Medication queries

[KirstyRobbie]

Hello

I've had my yearly review and as expected my hba1c has gone from 49-60 in the last year, I completely lost track and control from about October onwards, which I won't go into but basically various stresses and anxiety I suffer with. Currently I'm on ST Sukkarto 4x a day 2 at breakfast and 2 with evening meal. I have a real hard time shifting weight and especially keeping it off. My sugars range from 6-11 and always in the morning I can never get them lower than 9, my nurse just says I must be very resistant?!

Anyway I've been offered to try either "ozempic " or "trulicity" injection once a week, or a nhs low calorie diet course for 1 year which includes 3 months of shakes and soups and then help to re introduce solid foods back into my diet. I don't feel it would suit my lifestyle as I'm a very busy mum of 2 young children and with school and clubs ect I don't feel 900calories a day is sufficient enough?

Has anyone tried any of these or had any luck or advice?

please help.

 

[Rachox]

When you say you “lost track and control”, what were you doing to control your numbers apart from the tablets. Personally when I was diagnosed 5 years ago, I was offered bariatric surgery and Slimming Word type very low calorie diet on the NHS. However after doing some research which landed me on this forum I decided to go for a low carb diet, self monitoring and Metformin. I could stick to low carb as I was still eating real food rather than sipping shakes, soups etc…. If you used low carb before why not try it again, or if you didn’t try it how about it? Many of us type 2s find that it works brilliantly. Maybe worth a try before commencing another drug?

Edit for typo

 

[KirstyRobbie]

Yes it was low carb and a mixture of couch to 5k spin classes and home exercising, I was so in control and felt amazing , although I lost very little weight, mentally I felt great!

I can try low carb again, but my nurse isn't happy with the amount of weight I loose as it's very stubborn and wants me to dramatically loose a lot more then I did so on low carb,I only lost around10lbs over a 8/9month period that was the issue.

 

[AloeSvea]

Hi @KirstyRobbie. I can well imagine three months on a Very Low Calorie Diet (VLCD), with those food replacement shakes, whilst looking after young children is not a path you would want to take! (I've done VLCDs, and I have looked after young children! .)

If you make it a 'real food' VLCD - such a tiny-eating regime might in fact be easier than intermittent fasting, or no-food fasting in terms of giving you enough energy to live - which is the other metabolic treatment you could try that works well with highly resistant to insulin diabetes, and stubborn weight. That way you can serve your family the 'proper' portion, and serve yourself up the tiny version that is a VLCD with real food. (I've done a VLCD twice, so I do draw on personal experience here of what those portions look and feel like.)

The idea is that your body will take the fat you have on your body out of 'storage' and use it for the energy you need to just keep your body going, and for you to live your life. Fat out of storage is of course what you want.

If you want to give intermittent fasting a try - I have been doing a window of eating intermittent fasting regime which I find much easier than any other such I have tried before - mine is 10 hours, although many do their eating in 8 hours. I also cut out cafe food/eating out (even trying hard to be low carb, there is so much added sugar in eating-out food, and bad fats - eating such is obviousy, sigh, too much for me). And, most sadly - my sunrise to sunset eating and caloric-drinking regime cut out glasses of wine of an evening, which I really sadly suspect has also contributed to greater weight loss around my waist - where all that dangerous for us fat resides. I hadn't wanted those lovely wines to be part of my current much greater weight loss around my waist, but there you are. Sigh. (All is not lost - I still have my coffees!)

Anyway, back to you.

Looking up 10 lbs - 4kg? That is nothing to scoff at! In terms of weight loss. But yes, I understand you will be wanting dramatic weight loss - by the sound of it. And being able to sustain it. My only feeling is - how low carb did you go? My immediate thought is you could go lower then, as the first thing you do. Lower the carbs even more, but don't portion control, first at least. And see what happens. That is probably the regime that will fit in most with looking after and feeding young children?

 

[KirstyRobbie]

Thank you

I am just very hard on myself and so envious of people who can eat anything and it not affect them in anyway.

Would it be rude for me to suggest those options as you've mentioned above to the diabetic nurse and pharmacist? I know they are trying their best and only trying to help me, it's just doing the 900calorie diet of shakes and soups will really not suit my lifestyle and family, especially over the summer with going on holiday and events planned.

Which of those options of intermittent fasting or smaller portions would you say is best , for loosing weight and maintaining too? Or is it a mixture of both?

 

[lessci]

Thank you

I am just very hard on myself and so envious of people who can eat anything and it not affect them in anyway.

Would it be rude for me to suggest those options as you've mentioned above to the diabetic nurse and pharmacist? I know they are trying their best and only trying to help me, it's just doing the 900calorie diet of shakes and soups will really not suit my lifestyle and family, especially over the summer with going on holiday and events planned.

Which of those options of intermittent fasting or smaller portions would you say is best , for loosing weight and maintaining too? Or is it a mixture of both?

It's your body & your choice. I know when I go back to see my DN in July she won't be happy, because my weight hasn't really changed in the last 3 months, but I've lost 6cm (just over 2") from my weight measurement in that time which to me is much more important

 

[danziger]

FWIW, I didn’t lose much weight on the standard “eat all the cheese and cream you want” low carb diet but have now really reduced cheese and cream and mayo and cut out nuts (I fill up more on meat, eggs and fish) and it seems to be shifting. It’s more important to me though that my BG reading and HbA1C are within non-diabetic ranges and that this way of eating feels sustainable for the long-term. Do remember though that the approach you take is up to you, not your nurse or anyone else.

 

[AloeSvea]

Thank you

I am just very hard on myself and so envious of people who can eat anything and it not affect them in anyway.

Would it be rude for me to suggest those options as you've mentioned above to the diabetic nurse and pharmacist? I know they are trying their best and only trying to help me, it's just doing the 900calorie diet of shakes and soups will really not suit my lifestyle and family, especially over the summer with going on holiday and events planned.

Which of those options of intermittent fasting or smaller portions would you say is best , for loosing weight and maintaining too? Or is it a mixture of both?

Hi again there KirstyRobbie. I understand both the being hard on yourself (which of course you shouldn't be!) and absolutely the envy of folks who can eat yummy high carbs and it doesn't affect their blood glucose regulation. That lessens a lot over the years imho. Especially if you are able to improve your health profile to the extent you improve your cardio vascular health, or at least the risk factors. (This is a big deal for everyone in our current food environment, but of real interest to us with T2D at least, as the risk for having a stroke is so high.)

And make sure you have good LC/HF substitutes for foods you really miss? I'm in the middle of the cold season in my country, so I am enjoying Keto and LCHF baked goods, which I would be lost without. (I always have stevia in liquid and crystal form on hand in my kitchen.) And old Weight Watchers standbys, like their chocolate mousse made out of coconut milk, and WW jellies...that kind of thing.

OK - fasting or VLCD? This is where knowing your own body, and your own way of life comes in. Very personal! I like Prof D'Ogostino's way of looking at these treatments, as they are all good, and us giving them a bash and seeing how they affect us is the way to go. Also, this is Dr Fung's line of reasoning.

Are you self-monitoring? With a BG meter and test strips, and for me it is a tape measure, but your GP/practice nurse will be using the scales and your BMI to track you. But of course I think you should be tracking yourself, as only you will be able to be up close and personal with your body. I like the waist/height ratio most of all for weight loss, but I am one of those folks who lost a lot of weight soon after diagnosis (I tried different diet regimes and walked a lot) and have been normal weighted ever since. (I got to partial remission for some years, but that has been gone for a few years now, alas.) A really difficult thing, or maybe it is an interesting thing? (I think so) is that because T2D is metabolic, you kinda do need to understand your own metabolism intimately, imho, to get on top of it. For me, physical activity is a big part of it (it isn't for everyone) because I basically have a muscular build. Do you know how physical activity affects you? could be fun finding out!

But weight loss is of course primarily about how food, and its storage is affecting you. And how responsive you are to fasting. I basically think everyone is really responsive to fasting regimes! How could we all not be?! And how do-able VLCDs/tiny portions is, is a how it fits into your life thing. Only you can answer this.

Do you like journaling? I strongly recommend food/BG journaling for you on this new-food journey. I've been doing it the whole eight years since diagnosis. A good way to follow you and your body's responses to different eating, and not-eating, regimes.

And yes of course - coming in here for support and mental and emotional nourishment while you are on this journey!

 

[Higaomo]

Thank you

I am just very hard on myself and so envious of people who can eat anything and it not affect them in anyway.

Would it be rude for me to suggest those options as you've mentioned above to the diabetic nurse and pharmacist? I know they are trying their best and only trying to help me, it's just doing the 900calorie diet of shakes and soups will really not suit my lifestyle and family, especially over the summer with going on holiday and events planned.

Which of those options of intermittent fasting or smaller portions would you say is best , for loosing weight and maintaining too? Or is it a mixture of both?

How low did you go when previously ’low carb-ing’? It may be that you need to go lower initially to kick start weight loss - I found 20-30g a day worked well for me but we’re all different and it may be you need to experiment a bit to find your optimum level. Now I’m at a weight I’m happy with (I’ve lost 68lb) and, more importantly, my blood glucose is under control, I found that 50-80g a day is my ‘happy place’

I eat low/no carb when I’m on my own, but when I’m eating with my family I just have whatever they’re eating just without the bread/potatoes/pasta/rice/pastry so, for example, if it’s a roast dinner I eat the meat and veggies but no potatoes, if they’re getting fish and chips I just have the fish with peas/coleslaw but no chips, I keep some frozen Greek yogurt in their freezer to have when they’re having ice cream - it’s important to me that my granddaughter sees me eating (more or less) the same as everyone else

 

[KirstyRobbie]

So for example for breakfast I’ll have eggs, bacon, or plain Greek yogurt with chia seeds or occasionally strawberries.

lunch will be a salad with some sort of protein ( meat dish or cheese)

evening meal I will have the same to blend with my family ( I have a 3&6 year old, so again I don’t want them seeing me eat massive amounts different to them and giving them bad habits) I will have my small carb option then so a very small portion of pasta/rice/ a whole meal pitta if they have fajitas for example.

If I feel the need to snack I’ll have babybels, a handful of plain nuts, sometimes some peppers/carrots with houmous, ect.

 

[Higaomo]

That sounds similar to how I eat, but you could maybe try cutting out the evening meal carbs and see if that makes a difference?
I totally get the food messaging concerns with your children, but they won’t even notice as long as the rest of your plate is broadly the same as they’re eating

Do you have a blood glucose monitor? Everyone reacts differently to different carbs and testing is really the only way to find out what your body can tolerate and what sends it haywire