Back after a few years

[xyzzy]

So here's my first diabetes post on this forum for some years. I hope it's still a lively and supportive place.

I've just passed my 5th year since diagnosis and all was well with the world until a few weeks ago. I am a low carb advocate and have pretty much followed the same 120g / day diet for the last four years but was stricter in the first year until I lost some weight (lost 4 stone in 9 months) and got my BG's under control. Apart from at diagnosis in the last 5 years my HBA1c has never been outside the range of 4.7% to 5.8% - until the last one. My last hba1c came back at 6.5% which was surprising and then in the last few weeks despite maintaining my normal diet things have got well out of hand with all the old symptoms re-emerging (thirst, thrush etc.). I broke out my BG meter that I nowadays only very infrequently use to find readings in the high teens (19.7 was the highest). So back to my diabetic nurse last week who luckily saw something was up and is taking things seriously. She sent me away to do pre and post meal testing for a few days to see what was going on and it's not pleasant reading. I've now managed to get my average down to around 10 by going very low carb (around 30g / day). The nurse has told me to continue VLC for a month and then they'll review. She is suggesting a GAD test to see if the rise is down to insulin resistance or a decay in Beta cells. So a few questions.

Any other long term low carbers experienced this?

What's the thinking on the new meds Forxiga (Dapagliflozin) or Invokana (Canagliflozin)? I'm currently just taking Metformin and am loathed to take anything that stimulates insulin production as I want a pancreas that keeps working for as long as possible. I understand the new drugs just stop the absorption of glucose so you just pee out excess sugar? How effective are they?

What I want to achieve is to get back to the lifestyle balance I had for 4 years i.e. moderate low carbing as it has worked very successfully in terms of BG's, cholesterol, blood pressure and weight. I don't mind doing the VLC thing for a while to get control back but its not long term for me.

 

[zand]

Hi, welcome back! Sorry I can't really answer any of your questions, just wanted to say Hello again. I have been diagnosed for roughly the same amount of time as you and I am finding it more difficult to keep control now too, but don't have any knowledge of those drugs, sorry.

 

[Resurgam]

Perhaps introducing a little exercise - assuming that it is not already part of your daily routine.
I was able to eat up to 80 gm of carb a day when doing low carb for a long time - but it was 'just' for weight control - however, I suspect that I had been controlling diabetes for a long time as when, after diagnosis, I used a meter to test what spiked my blood glucose it was exactly the things I could not eat without putting on weight, and when that happened it was very fast unless I went straight back to very low carb, for me.
The addition of two short interludes of exercise each day made the difference between eating very low carb and the rather more relaxed amounts. I bought myself a trampoline, set it up in the garden and went out morning and afternoon to do a thousand bounces at a time - plus I did some stretches and tried to ensure full movement of my various joints. I didn't even have to get out of breath or break into a sweat, so it wasn't exactly arduous - in fact it was a very comfortable way to spend half an hour out in the fresh air. I intend to get back into the habit when the weather improves - I am sure it has got wetter in the last few years, there were very few weeks when I could not go out at least nine or ten times, even in the winter. Now it always seems to be raining. I might have to get a little one for indoors - a bijou trampette, in estate agent speak..

 

[xyzzy]

Perhaps introducing a little exercise - assuming that it is not already part of your daily routine.

Lol structured exercise has never been my strong point but I do walk 3 - 5km / day with the dogs." Over the 5 years I have managed to keep the majority of my weight loss. My current BMI is 25.2.

I see you describe yourself as a low carb nutcase - good for you. I have a T2 friend who has done less than 50g / day for over 5 years who runs marathons so don't let anyone say you need carbs to live. Personally I managed around a year at about 60g / day after diagnosis then once everything got back ok I upped my carbs until my BG meter said STOP. For me this has been around 120g / day but all people are different.

 

[Resurgam]

Walking was something I did but without any effect on my weight - which was what was important to me back before diagnosis. I needed to up my pulse rate - I bought a device from lloyds pharmacy which measured and recorded it, then upped my rate week by week until I found a spot which made the most difference in weight for the still easy effort. That was the thousand bounces twice a day - I didn't count once I started to time my sessions.
When I had a Labrador dog to exercise I started out running, not walking, and they cycling to keep up with him.

 

[walnut_face]

I just wonder @xyzzy if the passage of time has caused your carb tolerance to deteriorate? If so maybe your carb intake needs to decrease from your current 120g?

 

[ickihun]

So here's my first diabetes post on this forum for some years. I hope it's still a lively and supportive place.

I've just passed my 5th year since diagnosis and all was well with the world until a few weeks ago. I am a low carb advocate and have pretty much followed the same 120g / day diet for the last four years but was stricter in the first year until I lost some weight (lost 4 stone in 9 months) and got my BG's under control. Apart from at diagnosis in the last 5 years my HBA1c has never been outside the range of 4.7% to 5.8% - until the last one. My last hba1c came back at 6.5% which was surprising and then in the last few weeks despite maintaining my normal diet things have got well out of hand with all the old symptoms re-emerging (thirst, thrush etc.). I broke out my BG meter that I nowadays only very infrequently use to find readings in the high teens (19.7 was the highest). So back to my diabetic nurse last week who luckily saw something was up and is taking things seriously. She sent me away to do pre and post meal testing for a few days to see what was going on and it's not pleasant reading. I've now managed to get my average down to around 10 by going very low carb (around 30g / day). The nurse has told me to continue VLC for a month and then they'll review. She is suggesting a GAD test to see if the rise is down to insulin resistance or a decay in Beta cells. So a few questions.

Any other long term low carbers experienced this?

What's the thinking on the new meds Forxiga (Dapagliflozin) or Invokana (Canagliflozin)? I'm currently just taking Metformin and am loathed to take anything that stimulates insulin production as I want a pancreas that keeps working for as long as possible. I understand the new drugs just stop the absorption of glucose so you just pee out excess sugar? How effective are they?

What I want to achieve is to get back to the lifestyle balance I had for 4 years i.e. moderate low carbing as it has worked very successfully in terms of BG's, cholesterol, blood pressure and weight. I don't mind doing the VLC thing for a while to get control back but its not long term for me.

Welcome back.
Canagliflozin didn't agree with my thrush prone tract but an excellent bg reducer.
Stick to vlc if you can choose!
For me I've gained weight on the insulin route.

 

[Kristin251]

I have to keep my carbs under 20 per day. I've been doing that for over 25 years, way before diagnosis but like you I think I would have been diagnosed much sooner if I ate more carbs. Short walks after meals really helped when I was type 2. You don't need heavy exercise and that can actually raise some of us. Just a 15 min slow to moderate walks generally does the trick.

My bs shot up over night and nothing I didnwould bring it down. That's when type1 walked in the door and on insulin now.
I completely understand the med thing. They had me on amaryl and I rollercoastered. You never know when it's going to squeeze your pancreas. I was always treating random lows. Knowing what I know now I personally would go to small doses of insulin but FIRST I would lower your carbs a ton. Only above ground veggies. See if you can restore some insulin sensitivity. I eat your daily carb intake in a week! Some people can tolerate that many but some cannot. Maybe once you get your levels back in place you can up them. Be aware that protein spikes insulinas well.

My mantra is vlc, MODERRATE protein and higher healthy fats like avocado, olive oil, nut, and olives.

 

[xyzzy]

Hi, welcome back! Sorry I can't really answer any of your questions, just wanted to say Hello again. I have been diagnosed for roughly the same amount of time as you and I am finding it more difficult to keep control now too, but don't have any knowledge of those drugs, sorry.

Hi Zand, thanks for the welcome. Long time no speak etc. That's a hell of a lot of posts you've made!

I'm sorry to hear you are having control problems. When you've gone years without an issue its pretty depressing. I'm personally a bit worried that this is the first signs of "progression" so am back actively looking for answers. I won't let this disease beat me!

I know two T2's who are on those drugs and have been impressed with the results they've achieved. Both are now controlling their BG's and have lost loads of weight. As far as I can make out they are only given when everything else has failed and then you have to make pledges about dieting etc. - so I'm expecting a battle to get them. It kind of irks me that I can be a well behaved T2 who actively manages the condition, and tries to minimise my cost to the NHS but effectively would need to go through a period of being badly behaved, trying all the meds to get ones I consider are actually ok. The new ones work by getting your kidneys to filter the glucose out of your system so it doesn't get into your blood i.e. you end up peeing Lucozade As they are not insulin stimulating you don't get the associated weight gain in fact you can imagine they effectively filter calories so they enhance weight loss. Again like Metformin as they don't stimulate insulin there is effectively no hypo risk. I do know you have to have good kidney function for them to be prescribed but luckily I apparently have better kidney function than most non diabetics of my age.

Take care

Steve

 

[Enclave]

Just as a thought ... could you try 20g 0f carbs a day for a few weeks ... that will be a good indicator as to if your still able to lower with diet ...
Welcome back

 

[xyzzy]

I have to keep my carbs under 20 per day. I've been doing that for over 25 years,

Wow 25 years, wish I had that focus!

While I try and get back on track my current vlc mantra isn't quite so poetic. "Don't eat sugar or starch or anything that comes in a box".

I'm interested you "progressed" from T2 to T1 as I have several T1's in my family both childhood T1 and LADA . It was when I mentioned that to the nurse today the subject of a GAD test came up so maybe I've set some cogs whirling.

 

[xyzzy]

Just as a thought ... could you try 20g 0f carbs a day for a few weeks ... that will be a good indicator as to if your still able to lower with diet ...
Welcome back

Yep that's basically what I've agreed with the diabetic nurse. Actually that's something very different from 5 years ago - having a diabetic nurse tell you to continue with sub 40g for a month. Five years ago they'd have fainted and thrown a tirade of anger at you. Her position is very low carb is fine in dietary terms but ultimately not everyone has the mental focus to continue it forever which to be honest is true but great if you can.

So the plan is VLC for 4 weeks and monitor my BG's then try upping back to my normal 120g (where I'm happiest). If it all goes wrong then they'll consider other meds, GAD test etc. That seems fair although I am self funding the test strips!

 

[xyzzy]

Welcome back.
Canagliflozin didn't agree with my thrush prone tract but an excellent bg reducer.
Stick to vlc if you can choose!
For me I've gained weight on the insulin route.

Thanks for the advice and yes the "thrush prone tract" was a concern I had as its one of the symptoms I get quite readily and is a great nudge into reducing carbs!

 

[ickihun]

Thanks for the advice and yes the "thrush prone tract" was a concern I had as its one of the symptoms I get quite readily and is a great nudge into reducing carbs!

Interestingly since having a diuretic which excretes salt/sodium my tract has not complained, even in high bgs. I'll let my endocrologist know in feb incase he wants to represcribe.

 

[lovinglife]

Welcome back

 

[xyzzy]

I just wonder @xyzzy if the passage of time has caused your carb tolerance to deteriorate? If so maybe your carb intake needs to decrease from your current 120g?

Yes maybe but I want to investigate what choices I have. I'm happy and am reducing my carbs to sub 50g to get control back (hopefully). The winners in this game are the people who gain control over the condition long term and that can be achieved in many ways.

 

[Kristin251]

I progressed just before I turned 50. I do think my vlcing for years and my exercise prolonged the inevitable for years. But then I had to keep reducing all food to keep good levels. I had the GAD which indicated I need to inject insulin and my cpepetide was quite low. I eat very small meals that require very little insulin doses. I also had stomach issues so these small meals and snacks help control the bloating quite well. Looking back to my childhood I can see where I never processed carbs well. Always bloated and hungry then sleepy. So after 25 years of low carbing no love lost. I'm adopted so no family history but I can say I was dealt the best deck of genes.

Spounds like if you go low enough carb for a while you'll get it back. Then add 5 g per week like Atkins recommends to find your personal carb threshold.

 

[Brunneria]

Hey, welcome back!

 

[Indy51]

Welcome back Steve. Sorry to hear that you're struggling and hope you can wrestle the diabetes monster back into submission soon

 

[xyzzy]

Welcome back Steve. Sorry to hear that you're struggling and hope you can wrestle the diabetes monster back into submission soon

Indy you're still here I feel better already! **** right it's gonna get beaten (again...). Hope you're doing ok in the land of Oz, take care xx