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Type 2 My endocrinologist says to stop worrying about my glucose levels.

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iansmith6

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I was diagnosed a T2 about 3 years back and immediately went on a near zero carb diet. Lots of cauliflower and broccoli, 10g carbs or less per meal. I'm 160lb and 6ft so not overweight, I exercise before meals, otherwise healthy. I'm 47.

My fasting glucose is 100-130 depending if I'm having a good or bad day. Eating 2-3 carbs often puts me at 160 for 3 hours, and 10 can make me push 180. Kind of going insane with the diet, I crave carbs all day, and am always hungry due to a high metabolism. My AC last two tests were 6.1 and 6.5. I'm doing all I can but my numbers are slowly going up. I was 7 when I was diagnosed, and seem to be heading back there.

I try and keep my 1 hour under 140 and my 2hr under 120 but if I start a meal at 130 that's kind of hard. :|

I got an appt with an endocrinologist and the first thing he said when I started hsowing him my numbers was comment that the Libre Freestyle for a T2 was overkill and I was too obsessive over my numbers and to relax.

He said I was fine and should stop worrying. That it was ok to go up to, but not over 180 after a meal, and if I wanted a burger and fries once a week 250 or higher was acceptable. I know that meal would easily push me to 300. He also said there is no real difference in side effect prevention between 8 and 7, and I should let myself go to 7 if I was not happy with my current diet restrictions.

So is he right? Everything I read says that the closer you are to normal the better, that once you hit 140 you start doing long term damage, and even lower numbers over the long term are not good. But I was taken aback by his attitude, which I expected from a GP who usually sees me as thin and with low numbers and says I'm fine too.

I'm thin, have low numbers and Dr's are used to people who's diet consists of only having 5 slices of pizza instead of 6.

I'd like to eat more carb heavy food, but don't want to go blind in 10 years either.
 
Sometimes I think it depends on how obsessive or not the doctor is. If he judges you to be more obsessive than he is then that is too much and if less, well you might be expected to increase your vigilance. This is just a theory but it all comes back to what is normal and who defines that level?
For you own piece of mind why not ask him for some proof of his proclamations about BSL levels, HBA1Cs etc ? As diabetics we are encouraged to find out about our condition. Of course your doctor can take offence at being questioned about his recommendations made to you but, it is your health that is important, not his ego!!
Sometimes to ease the burden on one's fingers, doctors and DSN used to suggest to me doing BSLs in a rotating pattern, e.g. Monday, before breakfast, Tuesday 2 hours after breakfast, Wednesday 2 hours after lunch and so on. That way at the end of the week I have a profile or snapshot of your BSLs. More BSLs done more frequently if I am unwell or eating unusual foods.
The other important thing to remember, I find, is that unless you are committed to doing something about the BSL results you obtain, or use them helpfully, why do the BSL?
So as a TID I would use BSLs to determine if my diet and insulin balance was acceptable; to inform me that next time eating that particular food might be better handled by eating more or less (or none) of it, or taking more or less insulin; or as a reassurance that I I had 'guessed' the right dose or amount of food. BSLs are like feedback. And there are the hypos to consider too.
As a T2D how do you use you BSL readings? Would doing more be proportionately more useful? What does your doctor say is the bare minimum and how does that figure meld with your view of what seems to be an adequate number.?
 
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iansmith6 said:
I was diagnosed a T2 about 3 years back and immediately went on a near zero carb diet. Lots of cauliflower and broccoli, 10g carbs or less per meal. I'm 160lb and 6ft so not overweight, I exercise before meals, otherwise healthy. I'm 47.

My fasting glucose is 100-130 depending if I'm having a good or bad day. Eating 2-3 carbs often puts me at 160 for 3 hours, and 10 can make me push 180. Kind of going insane with the diet, I crave carbs all day, and am always hungry due to a high metabolism. My AC last two tests were 6.1 and 6.5. I'm doing all I can but my numbers are slowly going up. I was 7 when I was diagnosed, and seem to be heading back there.

I try and keep my 1 hour under 140 and my 2hr under 120 but if I start a meal at 130 that's kind of hard. :|

I got an appt with an endocrinologist and the first thing he said when I started hsowing him my numbers was comment that the Libre Freestyle for a T2 was overkill and I was too obsessive over my numbers and to relax.

He said I was fine and should stop worrying. That it was ok to go up to, but not over 180 after a meal, and if I wanted a burger and fries once a week 250 or higher was acceptable. I know that meal would easily push me to 300. He also said there is no real difference in side effect prevention between 8 and 7, and I should let myself go to 7 if I was not happy with my current diet restrictions.

So is he right? Everything I read says that the closer you are to normal the better, that once you hit 140 you start doing long term damage, and even lower numbers over the long term are not good. But I was taken aback by his attitude, which I expected from a GP who usually sees me as thin and with low numbers and says I'm fine too.

I'm thin, have low numbers and Dr's are used to people who's diet consists of only having 5 slices of pizza instead of 6.

I'd like to eat more carb heavy food, but don't want to go blind in 10 years either.
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Have you checked out the latest set of allowed BG values set out by the ADA [2018] They allow figures higher than ever before and claim that they even allow you to live longer. I had a WW3 yesterday with my family doctor to start with metformin and reduce my recently much increased values.Part of the problem it seems is that many of these doctors have not been well prepared in medical school
 
Hello there iansmith6!

I personally, would recommend you to keep your BSLs as near normal values, as possible. There is one simple reason - there wouldn't be a higher and lower limit for the normal :meh:blood sugar values, if it wasn't necessary, and as you point out yourself "Everything I read says that the closer you are to normal the better".
To sin now and then, probably doesn't have a noticeable bad effect, but if you have the strength, just go on and keep up your good values - I believe it will reward you later.

Edited to say: I meant to also mention, that "kitedoc" has some critical questions to consider...
 
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Occasionally, there are doctors who are interested in treating more than just the diabetes and consider the mental impact of managing it.
Personally, I find the hardest thing about managing type 1 is balancing the need to seek the perfect control with mental capacity that is needed to achieve this.
For me, this is the time I spend checking my BG, tweaking my medication (insulin) and the loss of enjoyment of food and exercise.
When we come across doctors who tell us we are testing too much or managing our diet too closely, some of these don't understand diabetes, some of these are trying to save money, some of these do not understand our personal need for control and but some of these are trying to help us manage ourselves as well as our diabetes.

I do not know whether this is the case for the OP ... but it may be.
 
I agree with the comments above about getting checked out for LADA, and the various possible motivations for your doc giving that advice.

But the real point of my post is your reference to being hungry all the time.
There is absolutley no need for that. Seriously. You can eat very well, and eat to satiety on a low carb or keto way of eating. There are many, many different ways of increasing your food enjoyment and satisfaction without bumping your blood glucose up high.

These include, but are not restricted to cheeses, cream, butter, added oils and mayo. Larger, fattier meat portions. Pate, nuts, creamy sauces. Low carb baking.

Other alternatives could be eating more often, introducing more snacks.

I have no idea if you have any dietary restrictions, but even with those (I have plenty) there are always ways around hunger - even if it is just a teaspoonful of psyllium husks in a glass of water.
 
I sighed when I read the advice on burger and fries - and the BG level to expect.
Would your endocrinologist drive down an urban street at 100mph? No? Why ever not? He might get away with it, and he might not kill someone or crash into anything, and what if the speed limit is half that or less - whats to worry about? Maybe he needs to reassess just what risks his advice to you might bring.
I found that by keeping to low carb foods I could get normal levels of BG - and my numbers went down on the same way of eating, presumably as my metabolism mended. I did not limit the other foods I ate, so if I was hungry I ate meat, eggs or cheese, or made a tuna salad or even a mushroom and sweet pepper stir fry - but I was hardy ever really hungry.
That seems to be a more normal response to low carb eating - so your ability to cope with carbs seems so low - have you ever been checked for Type one or other lack of insulin options?
 
This is an interesting topic, couple of months ago I had a 2 hr conversation about just that with my endocrinologist, who is the head of Endocrinology and Diabetes departments at one of the Zurich's hospitals. I told him about my concerns etc. Especially higher FBG and postprandial levels (than what I expected them to be on my current diet and exercise regime). He's answer was, if the only issue is (slightly) elevated blood sugars, say prediabetes levels (HbA1c up to 6.0-6.5 max), and there are no other risk factors present such as being overweight, no or very low physical activity, high cholesterol and high blood pressure, then the overall risk is low. Problems begin with some or all of these conditions being present together with high blood sugar. Then the combined risk becomes much higher.

He told me not to worry too much about occasional higher readings, just keep doing what I am doing right now, keep the normal weight, exercise regularly, eat healthy (i.e. "relatively" low carbs but don't get over-obsessed about it either), check cholesterol and blood pressure levels. If all else is in the normal ranges, than there is nothing to worry about. And btw, my current HbA1c levels are 5.3-5.5. and I am not even on a proper keto diet, just low(ish) carbs. But then, according to my Doctor, even if my HbA1c goes up a bit, there is nothing to worry about as long as everything else is is in check. Despite his assurances though, I'm still determined to keep my levels below 5.6 though ;-)
 
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