Need more info

bitofagit said:

Having now read a fair number of posts here, the diet issue seems to be the thing.
Is there something I'm missing?

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You are starting to understand it well, it's just that large parts of the NHS (and other medics worldwide) have yet to unlearn what they were taught and to adopt and adapt to what is now known. There are pockets where low carb is better promoted but they are still few and far between.
Typical official, NHS advice is lose weight but to increase whole or brown carbs, which simply doesn't work long term for most people.

So a Magnum has 23g of carbs of which 20g are sugar.

If you’re going down the diet-only approach you’ll have to ditch the Magnums and start checking the nutrition tables on the back of the things you’re putting in the trolley.

Many people stick to around 20-30g of carbs per day. Some can go higher but I wouldn’t count on it.

A rule I stuck to to keep it simple was if the number of carbs per 100g was above 5 I didn’t get it. It’s basic but if you’re only starting out sometimes that is what helps.

Don’t think you can take the Metformin and carry on eating whatever you want. The only outcome of that will be steady increases in medication until at some point you’re likely to need insulin. That’s not inevitable but it takes a considerable change.

Metformin - you're correct it won't solve anything on its own. But I don't see the logic of throwing the medicine in the bin until you've actually sorted the problem by diet. As I said in the other thread, you can get slow release metformin, so try that at a low dose in the meantime, and work at the problem with both meds and diet until you are in remission range, then throw them out? (that said, I took emotional comfort in my metformin. I miss it for some reason.).

You should get referred to a diabetes nurse or some sort of care equivalent who will do your annual tests, and offered a 1 hour presentation on diabetes that briefly talks about diet options, usually done online nowadays. Thats it, thats all the support you will get (unless you push or ask for more on a specific topic. I got a phone interview with a nutritionist as I asked for it, but again, you need to know what you want to ask them).

Low carb is anything below 100 - 150g, the posters above are going for keto range. My personal suspicion is that most who manage on low carb and not keto like myself are those diagnosed early by luck.

I managed 5 weeks on Metformin and Atorvastatin, but they were dreadful and it took quite some time to get over the consequences of such hellish treatments
Fortunately I knew that I am happiest when eating an Atkins type diet, and was back into normal numbers eating no more than 50 gm of carb a day after 6 months.
I tried to lower Hba1c by reducing to no more than 40 gm per day and it had no effect at all, exactly the same test result after a year.

bitofagit said:

Bloods review completed (HBa1C was 60) a couple of weeks ago, result of which Metformin prescribed, started and binned after 2 days - Not going to put up with that.
Onto low carb diet.

Now the thought occurs: was the Metformin prescribed rather than detail diet, the thinking being that I could take meds and just continue eating as normal? The only foodie suggestion was to cut down on alcohol - which I already had - and highlighted that bread was the worst for carbs. Oh and eat quinoa (suggested more than once).
Having now read a fair number of posts here, the diet issue seems to be the thing.
Is there something I'm missing?
Does the above make any sense?

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Metformin isn't a cure-all, alas. If you check the leaflet, it'll mention somewhere to try a dietary approach first for three months, and if that doesn't get the desired results, then to start Met. It tells your liver to not dump as much glucose as it normally would in the morning or stressful situations, and it makes you a little more insulin-sensitive, but not to a point where you can just eat whatever, and it'll take care of it. It just can't. Which is why, indeed, T2 is still considered a progressive condition. It does progress if you keep adding fuel to the fire. No fuel, no fire.

When Met made me miserable and I told the specialist and nurse at the hospital I wanted to try diet, they laughed at me. The dietician from the hospital kept pushing carbs, because I "need" them, and the diet I was proposing (Low carb, then, as I hadn't heard of Keto yet), was ludicrous.. Not something I could keep up, I wouldn't have the spine, just like every other T2 that came through their doors. I was literally told that by various medical professionals. And yes, I did fall off the wagon in a massive way, after SEVEN YEARS of low carb eating... And I'm getting back on the wagon as we speak, because glitches can and do happen.... And I was glitching short enough (two months or so) not to have any lasting damage. But all in all, seven years ago they said I wouldn't last a month. I did. And I will again.

With a HbA1c of 60, you'll have your numbers right as rain again if you cut the carbs. Metformin can make a dent, but not as much as diet can, so.... You're going to be fine.

bitofagit said:

Thank you for your replies.
It would seem that my thoughts are following what you suggest.
Regarding the 'Magnum incident', I ate that more as a test, with the resultant check showing me how disapproving my wife can actually be with just a look.

If you follow a LCHF diet but suddenly fancy a pizza for example, the impact of that in the middle of a low carb desert would be what? Would it be classified as falling off the wagon, impinge on an individuals progress?

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Off the wagon... Oh, I don't know. We all topple off at one point or another, often around the holidays and such. It's just a phrase to indicate a deviation from the diet, not the amount or duration. I guess that's for the individual to decide. As for having a one-off, it could kick you out of ketosis, should you follow a keto-diet, but it might not. We're all different, and some can just drift in and out of ketosis without problems. Others experience keto-flu all over again, and that's preferably avoided. (Fatigue, malaise, headaches...). Do keep in mind that carbs demand carbs... Once you've had a peak, your body'll ask for more, often that very day, if not a mere few hours later. Same as it would with drugs, really. It's easier to just keep going than to have one-offs that'll make you want more. To me, anyway. You might be different. And, there's fathead pizza, if you're up for cooking from scratch, which is low carb. I can't be bothered, so I'd just do an omelette with what I'd usually toss on a pizza on top. Cheese, deli meats, mushrooms... Also, if you've been at it with the low carbing for a while, a steep climb in blood sugars can make you feel very grotty until they come down. But that's, again, not the case for everyone.

When my mom got ill and passed away, I just quit caring about the whole diabetes thing all together. Mom first, and I'd get back on the wagon when the worst had passed. Going back and forth to Tilburg from Baarn almost daily while caring for her meant a lot of roadside foods, and grieving demanded cookies and chocolate, plain and simple. Not, excuse the pun, going to sugarcoat that. Since last week she's in an urn in our home, most of the paperwork is sorted save for the tax form (which I expect to get in another month or so), her flat's keys have been handed in, so everything's practically done and dusted... My husband is back to working regularly, -he was ill for a long time with long Covid- and my own days have gone back to the way they used to be before everything went to hell in a handbasket, for the most part. So. Back on the wagon I go. Circumstances are not quite ideal yet, but I have a rythm to my days now, and a little less stress to deal with, so I have no more excuses. It hasn't been easy so far, but after a while of eating like I shouldn't, I could expect keto flu. (Mind you, I have plenty of broth and such around to make up for the electrolytes I'm losing, so I got that sorted before starting!). But all in all... That's what I call having fallen thoroughly off the wagon. I may not have gone back to eating like I did before my diagnosis, but the cookies and chocolates were NOT blood sugar friendly. Far from it. They were nice, for a while... But I can do without. And without the gained weight!

Basically, we just give you some ideas on what could work for you. Don't get hung up on terminology, dogma's, what have you. Just figure out what works for you. I get carb-creep if I do have a one-off, I will crave more, so I usually just steer clear, present circumstances excluded. Others can't stick with a diet unless they have a carby meal once a week or once a month. Find what works for you, what makes this sustainable for the long run. We know the basics, we know what affects what.... But only you know what works for you.

bitofagit said:

Interesting.
Sorry to hear about your loss and problems Jo, but you seem to have a grip on things and haven't lost sight of your future - the very best of luck.

I think had this whole T2 thing happened a few years ago (which in reality, it did) I would not have had the resilience to say no to a beer or pasta, bread etc. whereas today I drink very little alcohol, predominately wine (and I don't mean by the bucket load!), and I am able to say no to a whole heap of stuff.
I shall stay under 100gm carbs per day (presently a lot less - excluding the 'Magnum Incident') and try to keep up with your suggestions. However, I am not going to be too prescriptive.
I intend to have a 'pizza moment' along with quite a few other 'moments' (testing along the way) after which I shall return each time to being 'good'. I believe I have sufficient faith in myself to carry this through without falling down too much.
It is the next set of bloods and review that will, possibly, dictate future action. Maybe I will be in remission ..........

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I have a feeling you're going to be absolutely fine.