Newly diagnosed Type 2

[Sam86]

Hi all.
I was diagnosed 29th November with HBa1C of 53 (asymptomatic). I immediately made changes and I’ve lost 1.5 stones since then.
However, just after Xmas I started with massively increased thirst, blurry vision (blurrier than normal) and slow healing wounds, so the DN put me on metformin. My fasting level on that day was 8.1mmol/L and I was advised to start using a monitor.
My levels since increasing metformin seem to be lower (eg today I’ve had:- fasting 6.8, after breakfast 8.5, before lunch 4.3 and after lunch 6.3.)

I have an eating disorder so skipping meals is something I’m working on (especially breakfast). So any suggestions for breakfast ideas would be appreciated.

 

[catinahat]

Welcome @Sam86
Skipping meals is not particularly a problem for us, it's the raised blood sugar from eating the wrong types of food that we need to avoid. Many of us use intermittent fasting as a strategy to manage our blood sugar.
Use your meter to find what is causing your blood sugar to rise. Test just before you eat and again 2hrs later. The difference between the two results show how your meal has affected your levels. A rise of more than 2mmol indicates that maybe there were too many carbohydrates in that meal for you to deal with.
Have a look at the nutritional thingy for some ideas, the link is at the bottom of my post.

 

[Sam86]

Welcome @Sam86
Skipping meals is not particularly a problem for us, it's the raised blood sugar from eating the wrong types of food that we need to avoid. Many of us use intermittent fasting as a strategy to manage our blood sugar.
Use your meter to find what is causing your blood sugar to rise. Test just before you eat and again 2hrs later. The difference between the two results show how your meal has affected your levels. A rise of more than 2mmol indicates that maybe there were too many carbohydrates in that meal for you to deal with.
Have a look at the nutritional thingy for some ideas, the link is at the bottom of my post.

Thanks for the reply.
Im a bit confused with it all to be honest because I’m in Ed therapy and been told I have to eat every 4 hours and not to do intermittent fasting and my DN has said that I absolutely cannot be skipping meals because I keep having hypos & ketones.
I’m averaging a rise of 1.7mmol currently so assuming that’s good

 

[Paul_]

Hi Sam, welcome to the forum. I don't have any experience with eating disorders and managing T2, but a few members here do so hopefully they'll post in reply.

Starting from the beginning here, what does a typical day of food/meals look like for you? What do you tend to eat?

I'd also add that it's unusual for T2 diabetics to have hypos. Metformin doesn't usually cause hypos either and it doesn't particularly have an impact on blood glucose levels by food. What happened leading up to the hypos you had and what did you experience when having them? Tagging in @Antje77 just in case any of this rings any LADA alarm bells (might not, but I'm no expert, Antje is).

 

[Antje77]

Tagging in @Antje77 just in case any of this rings any LADA alarm bells (might not, but I'm no expert, Antje is).

No LADA alarm bells at all at the moment with those numbers!
Apart from that, I agree with everything @Paul_ said.

I’m in Ed therapy and been told I have to eat every 4 hours and not to do intermittent fasting

If you need to eat every 4 hours to help overcome your ED, by all means do!
Your hba1c is just over the diabetes threshold, and the fingerprick numbers you mention aren't alarming either.

Some T2's find intermittent fasting helpful, others do just as well eating multiple times a day, as long as they choose their foods to not spike them too much.

my DN has said that I absolutely cannot be skipping meals because I keep having hypos & ketones.

How low are you going when you're seeing hypos?
When are you seeing ketones? Are you eating very low carb? Both eating very little carbs and not eating at all can cause ketones, which aren't harmful as long as your blood glucose is at a reasonable level (Worries about ketones usually start with BG around the mid 10's).

How far are you into recovering from your ED? If you're malnourished at the moment, this may be a cause for hypos, the whole metabolism works differently while recovering from the acute effects of an ED. Are you getting professional help with this?

However, just after Xmas I started with massively increased thirst, blurry vision (blurrier than normal) and slow healing wounds, so the DN put me on metformin. My fasting level on that day was 8.1mmol/L and I was advised to start using a monitor.
My levels since increasing metformin seem to be lower (eg today I’ve had:- fasting 6.8, after breakfast 8.5, before lunch 4.3 and after lunch 6.3.)

Have the symptoms you had after Christmas (thirst, blurry vision) gone away by now?
If so, it might be you were having high BG then but not now, possibly from too much Christmassy carbs.

So any suggestions for breakfast ideas would be appreciated.

Do you like bacon and eggs?
Full fat Greek yoghurt with some strawberries or blusberries?

 

[Sam86]

Hi Sam, welcome to the forum. I don't have any experience with eating disorders and managing T2, but a few members here do so hopefully they'll post in reply.

Starting from the beginning here, what does a typical day of food/meals look like for you? What do you tend to eat?

I'd also add that it's unusual for T2 diabetics to have hypos. Metformin doesn't usually cause hypos either and it doesn't particularly have an impact on blood glucose levels by food. What happened leading up to the hypos you had and what did you experience when having them? Tagging in @Antje77 just in case any of this rings any LADA alarm bells (might not, but I'm no expert, Antje is).

Food/meal - a current day for me is wake up 6-7am then either just a cappuccino until 12/1pm or a cappuccino & some fruit (such as half a banana or 6-8 grapes) at approx 8am. Then a whole meal sandwich for lunch followed finally by a carnivore only evening meal approx 6pm.
I’m supposed to be on a 4 hour plan but I’ve gone from eating once a day & slowly building up.

The worst hypo I had was yesterday. I woke up with a terrible headache that painkillers didn’t remove, had half a banana & then 500mg of metformin at 10:00. At 11:30 I felt really hungry & sick so had 2 bites of a browny whilst travelling to supermarket. By 12 I felt really unwell starting with a cold sweat followed by palpitations, shaking, paleness (according to my partner), extreme dizziness with black spots. I then collapsed. (Blood sugars at approx 1:15pm were 4.1 according to paramedics) Sugars finally went up to 7.1 two hours after my evening meal although fatigue was a thing for the rest of the day.
Hospital did say it was likely a combo of metformin & 1 of my other meds but I now have to monitor b4 & after every meal

 

[Sam86]

No LADA alarm bells at all at the moment with those numbers!
Apart from that, I agree with everything @Paul_ said.

If you need to eat every 4 hours to help overcome your ED, by all means do!
Your hba1c is just over the diabetes threshold, and the fingerprick numbers you mention aren't alarming either.

Some T2's find intermittent fasting helpful, others do just as well eating multiple times a day, as long as they choose their foods to not spike them too much.

How low are you going when you're seeing hypos?
When are you seeing ketones? Are you eating very low carb? Both eating very little carbs and not eating at all can cause ketones, which aren't harmful as long as your blood glucose is at a reasonable level (say mid 10's).

How far are you into recovering from your ED? If you're malnourished at the moment, this may be a cause for hypos, the whole metabolism works differently while recovering from the acute effects of an ED. Are you getting professional help with this?

Have the symptoms you had after Christmas (thirst, blurry vision) gone away by now?
If so, it might be you were having high BG then but not now, possibly from too much Christmassy carbs.

Do you like bacon and eggs?
Full fat Greek yoghurt with some strawberries or blusberries?

Hi,
I’m not sure how low I’m going as I wasn’t monitoring until it was suggested at hospital yesterday. Paramedic said it was 4.1 two hours after I last ate.

DN discovered Ketones were at 2.5 with a urine test. My BG at that same time was 8.1. Ketones have been negative since trying harder to eat more regularly.
I don’t eat things like bread, pasta, rice often. I eat baby potatoes 3 times a week (having 4 at any 1 time) but yes I restrict food (ie last Friday I ate nothing all day until 8pm when I had just a 6oz rump steak).
I’m doing CBT-E therapy for ED & am 13 sessions in and making some progress. (I have good days & bad days but having more good than bad currently). My therapist has been great support as is my partner.
I definitely went a bit OTT with the crimbo food with yorkie puds, pigs in blankets, sausage rolls etc & yes those symptoms have now gone away.
I do enjoy an egg & bacon omelette but I thought bacon was processed & therefore a no-no? Not a big lover of yogurt but I do love fruit

 

[Paul_]

Testing sounds especially important for you. I'm not medically qualified and I'm not offering any sort of medical opinion here, but from what you've said it strikes me that levelling out your carb intake may help. Your meals described in your post are quite high carb - bananas, grapes and wholemeal bread. Those will cause your blood glucose to rise.

Do you like any other fruit? Strawberries and raspberries are lower carb options than banana and grapes, for example.

For bread, wholemeal is generally between 15g and 25g per slice, so that's 30-50g for a two slice sandwich before you even get started. Do you have a Waitrose near you? If so, maybe consider trying Livlife bread. It's not cheap (£2 for a small loaf) and the slices are small, but it's only 3.4g carbs per slice and it's decent quality bread. Even if you had 4 slices, that's still probably less carbs than 1 slice of regular wholemeal. Also toasts and freezes well.

I'm wary of offering advice when you have factors at play that I don't have experience of. However, for diabetes management, the above options suggested are a start. Just make sure you test and watch it doesn't push blood glucose too low if you're eating infrequently. Most important, don't be a stranger around here, there are so many people with a wide range of experience, so there's always someone with a perspective to help.

 

[Paul_]

I do enjoy an egg & bacon omelette but I thought bacon was processed & therefore a no-no?

Bacon is a processed meat, however from a blood glucose perspective it's not a problem at all generally. Most bacon does contain nitrates though due to the processing, so these may have health consequences in the longer term if recent studies are correct.

 

[Antje77]

Hi,
I’m not sure how low I’m going as I wasn’t monitoring until it was suggested at hospital yesterday. Paramedic said it was 4.1 two hours after I last ate.

DN discovered Ketones were at 2.5 with a urine test. My BG at that same time was 8.1. Ketones have been negative since trying harder to eat more regularly.
I don’t eat things like bread, pasta, rice often. I eat baby potatoes 3 times a week (having 4 at any 1 time) but yes I restrict food (ie last Friday I ate nothing all day until 8pm when I had just a 6oz rump steak).
I’m doing CBT-E therapy for ED & am 13 sessions in and making some progress. (I have good days & bad days but having more good than bad currently). My therapist has been great support as is my partner.
I definitely went a bit OTT with the crimbo food with yorkie puds, pigs in blankets, sausage rolls etc & yes those symptoms have now gone away.
I do enjoy an egg & bacon omelette but I thought bacon was processed & therefore a no-no? Not a big lover of yogurt but I do love fruit

Ketones are perfectly normal when eating very little carbs (or simply not eating). This is why a very low carb way of eating is called a keto diet, it's aimed at getting ketones.
Now ketones while having high BG are alarming because of something called ketoacidosis, which can occur in type 1 diabetes mostly. It goes together with high BG, and it's not something to worry about if your numbers are mainly under 12 mmol/l, unless your on a medication endin on 'flozin' (!)

DN's can jump on seeing ketones because they mostly know them because of T1's having an emergency situation, and not be aware that it's completely normal to show ketones when eating little or little carbs.

I'm very happy to hear you are having more good days than bad days with your ED now!
If you went overboard on the carbs with crimbo food and had symptoms, but you're not having symptoms now, I'd expect it was all those high carb foods that caused your BG to go up and cause the symproms, and the problem seems to be solved now.

On this forum we are usually quick to hand out dietary information about diabetes. With an eating disorder thrown into the mix, things are bit different. No-one wants to accidentally trigger any part of the ED, this being such a nasty condition that can come back at you in sneaky ways.
With your hba1c just over the diabetic threshold, your main goal I think, is keeping up the good work on your ED as a first priority, without adding too much anxiousness about the diabetes.
I'm not sure what type of ED you have. But for diabetes, it's only the carbs that are relevant really, fats and proteins aren't an issue.

I do enjoy an egg & bacon omelette but I thought bacon was processed & therefore a no-no? Not a big lover of yogurt but I do love fruit

Processed or not processed is an interesting subject, but for diabetes it makes no difference at all!
Fruit is a bit tricky, as most fruits have a significant amount of carbs and sugars. But many of us find it works to have a small portion as part of a meal or as a dessert.

 

[Antje77]

And tagging @AndBreathe , who has managed her T2 for a long time without medication, and who knows way more about recovering from an eating disorder than I do.

 

[MrsA2]

Hospital did say it was likely a combo of metformin & 1 of my other meds

What other meds? Such information could be important

 

[Sam86]

What other meds? Such information could be important

Hi,
I’m on a few meds but the one they were concerned about is propranolol (a beta blocker also used to ease the symptoms of panic attacks). Apparently the DN wasn’t aware that I was on these when she prescribed metformin so I’ve had to stop them.
For clarification though I’m on metformin, ramipril, Omeprazole, b12, folic acid and sertraline

 

[AndBreathe]

@Sam86, as @Antje77 says, I lived with an ED many years ago. It nearly killed me. My T2 diagnosis was some many moons later, but it still dragged uo the fears of my ED, and how I would cope with changing eating habits, and for me, importantly how I could avoid become obsessed with it all.

My diagnosis is now over 10 years behind me (time flies when we're busy living), and I have been able to send my T2 into lobg term remission, and not revert to being adversely impacted by the memories and fears of my ED. That said, it took a while to reach the comfortable place I am in now of accepting both conditions and getting on with the positives in life.

Your situation may be like or very different to my own, depending partly on the type of ED you have and where you are on your journey of change. Change and acceptance can be very different things, in my experience, and sometimes we change reluctantly, but would ideally like to revert to our own personal comfort zzone that might not be like anyone else's.

Right now, I am not going to talk to you about diet or lifestyle for your T2, because in all likelyhood dealing with your ED is a much more pressing concern for your immediate and short term future health.

I'm sure you are all too aware that an ED can see us off, and it doesn't necessarily have to take a long time, if we have a couple of bits of (health) bad luck along the way. T2 Diabetes, is of course a condition that should be taken seriously, and in the long, usually much longer term, it can have some dire, even fatal consequences for us, but it tends to be over years, rather than days, weeks or months - particcularly in someone who's A1c test was pretty close to the diagnostic threshold.

So, for now, I would suggest you eat healthily - maybe going light on the bread, spuds, pasta and sweet treats, but overall, concentrate on getting your ED under control. Getting your ED sorted, sooner, rather than later is a key factor in a long and healthy life.

You have been prescribed Metformin, which will take the edge off things diabetes. With that and your regular monitoring, and the help you are receiving for your ED, hopefully it'll afford you a bit of breathing space to become healthier. Even if it means a bit more medication for a while, medication is not a one way street. When you are in a more robust place to tackle your lifestyle, more related to your T2, it could be you could reduce or even be rid of your meds.

Good luck my fellow travellor. I wish you every piece of good luck in moving forward. Life after an ED is possible, and a good life at that. It is a bump in the road. Honestly.

If I can help further, feel free to drop me a message.