New diagnosed with type 2 but running London marathon next week - advice pls!

[Rossi5]

Hi, I recently had blood results come back with a Hbac1 of 84. I’ve got a call with the nurse on weds by assuming that level is type 2. I’d like to lower with diet and no carbs plus exercise but I’m running the London marathon next week! I’ve trained so far to 23.5 miles with some increased carb loading a few days before and sugary treats which I suspect is why my hbac1 result is also high! I’ve cut carbs out over the last week or so and had no sugar at all but worried about what I should do before the marathon? Do I carb load as I have been doing in training or keep carbs out? I’ll be taking gels during the run to keep me going. My finger prick has been 13 mmol ish pretty standard since I found out last week. Potato for tea spiked it to 17 but then to 9 the next morning. Any advice would be very much appreciated? Thanks so much

 

[catinahat]

Welcome to the forum
I have no experience of running marathons but I would have thought that changing things this close to the event would be a mistake.
If your test results and diagnosis had come a couple of weeks later, you would have run the marathon and been wearing your finishers medal before you were aware that you were T2.
T2 diabetes doesn't just happen overnight, your ability to regulate your blood sugar has been deteriorating for month's, if not year's.
All through your training, and when you did that 23.5 miles you were diabetic, you just didn't know it then.
Another week is going to make no difference to your diabetes, but radical changes to your diet will probably have a massive impact on your ability to run a marathon.

 

[HSSS]

I’d spend the time (not training, working or sleeping) to plan what changes you’ll make after the marathon. Like others have said another week or so will make little difference in the grand scheme of things - but it will be incredibly important to make the changes after the event. 84 is not a little diabetic it’s quite a lot, despite the exercise you obviously do.

Perhaps get hold of a copy of The Art and Science of Low Carbohydrate Performance Paperback – by Jeff S. Volek & Stephen D. Phinney to learn how to do the exercise without the carb loading.

 

[Rossi5]

Thank you makes perfect sense but it’s hard not to question whether to carry on with the carbs.

 

[catinahat]

Thank you makes perfect sense but it’s hard not to question whether to carry on with the carbs.

Cutting carbs is something you definitely need to do but it can be tough. Your body can take quite a while to move away from burning sugar to using fat and protein.
Google low carb flue, it's not something you want to be dealing with during a marathon.

 

[Mrs HJG]

Good luck in the marathon @Rossi5 if you are carb-loading but using your muscles in ways and to an extent that I would have nightmares about, then you are already ahead of the game!

If you eat the carbs, you need your muscles to work them off, and I'd say a marathon is as good as that gets! But also 'exercise' can raise blood glucose, so once you have the London Marathon under your belt, taking less exercise and cutting the training carbs, you may find your blood glucose will be lowered to some extent 'naturally'. You don't say your age or weight, so T1/LADA may be a possibility, or the types of carbs you have been loading may have promoted insulin-resistance? The nurse should know the next steps and tests for you.

Diabetes will interfere with life enough in the future, so it can wait a fortnight, as long as you are feeling well and not having ketones, or blisters, but see what your nurse suggests.

Warning: If they want to put you on Metformin, the side-effects may not be conducive to long-distance running

 

[JustLucky]

Good luck with the marathon.
Before I was diagnosed I'd go running and feel great for a few days and after would feel worse, thought I just needed exercise to keep my stamina up to do everything in life. Didn't have a clue that by running I'd lower my sugars and that would keep me feeling better...
Not easy to give advice, maybe you should know best and see how you're feeling. Maybe measure the ketone levels, I don't know.

Mrs HJG has a good point, you don't know for sure you're t2, not until you do more testing.

 

[Rossi5]

Thanks all for the advice and kind words. I’ve cut out carbs for now and do feel better for it but I think I’ll have some I’ve the next few days before the marathon and then go zero carbs again after to get the blood sugar down.

 

[Outlier]

Wishing you every success for the marathon!

 

[Rossi5]

Hi all, so I got through the marathon. My blood sugar levels are fairly consistent around 13mmol almost regardless of what I eat with a slight spike to 15/16 a couple of times. The doc has prescribed 40mg gliclazide one per day. Any advice or experience of this at all please?

 

[JoKalsbeek]

Hi all, so I got through the marathon. My blood sugar levels are fairly consistent around 13mmol almost regardless of what I eat with a slight spike to 15/16 a couple of times. The doc has prescribed 40mg gliclazide one per day. Any advice or experience of this at all please?

Congrats on the marathon! (Late to the party, sorry!) What are you eating and drinking now? There might be some reasons there why your blood sugars remain high. Please do be as specific as possible. If you're high while really low carb, with no infection or steroids/statins/antidepressants and such in the mix, you might be looking at a different type of diabetes (as for now it's just a guess, C-peptide and GAD testing hasn't been done), so before we throw all sorts of advice at you... Let's make sure what might be upping your blood sugars. Then look further.

 

[HSSS]

Well done on the marathon

If you are no longer hitting the carbs for running purposes and especially if you are young, slim and fit (all less common in type 2 even though possible) and levels are rising I’d be making a lot of noise about ruling out type 1/LADA. I‘d also be asking for ketone testing strips in the meantime in case this is the situation.

Gliclizide makes your pancreas produce more Insulin to reduce blood glucose levels. If you are genuinely type 2 you almost certainly already produce a lot but it is ineffective because of insulin resistance. Adding more solves the short term problem of high blood glucose by brute force but actually increases the underlying problem over time as high circulating levels of insulin make you more resistant to it. This approach of reducing blood glucose whilst ignoring insulin levels is why type 2 was historically seen as progressive and only slows rather than avoids complications. Newer approaches that are dietary often have more dramatic effects and actually address the underlying issue of IR too.

Please tell me you have be warned about hypos on this medication and provided with testing equipment to allow you to drive safely and legally.

 

[Rossi5]

Thanks both, the docs tested for ketones last week and it was clear. I’ll remove all carbs from my diet for the next couple of weeks (I do like a beer so will still have a couple) and I’ll continue to run but far less than training for the marathon. I’ve been warned about hypo’s and have a testing kit so would keep an eye on it. They have also referred me to the consultant as I do think they’re wondering about type 1/LADA. Just not sure whether to wait before taking gliclazide and see whether the levels drop over a couple of weeks with no carbs or take the 40mg immediately and monitor

 

[JoKalsbeek]

Thanks both, the docs tested for ketones last week and it was clear. I’ll remove all carbs from my diet for the next couple of weeks (I do like a beer so will still have a couple) and I’ll continue to run but far less than training for the marathon. I’ve been warned about hypo’s and have a testing kit so would keep an eye on it. They have also referred me to the consultant as I do think they’re wondering about type 1/LADA. Just not sure whether to wait before taking gliclazide and see whether the levels drop over a couple of weeks with no carbs or take the 40mg immediately and monitor

No carbs whatsoever would be noticable very fast, not weeks, but days. You'd not return to normal most likely, but close to it anyway. Beer is liquid bread, so if you don't mind spiking and undoing everything you're working on... There are some beers that are low carb, but I don't know which ones are available out where you are. Worth a google if you don't want to go without.

 

[JoKalsbeek]

@Rossi5 By the way, zero carb and gliclazide in a T2 is somewhat likely to result in hypo's, so, yeah... Do test. Lots and lots and lots. (Hypo's are nasty.)

 

[HSSS]

Thanks both, the docs tested for ketones last week and it was clear. I’ll remove all carbs from my diet for the next couple of weeks (I do like a beer so will still have a couple) and I’ll continue to run but far less than training for the marathon. I’ve been warned about hypo’s and have a testing kit so would keep an eye on it. They have also referred me to the consultant as I do think they’re wondering about type 1/LADA. Just not sure whether to wait before taking gliclazide and see whether the levels drop over a couple of weeks with no carbs or take the 40mg immediately and monitor

I personally wouldn’t do both very low carb/keto and gliclizide together. Far too much risk of hypos Imo. I’d try the carb reduction and measure often and see what happens. You might well get a clearer answer within days. A type 2 will see bgl fall quickly, a type 1 might not.

 

[HSSS]

Red or dry white Wine or spirits with zero sugar mixers are a lot lower carb than bread. If you cut out the carbs you’ll likely react to alcohol a lot fast than usual too.

 

[Rossi5]

Great advice. So you guys think zero carbs with maybe a glass of red wine each night should see blood glucose get back down to 4-8mmol?

 

[Rossi5]

Without taking the gliclazide? Within a week?

 

[HSSS]

Great advice. So you guys think zero carbs with maybe a glass of red wine each night should see blood glucose get back down to 4-8mmol?

Zero carbs is almost impossible to achieve and unnecessary. Nutritional ketosis is almost always achieved at 20g a day and often under 50g a day. Whatever you decide it has to be sustainable for it to continue working. It’s not a one and done result and you’re able to go back to the old ways. You might regain some flexibility but it’s a lifestyle choice not a short term diet.

If you are type 2 then it didn’t happen overnight and won’t return to normal overnight but keto eating will rapidly show a noticeable difference in the right direction. If it doesn’t, or doesn’t last despite ongoing measures in the next few years, then seek further testing for type 1/lada/other rare varieties.