C-peptide test result and a chat with my GP

[Swiggy]

I have just had a chat with my GP about my latest results.
Hba1c 61, unchanged for last 12 months. It was 143 at diagnosis so I have done well on low carb, just not well enough.
C-peptide high at 1791. I don't know how I feel about this. Doc didn't know why that test was done as they know I'm insulin resistant as I'm type 2. I explained that I had a cyst on my pancreas as a child and, given that I have eaten fewer than 50g of carbs a day for the last two years and still have high blood sugar, her colleague wanted to check that I was correctly diagnosed as type 2.

Good news - GP is on board with low carb, recommended Michael Moseley's Blood Sugar diet (I have that).
My hba1c has come down a lot since diagnosis without medication.

Bad news - my weight has not shifted even after two years on low carb.
Suggested I try Orlistat. I said that I didn't think it was a good idea given the cream, cheese and fatty meat that I can eat. She said to try low carb, low fat diet. I'm not keen.
Even worse news - with a BMI of 39 I am eligible for weight loss surgery. I feel like such a failure. There's absolutely no way I'm going down that route.

She asked if I will consider Metformin and I just don't know what to do. I really wanted to beat this without medication but the doctor thinks I have gone as far as I can. Is there anything else I can try?

Oh and I know exercise has gone out of the window with lockdown so I should dig out my trainers.

 

[searley]

Cpep would normally only be done to see if you’ve stopped/stopping producing insulin

It can happen even though you are t2

 

[oldgreymare]

Hi @Swiggy, Firstly a big hug for trying to get a handle on your diabetes control. Your c-peptide does suggest a high degree of insulin resistance, so your pancreas may be pouring out very high levels of insulin even to address a small carb load - this will encourage your body to store fat, so fat loss will still be a challenge. But good news you are still able to produce high levels of your own insulin. You are NOT a failure. This is a metabolic disease that can be incredibly difficult to manage, but almost every diabetic can improve their control through active management.
Great that your GP supports low carb. Have you checked out dietdoctor.com for really yummy recipes? If your gut tolerates it, metformin is a really helpful drug that may have additional helpful effects re inflammation and cancer suppression. Plus any additional exercise you that can tolerate, even small increments in walking, can really help stabilise BG levels and importantly boost mental mood.

 

[Swiggy]

Hi @Swiggy, Firstly a big hug for trying to get a handle on your diabetes control. Your c-peptide does suggest a high degree of insulin resistance, so your pancreas may be pouring out very high levels of insulin even to address a small carb load - this will encourage your body to store fat, so fat loss will still be a challenge. But good news you are still able to produce high levels of your own insulin. You are NOT a failure. This is a metabolic disease that can be incredibly difficult to manage, but almost every diabetic can improve their control through active management.
Great that your GP supports low carb. Have you checked out dietdoctor.com for really yummy recipes? If your gut tolerates it, metformin is a really helpful drug that may have additional helpful effects re inflammation and cancer suppression. Plus any additional exercise you that can tolerate, even small increments in walking, can really help stabilise BG levels and importantly boost mental mood.

 

[Swiggy]

Thanks @oldgreymare I will keep on with the low carb and try a few walks around the block. I may try the Metformin, a helping hand might do me good. There's no way I will go down the surgery route and the Orlistat side effects sound worse than the Metformin ones.

 

[Swiggy]

Cpep would normally only be done to see if you’ve stopped/stopping producing insulin

It can happen even though you are t2

Thanks@searley, when I mentioned that I had a cyst on my pancreas as a child the GP suggested the c-peptide test just in case.

 

[Brunneria]

Swiggy,
That long on LC? That good a reduction? DEFINITELY not a failure!
Well done!
High levels of circulating insulin and the consequent insulin resistance makes it v hard to lose weight. I have seen v experienced long term low carbers say that you will only lose weight down to your level of insulin resistance.

The routes to reducing IR are usually cutting carbs further (since I don’t know what level of lc your lchf is, I have no idea if that would be workable for you). Then there is exercise. Again, the possibilities of that vary a great deal between people. And Metformin. Which may or may not suit you.

Some of us need all the tools that we can fit in our toolbox, so there is no shame whatsoever in trying another tool to see if it works for you.