This is adapted from a presentation I prepared for my local surgery Self management of Type 2 diabetes My first year to April 2015 Summary Diagnosed Type 2, March 2014 (HbA1c 65 mmol/mol, 8.1%) No medication Self-testing Low-carb diet Now in non-diabetic range (HbA1c 38 mmol/mol, 5.6%) 20 kg weight loss Improved lipid profile Introduction and diagnosis I had blood tests in March 2014 following reported listlessness and exhaustion. There were none of the ‘classic’ T2 symptoms of excessive thirst, need to urinate, blurred vision etc. Diagnosis was confirmed on 24 March with an HbA1c of 65 mmol/mol (8.1%). (It later transpired that in 2008 a blood test showed I had an HbA1c of 44 (6.2%), i.e. prediabetic. Apparently the trigger criterion was different then. Nothing was mentioned anyway, pity.) No guidance was given, I was just told this was life-changing, to lose weight (I was 90 kg, BMI of 31.5), exercise more and make an appointment to see the diabetes nurse. The earliest appointment available was for 16 April, over three weeks away. Because of elevated blood pressure (spot reading of 160/90 when blood samples taken) I was told to take two weeks of readings to take to this appointment (how? where? – at a chemist or buy yourself a meter, great, thanks). Because of total cholesterol of 6.9 I was prescribed Simvastatin without any explanatory discussion and without my prior agreement (I never took them). Something about me I’ve never been one for taking medication if I can help it. The human body is often underestimated as a self-healing mechanism. A few paracetamol a year is normally more than enough for me. I’m a scientist by training so when faced with something like this my first reaction is to find out about it and not take anything at face value without assessing it myself. On the other hand the T2 diagnosis was a wakeup call and the kick I needed to sort my weight and well being out. Immediately I started walking for about 30 minutes every day (average). I got on the internet and found the diabetes.co.uk website and forum; learned about carbohydrates and the impact on blood sugars; could understand the logic of low-carb high-fat (LCHF) diets; and just went for it at 50 g carbs per day – no bread, no potatoes, no rice, no pasta. Fortunately I didn’t suffer the withdrawal symptoms sometimes experienced by changing so abruptly. I bought a blood glucose monitor and started testing myself. I started losing weight straight away as I got into ketosis and my body started to preferentially burn stored fat for energy. I also read about cholesterol and statins and determined that I wasn’t going to touch them with a barge pole. First DN appointment Three weeks in and I was already making progress on diet and exercise alone. Fasting BGs were down from over 10 mmol/l to around 6.5; pre-dinner BGs in the high 5s; and BGs two hours after eating in the high 6s and mid 7s, so I was learning what I could and couldn’t eat in terms of blood sugar control. My weight was down from 90 kg to 84.5 kg, and blood pressure was down to around 140/80. It was agreed for me to carry on with diet and exercise alone, no medication, with a review in three months time. Interim progress In July 2014my HbA1c was 45 (6.3%, down from 65), so I was now in the prediabetic range. Total cholesterol was down to 6.0, but more importantly triglycerides were down from 5.66 to 1.97 mmol/l, and HDL-C was up from 1.22 to 1.62, with total/HDL and triglycerides/HDL ratios both dropping into normal range. ALT liver function was down from 51 to 17 iu/l, indicating a reversal of fatty liver condition. My weight was now 76 kg (BMI 26.6), a percentage loss of over 15%, and BP stable around 125/70. I had also invested in a rowing machine to supplement the walking. By October 2014my HbA1c was 42 (6.0%), weight was 72 kg (BMI 25.2) and BP around 120/65. One year on, March 2015 A picture speaks a thousand words, so rather than more dull text some more graphs follow covering the period from March 2014 to March 2015. My HbA1c is now 38 mmol/mol (5.6%) which is within the non-diabetic range. I am still diabetic of course but I am protecting the remaining beta cell function in my pancreas as best I can, and avoiding exacerbating my insulin resistance. This is all due to carbohydrate restriction, which has also reduced triglycerides significantly, and the fat component of the LCHF diet has helped raise my HDL-C to 1.95. In this context my total cholesterol of 6.1 is of no concern to me. The slight rises and falls in fasting blood sugar (the points are two-week averages) reflect life conditions such as work stress – but at least through testing I know what is going on. My weight is now stable at 70 +/- 1 kg (BMI 24.5), which represents a 22% loss in 12 months; and BP around 115/65. My waist is now 37 in (94 cm) having been 45.5 in (116 cm) a year ago. What do I eat? I’ve done all this without any medication, and just with diet and exercise. So what actually do I eat with LCHF? This is a typical day’s meals: Breakfast – cooked breakfast of bacon, eggs, mushrooms and tomato; occasionally full fat Greek yoghurt with a few berries. Tea and/or coffee with double cream. Lunch – ‘tapas’ style platter, choose from salami, olives, a little hummus, guacamole, cheese, mackerel pate, tomato, salad leaves. Dinner – avocado vinaigrette, meat or fish with above-ground vegetables or salad, berries and double cream, glass of red wine. Snacks if necessary – cheese or brazil nuts. Plenty of water. Decaffeinated tea or coffee after midday. Selected reading Trudi Deakin (X-Pert Health) - Eat Fat, Step-by-Step Guide to Low Carb Living http://www.xperthealth.org.uk/shop/details/p/handbook-lowcarb-highfat-lifestyle Trudi Deakin - High fat, low carb diets and the evidence, Diabetes UK Conference March 2015 http://www.xperthealth.org.uk/Portals/0/Downloads/High fat, low carb diets and the evidence_Diabetes UK 2015_reduced memory.pdf Dyson PA, et al. - A low-carbohydrate diet is more effective in reducing body-weight than healthy eating in both diabetic and non diabetic subjects, Diabetic Medicine, 2007 Andreas Eenfeldt - Low Carb, High Fat Food Revolution and the website www.dietdoctor.com/lchf Feinman RD et al. -Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base, Nutrition 31,1 Jan 2015, http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext#bib94 Zoe Harcombe (diet and nutrition blogger)- http://www.zoeharcombe.com/ Malcolm Kendrick - book The Great Cholesterol Con and blog at www.drmalcolmkendrick.org Jenny Ruhl - books Blood Sugar 101: What They Don’t Tell You About Diabetes, and Diet 101: The Truth About Low-Carb Diets; and the website www.phlaunt.com/diabetes Scientific American (after meta-analysis by Krauss RM et al in American Journal of Clinical Nutrition, March 2010) - Carbs against Cardio: More Evidence that Refined Carbohydrates, not Fats, Threaten the Heart http://www.scientificamerican.com/article/carbs-against-cardio/ Shai I, et al. - Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, New England Journal of Medicine, 2008. David Unwin - Diabesity: Perhaps we can make a difference after all? Diabesity in Practice 3, 4, 2014 http://www.diabesityinpractice.co.uk/media/content/_master/3963/files/pdf/dip3-4-131-4.pdf Westman EC, et al - The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, Nutrition & Metabolism (London), 2008.