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Big Drop in HBA1C - What now?

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rupertrigsby

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Hi All

This is my first post in this forum. I have scoured this forum quite a bit for advice over the past 3 months. A bit about myself:

I'm 46 and was diagnosed in November 2020 with Type 2. This came as big shock (but not a surprise) to me. I have always had a sweet tooth and was used to eating loads of rice, potatoes, chocolate, cakes, sugary drinks, flavoured milk etc...I also had a fairly sedentary lifestyle as I was WFH sat at my laptop all day. I had noticed that for several months I had not been sleeping well as I was waking up in the middle of the night to use the bathroom. I also noticed that I had unexplained weight loss. So I decided to go for a health-check.

The results were not good reading. I'm 6ft 2 and weighed just over 21 stone (down from 24 stone which was my heaviest ever). My HBA1C was 125, my cholesterol was 7.3 and blood pressure was 150/90. So my GP read me the riot act and explained what I needed to do. Cut out starchy carbs, start exercising, start taking 4 gliclazide tablets and one blood pressure pill per day. I have to say that I was really fearful of dropping dead. My dad was diabetic and so is my brother. I was afraid I wouldn't live long enough to see my 4 year old daughter grow up.

Anyway I did what my GP advised, cut out starchy carbs, started to measure my carb and calorie intake as well as testing my blood sugar regularly (the milk chocolate was hard to give up and I have to admit that I do have a few squares each day). I did go off the rails for a week around Christmas. **** that M&S Chocolate dessert!!!!! I started exercising, walking for 30 mins each day and building up to an hour each day in an attempt to cover at least 10k steps per day. I also started doing weights 3 times a week.

I went back to my GP for another HBA1C test in mid-Feb and my results came back 2 days ago. So my HBA1C is now 48, my cholesterol has dropped to 4.8 and my BP is 125/75. In addition, I have lost 2 stone. My GP has now started me on 4 metformin per day and reduced my gliclazide to 1 pill a day. When I mentioned to her how I was struggling to give up the chocolate she told me to choose one day a week where I can eat anything I want. Not so sure that is a good idea though!!

I do feel proud of myself for having turned things around in such a short time, especially with my love of sugar and my hatred for exercise but I am a bit stuck as to what to do now. In other words if I continue to be as disciplined as I was would my HBA1C drop drastically again to maybe low 30s and hopefully send me into remission? If I relax my diet a little bit now will that cause me to go in the opposite direction?

Would appreciate any advice you can give. I will do what is necessary to stay healthy but I guess I just want to know what I can "get away with" in terms of carbs per day etc...although my long term goal is to lose another 5 stone so that my BMI category becomes "normal".

Thanks in advance!!
 
You say "Would appreciate any advice you can give. I will do what is necessary to stay healthy but I guess I just want to know what I can "get away with" in terms of carbs per day etc...although my long term goal is to lose another 5 stone so that my BMI category becomes "normal"."

- I think you already know the answer!
If you relax too early you will just undo all the good work.

One thing that can help you fine tune your'Way Of Eating' is to test you Blood Glucose reaction to different foods (at different times of day).
We Type 2's tend to be a varied bunch and some can eat carbs but only for breakfast, others can eat carbs but only in the evening. And some like me can hardly eat any cars at an time
Some can eat apples, but for others like me even a raw carrot is too much.

Get a Blood Glucose Meter which takes cheap(er) test strips :
The SD Gluco Navii and the Spirit Helathcare TEE2 both have strips costing around £8 per pot of 50. Both are available online.

Test before every meal (at first) and then again 2hrs after first bite.
You have 2 goals:
1. Aim to keep your max BG reading to below 8.o0 mmol
2. Aim to limit the rise caused by a meal to below 2.0 mmol.

If you can still stay within those limits then you may have some space to relax your carb restriction.
 
I would worry about one day a week when you can 'eat anything' - big spikes in blood sugar can cause permanent damage and your 3 mth HbA1c could look fine but a 3 month average masks issues.
Better to find a substitute for milk chocolate? I tried switching to 85% from milk which was tough but as I went lowcarb (ie not just cutting out bread and obvious added sugar) I could have double cream instead so I carefully melt the chocolate and stir in some warmed cream and sweetener - a little for a milder 'milk choc' bar and more for chocolate mousse.

Going low carb improved my cholesterol and helped me lose loads of weight while never feeling hungry and having lots of 'treats' like cheese, cream, full fat real greek yogurt, rhubarb crumble made with ground almonds instead of flour and the occasional keto mug cake.
 
Lower carb Choc mousse recipe - a tub of double cream, gently warmed, 4-5 squares of 90% chocolate, eg Lindt, and sweetener such as erythritol or a stevia based sweetener.
Break the chocolate into small pieces, stir into warm cream until dissolved, add sweetener to taste. cool then whip.
makes 4 servings.
Can add vanilla or peppermint essence.
 
Hello and welome,

It doesn't sound like you have a meter and test regularly. I really recommend that you get one.

In terms of what you can get away with I totally get it. I am v very low carb less than 20 grams a day but to be honest most of those are 'treats'. I am a carboholic- I love them. I was devastated when diagnosed used to realise that my past diet was no way similar to my future so I totally get where you are coming from.

First of all the fewer carbs I eat the less I physically crave them. Would I love to eat chocolate every day- yes definitely. In Australia there is a brand of 'milk chocolate' that is very low carb and I have found one made from coconut cream that is also nice. I'm not a fan of coconut but these are really lovely. I also have diet jelly- given that up for Lenty this year- could not have done it a year ago.

This site literally saved my life- they have given me help, support and advice and don't sugarcoat their advice (although sugarcoat is probably not appropriate here). I have lost weight without being hungry for the first. time in my life.

I do not recommend a 'cheat' day. This is not a diet this is the rest of your life- that devastated me at first but with the support I received here my levels are well into the normal. No I can't eat like I used to but the consequences of uncontrolled diabetes scared me enough to radically change my diet. Some days I cope less well but my carb intake is always less than maybe 25 grams on a really really bad day. The recipe from @TriciaWs sound lovely- I'll have to try it.

Look at the things you can have without guilt- pork crackling, the skin on roast chicken, cream cheese- there are a lot of options.
if you need support or advice or just to vent you have found the best place in the world to be.

good luck, stick around- welcome.
 
Thanks everyone for your warm welcome and advice.

One thing that puzzles me however is that there seems to be a considerable difference between the advice given on forums such as this and the advice given by some Medical programs. I would assume that these programs are reviewed and approved by Medical experts but find myself confused.

This website was my first port of call after diagnosis and I have it to thank for the turnaround in my life. However, I went on the DESMOND course a few weeks ago and was struck by how different the advice on it was compared to this forum. The course seemed to promote the reduction of starchy and refined carbs rather than the elimination which appears to be the doctrine on this forum.

For example, DESMOND advised that instead of having 4 spoons of white rice with 2 spoons of veg, have 2 spoons of rice with 4 spoons of veg. Instead of 2 slices of white toast and jam in the morning, have 1 slice of white toast with Jam. Instead of 3 scoops of ice-cream have 1 scoop....etc.....things that (from what I have read so far) would be a no-no for most people on the forum.

I know we are all different and what spikes one person's blood sugar may not spike another's but is anyone able to clear up this confusion for me? Are the Medical programs just based on theory and little practical research???
 

I think it really depends how much the individual can tolerate that's why testing is so important. I don't eat normal bread as I've found the low carb alternatives to be tasty (livlife seeded loaf and carb zone wraps for me). But I do have a small portion of pasta and rice every now and again and it does not affect my blood sugars. Best to get a meter and see what works for you.

Edit to add: congratulations on reducing your hba1c!
 
I think that many in the medical profession still think that type 2 is a progressive illness and if you eat what they recommend it may well be.

Trust your meter- no better advice. My meter tells me low carb is the way to go.
 
rupertrigsby said:
Are the Medical programs just based on theory and little practical research???
Click to expand...

They’re based on the government’s standard ‘eatwell’ food guide (or their equivalent in other countries). There is a growing community of healthcare professionals advocating low carb - not just for diabetes, but to help with a raft of medical conditions. This article explains some of it: https://www.dailymail.co.uk/health/...octors-helping-patients-REVERSE-DIABETES.html

You might also want to look at the work of the Public Health Collaboration: https://phcuk.org/
 

> Our Research > Diabetes > Reversing Type 2 Diabetes

Reversing Type 2 Diabetes and ongoing remission
 
rupertrigsby said:
if I continue to be as disciplined as I was would my HBA1C drop drastically again to maybe low 30s and hopefully send me into remission? If I relax my diet a little bit now will that cause me to go in the opposite direction?
Click to expand...

I think you know the answer to both of these questions deep down..

Yes and yes.

You've done great things already so keep it up and you'll get all the extra benefits of healthy nutrition along with more weight oss and if you are anything like me a whole load of extra health problems disappearing. My blood pressure normalised and a host of other issues cured themselves.
 
Firstly, many congratulations on your progress so far. Four months is not a long time to change eating patterns that have been established for years so the longer you stick with your current regime the easier it will become.
I went on the Desmond course 7 years ago and equally came away feeling confused and, in my case, annoyed. Thanks to the support I found here I had already recognized that I was intolerant of carbohydrate so why continue to consume it? The Desmond course is predicated on the belief that most people will not substantially change their eating patterns. It also assumes, wrongly, that carbohydrate is an essential food group.
The reason that slimming groups make so much money is that clients 'go on a diet' then resume their former eating patterns. I suspect that you are thinking along these lines!
 
It is possible to include chocolate in a low carb lifestyle. Just as long as it is very dark chocolate. I regularly eat 85% 90% or even 100%, just a square or 2 at a time and usually at the end of my last meal of the day.
Granted it took some getting used to, I loved milk chocolate but the thought of no chocolate was too much and over a few weeks I worked my way up the percentage scale.
I find the 100% quite difficult to like, but it does kill any craving stone dead.
I find the 4g of carbs from 85% cocoa chocolate fits well with in my otherwise very low carb way of eating.
I have a tray of homemade millionaires shortbread in the fridge as we speak. One small square is all it takes to satisfy me.
LcHF is not about deprivation, it has to be way of eating for life for most of us.
You'll be surprised and pleased how much your tastes and cravings change over time
 
rupertrigsby said:
Are the Medical programs just based on theory and little practical research??
Click to expand...
Check out Dr David Unwin on YouTube and Google. Nhs gp who advocates low carb based on his own patients and research
 
rupertrigsby said:
For example, DESMOND advised that instead of having 4 spoons of white rice with 2 spoons of veg, have 2 spoons of rice with 4 spoons of veg.
Click to expand...

My take on this subject is that their starting point is NOT to 'cure' or put the disease into remission, it's to simply get people to reduce their carbs. I think that this ultimately is because they think that the 'general public' can't possibly be determined or researched enough to set their standards high and so set the bar extremely low. They haven't met you lot!!!! x
 
I have the Lindt 90% choc, max of 20g per day (2 squares), tastes fine though I’ve always liked dark chocolate to be fair. The 85% is slightly nicer and doesn’t spike me either, but prefer the 90% as it’s half the carbs of 85% so I can eat twice as much!
 
rupertrigsby said:
she told me to choose one day a week where I can eat anything I want.
Click to expand...

One thing to bear in mind when pondering this is that if that means suddenly eating 200 (plus) carbs which is EASILY done with certain types of carbs, it really isn't an 'eat them, wait a few hours' and you're back to square one the next day. I find that if I do have a relatively carby day (even though I can use insulin to lower immediate levels), my fasting level goes up for that day AND the next day and sometimes the day after that! Not by ginormous amounts but enough that I know it is my body basking in the glory of extra (easily absorbed) carbiness instead of what it usually gets (which is not a lot). That's why when we talk about changing our basal (long acting) requirements we have to wait a good 3 days to see if we've pitched it right. So, what I'm saying is that ONE day of carbs can take 3 days until you get back to your normal. x
 
Hello and Welcome

I attended the Desmond course and was given the same advice as you - waste of time - in fact when I was on the course some of the people had carrot cake with tea and sugar when we had a break - for lunch they had pasta etc ... I think I was the only one with a packed lunch full of stuff I could safely eat - I felt such a swot haha! but I was probably the only one who had at that point my diabetes under control. The less sugar you put in to your body the less it will crave it ... honestly. I have 85% or 90% Lindtt dark chocolate which I now enjoy (I didn't at first) with a little peanut butter on top sometimes - it hits the spot for me, You know what you have to do and if you do fall of the wagon diabetes is excellent at reminding you as if/when I do, my numbers creep up again ...
 
I attended DICE (the local DESMOND equivalent) and had a diabetic nurse telling us to base meals around starchy carbs, and a dietitian telling us carbs were unnecessary and cutting them out was the key to managing blood glucose. In the same room, at the same time. The low-carb advice is not the newcomer, the "Eatwell Plate" is - if you look at ration books from WW2, T2 diabetics had extra proteins and fats to make up for the inability to handle carbohydrate. Most medical or nursing professionals will have trained maybe 15-20 years ago and their knowledge and experience is sometimes well out of date. Good luck.
 
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