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Linagliptin

Discussion in 'Type 2 Diabetes' started by tinker1, Jan 11, 2022.

  1. tinker1

    tinker1 Type 2 · Active Member

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    Hi my blood sugars have risen slowly over the last ten years. I have kept to low carb and exercise I have taken 4 metfomin sr a day. My diabetic nurse now thinks I should progress onto Linagliptin to inprove insulin levels. I am feeling like I have failed myself are these feelings normal and how have people got on with linagliptin. Thanks in advance for replies
     
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  2. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    Hi @tinker1 I feel it is normal to feel you have failed - even if you have done everything the best you could. It's part of the blame culture around Type 2 Diabetes.

    Do you have a Blood Glucose meter and if so, did you use it to measure which foods to avoid and which were OK for you?
    How high has your HbA1C gone up to?
     
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  3. AGC_68

    AGC_68 · Well-Known Member

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    You haven't failed @tinker1 , you're doing the best that you can. Sometimes the system fails us though as we can't always get all the information about our the status of our body (internal fat, insulin production etc.) and/or the support that we need to make the most optimal choices. They pretty much only test glucose and cholesterol levels. Saves money which is important for the NHS, but they might save more money and improve public health with a better application of tests. It might be worth trying to reduce your internal fat by restricting your calories as well as going low carb. I didn't think I could've had much internal fat when I was diagnosed as I looked like a tank, but I followed the Newcastle protocol, went very low calorie and low carb for about 10 weeks. It made a huge difference.

    First I just tried cutting out starches and sugars without restricting calories too much, but the effect on blood glucose levels wasn't huge, I saw an improvement but not enough. So I went on the Newcastle protocol and low carb. So that was very low calories for about 10 weeks and what I ate was low carb. That really made a difference. I needed to lose the internal fat I had built up in and around the internal organs, especially liver and pancreas. It took time, but it did work. It is definitely worth trying. There are resources on this site that you might find really helpful. Start with this link (it will lead you to other useful links too):

    https://www.diabetes.co.uk/reversing-diabetes.html

    The key points are:
    • You have to lose some of that internal or belly fat. That means calorie restriction. You'll see results quicker if you go on a very low calorie diet for 2 to 3 months.
    • Reduce the carbohydrate intake in your diet drastically - no sugar, no starches (bread, pasta, potatoes etc.). Emphasize whole foods with plenty of protein, don't avoid natural healthy fats (but don't load up on them either, at this stage you need calorie restriction), eat plenty of non starchy vegetables with lots of greens and other colours. Make sure you get enough protein, that is a must have, you must meet your daily protein requirements in your diet). You don't store protein, you will need to eat it everyday, especially if you go low calorie. The body wants you to keep eating until you've had enough protein, make up the rest of your calories from healthy fats and non starchy veggies. The fat that comes naturally with eggs, fish, chicken, red meat and full fat Greek yoghurt is good to eat, fats like olive oils, and from avocados and nuts are good too. I used my Fitbit dashboard to log what I ate every day (if you don't have a Fitbit use an app or website like myfitnesspal to log your food). It gave me an understanding of how many calories I ate and how many grams of Protein, Fat and Carbs I was getting in. It really focussed things for me. The "800" books by Michael Mosley based on the great work by Prof Taylor in Newcastle describe really well what you need to do and give good advice and tips.
    • Move more, doesn't have to be crazily strenuous- walks, repeatedly sitting down and getting up from a wooden chair at the kitchen table, press ups (whatever is doable, hands on a wall, hands on a table, hands on the floor, whatever you can do). Again Mosley's books are helpful on this.
    • Be patient, and don't be too hard on yourself, it takes time. Work with your doctor/nurse. I told my doctor I was going to try diet and lifestyle rather than the Metformin she was going to prescribe. I didn't get any contact regarding support for T2 from the NHS for months. By then I'd luckily sorted it out myself . But I kept track of my BGs with a monitor and I did find that after about 7 or 8 weeks there were really good changes. If your BGs are spiking a lot talk to your GP, they may prescribe meds to help. They can reduce or even stop your meds once the low carb diet starts to make you less insulin resistant and bring your BGs down.
    Good luck, don't be disheartened. Take it one day at a time. There are forums on here with people who have found good health by going low carb or combining low carb with meds. Everyone is really helpful, everyone remembers how it felt when they were first diagnosed and the journey to get to good BG levels. I really recommend the Fast 800 book, it gives great background and good practical tips.
     
  4. tinker1

    tinker1 Type 2 · Active Member

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    Thanks for your reply my last test result was 55. I am very slim only size 8 so loosing weight will not help my blood sugars. I walk between 10k and 15ksteps everyday. I really do not know what else to do apart from add more meds ☹️
     
  5. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    An HbA1C of 55 isn't that bad. Neither does it seem to me to ne a level at which you would need to go on to Linagliptin. I would be hesitant about it even if unless your Insulin levels have been tested and found to be low. That would mean that your pancreas is in trouble and they want to use the linagliptin to squeeze out the most insulin they can from it., before the almost inevitable progression to insulin after the pancreas gives up.
    But if your pancreas isn't producing enough insulin then weight loss alone won't help since this may reduce insulin resistance, but is unlikely to increase insulin production.

    I am/was a slim T2 with an HbA1C of 53 so I didn't want to try weight loss either.
    Instead I chose a Low Carb way of eating - no reduction in calories - just a reduction in the amount of Carbohydrates I ate based upon the readings my BG meter was showing me. I needed to go down to between 20gms to 40gms of carbs per day.
    Low carb has a slightly better success rate than a calorie restricted diet does - though for most even if they increase their calories (I did) there can still be some weight loss, because a healthy normal weight man has around 20% or more body fat and a woman has even more. It is the fat around the internal organs an in the liver which do the damage, so if you rally have Type 2 (not a mis-diagnosed Type 1) then you do need to lose some weight , but juts that internal excess fat in and around your organs.
     
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  6. MrsA2

    MrsA2 Type 2 · Well-Known Member

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    It may be that you are what I'd know as a TOFI, thin on the outside, fat on the inside, where fat collects around the liver and causes (or is caused by) insulin resistance. So it's not a matter of weight as such.
    You could try:
    Cutting carbs even further and going keto or even carnivore for a while to see if that has an effect on bg
    Introducing longer fasting periods to give your body time to deal with the bg, perhaps having a day a week without food, or one meal a day. Whatever suits you and your bg.

    You may find that this results in a side effect of a little lower weight, but that's not the aim, lower bg is, as it sounds like you really don't want to go the more, and more, medication route. Worth a try perhaps?
     
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  7. AGC_68

    AGC_68 · Well-Known Member

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    @tinker1 - do not despair. As others have said a HBA1C of 55 is really not too bad. We don't get all the tests that could help us understand our optimal course of action. No one can know for sure what their internal fat stores are really like without an MRI. That's not going to be happening for all those diagnosed with T2. Too expensive. If you are a T2 your pancreas is probably producing insulin. I really wish they would measure insulin production and test for late onset T1 and other variants just to give a more certain diagnosis to us patients who have diabetes symptoms later in life. However it is true that the most likely thing when you develop symptoms at this stage in our lives it is going to be T2. Lowering your energy intake especially carb intake is very likely to make a difference. You don't have to be overweight to get internal fat in you liver and pancreas. It is not your fault, it just happens to some of us. At a certain age depending on genetics and diet your body cannot store away excess BG in you muscles and adipose tissue anymore. Other people can be overweight but are still able to store the excess away by producing more adipose fat. That's just genetics. Nothing we can do about that. For me the amount of adipose tissue my body will allow to build up before starting to pack the fat away internally is way lower than it used to be. I was built like a tank, huge muscles and very big build, so I did not look overweight. I could still do things athletically that most people half my age couldn't handle. But I had a HBA1C of 60. I went low carb and restricted my calories. I didn't look very different for quite a few months, but I lost weight and I was checking my BGs and they slowly started to improve. Thankfully the body starts to shed the internal fat first which is strongly indicated as a factor in T2 diabetes. The body also loses a lot of glycogen on low carb. This starts to give your body a bit more of a buffer - a storage space for glucose to keep you BG lower. You can't put much in there compared to your adipose tissue but it is the first short term storage for excess BG under the influence of insulin. As you eat less simple carbs your body slowly starts to need less insulin to manage you BG levels, as you lose weight you insulin resistance improves too. Your adipose fat cells can accept more glucose under the influence of insulin because you are under the set point amount of adipose fat where your body's adipose cells were not willing to allow any more energy in and to grow any bigger. If you're T2 your body is not willing to make anymore new adipose cells, it tucks any excess energy it is able to away in internal fat, the rest stays in the blood. This set point at which you can no longer store more energy or create more adipose fat cells is genetic come a certain age it is like a switch gets flipped if you have the genetic predisposition. Passing this set point loses you your metabolic flexibility. But if you get rid of the internally stored, visceral fat, especially in liver and the pancreas, things start to improve and you can go back to a maintenance level of calories, keeping the proportion of your diet that comes from carbs under more control. For some people this might not work fully, I won't know if it has worked fully for me until I get my next HBA1C results, but my self testing with strips is looking positive. But even if it did not bring me to an acceptable range and I needed to go on metformin or some other drugs, I would still limit my carbs to greens and non starchy veg, eat a good amount of protein, and make up the rest of my energy requirements from healthy fats. The goal is to have good BG levels good insulin levels, whatever combination of diet, activity and medication work for you. That is all that matters. Talk more to your Diabetes Specialist Nurse (DSN) about diet, low carb, activity, impact on meds etc. I only met mine for the first time yesterday! But it was a good and useful meeting. There's no one size fits all solution, it depends on the person, as long as you get good BG levels and your insulin levels are not having to be consistently high to keep them there that's good. Diet, activity, medication or any combination of these doesn't matter as long as you move towards that goal. Take it one step at a time and see what you have to do to get your numbers going in the right direction. You have time.
     
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