Next steps?

JTF04 said:

Hello everyone. I was diagnosed back in middle of July with a Hba1c of 127. The DN put me on gliclazide to bring it down fast and then gradually swapped it out for metformin. I now take 2 metformin in the morning and 2 at night. My DN was great and directed me to this forum where I saw the advice to low carb, which I started immediately. I had another Hba1c at start of November and practice nurse (not the DN) called yesterday to say the result was 42. I am obviously thrilled and grateful for all the advice and help that got me there. I have some questions on next steps though I would love some guidance on.
- PN asked if I wanted to stay on tablets or not. I said I maybe would till next test to check it's stable but it turns out I will not be tested till 6 months instead of 3. That seems a long time? I know you can't advise on medication but are there any views on whether at 42 diet alone can keep you there?
- I embraced low carb completely and aim for around 30 a day. No pasta, rice potato etc. I can't cut much more out. How do I get my number out of pre diabetic range then? Or should it naturally go down a bit further if I keep diet up? I still self test and am usually in the 6.5- 7.5 range.
- last one! I lost about 2 1/2 stone between initial symptoms and diet change but have been stuck for a while with still 2 stone to top of healthy BMI target weight. Will that start again or do I need to give it a bit of a kick start? I struggle with fasting, feeling sick and sore stomach if I don't eat at regular intervals.

Apologies for long post but it seems my success means GP practice no longer worried and standard advice re no need to test which I will ignore per the advice here.

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First off ... FANTASTIC RESULT...bravo .

As for meds. Metformin I have read has other benefits, so might be worth reading up on, before deciding ?

And will you continue trending down &/or maintaining steady....mmhh

If I could describe it in ways that made it easier for me to understand , I see T2D for our bodies, as a pot.

Because our regulation of Carbs had become compromised, over time our pot begins to fill, eventually overflows and the resulting mess gets stored in every part of our body.

The LCHF part, firstly limits the amount of carbs we drop into that pot, thus limiting any spill over.

Then our bodies, seeking out the extra glucose / sugar / energy that it's used to, goes hunting the extra, ...from those very hidden depths it stored it, before then turning on the pot to reduce the amount sat inside it.

And once that reduction is made,

Any top up (our food intake) is then used appropriately, which stops the pot spilling over again.

Over time our body begins to adapt to a lower level of glucose circulating around us (see vision changes etc)

Which is the point where we get back to more normal numbers & start managing our BG more effectively.

So I would say, continue on the diet & I'd expect the numbers to stabilise or as many on here have , drop a little further.

As for weight
No expert here.
My weight fell off as I went along

But I would concede it's not the same for everyone, and our body is a cunning foe.

It will resist and fight tooth & nail to preserve itself against of our actions, whether detrimental or a selected choice.


Perhaps mixing it up, with some short spell of IF might trick it into accepting you CAN survive on a lower 'level' of food intake..?

Best of luck finding something that works.
And once again, very well done.

JTF04 said:

I was diagnosed back in middle of July with a Hba1c of 127.

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JTF04 said:

called yesterday to say the result was 42.

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At diagnosis you must have had really high blood sugars in 4 months that is an amazing drop but remember that HbA1c "looks back" at historic levels so your 42 is probably still a bit higher than you are now. If you carry on with the diet I'd wager your next one will be back at "normal" levels.

Fasting is like exercise the more you do the easier it becomes but eating in a restricted time window can be equally powerful.

Your diet sounds pretty good so carry on with that and you'll likely get great results.

And well done you!

JTF04 said:

Hello everyone. I was diagnosed back in middle of July with a Hba1c of 127. The DN put me on gliclazide to bring it down fast and then gradually swapped it out for metformin. I now take 2 metformin in the morning and 2 at night. My DN was great and directed me to this forum where I saw the advice to low carb, which I started immediately. I had another Hba1c at start of November and practice nurse (not the DN) called yesterday to say the result was 42. I am obviously thrilled and grateful for all the advice and help that got me there. I have some questions on next steps though I would love some guidance on.
- PN asked if I wanted to stay on tablets or not. I said I maybe would till next test to check it's stable but it turns out I will not be tested till 6 months instead of 3. That seems a long time? I know you can't advise on medication but are there any views on whether at 42 diet alone can keep you there?
- I embraced low carb completely and aim for around 30 a day. No pasta, rice potato etc. I can't cut much more out. How do I get my number out of pre diabetic range then? Or should it naturally go down a bit further if I keep diet up? I still self test and am usually in the 6.5- 7.5 range.
- last one! I lost about 2 1/2 stone between initial symptoms and diet change but have been stuck for a while with still 2 stone to top of healthy BMI target weight. Will that start again or do I need to give it a bit of a kick start? I struggle with fasting, feeling sick and sore stomach if I don't eat at regular intervals.

Apologies for long post but it seems my success means GP practice no longer worried and standard advice re no need to test which I will ignore per the advice here.

Click to expand...

Fantastic achievement, congratulations. Good advice below and doubtless more to come from the supportive members here. Shrewd and quite unusual advice from DN to come here so well done to them as well.

You are doing so well! Bodies strive for homeostasis, so it's quite usual for short plateau periods when making radical changes for the benefit of your health. Keep on keeping on, and you should improve even more.

JTF04 said:

struggle with fasting

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Stunning achievement getting from 127 to 42, well done
You have had some great advice from the other posters, can't think of anything to add apart from this.
We all fast every night, I found that by delaying my breakfast (extending my overnight fast) helped me to get into the swing of it. I eventually found myself at lunchtime without realising I'd missed breakfast

catinahat said:

Stunning achievement getting from 127 to 42, well done
You have had some great advice from the other posters, can't think of anything to add apart from this.
We all fast every night, I found that by delaying my breakfast (extending my overnight fast) helped me to get into the swing of it. I eventually found myself at lunchtime without realising I'd missed breakfastI

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Yes I totally agree with catinhat on fasting. I was just like you on thinking I'd never be able to fast, yet now I can easily do 36 hours once in a while. I also began by delaying breakfast, and then by having dinner an j hour earlier so that the fasting gap was wider. I do believe you will surprise yourself and we truly do not need three meals per day! Good luck .. and amazing results so far which should spur you on x

Congratulations on your great results, and yes diet alone can keep your glucose levels at 42 or lower, without any medication. There are a "fair few" members of the forum who have done this, and are able to maintain low pre-diabetic and normal levels long term. Some, for example @Rachox, continue with metformin as it can also have other benefits.

If you're now eating a very low carb diet, you also need to be eating enough fat to replace the fuel you're no longer getting from quick fix shot term carbs. It can take a while for your body to start preferentially relying on burning fats for long term fuel instead, and if you've been used previously to a high carb diet, you may still be adjusting to this change, and this is probably why you feel a bit off and still need to eat regularly. Check up on "low carb flu" symptoms.

Thanks for the tag @Robbity , everyone needs to make their own decisions about what meds to take. I continue on Metformin, even after 5 years of non diabetic HbA1cs. I get no side effects and did a lot of reading about it before I took it at all. I am a retired nurse, so I think I am not so medication averse as some people, I’ve seen a lot of good from medication of many types. Here are a couple of articles that may be of interest:

NICE guidelines say to test hba1c 3 monthly til stable then 6 monthly. One great result isn’t (yet) stable. I’d ask the DN for another 3 month test as they are more switched, quoting guidance if necessary

That's an incredible result, absolutely well done. I've used diet only (bar the first 3 weeks on metformin) and went from 105 to 47 on a low carb vegetarian diet in 3 months. I've now started to fast for longer periods and don't eat from 7pm until 1pm the following day and I'm seeing good results in terms of energy. Keep it up, your next result will be even more fab.

Congrats @JTF04, that's inspirational

As @bulkbiker says above, you are probably already in the green zone, as your BGs have been tapering down over months.
That 42 is likely "polluted" with a few months of higher readings.

One word of advice, get your eyes checked, the body likes stasis & a vast drop in A1c in a short period has been known to kick off retinopathy.