Prescribed Metformin but wondering I can do this on diet alone

Goonergal said:

Just be aware that some people use breathalysers to check whether they are in ketosis - I have done it from time to time. A positive reading (in the absence of any alcohol consumption) = ketosis. Won’t put you in danger of drink driving as it’d show higher than expected, but something to be aware of.

I agree with @DCUKMod on the lows. I’ve only once caught a 2 (2.9) with a finger prick and that was prior to eating something I’d grabbed on the go due to extreme hunger on the way to a meeting. The reading was so low I tested again immediately on another finger on the other hand and the liver was already kicking in as it was 3.2. In these circumstances I find the post prandial rise is much higher than usual, presumably as the liver is helping out.

Click to expand...

That's very interesting with respect to the breathalyser. I've had some unbelievably high readings a few times now, and thought that the sensor might need replacing, even though it's only half way to its life expectancy. Perhaps I've achieved ketosis, and that's triggered the high readings, then I've come out of it after having something to eat.

It wasn't happening before I went low carb, so I think you've just explained a mystery, here.

I don't think I've ever had below a 4 on a finger prick test. Libre has dropped below 3.9 a few times, but on this new sensor, it's only very, very occasionally, and then not by much.

Finally got around to playing with the Libre web portal, rather than just the phone app. It seems to do a fair bit more with the data. One thing I'm curious about is the wording "Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial." This limit seems to be hard-coded into the portal, given that I've set my target range to 4.0 to 8.5 in both the mobile app and the web portal. I know I get to cut myself some slack for results within 2 hours of eating (a 2 hour PC blood test would miss them anyway) but maybe I should be worrying less about staying below the magical 8.5 the rest of the time. I've had a couple of exercise related spikes, as well as some 'bad food choice' ones.

Edit: I see it explained in some of the other settings and in the footer. 10 is the recommended upper limit for CGM, including after meal/exercise spikes. It's intentional that it cannot be changed in this report.

Brunneria said:

I think it is unfortunate (although totally understandable) that general rules are applied to everyone.

T1s are given guideline levels based on time in target, standard deviation, and upper and lower bg limits, because of long term complication risks. For them, the risk is less about beta cell damage (they are already gone or going), and more about damage from high blood glucose and - possibly - hyperinsulinemia, depending on their level of resistance.

Yet no one in orthodox medicine seems to recognise that T2s benefit from tighter targets. T2s don't just have to factor in hyperinsulinemia and long term damage from high blood glucose. They also need to know that every single blood glucose spike above (approx) 7.8mmol/l is likely to be killing beta cells (called glucotoxicity) and causing progressive damage with the knock on effect that their diabetes will worsen over time. Some people (I think it is Bernstein) argue that beta cell damage begins even lower, and suggest staying under 6.6mmol/l at all times.

If anyone wants to see the research on this, then the www.bloodsugar101.com website has links to the studies and analysis of them, and Bernstein discusses bg targets and the reasoning behind it repeatedly in his books and videos.

Consequently, in my opinion assigning an upper target of over 7.8mmol/l for any length of time whatsoever, is likely to lead to a progressive worsening of T2.

Sorry to be the bearer of bad news, and feel free to ignore me! But I feel (quite strongly) that looking for ways to expand and extend target ranges will (over time) backfire badly causing cumulative damage. This includes the brief spikes that are usually considered 'acceptable' in the 2 hours after eating.

Click to expand...

7.8 is fairly realistic for me, at the moment. Having adjusted my settings in the app to 4-0-7.8 mmol/L, I was still 94% in target for the last 24 hours, though that's dropped to 86% having just gone out (driving seems to spike me, as does exercise.) The Libre also seems to be fairly consistently reading 1mmol/L higher than a blood test at the moment, so I suspect the true 'in range' figure is higher.

The bad news comes with the good. I'm still evaluating whether I'm better off giving Metformin a try, and this might swing me in favour of doing so, if it'll protect me from longer term damage without any serious side effects.

Something's going to kill me in the next 30 years or so. I don't think avoiding all diabetic deterioration is any more a realistic goal than avoiding the general deterioration of my body as I get older. So I don't see the point in maintaining perfect figures. I do need to work out what's good enough.

I recently discovered my dad had it, too. So that's both parents. He lived to 79. My mum made it to 76. If I can manage the same and then die from something unrelated, then that's good enough for me.

Andydragon said:

Agreed
My dad had an awful existence from being blind, sharko (sp) feet. Ulcers and all sorts. I am sure the strokes he suffered from are a direct cause from the diabetes

It wasn’t just him who suffered, those who had to look after him (my mum) did too

trying to bend the rules by allowing yourself a higher level or not giving up the carbs or increasing the meds... it’s everyone’s choice but is it fair to overload the NHS or live a miserable existence for something that is, in many cases, avoidable?

It sounds harsh but we all have to adapt to missing out on stuff we used to like. It took me decades but I have changed. I’m not perfect and I still spoil myself but I may have to change to stay healthy.

The topic is about doing it by diet alone. The answer is yes, but that means diet, if you want to keep drinking or eating potatoes or rice then again, your choice, but this without meds... difficult for a lot of people

Click to expand...

I'm really not sure where this has come from. I have completely given up (normal) bread. I have given up on potatoes, rice and pasta, except as occasional treats in limited quantities. The NHS has advised me to try to stay below 9 (not 8.5) and as a general rule of thumb, I'm staying below 7, other than immediately after meals or (sometimes) exercise. I am still drinking beer, but both blood and Libre testing are showing no discernible difference in trends between days when I do and days when I don't. I'm optimistic for a pre-diabetic or even non-diabetic HbA1c next time around.

My mother hit 76, with some neuropathy in her feet that she tended to complain about, but other than that, no serious side effects. I didn't even know my dad had it until after he died, aged 79.

I'm not looking to throw caution to the wind and just let my blood sugar run riot. I am conscious that there's little point striving to achieve no deterioration whatsoever of this condition, when something else is likely to catch up with me in the next 30 years, anyway. If I can reach the end of my life without the really serious complications (blindness and amputations) I think I'll be contented enough.

My choices at this point are to be happy with my current figures, on no medication, or to take the Metformin I've already been offered, and get them even lower. That's what I'm trying to evaluate, here. I get that lower is better, unless you go too low on certain medications.

I appreciate others have far worse numbers, even if they're trying a lot harder than me, or taking a lot more medication. Meanwhile, others are doing better with ease. That seems to be the nature of this condition.

We're all here for support, rather than condemnation and guilt trips (burden to family and the NHS.) Much more of this negativity, and I think I'll go and manage this on my own, without the input of this forum.

Andydragon said:

You make a valid point. I can be somewhat too blunt at times (autism)

Click to expand...

Thanks. And I probably overreacted, if I'm honest.

You touched a nerve with the NHS thing. Years of listening to fatphobes say "But I'm only concerned with the burden that obesity places on the NHS" when what they really mean is "Your body shape disgusts me, and I don't think I should have to look at it." I've spent 35 years paying into that organisation. Plenty who haven't take more from it than me, and I'm fine with that, since that's the whole point of universal healthcare. But I refuse to be guilt tripped for relying on a resource that I've consistently funded through my tax and National Insurance contributions. As for being a burden to my family: my mother could be a nightmare in many ways, but apart from occasionally complaining about the neuropathy in her feet, and constantly chanting her mantra of "diabetics don't live past 60" her diabetes wasn't one of them.

@Brunneria 's post was a bit of a shock to my system. I'd previously thought that staying almost entirely below 8.5 on bloods (not testing within 2 hours of eating) meant I had this pretty well managed, and was going to avoid long term deterioration. But it came across as factual rather than judgemental, and it didn't try to shame or guilt trip me into changing what I was doing. When yours appeared to that, it was a sucker punch on top of the blow I'd already received. I needed to step away from the keyboard for the rest of the evening.

I'm still very confused, here. One thing that's missing as a point of reference, perhaps, is what a non-diabetic (but close to pre-diabetes) individual's bloods might look like on a daily basis. I'd bet that for some, it regularly spikes higher than mine. I'm really struggling to make sense of it all right now.

@Brunneria

My experience was similar after a curry and cocktails night with a friend. I ate just after 5pm, peaked at 13.8 around 6, and things didn't really settle down to normal until around midnight. If I were doing that every day, then obviously I'd be killing myself. But that's the worst I've 'behaved' since diagnosis in early July. Most of my figures stay within the 4.0 to 8.5 range, and my current Libre sensor is fairly consistently reading 1 mmol/L higher than blood testing. If I factor that in, then I can stay completely below 7.8 for days on end, though maybe having the odd blip. Yesterday's levels were the highest I've seen in over a week (and with no clear reason) but 8.7 was still my peak reading on the Libre (which I'd call 7.7 once corrected.)

I'm always very wary of arbitrary values. 70mph on the motorway is perfectly safe, but 71 is suddenly dangerous? In truth, we know that both carry risk, and the difference between them is minimal. These things work in degrees and shades of grey, yet we deal with arbitrary measurements where 42 means you're one thing, but 41 means you're not. It'd be interesting to see the trends for someone whose HbA1c was on the upper end of the non-diabetic or pre-diabetic scales. See if they show symptoms of insulin resisance, albeit not spiking quite as high or for quite as long.

Of course it's those same lines in the sand are what tell us to stay below 10mmol/L at all times, below 8.5, 2 hours PC etc. So it seems perfectly reasonable that it's a matter of damage limitation rather than damage elimination. But then so is life, and our bodies deteriorate in various ways with age. That's why I'm not convinced that complete elimination of all diabetic deterioration is a worthwhile goal, when other things are going to deteriorate anyway.

Alexandra100 said:

You might find this extract from Dr Richard K. Bernstein's classic book helpful:
http://www.diabetes-book.com/nondiabetic-versus-diabetic/
NB to translate the mgd/dl numbers he gives just divide by 18 to get our mmol/L.

Click to expand...

That was a very interesting read, and certainly improved my understanding. Thank you.

Pan123 said:

Hi

I am newly diabetic... diagnosed on the 1st Sept 2020. I have decided that I really want to reverse it. I am currently on the exante diet.. which means have less than 60g of carbs a day.. my goal is to loose enough weight to shock my body. I am currently 89kg and I am trying to loose at lease 2-3 stones.

I am also unsure about sugar spikes.. could someone explain this to me ?

and also what is libre?

Click to expand...

Fairly new to this myself, but learning rapidly.

Cutting carbs is definitely your best hope of regulating your blood sugar without medication. The real debate for me is how low I want to get it (am I happy just staying below the 9 that the diabetes nurse told me to, or should I set a lower limit?) Still in two minds about taking Metformin to get things even lower, even though I'm averaging below 7, and staying below the 8.5 limit I've set for myself 95%+ of the time (100%, some days.)

Libre is a flash glucose monitoring system: a device that you semi-permanently attach to your body, and then read with either a dedicated reader, or a phone with NFC technology. As well as giving instant readings whenever you zap it (with no per-use cost, as you would have with using a test strip for a blood test) it records the last 8 hours of trends, so you can see any highs and lows, even if you didn't happen to test while they were happening. It's great for seeing how certain foods and activities spike you. I've noticed that light exercise spikes me quite badly, whereas more intense exercise does not. It sounds like a dream come true, but it's expensive (over £100 a month for continuous use) and it tends to be less accurate than blood testing, to the point where some devices and software exist that allow you to calibrate its readings against blood ones.

Spikes being where your blood sugar raises significantly above its normal levels. You expect them after carby foods (and they can get pretty big if you go properly off the low carb rails for a day) as well as raised levels first thing in the morning (dawn phenomenon, where your liver dumps sugar into your bloodstream to wake you up, and then your tired pancreas and/or insulin resistance, assuming type 2, doesn't restore your levels as quickly as it should.)

The jury is out as to whether you can actually reverse diabetes. You're said to be in remission if you can achieve non-diabetic HbA1c results for a full 12 months on no medication (or possibly only Metformin) but you'll probably never get back to a state where your body can handle as many carbs as you throw at it, as a non-diabetic's can. If you're lucky, and don't have the condition severely, you can achieve blood sugar levels low enough to avoid long term complications. Precisely what those levels are seem to be a matter for debate. In the UK, Type 2's are generally instructed to stay below 8.5 mmol/L on blood tests before and 2 hours after meals. In the US, the advice seems to be to stay below 10 mmol/L, even including after-meal and exercise spikes. However, there's evidence that damage can occur even if you stay below these levels, and really your best hope of avoiding any diabetic complications is to get as close to non-diabetic blood sugar levels as you realistically can. If you're on medication that actively reduces blood sugar, then it also becomes important to stay above 3.9 mmol/L.

That's my understanding, only a couple of months into this. Errors and omissions excepted

I've had meals that should have spiked me and didn't, too. A small portion of chips with a mixed grill 2 days running, on a weekend away recently, that didn't upset my levels at all. I once did a paella (albeit rinsing the rice thoroughly 5 minutes in) and got a lower blood reading 2 hours PC than AC. It seems a lot of us still have an insulin reserve, that even with a compromised pancreas and/or insulin resistance, can still handle the occasional carby intake, as long as it gets a chance to recharge before the next hit. It perhaps recharges more slowly and not as fully as a non-diabetic's.

When we have enough (or almost enough) insulin, our bodies behave much as they should and convert excess blood sugar to fat. So yes, we'll put on weight from carby food, when that happens.

I think I've mentioned this earlier, but the Libre reveals that light exercise (pedalling my e-bike, using the motor to go uphill) spikes me quite badly, whereas working up a sweat and a 140-160 bpm heart rate, and making my legs ache on my exercise bike, does not. I think exercise releases sugar, but the exercise has to be quite intense for me to actually burn it off.