Conflicting viewpoints

Ricmel

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I am 59 and recently diagnosed (5 months) and my HbAc1 was 97. Since then I have lost 23kgs, gone low carb and exercise about an hour each day. The last 3 months my BG readings average 6.3 taking reading first thing in morning and the 2 hours after lunch and dinner. Never spike above 8 (well maybe 3 or 4 times in 3 months). I’m not on any meds at this time.

My diabetes councillor told me day 1 that if I need meds to get into normal range, just take them. Benefit outweighs all else. Lots of others (including some in here) advocate just diet and exercise.

I’m due my next Ac1 this week. Given the path I am on, am I likely to be able to continue to push BG numbers down or should I ask to go on meds? How long should I tolerate BG numbers above normal range?
 

bulkbiker

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I guess the best thing would be to wait until you get the HbA1c results.
If it's a lot lower than the first one, as it should be, then I'd recommend carry on what you are doing (obviously with great success).
I've managed ok in the past 5 years and am keeping the meds "in reserve" if ever I should need them although at the moment I can't see that happening in the near future.
My view is that medication should never be taken if improvements such as yours are being seen.
 
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EllieM

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Never spike above 8 (well maybe 3 or 4 times in 3 months). I’m not on any meds at this time.

Well, that sounds like normal range to me, (but as a T1 I may have lower expectations than some T2s?) Also, if you need to go lower (I agree with @bulkbiker that you should wait for your hba1c) have you got any more wiggle room to drop some more carbs?

But honestly, congrats on an awesome result. I personally don't have a problem with meds if you need them, but if you can avoid them then you've got something to fall back on if your levels go up unexpectedly...
 

Ricmel

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I could drop more carbs I guess but not sure how sustainable it would be. I am finding what I am doing food wise and exercise OK now and I think sustainable. I guess what I don’t know is if I just keep doing the same will my readings continue to improve?

I also don’t know how low I should be aiming. Although I am very rarely over 8 mmol (by my tester), I am also rarely below 5.8 which I think is still high? Or is that about OK?

I do like the idea of meds in reserve because I am guessing at some stage the numbers will turn on me.
 

Geordie_P

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Well, that sounds like normal range to me, (but as a T1 I may have lower expectations than some T2s?) Also, if you need to go lower (I agree with @bulkbiker that you should wait for your hba1c) have you got any more wiggle room to drop some more carbs?

But honestly, congrats on an awesome result. I personally don't have a problem with meds if you need them, but if you can avoid them then you've got something to fall back on if your levels go up unexpectedly...
I like this point about keeping the meds in reserve. My T2 father went on meds straight away when he was diagnosed, and to be fair, he's done quite well on it, but the dosage raised and raised over the years to the point that he *must* eat starchy food (apples, buns etc) at intervals, or he has dizzying hypos and faints. My concern is that he was diagnosed in his fifties, and I was diagnosed in my thirties, so with a twenty year head start, I could end up really needing a lot of meds. I'd rather stay off insulin if possible, and worry that I could also become resistant to injected insulin later. I'm not sure these concerns would come to pass, but I feel like reducing the actual need for medication, if possible, is generally a better course.
 

ianf0ster

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..................The last 3 months my BG readings average 6.3 taking reading first thing in morning and the 2 hours after lunch and dinner. Never spike above 8 (well maybe 3 or 4 times in 3 months). I’m not on any meds at this time.

My diabetes councillor told me day 1 that if I need meds to get into normal range, just take them. Benefit outweighs all else. Lots of others (including some in here) advocate just diet and exercise.

I’m due my next Ac1 this week. Given the path I am on, am I likely to be able to continue to push BG numbers down or should I ask to go on meds? How long should I tolerate BG numbers above normal range?
Don't worry , unless there is something you haven't mentioned then it's most unlikely that you will need medication in order to get your HbA1C down at least into the mid pre-diabetic range. But since you say you think this is sustainable, I confidently expect you to be into the 'normal' non-diabetic range within a year. This takes some time because your body needs to keep adjusting to 'new normal' BG's for itself, having got used to much higher ones. So for example my HbA1C got down to 45 quite quickly, but then the sticking factor was my Dawn Phenomenon which remained stubbornly high for about another 6 to 8 months and if you start the day at around 7.5 to 7.8 as I did, then it's very difficult to get down below 6.0 at all.

It takes time, but you have already done all the initial hard work just keep it sustainable and you will meet and maintain your goal.
 

Resurgam

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I like this point about keeping the meds in reserve. My T2 father went on meds straight away when he was diagnosed, and to be fair, he's done quite well on it, but the dosage raised and raised over the years to the point that he *must* eat starchy food (apples, buns etc) at intervals, or he has dizzying hypos and faints. My concern is that he was diagnosed in his fifties, and I was diagnosed in my thirties, so with a twenty year head start, I could end up really needing a lot of meds. I'd rather stay off insulin if possible, and worry that I could also become resistant to injected insulin later. I'm not sure these concerns would come to pass, but I feel like reducing the actual need for medication, if possible, is generally a better course.
Your father should get his medication reduced before he is seriously hurt - no one should be put in danger of sudden collapses, and I hope he doesn't drive or operate machinery.
On a low carb forum I am on several people have reported being kept on blood pressure tablets and having falls, one was on stairs and was rather serious.
 

NicoleC1971

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I like this point about keeping the meds in reserve. My T2 father went on meds straight away when he was diagnosed, and to be fair, he's done quite well on it, but the dosage raised and raised over the years to the point that he *must* eat starchy food (apples, buns etc) at intervals, or he has dizzying hypos and faints. My concern is that he was diagnosed in his fifties, and I was diagnosed in my thirties, so with a twenty year head start, I could end up really needing a lot of meds. I'd rather stay off insulin if possible, and worry that I could also become resistant to injected insulin later. I'm not sure these concerns would come to pass, but I feel like reducing the actual need for medication, if possible, is generally a better course.
So far you've made the hardest changes and it should show up in the hba1c result.
Don't forget that although your consultant is judging the hba1c he really should be congratulating you on dropping your insulin needs and resistance too.

Edited by mod to comply with forum rule B13
 
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coby

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I guess the best thing would be to wait until you get the HbA1c results.
If it's a lot lower than the first one, as it should be, then I'd recommend carry on what you are doing (obviously with great success).
I've managed ok in the past 5 years and am keeping the meds "in reserve" if ever I should need them although at the moment I can't see that happening in the near future.
My view is that medication should never be taken if improvements such as yours are being seen.
Bulkbiker is right. Why go on meds when you are doing okay? It would be different if you were struggling. You seem very good at staying in control :)
 

Mbaker

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Well done,very well done. Type 2 Diabetes can take years to be up, some say between 10 and 20. It has only been 5 months. Your body has to reverse damage and get used to a new normal.

I would focus on optimising to the max what is working. Hopefully you are mentally changing as well, in so far as knowing the standard foods are not worth a second a look, they have only been in existence for a second in human history.

As you exercise, a suggestion I would make is to perform a 10 minute walk after each meal - this is proven to reduce post prandial glucose rises and the amount of insulin under the curve. From my tests it pays dividends to prioritise resistance training over cardio, as muscle will suck up glucose, and the better you get at resistance, the quicker the an effective dose can be completes e.g 2 x 10 minutes could easily incorporate every muscle group multiple times.
 
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EllieM

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My diabetes councillor told me day 1 that if I need meds to get into normal range, just take them. Benefit outweighs all else. Lots of others (including some in here) advocate just diet and exercise.

No reason why both can't be right. Diet and exercise can put some people into remission (or at least lower the medication needed), so it's worth pursuing. Other people need medication in addition, there's no one size fits all solution to diabetes. Some people find the diet and exercise option unsustainable or too difficult or completely impossible (and there can be a multitude of reasons for this, so no need to criticise them) and medication is a good route for them.

And remember that medication can be reduced or eliminated if circumstances change. My 91 year old dad has been T2 since 2010, and moved from metformin to gliclazide over this time. 3 or 4 years ago I encouraged him to go low carb when he stayed with us for his winter (our summer) and as a result his clinic took him off medication when he returned home. Though he has a multitude of geriatric health conditions diabetic complications don't seem to be a factor for him.
 

Ricmel

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Thanks everyone for the replies. All very interesting stuff…there is much to learn. I think I have put lots of focus on lowering BG and not really thought about insulin resistance. I need to learn more about that.

I should get my Ac1 results early next week so I will report back and likely seek more input. I have to say this place is a fantastic resource.
 
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Jaylee

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I like this point about keeping the meds in reserve. My T2 father went on meds straight away when he was diagnosed, and to be fair, he's done quite well on it, but the dosage raised and raised over the years to the point that he *must* eat starchy food (apples, buns etc) at intervals, or he has dizzying hypos and faints. My concern is that he was diagnosed in his fifties, and I was diagnosed in my thirties, so with a twenty year head start, I could end up really needing a lot of meds. I'd rather stay off insulin if possible, and worry that I could also become resistant to injected insulin later. I'm not sure these concerns would come to pass, but I feel like reducing the actual need for medication, if possible, is generally a better course.

Hi Geordie,

It's unclear what insulin regime your father is on. But from what you say, this is a very "oldschool" approach for anyone prescribed insulin? Eat more carbs to stay on top of the dose.. As a T1 myself, growing up as a kid, this was what I was directed.
No-one ever thought to tweak the dose. & MDI was not an option back then.
Fast forward a few decades. This needn't be the case, or at least limit the lows or the severity of that can come with the territory of exogenous insulin use..
A basal bolus regime is more flexible at achieving this. Successfully tailored, it can reduce the need to snack because of the risk of lows..