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Questions regarding my situation

T

TheRealDrMundo

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hello,

Last month (30 days ago), I got diagnosed with T2 diabetes. I didn't really have symptoms other than some yeast infections. Nothing about real thirst or peeing every 30 minutes.

Numbers:
Triglycerides: 1495 (not a typo lol)
Fasting sugar: 199 mg/dl
A1C: 10.3
Cholesterol: can't remember but values weren't good
Iron: atleast half of what I need
Weight: 264 lbs, length 181cm
Age 28

I was put on Metformin 500mg twice a day, a statin and an other pill for my cholesterol, iron pill and I bought some fish oil pills and some vit D pills. I went on a low carb diet (still sometimes eat something carby), started walking more and moving, playing tennis once every week with friends etc. and started intermittent fasting. Didn't have a piece of chocolate or anything candy-like since my diagnosis.

Fast forward 30 days later, did some blood work last Friday. Results are really good.
Triglycerides: 350
Fasting sugar: 86 mg/dl (!)
A1C: 7.9
Cholesterol: Everything in good range except HDL
Iron: great values
Weight: 242 lbs

I still have to talk to my doctor, but I have a few questions about this.

How come my sugar dropped so low after one month? And my other values are really great aswell? I'm basically in the non diabetic range already (not with the A1C but with the BS). What does this suggest? I see a lot of people talking how they are not able to lower their fasting blood sugar, even with insulin therapy (which I have never done).

Can I get in a hypo? I'm so afraid of that, especially during my sleep. The only diabetes-related medication I take is Metformin and that doesn't seem to cause lows but I want to be sure.

Is it possible that I caught the disease early and therefore, am able to put this in remission quickly and regain a lot, if not all, of my insulin sensitivity once I lost some more weight and am on a healthy weight target?

I want to do everything I am able to do to beat this. I really enjoy food and it would suck for me to give this up. I was a unhealthy sugary eater before my diagnosis (late night snacking and all that) which I obviously do not plan to do. I know I can't go back to my old habits, which were ****, but I want to enjoy a pizza or french fries with a snack every now and then or drink beers with my friends once I have achieved my weight. I don't drink alcohol at home or anything like that, but when we go out (which is like once every 1.5 month) then we usually do some binge drinking. One of the reasons I am doing all this work is so I can enjoy my life again by doing things like this without fully going back to old habits pre-diagnosis.

(posted this on Reddit aswell, looking to get as many reactions as possible)
 
Hi @TheRealDrMundo - sounds like a hell of a good month. Congrats on those numbers.

At 28, you are still pretty young - and I really only mean that to say that you may find that things happen much faster for you. Absent any other pathology, if the underlying cause of a person's T2DM is the "classic" cycle of carbs driving insulin, and then elevated insulin causing progressive insulin resistance... it can take a couple of decades with no change in observable blood glucose (because you are just producing more and more insulin to clear out the blood glucose) to have blood glucose raised to the point that it is diagnosed. That's essentially why it can take time to reverse. However, there are plenty of cases of T2DM being reversed in a couple of weeks - so it entirely depends on your personal circumstances.

For me, I was eating far too many grapes and honey, and it kind of pushed things over the edge, but my blood glucose also dropped quite fast on making radical change to my diet (you have a few years on me though).

Bottom line - there is no particular reason to feel worried about any of this. Hypos (in the sense of life-threatening hypos) are only relevant to type 1's - where the body stops producing insulin (or with less common forms of diabetes that also interrupt normal insulin production) - type 2 is primarily associated with too much insulin, and the long-term goal for many Type 2s is to bring insulin under better control. It sounds like you are on the right track, and over time you will figure out where the balance is for you in terms of things to enjoy.

You may also want to consider using a CGM on a trial basis - that will give you some insight into how various food actually affect you - rather than what anyone suggests is happening; we really are unique snowflakes when it comes to this stuff.
 
Yoy are doing great, Hypos are not a problem for Type 2's unless they are taking insulin or some other glucose reducing drug like gliclazide, but not metformin which only acts to prevent the liver dumping excessive glucose into the bloodstream.

It is understandable why your Blood glucose has reduced mor than your HbA1C, because your BG is instantaneous, while HbA1C gives an approximate of how much glucose was in your blood for the life of a red blood cell (approx 3 months) - so it's like an average and thus slower to change. Your HbA1C should continue to drop for the next few weeks even if you make no more lifestyle changes.
 
Welcome to the forum @TheRealDrMundo . I’m going to echo @Chris24Main and congratulate you on bringing down your blood sugars. That’s a great achievement.

Hypos in general are not a cause for concern for classic type 2’s unless you are on blood sugar lowering drugs that can cause low blood sugars. Metformin is not one of those types of drugs. It has been around since the late 1950’s and is known to be a very safe drug.

Are those blood panel figures fasting figures. In other words did you fast? Did your Dr offer you an explanation as to why your triglycerides were that high Initially? They came down significantly, which is great.

If you don’t mind me asking what is your adjusted diet like now?
 
Thank you very much for your reply. Would you think that I am able to somewhat reverse the insulin resistance, since I am still young? I really want to go for this but I don't want to miss out on occasional fun activities with my friends or girlfriend (going out with dinner, having a couple of drinks while going dancing etc.) as long as I watch what I eat during other days? Thank you again, your words are comforting.

Thank you for explaining this.

Thank you very much. These figures are fasting figures indeed. Blood was taken in the morning at 11PM, didn't eat since 7PM the day before. Only water.
She didn't really have an explanation for my high triglycerides, she thinks its genetic but I was a big fan of fried food and would eat it multiple times a week (french fries, croquettes etc.). I've stopped that since my diagnosis. I still miss it though. That's why I think I can hold this diet if I can sometimes "cheat" on it.

My diet is basically intermittent fasting and low carb. I start during lunch hours (so 12PM) with whole wheat bread, eggs (scrambled or omelette) and bacon (not every day though). I don't really snack but if I snack its mostly just some pieces of charcuterie or some yogurt (which does have some sugar in it for the taste). Evenings I try to go as low carb as possible by eating a lot of veggies, chicken etc.

If I want to eat rice, I have brown rice. Haven't found a replacement yet for noodles but I would assume that whole wheat noodles are OK aswell. My dietician said they are OK.
 
Actually - your description of what you're eating still has quite a bit of carb in it - I guess it's still a big change from how you used to eat? The things that stand out are bread (whole wheat makes no difference), yoghurt with sugar, and brown rice. All fairly carb-heavy. Depends a lot on the quantity eaten as well, of course. If it's working for you, that's great, but you do have scope to reduce carbs further if needed.

I eat quite a bit of fried food, (and as much bacon as I want) but it's fried in lard or dripping or butter. The only vegetable oil I use is extra virgin olive oil. After getting on five years I do have the scope to allow myself a little leeway on occasion - but I've found that my taste for those carby things (like pizza) has pretty much gone.
 
So - yeah - there's good news and bad news...

I spent months and months, essentially trying to cling on to various foods - in the end I've settled into - "does it contain sugar or starch" - yes or no.

Keeps it simple, and if anything - my favourite, "if you had to pick one meal" type of food was noodles - generally egg noodles, stir fried. Love it. But - does it contain starch - yes, then no.

On the flip side of that coin though, once you understand the way that insulin works... you reservation about bacon for example - totally fine; does it contain sugar or starch, no - then every day if you want.. just not the bread so much...

The wholemeal thing ... you will get that continuously, and you'll have to make up your own mind, but the history of this is pretty illuminating -
it became clear after some analysis around the 50s, that refined grains were not so good, because they convert to quickly to sugars.
so - it's obvious therefore that whole grains are better than refined grains, because they convert more slowly to sugars.
over time, that became, whole grains are good, period.
but, without any evidence that this is the case, it's always been really that refined is worse than unrefined.. but the same amount of stuff in your gut will turn into sugar, so it's always simply better not to put it there in the first place.

Again though, things that contain no sugars and starch, but that you may feel "are not good for you" - in the absence of those sugars - it's a totally different story, so butter, cream, nuts, meat, eggs, high cocoa chocolate - these are doors you may find opening..
 
I'm another who loves good tasty food, and I can assure you that you will never go short of it by eating diabetes-friendly choices. Nor will your new way of eating ever be boring. One of the best changes is that all the foods we were brainwashed for years to avoid (largely driven by the low-fat foods industry) are perfectly fine for us, e.g. butter, olive oil, cream, full-fat yoghurt, fresh meat with the fat it comes in, many more. And once we stop eating the diabetes-unfriendly foods, we lose the taste for them, so double bonus.
 
I would suggest you explore low carb alternatives to rice. Cauliflower rice has become my staple for eating with curries, chinese, etc. Fine at home but in a restaurant I just order a side dish (usually mushrooms) no poppadoms, no nan bread. With regards to the wholemeal bread, there are a number of low carb breads on the market - some are better than others in my opinion e.g. Livlife. I always keep it handy in the freezer for when I fancy a bacon sandwich or some toast with a fry up. One loaf usually lasts me about 6 weeks. You have done so well in just a few weeks and I am sure you will lose your taste for sugar eventually. I would also switch to full fat greek yoghourt instead of flavoured and sugar laden yoghourt. You can always add some fresh berries.
 
Hi @TheRealDrMundo welcome to the forum.
Well done on tackling your T2 with success.
A few inputs from my experience.
First rule is: Don't panic. I confirm that Metformin does not cause hypos.
Next: You will have to learn how changing your diet affects your body. Do you have a CGM or test with finger pricks? Either way you can learn how different food affects your body. Measuring and logging (and plotting) or your numbers can be very gratifying, as it shows much your HbA1c was lowered, how much weight you lost, etc. But it will also keep you honest, if at some point it were to go in reverse.
There is an old rule that by measuring stuff, apparently we always want to win, so logging data is effective in dealing with T2. Note please that this applies for many things, not only HbA1c and weight. For example by measuring the temperature in your home, you likely will reduce your heating costs or by checking what you spend money on, you will spend less.
Furthermore: Consider easy wins. When diagnosed, I went cold turkey on fizzy drinks, (you probably did this already). Stop snacking, this is easier than one thinks. Drinking water and coffee or tea helps getting rid of feeling peckish, and after some time you don't miss the snacks. Don't eat when you are not hungry. I often skip lunch, others don't have breakfast.
A bit more effort needed: Educate yourself how different food types affect your body. Carbs are different from fat and from protein and our bodies are not like combustion engines. Our hunger is ruled by hormones. There are many books on this topic, such as Jason Fung's "The Diabetes Code". Unfortunately, we have been taught that fat is bad, largely based on a study by Ancel Keys, which never could be replicated. At the time in the 1950s and 1960s people where trying to find out why American men die of heart attacks in their 50s. Now we know this is due to smoking. This led to the promotion of low-fat food, where fat has been replaced by sugar. In my assessment the fact that the rates of obesity an diabetes started to increase signifcantly in the 1980s is directly related to this. I never liked low-fat food, and margarine and other low fat stuff is now banned from my fridge. On the other hadn I upped my intake of cheese and eggs. As fatty foods are more satiating they also last longer and don't make you feel hungry after two hours.

Finally: T2 is a marathon, not a sprint! You will need to find out what will be a sustainable solution for yourself. And you still can have fun and treat yourself.
 
Thanks everyone for your replies. I'm happy to learn that Metformin won't cause hypos.
I guess my next question is, once I lost some weight (im on 242lbs now, planning to go to 209), will that mean that my insulin resistance dramatically decrease and therefor am able to eat something carby like takeaway pizza or french fries once in a while? I know that I still have to maintain a diet of low carbs, which I am planning to do. However I feel this will be a lot easier if I can order something carby once every week or every two weeks.

Thank you!
 
So - this question is kind of sitting at the centre of all treatment for Diabetes, and all lifestyle ...management.

T2DM is (this is only one way of thinking about it) like your body saying "I just can't deal with having to pack away all this glucose anymore".

It can have taken 20 years to get to that point, but the nature of insulin resistance, is kind of like resistance to anything - it just takes more of the thing to have the same effect; that concept we all understand - it's the same for coffee, alcohol, but also exercise, and any form of drug.

Where it gets tricky, is that insulin's most famous job is clearing out that blood glucose, but it is responsible for over 100 jobs around the body, every single cell in your body has some deal going with insulin, and if you are "insulin resistant" - every single cell in your body will have a relationship that's off balance.

You can control your blood glucose, but that insulin resistance will only come down over time with keeping your insulin levels low, and the only way of doing that is by not triggering the need for it from the food you eat.

So - you can eat whatever you like - what you do (and the way it affects you) is entirely up to you, but there aren't any simple answers, and if you realise that insulin's primary job is energy management - ie, if it's high, you're in the business of storing energy, whatever you eat... then you can make a plan.
 
People's T2DM can be very individual, just as reaction to carbs can be. So we can't tell how many carbs we can deal with or which particular carbs we get less of a reaction to.

For some people the fact that pizza contains a lot of fat means that the carbs take longer to digest into glucose than carbs with less or no fat.

Through the 2 main Diabetes forums in the UK, I have heard of 2 people who claimed that after some time (not defined as to how many years) in remission, they could now eat 'normally' (not defined as to how many carbs per day) with no high glucose. One other person has expressed confidence that he will do this but isn't currently in remission and is still taking medication in tablet form (I presume at least metformin).
On the other hand, I'm aware of at least twice as many who thought they could start eating 'normally' and discovered they were mistaken. I have no intention, or even desire to find out if I could start eating 'normally', since I enjoy the foods that I do eat and don't feel especially lucky. I keep being reminded of Clint Eastwood in a Dirty Harry film saying he'd forgotten how many bullets he'd fired and asking a criminal '... so do you feel lucky, punk?'
 
The honest answer is no one knows and you will need to find for yourself.
However you are on the right track and losing that weight will most likely improve your HbA1c.
For what it's worth when I was at your stage, I said I love pasta and bread way too much to consider giving it up.
In addition, I had a busy travel schedule and lots of dinners in restaurants for networking, which I wasn't willing to forgo either.
However I was eating nothing carby on my two fast days per week, and this still allowed me to reach my target weight
and to reduce my HbA1c so that I am not taking any medication any more.
While I don't do very low carb, I've noticed that without trying I've reduced significantly my intake of carbs.
For example, pasta is now a treat and the large portions have disappeared.
When going for pizza I try to order those with a thin dough and leave off the outer ring.
On the other hand, I indulge in eggs of any kind, e.g. omelettes with vegetables, ham and cheese or fried eggs with bacon.
I have cheese for desert instead of a cake.

As you can see that people have different approaches. To me anything which works and is sustainable can be considered. People with T2 have an issue in that their body does not tolerate carbs and levels of tolerance vary a lot. There are different ways of regulating your carb intake. You can go very low carb, some people here on the forum say less than 20 g of carbs per day. On the other hand a low carb diet is often defined as fewer than 100 to 150 g of carbs per day, which is about half of the recommended carb intake for healthy individuals. You mention French fries - a single portion has between 40 and 50 g of carbs, which is more than people eat per day on a very low carb diet, but it could fit into a low carb diet. There is only one way to find out, namely you need to test before eating French fries and 2h afterwards and your body will tell you how it copes with it.

I wouldn't worry about questions which you cannot answer now. Try out what works for you by monitoring your blood sugar and regular HbA1c tests and you will find a sustainable solution for yourself.
 
Very helpful answers, thank you very much. I know that those are questions that do not matter now as I am not thinking about eating any of those foods any time soon.
My doctor said I didn't need to use a glucose meter because I'm not on insulin. My dietician agreed with my doctor when I told her this. However, when I do decide to try carby foods, I'll make sure to buy one.
 
It really doesn't work best like that in my opinion, with all due respect to your doctor and dietitian. They are probably thinking only about avoiding hypos, hence the insulin remark. I have been doing this for nearly five years now (never on any medication) and without the info from the meter I would have been in the dark almost all of the time.

If you start to use one now, you'll get a feeling for what food (or stress, or temperature, or illness) is doing to your BG levels in the short term. That will give you a clue about how your system is working now and how it's likely to react in the future. If you only start testing when you "try carby foods" you'll get a skewed response. And as I mentioned above, there's currently quite a bit of carb in what you're reporting eating.

I will sometimes have a few more carbs than my usual 20g a day - probably max every 2-3 months? But even then, it won't be a carbfest and probably not over 50-75g. Very often the carb is just from a couple of pints of beer.

If you can, in due course, manage to have something very carby once every week you will have been very lucky. If it was me, I'd be feeling the impact of those carbs on my BG for 3-4 days, with the prospect of another big glucose hit 3-4 days away. So the answer to your "can I do it" question is that I certainly can't, but you might be different.
 
Thank you for your reply. It might be a good idea to get a glucose meter now then. I have an appointment with my dietician next week and will repeat the question with your arguments added. Thank you!

A question out of interest is, why don't you take medication? As far as I know, Metformin should be able to increase your insulin sensitivity so you can handle more carbs.
 
That's the first time I've needed to think about that. The simple answer is that I don't currently take glucose-lowering medication because my blood glucose is normal.

I haven't ever been in a position where I needed to take medication. Dietary change - carb reduction - was enough to shift my BG to normal levels in a couple of months and in the process get rid of all the symptoms caused by the excess blood glucose. I really don't see why, from my current position of nearly five years symptom-free at normal BG, I'd want to start taking any sort of drug just so I maybe could have more carbs.

Even if I did think that was a good idea, metformin wouldn't do what you're suggesting. Metformin has zero impact on eaten carbs. What it does do is suppress the ability of your liver to add glucose to your system when it thinks you need it - the mechanism by which it does this "isn't fully understood" by current science (ref Bilous and Donnelly Handbook of Diabetes 5th ed). There are other medications (one of the flozins probably) which do actively lower blood glucose, but at my current normal levels I would be risking hypos with those unless I was to eat a considerable quantity of carb as long as I was taking the meds.

As a matter of interest, would you suggest taking medication to a non-diabetic person?
 
Thank you for your insights. I've come across topics where Metformin does indeed suppress glucose dumps from the liver. I've also read it reduces your resistance to insulin.

I wouldn't suggest Metformin to a non-diabetic as they do not have insulin resistance, which eliminates the need for Metformin (atleast how I understand it).

Do you "cheat" often on your diet? As in, do you sometimes have a day where you would have some carby foods?
 
It's all relative. A normal day for me is ~20g, from vegetables usually. Double my daily intake, and I'm still in ketosis, still using bodyfat. Triple it, maybe not so much.

In the first couple of years, I worked to stay in ketosis as much as possible - if I came out, it could take four or five days to get back in and that was a pain. As time's gone on, I can bump out of ketosis tonight and probably be back in tomorrow - I think this is because I'm much more adapted to using fat for fuel than glucose. It's taken a while to get here and I really don't want to lose the ability.

So I don't want to "cheat", because the only person I'm cheating is myself. And frankly carbs are not worth the damage, physical pain and discomfort from the symptoms caused by high blood glucose. In the last couple of years, I have found I can be a little more relaxed (mainly because I can be back in ketosis within 24 hours) but if I've gone over 100g/day since Christmas 2019, it was unintentional.
 
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