Life (more) miserable since diagnosis and Metformin

Hi and welcome. Unfortunately many newly diagnosed people have this sort of experience - just given metformin and told to get on with it. You'll find the forum is a good source of advise and support - and one thing - try to forget everything you think you know about what "healthy eating" is.

I have no experience with metforim myself (was offered it and didn't take it). However the side effects on the gut are well known and affect around a third of all users, so it's not uncommon.

The thing is that the big impact on your blood glucose is caused by the sugars in the food that you eat, either directly or when digested from carbohydrate. That means things like cereals, bread, rice, pasta, fruit, pastry, anything sugary, including root vegetables like potatoes etc are all sources of glucose - and they're also usually eaten in quantity. You can establish and evaluate the impact of these foods on your blood glucose by using a glucometer, which measures your blood glucose via a fingerprick.

I found my glucometer absolutely invaluable when I was diagnosed. It showed really clearly which foods did what to my BG levels, and therefore what I could and couldn't eat. The pattern is to test immediately before eating, to give you a baseline, and then again two hours later, by which time your insulin response should have dealt with the incoming glucose and got you back close to where you were two hours before. You are not testing to "see how high you go". The peak point is probably around 40-50 minutes after eating, but the test at the two hour mark shows how well your system worked to manage the excess glucose.

So - if the second test is within 2 mmol/l of the first, that shows you can cope with that level of carb. If not, it means yiur system currently cannot handle that amount. The result would be that the excess glucose hangs around in the bloodstream. High levels of glucose over time can cause damage to capillaries and nerves, and trigger high levels of insulin, and therefore risk making insulin resistance worse.

I cut out almost all carb (bar ~20g/day) from my diet in December 2019 and my BG was normal inside four months. I've lost around six stone since then. I eat all kinds of meat, fish, dairy and green veg. I can handle legumes and pulses, so they're on the list again every so often. These days there are "bread" substitutes that allow for bacon (and other) sandwiches, and zero-carb beer.

best of luck. Ask as many questions as you like. The key thing is to find what works for you, there's no single answer - and beware anyone who tells you what you "must do".

Hi @garabe and welcome to the forum.
I'm like @KennyA in that I have never taken (any) diabetes medication. I too used a low carbohydrate high protein (highish fat) way of eating to control my blood glucose and hence remission of just over 5 yrs. The main difference being that I was always slim to normal weight and only became 'overweight' a few months before T2D diagnosis.
Metformin is a drug which acts by 'persuading your liver' to put less glucose into your bloodstream. It takes time for the effect to build up and by it not tackling the primary source of high blood glucose it doesn't have a big effect. Thus, many forum members who have problems, even with the extended release version, find little difference if they decide to give up on taking it.

An LCHF way of eating (to satiety) together with cutting out snacking has a huge difference because, except for Type 1 diabetics, fat and even protein have hardly any effect on raising blood glucose (or on 'making you fat'. Indeed, LCHF has been shown in Dr David Unwin's over 150 low carb patients to be exceptionally good at 'curing' fatty liver, weight loss and normalising blood pressure, as well as producing T2D remission.

That's my take on it. There is sometimes a misconception as people think that the two hour mark is the high BG point, and that your BG has been rising steadily up to that point, when neither is actually the case. There seems also to have been a belief (current about five years ago when I was diagnosed) that you shouldn't see any BG rises/changes at all - this led to some issues among non-diabetics trying out CGMs who didn't understand that BGs fluctuate all the time.

Here's a personal example which I only found out through using a CGM. I had a small latte while waiting for a train. Normally I wouldn't fingerprick for something like this. The CGM showed that about 15 mins after drinking the latte (no sugar, this was just lactose) my BG started to rise from 5.3. After about 40 minutes it topped at 9.6. By 60 minutes I was back at 5.3. It would have been undetectable via normal pattern fingerpricking.

In addition, I don't like calling perfectly normal BG rises "spikes" - it makes them sound dangerous and unusual, and they are certainly not unusual. Given that non-diabetics experience them, normal rises are unlikely to be "dangerous" in the way they are sometimes described. The attached short study shows the impact of various meals on non-diabetic CGM wearers - they all show rises after eating, bigger rises the more carbs in the meal.





The graph is from the study and clearly shows the rises and falls in BG after eating (values in mg/dl). Remember these people are not diabetic.

So - yes, if someone was at 4.5 pre-meal, and at 6.5 or less at +2hrs, that would be OK. As you say, personally I would want to see a fair bit less than 6.5, but as it would have been a carby meal, it would do.

Don’t be afraid of fats, I never take any notice of the traffic light system on the front - it’s not fit for purpose. I only use leg & thigh meat from chicken, breast is pretty tasteless. I don’t consume loads of fat but I don’t avoid it either, I don’t add much but I don’t take it away, so I eat fattier cuts of meat like chicken legs, pork chops, lamb, steaks, salmon, eggs, a bit of cheese, butter avocados, good oils like extra virgin olive oil, avocado oil, nut oils like walnut, sesame, coconut oil, mayo, seeds sprinkled on my veggies & salads. Not loads of everything just normal portions.

These are all natural healthy foods that will keep you fuller for longer, the only macro I look at is carbs,
So for example today I’ve eaten
breakfast 2 eggs scrambled in a nob of butter with some grated cheese & everything but the bagel seasoning sprinkled on top (I’m addicted to that stuff)
Lunch a cooked chicken thigh diced, couple of cherry tomato bit of gherkin, a pickled onion all diced up and mixed with a tablespoon of mayo on a low carb roll
Dinner, a couple of Sainsburys Toulouse sausages 1.4g carb for 2, some cauliflower mash & green beans