be maintainable in the long run. If you are starting to feel resentful because you feel too restricted, you are much more likely to give in and have a really carby meal or even to go back to eating high carb.

I started out having slightly more carbs, even occasionally maybe having a tiny full-sugar cookie, but over time cut back more as I found I no longer missed these foods and discovered more alternatives to old favorites. My daily carb intake now is probably somewhere between 20g to 30g of carbs.

elmer_dinkley said:

I have read about Carb cutting as this is really my only option. I do not and haven't done for years drink fizzy soft drinks or beer. Not a big sweet eater but I am a carb addict. I got over weight with chips and crisp not beer and sweets. So what should be the carb limit I should aim for as I have seem some extreme differences in advice. For example I had a veggie bean chilli last night it was 19 gms of protein but 40 gms of carbs. How low should my daily intake be. Cheers folks

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First of all, welcome. I see that you joined the forum in August, and I also joined fairly recently. You have come to the right place.

I am sorry that you are having a rough time with the Metformin. It is considered a safe drug, but the side effects are an issue for some people.

It is a bit hard to give advice without knowing a little bit more. It sounds like you are on Metformin and no other drugs, right? Also, when were you diagnosed (edited to add: OK, thread title says 10 months), what was the HbA1C at diagnosis, and (if you have had subsequent tests) what is it now? (Sorry to ask for these personal details.)

Concerning carbs, some of us have had considerable success controlling our blood glucose with a low-carb diet, sometimes in combination with Metformin and some of us with no drugs at all. Moderate exercise is also helpful, although most studies show it has rather less impact than diet. It is impossible to say whether the diet approach will be sufficient to control your diabetes fully, but if you are medically able to try it, I would strongly recommend it.

You will find a lot of information on this forum, including for instance a separate low-carb sub-forum where people post recipes and cooking advice. I am also an unabashed fan of this website: https://www.dietdoctor.com/low-carb.

You are totally correct that there are "extreme differences of advice" concerning carbohydrates and Type 2 diabetes. At one end of the spectrum, the NHS (and here in America, the American Diabetes Association) tend to favor a "balanced diet" which at its most extreme, barely reduces the carbs at all.

You will need to experiment. I classify it like this, but others will disagree. Taking into account that the U.S. Recommended Daily Allowance is 225 to 325 grams of carbs per day (for non-diabetics):

• Low carb: 100 grams a day or fewer
• Very low carb: 50 grams a day or fewer
• Ultra low carb: 30 grams a day or fewer (sometimes referred to as "ketogenic" especially if it goes below 20g)

Only you can decide what is appropriate for your medical and lifestyle situation.

Me? I went straight for the "ultra low carb" option initially (the first two months after diagnosis). This brought my blood glucose to non-diabetic levels very fast (11 weeks). After then, I relaxed a little bit and there are days when I have, say, 50 grams.

But you do not necessarily have to be so extreme. It is, for all of us, an individual journey, a scientific experiment if you like.

Finally you should be warned that the low-carb, low-drug option is (weirdly) controversial and you may get some pushback from the medical community. It does not work for everyone, and it is not for everyone. Worth a try though, in my opinion.

Hello. The metformin can be awful for some people. I definitely would try and see the gp again. Or perhaps the diabetes nurse? It may be possible to book a double appointment with the nurse and you can have a proper conversation about your difficulties.

There is little to add to the way grateful has set it out for you. Like him I went ultra low from the beginning. I find it very difficult to only have a little because the cravings (for me) are so much worse if I have a little bit. I aim for under 30grms a day, but everyone has to find thier own level.

A top tip from ziggy, to keep a diary. In it record not only everything you eat and your bgls, but anything that affects you. Record if you are ill, stressed or have a bad nights sleep. Record what time you take the metformin, if what you eat makes the situation worse, times it gets bad etc. You are looking for patterns. If you do have to.drop the metformin a diary will help you manage the bgls. In fact it helps even with metformin!

Have you had a look at the dietdoctor site? There is a pay for section but a lot can be read for free. Have a listen to jason fung on youtube.

A few questions if I may? Do you have any other health problems?
Do you have your hbalc?
Do you have a great deal of weight to lose?
You of course dont have to answer, but one size does not suit all. However, I have found that low carb has changed my life and if that's the way you decide toto attack this then you will find a great deal of help here.

Good luck with it all.

elmer_dinkley said:

I was not told anything at all about numbers. The nurse then informed me that the blood test I had had 18months earlier for reflux had come back as prediabetic and they forgot to let me know. what ever numbers they said I was in shock and pretty angry. The doctor came in and tried to play it down and handed me the prescription for metaformin.

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That is shocking and you have my undiluted sympathy.

elmer_dinkley said:

... could anyone spare the time to explain what is HbA1C. thanks folks

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The HbA1C test is for "glycated hemoglobin." It is a clever test that measures the average level of glucose in your blood over the previous 8 to 12 weeks. It is the "gold standard" for diagnosing diabetes, and also for monitoring it in the longer term.

Unfortunately there are two measurement systems for HbA1C, one of them is a "percentage" number and the other one, "mmol/mol." The second system is more commonly used in the UK. I will list that number in parentheses below. These are the American guidelines. The UK ones are similar.

• Normal (non-diabetic): 5.6% (38) or lower.
• Pre-diabetic: 5.7% (39) to 6.4% (47)
• Diabetic: 6.5% (48) or higher.

Edited to add: If you can manage to control your blood glucose so that it is in the normal (non-diabetic) range, you will be very unlikely to suffer from the complications of the disease, assuming you haven't had any of them already. This is called "controlling diabetes" or "reversing" it. Once you have diabetes, you will always have it, but with good care you can largely avoid its consequences.

elmer_dinkley said:

many thanks that makes it clearer, sorry to be a pain but is this test usually a fasting blood test. when I went there seemed to be confusion on when I was having it done. Again I wasn't told anything

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Two tests are used to diagnose diabetes. The fasting blood test is an older test that shows your blood glucose levels on the day (and at the hour) that the test was taken. It is a good test, and once upon a time was the main test used. HbA1C is not a "fasting blood test" and came along in the past couple of decades.

In my case, they did both tests, to confirm diabetes.

Some people can’t tolerate metformin. The choice then is either get prescribed another type 2 medication, or eat a low carb diet. A low carb diet is much more effective in reducing blood sugars than metformin. High carb foods are very addictive and it does require some determination and willpower to change your diet.

The benefits of a low carb diet for me included losing weight so I am no longer obese, reducing high blood pressure, better concentration and lowering blood glucose from about 13 at diagnosis a year ago to around 5.5 now without any medication. I stopped taking metformin as I no longer needed it and it had bad side effects including brain fog, neuropathy (pins and needles in my hands), diarrhoea and tiredness from waking up in the night to pee.

I went through the 'take these tablets' situation 50 weeks ago.
I was so miserable with the pains in my joints and muscles, itching all over and what it did to my guts, and also my memory was failing, so just before Christmas '16 I stopped taking them. It was one tablet of Metformin and one Atorvastatin a day. I think I took two Metformin on two occasions, but it was just too dreadful. I pretend it didn't happen even to myself. (I got to the end of the post and came back to add this)
I decided that life was not worth living if it depended on taking the tablets.
On a low carb diet, I kept my numbers under 8 after eating. Sticking to the same menu after a few weeks the numbers dropped down to under 7 and last time I checked it was 6 mmol/l at the 2 hour stage. My Hba1c was 91 at diagnosis, dropped to 47 and then at 6 months it was 41.
I do not do high carb foods any more.
If I'd had the choice of taking the tablets or eating frogspawn - sorry frogs.
As it is I just had prawns with coleslaw and green salad. I will have coffee with cream and berries and cherries - a frozen mix, with more cream, in a little while.
I set a maximum of 60 gm of carbs per day, but I suspect that I often eat quite a bit less. I stick to the same low carb foods and eat what I feel like eating. I do sometimes have higher carb foods - up to 15 percent rather than the normal 10 percent limit, but in limited amounts. I go with my blood glucose levels mostly.
I feel very lucky that I can keep to normal levels without medication, and eat fairly freely.

elmer_dinkley said:

I have read about Carb cutting as this is really my only option.

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I'm another low carb success story. I was told by my GP that I was diabetic, and given an appointment with the diabetic nurse four weeks later. In the meantime I found this forum and decided low carb was worth trying. I went ultra low carb at first, but did relax this a very little after several months. I tested a lot at first, to find out what foods I couldn't tolerate. Now I have a wide range of meals I know I am fine with, I don't test quite so much. I bought Micheal Mosley's "8 week Blood Sugar Recipes" book and used it as my bible at first. It has lots of ideas for lovely things to eat. After a while your tastes will change and you will no longer be a "carb addict"!
I've had a very unenthusiastic response from my GP and nurse regarding low carb, but it seems to work for me,
I'm looking forward to my next HbA1c later this month!
If your surgery has on line access you can ask for your test results be put on line. NHS England wanted this made available in 2016, but you do have to request it in addition to the making appointment/repeat prescriptions facility.
Have a good read round the forums and come back with any questions. I've found the people on here much more helpful than my GP!

Hello again!
Thanks for all of that.

I am going to assume you are in the uk. If not, I apologise.

Your hbalc number tells you how far along the diabetic ladder you have been in the previous 3 months. In the uk, 42_48 is prediabetic. This would have been you when they forgot to tell you. Your number will now be above 48. These numbers are very useful. They give you an idea what to expect when you visit the gp and how to aim your longer term objectives about diet and exercise. You can just ask your surgery for a copy of your lab results. In the uk they have to give them to you, some charge 20p. I was dx ( diagnosed) at 53, so not too high but well into diabetic country.

The more useful.way to test is with a meter. I see that you are already doing this. Are you keeping records? And how are you timing the tests. You are aiming for a rise of about 2 about an hour after first bite. Testing again at 90 minutes. The best advice I had was to "eat to the meter" meaning eat foods that do not push your bgl above the rise of 2ish. Testing every now and then will only give you a very vague idea about your sugar levels. By more structured testing you will really be able to control your health. At the beginning I was testing all the time. Now not so much, but I still do it a fair bit.

The beauty of testing is that you can tell if you can control this with diet. Alot of people can do this, but testing, or making sure that you get your hbalc done regularly with proper follow up, is really the only way to know if its going well.

I am.sorry you are having such a dreadful time. I would like to say that your experience at the doctors was unusual, but if you have a read on here you will see that a lot of us had a similar experience. I have never seen a doctor about my t2d. However, I think it merits an official complaint, if you feel up to it..

Good luck with it all. Read everything you can find and come back and ask questions. Back in june I was brand new to all of this as well. Now feel sooooo much better. !! Keep in touch.

It is a real pain at first. I just couldn't see how I could have a meal not based around carbs. Now it is just normal. I still have to do a lot of packet reading in asda, but have quite a lot of go to foods now that make the whole thing a lot quicker.

The 2 week plan is a great idea. I am sure it will start off a bit rocky, so dont be too hard on yourself!!.

Let us know how it goes.x

elmer_dinkley said:

Not a big sweet eater but I am a carb addict. I got over weight with chips and crisp not beer and sweets. So what should be the carb limit I should aim for as I have seem some extreme differences in advice.

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Keep in mind that most of us will fail a 75g Oral glucose tolerance test. And our pancreas needs to output 2-3x the amount of insulin to attempt to bring down that glucose level.

Given this scenario, a good place to start would be 20-30g of carbs per meals. Up to 100g/day. And limit these carbs to leafy veg, nuts, cheese etc.

This might be helpful to provide some background...
http://www.diabetes.co.uk/forum/blog-entry/newbie-guide-to-t2d.1858/

All the best

elmer_dinkley said:

I am not going to give you a daily update on my progress. life is depressing enough without me moaning. Anyway I did a mushroom stew with quorn meatballs. I was surprised how low they are. Very nice but made the stock a bit too salty. I had a green shake this morning to try and avoid the cereal and banana breakfast. A couple of bit of fruit during the morning but was starving on my way home. Now did a quorn, mushroom and pea omelette, very tasty. Avoiding the bread (as I love toast) is the tricky bit. I cant thanks you lot enough, I was getting really down with all this and now can see some light ahead

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For me I found great joy in these...

My weightloss from the numbers in the notebook I found in the bathroom - I am not sure how far back it was, but it can't be so long ago - is over 3 stones. I was on a cholesterol lowering diet which made me put on weight hand over fist, now I keep having to buy new clothes and shoes - even my feet have shrunk.