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Clarity on my readings help..

EFMax

Member
Messages
20
Location
UK
Type of diabetes
Type 2
Treatment type
Non-insulin injectable medication (incretin mimetics)
Dislikes
All forms od "ism"
Type 2 crept up on me but already I am taking 3x medication. I started off with an HBA1C of 114.

I found Metformin too much (was on 4x 500mg of slow-release). I reduced it then stopped it.

My recent HBA1C was 66.. My GP wants me to go back on Metformin at 2x 500mg per day.

Is my GP just being cautious with my HBA1C at 66 or is it worth trying to get it down below 50.

Curent meds = Metformin, Dapagliflozin, Dulaglutide.

My diet is good and I exercise at least 3-4hrs per week often more.

Any feedback is welcome as I am still new to all of this.
 
Is it worth it getting under 50? Personally, I'd say, yeah... Being in the diabetic range usually means complications down the road, and those you might want to avoid.

The question then is, what do you consider to be a "good" diet? My guess is our ideas may differ a little, considering the amount of medication you're on. (Granted, you could be doing everything right for a T2, and still have high numbers if your pancreas is worn out for instance, or there's other meds in the mix. But just playing the odds here.) https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html <-- have a read, maybe you can tackle your T2 this way and maybe ditch some of the meds you're currently on -with your doc's blessing of course-, and still get better numbers without them. I think your current regime might give you hypo's on low carb though, so do test your heart out to be safe eh.
 
Thanks for the quick feedback.

Diet-wise, I have a good nutritional education and use to work in health and fitness (rowing instructor and personal training) so I try my best on that score. We have T2 and high blood pressure in the family (many from the Caribbean community have). I have, with the aid of meds, got my blood pressure down to around 125/80... before meds it was a mad 170/140.. From a sports point of view, my max HR was 205bpm at my fitess (age 42) but is closer to 170bpm now, with a resting HR of around 50bpm which seems good for my age now.

I will have a read of your suggestion and appreciate the heads up and reply.
 
@EFMax

hi and welcome,

If you have a background in nutritional education and health and fitness, then you should have no problem getting the damaging connection between high carb eating and high blood glucose.
With your background, have you been embracing low carb? Or is reducing carbs a new thing for you?
 
Hi EFMax. I too have a background in nutritional science but I have had to do a lot of rethinking after being diagnosed with Type 2. What is considered a balanced diet for someone with normal blood glucose control is not appropriate for someone with impaired glucose control. Would you like to tell us what you eat in an average day?
 

If you read the NICE treatment pathways, the T2 pathway always starts with Metformin because it is almost all upside and very little downside.
Metformin helps to lower insulin resistance, to reduce glucose production by the liver and suppress appetite.

If Metformin is not enough to control your BG then other medications are added but Metformin is usually retained as part of the treatment.

So, please consult your health care team, but I would suggest that persevering with the Metformin is a sensible option.

As others have said, you seem to be on a lot of medication.
It would help us to help you if you explained your regular diet.
A diet for fitness and performance in a non-diabetic might be radically different from a diet suitable for a T2 diabetic.
 

Hi.. I used to be a high carb sporty person but my carb intake now is pretty low, if I use any flour it is gluten free, no rice, no pasta, minimum potatoes, some noodles and veg but I have gone more high protein, some fat and as little carbs as possible - I cook 95% of my own food from scratch, don't use refined sugar but I have to accept that type 2 runs in my family although I can look at the rest of my family and see how their lifestyle has impacted on them so I do not copy them. I am starting to be more careful about my fruit intake as that was a bit on the high side.
 

Hi. I cook everything these days so no ready meals or anything like that. I am also awake about 21 hours per day and have been like that since the age of about 3 or 4 and with zero side effects that I am aware of.

My day usually starts with exercise first (5-10km bike ride around 8am) - breakfast is often eggs and baked beans or similar (no toast). Lunch is often fish-based (salmon or mackerel) with veg, noodles and salad. Dinner is often meat-based, last night was a simple wholemeal wrap with onions, peppers, mushrooms and a piece of diced up steak. If I have to snack then I will do so on something like cashew nuts. It is not unusual for me to go for another bike ride in the evening if I am in the mood or to do some weight-based workout in my flat.

I do not drink any tea or coffee nor fizzy drinks and I don't drink alcohol - all because I just do not like the taste so I drink between 2-3L of water per day.

Recent blood tests have shown that kidney function etc are all very good and my cholesterol is very low on all counts.

My BMI is high at 31.5 but this does not take into account the fact that I am a very muscular person much of which is to do with being a previous competitive indoor rower.

The above is typical but it does change from day to day.
 
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Hi EFMax. Thanks for posting a typical daily diet. If it were me I would not be having the baked beans, the noodles or the wholemeal wrap, all of which are contributing to carbohydrate intake. I would also avoid flour as it is also a carbohydrate source whether gluten free or not. To make your meals more satisfying without the carbohydrate try adding in more healthy fat sources e.g. avocado, dressings made with cold-pressed olive oil or rapeseed oil, oily fish (which you already do), some cheese, full fat plain yoghurt. I know that suggesting more fat really goes against decades of dietary advice!
Unfortunately your daily eating pattern sounds very much like the one described by the Desmond course that I went on. The NHS still seems to regard T2 diabetes as a progressive disease. It prescribes a low-fat, 'healthy' carbohydrate diet and assumes a steady increase in the type and number of medications given as a result. Many of us in this forum have thankfully discovered a better route: little carbohydrate, little or no medication and controlled blood glucose levels. I started with an HbA1c of 104 and, with the help of Metformin and a very low carbohydrate diet, got to normal blood glucose levels within 6 months. I have maintained this for 6 years and have given up the Metformin completely.
So, suggestions! Replace baked beans with grilled halloumi, mushrooms, tomatoes.
Replace ordinary noodles with black bean or soya bean noodles - very little carbohydrate, very high protein.
Replace the wrap with a very large lettuce leaf or just leave it out altogether.
Little or no fruit - berries or olives only.
Congratulations on your successes so far! You are on the right track.
Tweaking your diet in this way should make a big difference.
@Mbaker has helpful suggestions and insights as to fitness and diet
 
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Hello @EFMax,

Welcome to the forum and well done on reducing your HbA1c by almost half. We have members with initial HbA1c levels very close to yours, who have been able to reduce their blood sugars to normal levels (regardless of any genetic predisposition) and are now no longer on medication by just by changing the way they eat. So, it is definitely doable and definitely worth a try to see if it can work for you.

As to your diet, water is of course an excellent choice (as you will know yourself). However, if you were inclined to do so, most of us also have tea, coffee and low-carb alcohol (such as dry wine) without any raise in blood sugars.

As to your meals, you might want to consider dropping the baked beans, the noodles and the wholemeal wrap, all of which are quite carby.

As @Dr Snoddy has suggested, there are plenty of substitutes for these foods. You might also want to have a look at dietdoctor.com (no need to sign up, the vast of majority of recipes are free.)

Btw, do you have a meter? If not, would you willing to get one? As you will have often heard said --- if you don't measure it, it won't get fixed. Most of us test our blood sugar levels right before starting to eat and two hours after our first bite to see how our body copes with the carbs in the meal.

Testing blood sugar levels will be especially important if you decide to drop your carbs to an even lower levels as you are on blood sugar lowering medication. Combined with low carb, this might drop you in hypo (too low blood sugar) territory. So in your case, please work with you health care professionals on this.

Good luck on your journey. Keeping my fingers crossed.
 

Hi and welcome.
Looking at what you are eating it still looks fairly carby.. baked beans (especially first thing in the morning) , noodles and a wrap.
Personally I'd ditch all the carbs if possible and see over time if you can get off the meds completely.

I'd also suggest (if you aren't already) getting a blood glucose monitor and measuring just before and then 1 and 2 hours after your meals to monitor your blood sugar levels.. you might be surprised by what you see and amend your diet a bit more.
 

Totally appreciate your input and advice.. and yes my diet was centred around a "Desmond type course" that I was sent on... Changes are always hard but I will make the effort. I am not much of a dairy person, I don't like milk or milk-based stuff but will look at all of your suggestions. THANK YOU.

I spoke to my GP on Monday about me not getting on with 4x 500mg of Metfomin as it had not been revised since the start of the CV-19 situation - he said cut it down to 1 or 2x 500mg but I have booked an appointment with our diabetic nurse for further advice and suggestions..
 

Thanks. I will look to getting a monitor, I assuming that the "prick test" of the blood is the choice over the strips you pee on?

Ditching carbs completely leaves me feeling way too weak.. tried it a while back where under supervision from a specialist GP, my calorie intake was reduced to just below 800 per day... as I was working in a gym at the time and exercising every day I found that I could not cope with such a restrictive number of cals.. but I will try again as I am not exercising as hard as before.
 

Appreciate your feedback and will be looking into getting a meter.. thank you.
 
EFMax said:
Thanks. I will look to getting a monitor, I assuming that the "prick test" of the blood is the choice over the strips you pee on?
Click to expand...
Yes, the pee sticks I think only show levels when you are above a highish level anyways, blood tests are a lot better and a much better way of testing with better accuracy.

I suspect you were feeling weak because of the restricted cals, reduced carbs does not means reduced cals, you just replace the carbs with protein and fat to make up the calories.
 

Thank you... I note you live in Reading as well as myself.. appreciate your input.
 
Hi @EFMax you have made alot of progress from a very high HbA1c. My wife was trained 3 times in diet and nutrition, as a PT, Sports Science and Physio graduate - she ditched that mantra around 4.5 years ago after helping me get to remission of Type 2; her brother also a previous PT, also ditched what he learnt after trying LCHF. Clearly there are some nutrition facts that are accurate chemically, such as the macro and micro nutrients - but "we" are concerned with application and quality for metabolic health. So in short you may need to adjust what has been previously learned to make further progress.

My thoughts are that you should work with your health care professional to further de-prescribe, as you already have over a 40% improvement in your HbA1c. Straight up, it is likely the "healthy food" that could be holding you back.

I come from a traditional Caribbean background myself, so guessing our food paths may be similar. With such a high starting HbA1c (mine was 134), the course you might want to adopt could / should(?) be quite strident. The below foods are taken from the website of Dr Ted Naimen, he is a Dr who actively reverses Type 2 in his patients and also walks the walk with his physical regime. These foods are what he recommends https://burnfatnotsugar.com/index.html:



The highlighted foods in yellow should be avoided in the bottom right and perhaps coconut (flakes I use) raspberries, strawberries, blackberries and blueberries can be added in small amounts, but on the whole this will put you on the right path. Butter, ghee, coconut oil, lard should replace any oil / fat being used to cook and olive oil is good for drizzling. I would replace cashews with almonds, swap wholemeal wrap with keto homemade wrap, loads on YouTube, no beans (too starchy). In general your foods look great apart from usual starchy suspects - they just don't * work for persons with blood sugar dis-regulation.

Here's an example day of eating for me yesterday on a 16 / 6 eating window with 2 meals:

11.00 am (alternative kippers, punnet of garlic and buttered mushrooms, yes I do the whole lot)

Unsweetened coconut flakes, berries, 95% dark chocolate (lidl), 3 generous tablespoons of local farm yogurt, a little local farm milk, nutmeg, pecans, almonds, brazils and hazelnuts)

Sometimes I would add a further protein such as fish, last nights meat or scrambled eggs

16:00 Super seasoned leg of lamb, broccoli, greens and carrots (I can tolerate these, others should test)

Went back for additional meat. The picture does not convey the taste

Coconut, cream cheese and egg pancake with berries (had a couple more squares of dark chocolate)


So lots of healthy fat, ton of protein and low sugar carbs.

I was able to reduce my blood pressure by 15 - 20 points so close to 120 - 127 / 78 by eating fresh cooked garlic with meals (2 cloves), a couple of celery sticks and beetroot (again not strictly Keto, but results first).

You have got a workout ethic which alone should bring you close to remission in my view, but it appears you have alot of insulin resistance to get rid of. I would recommend a walk after every meal or cycle - this is proven to reduce glucose responses on any eating protocol. With the resistance training go to failure twice a week on the legs / glutes (e.g. pulse squats). My regime involves training everyday, Walking on average 7 miles a day in total, at a heart rate just below cardio zone, whilst on my walk I either do Karate blocks and punches, squats and push-ups or carry my X3 Bar (this is the best single exercise equipment I have ever used) and do maybe 100 dead lifts or bicep curls. I will then later do conventional dead lifts, bench press, squat, battle ropes and or static cycling. I focus on muscle building.

The elephant in the room may be your sleep. 3 hours is not enough to propagate natural killer cells for example. A lack of sleep also leads to insulin resistance, harder ability to burn body fat and poorer glucose metabolism. It may be worth you putting every other bit of advice as secondary and getting professional non-drug based help in this area.

If you do follow any of this advice, make sure you are monitoring you blood glucose and blood pressure, as medications will need adjusting - keep you Dr in the loop and warn her / him that you may be calling to reduce medication.

* It might be that after some years you can occasionally (really occasionally) bring in some other foods. I sometimes have clementines with my berries and today for the first time in 5 years I had a cut up plum with my berries - but the plum was one of a set for home ripening for the rest of the family, and mine was still hard so not sweet.
 
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All I can say is WOW.
Fantastic reply and loads and loads of info. Thank you.

Your points about previous education is a good one. I studied in 2002 & 2012 & 2015 and things have changed and the old school way of learning, to be fair, has not kept pace with what people like yourself know today.

I will look at all that you have shared. Food wise, I have clearly, a lot to learn. Milk and milk-based stuff is out cos I hate milk with a passion, it just makes me heave, so to garlic but there are always workarounds.

At 62, I can still do hard cardio and weights and shall look to additional stuff. With gyms re-open now, I just have to think of which to rejoin.

Sleep wise, that is never going to change.. I can easily get by on 90mins rest a day and as a child this was seriously looked into and after so many tests, it was said, there is nothing wrong with me. Laying in bed for what to me is extended periods of time is frustrating and boring - I totally understand the need to rest and get good sleep but it is a struggle for me to be in bed even for four hours, so I tend to go to bed around 2am but I am back up by 5am getting on with my day. Over the years there seems to be no obvious or noticeable side effects that I am medically aware of. All of this info that is coming in is great and I will take on board everything that is coming my way as this is how I learn so thank you.
 
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Maggie Thatcher reputably only slept 4 hours a night. Does a,second career in politics appeal?
 
Dr Snoddy said:
Maggie Thatcher reputably only slept 4 hours a night. Does a,second career in politics appeal?
Click to expand...

With my mouth and my views, I would have been put to sleep ages ago..
 
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