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Newbie - a little confused & worried

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bigalxyz

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41yo, male.

Two recent blood tests showing blood glucose (after 12 hour fast) of 17 and 16 mmol/litre respectively. GP told me anything over about 10 is indicative of type 2 diabetes.

Initial appointment at diabetes clinic tomorrow at my local GP surgery to discuss.

Questions/thoughts...

* these are very high numbers, if my understanding is correct. Previous tests have been totally normal - whatever has happened seems to have happened in the last 12 months. Having said that, a nasty back injury (fixed now, fingers crossed) has meant that my levels of physical activity have been very low, and I put quite a bit of weight on as a result (maybe 20kg - a lot in a short space of time). I guess that's where the problem lies. I also (unfortunately) took up smoking again. 18 months ago I was much lighter & fitter, climbing mountains with little difficulty & starting to train for a marathon.

* dietary advice sheet from GP suggested avoiding sugar (fine) and alcohol (fine) but suggested basis of diet should be starchy carbohydrates. This seems bizarre to me...starch is just chains of glucose molecules & enzymes break the chains down quickly anyway. A slice of bread eaten now is pretty much equivalent to a few spoonfuls of sugar eaten a little bit later on. If my body is having trouble coping with glucose, how is eating lots of food which is essentially made of glucose supposed to help me?! Wouldn't carbohydrate restriction be a more sensible approach?

* Last week GP suggested metformin may be advisable to try (as well as diet & exercise etc.). What (in broad terms) can I expect from this in terms of how I feel, the numbers, etc.? Currently I'm rather tired, sluggish, a bit light headed sometimes. Has been attributed to depression etc. in the past but I'm not so sure now.

* I'm new to all of this & panicking a bit. Looking for some reassurance that I'm not about to drop dead of a heart attack by the end of the week, etc. Now that my back is on the mend I'm starting to become more physically active - trying to go for regular walks, hoping to build up my fitness again, etc. I stopped smoking about a month ago (before I had any suspicion that I might be diabetic) & I've barely touched alcohol or caffeine for a month either. I'm kind of doing everything right at the moment...I hope so anyway.

Grateful for any comments, words of advice, etc.

Thx
Alan.
 
Hi Alan and welcome to the forum :) Your 20kg weight gain will certainly have raised your BG level which is too high. Lack of exercise too. The criteria for diagnosis of diabetes is in fact a fasting test above 7. You seem to be doing the right things now however. A diet consisting mainly of starchy carbs is not going to help you to control your diabetes - on the contrary you should reduce these carbs as you have already been thinking.

Here is some basic information to help you to control your diabetes which was put together by the former Monitors. The diet information is different from that which your doctor recommended but this is what we believe works the best for us. Have a read of this, look around the forum and ask as many questions as you like.

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.
Click to expand...
 
Many thanks for all that info - I'll browse through it in more detail later on.

On the diet front: in the run-up to getting the back injury I mentioned, I felt fitter & stronger than I had in maybe 20 years; I was losing weight, pretty energetic, getting lots of exercise, sleeping well, moods fine, etc. This was for a 6-month period where I ate virtually no carbohydrates whatsoever - I ate meat (and plenty of it, with the fat left on), fish, nuts, olive oil, salad, green veg & a little bit of fruit. Hunter-gatherer stuff. It seemed to suit me very well as a diet.
 
Hi Alan, and welcome!

Background: - I'm Type 2 and a low-carber, diagnosed 14 months ago, have lost about 40lbs up to now but am presently stuck fast and trying to be patient until the weight loss starts again!

I too work on the principle that, if I have a problem metabolising carbohydrate, the best thing is not to eat much of it. I try to keep under 50g per day, preferably below 30g, on a diet very similar to the one you briefly describe. Mine is a slightly modified version of Atkins; if you type 'Modified' into the search box on the Low Carb Forum you should find it.

My diet doesn't suit everyone, but it suits me very well. If your hunter-gatherer method of eating suited you previously, I'd go for it again. Many people on here, even if they don't go very low-carb, find that the NHS recommended diet is too high in carbs to give them good control of their blood glucose levels.

Do try to get a blood glucose meter/tester, and strips on prescription, from your GP. They are vital in the early phase, when you are learning which foods you can eat and which are disastrous for your levels. If they won't give you a meter and strips, in my opinion, you're better off limiting your carbs
than following the NHS diet.

Other people manage their levels very well on higher carb diets - but if it suits you, go for it!

Let us know how you get (got) on at the diabetes clinic.

Viv 8)
 
Thanks Viv.

Went to diabetes clinic to discuss with the nurse.

HbA1c (which she explained was the number they follow more closely than blood glucose) was something like 9.5% (I hadn't seen that number before today). She said she would like to see that down to 7% or lower.

As expected, prescription being issued for metformin, gradually increasing dose to 3x daily (assume 500mg pills). Said try these, come back straight away if anything untoward happens, otherwise we'll see you in 3 months' time.

Had the "why are you encouraging me to each plenty of starchy food when starch is MADE OF GLUCOSE" debate - no sign of a meeting of the minds there, just a bland spiel about keeping blood glucose levels stable (which even unrefined carbohydrates don't do particularly well). I'll save that debate with them for another day, I think. If I can go back there in 3 months' time having lost some weight & got my glucose under control, it'll be harder for them to grumble about my diet.

Said no compelling need at the moment to monitor blood glucose - but also that meant that according to whatever criteria they use, the NHS wouldn't pay for a testing kit for me.

Applied for medical exemption certificate (for free prescriptions)

Confirmed no need to notify DVLA because not taking insulin.

Slight concern over blood pressure. I do tend to suffer from the "white coat" effect though. I used to own a BP monitor which - ironically - I sold a few months ago. I've just ordered a new one though. In the past I'd get readings at home 10-20 points lower than I tended to see when I was in front of the doctor.

Ho hum..........
 
Hi Bigalyx. ust a tip regarding the blood pressure - take your BP monitor wih you next time you go to see Dr or nurse, Make sure you have some normal readings o show him/her . Make your final reading shortly before you leave home and be prepared to take a reading at the surgery.

My Bp rises by 70 to 80 points when I go into the surgery but then I am blessed with a particularly
difficult set of HCP's !

I know the Dr can arrange for you to have a 24 hr test but this can be inconvemient. testing your monitor againsyt their's from he beginning should reassure you all. BP is very important but its important to get it right too.
I often wonder ust how much medication I would be aking for my BP if the only readings aken into consideration were hose at the Drs. They have aken it ten times at one session and it remains at 190 and on a bad day rises to 200,
Funny thing is it doesn't happen at the hospital even if I am going to have an operation or "pins in my eyes".

I blame the diabetic nurse!

You seem to be geting everything sorted . Good luck.
 
Thanks.

Just swallowed first 500mg Metformin tablet. Anyone know how long this stuff takes to start working?

Alan.
 
Good question

I'll bump this up the board to see if someone who's been on metformin can give an idea of how long it took for them.

Benedict

PS welcome to the forum Alan
 
Hi bigalxyz and welcome to the forum, metformin will take a few days to work, but 500mg is a very small dose and even the max dose of 2000mg that I take will only help to reduce blood glucose (bg) levels by 1 or 2mmol/L so it is not a magic bullet and will require you do cut back on your diet, eating smaller portions will help but most of all cutting right back on your carbohydrate intake will make the most difference.

To know how much you personally will need to cut back on the carbs you will need to test your bg before and after meals, as you gradually reduce your carb intake your bg levels should reduce too, if you have been running high bg levels for a while it may best to reduce those numbers slowly so as to reduce the chance of temporary blurred vision.
 
Thanks. Have not had any problems with the drugs in the first 24 hours (eg was warned there was a chance of stomach upsets etc.) so have decided to up the dosage to 1000mg straight away (rather than after a week as the nurse suggested). Fingers crossed.

Diet is currently virtually devoid of carbs. Meat, eggs, (non-starchy) vegetables, salads, olive oil, water, not a lot else.

Managed a 6 mile walk this morning. A month ago I could barely walk to the end of the street. I'm still far far below where I was 18 months ago in terms of fitness, but it's heading in the right direction.

(got bloody sunburn now though)

All the best
alan
 
Live yoghurt is good first-aid for sunburn (tip from handsome young Greek - those were the days!)

Metformin might give you the runs in the intial stages - it did for me, but I settled in about 3 weeks and am fine now - 3 x 500mg per day. It has been known to help with weight loss, and also has a protective effect for some other conditions. Some people can't tolerate it at all, but there is a slow-release version which is easier on the system than the standard - though more expensive so you usually have to ask for it.

Your diet sounds very much like mine. Stick with it and let us know how you get on.

Viv 8)
 
Hello! I was always active but aways big when diagnosed. So to me I look to the positive diabetes will give me the impetus I need to get fit and active again. It seems that by becoming more active and giving up the smoking you're also adopting a similiar approach-strange but in a way this disease is going to be the making of me!
 
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