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Questions re first diabetic nurse appointment tomorrow.

M

Margarettt

Well-Known Member
Messages
367
Type of diabetes
Type 2
Treatment type
Diet only
I've known I was diabetic for almost four weeks (my hba1c was 54) and have been low carb for about three. I only had one day of readings with my meter before I opted for low carb and these numbers were 12 to 18. Almost immediately my numbers dropped and are now almost always high 5s to mid 7s. Low carb feels right to me.
But..... I haven't lost any weight yet, maybe a pound or two but certainly not what I would lose with strict calorie counting. Personally I don't mind this. If it doesn't start shifting soon I'll look at calories and portion sizes.
Tomorrow I have my first appointment with the diabetic nurse. They have already sent me a 12 week membership for weight watchers and I know tomorrows conversation will be all about weight. I'm not sure what to say if she pushes "healthy balanced diet"
In addition I have a knee replacement coming up in a couple of months she will go on about losing weight for that. The knee people have said they will go ahead if my hba1c is less than 65.
I had my other knee replaced in May and wonder if someone would have told me if I was diabetic from these pre op bloods. This leads me to wonder if I "became" diabetic in the three months recovering from the op. Most of which I spent in bed scoffing take outs and chocolate and gaining weight. This was exactly the period my hba1c of 54 would have been based on.
Apologies for this turning into my rambling thoughts. I think I'm just apprehensive about sticking to my low carb guns with the nurse tomorrow and I really value the helpful useful feedback on this forum.
 
I think you might well be right.

As far as weight loss goes I lost most of mine long after my BGs were back to normal levels. It also didn't work smoothly, and went in a series of steps. I lost more during the winter than in the summer. And once I started building up muscle again, I'm no longer losing much weight (if any) but am still losing fat (now under 34 inch waist).

You might see some HbA1c reduction even after only a month of low carb, but don't bet on it. You'll still have the hangover from months two and three going back.

The best thing I found with my DN was not to argue, but just to do what I was going to do anyway. At my first follow-up five months after diagnosis, and after five months on 20g/day, she nearly fell off the chair when my A1c had fallen from 50 to 36. Since then I have had no problems, but they still won't advise low carb for their other T2 patients. I suspect they know very well that it works, but officially have to continue with the NICE-approved line.

So - I challenge you to make your DN fall off her chair - if not this time, then next time.
 
This is absolutely my experience as well and isnt limited to the DN - GP was the same.
 
My thoughts:
OK, Weight Watchers can (I'm told) be complementary to Low Carb provided that they know that you are doing Low Carb to control your Diabetes.

Weight loss on Low Carb is often just a welcome side effect, but for some it isn't automatic and thus needs some work. Your nurse is probably pushing weight loss and 'healthy' balanced diet because that is all she knows (apart from medication) for controlling T2D, plus weight loss is certainly good for relief of overloaded joints. A well know Low Carb surgeon in Tasmania says that a proportion of his patients for hip/knee surgery wouldn't have needed the surgery if they had started on Low Carb before they first met him.

It's unlikely that even 3 month scoffing would have made you diabetic if starting from healthy. And surprisingly little gets picked up and passed on from routine blood tests - so they may well have not informed your GP that you were diabetic from the bloods taken for the first knee surgery. But that is just water under the bridge now.

Do I correctly recall that you don't feel so hungry since on Low Carb? That could be a signal that you can cut down on fats a little, or even move to 2 meals per day instead of 3 (but no snacks)! Those should help with weight loss.
 
It might take a bit longer for things to get back to normal - I don't weigh myself after decades of heavy handed comments from HCPs about my non compliance with their instructions to lose weight, but I think it took a month or two to begin once I was told I was type 2.
 
I was lucky that the GP I first saw after the higher HbA1c was OK with me trying low carb - the nurse I saw after wasn't, she actually said my GP had forgotten to add metformin and a statin. I took the letter from the lowcarbprogram but she ignored it.
But the worst was the dietician - the alternative to a full course of the old Desmond which was anti-low carb.
The dietician got annoyed with me in spite of my great finger prick readings, insisting I took a copy of the Eatwell plate and that I must eat more fibre. She did not actually check what I was eating ... just assumed it was all heavy fats and too much meat. And ignored the letter plus new research I'd printed off.
I politely declined a second appt.
At the 3 mth mark the DN was amazed by my results. Both my HbA1c and cholesterol markers had improved.
5 plus years on I'm still in remission, my cholesterol numbers are better than ever, and liver + kidney results all fine.
But after a brilliant start, the weight loss stalled a couple of years ago.

questions
Check when you'll be getting the foot checks, and if the annual eye check at the hospital has been booked/referred
You should be on 3 mth bloods for a while then 6 mthly as they improve
If you are doing low carb you really need a blood sugar meter - some GP's will prescribe this, but probably not. Worth asking as it's impossible to work out how many carbs your body can handle without one (most of us have to self-fund).
 
Mmm. I’m another in the school of listen to what they say, go away and do what you want and what your meter says.

Over the years I have had many tell me I need carbs. To my everlasting regret I stopped the low carb diet.

4 years later I went back to it. One nurse agreed low carb was the right thing. The next congratulated me on my HbA1c reduction without asking how I did it! My libre tells me what works now.

Definitely agree, ask about foot and eye checks.
 
KennyA said:
So - I challenge you to make your DN fall off her chair - if not this time, then next time.
Click to expand...
Thanks Kenny. I will think about your response while I'm trying to be brave. Challenged accepted.
 
Thanks Ian. You are correct in everything. I googled and weight watchers can be done alongside low carb. In all the times I've spent money on weight watchers no on has suggested that.
Re when I became diabetic. I grew up on meat with lots of carbs then pudding. My parents were both type 2 by my age and I've lost and gained lots of weight my entire adult life. The last time I was officially tested for diabetes has to be four or five years ago so thats my window. The only reason I think maybe recovering from the knee op was that I lost loads and loads of weight for that surgery and gained it all in two or three months of recovering. Regardless you are correct I'm diabetic now and looking forward.
Yes I said I'm very rarely hungry. Since your previous helpful post I often only have two meals (YOU told me not to say skipped a meal) and often if I do take lunch to work its a boiled egg and a cube of cheese. I bought an air fryer at the weekend .As of this morning I have lost 3lb in 3 weeks so its a bit more respectable. The problem now is I'm recovering from one new knee and about to have another one so my movement is limited but I'm getting there.
Thank you
 
TriciaWs said:
But the worst was the dietician - the alternative to a full course of the old Desmond which was anti-low carb.
Click to expand...
They seem to have enrolled me in a six part course. One of which is looking after your feet and the rest is what you should be eating! We'll see
This is really useful thank you. I have the eye appointment next Monday but will ask about foot checks. I use my meter religiously and my numbers are coming down but I think I need to buy a new one. It seems the one I bought you can only buy strips and lancets together. I now have enough spare lancets for a market stall.
Thank you
'
 
Thank you. It all seems very brave to someone who has been doing what the doctor says for 50 years
 
It is very brave, but wholly liberating once we do it. Remembering that the medics have to toe the party line and they have other pressures than keeping us healthy in a way that doesn't make profits for the paymasters is key. Self-education (use us - we've been there) takes a whole lot of pressure off us. Because I need these people on board, I do the smile-and-nod thing (difficult over the phone!) and just get on with the diet I know works for me and which has taken me into remission (YAY!). Weight loss goes in fits and starts, and I am one of those people who bloats in hot weather, but I now have a BMI in the normal range albeit weight that fluctuates within about 3 lb., and I'd like to be lighter so still a works-in-progress. Much more importantly, my BG is in the non-diabetic range. Last time I spoke with Nursie (by phone!) she was really nice, which was more than a bit of a shock, though neither she nor GP have ever asked me how I have done this. If I'd been offered any kind of course, I'd have gone on it just out of curiosity.

It's all about management skills. I was pretty annoyed initially at getting the wrong advice by the medics, but I've got over myself and see my way to working with them and allowing them to tick those boxes that their paymasters want without compromising my health. I might, after all, need them in the future for other health reasons, and it's easier to manipulate people in a gentle way so they don't realise than to oppose them in a way that antagonises them. But we all do things differently, so whatever works is worth examining so that we can choose the end game we require.
 


Proper studies have shown that taking additional exercise does not help with weight loss in the medium term. So in my opinion, a Low Carb Way of Eating vastly outweighs any exercise regime!
I have said this elsewhere in the forum a few times, but many people don't believe it because it goes against most logic as well as what we are constantly told. Except that additional exercise tends to makes us hungry and makes us feel that we deserve a treat for doing it!

This was most recently mentioned (the exercise not helping with weight Loss) in a BBC morning program (Con or Cure) by Dr Xand Van Tulleken - I think it was in the last program in that series and was a few months ago. I'm not sure if it is still available on BBC IPlayer. Unfortunately he didn't give the reference number/name of the latest study.
 
True exercise doesn’t really help with weight loss, what it does for me though is help my BG if I can do 20 minutes walk after main meal and it builds muscle and aerobic exercise is good for your heart. It also helps my mental health looking at the bigger picture any exercise is good for your all round health, just don’t rely on it for weight loss
 
You've had a lot of great responses here, and as my experience of diabetes management is a similar length as yours, I can't offer any more advice of value on that count.

On weight loss, I've had a lot of success on keto, but I'm coming from a more extreme end of obesity. As such, I'll offer some things that have worked for me personally, just in case any are of help to you. If not, nothing lost.

Work out your base level of calorie burn when at rest (basal metabolic rate). A lot of food tracking apps out there will do this for you, or there are calculators available (happy to suggest some if needed). This number is never 100% accurate, it's just a guide as to what your body needs per day to maintain weight, even if you sit doing nothing.

I monitor calorie intake, but I don't stress about it. I aim to consume 20% fewer calories per day than my basal metabolic rate. If I exercise and am hungry, I aim to eat back 50% of calories burnt during exercise (in line with low carb macros). The reason for this is that if you're looking to lose weight on a high fat low carb diet, making your own body fat part of the equation can have positive results. Additionally, as is evident from the state I got myself in, I'm not very good at portion control and can eat too much, so it keeps that in check. More than anything, it just gives me confidence that I'm not doing my usual bad habits, and allows me to feel in control of my food rather than the other way round - sometimes this psychological element is more important than anything else. Low carb / keto aren't magic diets. Regardless of diet, losing fat mass eventually all boils down to consuming less and/or burning more than your body requires. Some people can do this instinctively, others can't.

Tracking fat intake. I'm going to fly in the face of most people's low carb advice here - track your fat intake. Hunger is a poor indicator of when you're hungry (e.g. sometimes you're just thirsty). Equally, fullness is a poor indicator of when you're full (e.g. by the time that message is triggered to your brain, you'll have eaten more since then). Everyone is different, we all have different abilities to manage these bodily sensations, but fat is calorie dense so it can be easy to eat enough that you go above your body's calorie requirements if you're not careful. Worth checking at least, if nothing else.

Not all exercise is equal, but it is all beneficial. A gentle stroll is good, but it's not going to burn much fat. If you have one already, or would consider getting one, a wearable fitness tracker will allow you to track exercise more effectively. Perfectly decent, but basic ones can be purchased for £40 if you haven't got one (happy to recommend if you want). You're looking to keep your heart rate in weight control (60-70% max heart rate) or aerobic (70-80% max heart rate) zones. These are the most efficient zones for burning (what few) carbs are in your system, plus fat mass too, without causing exhaustion. Almost impossible to do without a fitness tracker, but keeping my heart rate in these zones has had a huge positive impact on blood glucose levels, weight loss, blood pressure, and resting heart rate for me personally.

If you're not feeling hungry at breakfast, skip it. I don't have a fasting schedule or regime, I don't even see it as fasting really, I'm just not eating until I'm hungry. I've never gone longer than 18 hours (mostly 16hrs) from dinner to food the next day, but it can aid weight loss if done right. I only do it when I feel like it and when it fits with my day.

Most importantly, don't stress about it. I've only written the above because it might be of help to you, or someone else reading the forum. If you can't or don't want to do these, then don't. Just keep up your good work, keep blood glucose moving in the right direction, keep making better choices with what you're eating, and it'll all fall into line in the end.
 
Thanks Paul. Loads to think about there, I have a fitness tracker (although I only really use the step counter) and I actually have a rough idea of what my calorie deficit needs to be to lose weight (many years of every diet known to man) For now my plan is to use less fat and reduce portions a bit. I'm actually enjoying not feeling guilt for bacon and eggs or a creamy sauce so I'm going to try things gently without heavy duty tracking but I may well come back to you if I need to push a bit harder.
 
ianf0ster said:
Proper studies have shown that taking additional exercise does not help with weight loss in the medium term. So in my opinion, a Low Carb Way of Eating vastly outweighs any exercise regime!
<snip>
Click to expand...

However it can help with many other things, including sleep quality, mental health, bone density (weight bearing exercise), and keeping muscle mass which is vital especially as we age. If the exercise is going out for a walk or cycle it also helps build vitamin D reserves, though I take a supplement in winter.
 
Exactly the approach I used with my diet and exercise. Once I had the overall approach in place, I then started making small, simple changes, but effective ones, and just built it out bit by bit. Still changing things now. If something doesn't work, I don't stress and just change it back. Makes the changes much easier, both psychologically and physically.
 
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