Newly diagnosed as type 2 diabetes

[G3S]

Hi All,

I am new to this forum. I have been recently diagnosed type 2 diabetes and my blood sugar is 60. NHS nurse scheduled some follow up for foot and eye check up. is this level is very high to get it control? any advise would be really helpful

I am an Asian and my current weight is 102 kg and i controlled my food portion and doing weekly 2 hrs exercises. But still I am not able to reduce my weight/any change in the weight scale. Could anyone please advise me what should I do as first step to make some change to get better and healthy lifestyle.

Looking forward to hear some support from you all. Thanks in advance.

Thanks,
G3S

 

[chrisjohnh]

Before taking any mitigation measures it is useful to know **exactly** what one is ingesting, specifically: how many calories per day, how many carbs (and what kind?), fats, protein, fibre and so on. How are they distributed across meals, or between meals?

Very probably you can fix this within a matter of months, so be optimistic. What inspired me after diagnosis (with a figure higher, i.e. worse, than yours) in particular was David Cavan's book "Reverse Your Diabetes: The Step-by-Step Plan to Take Control of Type 2 Diabetes", published in 2014.

Good luck on this journey: as Cavan writes in his opening: do not worry, take control.

 

[G3S]

Before taking any mitigation measures it is useful to know **exactly** what one is ingesting, specifically: how many calories per day, how many carbs (and what kind?), fats, protein, fibre and so on. How are they distributed across meals, or between meals?

Very probably you can fix this within a matter of months, so be optimistic. What inspired me after diagnosis (with a figure higher, i.e. worse, than yours) in particular was David Cavan's book "Reverse Your Diabetes: The Step-by-Step Plan to Take Control of Type 2 Diabetes", published in 2014.

Good luck on this journey: as Cavan writes in his opening: do not worry, take control.

Thanks ChrisJohn for referring me to book 'Reverse Your Diabetes' by David Cavan. I liked the quotes 'Do not worry, take control'. Let me read and make some changes to my lifestyle slowly.

 

[Ronancastled]

I am new to this forum. I have been recently diagnosed type 2 diabetes and my blood sugar is 60. NHS nurse scheduled some follow up for foot and eye check up. is this level is very high to get it control?

As you probably know 48 is the cutoff so you're not overly high.
I've seen people diagnosed in the 100s fall back to non-diabetic levels at there 3 month follow up.
I've seen prediabteics fall into full blown T2 despite huge efforts, every case appears to be different.

my current weight is 102 kg and i controlled my food portion and doing weekly 2 hrs exercises. But still I am not able to reduce my weight/any change in the weight scale. Could anyone please advise me what should I do as first step to make some change to get better and healthy lifestyle.

Forget about portion sizes, this is all about carbs & nothing else.
Research low carb eating, look up Dr. Jason Fung & Sarah Halberg online.
You have a window of opportunity to turn this around if you act now.

 

[G3S]

Thanks Ronan. I was bit worried because NHS nurse asked me to take some medicine immediately since 60 is bit on the high side. Thanks for your support.

I m looking into low carb food and also will read Jason fung book

 

[G3S]

Should i avoid fruits altogether when i try low carbs foods?
Also i feel so hungry in the mid noon and this was not there earlier. Hunger is because of increased blood sugar level i believe. Is there anything i can do to reduce the hunger without eating?

 

[chrisjohnh]

Is it truly about carbs and nothing else? My understanding, albeit provisional, is that the priority is to clear the excess fat from the liver and pancreas. If I reduce daily carbs to, say, 20g and at the same time (however much fats and protein it may require) consume 3000 cals whilst doing little exercise, will that visceral fat magically dissipate? I wish we all knew the definitive answer to this, if there is any.

I worry about the following analogy: say I have a car with an almost totally knackered engine and when I drive it above 10mph its behaviour is dangerously dysfunctional. So, I instead adopt the ultra-low-speed strategy (being "all that matters") to keep below 10mph and then describe my driving as being "in remission", even though the engine is still knackered and likely to become even more so as time goes on. Is remission merely getting continuing "good" HbA1c results by presenting few carbs to one's metabolism? Or is remission getting continuing "good" HbA1c results by clearing away that excess fat and then being able to eat plenty of carbs with a no longer knackered engine?

Oh for the truth about all this! All advice welcomed!

 

[G3S]

Sorry for being naive. I understand your analogy, remove the excess fat around the internal organs like liver and pancreas might bring overall health should be long term goal. By adapting to low carb foods, can we make some changes to blood sugar levels. I mean getting it in control in my case

 

[Deleted member 543160]

@G3S - I was diagnosed in November 2013 with similar HbA1c levels to you (60-61), which is definitely diabetic but not particularly high, and I was very much overweight. My exercise was mainly routine household activities. But by cutting right down on all high carbohydrate/sugar foods, by Feb 2014 my HbA1c had reduced to a pre-diabetic level of 47and is currently much lower. In the first few months I also lost around 20 kilos with diet alone, and have since lost more.

As a T2, My body no longer handles carbs vey well, so for me it's essentially a matter of balancing reduced carbs with normal full fat food for my energy needs, and not much change in my protein requirements. I've never needed to count calories.

With an LCHF/ketogenic diet we're basically doing two things: reducing carbohydrate consumption to lower our glucose to acceptable levels, and balancing fat against lowered carbs for weight maintenance or reduction - eating enough fat to replace those carbs and keep weight stable, or reducing it to the point where we resort to burning off stored body fat instead (hopefully!) resulting in desired weight loss. We may reach a point where our body hasn't yet (re)adapted to the point where it uses fat for fuel, so we may get hungry for a short rime while it learns to do so.

Many of us are fortunate in that we are able to manage our T2 mainly by diet alone, but there are others who however hard they try, for various reasons end up needing medicines as well.

ETA:
I've just seen your follow up post regarding fruit: unless you go extremely low carb, it's generally OK to eat small quantities of low carb fruit, e.g. berries, without issue, and I do so without any problems, but check your glucose levels to see what effects it might have on you. Diet Doctor is a great resource and has some useful charts showing carbs in fruit, vegetables. etc. As a bonus, Jason Fung is also one of its regular contributors...

Some people are very anti fruit because of fructose, but our livers can usually handle & use the small amounts found in fruit - it's generally added fructose. e.g. in the form of high fructose corn syrup, that is the main issue and needs to be avoided.

 

[ThoseRainyDays]

Sorry for being naive. I understand your analogy, remove the excess fat around the internal organs like liver and pancreas might bring overall health should be long term goal. By adapting to low carb foods, can we make some changes to blood sugar levels. I mean getting it in control in my case

After 3 months of low carb, my blood sugars are under control with a hba1c of 36 which is in the non diabetic level. I was diagnosed as type 2 after a HbA1c of 65. Low carb keeps my bloods in the 5's and 6s and has allowed me to lose nearly 3 stone in 5 months. Low carb should help you reduce your hba1c if you're a type 2.

 

[Daibell]

Is it truly about carbs and nothing else? My understanding, albeit provisional, is that the priority is to clear the excess fat from the liver and pancreas. If I reduce daily carbs to, say, 20g and at the same time (however much fats and protein it may require) consume 3000 cals whilst doing little exercise, will that visceral fat magically dissipate? I wish we all knew the definitive answer to this, if there is any.

I worry about the following analogy: say I have a car with an almost totally knackered engine and when I drive it above 10mph its behaviour is dangerously dysfunctional. So, I instead adopt the ultra-low-speed strategy (being "all that matters") to keep below 10mph and then describe my driving as being "in remission", even though the engine is still knackered and likely to become even more so as time goes on. Is remission merely getting continuing "good" HbA1c results by presenting few carbs to one's metabolism? Or is remission getting continuing "good" HbA1c results by clearing away that excess fat and then being able to eat plenty of carbs with a no longer knackered engine?

Oh for the truth about all this! All advice welcomed!

Hi. I don't believe Calories have any relevance in this. Carbs are the main cause of weight gain and fat deposits so keeping them down is surely the way to go. I think you may be referring to Newcastle Diet stuff which I question. The problem I have with Calories is that there is no definition of the food group mix hence 3000 Calories etc has no meaning. A Calorie is purely a measure of energy and not all calories are equal when it comes to food input.

 

[chrisjohnh]

Thanks Daibell for that observatiion "Carbs are the main cause of weight gain and fat deposits so keeping them down is surely the way to go." It was on that assumption that I suppressed carbs quite a lot in my own remission journey, although I did monitor my cals as well, perhaps superfluously, as though to hedge my bets. And I still measure and monitor both of them, week in week out.

Still, could it be argued that weight loss (to eliminate that visceral fat) must be tantamount to energy loss (assuming E still equals MC-squared!) and that even if one is focusing only on reducing carbs to achieve remission the necessary entailment is that it shall bring about a net calorie deficit, whether or not one chooses to observe, measure and take heed of that?

 

[Outlier]

An observation about visceral fat based totally on my experience not medical research;

How many of us have prepared wild animals for the table? These creatures eat a biologically-appropriate diet, take lots of exercise and are generally pretty healthy apart from injuries. When their guts are examined, the first place they carry fat (except for one species of deer) is visceral. This applies to UK creatures only, as that is the extent of my experience, but it's pretty wide experience within those limits.

I strongly suspect that visceral fat has a protective purpose, and has been conveniently demonised. One day science might think differently. Those of us who are or have been overweight will lose some visceral fat, but it is arguable that the aim of losing most/all of it is a bandwagon not good science.

 

[chrisjohnh]

What then is your most favoured hypothesis as to the root cause of T2D?

 

[bulkbiker]

that even if one is focusing only on reducing carbs to achieve remission the necessary entailment is that it shall bring about a net calorie deficit, whether or not one chooses to observe, measure and take heed of that?

By reducing carbs you may or may not have a "calorific deficit" however in my opinion a deliberate reduction in calories is not necessary.
This is mainly because the consumption of very low carb over time reduces insulin excursions and allows the natural regulation of food consumption that the body used to do when we were a more "normal" weight.
We have hormones that control appetite and we allow them to function normally by not causing insulin spikes and retuning our blood sugar levels to normal.
This leads to an increase in satiety which could mean that we feel the need to eat less and less often.

I feel very strongly that the CICO mindset has stopped us looking at the FOOD that we eat (we don't eat "calories") and has led to the thought that 300 calories worth of doughnut is the equivalent to 300 calories of sirloin steak and it isn't.

 

[chrisjohnh]

By reducing carbs you may or may not have a "calorific deficit" however in my opinion a deliberate reduction in calories is not necessary.
This is mainly because the consumption of very low carb over time reduces insulin excursions and allows the natural regulation of food consumption that the body used to do when we were a more "normal" weight.
We have hormones that control appetite and we allow them to function normally by not causing insulin spikes and retuning our blood sugar levels to normal.
This leads to an increase in satiety which could mean that we feel the need to eat less and less often.

I feel very strongly that the CICO mindset has stopped us looking at the FOOD that we eat (we don't eat "calories") and has led to the thought that 300 calories worth of doughnut is the equivalent to 300 calories of sirloin steak and it isn't.

Thank you for these thoughts. Let us then consider the Taylor experiment which found that the probability of remission increased with the amount of weight lost and with the amount of intra-organ fat lost. Is it your view that the wrong conclusion has been drawn from this? That is, the remission success rate was actually correlating with carb reduction, a parameter not reported, and perhaps not even measured, in that experiment? I still seek an answer to this question: if I weigh 20 stone and drop my carbs to 20g a day but - by whatever means it takes - maintain that weight and all my visceral fat and get my HbA1c down to 40 for a year, is that a genuine remission? In that scenario the low result is surely just an obvious and trivial outcome of not stoking the fire with more fuel, but it is not arresting the continuing exhaustion of the pancreas by the assault of the visceral fat? Which is why after a few years I would land up on drugs. My impression is that to achieve genuine remission and healthier organs underlying that, explicit loss of weight is going to be essential for most, that 20 stone has to come down to 10 stone, and that reduction of mass is a reduction of energy by straight physics, even if carb reduction is the facilitating tactic in that.

 

[bulkbiker]

That is, the remission success rate was actually correlating with carb reduction, a parameter not reported, and perhaps not even measured, in that experiment?

The original experiments that the DiRECT study was based on actively tested for ketones so it would be likely that ketosis can be attained .. starvation rather than nutritional but still ketosis. This could also explain why over time the success rate drops as too many carbs overcome the starvation benefits. But still we all know that crash diets rarely (if ever) lead to long term weight loss.

if I weigh 20 stone and drop my carbs to 20g a day but - by whatever means it takes - maintain that weight and all my visceral fat and get my HbA1c down to 40 for a year, is that a genuine remission?

Yes by every measure that any study uses.. in fact anything sub 48 mmol/mol is classed as "remission" .. personally my standards are a bit higher. (That was the DiRECT criteria too).

My impression is that to achieve genuine remission and healthier organs underlying that, explicit loss of weight is going to be essential for most,

I got into remission before the majority of my weight loss and I never really counted calories simply reduced carbs to a minimum and ate whenever hungry. That's what I mean but allowing our natural hormonal mechanisms to regain control of hunger. Our bodies are smart enough to recognise satiety and hunger when we don't overfill them with carby rubbish.

that reduction of mass is a reduction of energy by straight physics

If our bodies were closed systems (like bomb calorimeters) I might agree ... however they aren't so your argument kind of falls down.

 

[Lupf]

Still, could it be argued that weight loss (to eliminate that visceral fat) must be tantamount to energy loss (assuming E still equals MC-squared!) and that even if one is focusing only on reducing carbs to achieve remission the necessary entailment is that it shall bring about a net calorie deficit, whether or not one chooses to observe, measure and take heed of that?

This analogy assumes that our bodies are like combustion engines and weight loss is achieved by reducing calories, but this is incorrect. Most diets fail because of this approach. If you reduce calorie intake you will initially lose weight, but then your base metabolic rate will go down, so that say instead of needing 2000 calories per day you will only need 1500 calories per day. You will then stop losing, even gaining weight, be hungry all the time, which will make you miserable and you will eventually give up. This leads to yo-yo dieting.
Our bodies are hormonal engines. When the body produces insulin we get hungry. Eating carbs will only give you a quick fix and make you more hungry. By replacing carbs with fat you will get more satiated and won't feel hungry or miserable anymore. For some people this switch is sufficient to lose weight. Intermittent fasting has worked for me, and I lost 10 kg. It is well tested by human evolution, when our ancestors failed to hunt mammoth they had not enough food and the body starts to burn the fat around around male bellies.

 

[G3S]

@G3S - I was diagnosed in November 2013 with similar HbA1c levels to you (60-61), which is definitely diabetic but not particularly high, and I was very much overweight. My exercise was mainly routine household activities. But by cutting right down on all high carbohydrate/sugar foods, by Feb 2014 my HbA1c had reduced to a pre-diabetic level of 47and is currently much lower. In the first few months I also lost around 20 kilos with diet alone, and have since lost more.

As a T2, My body no longer handles carbs vey well, so for me it's essentially a matter of balancing reduced carbs with normal full fat food for my energy needs, and not much change in my protein requirements. I've never needed to count calories.

With an LCHF/ketogenic diet we're basically doing two things: reducing carbohydrate consumption to lower our glucose to acceptable levels, and balancing fat against lowered carbs for weight maintenance or reduction - eating enough fat to replace those carbs and keep weight stable, or reducing it to the point where we resort to burning off stored body fat instead (hopefully!) resulting in desired weight loss. We may reach a point where our body hasn't yet (re)adapted to the point where it uses fat for fuel, so we may get hungry for a short rime while it learns to do so.

Many of us are fortunate in that we are able to manage our T2 mainly by diet alone, but there are others who however hard they try, for various reasons end up needing medicines as well.

ETA:
I've just seen your follow up post regarding fruit: unless you go extremely low carb, it's generally OK to eat small quantities of low carb fruit, e.g. berries, without issue, and I do so without any problems, but check your glucose levels to see what effects it might have on you. Diet Doctor is a great resource and has some useful charts showing carbs in fruit, vegetables. etc. As a bonus, Jason Fung is also one of its regular contributors...

Some people are very anti fruit because of fructose, but our livers can usually handle & use the small amounts found in fruit - it's generally added fructose. e.g. in the form of high fructose corn syrup, that is the main issue and needs to be avoided.

Thanks Robbity2 for your sharing your personal experience here. Will definitely look into LCHF diet to get the BG into control.

 

[chrisjohnh]

The original experiments that the DiRECT study was based on actively tested for ketones so it would be likely that ketosis can be attained .. starvation rather than nutritional but still ketosis. This could also explain why over time the success rate drops as too many carbs overcome the starvation benefits. But still we all know that crash diets rarely (if ever) lead to long term weight loss.



Yes by every measure that any study uses.. in fact anything sub 48 mmol/mol is classed as "remission" .. personally my standards are a bit higher. (That was the DiRECT criteria too).



I got into remission before the majority of my weight loss and I never really counted calories simply reduced carbs to a minimum and ate whenever hungry. That's what I mean but allowing our natural hormonal mechanisms to regain control of hunger. Our bodies are smart enough to recognise satiety and hunger when we don't overfill them with carby rubbish.



If our bodies were closed systems (like bomb calorimeters) I might agree ... however they aren't so your argument kind of falls down.

Many thanks indeed for these observations which I will have a good think about. I do agree that the key is to eat real food only and to keep carbs well down. This thread developed from the questions posed above by G3S who will find, as I did originally, that the forum may offer a multitude of opinions about all this, as also does the medical profession and also the frontline science community. It may be very confusing. We all have to experiment on ourselves and find our own way, with or without clear and stable theories. For myself I am aware that 12 months after diagnosis of T2D about 1 in 20 will be in remission, after 24 months about 1 in 60 and after 5 years fewer than 1 in 10,000. No wonder long term remission is a mere fairytale to most GPs, most will never encounter such a case in their entire careers. We need to know whether those thousands of relapsers gained weight or gained carbs or gained junk food or lost functioning beta cells. Why did it all go wrong for them? Will it go wrong for me likewise? None of us knows …