HbA1c result

[KennyA]

Hi Jo,

Just wanted to say that I really appreciate your post on another persons thread that I've just read which was very helpful to me. My lovely diabetic nurse when I was initially diagnosed seems to be quite outdated with her advice (still have chocolate but not as much to treat yourself etc.)

She told me that I must have my metformin (2 in the morning and 2 in the evening) as I actually eat the food, but looking at your post saying you should eat the food first and then have it. How long should I wait? 10 minutes, 20 minutes etc? When you mentioned the "explosive" bit that explains a few things to me, haha.

Unfortunately I never got any diet advice at all from my nurse. She forgot to put me on the NHS course that she initially offered. I was diagnosed at 110 h1abc in Jan 2023 and when I got it down to 60 she said I must know what I was doing so the diet course probably wasn't worth it.

I have got down to 38 which I am grateful for but it's meant I literally hardly eat anything anymore.
A days meal consists of 2 slices of wholemeal bread toast for breakfast with no added sugar drink (1/2 a pint). Lunch time is a sandwich of lettuce, tomato, onion, peppers and two slices of meat (ham, beef, turkey etc.). I then have dinner at about 5pm which is usually chicken, steak, gammon with a side salad (lettuce, tomato, onion, peppers) while the people I eat with have chips, jacket potatoes, new potatoes.

Does this sound ok to you?

I noticed that you mention greek yoghurt so I'm going to start having that as I do really like yoghurt.
Any other food recommendations would be gratefully received. I have moved last year and have got my first meeting with the diabetic nurse in my new area next week - I have a feeling that because I am down to 38 she is probably going to just tell me to carry on with what I am doing. To be honest, because the old diabetic nurse seemed a bit outdated with her approach (she was asounded that I got it down from 110 so quickly and kept it off as she said most of her other patients hadn't been able to do that - but if the advice she gives isn't the greatest ......).

She told me that crisps were fine to eat diabetes wise (she did say there are no health benefits at all to them but they are a nice treat). Is the thinking of that still the same? I thought potatoes were bad so I stopped eating crisps entirely (I do really miss them).

Hi - thanks for the tag @Lupf

That's an amazing reduction. Well done.

The thing about metformin is that it has zero impact on carb/glucose in your food or bloodstream. What it does is stop your liver making glucose when it thinks you need it. Modern science knows it does this, but how it does this "isn't fully understood" (Bilous and Donnelly Handbook of Diabetes). What that means in practice is that often people find that their BG (HbA1c) will rise a little if they stop taking metformin because the liver will try to push BG levels up to where it thinks they should be - and that might be quite a bit higher than where you currently are.

I have no personal experience of this myself (never having taken any medication) but I do wonder if building up a bit of "experience" at the normal BG level might make the liver less inclined to try to raise levels if/when metformin is stopped.

I would disagree with the nurse about crisps. They're potato - and about 70% carb. I know they're only 13-14g carb a (small) bag but personally one bag is never enough and two is too many. Bear in mind that I aim for around 20g carb/day total, so one bag is nearly a full day ration. I also don't go near bread at all, for much the same reason. I do buy low carb rolls and bagels at about 3g carb each, which you definitely aren't going to be fooled into thinking are "real bread" but do allow for bacon sandwiches etc.

Is it sustainable? I'm over five years in, and if anything it's got much easier as time has passed. My BG was normal within four months of starting low carb, and in the years following I have lost around six stone (not entirely sure where I was when I started, some estimates in sig block). I can say I've never been hungry in that time, but then I eat a lot of fat with my protein.

I eat meat (all kinds) fish, dairy (cream, cheese etc, but not milk) green vegetables (I think my carb intake is all from veg) and in smaller quantities pulses/legumes - which seems to have no impact on my BG. Low carb beer, red wine, spirits, and a lot of coffee. None of the things that are normally used to bulk up meals - eg pasta, bread, pastry, potatoes, rice, and nothing sugary, including most fruit (berries an occasional exception).

After I'd lost enough weight I went back to playing football again and while I'm still losing size/bodyfat (much more slowly than in 2022/3) I am gaining a bit of weight which is clearly due to new muscle. I'm not bothered by that because the weight itself doesn't matter, it's the bodyfat, and especially visceral bodyfat, that I want/need to avoid.

Does that help?

 

[peterb999]

Thanks to all of you for your responses. It's a lot to think about, but I will start looking into to it all. To be honest, I sort of buried my head in the sand a bit but did make big changes. I was originally 20 stones and had already got that down to 14 stones thanks to my wife who went on a bit of a health kick for both of us and still made delicious food but a lot better for us. Unfortunately once I was diagnosed our marriage changed a lot - I sort of understood as her father was very ill before he died. He had all sorts of things wrong with him including diabetes but wouldn't make any changes to his lifestyle at all, became very ill and died quite a horrible death. I loved him very much, he was a larger than life person and both my wife and I were devastated when he died. She thought that she would have to go through all of that again with me and to be honest I couldn't and can't really blame her as it was really very hard to see him go through it and not help himself at all.

It's funny that we've now been divorced for a year and I've never spoken to anyone about the breakup - people do ask but I just say it is one of those things. We do have a wonderful daughter, she really is fabulous, so I still see my ex maybe once or twice every 6 months when I'm picking up my daughter from her house (she is at Uni for another year). It's weird seeing her after being married 22 years. I don't really know why I'm telling you all this, haha.

Anyway, the food I eat doesn't make me feel any hungrier than I used to feel when I would eat all the time - I would still be starving and now I do look forward to the meals I have but I am very strict with myself and never snack between meals. I really don't know if it is sustainable or not but I still love life and want to stick around for as long as possible. I will start eating more fish I think as I do like that. I did mention to the diabetic nurse that I'd like tunafish but she insisted I shouldn't have it as it was bad for diabetes (she was talking about the canned tuna and not fresh tuna). Is that right?, or should I be able to eat it.

The reason I am still on metformin is because when I saw the nurse in December I had got down to 49 and she said I shoiuld stay on it for the rest of my life as there were no down sides to it whatsoever and it had been used for so many decades without any side effects really. It is true that I haven't suffered any (apart from the number 2 toilet stuff but maybe that is because I took the tablets with the meal).

Maybe when I meet the nurse next week she will suggest coming off it (I had the blood test last week so I saw the results of 38). I am meeting the diabetic nurse who took my blood and she did seem really nice - but I always do say to people that I'd rather they were brutally honest than sugar coat stuff. I am never bothered about getting the riot act or anything like that as we all make mistakes.

I am completely confident that we've cracked the liver results. With it going down by over 500 in 8 days I think I've got to the root cause and won't be that daft again.

 

[Resurgam]

@peterb999 totally wrong. Tuna is absolutely fine. There is absolutely no reason from the point of view of diabetes that you should avoid any meat or fish - or eggs, cheese or other dairy if it has not had something containing carbs added to it.
I had dreadful side effects from taking Metformin and Atorvastatin - I stopped it as things were becoming seriously problematic - never needed them in the first place and had to do quite a bit of work to get back what I lost - and do a lot of cleaning of carpets and upholstery as well. I did get a really good quality cleaning machine though, so it is an ill wind.....
I am glad you sorted out the problem with your liver - must have been concerning - overdosing on supplements is quite common, I am told, as people think if it is good, more must be better. A former neighbour of mine killed their pregnant ***** by doubling up on multivitamin and minerals.

 

[Resurgam]

That was 'female dog' by the way.

 

[KennyA]

I will start eating more fish I think as I do like that. I did mention to the diabetic nurse that I'd like tunafish but she insisted I shouldn't have it as it was bad for diabetes (she was talking about the canned tuna and not fresh tuna). Is that right?, or should I be able to eat it.

The reason I am still on metformin is because when I saw the nurse in December I had got down to 49 and she said I shoiuld stay on it for the rest of my life as there were no down sides to it whatsoever and it had been used for so many decades without any side effects really. It is true that I haven't suffered any (apart from the number 2 toilet stuff but maybe that is because I took the tablets with the meal).

Hi.

Is this the same nurse that said crisps were OK? I don't remotely see how tuna is "bad for diabetes". It doesn't contain any carbs. We eat large amounts of canned, bottled and fresh tuna. Bilous and Donnelly (Handbook of Diabetes) say:

Fish oils are rich in n‐3 fatty acids and have lower triglyceride levels, and there is evidence that higher fish intake is associated with less CVD in diabetes; accordingly, 2–3 servings of fish per week are recommended.

On the metformin - there are well known side effects which you seem to have experienced and they are reasonably common. Bilous and Donnelly say:

Metformin increases insulin action (the exact mechanism is unclear), lowering glucose mainly by decreasing hepatic glucose output. Unlike sulfonylureas, it does not cause hypoglycaemia or weight gain and, indeed, has some appetite‐suppressing activity that may encourage weight loss.....Major side effects are nausea, anorexia, or diarrhoea, which affect about one‐third of patients. Lactic acidosis is a rare but serious side‐effect that carries high mortality. It can be avoided by not giving metformin to patients with renal, hepatic, cardiac, or respiratory failure or those with a history of alcohol abuse.

Personally, I don't see why I'd take a medication that I didn't need.

 

[peterb999]

Thanks, I thought it was odd about the tunafish but it was my first meeting with her so it was all a bit much taking all of it in.

I'll see what the new nurse says next week regarding the metformin. I'm just a bit concerned about coming off it but I'll see what her advice is and then have a good think about it.

 

[JoKalsbeek]

Thanks, I thought it was odd about the tunafish but it was my first meeting with her so it was all a bit much taking all of it in.

I'll see what the new nurse says next week regarding the metformin. I'm just a bit concerned about coming off it but I'll see what her advice is and then have a good think about it.

Go with your gut. (In the case of metformin, quite literally!) I was on metformin and gliclazide, and could ditch both because my diet got things sorted... But that's me. Conventional advice sayd once you're on diabetes medication, you're on it for life, but many, many people here have proved otherwise... Even people who were on insulin. In the end, you're the patient, it's your body, you decide what you put in it... Not a bunch of faceless strangers on a forum like us, not the nurse, new or otherwise, you. So just gather as much information as you can/want, see what you feel comfortable with and suits your needs, test to see what works for you, and go with that.

Personally though, if canned tuna was a no-go, I'd be in trouble, because I eat at least 3 tins a week... Always with oil, as the brine tends to make the whole thing taste like the can it came in. I wouldn't know what to do with fresh tuna, to be honest.

I'm sorry about the divorce... The trauma of her father might've been a bit much, when it seemed like she would have to go through the same thing all over again with another loved one... I think you did deserve a chance to show you weren't just going to do nothing about it. Still... Easy to say, hindsight being 20/20 and you having taken this bull by the horns, which I suppose she didn't expect. If even doctors still believe T2 is per definition a progressive condition, rather than one that is progressive if no action is taken by the patient, well... Can't blame her for running scared. You're taking it rather well though, it seems. Good on you.

Have a great weekend!
Jo

 

[JoKalsbeek]

I had my blood test yesterday. I told the nurse about me overdosing on Vitamin D3. She didn't really know anything about the doses but I told her that I was taking 8,000 iu a day. She went to see the doctor to see what he said. When she came back, she said I must have misunderstood the dose as there is no way I can have bought tablets that were 4000IU as they are not sold. Obviously it was quite embarrasing telling her that I am not wrong and I am that stupid. She went back and then brought the owner of the practice to talk to me, he is still unconvined that I was taking that much and I must be mistaken and asked me to check again when I got home.

They took the blood and I've got the results today. The surgery hasn't phoned me yet, but I found the results on the NHS app this morning (I love the NHS app, it's so useful). The ALT has gone down from 673 U/L to 167 U/L so that is a lot better I presume, but still far too high. I'm now waiting for the phone call and no doubt the telling off that I am going to get (which I completely deserve). Thanks for all the responses to this thread, it really does help talking about it as I don't fully trust doctors not to sugar coat stuff - I'm the sort of person who needs brutal honesty and I have no problem getting the riot act when I do stupid things.

Usually, on the forum, I'd advise people not to take supplements unless a blood test showed a massive deficit, and then to go with the doc's prescribed dosages... Vit D toxicity is a thing, as are other vitamins that can get stacked in the liver in toxic doses. So I know this. I do. I also read about a certain treatment with, amongst other things, extremely high dosages of vitamins A and E for a condition I suspect I have, but can't get confirmed without surgery, which I won't submit to. So I went my own way, took the ridiculously high dosages of A and E, and didn't connect the dots until yesterday... About the sudden massive bruising, my eyesight going to hell in a handbasket (I'm currently wearing +3.5 reading specs and I am still crawling into my screen, squinting), the constant headaches, red flushed face etc, etc. Had another look at A & E toxicity, and sure enough...

So even people who should -and do!- know better, still make mistakes. You found out, and your liver is recovering. Yay! Why read a riot act when you're human and we tend to make mistakes? You're sorting it, so just kudos from me, in any case.

Glad you found out it wasn't anything that couldn't be fixed with time!
Jo