Type 2 Diabetic or not?

[mojo37]

Guys im a gp
I do know what diabetes is and how its diagnosed but i was just confused about tge results. Im just a gp and no endocrinologist so whatever i studied about diabetes during college was not in depth as what an endocrinologist studied.
What i also know is that there is something called obesity related diabetes and thats not only because youre overweight...normal BMI people can even have it. Its because the internal organs that regulated glucose metabolism ( liver and pancreas ) are covered with a thick layer of fat and that causes them to function in a less than optimum manner. Ive had a fatty liver ( not alcoholic fatty liver ) for years and maybe thats the reason but ive always got regular blood check ups and everything was good. So thats why i was wondering if is was a phase or something is actually wrobg with my pancreas( but i think not brcause my OGTT was normal )or my tissue insulin receptors. And i wanted to know now if i stay at about 85 kg now but start eating more carbs but try not to gain a massive amount of food..will this keep my glucose levels normal or not?
And another question.. if i start taking metformin just to keep my weight at about 85kg and normal blood sugars but without qctually dieting...has anyone tried this before ? And did it work?
Sorry for the long post guys and thanks a lot for replying .

Re the metformin part of your question I don't find that metformin affects my weight or appetite..It gives me an upset stomach sometimes but that's all .

 

[mojo37]

Regarding Metformin...I was on it for 7 months between January and August of this year. I have just taken myself off it as I lost 3 stone and look skeletal. (I was prediabetic last Dec 45% a1c which is why my dr put me on it) If you need to lose weight it's the perfect medication but if not exercise and right food may be better. That's what I'm doing now and hope to put some weight back on. I hope you can get it sorted out.

For me it doesn't work in that way ..wish it did

 

[LezLezLez]

So who says you are diabetic and what is their definition please?

 

[Alexandra100]

Im just a gp and no endocrinologist so whatever i studied about diabetes during college was not in depth as what an endocrinologist studied.

Congratulations on turning your health around. Are you aware that resistance training can be very helpful for lowering bg in the long term (though some, but not all, people find it raises bg in the short term). IMO it would help you and your patients if you read up about diabetes. My preferred books are: Jenny Ruhl's "Blood Sugar 101" or "Your Diabetes Questions Answered" and / or Dr Bernstein's "Diabetes Solution". Of these, "Your Diabetes Questions Answered" is the easiest read. Diabetes treatment is a vast subject and research is moving on all the time, so whatever you were taught in college will certainly be out of date by now. You can read quite a lot of Dr B's book on his website http://www.diabetes-book.com and JR has a lot of info on her site: https://www.bloodsugar101.com
Good luck! I hope you can get back to your weight training. I'd certainly miss mine terribly.

 

[Mal S]

So who says you are diabetic and what is their definition please?

My gp looked through my medical notes going back to 2017. My a1c level was 49. I had another test done in July last year...49 again. ..she said to try diet and exercise until November. I lost 1 1/2 stone by cutting out sugar. A1c test in December was 46. Gp said I am diabetic and put me on Metformin. That's when the weight fell off drastically. I weigh 60kg now and am 5.6 tall. My a1c level is now 45. It may go up though as I stopped the Metformin last week. I am trying so hard eating the so called right foods but trying to eat more calories to put on weight. My calorie intake is so low but I'm in a state with reading too much information on the foods to eat and avoid. Have to see my gp in October for another a1c test. I'm terrified it will be higher and I'll be put on Gliclazide. As you can probably tell, I'm absolutely obsessed about all this. Has anyone put on weight when they stopped taking Metformin? I'm wearing myself out with all this and get upset when people ask if I am ok as I'm so thin..Any advice would be more than welcome.

 

[Mal S]

Re the metformin part of your question I don't find that metformin affects my weight or appetite..It gives me an upset stomach sometimes but that's all .

I wonder why metformin makes some people lose a lot of weight but not others?

 

[Resurgam]

I am trying so hard eating the so called right foods but trying to eat more calories to put on weight. My calorie intake is so low but I'm in a state with reading too much information on the foods to eat and avoid. .

What are 'the right foods' you are eating?
Can you give details of a typical day's menu so we can perhaps give advice about what to cut out and what to include?

 

[JulieGuildford]

Ooh, we get to advise a GP! (Sorry, that is making me gleeful). You have an impaired metabolism, and carbs will always be a problem. You can still have carbs and reduce portion size, but in all likelyhood that will mean you will progress to full fledged T2. While going hungry in the meantime. You already were borderline diabetic with the HbA1c of 6.8. Just barely still in the prediabetic stage. You missed a T2 diagnosis by a hair. Remember, the weight came on because of your impaired ability to process carbs: When you're insensitive to your own insulin, rather than help you burn off the blood sugars, it just stores the glucose in available fat cells instead. You don't get diabetes because you're obese (or TOFI: Thin Outside, Fat Inside), you get bigger because you are becoming a diabetic. It's when the cells can no longer cater to the storage demand, that the glucose spills out into the rest of your body, because it's got nowhere else to go. Blood, organs, saliva, tears. Voila, T2.

Jo

"You don't get diabetes because you're obese (or TOFI: Thin Outside, Fat Inside), you get bigger because you are becoming a diabetic."

My first reply Jo so getting to grips with the system. I didn't think getting bigger was like a symptom almost, I thought losing weight without trying was. I have no symptoms but I have steadily gained weight. I was tested as I'm now 19st, 5ft 6, size 22/24, and was told a couple of months ago that I'm prediabetic at a level of 42. I bought a testing kit myself to monitor my blood but after a week of testing my range was 6.3 to 6.8, which is OK I believe, so I've stopped testing now as due to go on an NHS funded course.

Anyway, should GPs be looking out for weight gain as well as loss?

Thanks Jo,
Julie (newbie)

 

[EllieM]

"You don't get diabetes because you're obese (or TOFI: Thin Outside, Fat Inside), you get bigger because you are becoming a diabetic."

My first reply Jo so getting to grips with the system. I didn't think getting bigger was like a symptom almost, I thought losing weight without trying was. I have no symptoms but I have steadily gained weight. I was tested as I'm now 19st, 5ft 6, size 22/24, and was told a couple of months ago that I'm prediabetic at a level of 42. I bought a testing kit myself to monitor my blood but after a week of testing my range was 6.3 to 6.8, which is OK I believe, so I've stopped testing now as due to go on an NHS funded course.

Anyway, should GPs be looking out for weight gain as well as loss?

Thanks Jo,
Julie (newbie)

As a very gross generalisation (and there are exceptions to every rule), weight gain is a symptom of T2 diabetes (high blood sugars as a result of inability to process carbs properly leads to lots of insulin which converts sugars to fat), while weight loss tends to go with T1 diabetes (insufficient insulin causes weight loss and high blood sugar). So yes, GPS should be looking out for both.

ps Welcome to the forums.

 

[VashtiB]

Moey welcome to the forum. Please feel free to ask any question you like I'm a newbie and have questions and other people's questions often help me- I'm sure your questions will help other people. Given the complaints (including mine) about the lack of knowledge some experienced GPs have I am not surprised that a young doctor will have many questions. Given you have a personal stake hopefully you will be able to educate other doctors around you.

Welcome.

 

[VashtiB]

Julie- also welcome- you're lucky to be able to get in before actually diagnosed with diabetes. Hopefully that will make it easier to turn around. I'm on the very low carb lifestyle and am losing weight- not as fast as others but steadily. I figure that at least the weight is going in the right direction. I do LCHF to help not feeling hungry. I figure that even is I lose 1/2 a kg a week then that's 26 kgs in a year- hopefully at least 1 dress size (okay I'm hoping for 2).

Good luck and welcome.

 

[JoKalsbeek]

"You don't get diabetes because you're obese (or TOFI: Thin Outside, Fat Inside), you get bigger because you are becoming a diabetic."

My first reply Jo so getting to grips with the system. I didn't think getting bigger was like a symptom almost, I thought losing weight without trying was. I have no symptoms but I have steadily gained weight. I was tested as I'm now 19st, 5ft 6, size 22/24, and was told a couple of months ago that I'm prediabetic at a level of 42. I bought a testing kit myself to monitor my blood but after a week of testing my range was 6.3 to 6.8, which is OK I believe, so I've stopped testing now as due to go on an NHS funded course.

Anyway, should GPs be looking out for weight gain as well as loss?

Thanks Jo,
Julie (newbie)

Hi Julie,

I gained weight and could not possibly drop it no matter what I did, for about 15 years. In that time I was prediabetic but no-one bothered to actually notify me about what was in my files. The dietician telling me to eat 6 extra slices of bread a day certainly didn't help. (That's when I went from obese, to morbidly obese and diabetic). By the time I was very, very ill I did suddenly lose 10 kilo's, which made me think it was cancer, so I hurried off to the GP. Due to that sudden weight loss -which still left me obese by the way- I did get checked for T1, but nope... T2 here. From what I understand the majority of T2's gain weight, provided they have a lot of fat cells to fill. Some people just naturally have fewer. It's when there's sudden weight loss, it's (more often than not) a T1 wasting away rapidly. I seem to have been an exception, which do happen.

The NHS courses are a bit hit-and-miss, I'm sorry to say. But hey, at least you get courses. The Dutch just flounder on their own. Seriously though, some teachers are up-to-date with recent developments (Like the NHS endorsing low carb/high fat since the beginning of this year), others still insist carbs are vital to life. Which they're not. (And there's no such thing as a "good carb" to a T2.). So I'm hoping you catch one of the up-to-speed ones. In the meantime, you're in the right place to learn. https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ Might help you too.

Good luck, and welcome!
Jo

 

[Mr_Phillips 2]

Congratulations for that
And how is your blood glucose measuremants so far when youre not dieting ?

I don’t think I deserve to be congratulated as it is more due to luck. My last HbA1c in May 2019 was 41 which was an increase from a reading of 38 in December 2018. This increase is slightly perturbing as it could be to do with not following any diets but I take comfort from the fact that when I had my HbA1c done in May I was not well so the next test is going to be interesting. I have not posted much on this forum because,the way I am dealing with my condition is at variance with most forum members.

 

[mojo37]

I wonder why metformin makes some people lose a lot of weight but not others?

I know the only thing it does for me ( and it's not a plus ) is give me a gippy belly tho that seems to have settled down now ( have been put on SR and an increased dose .Some people say metformin decreases their appetite again it doesn't affect mine , then again we are slightly different when it comes to diabetes with or without meds .

 

[mojo37]

My gp looked through my medical notes going back to 2017. My a1c level was 49. I had another test done in July last year...49 again. ..she said to try diet and exercise until November. I lost 1 1/2 stone by cutting out sugar. A1c test in December was 46. Gp said I am diabetic and put me on Metformin. That's when the weight fell off drastically. I weigh 60kg now and am 5.6 tall. My a1c level is now 45. It may go up though as I stopped the Metformin last week. I am trying so hard eating the so called right foods but trying to eat more calories to put on weight. My calorie intake is so low but I'm in a state with reading too much information on the foods to eat and avoid. Have to see my gp in October for another a1c test. I'm terrified it will be higher and I'll be put on Gliclazide. As you can probably tell, I'm absolutely obsessed about all this. Has anyone put on weight when they stopped taking Metformin? I'm wearing myself out with all this and get upset when people ask if I am ok as I'm so thin..Any advice would be more than welcome.

Do you think there are any other reasons for your weight loss other than the metformin .

 

[mojo37]

As a very gross generalisation (and there are exceptions to every rule), weight gain is a symptom of T2 diabetes (high blood sugars as a result of inability to process carbs properly leads to lots of insulin which converts sugars to fat), while weight loss tends to go with T1 diabetes (insufficient insulin causes weight loss and high blood sugar). So yes, GPS should be looking out for both.

ps Welcome to the forums.

I think I am certainly an exception to that rule ..I have been overweight for years long long before any high BG.

 

[Mal S]

Do you think there are any other reasons for your weight loss other than the metformin .

Mojo 37 yes I think so now. I had a very energetic job for the first 7 months I was on Metformin and didnt eat enough. I was practically food phobic. I spent ages doing food shopping, looking at every label. I became quite obsessed about food. During work days I'd eat brioche, sandwiches and the odd chocolate.. not the right things I realise now. I'm testing my bs before and after everything I eat. Crazy I know but I don't want to have to take meds.

 

[Mal S]

I know the only thing it does for me ( and it's not a plus ) is give me a gippy belly tho that seems to have settled down now ( have been put on SR and an increased dose .Some people say metformin decreases their appetite again it doesn't affect mine , then again we are slightly different when it comes to diabetes with or without meds .

Yes I had terrible stomach upsets and nausea for the first couple of weeks only. I had 1 hypo..in July when we had that hot day..93% I hadn't eaten enough that day and didnt drink enough water either. It terrifies me though as I was out and about. I'm just trying to help myself with this so I dont have to go on any meds...?

 

[Mal S]

Yes I had terrible stomach upsets and nausea for the first couple of weeks only. I had 1 hypo..in July when we had that hot day..93% I hadn't eaten enough that day and didnt drink enough water either. It terrifies me though as I was out and about. I'm just trying to help myself with this so I dont have to go on any meds...?

My a1c level in July was 6.3%. Isn't that prediabetic?

 

[mojo37]

Yes I had terrible stomach upsets and nausea for the first couple of weeks only. I had 1 hypo..in July when we had that hot day..93% I hadn't eaten enough that day and didnt drink enough water either. It terrifies me though as I was out and about. I'm just trying to help myself with this so I dont have to go on any meds...?

It's all trial and error what works for one person doesn't for another, at least on this forum you will get plenty of advise far more than at the dr's or dn clinic. Then it is up to you to find what works for ..every time I go to see my DN ( apart from once when she was pleased with me ..had reduced my hbc1a she tries to get me to take more meds esp statins.