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Recently diagnosed type 2 but given very little advice from my GP

T

TrishMabey

Member
Messages
9
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Morning all. I was diagnosed with T2D last month and the only advice I've had from my GP is a little about diet which amounted to cutting down portion size and switching to brown bread and rice (which I was doing anyway).

They will call me back in 3 months for new blood tests. I have no idea what my blood readings are now and have no idea how to test myself. Is this normal in the early months?

After reading some articles on the forum I've cut out bread, pasta and rice altogether. I have also eliminated chocolate, sweets (turns out my Jakemans cough sweets per 100 grams are 98 grams of carbs of which 76% sugars!!), cakes and biscuits.

Should I be concerned with all carbs or just those with high sugars?

Is there a recommended number of carbs I should be aiming for or just take a common sense approach?

I've been prescribed Metformin 500mg.

Sorry if these questions have been asked before but I'm finding there's an awful lot of info available here but I'm still trying to navigate my way through it.

Many thanks in advance
Kind regards
Trish
 
Hi @TrishMabey and welcome to the forum.

The standard way to find out what your BG is doing currently is through a fingerprick test using a glucometer. This gives a snapshot reading which can be subject to error of up to 15% either way (so a true value of 6.0mmol/l could be shown as anywhere between 5.1 and 6.9). Officially T2s not on insulin "do not need" to check BG levels - I found monitoring was essential to get control. One reading tells you very little because BGs change in response to many stimuli, not only food - your liver is constantly adjusting levels all the time. The metformin you've been prescribed hinders the ability of you liver to make new glucose, it doesn't affect the carb and sugars in your food.

Experience on the forum is that the best way to use fingerprick tests is in a structured pattern: you test before meals, to establish a baseline, and then again two hours later. This is NOT to see "how high you go" - in fact the peak blood glucose will probably be around 45 minutes after eating, as carbs are digested to glucose and enter the bloodstream, and before your natural insulin response has really tackled the rising levels.

Testing at the two hour point then shows you how well (or otherwise) your insulin response handled the carbs. If you're more than 2mmol/l above where you started, or above 8.0mmol/l, your insulin response is not currently able to cope with that amount of carb/glucose. So what it will tell you, over time, is the foods you can cope with and the foods that will tend to push your BG up.

The other testing method is a constant glucose monitor (CGM). These you wear constantly, and they monitor the level of glucose in lymph, rather than blood - but it can then estimate a value for blood glucose. The great thing about CGMs is that they give you a complete picture and you can see how BG levels vary over a day (BG variation is perfectly natural and happens to everyone, non-diabetics included). The downside of CGMs is the cost. T2s not on insulin won't get them, and many T2s on insulin don't get them either. The NHS is more concerned about LOW blood glucose for insulin users than it is about the rest of us managing our diabetes.

You're right to watch out for carbs and sugars. All carbs get digested to sugars anyway, so they end up as the same thing. As to levels to aim for - that depends on you. I saw two very clear things when I cut my carb intake. The first was a very quick drop in BG from 50mmol/mol (HbA1c test) when diagnosed in December 2019, to 38 by April 2020. Over the next few years I lost about six stone, all acquired while undiagnosed.

The normal "low carb" level is anything less than approx 130g carb/day. I went for 20g carb/day at diagnosis, which is exceptionally low, but suited temperament and style. This means no bread, pasta, pastry, rice, sugar, cereals, potatoes, fruit, beer, etc. It's therefore eliminating carb in both concentration and volume - eg a food might be quite low in carb in percentage terms (eg 7%) but if you're going to eat 400g of it that's going to be getting on for 30g carb.

I've largely kept to that since. The thing is that we are all different, and I'd suggest our T2 may well be different, and while I think carb reduction is the route well worth trying, unfortunately there's no firm guarantee. That said, if you look at the "Success Stories" section of the forum you'll find a quantity of accounts from people who've had a lot of success.

The forum is a great resource, and questions are encouraged. You'll find people here who've been down this road before you, and know where most of the bumps are.
 
KennyA said:
Hi @TrishMabey and welcome to the forum.

The standard way to find out what your BG is doing currently is through a fingerprick test using a glucometer. This gives a snapshot reading which can be subject to error of up to 15% either way (so a true value of 6.0mmol/l could be shown as anywhere between 5.1 and 6.9). Officially T2s not on insulin "do not need" to check BG levels - I found monitoring was essential to get control. One reading tells you very little because BGs change in response to many stimuli, not only food - your liver is constantly adjusting levels all the time. The metformin you've been prescribed hinders the ability of you liver to make new glucose, it doesn't affect the carb and sugars in your food.

Experience on the forum is that the best way to use fingerprick tests is in a structured pattern: you test before meals, to establish a baseline, and then again two hours later. This is NOT to see "how high you go" - in fact the peak blood glucose will probably be around 45 minutes after eating, as carbs are digested to glucose and enter the bloodstream, and before your natural insulin response has really tackled the rising levels.

Testing at the two hour point then shows you how well (or otherwise) your insulin response handled the carbs. If you're more than 2mmol/l above where you started, or above 8.0mmol/l, your insulin response is not currently able to cope with that amount of carb/glucose. So what it will tell you, over time, is the foods you can cope with and the foods that will tend to push your BG up.

The other testing method is a constant glucose monitor (CGM). These you wear constantly, and they monitor the level of glucose in lymph, rather than blood - but it can then estimate a value for blood glucose. The great thing about CGMs is that they give you a complete picture and you can see how BG levels vary over a day (BG variation is perfectly natural and happens to everyone, non-diabetics included). The downside of CGMs is the cost. T2s not on insulin won't get them, and many T2s on insulin don't get them either. The NHS is more concerned about LOW blood glucose for insulin users than it is about the rest of us managing our diabetes.

You're right to watch out for carbs and sugars. All carbs get digested to sugars anyway, so they end up as the same thing. As to levels to aim for - that depends on you. I saw two very clear things when I cut my carb intake. The first was a very quick drop in BG from 50mmol/mol (HbA1c test) when diagnosed in December 2019, to 38 by April 2020. Over the next few years I lost about six stone, all acquired while undiagnosed.

The normal "low carb" level is anything less than approx 130g carb/day. I went for 20g carb/day at diagnosis, which is exceptionally low, but suited temperament and style. This means no bread, pasta, pastry, rice, sugar, cereals, potatoes, fruit, beer, etc. It's therefore eliminating carb in both concentration and volume - eg a food might be quite low in carb in percentage terms (eg 7%) but if you're going to eat 400g of it that's going to be getting on for 30g carb.

I've largely kept to that since. The thing is that we are all different, and I'd suggest our T2 may well be different, and while I think carb reduction is the route well worth trying, unfortunately there's no firm guarantee. That said, if you look at the "Success Stories" section of the forum you'll find a quantity of accounts from people who've had a lot of success.

The forum is a great resource, and questions are encouraged. You'll find people here who've been down this road before you, and know where most of the bumps are.
Click to expand...
Thank you so much for that Kenny.

I don't have a glucometer so I will check with my GP as to their position on this. I will also ask for my recorded blood glucose levels, so I have a starting point for my journey.

I hope it's okay to raise more questions as they occur to me. I'm primary carer for my partner (who has COPD, heart failure and mobility issues) and have a alcoholic stepson who lives with us. We were just turning a corner with the stepson when this diagnosis turned up. There's just so much to deal with...
 
First of all very well done on what you have done cutting out the foods you like (It is very hard work) When ypou go to see GP ask for you results to the Hba1c test and also ask of a blood sugar monitor, testing strips etc. You should get them for nothing. You may be diet control only depending on your result.
Ask any questions you want we have all been there (me not that long ago) we will do our absolute best to help
 
TrishMabey said:
Thank you so much for that Kenny.

I don't have a glucometer so I will check with my GP as to their position on this. I will also ask for my recorded blood glucose levels, so I have a starting point for my journey.

I hope it's okay to raise more questions as they occur to me. I'm primary carer for my partner (who has COPD, heart failure and mobility issues) and have a alcoholic stepson who lives with us. We were just turning a corner with the stepson when this diagnosis turned up. There's just so much to deal with...
Click to expand...
If your GP follows the official line you will be told NOT to test. Main reason is that if told to test, you would need to be prescribed a meter and enough strips. They aren't that expensive but if all the T2s in the UK got them it would be a significant increase in cost. It also goes along with the notion that T2 is progressive, can't be reversed, will always and only get worse, all that junk - testing is irrelevant if that's your view.

As a practising T2 in remission for years, I think testing is essential in managing an eminently reversable condition, and is probably the single most important bit of information you can have. .

I have used a Gluco RXQ since diagnosis. It is an old model and doesn't (eg) link to your phone or anything whizzy. But it works, and Gluco will give you one free. The strips, which is where the real cost is, are also less expensive than some other makes.

@Rachox has an up to date list of machines - Rachox, can you oblige please?
 
Mark Rawlinson said:
First of all very well done on what you have done cutting out the foods you like (It is very hard work) When ypou go to see GP ask for you results to the Hba1c test and also ask of a blood sugar monitor, testing strips etc. You should get them for nothing. You may be diet control only depending on your result.
Ask any questions you want we have all been there (me not that long ago) we will do our absolute best to help
Click to expand...
Thank you Mark, I really do appreciate that.
 
KennyA said:
If your GP follows the official line you will be told NOT to test. Main reason is that if told to test, you would need to be prescribed a meter and enough strips. They aren't that expensive but if all the T2s in the UK got them it would be a significant increase in cost. It also goes along with the notion that T2 is progressive, can't be reversed, will always and only get worse, all that junk - testing is irrelevant if that's your view.

As a practising T2 in remission for years, I think testing is essential in managing an eminently reversable condition, and is probably the single most important bit of information you can have. .

I have used a Gluco RXQ since diagnosis. It is an old model and doesn't (eg) link to your phone or anything whizzy. But it works, and Gluco will give you one free. The strips, which is where the real cost is, are also less expensive than some other makes.

@Rachox has an up to date list of machines - Rachox, can you oblige please?
Click to expand...
Kenny, I'd be interested in looking at the testing kits. I had a quick look on-line but there's too many to check out properly. Any recommendations with regards to a reliable brand would be useful. Thanks again. Trish
 
TrishMabey said:
Kenny, I'd be interested in looking at the testing kits. I had a quick look on-line but there's too many to check out properly. Any recommendations with regards to a reliable brand would be useful. Thanks again. Trish
Click to expand...
Wait to see your Dr prescribes you one, I was given mine by the diabetic nurse at the practice
 
@TrishMabey, as you are on Metformin only you are very unlikely to get a meter on prescription. Almost all the T2 who aren’t on insulin have to self fund, I’ll tag one of our members @Rachox who has some information on meters that may be helpful to you, I personally use the Tee2+ the strips are very reasonably priced
 
@TrishMabey
I have taken the liberty of posting the most useful info provided by member @Rachox on Blood Glucose meters and CGM devices.
With thanks to @Rachox..



HOME HEALTH have the Gluco Navii, which is a fairly new model and seems to be getting good reviews.

https://homehealth-uk.com/all-produ...ose-meter-test-strips-choose-mmol-l-or-mg-dl/



Links to the strips for future orders:

https://homehealth-uk.com/all-products/glucose-navii-blood-glucose-test-strips-50-strip-pack/



Then they sell the older SD Code Free, details to be found here!

https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/





SPIRIT HEALTHCARE have a meter called the Tee2 + which is quite popular:

https://shop.spirit-health.co.uk/co...e2-blood-glucose-meter?variant=19264017268793



The strips are to be found here:

https://shop.spirit-health.co.uk/co...py-of-tee2-test-strips?variant=19264017367097



If there is a choice of units of measurement then ‘mmol/L’ are the standard units in the UK, ‘mg/dl’ in the US, other countries may vary.



Don’t forget to check the box if you have diabetes so you can buy VAT free. (for all meters and strips)



Abbott usually offer a free 15 day trial of the Freestyle LIBRE 2 plus, but currently this scheme is on hold. Here’s the link to try when hopefully the trial is offered again:

Sampling | Diabetes Care | Abbott



Dexcom also offer a free trial of their Dexcom one + here

The Dexcom ONE+ CGM (Continuous Glucose Montoring) system | Dexcom
 
TrishMabey said:
Kenny, I'd be interested in looking at the testing kits. I had a quick look on-line but there's too many to check out properly. Any recommendations with regards to a reliable brand would be useful. Thanks again. Trish
Click to expand...
I've only ever used the Gluco RXQ, and have no experience of any others. As said above, the RXQ does the job, doesn't have any of the add-ons now standard, and my first lasted about five years. And the strips are less expensive.
 
My friend just told me she still has a WaveSense Jazz Tester from when she had gestational diabetes 22 years ago. She will happily let me have it.

A little research shows these are still being made and strips etc are still available. It was only used for a max of one year. My question is this: Can anyone think of any reasons it might not be usable, for reasons of it's age or anything else that hasn't yet occurred to me.

Thanks in advance

Trish
 
TrishMabey said:
My friend just told me she still has a WaveSense Jazz Tester from when she had gestational diabetes 22 years ago. She will happily let me have it.

A little research shows these are still being made and strips etc are still available. It was only used for a max of one year. My question is this: Can anyone think of any reasons it might not be usable, for reasons of it's age or anything else that hasn't yet occurred to me.

Thanks in advance

Trish
Click to expand...
The monitor needs to be checked for accuracy. I believe they become less accurate over time, but you can check the meter using a control solution. Also by comparison with a lab test when you have your test done by HCP. Test strips also have a shelf life.

Other factors to consider are where the meter has been stored, has it been exposed to damp or heat. I would not choose to use an old, second hand meter. If you do, consider and compare the costs of the strips , test fluid solution, lancets, etc with the costs of a new one from the information already provided in this thread. Bear in mind that you can claim VAT exemption, too.

One other thing is that as someone newly diagnosed your GP could, possibly, be persuaded to prescribe, for a limited period, a meter and strips, etc. so that you can gain understanding of how to manage diet and blood glucose levels. There appears to be a bit of a postcode lottery with that, but some are fortunate enough to have enlightened GPs.
 
Thanks for that Pipp. On reflection it'll probably be less problematical to buy a new one, at least I'll know it works correctly! There's enough to take on board without all that faff... Thanks again...
 
TrishMabey said:
Thanks for that Pipp. On reflection it'll probably be less problematical to buy a new one, at least I'll know it works correctly! There's enough to take on board without all that faff... Thanks again...
Click to expand...
My meter is 9 years old and seems fine - but an old one might require new batteries. For type 2 it is more a means to check increases rather than actual values so accuracy is not really an issue.
They don't cost all that much though - if the old one has been left with the batteries in and is all corroded inside then a new one would be a good idea.
I just ordered some new strips for mine, from Spirit healthcare, I signed up back in 2016 and declared myself diabetic by email so I get the things without paying VAT. Sorting out what I could or could not eat cost under £30 and the pot of strips I just bought was around £10, which is not exorbitant as it proved so useful to me, and also for correcting people at the clinic who tried to tell me that brown carbs were OK when there on the screen was a number in the low teens rather than about 5 or 6 mmol/l as in the previous days tests.
 
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