Diagnosed This Week - Minimal Info Given - Not Sure What to Do

jcwebguy said:

With low carb, how low is low. I presume no carb is impossible as some veggies have carbs, etc, but not sure what to target. I read some things that say 45-60 per meal but others say that is way high. I've been trying to keep it under 30 if not more, but that seems like a shot in the dark. Carrots are one of the few vegetables I can eat without going ... bleh ... but I'm trying to work more in. But if 4-6 baby carrots is too much and is reversing any good, I can try and cut them out too.

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You set your own carb limit by using a glucose meter to tell you what they are. We call it "eating to your meter" Without a meter you are working totally blind. Have you bought one yet? They are easy to use and come with an instruction leaflet. You may have a few failed tests at first, but after a day or so it will become second nature.

I notice from the measurement units you are quoting that you must be outside the UK.

You test immediately before you eat then again a couple of hours after your first bite. You then look at any rise from before to after, and the aim is to keep as flat as possible. This will take time, but the higher the rise is the more carbs there are in that meal that need reducing in portion size or eliminating. I have to say at this juncture that carrots are not one of the best veggies to eat, but your meter will tell you if they are OK for you in the portions you eat. You also need to keep a food diary including portion sizes and record your levels alongside with any notes such as stress, exercise etc.

jcwebguy said:

I'm worried that my doctor will want to put me on meds, and that once on I will never get off. Do people reasonably ever get on some diabetes medication and then get off - not sure how that works? If I try to push off meds for a while will that cause irreparable harm to my system with higher glucose levels? How quickly should I see my glucose levels drop from the change in diet and exercise?

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Many, many Type 2s on this forum started on meds and managed to come off them. Some have even managed to come off insulin. Whether you are prescribed them now is a matter for your doctor. They all vary. One of the best ways to approach this is to ask your doctor for 3 months grace on diet and exercise only, with a further HbA1c in 3 months. He may agree.

How quickly your levels drop will depend on lots of things, from how strict your diet is to how much damage your pancreas has suffered, to how insulin resistant you are. It can happen quickly, but this is a marathon, not a sprint, and often lowering them too much too quickly can make you feel rough. It is also a diet for life, not a few months, so has to be enjoyed, be sustainable, and contain all the nourishment we need.

This may help you
https://www.dietdoctor.com/low-carb/foods#foodlist

jcwebguy said:

Hello all,

Thanks for the encouraging words.

Found a copy of my results of blood work from last April when I got some life insurance, and my a1c was 5.8 back then. Wish I had known what it meant then.



For every question there seems to be about 100 different answers out there, so just trying to sort it all out and stay positive when I can (which is not easy right now).

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There is no right amount of carbs everyone is different so we all eat different amounts some go very low others eat more Nothing will happen overnight it takes time for your body to adjust to a new regime. As to the meds they would probably only put you on Metformin and that is not a bad drug it does have protective benefits plenty here take it

From reports on this forum how low we need to go to control our BG levels is very varied. You might be able to eat all sorts of carb containing fruits veges and even grain - porridge oats seems to be one of the things you can either eat or not, meters show a slight rise or a huge one, just the luck of the draw or flip of a coin.
There are lots of options even for the most carb sensitive, like me.
I'm just thankful I can do low carb and not need tablets - I seem to get every possible side effect and very little benefit.
If you can get a meter you can start to work out what will be your everyday menu and what you need to avoid.

I did just that jcwebguy and after reading all of the instructions, soon picked up what I needed to do. Hardest thing for me is to make the time to test, eat, hydrate when so busy with work! Good luck but it's important in my opinion to make the time at the right times rather than only when you have a spare few minutes.
I would also recommend buying and reading a book which I found very helpful, not really for the recipes but for the understanding behind the LCHF ethos.
The Real Meal Revolution by Noakes, Proudfoot & Creed ISBN: 978-1-47213-569-8
I also bought myself a Pocket Counter book that showed me how many grams of Carbs are in most types of food which proved a revelation for me when starting to measure what I could now consume.

jcwebguy said:

Exercise and ketones - I bought some ketone strips, and my ketone level shows as 15 (low) which is the same it was at my dr appt 6 days ago.

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Any result other than negative is abnormal, for urine sticks. Hence you are producing some ketones, and exercise would aggravate that. The advice I've seen on various sites is that low/moderate levels (+ or ++) isn't an emergency, but it needs to be watched to make sure it doesn't become one. And exercise should definitely be avoided if there are detectable amounts of ketones in your urine.

jcwebguy said:

With low carb, how low is low. I presume no carb is impossible as some veggies have carbs, etc, but not sure what to target. I read some things that say 45-60 per meal but others say that is way high. I've been trying to keep it under 30 if not more, but that seems like a shot in the dark.

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60 per meal would be pretty close to the official guidelines, which is a ton of carbs for a diabetic. 30 per meal is well under the recommendations, so would be considered low carb. Some diets go even lower, to 20 carbs or fewer per day, but that's also probably not a good idea while you're producing elevated levels of ketones.

jcwebguy said:

I'm worried that my doctor will want to put me on meds, and that once on I will never get off. Do people reasonably ever get on some diabetes medication and then get off - not sure how that works?

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Diabetic meds aren't addictive and don't result in a physical dependency. Coming off of them shouldn't be a problem.

jcwebguy said:

How difficult is it to get started on a blood glucose monitor? Is it something I need a professional to show me how to use or are they safe enough I can just go buy one and use it?

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It's very easy, and comes with an instruction booklet. It's a good idea to buy some testing strips and lancets while buying the meter, since it will typically only include a few of those.

The thing is, if you go very low carb, you can go into a state called nutritional ketosis. That is not dangerous, in fact it is positive - many of us strive for it, actually.

Moderate on your pee sticks is not a problem. High on your pee sticks *may* be a problem - but only if your glucose is also very high. And that only happens when you can make little or no insulin of your own.

However, your blood tests show an improvement over the course of a few days. That implies that the lower carbs are working for you - you are making insulin, and by eating lower carbs, your body is coping better. The chances of your ketones rising to dangerous levels is minimal IMO - but if you get that blood glucose meter and test, you will know.

Glucose climbing - back off on the exercise
Glucose falling - you'll do fine.

BarbaraG said:

The thing is, if you go very low carb, you can go into a state called nutritional ketosis. That is not dangerous, in fact it is positive - many of us strive for it, actually.

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Going into nutritional ketosis is a bad idea when producing ketones during hyperglycemia. The focus at that point should be on less ketones!

BarbaraG said:

Moderate on your pee sticks is not a problem. High on your pee sticks *may* be a problem - but only if your glucose is also very high.

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Moderate levels of ketones indicates a impending problem for a newly diagnosed and uncontrolled diabetic. Please do not downplay the risks associated with that. It is not in any way equivalent to someone with controlled diabetes being on a low-carb diet.

You need to get yourself a Blood Sugar meter .. then you can start reading for ketones .. if your sugars in double figures and you show ketones it bad .. if your sugars are in the normal range it ok ..

ME_Valentijn said:

Going into nutritional ketosis is a bad idea when producing ketones during hyperglycemia.

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The two states are mutually exclusive.

Nutritional ketosis happens when there is adequate insulin production for a low carb diet.

Ketoacidosis happens when there is insufficient insulin for the carb level in the diet.

Edited to add: This chart shows the difference very well.

Brunneria said:

Edited to add: This chart shows the difference very well.

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This is insanely inappropriate. HE ISN'T ON A KETOGENIC DIET. He's a newly diagnosed and untreated diabetic with elevated ketones in his urine and symptoms of hyperglycemia.

The only "optimal zone" of ketone levels for someone with hyperglycemia is 0. What is wrong with you people?

jcwebguy, it seems like you have the kind of attitude that will help you get on top of this. Follow Daisy's advice for the basics and you shouldn't go far wrong: I cut carbs hard and had some fat from things like sardines, salmon and nuts, and I lost a lot of weight very rapidly- a lb or two a day, until my weight levelled off. I was quite overweight, so it may be different for you, but my blood-glucose and triglycerides went from dangerously high to non-diabetic and normal. I did a limited calorie version of the Banting diet (no starch, no grain-based food, no added sugar, no milk, nothing that grows underground). Now I'm basically keeping to the normal Banting diet, (without the toast). Might be worth looking into- I was 36 when diagnosed, 5'11 220lbs possibly somewhat similar to you. Now I'm 169lbs and the doctor said he doesn't think I have type 2 after all. Still, I need to be careful, but I feel better on a low carb diet anyway. Very, very maintainable way to live in the long term. When I used to get sluggish from dieting too hard, I started having a boiled egg or some almonds/ sunflower seeds, and that set me straight

Don't worry, you will get Normal back. It will be a new normal, but normal none the less.

Have you done any reading on Foamy Urine?
Here is a good, commonsense link.
http://www.healthline.com/health/foamy-urine#Symptoms2
At this point, I would be tempted to just put worries about urine on the back burner, and mention them when you see your doc.

What are your blood sugars like? They are what you should be concentrating on really. If you aren't self testing then I suggest you start. It is important. I have never tested my ketones but I check my blood glucose frequently. Your doctor can sort out your urine issues for you.

jcwebguy said:

She kind of laughed, said "people still use ketone test strips?" and said I should ease up a bit until I see the doctor. Mild exercise and not cutting too far down on the diet.

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Sorry, but she's wrong. Urine strips are pretty accurate, though they don't measure exactly the same thing as blood testers. And exercise should not be done while hyperglycemic and producing ketones.

From the American Diabetes Association:

Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours.

Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control. Talk to your doctor at once if your urine results show moderate or large amounts of ketones.

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You should probably also read about the symptoms of Diabetic Ketoacidosis, especially while various idiots are encouraging you to exercise while producing ketones, and suggesting that producing ketones is not something to worry about. Because they are idiots, they think that ketone production due to hyperglycemia is no different than ketone production due to diet. But they are very different.

Dietary ketosis is a controlled fat-burning state which is deliberately induced and kept in check by the body's ability to produce sufficient insulin. Hyperglycemic ketone production, on the other hand, happens because your body is not capable of producing enough insulin to keep up with your current glucose intake, accumulation, and/or production. It is out of control, and it can quickly escalate, especially if exacerbated by exercise, dehydration, etc. Low levels of ketones are not an emergency, but they are an indication to watch out for one.

jcwebguy said:

I'm sure these ups and downs are normal, they are just difficult.

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It's not really normal. It's just happens frequently during diagnosis when you're very hyperglycemic and your doctor doesn't take diabetes seriously.

jcwebguy said:

How do I get my ketones to 0? They've shown as at least 15 (low) since my doctor appointment a week ago.

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Get your blood sugar down, drink plenty of water, and don't exercise. Limited carbs can help. You also really need a blood glucose meter to check, which you can probably buy at your local pharmacy.

As your symptoms came on reasonably quickly and your HbA1c was 5.8% in May last year when you would have appear not to have been diabetic or even pre diabetic at that time.( See what is HbA1c on this site which has a nice diagram). You have not mentioned if you have lost weight recently . Did you doctor consider if are a type 1 rather than a type 2 ? There are some tests which can be undertaken ( GAD antibody test and or Cpeptide test ).Might be worth asking when you see your doctor as it possible to get T1 at any age although more common in youngsters. The main difference in layman's terms is that T2 usually at diagnosis have cells producing insulin but it is not very effective for various reasons. A T1 usually has lost the cells which were producing insulin so need insulin needs to be replaced