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Type 2 Numbers Up - 4 Options?

warop31

Member
Messages
24
Type of diabetes
Type 2
Hello,

My recent HbA1c result was the worst I've had since diagnosis 5 years ago, at 68, up from 62 three months ago, and continuing an upward trend which has seen it climb from a pretty decent 48 about 16 months ago, to 56, then 62 and now 68.

Nothing much has changed in terms of my eating or exercise habits in this time, but I had thought that the more recent increases could be down to significant levels of stress during this period, which have thankfully now lowered. I reckon I'm kidding myself though, as due to my most recent result, I've started monitoring 5-6 times daily, and despite the excess stress being out of my life now, I'm still coming out far too high.

So, as I see it, I've got four options. I eat and exercise fairly sensibly and consistently, so I could just let my doc do what he will inevitably suggest, and increase (or possibly change) my meds. I'm currently on 2x500mg Metformin and 1x80mg Gliclazide daily, but on one occasion quite soon after diagnosis when my doc increased my Metformin by an extra 500mg (at that stage I simply hadn't got my head round what to eat so numbers were still out of control), I struggled to function. Dosing off to sleep in the middle of the afternoon for example, so not keen to go down that road again.

Option two is to ask him if I can jump straight onto insulin. I have a type 2 colleague who swears it's the best thing he ever did, having arrived at a similar scenario to the one I currently face.

Option 3 is to carry on as I am, but just try that bit harder with both eating and exercise and see what happens.

Option 4 is to go full pelt at changing my diet. The Michael Mosley book is very topical in our family right now, containing stories of Type 2 reversal and the like, which I'm sure is possible, but only if you choose to live like a monk, as far as I can see! There may be some middle ground, and my wife is adamant that I should try this before even contemplating insulin, and she's probably right, but the prospect of living on spinach and pine nuts is hardly one to savour!

1, 2, 3 or 4 folks!? Or, do options 5 or 6 also need investigating?

Thanks in advance.
 
Option 1 may prove useful if you feel that you now have a better idea of managing diabetes. Only if you don't end up feeling as bad as you did the first time your medication was increased.

Option 3 all depends on how hard you're currently trying? Are you aware of carb counting, glycemic indexes, the body's response to carbohydrates when consumed with fats, protein, etc?

How much exercise are you doing and how is your weight?

4 would be the hardest I'd say. There are people on the forum who eat extremely low amounts of carbohydrates per day and are perfectly happy. If it were me, I don't think I'd like that at all.

Insulin treatment would be a good option to allow yourself a bit of freedom and a means to keep your BG down. Although some can go through life without the need for insulin therapy - many type 2's develop too severe resistance to insulin and this is their only viable route to successful diabetes management.

Grant
 
I can only speak for me, but I am med free and intend to stay that way as long as I possibly can.

If your pancreas is knackered and no matter what you do your levels keep rising, then that is one issue, but if you still produce enough of your own insulin then, were it me, I would go a bit more hardcore on the carb front. I could never envisage myself taking/upping meds to cover my eating habits. Diet is the key, not meds.

I certainly don't eat like a monk. I eat very well and lots of it. I am very rarely hungry and enjoy all my meals. I follow a low carb/high fat routine with occasional treats and special meals thrown in. I've never eaten spinach or pine nuts either! I avoid rice, pasta, cereals, flour and proper bread, but still eat potatoes as my meter tells me they are OK for me in small portions

Have you seen the success stories on here? Inspiring.

You may find this interesting

http://www.dietdoctor.com/low-carb/60-seconds
 
Hi Grant, thanks so much for your response.

I've been trying pretty hard in the last week or so since my results were revealed, and just today my numbers have dropped to a much more acceptable level. Not sure why really - can it take a number of days for diet changes to take full effect?

I'm aware of all of the things you mention, but I've never carb counted religiously, and only recently did I learn that carbs should never be consumed on their own! Is that what you mean?

My weight is good, in fact I recently visited a nutritionist looking for advice on putting weight on! I have put on a few pounds since, but prior to that I was borderline underweight. Now, I'm maybe about half a stone above the "underweight" threshold for my height. My exercise, apart from chasing around after my 3 year old grandson, consists of brisk walking, 30-50 minutes 5 or 6 days a week.
 
Thanks for this, your quotes regarding how you eat are inspiring in themselves!

Is there a way to easily find out if my pancreas is "knackered"?

Just to confirm, you eat 30gms carbs a day, and no meds?

What do you mean by "proper bread"? I love bread!
 
So it looks as though there's already some improvement, that's great news I suppose it could take a couple of days for diet to make a difference.

Sure you can consume carbohydrates by themselves, but there could be a more noticeable BG spike post-meal than if you were to consume the carbs with protein and/or fat. This is because the absorption rate is slowed down by proteins and fats. So in your case, as a diabetic watching their numbers, it would probably be best to not eat purely carb based meals. Equally, low GI foods will help to lessen any post-meal spiking action.

Seems like you're fairly active with the walking. What about trying a couple days a week cycling or jogging instead of the walking?

Grant
 
Insulin is the best thing I ever did. It saved my life!! I am type 1 now. That being said I agree with @Bluetit1802 in that I would never take/ up meds just so I can eat. I have eaten very low carbs for 25+ years and love my food. My bs was great for many years eating low carb. Insulin is great and required for life for some of us but not always as easy as it sounds. It too requires effort. It's not a piece of cake so to speak.

If I were you I would opt to lower my carbs and change my diet before anything. There are plenty of great low carb foods that are very satisfying. I do love spinach and pine nuts but I rarely eat them.

Think of cheeseburgers, chicken thighs, eggs fried in butter, avocado( guacamole with celery ) fatty salmon and tuna with mayo, olive oil, other nuts,etc

What's your diet like now? What's a sample menu?
 
If you are bordering under weight then the Michael Mosley diet is not a sensible option, I'm assuming from what you have said your MBI would be less than 20 and I think he says this. I just briefly glanced at his book and looked at those it wasn't suitable for, perhaps someone with the book could check this out.
I think you may need to check with your doctor if your body is still making insulin.
 

Yes, around 30g carbs a day and no meds.

I also love bread and ate mounds of it before diagnosis. Testing has told me this is a bad idea, even 1 slice of ordinary bread. I now eat Lidl high protein rolls, which are very low carb (about 8g per roll). If you have a Lidl near you, have a try. Sliced in half and frozen they keep very well and are delicious toasted with lots of butter. There are other low carb breads, notably Livlife from Waitrose and Burgen from most supermarkets, but not as low carb as the Lidl rolls.

There are tests you can have to see how much insulin your pancreas is producing. I'm not well up on these, but think the main one is a C-peptide test.

Use your meter to tell you what your meals are doing to you. Test before you eat and again 2 hours after your first bite. Any rise needs to be under 2mmol/l, preferably a lot less. If it is too high a rise, there were too many carbs in that meal and you need to tweak it next time, either by reducing carb portion sizes or eliminating them completely.

A word of warning though, if you intend to try the low carb route (and that is my advice) you will need to review your Gliclazide dose with your doctor. The fewer carbs you eat, the less insulin you need, and therefore the less Gliclazide. (Gliclazide works by encouraging your pancreas to produce more insulin)

Read round the forums, and ask questions.
 
The tests are GAD and c peptide. However it sounds as though lowering carbs will take you a long way. If you try that first and see improvement then you are making your own insulin. How much is the question. Keep in mind every time you spike your bs to undesirable levels, you are taxing your pancreas and burning out beta cells. It is said any reading above 140 is when damage starts to occur. Might be a good idea to address this as soon as possible.

And yes, it can take a few days to see consistently lower numbers. The body likes to have a set point and needs to be persuaded to set it lower. As your spikes become lower,Mao will your set point. I always say 1 bad meal equals 3 bad bs days, even with injected insulin.

I eat a under 20 carbs per day. Have been doing that for years.
 
I do occasionally try jogging or cycling Grant, but I find I do fine with walking - I think my main area for improvement is definitely via my mouth rather than my legs!
 
Hi, thanks so much for the response.

Based on what I've read today, I think I'll park the insulin idea for a while, as it seems there are definitely better options still available to me.

Normally, I have some Stornoway black pudding (2 thin slices) and 2 eggs at breakfast, along with an increasingly small piece of toast to satisfy my bread and sweet craving (no sugar jam). I would then have a snack of some berries, mainly strawberries, with some Greek yogurt for a mid-morning snack, then for lunch typically I'd have smoked mackerel on a single small slice or sourdough bread, and a single chocolate button for my sweet fix. Some nuts along with a piece of fruit for afternoon snack, and then for dinner it could be any number of things. Thankfully my wife, who does almost all of the cooking and is non-diabetic, is currently following a low-carb regime, so it is invariably a high protein/fat, low-carb meal.
 
Thanks again. We have a Lidl within reasonable distance, so I'll definitely try those rolls. Since my earlier post, I've had my lowest reading since re-starting regular checks just 5 days ago, and it came after a virtually no carb lunch and a 50 minute walk, so your point about Gliclazide is very pertinent. Reading was 4.6, but felt hypo-y, so was expecting lower. I assume that these C-peptide tests aren't done as a matter of course? Sounds like it would need to be done to ascertain what to do regarding Glic?
 
Thanks for your reply. Very interesting regarding the set point. Only today have my readings been generally below 7.8 (which I think is equivalent to 140), with a couple very marginally above - that's a significant improvement on recent days since starting checks again.
 
@warop31 - As a matter of interest, did your slightly increased levels coincide at all with your attempts to gain weight?

In your shoes, I would try the following.

If the levels going up coincided with your weight gain, I'd look at what I utilised to achieve that, and if it was carb content, I'd consider dropping the additional carb (or whatever) and increase my fats a trifle.

If that's a red herring, then for the first week or so, I would do nothing to alter my usual diet, or current, frequent testing regime, but I would weight or measure the quantities I was eating with a very critical eye, and record it. Carb creep can be so easily accomplished when we consider ourselves too be "in the groove". For example, this evening I had some magnificent (even if I do blow my own trumpet) roast belly pork, with roasted Mediterranean vegetables. There were a lot of veggies there as I had bought a ready to roast tray when I'd gone to Tesco yesterday afternoon to buy veg. As it was in the lucky bin (yellow stickers), reduced to 20p, I thought I'd spare myself the prep for a change. The total carb content on the package was 24gr and I snaffled a very decent proportion of it, as I was in tortured mode, having delayed eating slightly in order to ensure fab crackling.

Were I calculating, based on my eye, I wouldn't have guessed that many.

If that reveals nothing I might try a similar period, removing absolutely as many carbs as I could from my diet, just to see if anything at all makes a difference. As you are already extremely trim, you would have to remember to up your fats a bit in this phase, to try to avert any weight loss. I know how tricky it is to get weight on sometimes.

If that doesn't reveal anything I might have to submit to a chat with the Doc and take it from there.
 
A c-peptide test will tell you how much insulin you are producing. If it is very high then you are very insulin resistant and making a large amount. Adding more in this case is not optimal and diet is the solution. If your insulin level is on the low side then it may be that your pancreas is struggling to produce enough even with the glicazide and going on insulin might be the answer. If it was me, I would not make any decisions until you know how much insulin your body is producing.
 
I would tend to think if reducing carbs is reducing bs then you are making your own. Reducing carbs will also most likely make you more insulin sensative. You will have to watch your med doses carefully. You most likely felt hypo, even when you weren't because your body is not used to being there. It will adjust. Perhaps you can even get off your meds with the right diet rather than add new ones with the wrong diet. Best of both worlds. The more you can reduce carbs the better. Try an avocado if you like them. They are amazing for bs and reducing cravings.

Personally I would try LCHF before insulin. As I said it keeps me alive but I have no alternative. It's not a walk in the park. It also doesn't mean you can eat whatever you want and all will be well. It has its own tricks and loads of testing. If it can be post poned I would take that route.

Best of luck. We have all given up our beloved foods for our health. It takes time and routine to figure out what works for you but then it's a snap
 
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