New poster with a few questions

[lunarbelle]

Hi ,please bare with me i am new to this ,I have been type 2 for around 7 years and am currently taking metformin and actos ,iam 52 years old i have never had any of the symptoms that go with diabetes , i work long hours on shifts and don,t get a lot of sleep between shifts ,iam a fairly big lad and have not really changed my eating habits to cater for this illness ,because i work 13 hour shifts i take plenty of sandwiches (white bread lovely) and loads of carbs,and also choccy biscuits ,i don,t get much chance for much exercise due to work .
This morning i went to the doctors over something else and he stated he wasn,t happy with my blood tests and showed me the results for the past years the highest and last few being 7, he said i need to take Gliclazide 80mg twice a day along with my other tablets for the next 4 weeks if my levels don,t get better he is going to put me on insulin.
Surely if my count has never been above 7 on my tests and i have not had any symptoms of diabetes he is wrong to suggest going on insulin yet .
I will say its given me the shove i need to change my lifestyle and diet and get my reading lower this way .
Any advice would be appreciated. (sorry for spelling mistakes)

 

[Unbeliever]

I am certainly no expert but if you are speaking of 7 on your HBA1C in spite of your diet and lifestyle I would say you were doing very well. Of course it is in your own interests to change your diet and lifestyle and maybe even wihout the medication you will see a great improvement in your levels.

It does sound a bit oddd that your Dr is so worried about these figures. Is he perhaps concerned about some of the other results of the HBA1C?

Is it even possible he is using the insulin as some sort of threat because he may think that you could achieve much better results by making the changes you mentioned?

Maybe he thinks you are in danger of suffering complications??

 

[daisy1]

Hi Lunarbelle and welcome to the forum I think your diet needs serious revision - as I think you know. You will have a lot less problems if you change your eating habits and maybe could avoid going on insulin if a better diet can bring your levels down. I presume the 7 you mention is your HbA1c level, which needs bringing down. You have certainly made a good first step by joining this forum. Here is some basic information which the Forum Monitors have prepared for new members and I think you can benefit from it even though you are not newly diagnosed. You need to work out some low carb snacks that you can have while you are on your long shifts. Have a good read around the forum to get some ideas. Ask as many questions as you like and everyone will be pleased to help you.

Here is the advice that Ken and I, as Forum Monitors, usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

For more information on CARBOHYDRATE see here:

viewtopic.php?f=3&t=20306

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.


As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

For TIPS FOR STRIPS see here:

viewtopic.php?f=20&t=19002#p173253

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2011 NICE guidelines for Bg levels are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l...(Type 1 & 2)
2 hrs after meals........................no more than 8.5 mmol/l.....( Type 2)

2hrs after meals......................... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do at least 30 minutes moderate exercise a day, it can be split into 10 min sessions to start with. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Finally a few QUESTIONS TO ASK AT DIABETES CLINIC.

viewtopic.php?f=20&t=17091



Sue/Ken.

 

[Snodger]

I presume the 7 you mention is your HbA1c level, which needs bringing down.

I don't wish to detract from your useful new member advice, daisy1, but if lunarbelle's HbA1c is 7 then it's well within NICE guidelines for Type 2.
"People with type 2 diabetes should be set a target HbA1C level of between 6.5% and 7.5%" -
http://www.nice.org.uk/guidance/index.j ... le&o=29002

 

[daisy1]

Yes - you are right according to your link. Thanks for correcting me

 

[cugila]

I presume the 7 you mention is your HbA1c level, which needs bringing down.

I don't wish to detract from your useful new member advice, daisy1, but if lunarbelle's HbA1c is 7 then it's well within NICE guidelines for Type 2.
"People with type 2 diabetes should be set a target HbA1C level of between 6.5% and 7.5%" -
http://www.nice.org.uk/guidance/index.j ... le&o=29002

That guidance was from 2002.......it was updated and superceeded in 2008 and the new advice is still current advice in 2011......check out the quick reference guide issued May 2009 NICE Clinical guideline 87 which is an update of Clinical guidline 66......see here :

The guidance was published following a review of 4 separate NICE guidelines on various aspects of diabetes management first introduced in 2002. These have been superseded by this new guidance.

KEY PRIORITIES FOR IMPLEMENTATION
•Offer structured education to all patients and/or carers at diagnosis, with annual reinforcement and
review.
•Provide individualised and ongoing dietary advice from a healthcare professional with relevant expertise.
•Set a target HbA1c in partnership with the patient (this may be higher than the general target of 6.5%) and then:
- Encourage maintenance of the target unless side effects or efforts to achieve this impair quality of life. - Offer therapy to help achieve and maintain target HbA1c.
- Advise those with a higher HbA1c of the benefits of any reduction towards the agreed target.
- Avoid pursuing highly intensive management to achieve HbA1c <6.5%.

As we know that complications can start to set in when HbA1c levels are consistently at HbA1c levels of 7% and above I cannot understand anybody who thinks a level of 7.5% is a suitable level for any Type 2. We want to see people without complications........not encourage them to think that 7% and above is a good level to be at. 7% needs to be reduced as Daisy has stated......good advice ! It's also her opinion in the same way that it is also mine too.

We encourage people to do better....NOT tell them higher levels are fine.......why would anybody who cares about someones health do that ! We frequently see advice from HCP's which is frankly not helpful and certainly not always in the Patients best interests.......hence many of us give different advice. That is what makes this place so successful and why many of the new Members especially get great results after following the advice on here as opposed to HCP advice. If we think it's rubbish.....we say so....... :twisted:

Part of the advice also states :

Inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health.

We are certainly not in the business of perpetuating the rubbish advice in certain areas of the NHS/DUK.....we want people to be better informed and better controlled. I think we have had this conversation before....... :wink:

 

[Snodger]

Cugila, fair point that I linked to the old guidelines, but actually, the most recent evidence strongly suggests that NICE should go back to them. I know it seems common sense to get HbA1c down as far as possible, it's not that straightforward - research is taking place which it's important to be aware of, see below.

I posted the other day about the article in a recent BMJ about HbA1cs in Type 2s - Iona Heath, chair of Royal College of GPs - http://www.bmj.com/content/342/bmj.d2254
I quote "evidence is now mounting...that intensive glycaemic control in Type 2 diabetes increases mortality"
To give you an idea of what is meant by "intensive", one of the most recent pieces of evidence was published last month in the New England Journal of Medicine - http://www.nejm.org/doi/full/10.1056/NEJMoa1006524
Here they did a trial where they had an intensive therapy group getting HbA1c down to 6 or lower, and a control group where HbA1c was 7-7.9. The trial was meant to last five years. They were forced to stop the trial after 3.7 years because so many of the intensive therapy group were dying. They had to get them all back up to 7 and monitor them to see if they were okay.
Again, I quote:
"After termination of the intensive therapy, due to higher mortality in the intensive-therapy group, the target glycated hemoglobin level was 7 to 7.9% for all participants, who were followed until the planned end of the trial." They conclude that intensive therapy "cannot be recommended".

No doubt NICE will update its guidelines in the light of the latest research in due course. In the meantime, these are significant risks being reported in extremely respected journals... useful for all of us who care about each other's health risks to be aware of.

 

[sugarless sue]

We randomly assigned participants with type 2 diabetes and cardiovascular disease or additional cardiovascular risk factors to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level of 7 to 7.9%). After termination of the intensive therapy, due to higher mortality in the intensive-therapy group, the target glycated hemoglobin level was 7 to 7.9% for all participants, who were followed until the planned end of the trial.

A quote taken from that study, these people had other issues apart from Diabetes so the question is,did they die from the lowering of HbA1c or from their other issues. Type 2 Diabetics who do not have Cardiovascular issues may be quite safe trying to lower their HbA1c down to lower numbers to prevent the onset of complications which occur when the HbA1c is over 7 %.

Personally I am quite happy to keep in the 6's, 7 or over is too high for me.

 

[catherinecherub]

It's a bit like this study on older Type 2's.

Older people are more at risk of dying anyway and there is nothing here that proves why these people died.


http://www.medicalnewstoday.com/articles/222730.php

 

[cugila]

Snodger.
I am fully aware of all the research and indeed the ongoing research that is taking place and that some circles think that the HbA1c levels should be higher. That's the problem. The so called guidelines are constantly being 'dumbed down.' Why, when the NHS and others know that certain levels are probably going to lead you into complications further down the line, do they not try instead to encourage people to have lower levels, so that they can avoid the complications. It's almost as if they are determined to get us all needing medication, and more problems ? A recipe for disaster in my view........

I have NEVER advocated anybody going as low as the 5+ levels as I think that is too low. Risks of hypoglycaemia. I do however advocate levels of 6% or above up to 6.5% in accordance with the present guidelines.

Now, we here do not wish to see Members thinking that a level such as 7% HbA1c is fine.....it isn't. If there are people who because of their own particular set of circumstances wish to keep those sort of levels then that is fine by me.......I will never agree with that despite any thoughts from the medical profession that higher levels are OK.

I once had such higher levels because I religiously followed the medical advice dished out by the NHS and DUK. what did it get me ? High Bg levels throughout the day, eyesight problems, heart problems etc etc....... How did I reverse ALL those problems ? By following the sort of advice that we routinely hand out to new Members every day......that is the route to good, sometimes excellent control.......not blindly following the NHS/DUK advice. It is flawed and doesn't work for many of us.......that is what this place is about, givimg people information and alternatives which DO work for many.

So in this case you and I are going to have to agree to disagree again.......I can live with that. Just don't expect me to agree that HbA1c levels of above 6.5% are good.........they simply are not !

I do not follow all the guidelines........

 

[lunarbelle]

Many thanks for the replies even though i don,t fully understand some of the last posts , i din,t think the doctor was trying to spur me on with threats of insulin ,he was very serious and took a very stern attitude towards me and was very clear in telling me that if i can,t get my level down from 7 in the next 4 weeks then he will put me on insulin,i found this very strange as i have seen other doctors at the practise of late over other issues who have stated it yes it was a little high and to try and lose some weight and adopt a better life style .
any way it has gave me a quick up the rear to change a few things ,one being today went to work with no bread and just salad and fruit ,well after 13 hours at work i could have eaten the first dog on the street i came across (between bread ),it was a struggle but i managed and no doubt it will get better ,bear in mind my usual food for work was loads of white bread and kit kats and coffee , yet still didn,t suffer the side effects you read about with this disease .
After spending a few hours on the net i find it s very confusing to get some clear guidance on what not to eat or do for the best , i know every ones case is differant .
Is bread a total no no or is brown ok, is fruit no good , looks like i will have to do some heavy surfing to get a more clear picture and yes i know i should have done this a while ago.
many thanks .

 

[daisy1]

Hi again lunarbelle I'm not suggesting that you follow a complete diet but I thought you could pick and choose foods from two versions of Viv's diet which would give you a good idea of the sort of things that would be good for you to eat. I think this might help answer a lot of your questions. One good side effect of eating in a low-carb way is that your hunger will reduce naturally so the dogs around you will live a bit longer :wink:

This is the main diet:

viewtopic.php?f=18&t=18803#p170998

and this gives more examples of things you can eat, following on from the main diet:

viewtopic.php?f=18&t=18803&start=15#p176592

Hope you find this a useful guide to get you started

(Thanks Viv )

 

[lunarbelle]

Again thanks for replies , I think i may have a problem but i m not quite sure.
since i have been on the gliclazide on wednesday i have never felt so rough and when it gets to night time i am getting very light headed and shaking plus sweating and cramps whilst in bed .
Is this due to the glicazide and the metformin i was already on and is it being made worse as i have cut down my carbs a lot since Wednesday.
I felt perfectly well before i saw the doctor and he started me on the glicazide ,don,t think i will take these anymore and wait till the doctors open on Tuesday .
Any help would be appreciated.

 

[sugarless sue]

Are you testing your Bg levels when this happens ? It may be that the combination of Gliclizide and the fact that you are reducing carbs is causing you to Hypo in the evening.

If this continues you may need to see your doctor about it. If you are reducing carbs you may not require the Gliclizide but you have to test to see what your levels are and see the doctor to discuss.

 

[viviennem]

Lunarbelle, if you went to work with just salad and fruit and no protein you definitely would end up very hungry and ready to eat a dog (take the skin off first! :lol: :wink: ).

Protein and fat - chicken, ham, a piece of cheese, mayo on that salad - keep you feeling fuller for longer. If you have a protein breakfast (eg an omelette) and take protein and salad for lunch, you'll be okay.

Read the diet through again, carefully, also the meal sheet (what I eat) which I think Daisy sent to you too. You might get a headache to start with, but it will go.

Don't forget to drink plenty of water. And keep testing!

Viv 8)

 

[viviennem]

By the way, you don't have to get the symptoms to be diabetic. I've never had a symptom, ever, but I'm still diabetic! :roll:

Viv 8)

 

[lunarbelle]

Thanks again for replies,
No i don,t self test and never have done and it has never been suggested for me to ,do you think it would benefit to do the tests ,again i have read for and against doing this and probably never bothered because ive always felt so well and never suffered any ill effects .
I have not taken the gliclizide today but have stuck to my diet and feel a lot better .
many thanks.