Recently diagnosed and so many questions

[aseret]

I have lived in France for seven years.I have joined this site because I need some help, advice and support which I cant get here due to language problems. My french is good, but this is a health issue, and I want to make sure I get it right.

I have been complaining to my GP about my gradual weight gain for some time. My family has a history of thyroid problems, my grandmother had hashimotos disease, my mother had hyperthyroidism and was treated with radio-active iodine (?) and my sister was hyper, received treatment and is now hypo and takes thyroxine daily. There is no family history of diabetes. My doctor has been checking me at fairly regular intervals, declaring my thyroid to be ' a bit sluggish, but not requiring treatment'. She has been monitoring my blood glucose because it was a little high. Then a month ago, she declared that I was diabetic (type 2) and prescribed Metformin, which I took for ten days or so but the side effects meant that i could not be more than 100 yards from a loo at any time! Medication has been changed to gliclazide, I take 30mg per day.

I have received very little advice other than a leaflet in French. (but that may be a language and clutural problem, although my GP is German and speaks excellent English). My doctor told me that I must lose weight, cut out added sugars from diet, swap 'good' carbs for 'bad' and not eat bananas. She did say that I should buy a meter and that she could prescribe strips, as my prescriptions are free. On a trip to the uk last week, I picked up a meter and several information leaflets from Boots, and from my mothers GP surgery. I have been testing myself for a week now, keeping a log book and complete food diary and shall return to her after my next blood test on Monday. The problem with the self testing is that I dont know what I am looking for.

I have lead a very active and sporty life, running, horseriding and playing netball until into my forties. The reward for this is dodgy knee joints and hip and back trouble. I still have horses and dogs and a very rural lifestyle and my job keeps me on my feet all day, I go to an excercise class twice a week and walk my dogs 40 minutes each day. I dont eat any processed foods. If I follow the NHS guidelines for diet, I will be eating more carbohydrates than I currently do, less protein and less fat. A good few years ago, I did the Atkins diet and lost 17lbs in a month, and after the initial withdrawal symptoms of the first 10 days, I felt great. Once I re-introduced carbs into my diet, I was done for! I know from experience that carbs are my enemy not fat and certainly not proteins! (my cholesterols levels are low-average for my age, which is 55).

As far as diet goes, traditionally (in my case), dieting in order to lose weight means cutting calorific intake, together with increased excercise but also includes constantly feeling hungry, not eating between meals and periods of fasting. This fasting cant be good for blood sugar levels, because it means the readings 'spike' constantly. I cant bring myself to eat 'energy' bars in any shape or form, perhaps its a mental thing, I would consider them as 'wasted' calories. IE calories eaten for no enjoyment! In the past, I would have eaten a banana during the day as a snack and for the extra 'zing' it gave me :thumbdown: :? :? .

What is the link between obesity and type 2 diabetes? Is the diabetes making me fat or is the fat making me diabetic? Whats the difference between low carb and low GI? How much is low? What percentage of my diet should be carbs? Protein? Fat? Should there be a daily limit? Sorry, I could go on and on and I am already a good few paragraphs more than is respectable.

 

[Grazer]

Hi and welcome! Lots of questions there. No real fixed answer though; we're all different and it's down to try then test and adjust as necessary. Rather than try to answer them one by one, here is the overall approach I took. It gave me near normal blood sugar levels and had the by-product of giving me a BMI of 22, lower blood pressure (155/85 to 118/75)and cholesterol levels dropping from 5.5 to 3.8:-
In general terms you will need to reduce the total number of carbohydrates you eat per day. All carbohydrates turn to sugar when we eat them, and no type 2 diabetic on diet only, or on diet and metformin only, can control their blood sugars (BGs) without controlling their carb intake. Even those on strong medication normally choose to control their carb intake to keep the level of medication they take down. The total number of carbs per day you can eat depends on how advanced your diabetes is. It’s perhaps worth starting at about 50% of normal levels for a non-diabetic then adjusting up or down according to how you get on. So that means eating 150 grams of carbs per day for a man, 125 for a woman. You can read the total carb content of food under “nutritional info” on the packet or wrapping, or look it up on the internet for loose food. Just google “carb content..”
You also need to stop or reduce the bad carbs; that is the starchy ones that make your BG go up quickly.
So obviously no sugar or glucose! But also no white bread, white rice, pasta, flour products like pastry, cake and batter. You can eat a little basmati rice, wholewheat pasta or the tri-color pasta fusilli ones in small quantities. Boiled new potatos (again not too many) are OK but not old pots mashed, boiled or in their jackets. (Roast is not so bad, the fat slows their absorption and conversion to glucose in the blood) Amongst other veg, parsnips are about the worst for BG, and carrots not great but ok in smaller amounts.
Multi grain bread (not wholemeal) is not SO bad, but lots of us eat Burgen soya and linseed bread from tescos and sainsburys, although all bread should be in limited amounts.
All fruit has carbohydrates, and needs to be included in the amounts of carbs you eat in a day. For most people, bananas are about the worst for pushing our BG up and berries (like strawberries, raspberries etc) are the least bad.
No sweeties!
Exercise is important. I tend to exercise about an hour after eating when I know my BG will be peaking. This helps to bring it down quicker and further. I do ten minutes hard work on an exercise machine, but you could run up and down stairs for ten minutes or go for a brisk walk.
Returning to types of food and quantities of carbs - you can only find out how many you can eat by testing. Most type 2’s are not given access to testing equipment, so you should get your own – although try arguing with your Doc that you want to manage to NICE guideline blood sugar levels, and can’t do that without testing! If you have to buy a meter, they are cheap and most manufacturers will give them away for free. They make their money on the strips you have to use! So go for the meter with the cheapest testing strips. The SD Codefree available on the internet is about the cheapest at the moment. Some people test before and after eating, on waking (fasting test) and before bed. But if you have limited strips because of cost, the key to me is testing 2 hours after eating. If your BG is above, say, 7.8 at that stage, you need to cut down on the carb content the next time you have that meal. Test after various different meals and you soon get to see a pattern of what you can and can’t eat, and in what quantities. Keep careful records of what you ate and when, together with the result, so you can refer back at a later date. You can then reduce your testing. I said “below, say, 7.8” because NICE guidelines are below 8.5 but most of us think that’s a little high. 7.8 is the max. level at 2 hours after eating that a non-diabetic normally gets to so is perhaps a better target. Some then set progressively lower targets.
One last thing; you went from metformn to gliclazide because you couldn't stomach the metformin. However, there is a type of metformin ccalled "slow release" which doesn't give those unpleasant side effects, and doesn't have the same potentially long term bad effect on your pancreas as gliclazide. Perhaps it's worth discussing the option with your doctor.
Do ask lots of questions; there is normally an answer on here. The more you get to learn about your diabetes, the better it will be.
Good luck!

 

[phoenix]

Hi,
What you are and aren't entitled to , and what will be fully reimbursed under your ALD France is set out in the documents on this page (the second one about entitlement is in force at the moment) but the others have some useful information.
http://www.has-sante.fr/portail/jcms/c_ ... -de-type-2

I understand you have a meter, have you tried to get strips for it in France ? Unfortunately, there are some meters sold in the UK that are not sold here , some you can get strips for but others not.
Doctors can prescribe a meter (it has to last for 4 years). If you have to get a new one, get it on prescription they are neither free nor cheap here, especially in your local pharmacie.A few internet pharmacies are beginning to sell them at lower prices (compare the prices http://shopping.cherchons.com/lecteur-d ... e_1_0.html)

They changed the law a year ago and doctors aren't allowed to prescribe strips freely to people with T2 on diet and/or oral medications ;well they can prescribe but you won't get reimbursed above 200 strips a year. They are not supposed to prescribe them automatically
(edit I've just noticed you are now taking gliclazide, which is why you'll get some but they are still very limited as below.)*

Unfortunately there is not a market for strips on ebay here (well there wasn't last time I looked), if you want to use more strips than you can get prescribed then I suggest you get someone to get them in the UK and send them to you. They are a bit cheaper in the pharmacie here than the UK but not cheap.(100 about €40)

*Here's the bit about strips/meters from the document

"Par arrêté ministériel du 25 février 2011, la prise en charge des bandelettes d’autosurveillance glycémique par l’Assurance maladie est limitée à 200 par an, à l’exception des patients pour lesquels une insulinothérapie est en cours ou prévue à court ou moyen terme.
Les lecteurs de glycémie pris en charge sont garantis au minimum 4 ans. La mise en jeu de cette garantie permet le remplacement de l’appareil par son fabricant/distributeur, rendant inutile une nouvelle prescription par le médecin. Les patients doivent conserver tous documents relatifs à cette garantie pour en bénéficier. Un lecteur de glycémie est remboursable tous les 4 ans. Un autopiqueur est remboursable tous les ans."

for further info about strips and T2 see
http://www.ameli.fr/fileadmin/user_uplo ... -usage.pdf

NB I've just followed up one of the cheaper One Touch meters on the link above. It implies that it costs €20.70+ p&p . That's not for the kit pictures, it's just for the control solution. The kit actually costs actually costs €75 80. I think that I was right in the first place, they aren't cheaply available in France!

 

[daisy1]

Hi Aseret and welcome to the forum

I see you have received plenty of good advice and I am going to give you some more - the information we give to new members - and I hope you will find it useful. Ask any more questions you like as there is always someone here to help you.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find well over 30,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips
The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.
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Please sign our e-petition for free testing for all type 2's; here's the link:
http://www.diabetes.co.uk/petition/

Do get your friends and colleagues to sign as well.

 

[Daibell]

Hi. I agree with Grazer's comments. Note that if you are overweight you are probably insulin resistant which implies producing too much insulin as a result of the muscles being unable to use it. Metformin would normally be better than Gliclazide for insulin resistance as Gliclazide tries to get the pancreas to increase insulin production and can cause weight gain. Discuss with the doc having Metformin SR instead of Gliclazide which should solve the stomach problems. Note this assumes insulin resistance is the problem which I'm not in a position to judge and it is possible to have multiple issues.