Do I push harder?

[nirouleur]

Hi folks,

Looking some advice about how hard I push my GP practice. I'm Type 2 and my regular test readings have been in the 15-20 range for about 3-4 months now. I haven't had an A1C in a while (although I know that's the important figure). So far this year, I've been on Forxiga for about 8 weeks and couldn't tolerate it. In fact, I think it may have screwed me up a little.

I've now been on Trulicity for just over 5 weeks, but my levels don't seem to be coming down. I'm getting lots of the side effects (nausea, fatigue, etc), however, I don't feel like I'm getting as many of the benefits as I might (although I've lost just over a stone in the last couple of months and my appetite is definitely lessened).

I've been trying to transition onto LCHF for quite some time, but I find it really, really difficult. I'm very anti-vegetables - always have been - so bulking up on those and trying to keep the protein down and away from processed carbs is a struggle. I know I'm paying for it, but that's a battle I need to keep fighting. I'm getting a little bit of intermittent fasting in too, which is actually easier than I imagined.

That's all by way of background. My real question is what sort and regularity of support and testing should I be getting from my GP? As I say, my meds have been changed a couple of times, but my progress isn't being assessed beyond me taking my BG at random intervals. And in terms of a treatment path, if Trulicity doesn't work, I've been told I'll be on to insulin - is that the only option available? I've got nothing in terms of dietary or nutritional support (although I suspect it'd toe the NHS line which we all know is daft). I'd love to get more exercise, but my body is just in too bad a shape and my energy levels are just too low at the minute.

I've been advised to maybe go above my GP to our regional health provider and try to get referred to a endocrinologist, but I'm a little uncomfortable with that - would it be worth pursuing?

Sorry for the slightly vague rambling - I've got a lot going on and I'm just trying to make sense of where I am, what direction I need to go in and how long I wait (with my levels as high as they are). Thanks for your time...

 

[carty]

Perhaps if you were to test your glucose before meals and 2 hours after ,it would give you a picture of what your overall levels are on a daily basis .it would also show you how the food that you are eating affects your levels.Also I would ask the GP to test for vitamin d and your magnesium levels these can affect your energy levels There are some good recipes on this forum ,have a browse and see if anything takes your fancy
CAROL

 

[GrantGam]

You really don't want BG in the 15-20mmol/L range, ever.

Any idea why your energy levels are low? Exercise is up there with the best 'drug free' treatments for diabetes so it's recommended to get as much of it as possible. Congratulations on the weight loss, it certainly helps. Have you much more to loose before getting into your ideal weight range?

What medication have you tried? I don't see any mention of Metformin in your post?

Insulin may be the most sensible option for you considering how high your BG levels seem to be.

Grant

 

[nirouleur]

You really don't want BG in the 15-20mmol/L range, ever.

Yes - that's very much my understanding, too. Which is why having them around that level every time I test over the past number of months really does worry me.

Any idea why your energy levels are low? Exercise is up there with the best 'drug free' treatments for diabetes so it's recommended to get as much of it as possible. Congratulations on the weight loss, it certainly helps. Have you much more to loose before getting into your ideal weight range?

I'm guessing it's a combination of high BG levels and the side-effects from Trulicity. I do try to keep myself active, but it's more difficult at the minute than it has been for me in the past. I still need to lose maybe 4 stone, although 2-2.5 might be more realistic. Whether it ultimately sorts my BG levels or not, I don't know.

What medication have you tried? I don't see any mention of Metformin in your post?

Insulin may be the most sensible option for you considering how high your BG levels seem to be.

Sorry - I'm on 2000mg of Metformin daily as well as the weekly Trulicity injection. I do suspect insulin might be needed but my fear there is of the associated weight gain and, I guess, the sense of defeat that comes with it.

 

[sugarleveller]

You should be getting your HbA1c tested every three months along with your cholesterol, liver and kidney functions. You should also have access to a diabetes specialist who can refer you to an endocrinologist. I also see the nurse at the clinic who will do a diabetes check up (feet etc).

You should ask for access to a diabetes specialist. GPs do not know enough. To be honest, I find the lack of knowledge at both GP and diabetic nurse level to be appalling. Don't worry about what they think of you, you need to be assertive when it comes to your medical care. Clearly you need to have your meds looked at.

Weight lifting will bring down your sugars overnight. Cardio will a bit, but not as much as lifting weights.
Have you tried the old wives remedy of 1 tablespoon apple cider vinegar in water before a meal and before you sleep? It has been scientifically proven to work slightly.

Telling yourself you are 'anti-vegetables' won't do you any favours. You HAVE to change your palate and it is possible. For me boiled eggs are the only thing that actually lowers my sugar levels (no more than one or two). Try just eating two boiled eggs for dinner - I always do that when I need to 'fix' my sugar levels.

I went on the 8 week blood sugar diet and though it was bloody hard, it really helped and it changed my palate and what I like to eat. I also lost 2 1/2 stone on it. Zoodles and cauliflower rice have been a saving grace. I hated both vegetables before. Also, have you tried eating those carb free noodles - I think its called barenaked - these all help transition on low carb.

 

[GrantGam]

Although weight loss does help control BG, I don't think losing four stone would get your BG out of the 20's.

Don't see insulin treatment as a sign of defeat, in fact it's the opposite! Not all type 2 diabetics have brought their condition on through poor lifestyle choices. For all you know, this could have been inevitable. There are many causes for all types of diabetes so don't think that you could have beaten it with just diet and/or exercise.

Insulin is known to cause weight gain, but I bet if you got those numbers down into your target range that you'd find yourself with loads of extra energy that you could put towards the exercise you currently are unable to participate in. I, like many other insulin users on this forum, haven't put on any weight since using insulin. It's one of these things that you won't know till you try it.

The most important thing is your health and if that means a few daily injections then it's really a small price to pay

I'd arrange an appointment with your GP for an HbA1c blood test and take things from there. Let them know exactly what you've told us and you can discuss further treatment options available to you. Whether that's insulin or not ultimately depends on your agreed decision.

Good luck,
Grant

 

[nirouleur]

Insulin is known to cause weight gain, but I bet if you got those numbers down into your target range that you'd find yourself with loads of extra energy that you could put towards the exercise you currently are unable to participate in. I, like many other insulin users on this forum, haven't put on any weight since using insulin. It's one of these things that you won't know till you try it.

Thanks, Grant - this is one of the most encouraging things I've read recently. Both my parents are Type 2, so I suppose there's more than a little of my genetics in it! But I had always understood weight gain was guaranteed on insulin - good to know you've kept in manageable. Cheers...

 

[nirouleur]

Thanks @sugarleveller - lots to think about there. Appreciate the pointer of focusing on weights more so than cardio - I have all the gear in my garage to do that but I've been neglecting it.

And the boiled eggs tip... I'm trying to introduce eggs for breakfast when not fasting.

I did read about the spoonful of vinegar thing. Never taken vinegar with anything and always found it quite repulsive, but the accepted wisdom seems to be that it makes a difference - small or otherwise.

 

[kokhongw]

I've been trying to transition onto LCHF for quite some time, but I find it really, really difficult. I'm very anti-vegetables - always have been - so bulking up on those and trying to keep the protein down and away from processed carbs is a struggle.

I am not a big fan of veg, and my LCHF is mainly eggs, cheese, nuts and roast pork belly to have stable glucose and little hunger. But not having veg means a rather tough output. So we need the fiber...sooner better than later.

 

[spendercat]

I have always found fasting to be unproductive. If I don't eat my liver just keeps kicking out glucose and my BG goes higher and higher!
A cheese omelette with a few greens on the other hand will bring my sugars down from 10 to 6 within an hour. That's just me, but don't assume going hungry helps.
Don't worry about the veggies, Low Carb High Fat isn't high veggies.
What you probably have not realised is that meds only work to an extent. They only bring your BGs down by 10%+. They work best combined with a controlled carb diet.
Insulin is your best bet if you really can't change your eating habits.
Take control. Eat to the meter.

 

[nirouleur]

I actually had a frank and refreshing conversation with my GP today - a little unexpected, but a pleasant development. I have an appointment with our diabetic nurse first thing in the morning to "start the conversation" around taking insulin. He was very clear that he'd prefer lifestyle changes over medication (because of the weight gain normally associated with insulin) but if I can't make the necessary changes to diet, then high BG levels will be doing more damage than is acceptable and need attended to.

 

[VinnyJames]

@sugarleveller or anyone really....



"Weight lifting will bring down your sugars overnight. Cardio will a bit, but not as much as lifting weights."



Is there any science behind this claim?

Any articles/links?

 

[nirouleur]

Hmm. So I had my appointment, and at one point seriously considered walking out - I felt so patronised and disbelieved.

I did get a full suite of blood tests though, and we'll wait for the results of those before taking any decisions about insulin - I guess I was a little surprised by the all round implications of starting this treatment. But if I need it, I need it.

But between accusing me of simply not being fit, not really knowing what cramps are (even though I'm suffering a lot from them!) and that I was maybe exaggerating my symptoms, I was close to losing it. I was told, and I quote "you'll feel like ****" on a low-carb diet, which I don't believe at all from those who've tried it.

Tough one today. I've also been put on gliclazide temporarily to see if that gets my levels down. Let's see...

 

[AndBreathe]

Hmm. So I had my appointment, and at one point seriously considered walking out - I felt so patronised and disbelieved.

I did get a full suite of blood tests though, and we'll wait for the results of those before taking any decisions about insulin - I guess I was a little surprised by the all round implications of starting this treatment. But if I need it, I need it.

But between accusing me of simply not being fit, not really knowing what cramps are (even though I'm suffering a lot from them!) and that I was maybe exaggerating my symptoms, I was close to losing it. I was told, and I quote "you'll feel like ****" on a low-carb diet, which I don't believe at all from those who've tried it.

Tough one today. I've also been put on gliclazide temporarily to see if that gets my levels down. Let's see...

@nirouleur , to be perfectly frank, personally, I would try almost anything rather than go onto insulin, although I'm also sensible enough to appreciate that being safe, in terms of my blood numbers is more important than my ego of wanting to stay free of, or on minimal medication.

I appreciate you are finding the transition to fewer carbs to be tricky, but it is an approach than has proven to be very successful for many people in reducing the blood numbers by impressive amounts.

I know from my own perspective that what I eat was pivotal to achieving improved bloods. The same tends to be pretty true for most T2s. For me, my way of eating is my biggest weapon in keeping things in a decent place.

What is it about the lower carb way of eating that causes you most challenge? I wonder if we might have any ideas to help you at all.

Whatever you choose to do, I hope it works out well for you.

 

[nirouleur]

@nirouleur , to be perfectly frank, personally, I would try almost anything rather than go onto insulin, although I'm also sensible enough to appreciate that being safe, in terms of my blood numbers is more important than my ego of wanting to stay free of, or on minimal medication.

Frankness appreciated - I do feel the same way, and if I'm honest, it seems that my health people are of the same mind and are trying to ensure I completely exhaust all other options before taking that decision.

What is it about the lower carb way of eating that causes you most challenge? I wonder if we might have any ideas to help you at all.

Whatever you choose to do, I hope it works out well for you.

Thank you.

If I'm honest, I'm not sure where the hang-up is. I think it's a combination of factors, some of them probably imagined and invented than actual real issues. I'm not a planner, so I make too many ad-hoc decisions about what to eat, particularly for lunch when I'm at work. There's the part of me that struggles to give up the carbs, but I know that's an addiction thing. The vegetables thing I've already mentioned above - I see low-carb as requiring more vegetables than I currently eat to ensure adequate nutrition/energy, but I don't do well with them. As someone has already said I'm maybe making that a bigger thing than it needs to be.

I need to take the time to sit down, gather some recipes, do the shopping lists and organise myself.

 

[AndBreathe]

Frankness appreciated - I do feel the same way, and if I'm honest, it seems that my health people are of the same mind and are trying to ensure I completely exhaust all other options before taking that decision.


Thank you.

If I'm honest, I'm not sure where the hang-up is. I think it's a combination of factors, some of them probably imagined and invented than actual real issues. I'm not a planner, so I make too many ad-hoc decisions about what to eat, particularly for lunch when I'm at work. There's the part of me that struggles to give up the carbs, but I know that's an addiction thing. The vegetables thing I've already mentioned above - I see low-carb as requiring more vegetables than I currently eat to ensure adequate nutrition/energy, but I don't do well with them. As someone has already said I'm maybe making that a bigger thing than it needs to be.

I need to take the time to sit down, gather some recipes, do the shopping lists and organise myself.

OK. As I have inferred already, as adults, we all make our own choices in life, and I respect your right to make differing ones to those I might. However, the early stages of adopting any treatment or lifestyle is a steep learning curve, and often requires some adjustment along the way. It's a period of flux and variability, not best suited to significant numbers of "ad-hoc" decisions. Let me try to explain more fulsomely what I mean.

Should you elect to give reducing your carbs a go, there are many, many people on here who would be happy to offer you some suggestions for things you might like to eat - concentrating on things you like. Frankly, if I had been told my diet had to be based around kidneys (one of the few things I don't enjoy) I would have resisted, so whilst I can eat most things in a LC diet, I absolutely still have preferences and things I prefer to eat over others.

Should elect to reduce your carbs, it would require a bit of thought, and could be done on a phased basis, to allow you to monitor both your progress, and to learn how specific things you eat, as they can vary. Some folks, mysteriously, do fine on things others find them sky-high. For instance, I have always been able to eat modest portions of rice, whereas others find reading the package raises their bloods, just about.

Should you elect to try, and be offered insulin, I believe, from my reading, it means one of two things. Either you will be prescribed fixed doses of insulin every day. In order for your bloods to be as predictable as expected, you would need to eat the same sorts of foods pretty much every day. If you decide to eat way more, there may not be enough insulin in your system to retain decent levels, or conversely, if you decide not to eat, for whatever reason, there is the chance your bloods will drop to and unfavourable and/or uncomfortable place.

If you were started on a variable does insulin, then you would have to become competent in assessing, relatively accurately, the amount of carb in each thing you eat, then giving yourself the calculated matched dose of insulin for the carbs you have eaten.

With the best will in the world, I don't interpret any of those options as being without a certain amount of planning in the early days and a good deal of application over the longer term.

Given those options, personally, I would very, very seriously consider giving dietary changes a go, before further considering insulin, but, as I say, it's your body and your choice.

I really do wish you well, and reiterate there are people here who will help you on a day to day basis, really whichever way you decide to go.

 

[MikePea]

Hi Niroulier.
You have been given some excellent advice here from those who actually tried both medication and diet. They speak from personal experience. Not everybody will react the same way to the same treatment.. The advice is TO TRY the diet LCHF.
There are many excellent food chioses not all of them veg. Have a go.
The exercise will make weight loss much easier. I only walk, which was a struggle at first, but I lost weight. Even began to enjoy the change in diet.
Now there is no medication. Lost nearly 3 stone Still exercise regularly. ( Just walking). Try it. Please.

 

[GrantGam]

My tuppence, if it's worth anything...

As a HUGE food lover and a passionate cook and baker, I love carbohydrates. I live for them, the tastes, the smells, the textures. Incredible!

As a type 1, I have the "luxury" of MDI where I can adjust my bolus dose to suit my meals, dependant on their carbohydrate content. Now, that does mean that I eat what I want, but it doesn't mean that I do this with disregard to my own health. There is no "free pass" for a diabetic. My carbohydrate intake is careful balanced against my activity and exercise levels.

Basically, I don't crank up the insulin pen to compensate for a widely varying diet. I crank up the exercise to make this a possibility. This is something that you may be able to do, but without the insulin. Considering your precious pancreas is still making it.

In short, try LCHF if you can stick to that diet. I've done it, I found it hard. But I also found it, very, very good for BG management.

Otherwise, the exercise really needs to be turned up tenfold if there is going to be no dietary adjustment.

Good luck
Grant

 

[chalup]

Hmm. So I had my appointment, and at one point seriously considered walking out - I felt so patronised and disbelieved.

I did get a full suite of blood tests though, and we'll wait for the results of those before taking any decisions about insulin - I guess I was a little surprised by the all round implications of starting this treatment. But if I need it, I need it.

But between accusing me of simply not being fit, not really knowing what cramps are (even though I'm suffering a lot from them!) and that I was maybe exaggerating my symptoms, I was close to losing it. I was told, and I quote "you'll feel like ****" on a low-carb diet, which I don't believe at all from those who've tried it.

Tough one today. I've also been put on gliclazide temporarily to see if that gets my levels down. Let's see...

I am sitting here eating bacon mushroom cheeseburger casserole and it is to die for. I don't feel like ****. Maybe have a look at the low carb program on this site. It might be easier for you to sort it out if you have a guide to reference. Good luck.

 

[CollieBoy]

@nirouleur As someone who WAS on Insulin, Gliclazide, et al, as well as having discovered LCHF (which I treat as Low Carb HighER Fat), My way of dealing with meds was to treat them as a temporary evil, to be weaned off of once I could1
As for feeling sh*t on low carb, after the adjustment to low carb eating (soon over), if you aint feelin "satisfied" , you propbably need a better recipe book!