Recently diagnosed and feeling deflated after first nurse appointment...

[KK951]

Seven weeks ago I was diagnosed with type 2 diabetes with a HBA1C of 94 (having had gestational diabetes a few years previously). I'm 46 and my children are now primary school age, so I want to be around and be fit and healthy for many years to come.

However, I'm feeling very deflated after only just having had my first appointment with the diabetic nurse. I had a second HBA1C test five weeks after my first (to confirm the diagnosis) and brought it down to 60 mmol, having made diet/lifestyle changes, lost 15 pounds, and having started on metformin four weeks ago. I thought this was great progress (given almost half the period my blood sugar was averaged over was pre-diagnosis), but the nurse was very dismissive of low carb diets, said they weren't sustainable and just credited the drop in blood sugar to the metformin with doing its job. While she talked about diet (the standard NHS advice), she didn't even discuss weight loss (I am overweight), isn't even aware that I've lost weight post diagnosis (as I was never weighed by GP on diagnosis and she didn't ask). She made the future sound bleak with taking multiple medications for life being inevitable, high risk for stroke, heart problems and so on. She just seemed to want to push more medication on to me, which I declined for now until I have another HBA1C test in three months, and other test results back (kidney function etc.) so we can review the full picture. She didn't mention the path to remission programme either, and when I asked her about the possibility of getting numbers back in a normal range she seemed very sceptical.

To top it off my blood pressure was a bit high, so now I'm having to monitor that too and potentially face more medication should it not come down. I've never suffered with high blood pressure before, so that was a bit unexpected.

Anyone been in my shoes / able to give me something positive to cling on to?! I was trying to face everything in a positive way, and having previously had gestational diabetes in two pregnancies, it wasn't a total shock (although the level of my initial HBA1C was), and I feel fairly well versed on the subject, but I guess I was just expecting a bit more positivity from professionals and a greater focus on diet and lifestyle changes, at least to begin with, but I've left feeling far more negative about it all, and wondering if I was deluded to think I might be able to get this under control with diet and lifestyle changes. I'm not averse to taking medication if I need it, but if I am able to reverse the diabetes and eventually come off medication, I certainly want to give it a try.

 

[WaveyDavey123]

I'd say you need to find a more supportive nurse - terrible bedside manner it sounds like.

My numbers are nothing like as bad as yours so bear that in mind but I've definitely found that low carb diet and losing weight make a big difference. I am more or less on the cusp of type 2 and pre-diabetic personally for context. So I do it all by diet alone and have been working on it all about 3 years now. Slipped for a year until June this year and it's all sailing downwards again now.

The one thing I would say though - is that I had a teeny bit of advice on this forum that I no longer like. I was led to being a bit of a low protein Atkins style diet for a good while. So plenty of bacon and eggs -zero potato, pasta, bread etc.

Yeah so I got diagnosed with stage 3a chronic kidney disease back in August which is why I'm back on the healthy plan again now in earnest. Be careful with high protein low carb - it's not good for your kidneys I now find. So lots of bacon - bad idea because of all the salt. The positive thing in that is that it's forced me to really now go for a proper balanced diet. Atkins-style is very effective for rapid weight loss but not so good for other things.

But weight loss is certainly important - that visceral fat around your internal organs is half (if not most) of the reason the old type 2 happens in the first place.

 

[helenb1979]

What a terrible nurse. I started off 7 months ago with a level of 126 and in that time I have halved it. Not going to lie. I am stubborn and cut everything out. Changed diet.more exercise and yes I do take medication. Still a long way to go I might not beat this but I will give it my best shot. We all support each other here and we are all in this together.

 

[zand]

I had similar when I was diagnosed. I just smiled sweetly and nodded then went back to my low carb diet. 15 years on and I may need to start medication soon. Just show her iow carb IS sustainable by your future results.

 

[Resurgam]

@KK951 How dismal to have such a negative response to your progress.
I had a HbA1c of 91 at diagnosis, 41 at the 6 month mark.
That was ten years ago now and I have been feeling a lot better than for the previous two decades when I as being badgered to eat a high carb healthy diet.

I was put onto medication at diagnosis, but that was absolutely dreadful and I stopped taking Metformin and Atorvastatin after 5 weeks as I could not live with the side effects.

I have eaten a very low carb diet for ten years and had only good results but last winter I had one illness after another and it has been difficult - after Covid, 'flu' and then a hacking cough for weeks I should be thankful just to be here, really - and I still hope for improvement.

My last annual check resulted in a prescription for Dapagliflozin as it is supposed to be good for heart and kidneys so I agreed to try it - it has taken a few days to adapt to it but having accommodated its requirements I have seen a slight reduction in weight and in BG levels. I'll try almost anything to see if it works.

My blood pressure is good, a feature of low carb eating perhaps - though I put true cinnamon in my coffee and use it in cooking, which could be a factor. It is rather nicer than the cassia sold as cinnamon in most supermarkets.
I was diagnosed at the age of 65, am 75 now and still going out with the morris dancers - still go out on May mornings to dance up the sun.

The only downside, if it can be called that is shrinking out of my clothes and having to adapt or replace at fairly regular intervals. I was almost spherical at diagnosis and my waist shrank by 12 inches - my shape is still changing and recovering.
As you have a 20 year start on me you will hopefully be able to smile at that nurse's bewilderment at your results in another few months.

 

[Antje77]

Hi @KK951 , welcome to the forum.

Reducing your hba1c from 94 to 60 in only 7 weeks is absolutely amazing, well done!
If it was me, I would want to see what happens first in another couple of months before I'd start to think about more medication too.

Anyone been in my shoes / able to give me something positive to cling on to?! I was trying to face everything in a positive way

I can definitely give you something positive to cling on to, it's your own experience and lab work!
(Not from own experience, I'm sorry, I turned out to be a T1 after all and my practice nurse had no idea why I thought I might be misdiagnosed after two years, but have a look at the sucess stories part of the forum to find countless similar stories to your own: https://www.diabetes.co.uk/forum/category/success-stories-and-testimonials.43/ )

I guess I was just expecting a bit more positivity from professionals and a greater focus on diet and lifestyle changes, at least to begin with, but I've left feeling far more negative about it all, and wondering if I was deluded to think I might be able to get this under control with diet and lifestyle changes. I'm not averse to taking medication if I need it, but if I am able to reverse the diabetes and eventually come off medication, I certainly want to give it a try.

Not all HCP's are the same, and diabetes nurses with a GP are not always aware of everything. Heck, my diabetes specialist nurse in the hospital I see for my T1 panics every time I tell her how little carbs I eat. Thankfully my endo is perfectly fine with it.
There are GP's/nurses promoting low carb for diabetes, just not all of them.

 

[Antje77]

so I got diagnosed with stage 3a chronic kidney disease back in August which is why I'm back on the healthy plan again now in earnest. Be careful with high protein low carb - it's not good for your kidneys I now find. So lots of bacon - bad idea because of all the salt. The positive thing in that is that it's forced me to really now go for a proper balanced diet. Atkins-style is very effective for rapid weight loss but not so good for other things.

High protein can definitely be a problem with existing kidney problems. Without kidney problems, it shouldn't be an issue.
Kidneys do not like a lot of salt, but there is no salt in protein as such.

 

[KennyA]

Seven weeks ago I was diagnosed with type 2 diabetes with a HBA1C of 94 (having had gestational diabetes a few years previously). I'm 46 and my children are now primary school age, so I want to be around and be fit and healthy for many years to come.

However, I'm feeling very deflated after only just having had my first appointment with the diabetic nurse. I had a second HBA1C test five weeks after my first (to confirm the diagnosis) and brought it down to 60 mmol, having made diet/lifestyle changes, lost 15 pounds, and having started on metformin four weeks ago. I thought this was great progress (given almost half the period my blood sugar was averaged over was pre-diagnosis), but the nurse was very dismissive of low carb diets, said they weren't sustainable and just credited the drop in blood sugar to the metformin with doing its job. While she talked about diet (the standard NHS advice), she didn't even discuss weight loss (I am overweight), isn't even aware that I've lost weight post diagnosis (as I was never weighed by GP on diagnosis and she didn't ask). She made the future sound bleak with taking multiple medications for life being inevitable, high risk for stroke, heart problems and so on. She just seemed to want to push more medication on to me, which I declined for now until I have another HBA1C test in three months, and other test results back (kidney function etc.) so we can review the full picture. She didn't mention the path to remission programme either, and when I asked her about the possibility of getting numbers back in a normal range she seemed very sceptical.

To top it off my blood pressure was a bit high, so now I'm having to monitor that too and potentially face more medication should it not come down. I've never suffered with high blood pressure before, so that was a bit unexpected.

Anyone been in my shoes / able to give me something positive to cling on to?! I was trying to face everything in a positive way, and having previously had gestational diabetes in two pregnancies, it wasn't a total shock (although the level of my initial HBA1C was), and I feel fairly well versed on the subject, but I guess I was just expecting a bit more positivity from professionals and a greater focus on diet and lifestyle changes, at least to begin with, but I've left feeling far more negative about it all, and wondering if I was deluded to think I might be able to get this under control with diet and lifestyle changes. I'm not averse to taking medication if I need it, but if I am able to reverse the diabetes and eventually come off medication, I certainly want to give it a try.

Put all that to one side. It's typical of a very out of date way of thinking about T2 and unfortunately it still persists in parts of the health services and most of the media.

You've done really well yourself, and that is the most important thing. No reason why it shou;ldn't continue. BTW, metformin won't produce those sorts of changes - it affects the ability of your liver to make new glucose, and has no impact on glucose/carb in what you eat.

I started from a lower level than you, but after ten years of undiagnosed T2 I was at normal BG levels within four months. Plus I've lost about 90lbs. I've been on the same very low carb diet since December 2019, and haven't ever been on any medication. So much for being unsustainable.

Keep at it. What you're doing is working.

 

[KK951]

Thank you for all your comments - good to have some positivity and success stories I suspect I will be doing a lot of nodding and smiling at professionals in future appointments, but either way, I hope to prove that nurse wrong, should I have the pleasure of seeing her again!

 

[Lainie71]

Yes I had the same, went keto diet with exercise and never looked back. Terrible attitude of the nurse, but then again I am not surprised. I do a lot of nodding etc & they dont ask me about statins anymore and meds haven't been suggested for years. Dont let it get you down, you are doing really well.

 

[))Denise((]

Nurse is probably a practice nurse, they have 'training' which is the usual old NHS rubbish. If there is another nurse at your surgery, see that one. I refuse to see one nurse at my surgery, she has no bedside manner and just spouts nonsense to me. After 19 years with Type 2, my GP knows my approach, and another nurse at my surgery just does blood tests, weighing and measuring, blood pressure and foot checks.

 

[Daibell]

Sad your nurse is poor. Metformin doesn't usually have that much effect on BS or weight but GPs like to be able to offer you 'something'. The low-carb diet is the best way forward and your nurse is wrong. I've been having low carbs for around 20 years now and you do get used to avoiding the carby foods. It's not a diet - it's a lifestyle you can maintain.

 

[WaveyDavey123]

High protein can definitely be a problem with existing kidney problems. Without kidney problems, it shouldn't be an issue.
Kidneys do not like a lot of salt, but there is no salt in protein as such.

Yeah but the advice was along the lines of "Do you like bacon and eggs" - me says yes. My bad really just saying be careful

 

[NoMoreBeerAnymore]

Seven weeks ago I was diagnosed with type 2 diabetes with a HBA1C of 94 (having had gestational diabetes a few years previously). I'm 46 and my children are now primary school age, so I want to be around and be fit and healthy for many years to come.

However, I'm feeling very deflated after only just having had my first appointment with the diabetic nurse. I had a second HBA1C test five weeks after my first (to confirm the diagnosis) and brought it down to 60 mmol, having made diet/lifestyle changes, lost 15 pounds, and having started on metformin four weeks ago. I thought this was great progress (given almost half the period my blood sugar was averaged over was pre-diagnosis), but the nurse was very dismissive of low carb diets, said they weren't sustainable and just credited the drop in blood sugar to the metformin with doing its job. While she talked about diet (the standard NHS advice), she didn't even discuss weight loss (I am overweight), isn't even aware that I've lost weight post diagnosis (as I was never weighed by GP on diagnosis and she didn't ask). She made the future sound bleak with taking multiple medications for life being inevitable, high risk for stroke, heart problems and so on. She just seemed to want to push more medication on to me, which I declined for now until I have another HBA1C test in three months, and other test results back (kidney function etc.) so we can review the full picture. She didn't mention the path to remission programme either, and when I asked her about the possibility of getting numbers back in a normal range she seemed very sceptical.

To top it off my blood pressure was a bit high, so now I'm having to monitor that too and potentially face more medication should it not come down. I've never suffered with high blood pressure before, so that was a bit unexpected.

Anyone been in my shoes / able to give me something positive to cling on to?! I was trying to face everything in a positive way, and having previously had gestational diabetes in two pregnancies, it wasn't a total shock (although the level of my initial HBA1C was), and I feel fairly well versed on the subject, but I guess I was just expecting a bit more positivity from professionals and a greater focus on diet and lifestyle changes, at least to begin with, but I've left feeling far more negative about it all, and wondering if I was deluded to think I might be able to get this under control with diet and lifestyle changes. I'm not averse to taking medication if I need it, but if I am able to reverse the diabetes and eventually come off medication, I certainly want to give it a try.

Hi, I was diagnosed 3 years ago with an a1c of 120. I didn't take it seriously and in January I was told my high glucose has given me atrial ventricular disease. So I went on a low carb diet and went to the gym. I dropped from 110kg to 85kg. I also garden hard, chopping firewood, digging as well as the gym. I try to do at least 30 mins exercise a day. My 30 day average is now 5.5, diabetes is still there but its put in the cupboard for when I am an old. I am 56 now.

Your significant other needs to help you, mine didn't and she used to get really upset when I said no to carbs.

I am staying on the meds, Metformin is pretty good stuff

 

[Angelofthemarches]

I'd say you need to find a more supportive nurse - terrible bedside manner it sounds like.

My numbers are nothing like as bad as yours so bear that in mind but I've definitely found that low carb diet and losing weight make a big difference. I am more or less on the cusp of type 2 and pre-diabetic personally for context. So I do it all by diet alone and have been working on it all about 3 years now. Slipped for a year until June this year and it's all sailing downwards again now.

The one thing I would say though - is that I had a teeny bit of advice on this forum that I no longer like. I was led to being a bit of a low protein Atkins style diet for a good while. So plenty of bacon and eggs -zero potato, pasta, bread etc.

Yeah so I got diagnosed with stage 3a chronic kidney disease back in August which is why I'm back on the healthy plan again now in earnest. Be careful with high protein low carb - it's not good for your kidneys I now find. So lots of bacon - bad idea because of all the salt. The positive thing in that is that it's forced me to really now go for a proper balanced diet. Atkins-style is very effective for rapid weight loss but not so good for other things.

But weight loss is certainly important - that visceral fat around your internal organs is half (if not most) of the reason the old type 2 happens in the first place.

I thought keto was supposed to be low carb, high fat, medium protein?

 

[Rosie9876]

WEllie don

Seven weeks ago I was diagnosed with type 2 diabetes with a HBA1C of 94 (having had gestational diabetes a few years previously). I'm 46 and my children are now primary school age, so I want to be around and be fit and healthy for many years to come.

However, I'm feeling very deflated after only just having had my first appointment with the diabetic nurse. I had a second HBA1C test five weeks after my first (to confirm the diagnosis) and brought it down to 60 mmol, having made diet/lifestyle changes, lost 15 pounds, and having started on metformin four weeks ago. I thought this was great progress (given almost half the period my blood sugar was averaged over was pre-diagnosis), but the nurse was very dismissive of low carb diets, said they weren't sustainable and just credited the drop in blood sugar to the metformin with doing its job. While she talked about diet (the standard NHS advice), she didn't even discuss weight loss (I am overweight), isn't even aware that I've lost weight post diagnosis (as I was never weighed by GP on diagnosis and she didn't ask). She made the future sound bleak with taking multiple medications for life being inevitable, high risk for stroke, heart problems and so on. She just seemed to want to push more medication on to me, which I declined for now until I have another HBA1C test in three months, and other test results back (kidney function etc.) so we can review the full picture. She didn't mention the path to remission programme either, and when I asked her about the possibility of getting numbers back in a normal range she seemed very sceptical.

To top it off my blood pressure was a bit high, so now I'm having to monitor that too and potentially face more medication should it not come down. I've never suffered with high blood pressure before, so that was a bit unexpected.

Anyone been in my shoes / able to give me something positive to cling on to?! I was trying to face everything in a positive way, and having previously had gestational diabetes in two pregnancies, it wasn't a total shock (although the level of my initial HBA1C was), and I feel fairly well versed on the subject, but I guess I was just expecting a bit more positivity from professionals and a greater focus on diet and lifestyle changes, at least to begin with, but I've left feeling far more negative about it all, and wondering if I was deluded to think I might be able to get this under control with diet and lifestyle changes. I'm not averse to taking medication if I need it, but if I am able to reverse the diabetes and eventually come off medication, I certainly want to give it a try.

Well done you! Your improvement is amazing. So trust yourself. There might be bumps on the road ahead. If so, be kind to yourself. Your DN sounds like she might benefit from a career away from caring, but hats off to your GP practice for testing for diabetes.

 

[lovinglife]

I thought keto was supposed to be low carb, high fat, medium protein?

Keto doesn’t have to be high anything - just minimal carbs of around 20g carb a day - some may be able to eat more - keto diet is about being in ketosis - so as long as your in ketosis with the level of carbs you’re eating then you’re on a keto diet. I don’t eat high fat or high protein, just normal amounts of both, I don’t avoid fats at all but I don’t add a lot either, those I add are from unsaturated sources like avocado, nut oils, good virgin olive oil, a little bit of butter, I eat oily fish but not a lot of animal fat or dairy as in cream or cheese as I find dairy makes me gain weight

 

[Button43]

Well done on your reduction of HBA1c so far.

Heres my story - I was diagnosed T2 a few years ago, lost some weight (about 2 stone/12 kg) after diagnosis and got my HBA1c down to around the diabetic threshold. But was told by a diabetic nurse that it wasn't good enough and she was very unsupportive (she also pretty much told me Id need meds for the rest of my life and id progess to insulin eventually). I kinda went of the rails a bit and thought well if thats not good enough why am I bothering trying. Fast forward a few years later to May 2025, and my HBA1c came back as 80. I was still diet controlled, so the nurse wanted to put me on meds - I cant take metformin, so was given a flozin. I didnt like the potential side effects of any of the diabetic meds so decided to try to do something about it. I researched and found that low carb diet could help, so I changed my diet.

I changed surgeries by then as Id moved and at my next review a few months later I had lost weight and got my hba1c to 52. Nurse agreed that it wasn't just the tablets, that my weight loss and diet change was a huge part to my success, we we agreed trialling coming off the meds. Next review Id lost more weight, and reduced my HBA1c even more. I have stayed off meds and through a low carb diet I have now lost nearly 7 stone (approx 44kg) and my last hba1c in April was 41. I wear a cgm and my predicted hba1c at present is around 38-40.

We are all different and different things work for different people, but I wanted to share my story to show that it is possible, in some cases, to come off meds, lose weight and get your HBA1c down. There are also some unsupportive nurses out there, but there are also really supportive ones that really do offer help, listen and encourage.

Good luck and well done on your achievements so far - keep going!

 

[KennyA]

I thought keto was supposed to be low carb, high fat, medium protein?

Keto is not strictly defined and you can find claimed "keto" products with 30-40g carb. That's nobody's idea of a sensible definition. In addition, I don't recognise the description of Atkins being a "low protein" diet. Quite the reverse.

To my mind a keto diet is simply one that achieves and sustains dietary ketosis. The carb reduction needed will be different for different people, and at different times. In the beginning I needed several days of 20g carb to get into ketosis, and anything around 30-40 would take me out. After nearly seven years I find I can maintain ketosis with occasional 40g carb days, and when I do come out, I can be back in with 12-24 hours of no carb.

I have no good idea how much protein or fat I eat - the only thing I monitor is carbs. I avoid the recommended processed "healthy" seed oils and other similar factory stuff. I don't add extra fat to anything - just eat mainly meat/fish/dairy. For example, I've just had some cold meat and cheese with a toasted low carb bagel.

I understand the salt issue for people with kidney disease or damage. Healthy kidneys, though, are designed to maintain and balance salt requirements. The salt issue was one that was often cited years ago as "what keto will inevitably do to you" and I suppose you will still find those references on the internet.