Newly diagnosed, some personal details, some questions.. and a hullo!

paulmh said:

Hi.

I was diagnosed T2 in November last year with really high numbers - HbA1C of 123, blood sugar of 17. I suspect I have had T2 for quite a while, I had a couple of symptoms which I had been concerned about including blurry vision. I was tested about three years ago and had a fasting level of 6.2, so they said I should be aware of it. Clearly it came home to roost!

More background - I had a DVT last March which is probably not linked to my T2 - but the explanation for that DVT was constructed pre-diagnosis, so I don't know enough about the condition to be able to say if the T2 wasn't a contributory factor. Anyway, as a result of the DVT I got back into gym work - I have a very sedentary job, sitting at a desk writing documents, and had been slacking for a few years - so I had already lost some weight prior to my T2 diagnosis in November. When diagnosed with T2 I upped the gym and now go most days. Currently I've got a BMI of 27ish, I'm 1.79m and 86kg. Blood pressure at last check was 120/76, resting pulse 64. I had a blood test six weeks after diagnosis and my HbA1C was down to 77.

When I was diagnosed I made a conscious decision to not freak myself out by reading lots of stuff on diabetes, instead I tried to find some simple actions I could take which seemed to be agreed upon across different sources, so I started recording carbs and calories, working to keep my carbs below 100g a day. The doc gave me a testing meter which I use twice a day, pre-breakfast and pre-evening meal. I'm on two 500g doses of Metformin a day. I'm slowly coming to terms with the fact that having lots of "good" days doesn't mean I can reward myself with a "naughty" day! Bloods tend to be mostly 6's with sometimes 7s but I notice that if I do thing like test two hours after a meal it could be anything - by which I mean I find it hard to predict what effect different foods have on my levels.

I'm working to lose the last few kgs of weight that will get my BMI below 25. I don't drink or smoke - 14 years sober, 17 years tobacco free. I generally don't feel like I've got a huge amount of wriggle room in terms of lifestyle changes, but I'll keep on top of the carbs and calories and keep trying to learn from places like this about how to improve and adjust what I do. But I've got some questions at this moment.

One is, when I'm exercising my heart rate can go pretty high - higher than recommended. I'm wondering if this is as a result of diabetic damage to blood vessels. I've been told that diabetic damage to vessels can't be undone - is this correct? Second and also to do with the heart I notice that my rate is high in the morning when I wake up - maybe 80. Within a few minutes of getting up its gone back to a healthy resting rate. I'm wondering if this is related to my third question, which is one I suspect can't easily be answered on a forum but - I am having trouble working. I find I just want to sleep a lot, and I'm neglecting my work - I have my own business and its suffering just now. I feel that I adjusted pretty well to my diagnosis of T2 but I'm wondering if I have a touch of situational depression or low mood. Is this something that others have experienced?

Sorry this ended up a bit long, so thanks for reading it to the end if you did - also - Hullo!

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Hi @paulmh,the symptom’s you describe are fairly normal( ish),I will tag @daisy1 for the info that is given to new posters,have a good read and come back with any A’s,clive

Hi Paul. Well done on your progress so far and welcome to the forum. I see daisy1 has been tagged for you for the welcome pack which contains loads of helpful links.
I was diagnosed last May and like you started a low carb diet keeping to under 100g of carbs but after around six weeks my sugars plateaued and weren’t low enough, so I dropped to between 50-70g of carbs instead. That did the trick and my last two HbA1c results were at a non diabetic level. Exercise doesn’t feature in my plan much due to arthritis but I do try to walk more than I did.
Keep up the good work, you’re doing well

Welcome @paulmh to the Forum

@paulmh

Hello Paul and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you want and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

paulmh said:

Many thanks everyone for your warm welcomes and thank you for the info Daisy, its really useful to have all of that material in one place. If anyone could steer me towards threads on low mood and low energy levels. perhaps as a result of adopting a low carb diet, I'd be grateful.

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I haven't read this yet, and it's not very recent, but still may be interesting:
http://diabetesupdate.blogspot.co.uk/2009/11/effect-of-atkins-diet-long-term-on-mood.html

paulmh said:

I had a DVT last March

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Does this mean you are (like me) taking an anti-coagulant?

Alexandra100 said:

I haven't read this yet, and it's not very recent, but still may be interesting:
http://diabetesupdate.blogspot.co.uk/2009/11/effect-of-atkins-diet-long-term-on-mood.html

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I have now read this, and it IS interesting. For anyone who doesn't want to read all of this long article, I have copied below JR's conclusions:

"So I think the mood issue is real and I think that until it is addressed, people will alway have trouble sticking with a low carb diet, long term, no matter what it's impact on their health if it is too extreme.

And it is that factor of extremeness that I think this study sheds some interesting light on.

If we ignore the issue of "fat" which is really a red herring in these two diets, what we see here is that for people WITHOUT diabetes, there may be a much better outcome in terms of mood with a diet that though it restricts carbs a lot compared to the Standard Diet, doesn't restrict them extremely.

In short, for people who do not have diabetes, a diet of 165 g a day is a huge improvement on one of 300 g a day and may be all that is needed. The women eating that 165 grams of carbs a day did lose the same amount of weight and more importantly, their blood sugar profile and blood pressure did not vary from that of the people eating at much lower levels.

For people WITH diabetes this finding is negated by the fact that few of us can tolerate 165 grams of carbohydrate without seeing very poor blood sugars, ones guaranteed to produce complications.

But what I would take from this study is that it supports the strategy I have been promoting for the past 5 years--one that suggests you cut your carbs down ONLY to the level that gives you safe blood sugars, and no lower.

What that level will be varies from person to person and can only be determined using the strategy described HERE.

More importantly, what this study suggests is that if, like me, you find you can only control your blood sugar by eating at extremely low carbohydrate intake levels--for me it was no more than 50 grams a day with no single meal being higher than 12 g--if you start feeling depressed or rundown, it's time to look into finding a medication that will let you raise your carb intake a bit, but still keep hitting your blood sugar targets without making yourself miserable.

For me, the difference between eating at 100 g a day and 50 g a day is that I can do it, year in and year out, happily. (I'm in year 7 of maintaining a 17% loss of body weight.) But I can only eat 100 g a day using fast acting insulin at some meals.

Not EVERYONE gets depressed or exhausted on a long term low carb diet. The people who stay on these diets for years at a time and write the enthusiastic LC blogs are those who feel better on the diet, not worse. There are quite a few people that match that description, especially among those whose blood sugar is hard to control.

But if you run into problems as your low carb diet hits 8 months, or a year, or two, don't fear turning to medication for help. Insulin, metformin, and for some people Byetta, can make a big difference in how easy it is to control your blood sugar and your weight.

Our goal, after all is health but there is little point in purchasing "health" at the cost of your happiness. If after 6 months of eating a very low carb diet your energy level is low and your mood deteriorating, it's time to start tweaking. Talk to your doctor about adding the safe drugs to your regimen.

Too many people treat using medication as if this were a personal failure. It isn't. The safe medications are is just another set of tools to allow you to live a healthy and happy life."

Posted by Jenny at 9:24 AM

I started my low carb journey on <100g per day but my blood sugars weren’t quite as low as I wanted them. This is on 3 x 500mgs of Metformin per day. I reduced my carbs to between 50-70g per day and now have a non diabetic HbA1c. I have considered asking to reduce the medication but as you say would it compromise by happiness by having to restrict my diet further? I’m happy where I am at the moment. I have room for ‘tweaking’, decreasing or increasing my Metformin if change occurs, or increasing or reducing carbs if necessary

I have just changed my signature to reflect that I got to normal readings after 6 months and that is over 6 months ago.
I read some of the article about Atkins until I realized it is not the Atkins diet I use - I have copies of New Diet Revolution, from when Dr Atkins was involved, so do not recognize the calorie controlled Atkins diet at all.
I am very happy eating according to the 'rules' as laid out in my books and can't really complain about any aspect of it.
I eat to keep my BG levels normal, which seems to start the normalization of metabolism so there are further consequences such as weightloss - and I prefer to take the optimist's view that as long as am breathing and have a pulse the normal processes will continue to function, so healing renewal and development all ongoing.

paulmh said:

Another question @Resurgam - when you say you're "in remission", does that mean that you have a diet and lifestyle which, while you maintain it, keeps your BS in range, but if you stopped maintaining it you'd be back to out of range BS again? I read stuff about people being cured of T2 but I don't know if that means they no longer have it, or that they have a lifestyle which means that their T2 has no ill effects.

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I will never think of myself as ‘cured’ ‘in remission’ or ‘reversed’, my GP agrees that although my blood sugars and HbA1c are currently at non diabetic levels, I should be described as very well controlled. I believe that if I stop my meds and/or relax my diet, my sugars will rise again.

paulmh said:

Hi Resurgam, that's pretty inspirational particularly since my diagnosis levels were very similar to yours (Hb a bit higher). How long did it take you of eating a very low carb diet to get off medication all together?

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It wasn't something planned nor discussed with HCPs. I was diagnosed mid November 2016 and prescribed Metformin and a statin and was so ill physically and mentally that I went out and bought all the Christmas shopping twice - the second time I came out of the supermarket and could not find the car, so I wandered around looking for it, then when I found it I opened the back and it was already full up. I was severely shaken and stopped the tablets.
I spent all last year relearning the folk songs I have sung all my life. Fortunately I had agreed to send a written copy to the English folk dance and song society library in London and so I had that to refer to. The thought that I might have raised BG again and be pushed to take tablets really stops me from straying off plan, though I am delighted to find that what I can eat is really the sorts of foods I want to eat.

paulmh said:

Another question @Resurgam - when you say you're "in remission", does that mean that you have a diet and lifestyle which, while you maintain it, keeps your BS in range, but if you stopped maintaining it you'd be back to out of range BS again? I read stuff about people being cured of T2 but I don't know if that means they no longer have it, or that they have a lifestyle which means that their T2 has no ill effects.

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I have resisted changing my description from type two for some time now - but I think that I should acknowledge my life free of all concerns about diabetes.
I suspect that I had diabetes for a long time, but I have tried to eat low carb since the 1970s and only gone off plan due to the influence of those against such a dangerous and crackpot notion of carbohydrate making me feel ill and put on weight. As soon as I was able to get away with it, I went back to low carbing and I will now stick to it for as long as possible.
All I need to do is not eat high carb foods.
I am more active now, but that is because I feel better and want to do more, it is not part of the treatment but as a result of it.

paulmh said:

Hi Alexandra

I was on Edoxaban for six months, April to October. It was at the end of the drug treatment that I had a blood work up and the diabetes was picked up. Apparently the blood work up I had in April didn't include glucose and HbA1C which is a shame because we'd have picked it up earlier. I'm no longer on the anti-coagulant.

Specialist decided that the DVT had a specific cause but of course that was before my diabetes diagnosis. I now see that diabetes increases the risk of DVTs so I'm sure it would have been a contributory factor. I changed my behaviour with regard to exercise after the DVT diagnosis and now cycle probably 80 - 100km a week to try and improve the circulation in my legs, and also to help reduce my weight and improve my cardio fitness.

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Congratulations on your exercise regime!

I asked about anti-coagulants because I have recently had to start taking one due to my worsening AF, and discovered much to my dismay that Apixaban may raise bg but Warfarin reduces it! (Even knowing this I am still not ready to take Warfarin.) I encountered some resistance when I asked to change from Apixaban to Dabigatran, but succeeded when I simply stopped taking the Apixaban. I had the impression the doctor thought I would drop dead overnight as a result. It was kind of her to care! I have my suspicions that Dabigatran and the other NOACs may also raise bg, but I have not been able to find any evidence. I can't tell from my own experience because I am also obliged at present to take Furosemide (diuretic) which may also raise bg. I have gone into all this just in case your DVT recurs, so you will be pre-warned.

As regards diabetes as a cause of DVT, I don't have any specialist knowledge. I do think based on my own experience that bg that is above "normal" but below what is considered to be pre-diabetes can cause all sorts of health problems, which may resolve when the bg is lowered. When I found out about my A1c of 41 I was just concerned not to let it get worse. It was not even categorised as pre-diabetic, so I had no idea it might already be causing any symptoms and what I experienced cannot have been a placebo effect. After only a few weeks of a lower carb diet, which initially was not really very low at all, I suddenly realised that the reflux that had plagued me literally for years had virtually disappeared. Then, I realised that my bad back was not nearly as bad or stiff as it had been, which was confirmed by my physio. For years I had been plagued with fluctuating vision, which made getting a prescription for spectacles a bit of a nightmare. IMO I am now seeing better and the improvement seems more stable. High bg affects the nerves, and in particular the vagal nerve, which is implicated in indigestion and also in arrhythmias. I was hoping that lowering my bg might have cured my AF, (also vagal), but so far my AF has just got worse! Could it be that changing my bg did affect my vagal nerve's relationship with my heart, but unfortunately upset it rather than soothing it?

Good luck!