Newly Diagnosed and Confused

[IBEX82]

Hi all,

Apologies if I’m posting in the wrong place. I am a newly diagnosed Type 2 Diabetic and I have an auto immune condition. I have been placed on gliclazide 80mg, once in the morning and once before evening meal.

I was diagnosed in hospital and due to this my contact is the diabetes specialist nurse at the hospital. I have been given BG monitor and advised to monitor 2-4 times per day as I’m on steroids for my auto immune condition which is affecting my BG levels and the gliclazide can cause lows.

The diabetes specialist nurse gave some initial dietary advice but one of those tips was to have a small amount of carbohydrate at each meal. However, I am obese and under a NHS weight loss programme with a view to lose weight pre gastric bypass surgery. My dietician has recently started me on a low carb, high protein diet and I have started to lose weight. So the new information froth the diabetes nurse is confusing. I spoke to her about this and she said to discuss with my dietician at my next appointment as she will likely change my diet again due to the new diabetes diagnosis.

I have been testing my BG the last week and my fasting morning readings have been 4.1-4.8. My post breakfast readings 6.7-8.1 and my post dinner readings are 10.2-14.7 which is high but I am thinking this is because I have introduced more carbohydrates at each meal.

Any advice or pointers would be helpful. Who do I follow advice wise? Obviously I want to get my HBA1C in range and lose weight as this is important for my overall health but I do not want to risk hypoglycaemic episodes.

My GP has prescribed my tests strips, and lancets and done a medical exemption form for me which I think the strips and lancets I’m lucky given what I’ve read online as some GPs won’t prescribe these for type 2s. Since I have the testing available to me I want make full use of it to help my BG and diet but I just don’t know where to start.

Thank you for reading.

 

[catinahat]

Hello @IBEX82 welcome to the forum
I'm sure you'll get lots of replies soon but while you're waiting have a read of this blog by @JoKalsbeek
https://www.diabetes.co.uk/forum/blog/jokalsbeek.401801/
I am sure that you will find it helpful

 

[Pipp]

Hello and welcome, @IBEX82 . You are not posting in the wrong place.
Here is the forum admin information for new members.
https://www.diabetes.co.uk/forum/threads/basic-information-for-newly-diagnosed-diabetics.17088/

Have a read and ask more questions. There are plenty of knowledgeable and helpful members who will assist.

 

[Pipp]

With a trigger happy finger that hit ‘send’ too soon, I would add that your fasting blood glucose level is one I envy, @IBEX82 . The best use of your meter would be fasting, before each meal, and two hours after. Keep records of what you have eaten and the effect the foods have on your blood levels.

As for the advice from the nurse specialist, the suggestion was to discuss with the dietician at your next appointment. I would see that as advice to continue with dietician advice until you see him/her. Especially if the recommendation from diabetes nurse to have carbs with every meal is causing high blood glucose after meals.

 

[Rachox]

Hi and welcome to the forum!
I’ll just tag in a couple of people who have steroids and type 2, who may be able to help you with regards to the steroid use and blood sugar levels @xfieldok and @JohnEGreen .
I would second @Pipp ’s advice and test before and 2 hours after your meals that way you’ll know what meals suit you.

 

[HSSS]

Welcome.

Your dietician low carb diet is ideal for diabetes. The only reason you are being advised to add carbs is to counteract the glicazide and prevent lows. It seems eminently more reasonable to have less glicazide if that seems at risk of happening rather than adding carbs. Sadly it’s outdated practice from a diabetic nurse unfamiliar with how low carb can help type 2. Medicate to diet not the other way around.

It’s possible that a low carb diet will work well enough that it stabilises both your blood sugars and weight and may even mean you no longer feel the need for gastric surgery. The diabetes and inability to process carbs may well have been a factor in weight gain and lack of success of other types of diets.

The only thing I’d say is high protein tends to be replaced by high fats for diabetes but the nhs are largely still terrified of fats, unnecessarily so according to most of the more recent research on fats and cholesterol etc. Fats will not affect blood glucose and keep you feeling full. Protein for some diabetics has some effect on glucose.

I agree with pipp it seems your diabetic nurse has endorsed staying on dieticians low carb until such time as you revisit the dietician, especially if that way of eating is keeping both your weight and bgl down. And I also agree with the testing before and after each meal. You can really see the direct effect of each food that way. Keep records of it in case you need to convince the nurse low carb foods work!

Your post dinner readings are a bit high, suggesting too many carbs in that meal. Ideally you want a rise of no more than 2mmol from the pre dinner levels and in a perfect world under 7.8 at 2

Your fasting readings are great but if you further reduce carbs keep an eye out they don’t go too low and if they seem to be heading that way get the diabetic nurse to reduce meds - not increase the carbs that are the cause of the problems.

 

[JoKalsbeek]

They have to perscribe strips if you're on gliclazide, because it can cause hypo's. Oh, what a pickle... I don't know how much steroids you're on, I do know when I get a shot for my hip of shoulder my bloodsugars go up a little... I'll see an 8 or something for a day and then it'll level off again. (I am on a keto diet: 20 or less grams of carbs a day). It's all a bit complicated, you see.... Normally, for a T2, I'd advise a low carb, high fat (moderate protein) diet to start with, maybe consider keto later if it suits... As you noticed, you dropped weight like that. And I have a feeling you could forgo the bypass entirely if you stay on this course and keep low carbing for life, as you'd not just lose weight, but keep your bloodsugars in non-diabetic levels as well, which you really, really want to achieve... You see, your weight didn't cause the diabetes. It's your body's inability to process carbs (which is an insulin issue), which piled on weight. That's why conventional low-fat diets didn't work, as I'm sure you tried them. I know I did, and I went from obese to morbidly obese and diabetic with all those "healthy carbs" I was told to eat. It's a symptom of pre- and later diabetes, not a cause. And now you know why you gained the weight to begin with: It was the carbs all along. And going low carb/high fat (moderate protein), for me, meant getting off metformin and gliclazide entirely, and I've had normal bloodsugars ever since. So right now you're just adding carbs to avoid hypo's the gliclazide might give you. But that influences your bloodsugars too and makes them go up. While you're on the glic to make them go down! So I'm not seeing a whole lot of sense here. Drawback being... I'm not a doctor and I have no idea what the impact of your steroids is, and whether you're on the indefinitely or temporarily or what... Are they shots, pills you take every day...? It all could make a difference, and I don't know how much of a difference. And a lot of autoimmune issues do improve on a low carb diet because carbs are inflammatory by nature. I know my rheumatism is a whole lot better (no medication for that whatsoever and I have no trouble brushing my own hair or turning a key, which used to be absolute cry-because-it-hurt-so-bad agony), and I don't need as much thyroid hormone supplements as I used to.

I think you really need to go back to the dietician who perscribed the low carb thing and go over all this with her. She seems rather clued in, more so than the others you talked to. But really... Taking medication to lower bloodglucose and then needing carbs to not hypo is.... Really counterproductive. Plus, you're in the diabetic complications red zone with those numbers, and you'll put weight on again, after your hard work. I think you can do this if you go straight to keto, but you can't do it without assistance/support from your dietician, and a whole lot of teststrips.

Just don't start low carbing again while on gliclazide, because you will crash & burn. I see @catinahat alredy shared my little Nutritional Thingy, (Thanks!) but really.... Be careful.

 

[IBEX82]

Thanks all. So much helpful information and I will have a good read with the links provided.

I think you are all right and I’ll will continue with the low carb approach suggested by my weight loss dietician.

As a couple of you pointed out if I start to get too many lows it would make sense to decrease the medication rather than increasing the carbs which is causing the problem.

I am tracking my BG and will incorporate a food diary. I will also start doing pre meal and 2 hour post meal readings to see where I’m going wrong.

Also I see the magic number is around 7 so with my lunch readings I’m sometimes a little above this but this may because I introduced a little more carbs.

My dietician suggested around 30-50g carbs and perhaps I need to look at more fats then protein - I believe this is moderate carbs? As I thought low was 20g? I definitely need more reading!

 

[Pipp]

Would also be cautious with steroids in the mix, and if you are finding blood glucose falling too low don’t be afraid to use carb to stabilise, particularly in these early days following diagnosis. Do you have to take steroids daily, or is it as a ‘rescue’ for flare up of the auto-immune condition? I ask because I need short courses a couple of times a year, and they play havoc with my blood glucose levels. It used to be just for a week or so, but more recently taking much longer to settle.

 

[IBEX82]

They have to perscribe strips if you're on gliclazide, because it can cause hypo's. Oh, what a pickle... I don't know how much steroids you're on, I do know when I get a shot for my hip of shoulder my bloodsugars go up a little... I'll see an 8 or something for a day and then it'll level off again. (I am on a keto diet: 20 or less grams of carbs a day). It's all a bit complicated, you see.... Normally, for a T2, I'd advise a low carb, high fat (moderate protein) diet to start with, maybe consider keto later if it suits... As you noticed, you dropped weight like that. And I have a feeling you could forgo the bypass entirely if you stay on this course and keep low carbing for life, as you'd not just lose weight, but keep your bloodsugars in non-diabetic levels as well, which you really, really want to achieve... You see, your weight didn't cause the diabetes. It's your body's inability to process carbs (which is an insulin issue), which piled on weight. That's why conventional low-fat diets didn't work, as I'm sure you tried them. I know I did, and I went from obese to morbidly obese and diabetic with all those "healthy carbs" I was told to eat. It's a symptom of pre- and later diabetes, not a cause. And now you know why you gained the weight to begin with: It was the carbs all along. And going low carb/high fat (moderate protein), for me, meant getting off metformin and gliclazide entirely, and I've had normal bloodsugars ever since. So right now you're just adding carbs to avoid hypo's the gliclazide might give you. But that influences your bloodsugars too and makes them go up. While you're on the glic to make them go down! So I'm not seeing a whole lot of sense here. Drawback being... I'm not a doctor and I have no idea what the impact of your steroids is, and whether you're on the indefinitely or temporarily or what... Are they shots, pills you take every day...? It all could make a difference, and I don't know how much of a difference. And a lot of autoimmune issues do improve on a low carb diet because carbs are inflammatory by nature. I know my rheumatism is a whole lot better (no medication for that whatsoever and I have no trouble brushing my own hair or turning a key, which used to be absolute cry-because-it-hurt-so-bad agony), and I don't need as much thyroid hormone supplements as I used to.

I think you really need to go back to the dietician who perscribed the low carb thing and go over all this with her. She seems rather clued in, more so than the others you talked to. But really... Taking medication to lower bloodglucose and then needing carbs to not hypo is.... Really counterproductive. Plus, you're in the diabetic complications red zone with those numbers, and you'll put weight on again, after your hard work. I think you can do this if you go straight to keto, but you can't do it without assistance/support from your dietician, and a whole lot of teststrips.

Just don't start low carbing again while on gliclazide, because you will crash & burn. I see @catinahat alredy shared my little Nutritional Thingy, (Thanks!) but really.... Be careful.

This is so helpful. Thank you for such a detailed post. I am taking 60 mg of steroids orally on a reducing regime for 6 months to help with a flare at the moment. My maintain dose will eventually be around 15-20mg by December hopefully if they are working to control my symptoms.

I have tried every NHS diet known to man and gained more and more weight with no end insight. I was relieved when this dietician suggested my current plan as for the first time in years I started to lose weight and be in control of my diet.. I feel like the diabetes diagnosis has made things more complicated but perhaps has been missed for a while.

I obviously do not want to risk hypos and making myself ill but the earliest I can get in with my dietician again is August 5th so I guess my mantra will be test, test and more test.

An example of BG and food today.

Fast BG 4.1
Breakfast: one scrambled egg, two bacon rashers and one fresh tomato.
BG two hours post 7.3

So going by the 2s increase rule this is too high at 7.3? It should be around 6? But the meal itself was low carb but I did take my steroid so perhaps that has pushed it up higher?

I did take my steroid at 9am and the diabetes nurse advised the way the steroids work is that they will have an increasingly higher effect as the day wears on.

 

[IBEX82]

Would also be cautious with steroids in the mix, and if you are finding blood glucose falling too low don’t be afraid to use carb to stabilise, particularly in these early days following diagnosis. Do you have to take steroids daily, or is it as a ‘rescue’ for flare up of the auto-immune condition? I ask because I need short courses a couple of times a year, and they play havoc with my blood glucose levels. It used to be just for a week or so, but more recently taking much longer to settle.

So they will be long term with a maintenance dose between 15-20mg and that will be daily ongoing by December but as my flare is active now I’m 60mg which will reduce as time goes on providing symptoms decrease.

The diabetes nurse said anything below 4 was too low and to drink 200ml lucozade - if it had come above 4 following a lucozade then follow up with a biscuit... is this about right? I worry about the hypos.. they don’t sound great at all

 

[JoKalsbeek]

So they will be long term with a maintenance dose between 15-20mg and that will be daily ongoing by December but as my flare is active now I’m 60mg which will reduce as time goes on providing symptoms decrease.

The diabetes nurse said anything below 4 was too low and to drink 200ml lucozade - if it had come above 4 following a lucozade then follow up with a biscuit... is this about right? I worry about the hypos.. they don’t sound great at all

I'm not going to lie, hypo's are no fun at all. For me, I get really, REALLY contrary, so even though I know I should eat and drink something sugary, I don't want to. Not very convenient, that, and my poor husband had a lot to contend with when I was still on glic and hypo-ed often. But just keep an eye on things, and if you feel slightly off, even if you can't put your finger on why, test and see where you're at. Your gut'll sometimes tell you before you consiously realise know what's going on. If you are low, have something liquid with sugars; if it's wet it'll hit your bloodstream quicker than if it's a cookie or something. Those take a little while longer to get into your system. Usual advice is to have a drink first (OJ or something, as from what I understand lucozade recently changed their sugar content. Could be wrong though as I don't know the stuff. Never saw it here in the Netherlands). Then after you do the quick liquid rise for your bloodsugars, you toss in something that's a bit slower, so you don't spike and crash right down again. (Yay, oreo's! ) As for the steroids and your breakfast: You said fasting bloodsugars were 4.1, but how soon after that did you eat breakfast? Was there, say, an hour or something between that time? In the morning we experience Dawn Phenomenon. That means our liver dumps glucose to help us start the day, until we eat. That could also have upped your bloodsugars, so it doesn't have to be entirely your steroids and such. And, I don't know what you're suffering from, but if you're ill, have an infection or pain, that too can make your bloodsugars rise. For the moment, I think I'd not worry too much about the 2.0 mmol/l after-meal rise target, as that is based on no other spike-reasons than carb-intake, and just try to stay in between 4.5 and 8.5 as much as you can. If your steroids' effect on your bloodsugars is cumulative, and you're going to lower the dose after the flare-up, I think it's just one of those things to live with, and just do the best you can with what you have. I mean, when I get my shots, steroids, flu jab, that sort of thing, my BG's 'll go up for a bit... But most of the time they're still in range, or drop back to in range soon enough. Not the range I'd like them to be in, but not so high that they'll cause complications. Keep things do-able within your medical needs, and find out what works for you, specifically. Your meter'll help you with that. If you keep seeing double digits though, and you're not dropping back down, ask for help, and maybe discuss temporary insulin during flare-ups if you're hitting teens and twenties. It's not unusual, you wouldn't be the only one.

One more thing: The type 2's been a long time coming. It was responsible for your weight gain, and that was the reason why other diets didn't work. It's genetics, alas, in combination with our modern western diet. Most of us just aren't built for this, literally. So, when you say this: "I feel like the diabetes diagnosis has made things more complicated but perhaps has been missed for a while." you're looking at it backwards... Getting the diagnosis means you now know you have a metabolic issue...! And that metabolic issue is responsible for your weight gain. And if you have metabolic syndrome, it's also to do with high cholesterol, high bloodpressure, non-alcoholic fatty liver disease/cirrhosis of the liver... If you can't process carbs effectively, you have your answer to all those things right there. You have a diagnosis; that means you finally have the solution too. Knowing what the problem was to begin with, can help you solve it! I know my quality of life changed dramatically. And I thought T2'd be a death sentence when I just found out. Instead, once I knew what the issue was and tackled that, I got my life back. It's actually worth living these days, and before, it was just existing. Barely.

Silver linings.
Jo

 

[IBEX82]

I'm not going to lie, hypo's are no fun at all. For me, I get really, REALLY contrary, so even though I know I should eat and drink something sugary, I don't want to. Not very convenient, that, and my poor husband had a lot to contend with when I was still on glic and hypo-ed often. But just keep an eye on things, and if you feel slightly off, even if you can't put your finger on why, test and see where you're at. Your gut'll sometimes tell you before you consiously realise know what's going on. If you are low, have something liquid with sugars; if it's wet it'll hit your bloodstream quicker than if it's a cookie or something. Those take a little while longer to get into your system. Usual advice is to have a drink first (OJ or something, as from what I understand lucozade recently changed their sugar content. Could be wrong though as I don't know the stuff. Never saw it here in the Netherlands). Then after you do the quick liquid rise for your bloodsugars, you toss in something that's a bit slower, so you don't spike and crash right down again. (Yay, oreo's! ) As for the steroids and your breakfast: You said fasting bloodsugars were 4.1, but how soon after that did you eat breakfast? Was there, say, an hour or something between that time? In the morning we experience Dawn Phenomenon. That means our liver dumps glucose to help us start the day, until we eat. That could also have upped your bloodsugars, so it doesn't have to be entirely your steroids and such. And, I don't know what you're suffering from, but if you're ill, have an infection or pain, that too can make your bloodsugars rise. For the moment, I think I'd not worry too much about the 2.0 mmol/l after-meal rise target, as that is based on no other spike-reasons than carb-intake, and just try to stay in between 4.5 and 8.5 as much as you can. If your steroids' effect on your bloodsugars is cumulative, and you're going to lower the dose after the flare-up, I think it's just one of those things to live with, and just do the best you can with what you have. I mean, when I get my shots, steroids, flu jab, that sort of thing, my BG's 'll go up for a bit... But most of the time they're still in range, or drop back to in range soon enough. Not the range I'd like them to be in, but not so high that they'll cause complications. Keep things do-able within your medical needs, and find out what works for you, specifically. Your meter'll help you with that. If you keep seeing double digits though, and you're not dropping back down, ask for help, and maybe discuss temporary insulin during flare-ups if you're hitting teens and twenties. It's not unusual, you wouldn't be the only one.

One more thing: The type 2's been a long time coming. It was responsible for your weight gain, and that was the reason why other diets didn't work. It's genetics, alas, in combination with our modern western diet. Most of us just aren't built for this, literally. So, when you say this: "I feel like the diabetes diagnosis has made things more complicated but perhaps has been missed for a while." you're looking at it backwards... Getting the diagnosis means you now know you have a metabolic issue...! And that metabolic issue is responsible for your weight gain. And if you have metabolic syndrome, it's also to do with high cholesterol, high bloodpressure, non-alcoholic fatty liver disease/cirrhosis of the liver... If you can't process carbs effectively, you have your answer to all those things right there. You have a diagnosis; that means you finally have the solution too. Knowing what the problem was to begin with, can help you solve it! I know my quality of life changed dramatically. And I thought T2'd be a death sentence when I just found out. Instead, once I knew what the issue was and tackled that, I got my life back. It's actually worth living these days, and before, it was just existing. Barely.

Silver linings.
Jo

Thanks Jo! You’re so knowledgeable and I can only hope in time I’ll get there myself

I had my breakfast around 20 mins after my fasting BG as I was making it Is that okay? I am in an auto immune flare and I am post surgery following thrombolysis and thrombectomy due to a DVT. So dissolution and removal of clot to my right leg with stents fitted to large veins to keep them open so I am in pain too. I’ll take the advice and not worry to much about the 2s.. just try to stay below 8.5 great advice! I guess it’s easy to blame the steroids for everything!

And yes, you are right - I know now the cause.. the reason why every healthy carb diet has failed me and the reason I have gained so much weight eating the right things! Blessing in disguise and now I can start making thing right - I am aware it’s not an overnight job but I’m starting on the right path and another silver lining... my cholesterol is low

 

[JoKalsbeek]

Thanks Jo! You’re so knowledgeable and I can only hope in time I’ll get there myself

I had my breakfast around 20 mins after my fasting BG as I was making it Is that okay? I am in an auto immune flare and I am post surgery following thrombolysis and thrombectomy due to a DVT. So dissolution and removal of clot to my right leg with stents fitted to large veins to keep them open so I am in pain too. I’ll take the advice and not worry to much about the 2s.. just try to stay below 8.5 great advice! I guess it’s easy to blame the steroids for everything!

And yes, you are right - I know now the cause.. the reason why every healthy carb diet has failed me and the reason I have gained so much weight eating the right things! Blessing in disguise and now I can start making thing right - I am aware it’s not an overnight job but I’m starting on the right path and another silver lining... my cholesterol is low

I just know a few things about a few things.... Just sounds like a lot, when you're just getting started, haha. Seriously, you're going to feel better. The only way is up, from here.
Jo

 

[Pipp]

I haven’t experienced hypos, so glad that @JoKalsbeek has given such a good explanation.

 

[Daibell]

Hi. You don't need to have any carbs in your diet as long as you have enough fibre and other minerals etc from your fats, proteins, veg and fruit. All of this 'must have some carbs' can be tracked from PHE and other Global diet 'experts' and is not based on good science. Most people do choose to have some carbs but they are not essential for health as long as you have the other food types. When you do have some carbs then choose the low-GI fibrous ones. Gliclazide should be adjusted by the HCP to match your blood sugar control needs and the carbs should not be taken just to balance the wrong Gliclazide dose.

 

[IBEX82]

Hi. You don't need to have any carbs in your diet as long as you have enough fibre and other minerals etc from your fats, proteins, veg and fruit. All of this 'must have some carbs' can be tracked from PHE and other Global diet 'experts' and is not based on good science. Most people do choose to have some carbs but they are not essential for health as long as you have the other food types. When you do have some carbs then choose the low-GI fibrous ones. Gliclazide should be adjusted by the HCP to match your blood sugar control needs and the carbs should not be taken just to balance the wrong Gliclazide dose.

Makes perfect sense and correlated to what my dietician has said. Although I was trying low carb first to see how I managed. It doesn’t appear logical to eat more carbs to take medication..I am hoping the goal is to end up medication free if possible? Although I know that might not be completely possible due to the steroids.

 

[HSSS]

Possibly not, only time will tell, but you can minimise what you do need and lessen the chances of complications significantly

 

[IBEX82]

Ohhh it’s so disappointing.

Pre breakfast 4.7.... two hours post: 8.2

Breakfast: 1 egg scrambled and a small chopped tomato with a cuppa. Builders tea so just a threat of milk.

I may forgo my steroids tomorrow until I’ve done my after breakfast BG... see if it makes a difference.

 

[bulkbiker]

Ohhh it’s so disappointing.

Pre breakfast 4.7.... two hours post: 8.2

Breakfast: 1 egg scrambled and a small chopped tomato with a cuppa. Builders tea so just a threat of milk.

I may forgo my steroids tomorrow until I’ve done my after breakfast BG... see if it makes a difference.

Maybe next time try 2 eggs and no tomato and in some butter to the mix for extra satiety?