Struggling with a total change of direction in carb counting and need help/advice

[chocoholicnomore]

I've been type 2 diabetic for 14 years and on metformin the whole time. Control has been up and down over those years and was mainly controlled by low carbing. Followed Dr Mosley 8 week sugar diet a number of years ago but my carb intake has slowly sub consciously creeped up. Although any time I had high readings I would go ultra low carb and/or fast to get my readings back down. However, as I'm getting older (and more complacent) it's becoming more of a struggle and my last couple of hba1c results have been in the 70s. My DN has now put me on dapafliglozin but is insistent that I must eat carbs at every meal and eat regularly. No low carb and no fasting as that could result in ketoacidosis. But I'm struggling psychologically and feel that I no longer have any control. And I'm eating way too many carbs due to fear of ketoacidosis kicking in. When my BG is 11 in the morning for example I want to skip breakfast to get it back down or have a low carb breakfast but DN is adamant that I can't do that. So, I'm over compensating and my BG levels are not as low as I want.
Does anyone have any advice that could help me? What's the lowest number of carbs that I should aim for at each meal? Is my DN being over cautious?
Also, I'm a bit of a chocoholic and her telling me to eat more carbs feels like a green light to eat what I want. I know it isn't and it's all in my mind but I'm really struggling.
Thanks for any help/advice that you can give me.

 

[dawnmc]

I'm on a similar drug as well as jardiance, nurse advised me to eat regularly too. I don't eat breakfast and I low carb, not had any problems. But obviously I'm no medic, but I'm not about to force myself to eat either. My levels have come down but never enough to go hypo. You need to use your meter to see if the food and drugs are working.

 

[HSSS]

I’d go back and talk to her and say you are not happy with the medication for all the reasons you listed above and ask for an alternative choice. It’s supposed to be a two way conversation and you are supposed to be involved in the decisions made not just told what to do. There are a fair number of other medications that could be considered that don’t have the risk of dka if meals are skipped/low carbing. The risk is small but it is real according to the literature and a few members have had that unfortunate experience. I’m surprised she didn’t give you a minimum number of carbs though.

 

[Rachox]

I suppose when it comes down to it which is more of a struggle, low carb/fasting and Metformin or trying to balance carbs with this new med or trying something else. As @HSSS says I think this deserves another conversation with your DN remembering that she is there to advise not dictate. Write down things you want to mention and don’t be rushed.

 

[Resurgam]

When working on lowering my HbA1c I did find that my blood glucose level continued to rise if I did not eat first thing - it might not for you of course, but it is something to check on.
Now that my levels are normal I can fast all day and its fine.

 

[Chris24Main]

My experience of similar advice was that the fear of Ketoacidosis is misplaced. Ketoacidosis happens when everything is sky-high except insulin, so your liver pumps out Ketones, while your blood sugar is also high. If you have any insulin, or any ability to produce insulin, that stops Ketone production. People on a "normal" carb diet will almost never produce any quantity of Ketones, because their insulin levels will generally be high enough to hold your liver in fat storage, not fat burning (where ketone production is a way of making use of excess fatty acids).

The misplaced fear of Ketoacidosis leads to really dodgy advice, but it is real, because it's life-threatening for Type 1 diabetics.

You are effectively on a new drug which thrashes your Pancreas to create more insulin. Because of that, you are being told not to reduce carbs. But, the carbs will continue to make the underlying situation worse, because more insulin will be demanded.. you can see that this is a never-ending cycle.

Totally support going back to your DN, and also the writing down suggestion from @Rachox - that's exactly what I did, and it gives you real power in the meeting - do not leave until you've gone through the things you wrote down. These meetings are always difficult, but for me, very low carb, high fat, and intermittent fasting was the solution. That doesn't mean it will work for you, but in the end, T2DM is about having too much blood glucose and insulin circulating, so any strategy should be aimed at reducing both.

 

[Antje77]

You are effectively on a new drug which thrashes your Pancreas to create more insulin. Because of that, you are being told not to reduce carbs. But, the carbs will continue to make the underlying situation worse, because more insulin will be demanded.. you can see that this is a never-ending cycle.

Dapagliflozin doesn't make your pancreas produce more insulin (are you thinking of gliclazide?), it make you pee out excess glucose.

Ketoacidosis happens when everything is sky-high except insulin, so your liver pumps out Ketones, while your blood sugar is also high.

It's also known for a rare side effect where you can develop DKA without high blood glucose.

The Reporting Frequency of Ketoacidosis Events with Dapagliflozin from the European Spontaneous Reporting System: The DAPA-KETO Study

Dapagliflozin was associated with an increased risk of diabetic ketoacidosis that has led to the European withdrawal of the authorization for the type 1 diabetes. However, it is still used for the treatment of type 2 diabetes. Therefore, we aim to evaluate ...

www.ncbi.nlm.nih.gov

 

[Chris24Main]

Thanks for the correction @Antje77 - I should have checked.

and thanks more broadly - I thought that class of drugs had been stopped altogether. For what it's worth, when I was put on Glyclazide myself, I was told that the result was that I would pee out excess sugar, but that's no excuse...