@EllieM I actually don't see cpeptide on any of my local doctors blood results . they must not do it, I don't have the hospital bloods available to me
low bmi type 2 - doctor wants me to half my medication - I'm very worried about this
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I have read most of your thread, but I apologise I haven’t gone beyond your post here.
I am a low BMI. I eat less than 100gr carb a day. Some days, like today, much less than that. I am 160cm tall, and weigh an average of 48.5kg (steady for several years +/- 1kg). I dont track calories every day, but when I was, I was getting through about 2500. I’m Not a gym bunny, but I do keep moving.
In terms of the impacts of your various remedial strategies to tackle your diabetes, I’d be surprised if Metformin gave you the biggest impact. I tend to view Metformin as oiling the cogs, rather than driving the motor or condition improvement.
In terms of your numbers, today, when you have Covid, there isn’t a massive amount you can do about that. Elevated sugars is a common symptom of Covid, but for the vast majority of folks, their sugars come back into line as they recover.
I’ll pose a question now.
if you were staying on your full dose of Metformin, what would you be doing, and what would your expectation be for your next HbA1c?
I’m not supporting the medics or saying they are wrong, but if your dose is reduced, then there is nothing to say that if you show your diabetes is gaining ground you couldn’t have your meds increased again.
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On a reduced carb diet, if you need more calories, you can add a bit more fat to your diet. I don’t mean eating slabs of butter, more adding butter to veg, or having coffee with cream, rather than milk.
In terms of energy delivery, it just takes a little longer for dietary fat to turn to body fuel energy, but it does get there.
Thanks @AndBreathe I've never really ate butter but I like the idea of cream to coffee - good tip. I love my coffee but the milk sometimes is an issue.
I've started adding EV olive oil to meals also.
You are getting many good fats with that and not much saturated fats. And it helps regulate bloodx ugars
Hi @AndBreathe thanks, your BMI is identical to mine. 18.9. Yeah 2500 calories would stabilise weight for me. 2800 gain a little.
If I was on my full meds I would -
1. Relax more . I wouldn't have to figure out what amount of carbs works with the new meds. I know exactly what works for me now to get good hba1c . And I know how to maintain and slightly gain weight with my current meds. I would have to do less research of nutritional values and how all the diet needs to be adjusted
2. I would use more carbs than I would to try and increase my BMI a little. As well as the good fats, proteins etc... I may loose more weight with covid in the coming weeks yet. So starting on half my meds with my BMI on the limit is not ideal.
3. I would worry less. I know I would get more spikes over 11 etc.. and they can worry me. when I have a green trend for the week it is such a good feeling. And especially as of recent I could achieve this without much thinking.
4. I could help my partner with more tasks and have more time to spend with her and my child instead of having to do more research and thinking about blood sugars
5. I wouldn't have to buy new libre sensors. They would be a necessity for me under half of my meds for 4 to 8 weeks I'd say. I'm very analytical and want to know what's going on. But at the same time I like it when I know what's going on and I don't have to be as analytical anymore.
Basically going on half meds is like starting all over again, when I've spent the last 8 months working hard on a system that works and my life is easier now and it's going to be taken away from me.
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Cream is lower carb than milk, and much more calorific.
Choose fattier cuts of meats - belly pork, shoulder of lamb, or chicken thigh, rather than breast, to top up tastier fats and to add calories.
It really is very doable to be low carb, slight and active.
I was diagnosed in the dark ages of 2103 and have eaten similarly to I describe since. My A1c was 73 on diagnosis, and 37 4 months later. It has been 33 or lower, ever since. I modified my diet post-diagnosis, being guided by my meter (pre-libre).
A couple of years ago, I took part in some research into heart disease in those with T2. I had various MRIs, high resolution CT scans, bloods, ECG, Stress ECG, gas transfer tests to see how my heart and circulation was coping. All clear and very low levels of arterial calcium. A low carb diet isn’t hurting me at all. In fact the cardiologists were supportive of it.
I live a good life, with plenty of energy to develop and maintain a large garden, walk 20 miles in a session, or when on long trips, at least 10km a day, every day for 3 months.
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I’ll comment on your points in the order you make them:
1. You have your nutritional values “bank” now, so new foods would be an add on, but you have a decent base.
Metformin is often associated with weight loss, so in your position, a trimming back might help you out because it might be easier for you to maintain or gain weight. Most T2 are looking to trim up a bit, so Metformin is advantageous in that regard.
2. Why increase carbs, when you can increase caloric intake, in a nutritionally dense way, without, by just adding a bit of butter to veg, or choosing chicken thigh over breast, etc.
3. You might be pleasantly surprised how your blood sugars react to trimming back Metformin. Many things impact blood sugars, from diet to illness (a you are finding out now), to weather, to stress, to sleep, to hormonal movements. when reviewing blood sugars, with T2, it is important to look for trends, rather than spot values, so I might be inclined to ogre you to look as much at average blood sugar, and time in range, as at spot values. Spot values can deliver some nasty red herrings.
4. Just do it. You have banked a huge amount of information, data and experience, so cut yourself some slack. Your recent blood sugar stands you in extremely good stead. Provided you have regular bloods done, and you are continuing with good practise, you’ll not go too far wrong.
5. You could contract with yourself to reduce your sensor usage. Many folks living with T2 use the Libre periodically, rather than regularly or full-time. You could perhaps consider pausing Libre use for, say, a month, then use a sensor. That would see you over the very early days of your body adjusting.
Those are just my thoughts. I’m certainly not saying you give up caring about what’s going on. I’m more suggesting maybe now is a decent time to use the foundations you have spent recent months laying, over the longer term.
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that still doesn’t identify which changes caused how much of the drop
I suspect partly from the extra medication, partly because you were more settled with your routine anyway and partly because the low carb had started working.
Dawn phenomenon happens at any time of the day after a while without food as well as in the early hours. Foot on the floor syndrome is much the same. Whatever you call it it’s the same mechanism happening. After getting out of bed is a very common time for it to happen. So are the higher spikes at 9am before or after breakfast?
not so much if you ditch the whole grains. They have virtually the same carbs as the white versions, they just absorb slightly slower but it takes longer. Neither a spike nor a prolonged bump are good. Cashews are one of the highest carb nuts going btw. I won’t even mention the oats beyond the fact they are two thirds carbs and the whole lower gi thing doesn’t really work for lots and lots of us
Metformin doesn’t usually cause much weightloss in reality and if it is having that effect on you then lowering Metformin would help your situation wouldn’t it?
Unfortunately “living with” covid means just that. We will all repeatedly get infected and have to deal with the consequences. Hopefully short lived but sadly not always.
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HSSS
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carbs are not the way to gain weight unless you want to also raise blood glucose. Fats and proteins are. I’m not sure you’re quite grasping that. If you push your body to deal with more carbs than it can cope with (using medication to push down bgl) then you are still raising insulin levels to deal with those carbs. Over time that extra insulin increases resistance to itself and is what makes T2 progressive.
you probably wouldn’t get those spikes now. And less likely to if you went back to the 100g (or less). You can still exercise as you are to help things.
Theres not much more to research unless you want to. Drop some carbs replace with fats and proteins. Simple. Monitor. Ask for a repeat hba1c in 3 months to check the effects. Adjust if necessary at that point.
or use a meter as that can work out cheaper. Or use a libre two weeks on two off.
It’s not square one. You still have all the same knowledge you’ve gained in the last 8 months. You’ve already stepped the carbs down from pre diagnosis. You just need to take another step. Diabetes will be for life. Things will happen, illness, life events, burnout, injury etc etc. Having to readjust along the way is part of the deal unfortunately. I still think you aren’t giving yourself credit for the changes you made and attributing more than is warranted to the metformin. A short trial at the lower dose would establish what the truth is and you’d know for sure.
Athletes, construction workers and others active non obese people maintain their weight on keto let alone low carb. Yes I understand it’s difficult for you but I think that’s because you are holding onto carbs for calories and not replacing them sufficiently with fats and proteins to meet your needs.
If it’s really too big an issue for you (and we all have our limits of what’s doable) why not use this list to try and convince your dr to keep your dosage the same.
All of my comments assume you are in fact type 2. Which tests were done to confirm you are T2 rather than a slow onset type 1 who is holding it at bay for now with the exercise. Weight loss, slim build and a rapid rise from normal to such a high hba1c all are flags that should be considered. The tests would normally be antibodies (only 100% if positive as a negative can still occur in T1) and cpeptide/insulin
Alternatively it is possible that the hba1c is inaccurate if you have any conditions that affect the life span or shape of red blood cells eg some anemias, sickle cell and others. In which case maybe it never was as high as believed. There is a fructosamine test that is more accurate if that’s case.
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I have too say what you have achieved most T2 wished they could do you are on the path to putting your diabetes into remission with your hb1ac that low what more do you expect personally I think what your medical team is doing is exactly what my docters have done with my medication I have been taken off insulin as hb1ac was 115 now down to 42 and I have been advised to keep doing what I am doing low carb diet with high fat, and proteins and give it next blood test and I may have another reduction or medication stopped which Is what I want after being nearly 10 years T2.
I think the problem you have and many of us don't realise is the root cause is that we are insulin resistance and that is why many or us became a T2 and now you have change lifestyle and cut poor foods out your body is becoming insulin sensitive and your sugars have got I'm line and your body is telling you that it can process foods better and this will benefit you in future.
With regards to your exercise are you doing cardio or just weights as I think your not eating enough as now your metabolism has been kicked started you most likely need to be in a calorie surplus to as they say bulk up to stop your body from losing weight.
I think the problem you have and many of us don't realise is the root cause is that we are insulin resistance and that is why many or us became a T2 and now you have change lifestyle and cut poor foods out your body is becoming insulin sensitive and your sugars have got I'm line and your body is telling you that it can process foods better and this will benefit you in future.
With regards to your exercise are you doing cardio or just weights as I think your not eating enough as now your metabolism has been kicked started you most likely need to be in a calorie surplus to as they say bulk up to stop your body from losing weight.
Type 2 diabetes is essentially Insulin resistance, improve this and everything improves.
High blood sugars with Insulin resistance causes Glucose to not be utilised, hence malnourishment. But if eating low carb your body uses Ketone bodies for fuel.
Your consultant insisting on 200g carbs a day is dinosaur thinking, for me even 100g a day would be far too much, but your evidence shows it works for you, so your consultant was wrong. Your readings prove that.
With the level of carbs you're eating, your Insulin resistance cannot really be improving, and THAT is the overriding problem.
Don't be afraid of fats and protein, the non dinosaur doctors are rapidly realising, that carbs ARE the problem.
Your consultants approach is the old thinking of eating to balance meds, rather than balance meds to what you eat.
Halving your Metformin, will have very little affect on your situation, and if it does then it can be increased again.
High blood sugars with Insulin resistance causes Glucose to not be utilised, hence malnourishment. But if eating low carb your body uses Ketone bodies for fuel.
Your consultant insisting on 200g carbs a day is dinosaur thinking, for me even 100g a day would be far too much, but your evidence shows it works for you, so your consultant was wrong. Your readings prove that.
With the level of carbs you're eating, your Insulin resistance cannot really be improving, and THAT is the overriding problem.
Don't be afraid of fats and protein, the non dinosaur doctors are rapidly realising, that carbs ARE the problem.
Your consultants approach is the old thinking of eating to balance meds, rather than balance meds to what you eat.
Halving your Metformin, will have very little affect on your situation, and if it does then it can be increased again.
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And there are other types of diabetes as well. Given that @jn81 is a relatively unusual case I would really hope that all the possible tests have been done to rule out non T2 types... (MODY, T3c etc etc).
Resurgam
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@jn81 I do feel that you are really pushing yourself to be in control of your blood glucose by eating things regarded as 'healthy' such as whole grain - but I got such an easy ride as I was pushed to eat high carb low fat for decades and was hugely fat when I was told I was 'a very bad diabetic' - I'd had a test result which was high glucose ten years earlier, but they just kept on with the same old rubbish diet and it was me doing it wrong all the time.
When diagnosed I ate only protein and fat for three days, then went back to 50 gm of carb a day max, as that was my Atkins diet limit.
I am now 7 years into the low carb way of eating.
I wanted to get HbA1c into the 30s and reduced my intake of carbs by 10 gm a day - my HbA1c remained exactly the same, but I have stuck with the 40gm as I'd got used to it.
Getting most of my nutrition from meat, fish, eggs, cheese, cream, yoghurt seems really easy to me. I have mushrooms, low carb veges, salad, berries all in various forms, and have found my strength improving even though I am over 70 years old now. I have even gone back to work servicing knitting machines in the last 5 years.
My after eating levels tend to be around 7 or a bit less depending on if I have dessert or not.
I drink coffee with cream or peppermint, liquorice or lemon tea.
My weight has dropped, and my shape keeps changing, so each Autumn I need to adjust the fit of my clothes or make new ones as my metabolism corrects itself. I grew to adulthood with a 24 inch waist, it was only the high carb low fat diet which affected my weight so badly - I was just about spherical at diagnosis.
Metformin had a really violent effect on my so I stopped taking it after a few weeks, so that was probably lucky for me, and these days I don't need any medication. I read that you feel that your improvement is to some great extent reliant on medication, but a lot of people are finding that it is diet, not tablets which is the key to control.
I do read so much diet advice which is just absolute nonsense, so I do urge you to actually test how you react to different ways of eating rather than going by what you think might happen.
When diagnosed I ate only protein and fat for three days, then went back to 50 gm of carb a day max, as that was my Atkins diet limit.
I am now 7 years into the low carb way of eating.
I wanted to get HbA1c into the 30s and reduced my intake of carbs by 10 gm a day - my HbA1c remained exactly the same, but I have stuck with the 40gm as I'd got used to it.
Getting most of my nutrition from meat, fish, eggs, cheese, cream, yoghurt seems really easy to me. I have mushrooms, low carb veges, salad, berries all in various forms, and have found my strength improving even though I am over 70 years old now. I have even gone back to work servicing knitting machines in the last 5 years.
My after eating levels tend to be around 7 or a bit less depending on if I have dessert or not.
I drink coffee with cream or peppermint, liquorice or lemon tea.
My weight has dropped, and my shape keeps changing, so each Autumn I need to adjust the fit of my clothes or make new ones as my metabolism corrects itself. I grew to adulthood with a 24 inch waist, it was only the high carb low fat diet which affected my weight so badly - I was just about spherical at diagnosis.
Metformin had a really violent effect on my so I stopped taking it after a few weeks, so that was probably lucky for me, and these days I don't need any medication. I read that you feel that your improvement is to some great extent reliant on medication, but a lot of people are finding that it is diet, not tablets which is the key to control.
I do read so much diet advice which is just absolute nonsense, so I do urge you to actually test how you react to different ways of eating rather than going by what you think might happen.
thanks everybody for all of the messages, there is a lot to go though.
I will when I have time , but I must admit I am feeling much better after hearing everybody's advice and their own expereinces.
much appreciated.
I had a call with a nutritionist today and it was also excellent.
so feeling much more positive if they half the medications.
I will when I have time , but I must admit I am feeling much better after hearing everybody's advice and their own expereinces.
much appreciated.
I had a call with a nutritionist today and it was also excellent.
so feeling much more positive if they half the medications.
I'm doing both cardio & weights.
I try to eat 2500 calorie or more and was slightly gaining weight, until covid wiped it.
Just had a 'shake' earlier -> 25 ml olive oil, 60g peanut butter, 30g whey protein and water. Think it was close to 700 calories, so there are ways ..
Loving sardines at the moment as a handy alternative. over 200 calories, not too much salt, lots of protein and I like the taste.
I think I need to draw up a 3 or 4 day diet plan with alternatives for each of my 6 meals. will make shopping & meal planning easier
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What sort of cardio are you doing if your running then this will be counter productive if trying to bulk up with food and weights as you will be burning more calories running.
Also I think you need to try and find out what your calories maintenance is for your height and weight because even if your consuming 2500 you are most likely burning more and being in a calorie deficit.
