- Messages
- 4,380
- Type of diabetes
- Type 2
- Treatment type
- Tablets (oral)
- Dislikes
-
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
This might get a little complicated as it is broad ranging. If in doubt skip to the end then read the middle. 
I had a scary HbA1c of 7.2% at my last test which is roughly equivalent to an average BG reading of 8.9 mmol/L.
This was compounded by my having done an A1CNow test on the same day as the blood test with a result of 6.1%. So I was shocked.
I girded my loins (does this mean putting on some trolleys?) and went strict LCHF again with a testing regime.
One thing was very obvious - I had been deluding myself that I could cope with a few extra carbs such as a slice or two of bread or a roll once a day. Tests with long term BG levels (3+ hours) over 10 put me right on that one. Bread is out, slice of apple pie and cream took me stratospheric.
One nice surprise was that baked beans seem to be OK especially if eaten with a lot of protein and fat. I have a very limited list of feel good foods from my old "can eat anything and probably will" days.
So I am now low carbing and also OMAD, with the single meal not being very large. Well, cream+butter+coffee in the morning and one meal type meal late afternoon.
I have trimmed off nearly 8 lbs over the last 3 weeks but stalled for the last few days despite eating less and exercising more.(!)
My 7 day testing average is 6.7
My 14 day testing average is 7.3
My 30 day testing average is 7.3 (well, haven't been testing for 30 days yet)
Those numbers tie in with an expected HbA1c of between 6.1% and 6.4% which would be me back on track.
However I know that I have been bad so I can believe the laboratory test over the A1CNow test in this instance.
However all this having been said, I am still not happy with some of my numbers (even tough it looks as though they may reflect my long term BG maintenance prior to my blip).
On to the DN appointment. Our long term DSN (who was lovely, very supportive, and regarded me as one of her star patients) has moved to another area so we have a locum covering for the moment. She is also lovely and very supportive of my self management. She was amazed that I had been diagnosed for over 10 years and was still on diet, exercise and Metformin. [I had to check my signature to remind myself I was diagnosed in March 2008 so it is over 11 years since diagnosis.] She said than almost everyone was on insulin by that stage.
She held up her end of the discussion very gamely, even when I mentioned chatting to Prof Roy Taylor at a conference about my ideal weight.
She laid out 3 options:
(1) Stay on my current medication.
(2) Up me from 3 * 500 mg Metformin a day to 4.
(3) Add in a secondary medication.
We agreed I would stay as is and have another HbA1c in 3 months to see if I had regained control before adding in another 500 mg of Metformin.
However her discussion of a secondary medication (which she said she didn't think was necessary at the moment) gave me food for thought.
The two options she mentioned were:
(a) SGLT2 inhibitors. https://www.diabetes.co.uk/diabetes-medication/sglt2-inhibitors.html. Basically your kidneys don't reabsorb sugar after filtering it out, so you pee sugar. You need to drink a lot of fluids to keep the flushing out working. Not recommended if you have dodgy kidneys so my reduced eGFR rating might suggest this isn't for me. I did note that the linked article talked about it being added if Metformin and insulin weren't working. I would have expected it to be the other way round.
(b) DPP-4 inhibitors (Gliptins). https://www.diabetes.co.uk/diabetes-medication/dpp-4-inhibitors.html.
"They work by blocking the action of DPP-4, an enzyme which destroys a group of gastrointestinal hormones called incretins.
Incretins help stimulate the production of insulin when it is needed (e.g. after eating) and reduce the production of glucagon by the liver when it is not needed (e.g. during digestion). They also slow down digestion and decrease appetite. So by protecting incretins from damage, DPP-4 inhibitors help regulate blood glucose levels.
"
That sounds interesting - more below.
Hmmm..."DPP-4 inhibitors may be used as a second or third line medication for people with type 2 diabetes after prescribing metformin and sulphonylureas, and as an alternative to thiazolidinedione medication."
Sulphonylureas weren't mentioned. https://www.diabetes.co.uk/diabetes-medication/sulphonylureas.html. These turn up the wick on your pancreas which I have always thought was the last desperate step before insulin. To quote Tyrell "The light that burns twice as bright burns half as long."! Not keen on this.
Also "DPP-4 inhibitors have been linked with an increased risk of pancreatitis. If you experience a severe pain in your upper abdomen which may be accompanied with nausea and/or vomiting, call for medical help.".
Oh, blimey! https://www.diabetes.co.uk/diabetes-medication/thiazolidinediones.html. These are supposed to reduce Insulin Resistance and preserve the insulin producing cells. Sounds right up my street! Downside is the risk of weight gain (blood glucose zipping into the fat cells, presumably) with DPP-4 as an alternative if weight gain might be an issue. However I don't think weight gain would be a major issue for me. I could tolerate a few extra pounds if I didn't have IR and my pancreas was producing sufficient insulin. Where do I sign?
Thank you for reading this far.
My current issue is this:
my fasting BG is in the high 6s and low 7s although this matches my general levels through the day.
Even after a long cycle ride fuelled only by coffee+cream+butter first thing in the morning my BG still seems to be over 6 (although I note a 5.4 when I didn't go on a bike ride and a 4.8 when I ate at 11:50).
I am virtually not eating carbohydrates so my body must be manufacturing them and keeping my base level around 6.
This suggests that the feedback mechanism which should prevent too much glucose being generated (or at least retained in the blood stream) isn't working correctly.
I'm not really eating carbohydrates, I'm burning off a lot of energy (hopefully ketones) but my fasting BG is still slightly elevated.
One hypothesis is that my incretins are being killed off before they can do their work fully so DPP4-inhibitors might address this.
I do note that I had better results when I ate something earlier in the day, so perhaps fasting for much of the day might be counter productive for BG control although beneficial for maintaining ketosis and weight loss.
Does the team think that I should experiment with Januvia/Sitagliptin or does that increase the risk profile?
On review, Pioglitazone looks a very interesting (for me perhaps preferable option) option so I would like to know what the downsides are.
End note: I'm confused by the order of adding in medications implied in the linked articles above, and their priorities in prescribing.
I had a scary HbA1c of 7.2% at my last test which is roughly equivalent to an average BG reading of 8.9 mmol/L.
This was compounded by my having done an A1CNow test on the same day as the blood test with a result of 6.1%. So I was shocked.
I girded my loins (does this mean putting on some trolleys?) and went strict LCHF again with a testing regime.
One thing was very obvious - I had been deluding myself that I could cope with a few extra carbs such as a slice or two of bread or a roll once a day. Tests with long term BG levels (3+ hours) over 10 put me right on that one. Bread is out, slice of apple pie and cream took me stratospheric.
One nice surprise was that baked beans seem to be OK especially if eaten with a lot of protein and fat. I have a very limited list of feel good foods from my old "can eat anything and probably will" days.
So I am now low carbing and also OMAD, with the single meal not being very large. Well, cream+butter+coffee in the morning and one meal type meal late afternoon.
I have trimmed off nearly 8 lbs over the last 3 weeks but stalled for the last few days despite eating less and exercising more.(!)
My 7 day testing average is 6.7
My 14 day testing average is 7.3
My 30 day testing average is 7.3 (well, haven't been testing for 30 days yet)
Those numbers tie in with an expected HbA1c of between 6.1% and 6.4% which would be me back on track.
However I know that I have been bad so I can believe the laboratory test over the A1CNow test in this instance.
However all this having been said, I am still not happy with some of my numbers (even tough it looks as though they may reflect my long term BG maintenance prior to my blip).
On to the DN appointment. Our long term DSN (who was lovely, very supportive, and regarded me as one of her star patients) has moved to another area so we have a locum covering for the moment. She is also lovely and very supportive of my self management. She was amazed that I had been diagnosed for over 10 years and was still on diet, exercise and Metformin. [I had to check my signature to remind myself I was diagnosed in March 2008 so it is over 11 years since diagnosis.] She said than almost everyone was on insulin by that stage.
She held up her end of the discussion very gamely, even when I mentioned chatting to Prof Roy Taylor at a conference about my ideal weight.
She laid out 3 options:
(1) Stay on my current medication.
(2) Up me from 3 * 500 mg Metformin a day to 4.
(3) Add in a secondary medication.
We agreed I would stay as is and have another HbA1c in 3 months to see if I had regained control before adding in another 500 mg of Metformin.
However her discussion of a secondary medication (which she said she didn't think was necessary at the moment) gave me food for thought.
The two options she mentioned were:
(a) SGLT2 inhibitors. https://www.diabetes.co.uk/diabetes-medication/sglt2-inhibitors.html. Basically your kidneys don't reabsorb sugar after filtering it out, so you pee sugar. You need to drink a lot of fluids to keep the flushing out working. Not recommended if you have dodgy kidneys so my reduced eGFR rating might suggest this isn't for me. I did note that the linked article talked about it being added if Metformin and insulin weren't working. I would have expected it to be the other way round.
(b) DPP-4 inhibitors (Gliptins). https://www.diabetes.co.uk/diabetes-medication/dpp-4-inhibitors.html.
"They work by blocking the action of DPP-4, an enzyme which destroys a group of gastrointestinal hormones called incretins.
Incretins help stimulate the production of insulin when it is needed (e.g. after eating) and reduce the production of glucagon by the liver when it is not needed (e.g. during digestion). They also slow down digestion and decrease appetite. So by protecting incretins from damage, DPP-4 inhibitors help regulate blood glucose levels.
"
That sounds interesting - more below.
Hmmm..."DPP-4 inhibitors may be used as a second or third line medication for people with type 2 diabetes after prescribing metformin and sulphonylureas, and as an alternative to thiazolidinedione medication."
Sulphonylureas weren't mentioned. https://www.diabetes.co.uk/diabetes-medication/sulphonylureas.html. These turn up the wick on your pancreas which I have always thought was the last desperate step before insulin. To quote Tyrell "The light that burns twice as bright burns half as long."! Not keen on this.
Also "DPP-4 inhibitors have been linked with an increased risk of pancreatitis. If you experience a severe pain in your upper abdomen which may be accompanied with nausea and/or vomiting, call for medical help.".
Oh, blimey! https://www.diabetes.co.uk/diabetes-medication/thiazolidinediones.html. These are supposed to reduce Insulin Resistance and preserve the insulin producing cells. Sounds right up my street! Downside is the risk of weight gain (blood glucose zipping into the fat cells, presumably) with DPP-4 as an alternative if weight gain might be an issue. However I don't think weight gain would be a major issue for me. I could tolerate a few extra pounds if I didn't have IR and my pancreas was producing sufficient insulin. Where do I sign?
Thank you for reading this far.
My current issue is this:
my fasting BG is in the high 6s and low 7s although this matches my general levels through the day.
Even after a long cycle ride fuelled only by coffee+cream+butter first thing in the morning my BG still seems to be over 6 (although I note a 5.4 when I didn't go on a bike ride and a 4.8 when I ate at 11:50).
I am virtually not eating carbohydrates so my body must be manufacturing them and keeping my base level around 6.
This suggests that the feedback mechanism which should prevent too much glucose being generated (or at least retained in the blood stream) isn't working correctly.
I'm not really eating carbohydrates, I'm burning off a lot of energy (hopefully ketones) but my fasting BG is still slightly elevated.
One hypothesis is that my incretins are being killed off before they can do their work fully so DPP4-inhibitors might address this.
I do note that I had better results when I ate something earlier in the day, so perhaps fasting for much of the day might be counter productive for BG control although beneficial for maintaining ketosis and weight loss.
Does the team think that I should experiment with Januvia/Sitagliptin or does that increase the risk profile?
On review, Pioglitazone looks a very interesting (for me perhaps preferable option) option so I would like to know what the downsides are.
End note: I'm confused by the order of adding in medications implied in the linked articles above, and their priorities in prescribing.
