Confused Newbie

[ScottishLass21]

Hi, this is my first post on this forum.

I had gestational diabetes when pregnant with my daughter who is now four. It was diet controlled throughout.

My annual tests were all fine until this year when my fasting BG came back at 8.9 a couple of weeks ago. I only got bloods taken for a HbA1c today so I won't have the results for around a week.

In the meantime I've taken up the Libre trial and have been wearing it for a few days now. My intention is to use this 2 week period to play around with different foods.

I've drastically changed my diet and switched to lower carb. I find this difficult as a vegetarian who can't stomach many substitutes (e.g. Quorn) I've managed to get my readings all between 4 and 9 with a few exceptions so was pretty happy until I read that a spike of more than 2 was an issue. I frequently jump from, for example, 5.5 pre food to 8.5 after. Do I need to cut back further? I'm honestly not sure how I can but if I need to I'll work it out.

My diet is now super high in fat which I'm reading here is fine but I'm worried about saturated fat levels specifically.

I'm also due to go on holiday to NYC in a couple of months and I'm so worried about managing my levels when there.

I just feel very confused and worried.

 

[Pipp]

Hello, and welcome @ScottishLass21

Great that you are monitoring blood glucose levels.
How long after eating was your level of 8.5? Are you recording what you have eaten so that you can check how various food and drink affects the BG readings? That would give you data to be able to work out a plan to manage.

How about waiting until you have your HbA1c before deciding on that plan.
Many members here with T2 manage their levels by adopting a low carb way of eating. Some ideas can be found on this site

Vegetarian Keto Recipes - Simple & Delicious - Diet Doctor

Whether you're a full-time vegetarian, not in the mood for meat or getting ready for Meatless Monday, we've got some excellent options for you and your family. What's your favorite vegetarian recipe?

www.dietdoctor.com

There is also some 8nfo for new members in my signature beneath this post. Have a read, then ask questions. Our members are willing to offer advice based on their own experiences.

 

[AloeSvea]

Hi @ScottishLass21. I will say the same thing I say to everyone embarking on a low carb (or lower carb) way of eating, and are afraid of saturated fat, or higher fat. One, I hear you as I have been there too. It's hard to fly in the face of all that conditioning on high healthy wholegrains and unhealthy animal products, and fat, at least without a self conscious giggle or two! And two, this means you perhaps should start recording your biomarkers to reassure yourself of the healthiness of this new (and probably lifelong) way of eating for you. and three, start looking into the history and current thought on saturated fat in particular in a healthy diet, yourself, for reassurance.

But yeah - absolutely possible to haver a lower carb vegetarian diet and you will be spoilt for choice on dieatary plans to do it to your liking, and health goals.

And, lastly but not least - in any (western?) highly populated place you will be spoilt for choice for LCHF/keto vegetarian/vegan food outlets, and NYC is sure one of those! Is my understanding at least. (And - have a great time when you are there! I'm envious as all heck .)

 

[ScottishLass21]

Hi @ScottishLass21. I will say the same thing I say to everyone embarking on a low carb (or lower carb) way of eating, and are afraid of saturated fat, or higher fat. One, I hear you as I have been there too. It's hard to fly in the face of all that conditioning on high healthy wholegrains and unhealthy animal products, and fat, at least without a self conscious giggle or two! And two, this means you perhaps should start recording your biomarkers to reassure yourself of the healthiness of this new (and probably lifelong) way of eating for you. and three, start looking into the history and current thought on saturated fat in particular in a healthy diet, yourself, for reassurance.

But yeah - absolutely possible to haver a lower carb vegetarian diet and you will be spoilt for choice on dieatary plans to do it to your liking, and health goals.

And, lastly but not least - in any (western?) highly populated place you will be spoilt for choice for LCHF/keto vegetarian/vegan food outlets, and NYC is sure one of those! Is my understanding at least. (And - have a great time when you are there! I'm envious as all heck .)

Thank you for the reassurance on the high fat diet @AloeSvea

In terms of biomarkers, are you referring to BP, cholesterol etc? Ill have a look into where i can get these checked. Thank you.

I know there are options out there for me in NYC, the difficulty is balancing my needs with that of my family/wider group. Food at the airport and on the plane etc is where I'm most concerned. I'd arranged a veg meal but that will most likely be pasta so I'll need to take food with me.

 

[ScottishLass21]

Thanks for replying @Pipp

I'm keeping a food diary and recording levels at 60, 90 and 120 mins after as I wasn't sure if there was a best time. So far I have established no bread products, wholemeal or otherwise (which I knew was likely from reading here anyway), beans aren't bad but aren't great either. Pretty much the only things that don't raise my level much are omelettes, nutty snacks and my one meal out where I had a huge portion of edamame and a little tofu dish (which I dont usually like but I'm learning to embrace!)

I don't want to delay any planning. It is clear from what I am seeing in my levels so I couldn't, with clear conscience, continue any other way, knowing what I know now.

 

[KennyA]

Hi, this is my first post on this forum.

I had gestational diabetes when pregnant with my daughter who is now four. It was diet controlled throughout.

My annual tests were all fine until this year when my fasting BG came back at 8.9 a couple of weeks ago. I only got bloods taken for a HbA1c today so I won't have the results for around a week.

In the meantime I've taken up the Libre trial and have been wearing it for a few days now. My intention is to use this 2 week period to play around with different foods.

I've drastically changed my diet and switched to lower carb. I find this difficult as a vegetarian who can't stomach many substitutes (e.g. Quorn) I've managed to get my readings all between 4 and 9 with a few exceptions so was pretty happy until I read that a spike of more than 2 was an issue. I frequently jump from, for example, 5.5 pre food to 8.5 after. Do I need to cut back further? I'm honestly not sure how I can but if I need to I'll work it out.

My diet is now super high in fat which I'm reading here is fine but I'm worried about saturated fat levels specifically.

I'm also due to go on holiday to NYC in a couple of months and I'm so worried about managing my levels when there.

I just feel very confused and worried.

Hi and welcome

It's perfectly normal for levels to rise in the first hour after eating. A single small latte will take me from around 5 to 9.6 in about 30 minutes. That's the point of testing at +2 hours - you're testing to see how well you system copes with the carb/glucose load, not to see how high you go. My latte rise is totally gone at around 1 hr, so that's fine.

There's a lot of stuff still floating around about the dangers of fat. Like you, when I started out I had to change my mind about a lot of things that I had been assured for years were true.

I'm going to post a few recent (I think all within the last 10-12 years) research papers which clearly show that saturated fat is not the problem that it's been claimed to be. In particular the Journal of the American College of Cardiology posted a paper in 2020 (first one below) that admits the recent guidance on dietary saturated fat is simply wrong.

https://www.sciencedirect.com/science/article/pii/S0735109720356874?via%3Dihub=&utm_source=arrow.proteinpower.com&utm_medium=referral&utm_campaign=the-arrow-188

• Several foods relatively rich in SFAs, such as whole-fat dairy, dark chocolate, and unprocessed meat, are not associated with increased CVD or diabetes risk.
• There is no robust evidence that current population-wide arbitrary upper limits on saturated fat consumption in the United States will prevent CVD or reduce mortality.

These papers are more about cholesterol levels (and why there is an issue with current guidance) than saturated fat per se, but as the "no sat fat" advice is aimed at reducing cholesterol etc they might be helpful.

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and...

www.bmj.com

Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study - PMC

Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total ...

www.ncbi.nlm.nih.gov

Best of luck.

 

[Chris24Main]

I don't want to delay any planning. It is clear from what I am seeing in my levels so I couldn't, with clear conscience, continue any other way, knowing what I know now.

That's all you need, right there...
All the advice above is great, noting more to add, you will find that you really are a unique snowflake, at least as far as nutrition is concerned, what you've become accustomed to will have a big impact on your gut biome, for example... so what your own personal response and tolerances are will be unique to you, but with that attitude, you'll be fine.

Just don't expect to solve it all overnight - whatever you settle on needs to work for you for the long term; expect some bumps in the road and they won't surprise you...

 

[Lupf]

Hi @ScottishLass21 welcome to the forum.
Important is not to panic. But I can see that you are doing well already.

Regarding your HbA1c test: this is the test your GP will use to tell you if you are diabetic or not.
If your HbA1c is 48 mmol or higher you are diabetic, if over 42 you are prediabetic.
Typically tests will be done much quicker than what you were quoted, so give it two or three days and call them up to ask for your result.
If you are diagnosed diabetic and assuming you live in Scotland
you can sign up to https://patient.mydiabetesmyway.scot.nhs.uk/. This will give you instant access to your lab results.
You GP might have to tick a box for this, simply ask at your next visit.

I echo all the comments above, in particular.
- Fat is not bad, in fact saturated fatty acids are probably good for you, and certainly help maintaining weight as fatty food is more satiating.
I hope you like cheese, full fat yoghurt, whole milk, eggs, hummus, nuts. ....
Personally I banned all low fat food from my fridge.
- In all humans, also in healthy people our sugar level will rise when we eat carbs. if after two hours these are back to before then this is normal and there is nothing to worry. So don't fret about these normal rises.
- We are all indivuals and you have to find out what works for yourself and what doesn't.

A couple more comments
- The necessary changes to your diet will depend on your HbA1c. Many of us including myself were diagnosed with an HbA1c over 100, so this needed a lot of changes, even if it took me a while to get there. If yours ends up in the 50s then maybe only minor adjustments are needed.
As the HbA1c measured the fraction of red blood cells which have glucose attached, aka "glycated", it will take 3 months until the effects of a change of diet is fully visible, so you need to be patient.
- Traveling in particular flights seem to be difficult for T2. I've ended up treating travel days as fast days, i.e. I only drink water on short flights and train rides. I know this is not an option for a transatlantic flight, and I treat these as exemptions, leave out the bread and have a 2nd glass of red wine instead.

Best wishes for your journey.

 

[Melgar]

@ScottishLass21 NYC is full of wonderful food outlets and restaurants. You will be spoilt for choice. I have spent quite a bit of time in NYC. I’m off to NYC in December for a festive meet up with friends. The time difference between the UK and the US east coast is only 5 hrs, so your body clock might throw a wobbly, might be a good idea to drink plenty of water on your flight.

 

[ScottishLass21]

Thank you @KennyA, I'll have a look at those links tonight. Thanks for the reassurance about the BG levels. At lunchtime, my level was 4.1 just prior to eating but was 5.9 2 hours later. Not sure if it is concerning that it doesn't come back to pre-food levels in that time? It did go higher within the 2 hours - up to about 7.5.

 

[ScottishLass21]

That's all you need, right there...
All the advice above is great, noting more to add, you will find that you really are a unique snowflake, at least as far as nutrition is concerned, what you've become accustomed to will have a big impact on your gut biome, for example... so what your own personal response and tolerances are will be unique to you, but with that attitude, you'll be fine.

Just don't expect to solve it all overnight - whatever you settle on needs to work for you for the long term; expect some bumps in the road and they won't surprise you...

Thanks @Chris24Main, I know it won't be an overnight thing but it is taking time to get my head around this being a life long change. I'm trying to stop looking too far ahead and focus on the here and now though.

 

[KennyA]

Thank you @KennyA, I'll have a look at those links tonight. Thanks for the reassurance about the BG levels. At lunchtime, my level was 4.1 just prior to eating but was 5.9 2 hours later. Not sure if it is concerning that it doesn't come back to pre-food levels in that time? It did go higher within the 2 hours - up to about 7.5.

Depends on you and what you ate. For me, that would be acceptable, but I'd know I'd eaten something carby and dealt with it, just about. There is error in all systems of blood glucose monitoring so don't get stressed over small differences. I'm going to post a CGM graph of a non-diabetic person's day - you'll see big rises and falls in BG, quite normal.

 

[ScottishLass21]

Hi @ScottishLass21 welcome to the forum.
Important is not to panic. But I can see that you are doing well already.

Regarding your HbA1c test: this is the test your GP will use to tell you if you are diabetic or not.
If your HbA1c is 48 mmol or higher you are diabetic, if over 42 you are prediabetic.
Typically tests will be done much quicker than what you were quoted, so give it two or three days and call them up to ask for your result.
If you are diagnosed diabetic and assuming you live in Scotland
you can sign up to https://patient.mydiabetesmyway.scot.nhs.uk/. This will give you instant access to your lab results.
You GP might have to tick a box for this, simply ask at your next visit.

I echo all the comments above, in particular.
- Fat is not bad, in fact saturated fatty acids are probably good for you, and certainly help maintaining weight as fatty food is more satiating.
I hope you like cheese, full fat yoghurt, whole milk, eggs, hummus, nuts. ....
Personally I banned all low fat food from my fridge.
- In all humans, also in healthy people our sugar level will rise when we eat carbs. if after two hours these are back to before then this is normal and there is nothing to worry. So don't fret about these normal rises.
- We are all indivuals and you have to find out what works for yourself and what doesn't.

A couple more comments
- The necessary changes to your diet will depend on your HbA1c. Many of us including myself were diagnosed with an HbA1c over 100, so this needed a lot of changes, even if it took me a while to get there. If yours ends up in the 50s then maybe only minor adjustments are needed.
As the HbA1c measured the fraction of red blood cells which have glucose attached, aka "glycated", it will take 3 months until the effects of a change of diet is fully visible, so you need to be patient.
- Traveling in particular flights seem to be difficult for T2. I've ended up treating travel days as fast days, i.e. I only drink water on short flights and train rides. I know this is not an option for a transatlantic flight, and I treat these as exemptions, leave out the bread and have a 2nd glass of red wine instead.

Best wishes for your journey.

Hi @Lupf, thanks for the guidance on the HbA1c. I received a call this afternoon to say my results were in and to get booked in with the nurse on Friday. No results were shared which is very frustrating.

Thanks also for the tips on travelling. I'm not sure if I'll manage fasting but if I can find some suitable small snacks to take then I can live without a full meal.

 

[ScottishLass21]

@ScottishLass21 NYC is full of wonderful food outlets and restaurants. You will be spoilt for choice. I have spent quite a bit of time in NYC. I’m off to NYC in December for a festive meet up with friends. The time difference between the UK and the US east coast is only 5 hrs, so your body clock might throw a wobbly, might be a good idea to drink plenty of water on your flight.

Hi @Melgar I'll certainly make sure I up the water intake for the flight, thank you.

 

[ScottishLass21]

Depends on you and what you ate. For me, that would be acceptable, but I'd know I'd eaten something carby and dealt with it, just about. There is error in all systems of blood glucose monitoring so don't get stressed over small differences. I'm going to post a CGM graph of a non-diabetic person's day - you'll see big rises and falls in BG, quite normal.

Thanks @KennyA, this is really helpful. I'm just a little confused about what the main issues to look out for actually are - is it how long it takes for BG to get back to pre food levels, how high the BG levels get after food, the difference between pre food and 2 hours after. I'm so very confused about it all.

 

[KennyA]

Thanks @KennyA, this is really helpful. I'm just a little confused about what the main issues to look out for actually are - is it how long it takes for BG to get back to pre food levels, how high the BG levels get after food, the difference between pre food and 2 hours after. I'm so very confused about it all.

It is confusing but it does become clearer. Many things will raise your BG, or at least cause your liver to raise your BG, in addition to food. But food is probably the biggest impact and also it's one you can completely control.

The thing with having raised blood glucose is that if it persists over time it can do damage to capillaries and nerves, and that can lead to real problems. I'm not talking about an hour or two, I mean weeks, months and years. I started to get damage with an HbA1c around 43/44, other people report no symptoms with much higher BGs. As the graph above demonstrates, non-diabetic people get BG rises after food, and in response to other stimuli.

The key thing (in my opinion) is to deal with it for the long-term. You need to find what works for you, because you'll be eating it for a while. There's little point in me telling you to eat what I eat because I'm not a vegetarian - but there are folks on here who have succesfully done low carb as vegetarians.

I don't eat very much carb at all - around 20g/day, which is the equivalent of one apple. So I don't expect to see much change in BGs after food and I don't test all that often these days. However, I was on holiday recently and had some food that I wasn't all that sure about (and some more that I definitely was, but ate it anyway) and was getting things like starting BG 4.7, at +2 hrs 6.2. That's OK, but I hadn't seen a result over 6 for some time, so I concluded that a) there was a fair amount of carb in the food b) I dealt with it OK on that occasion c) still probably wouldn't want to be seeing this after every meal.

So you're really testing yourself. Does your system cope with the level of carb in the food that you're eating, and how well does it do that? Again, my personal view is that I don't think a short-lived rise in BG, even to comparatively high levels, is that much of a problem, provided your system can clear it within two hours. So I'm OK with an up and down inside an hour or so. What I'm trying to avoid is long-term elevated blood glucose levels.

 

[ScottishLass21]

It is confusing but it does become clearer. Many things will raise your BG, or at least cause your liver to raise your BG, in addition to food. But food is probably the biggest impact and also it's one you can completely control.

The thing with having raised blood glucose is that if it persists over time it can do damage to capillaries and nerves, and that can lead to real problems. I'm not talking about an hour or two, I mean weeks, months and years. I started to get damage with an HbA1c around 43/44, other people report no symptoms with much higher BGs. As the graph above demonstrates, non-diabetic people get BG rises after food, and in response to other stimuli.

The key thing (in my opinion) is to deal with it for the long-term. You need to find what works for you, because you'll be eating it for a while. There's little point in me telling you to eat what I eat because I'm not a vegetarian - but there are folks on here who have succesfully done low carb as vegetarians.

I don't eat very much carb at all - around 20g/day, which is the equivalent of one apple. So I don't expect to see much change in BGs after food and I don't test all that often these days. However, I was on holiday recently and had some food that I wasn't all that sure about (and some more that I definitely was, but ate it anyway) and was getting things like starting BG 4.7, at +2 hrs 6.2. That's OK, but I hadn't seen a result over 6 for some time, so I concluded that a) there was a fair amount of carb in the food b) I dealt with it OK on that occasion c) still probably wouldn't want to be seeing this after every meal.

So you're really testing yourself. Does your system cope with the level of carb in the food that you're eating, and how well does it do that? Again, my personal view is that I don't think a short-lived rise in BG, even to comparatively high levels, is that much of a problem, provided your system can clear it within two hours. So I'm OK with an up and down inside an hour or so. What I'm trying to avoid is long-term elevated blood glucose levels.

Thank you for sharing your thoughts @Kenny I think I'm just so overwhelmed and overthinking things.

 

[Mac Dabrowski]

Depends on you and what you ate. For me, that would be acceptable, but I'd know I'd eaten something carby and dealt with it, just about. There is error in all systems of blood glucose monitoring so don't get stressed over small differences. I'm going to post a CGM graph of a non-diabetic person's day - you'll see big rises and falls in BG, quite normal.

I might be overreacting, but these readings are not entirely normal for a healthy person. Unless the person was eating lots of carbs/sugars with high GI, or been releasing a lot of cortisol etc.

 

[KennyA]

I might be overreacting, but these readings are not entirely normal for a healthy person. Unless the person was eating lots of carbs/sugars with high GI, or been releasing a lot of cortisol etc.

You might need to look at a lot more CGM graphs from non-diabetic people. It could also be worth having a read of this:

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

pmc.ncbi.nlm.nih.gov

which shows that non-diabetic people do indeed have considerable variation in their BGs over the course of a day, naturally influenced a lot by what they've eaten.

 

[Mac Dabrowski]

You might need to look at a lot more CGM graphs from non-diabetic people. It could also be worth having a read of this:

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

pmc.ncbi.nlm.nih.gov

which shows that non-diabetic people do indeed have considerable variation in their BGs over the course of a day, naturally influenced a lot by what they've eaten.

Thanks, very useful paper. Do you know any literature on individuals wearing CGMs and on low carb diet or keto?