Hi there diagnosed type 2 last Tuesday and already a bit concerned.

The two are not mutually exclusive. (I'm doing both.)

Both low carb and Metformin address blood glucose control - just from different directions. Low carb avoids adding glucose (via carbs) to a system that is no longer very good at handling it. Metformin makes your system better at moving the glucose you put in into the places that need it. If there's a way to address the underlying problem, I haven't found it. (My personal experience with diabetes is very brief, but I've been preparing for it for years - since every descendant of my maternal grandfather who is my age or older has it.) Of the diabetes medicines, Metformin is the most innocuous (as long as you can handle the GI results). (I would refuse to take sulfonylureas - my personal opinion is that they are harmful and decrease the time between diagnosis and insulin insufficiency.)

I was diagnosed in October. I started low carb immediately (< 20 grams in 3 hours/capped at 50 grams a day). Within 3 days my blood glucose levels were essentially normal. (97% of my readings since then have been normal (under 7.8 during the day and under 5.6 fasting). Of the handful outside of the normal range, none have been anywhere near the diabetes-normal that you will likely be encouraged to strive for of 10 mmol/dl by 2 hours after eating. I haven't had a second A1c, but based on ~400 readings I expect it to be around 5.39%.

What I have done since diagnosis is to test to see how my blood glucose responds to any new food. I test before my first bite, at 1 hour, at 2 hours and (if hour 2 is above hour 1) at hour 3. If any of the readings are above 7, I cautiously try the food again. If I get a repeat performance, I dump the food or try it in a much smaller portion.

Be prepared for resistance if you suggest a low carb diet to your health care professionals. Most health care professionals are not on board yet (or view low-carb as somewhere north of 100 grams of carbs a day - a level that would not allow me to control my blood glucose). Research supports it as a first approach to management - but if you decide that is how you want to go you may need to advocate for yourself. Here's a compilation of research.

As a first step, you may want to get a meter and start testing so you see what your patterns are, and what you are reacting to. There is a wide variation in how people react - what foods, how high the spike, how long it takes to return to normal. You are likely to have much better control (and much less anxiety) if you become good buddies with your diabetes.

The 2015 revision of the NICE recommendations says that Type 2 diabetics should be encouraged to eat as a healthy person eats and every NHS dietitian will push that message. Whatever they may think privately they could be accused of malpractice if they go against what their bosses say. I find this illogical.

When diagnosed with pre diabetes or diabetes proper the method is to measure your blood sugar and if it is too high you are diagnosed. The diet advice makes it go higher since dietitians say you must eat carbs with every meal. I can't see the sense in that advice.

When I was provided with a meter I assumed it was to help me control my sugar level. It wasn't, it was only given to me to check I wasn't hypo due to the drug I had been given. I used it to control my sugar level by using it to identify which foods caused me to spike. The NHS doesn't seem to make any allowance for controlling your levels by the use of food, they only do pills.

My advice is to tread carefully when you see your nurse and don't bang on about low carb since you may put her in a difficult position. She may agree with you but she can't start carrying out treatments that are not approved by NICE. Afterwards go home and read the information on this site. You know it makes sense.

Hi supergirth, and welcome.

It is impossible to treat a virus with antibiotics - because antibiotics treat a bacterial infection, and have no effect whatsoever on viruses. So I think they may just be giving you antibiotics in the hope that it works - kind of like a scattergun effect.

Your 'viral' symptoms of fatigue and mugginess and lacklustreness could very well be caused by high blood glucose. I get those reactions every time I eat too many carbs.

So I am kind of questioning whether your surgery is looking at this in your best interests...

The NHS is actively discouraging providing T2 diabetics with testing equipment, based on the costs. So when you see your nurse/doc they will probably tell you that T2s don't need to test, and it will make you obsessed and stress you to know what your bg is at. I was told exactly this. Nonsense of course, but as @Squire Fulwood says, they have to toe the party line.

Many people here fund their own testing and consider it an invaluable tool to get control and tailor their diet to suit their body's individual reaction to certain foods. We are all different. For instance, some can eat porridge with no ill effects, others can't, unless they want their bg to shoot skywards. How would we know this without a home bg meter?

There are lots of meters on the market, but the cheapest I have seen is the SD Codefreee, available from Homehealth, eBay or Amazon. If you are in the UK, go for the mmol/l unit version. The other version is for the US.

Hope that helps.

You are not alone in your feelings about the doctor and the practice nurse. I was diagnosed Type 2 diabetic almost one year ago now. The eye exam will come from the hospital and they will put drops in your eyes so they can check your eye health and this will become a yearly check - it took several months for mine to come through. The doctor I saw gave me the same info and prescribed metformin - I read all I could and signed up to this forum even though the guidance was not to......
Diabetic Nurse was a quicker appointment - but gave the advice of eat carbs with every meal (something which pushes up my blood glucose levels and keeps them high) - as others have said they have to give the NICE advice.
I went to the DESMOND Day - this took months to come through - I felt like the school swat! Others in the group were either reluctant to answer questions or had not read a thing about becoming diabetic - like the health implications.......

Like you I found the information very conflicting. I was only informed recently that I will continue to have Fasting Blood Tests every three months until they get the medication right and I get my blood sugar levels down to a reasonable level (I have yet to accomplish this).

Following suggestions on this forum I purchased my own testing kit and I continue to purchase my own supplies - I went through a period of testing before and after meals and learnt how my blood glucose levels reacted to certain foods - I gradually learnt what was OK and what was not acceptable for me -- because we all react differently it has to be something we each do for ourselves.
I still cannot get my blood glucose levels down as low as my doctor wishes - I have to go back shortly to see him again as just had yet another fasting blood test - looking at perhaps changing medication - I have already had Metformin doubled but does not appear to be making much difference.
I do keep my carb intake low - perhaps I need to make it lower still but it is not easy.

My advice if I can give any is it will be this all takes time, it is a learning curve for you - it is your health and you need to make decisions on how you are going to look after yourself. If you cannot afford to purchase you own testing kit then do ask your doctor if they will provide one even if it is only for a few months so you can begin to learn.

Hope this helps.

As someone who (along with lots of others on this forum) has reduced her BG readings to reasonably low numbers, I would disagree that you can reverse type 2 just by low carbing. I would prefer to say that my T2 is in remission for as long as I eat a low carb diet.

I believe there are diets that claims to reverse it by giving you the knowledge to get rid of the visceral fat which as I understand it) prevents your pancreas from working properly but you have to stick to less than 800 calories a day for 8 weeks. There are many brave people undergoing these diets and posting about their experiences on this forum. If you want to know more then search on this forum for ND or Newcastle Diet or 8 week diet.

Hi @supergirthuk welcome to the forum, I will tag @daisy1 who will be able to provide you with useful info for newbies.

Do you know what your fasting BG level was? If you have a virus/illness then your BG levels can be raised. If you are borderline for diabetic classification I would ask for a second test in a week or two after you have tried low-carb for a while. OR ask for a HbA1c test which looks at your BG levels over the last 3 months or so.

As others have said the NHS staff have to follow official guidelines, in my own experience I fought against the prescribed drugs and asked (begged and pleaded!) to try diet control first. I was given 3 months and my GP wasn't very encouraging to say the least, but I am stubborn so I went low carb and lowered my BG levels enough for my GP to allow me to continue.
Its been over 5 years since I was formally diagnosed (I had gestational diabetes 9 years ago and think it never went away but I wasn't given any follow up). I have been diet controlled ever since, it isn't easy (especially as I am also vegetarian) but when I see the issues many of my family have (about last 5 generations on both sides of family have been diabetic, all my siblings are too) family members have lots of complications but most don't really control their diet at all, they use medication and eat what they want; but have many hypos and hypers, leading to retinopathy, ulcers, amputations etc. scary! In my opinion its better to have a good diet control first and medication if needed too, to keep your BG levels as stable as possible.
If you do want to go low-carb then I suggest getting a meter to test which and how foods raise your BG levels. we are all different. The low carb forum has lots of recipe ideas and ways to substitute foods, so mashed cauliflower instead of mashed potatoes etc

Good luck and ask as many questions as you need

supergirthuk said:

Thanks Neohdiver and Squire Fulwood,

It's all very daunting because I was, and pretty much still am, ignorant about diabetes. So to meet the first hurdle of diet and not know which way to jump is infuriating as what I have understood from what I've seen on YouTube having a low carb diet and being on medication work against each other. The advice for the meds seems to be to have a balanced diet whereas I'm seeing people implore me that the dependency on meds can eliminated and type 2 can be reversed via a low carb diet and exercise.

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Definitely daunting.

As far as working against each other, Metformin and low carb complement each other. There are other medications that are, at least, more challenging with low carb.

Simplistically speaking, the elevated blood sugar that characterizes diabetes has two sources. In the first stage of Type 2 diabetes, your body doesn't use insulin well (insulin resistant), so it takes longer for your insulin to "clean up" after a meal. In the second stage, your body doesn't make enough insulin (insulin insufficiency), so since there is less of it, it takes even longer and can't ever really get caught up. Metformin treats the first stage - it makes the insulin you have more efficient. Sulfonylureas work on the second stage - they help your body make more insulin. The challenge is that your body lets insulin out to do its job in response to eating. When your system works properly, it leaves a certain amount of glucose in your blooodstream at all times by matching how much insulin is sent out to the food you consumed.

Sulfonylureas make your body release it at a steady pace. When extra insulin is floating about with no food-related glucose to move, it just keeps moving glucose out anyway can drops your blood sugar below where it needs to be (a hypo). That's the reason for eating a steady, but relatively high, quantity of carbs if you are on a sulfonylurea - to keep the insulin the drugs make your body spit out busy (without dropping your glucose below a safe level). So people who are taking sulfonylureas (e.g. Glyburide, Glucovance, Glipizide, Metaglip, Glimepiride, Avandaryl, Duetact) and who switch to low carbs risk having lows because they don't have enough carbs/glucose to match the added steady-state of insulin. The sulfonylurea dose can be adjusted - but it isn't the automatically harmless match that Metformin is. That may be what is being referred to as an incompatibility with meds and low carbs.

(I have other issues with sulfonylureas - a well documented side effect of sulfonylureas is that they (at least temporarily) can destroy or exhaust the cells that produce insulin - so they may move you to insulin insufficiency/dependency faster. I don't ever plan on taking them for that reason. If I become insulin insufficient (the natural progression of Type 2 diabetes as chronically elevated blood sugar kills off the beta cells that produce insulin), I will push pretty hard to go straight to insulin. I hope to avoid that entirely by keeping my diabetes in remission by diet)

supergirthuk said:

I started Metformin (1x500mg daily) yesterday but every youtube vid I see saying a lot about low carb diet being the way to go instead of drugs.

Concerned that I may be going down the wrong path in prioritising blood glucose control instead of the actual cause of the diesase which insulin resistance.

I have not seen the dietician or had the Diabetic team contact me yet but have seen the nurse who seems to be taking her time about things.

Any help or advice is gratefully received.

Many thanks.

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Hi supergirth

Welcome it is a great resource.
My two Bobs worth -Get a Meter Monitor your levels and ask questions here about them

I know everyone is different but I've never noticed a drop in energy levels when accustomed to low carbing except during the first week when I was adjusting. There is a thing called carb flu that a lot of people go through when you feel horrible for 1-7 days but if you just continue keeping the carbs right down you do come out the other side of the carb flu and, indeed, a lot of people then experience a feeling of well-being or even euphoria.

I started on a low carb high fat diet which I found was not to my taste, I now follow a very low carb, medium fat, average protein diet with most of my carbs coming from leafy green veg and a small amount of good equality high % chocolate (purely for medicinal purposes of course ) and I have lost 4st since the end of August. When I started this way of eating I felt old, constantly tired and with no enthusiasm for anything. I now feel like there's a lot more life left for me to enjoy and, as a side benefit, I am a lot less stuck in my rut and a lot more interested in trying new things.

The main thing about low carb is that it can be tailored by you to your taste.

supergirthuk said:

Thanks again Neohdiver,

This lot is hard enough to follow without feeling so fatigued for whatever the reason I am.

I take on board what you are saying but I'm certainly at the bottom of my learning curve and I suspect it will take me a lot of time, if I ever do, to get used to the terminology and finer detail of it all.

I will get it under control eventually.

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That's to be expected. I had years of advance warning (because of family history), so I didn't come into it blind.

One of the unexpected surprises of low carb (or reduced blood glucose) is that I have much more energy. I thought that my fatigue was just due to my impossible life situations - until someone pointed out (after I had reduced my blood sugar) a sudden change in my affect. I checked my blood sugar and - sure enough - it was one of the rare times I've been around (or over) 7.2. i started paying more attention after that and elevated blood sugar definitely hits me like a ton of bricks. If I am being attentive, I can usually tell when I go above 7.2 (and I was there constantly for probably most of a year before that - no wonder I was fatigued.

As to following the information. If it seems like an understandable explanation (I tried to make it simple) bookmark it and come back later when you're ready to digest it.

Even the step of getting a monitor and watching what's going on (whether you understand why, or not) is a great way to start to conquer this beast! Information gives you the power to change.

@supergirthuk

Hello and welcome to the forum As other members have recommended, I think a low carb diet is the way to go and not restricting fat which will give you energy. Here is the information we give to new members and I hope you will find it useful. Ask more questions and someone will be able to help.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 150,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

LOW CARB PROGRAM:
http://www.diabetes.co.uk/low carb program


Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

supergirthuk said:

I also have read the low carb diet massively reduces energy levels because of it being the body's supply of energy so I am thinking If I do go low carb and immediately reduce my energy levels where will the energy come from to exercise enough to lose my weight which I suspect is the key to reducing the probability of and onset of the severe complications.


That all said, I'm a prime candidate for diabetes at 54, 320lb/146kg and 5ft8/1.75m with an extremely sedatory lifestyle (no family history of diabetes though) but at least I know I have it as opposed to the poor people out there who don't even know.

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Hi @supergirthuk. Welcome and well done on having found this forum and researching for yourself how to manage your condition. There is a lot of good advice and support on here.
Regarding the low carb diet reducing energy levels, if you read some of the threads on here you will see that a lot of forum members follow a Low Carbohydrate High Fat approach to eating, because eating more healthy fats, like butter, cream and cheese, replace the energy we would have got from sugars and carbohydrates (which turn into sugars in our bodies). Fats also make us feel fuller, so we don't feel the need to eat more.

I am not on metaformin but from what I have read on here I gather it does help with weight loss, so that might be the reason your GP prescribed it. It is also said to strengthen your heart.
Exercise does not help that much with weight loss, unless you are running a marathon every day, or spending hours in the gym daily. The saying is you can't exercise out a bad diet. So it is probably best to look at your diet, including portion control - the NHS advice is to eat portions no bigger than your fist. It is difficult at first, but you will get used to it after a while.

supergirthuk said:

I have lost considerable amounts of weight in the past (9.5 stone over about 20 months on the old Slimming world red and green (mostly green days) along with exercise) so I know the willpower is there and the drive too but thing I'm starting to fear is that I'm not the dietician or pharmacist/chemist I might need to be to get to grips with managing this.

I suppose time alone will tell.

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Hi supergirthuk,welcome to the forum,when i first joined the forum..i was 17st 8 lbs and my bs's were 26.8 mmols, blood pressure 190/110 had neropathy in both feet felt like walking on glass, but by following lchf and the advice from posters here, my bs is now regularly in the 4.5 mmols and my bp 120/55
This is over 17 months much hard work ...but it's been worth it now weigh 12st 9lbs
Neropathy totaly gone now
This forum is literally a life saver

If you can manage that using Slimming World then you'll find this a lot easier. I was (am) a Slimming World (and WeightWatchers and Rosemary Conley classes) failure; I was just so hungry ALL the time, especially on green days.

Just a thought - further up the thread you mention exercise. Now, exercise can and really does help but it isn't essential. I have arthritis in both my knees and neck and a dodgy back so I can only manage a 20-30 minute walk on a dry day. But, as they say, 'every little helps'.