Type 2 Advice on if medication is required

[MKD75]

I am T2, diagnosed November 2016 and have always managed my diet.

Diagnosis at first a1c was 51 then 49, 2 weeks later.

I got it down to 42 the next test, gave up smoking and it went to 51 again thru weight gain the following test.

My last test in January it was back to 48.

My nurse wants to put me on metformin but I’ve refused as I know I can get it back to under 48 with diet and exercise. Am I right to refuse it?

Also, My cholesterol was 5.4 then 5.7 and now down to 4.9 and my nurse wants to to take a statin. Surely I don’t need statins of my cholesterol is 4.9?

Any advise gratefully received.

 

[sally and james]

As a T2, you should be able to get your HbA1c down lower than high 40's with dietary improvements, but what sort of diet are you eating? Tell us what you eat in a typical day. There may be much you can do to avoid drugs, if that is what you want.
Sally

 

[Bluetit1802]

Goodness, your nurse loves prescribing pills!!!

With a total cholesterol of 4.9 and an HbA1c of 48 she seems to be being rather over generous with her prescriptions.

Have you got the breakdown of your cholesterol? (HDL/LDL/Triglycerides?) You need those before you make any decision at all. The total cholesterol is just a total of the good stuff and the bad stuff, so you need to know. Doctors are now recommended to look at the lipids as a whole, not simply cherry pick one of them or go by the total.

With a few tweaks to your diet, a food diary, and home testing with your own meter, there is no reason why you can't get your BS levels right down to normal levels before your next test.

 

[MKD75]

Yes I definitely do. I take Cinnamon tablets before each meals which I put down to my cholesterol lowering so quickly in the past 3 months (nurse didn’t agree). Normally skip breakfast but if I do have it I have porridge & raspberries (Tesco’s original sachets are lowest carbs/sugar) they don’t tend to spike me. Lunch chicken & veg or crackers and cheese or occasionally a ham sandwich with super seeded brown bread. Tea is usually meat and veg, try not to have potatoes too often although they don’t affect me that much. Can’t eat rice anymore as that spikes me.. once I week I have spag bol and pasta.. snacks are dry roasted nuts, cheddar crackers, 80% dark chocolate. However, I am not always good, had a 2 week binge at Christmas.. I work long hours in a sedentary job but got a Fitbit in January and make sure I do at least 30 mins of active exercise per day. I stopped smoking and gave up except the occasional gin and diet lemonade. My main problem is exercise I think.

 

[sally and james]

@MKD75 You say that some things do/don't spike you. Are you testing immediately before eating and then two hours later. The rise in your blood sugars should, ideally be less than 2. Are you sure that porridge, crackers, bread, potatoes, pasta and dry roasted nuts are not spiking you? They would cause too much of a rise for most diabetics and, even though each one is only occasional, they all add up.
Exercise does help a bit, but don't rely on it. As they say, "you can't out run a bad diet". As far as blood sugars are concerned, it's all about what goes in your mouth. (sorry!)
There are many views on cholesterol, but personally I would ignore it. Almost all the cholesterol in your blood is made in your body, so don't worry about diet in this respect. Like nurse, I wouldn't bother with cinnamon pills.
Look after the blood sugars and everything else will look after itself.
Sally

 

[Guzzler]

You could easily lower your HbA1c going by the foods you have listed.

As to medication, our Health Care Professionals are there to advise. No one can compel you to take medication if you choose not to.

 

[MKD75]

@MKD75 You say that some things do/don't spike you. Are you testing immediately before eating and then two hours later. The rise in your blood sugars should, ideally be less than 2. Are you sure that porridge, crackers, bread, potatoes, pasta and dry roasted nuts are not spiking you? They would cause too much of a rise for most diabetics and, even though each one is only occasional, they all add up.
Exercise does help a bit, but don't rely on it. As they say, "you can't out run a bad diet". As far as blood sugars are concerned, it's all about what goes in your mouth. (sorry!)
There are many views on cholesterol, but personally I would ignore it. Almost all the cholesterol in your blood is made in your body, so don't worry about diet in this respect. Like nurse, I wouldn't bother with cinnamon pills.
Look after the blood sugars and everything else will look after itself.
Sally

Thank you- example of today, I had roast chicken today with 3 small potatoes and a pile of veg and my test almost 2 hours after was 7.3 (6.3 before tea). Most days I have virtually no carbs but prob 3 days a week I’ll have bread or potatoes. When I got my blood down to 42 within 3 months it was because I cut out all carbs and sugar and lived on salad/veg and meat daily. Id find it hard to maintain forever purely because I want to be able to have the odd meal out etc. I wonder if there are any other tips? Ideas for snacks?

 

[MKD75]

You could easily lower your HbA1c going by the foods you have listed.

As to medication, our Health Care Professionals are there to advise. No one can compel you to take medication if you choose not to.

Yes she only advises but I wonder why she’s advising me to take a statin if my cholesterol is 4.9? I’d call that below average ?

 

[sally and james]

I wonder if there are any other tips? Ideas for snacks?

We find that, since going LCHF (less than 30g carb per day) almost five years ago, that we don't need snacks.
There is much more to a LCHF diet than just meat and veg/salad, you need to look around the forum and Diet Doctor for recipes and ideas. Your diet sounds as if it might me lacking fats. If you really, really want to avoid drugs and have normal blood sugars, I'm afraid you have to really, really go for it - all the time. It takes adjustment, but hundreds, thousands of us have done it and feel much better for it.
Sally

 

[MKD75]

Goodness, your nurse loves prescribing pills!!!

With a total cholesterol of 4.9 and an HbA1c of 48 she seems to be being rather over generous with her prescriptions.

Have you got the breakdown of your cholesterol? (HDL/LDL/Triglycerides?) You need those before you make any decision at all. The total cholesterol is just a total of the good stuff and the bad stuff, so you need to know. Doctors are now recommended to look at the lipids as a whole, not simply cherry pick one of them or go by the total.

With a few tweaks to your diet, a food diary, and home testing with your own meter, there is no reason why you can't get your BS levels right down to normal levels before your next test.

Thank you!! I’m positive I will. I’ve just signed up for 10,000 steps per day throughout March to raise money for Cancer Research so will be doubling my exercise throughout March. I think she is over prescribing - the highest I’ve ever been is 51 and I would have got it lower this test only the past 3 mo the have been stressful or busy (brought a house and has a 2 week Christmas holiday).

My results are below but I don’t really understand them?

Urea and electrolytes;Serum cholesterol/HDL ratio Report, Satisfactory, No Further Action

Coded entry Urea and electrolytes
Coded entry Serum sodium level 138 mmol/L [133 - 146]
Coded entry Serum potassium level 4.2 mmol/L [3.5 - 5.3]
Coded entry Serum HDL cholesterol level 1.11 mmol/L [1 - 3]
Coded entry Serum cholesterol/HDL ratio 4.4 mmol/mmol [< 4]
Coded entry Serum non high density lipoprotein cholesterol level 3.8 mmol/L
Coded entry Serum creatinine level 70 umol/L [45 - 84]
Coded entry Serum cholesterol level 4.9 mmol/L [< 5]
Coded entry Serum urea level 4.3 mmol/L [2.5 - 7.8]
Coded entry eGFR using creatinine (CKD-EPI) per 1.73 square metres > 90 mL/min [60 - 150]
Coded entry Serum cholesterol/HDL ratio

 

[MKD75]

We find that, since going LCHF (less than 30g carb per day) almost five years ago, that we don't need snacks.
There is much more to a LCHF diet than just meat and veg/salad, you need to look around the forum and Diet Doctor for recipes and ideas. Your diet sounds as if it might me lacking fats. If you really, really want to avoid drugs and have normal blood sugars, I'm afraid you have to really, really go for it - all the time. It takes adjustment, but hundreds, thousands of us have done it and feel much better for it.
Sally

May I ask how long you have been managing yours by diet alone? I thought T2 can be progressive so even though diet may work now ok for a while but most people have to go onto medication or insulin after X amount of years? I’m hoping that’s not always the case? Hence why I want to stay off medication as long as possible.

 

[sally and james]

May I ask how long you have been managing yours by diet alone? I thought T2 can be progressive so even though diet may work now ok for a while but most people have to go onto medication or insulin after X amount of years? I’m hoping that’s not always the case? Hence why I want to stay off medication as long as possible.

My husband (I am just a supporting act on the Low Carb road) has been managing T2 diabetes for four and a half years on a low carb diet and no meds. His spot blood sugar reading on diagnosis was 24mmol/L and, I think, his HbA1c was 75. It took nine days of low carb to bring spot readings permanently down to normal levels. Our idea of "normal" is Under 6 at 2 hours after a meal and usually under 5, or at least under 5.5 fasting or pre-meal. HbA1c readings have all been in the low 30's. There has been reversal of the complications which lead to diagnosis.
Type 2 diabetes is thought to be progressive BECAUSE of the treatments and dietary advice given out by many of the medical community, though the tide is gradually turning. The recommended diet of starchy carbs at every meal constantly puts up blood sugars and increases the amount of insulin going around the body. Both of these are not a good thing! As your insulin resistance increases, due to high circulating levels trying to cope with all the sugar, Nursey will put you on more drugs, which includes, guess what, more insulin.
There are now many people, and doctors supporting them, who have rejected this approach and gone for the Low Carb lifestyle. It's an option open to you too.
Sally

 

[MKD75]

My husband (I am just a supporting act on the Low Carb road) has been managing T2 diabetes for four and a half years on a low carb diet and no meds. His spot blood sugar reading on diagnosis was 24mmol/L and, I think, his HbA1c was 75. It took nine days of low carb to bring spot readings permanently down to normal levels. Our idea of "normal" is Under 6 at 2 hours after a meal and usually under 5, or at least under 5.5 fasting or pre-meal. HbA1c readings have all been in the low 30's. There has been reversal of the complications which lead to diagnosis.
Type 2 diabetes is thought to be progressive BECAUSE of the treatments and dietary advice given out by many of the medical community, though the tide is gradually turning. The recommended diet of starchy carbs at every meal constantly puts up blood sugars and increases the amount of insulin going around the body. Both of these are not a good thing! As your insulin resistance increases, due to high circulating levels trying to cope with all the sugar, Nursey will put you on more drugs, which includes, guess what, more insulin.
There are now many people, and doctors supporting them, who have rejected this approach and gone for the Low Carb lifestyle. It's an option open to you too.
Sally

My goodness that’s amazing! Love hearing stories like this! Thank you.

 

[Bluetit1802]

Thank you!! I’m positive I will. I’ve just signed up for 10,000 steps per day throughout March to raise money for Cancer Research so will be doubling my exercise throughout March. I think she is over prescribing - the highest I’ve ever been is 51 and I would have got it lower this test only the past 3 mo the have been stressful or busy (brought a house and has a 2 week Christmas holiday).

My results are below but I don’t really understand them?

Urea and electrolytes;Serum cholesterol/HDL ratio Report, Satisfactory, No Further Action

Coded entry Urea and electrolytes
Coded entry Serum sodium level 138 mmol/L [133 - 146]
Coded entry Serum potassium level 4.2 mmol/L [3.5 - 5.3]
Coded entry Serum HDL cholesterol level 1.11 mmol/L [1 - 3]
Coded entry Serum cholesterol/HDL ratio 4.4 mmol/mmol [< 4]
Coded entry Serum non high density lipoprotein cholesterol level 3.8 mmol/L
Coded entry Serum creatinine level 70 umol/L [45 - 84]
Coded entry Serum cholesterol level 4.9 mmol/L [< 5]
Coded entry Serum urea level 4.3 mmol/L [2.5 - 7.8]
Coded entry eGFR using creatinine (CKD-EPI) per 1.73 square metres > 90 mL/min [60 - 150]
Coded entry Serum cholesterol/HDL ratio

You can see from the comment right at the top that all these results are satisfactory and NO FURTHER ACTION is required. Your nurse was over cautious for reasons best known to herself. I can't imagine why she offered you any medication with those results.

Also, your stressful 3 months may well be a very good reason why your HbA1c wasn't a bit lower. (Buying a house is a very stressful experience) However, your approach to your diet could be improved! If you want to remain medication free, it would help you to tweak some of your meals and reduce the carbs a bit more.

Good luck with your 10,000 steps throughout March to raise money for Cancer Research.