T2 Management via Diet and Exercise - Getting the Balance Right

[AdamJames]

I expect to a lot of people this may all be a case of "No [surprise] Sherlock!", but it's quite a new way of looking at things for me.

Does any of this ring true for other overweight Type 2s here who have monitored their diet, weight and blood glucose for a while? Not the precise numbers, but the general picture.

It's too early to be sure for me yet but this is the picture I'm building from my recordings:

* Maintaining weight by eating a lot of calories and exercising results in me having a fasting bg of about 7.

* It doesn't matter whether those daily calories contain 300g of carbs or 40g of carbs and more fat, the fasting bg reaches the same level.

* If I choose the high carb approach, I can get the best effect in minimising the 2hr postprandial rise - very noticeably so.

* If I choose the LCHF approach, I could *possibly* get the same effect in minimising the spikes but I'd need to reduce the carbs in any single meal a heck of a lot more than the high-carb approach, as my carb tolerance reduces.

* If I were willing to practically eradicate carbs, presumably this would be even better at controlling bgs than the common LCHF diet I've tried?

* Neither of the weight-maintenance approaches are good for where I am at right now. I don't want a fasting level of 7, even after putting in the effort of an hour's walk the night before! I've been able to get as low as 4.5 in the recent past, and I had been restricting calories at that time.

Conclusions:

* I cannot safely (i.e. with good blood sugar control) maintain my current weight by either of these diets and the kind of exercise which is manageable on a daily basis.

* The only thing which seems to enable me to get great fasting readings is calorie restriction and/or exercise to the point of weight loss.

A perspective based on the above:

* "Lose weight and your blood sugars may improve" is often what overweight Type 2 diabetics are told. However, right now for me it seems more appropriate to view it the other way around, especially since diabetics should try to get blood sugar under control ASAP, so: "Eat and exercise so that I get good fasting readings and reduce blood sugar spikes. By necessity this will involve too few calories for maintenance, so as a consequence I will lose weight.".

* There will be probably an ideal amount and timing of daily carbs (in terms of avoiding big long spikes) to eat while doing that. There may be more than one magic number - it could be something close to zero ( = don't tax your metabolism with carbs), AND something moderate (regularly give it about the amount of carbs it can just safely cope with).

I'm really more interested in people's personal observations about their own management rather than any theory, though any insight would be interesting!

 

[Goonergal]

For me fasting levels can be reduced by:

- Intermittent fasting (one meal a day is particularly effective)
- Ensuring as big a window as possible between dinner and morning test (i.e. early dinner)
- Low carbs (very low) and not too much protein- too much protein and the fasting level is noticeably higher

I haven’t noticed a correlation between exercise and FBGs, but most of my exercise is built around my daily routine and is spread out across the day.

 

[AdamJames]

For me fasting levels can be reduced by:

- Intermittent fasting (one meal a day is particularly effective)
- Ensuring as big a window as possible between dinner and morning test (i.e. early dinner)
- Low carbs (very low) and not too much protein- too much protein and the fasting level is noticeably higher

I haven’t noticed a correlation between exercise and FBGs, but most of my exercise is built around my daily routine and is spread out across the day.

Straight away some great insight, thank you!

I STILL haven't tried fasting, I really must see what that does for me!

Also I've only just now started working out my "macros" and it may well be that my protein intake has been a little high, that's something to experiment with.

What's very low carbs for you? A rough idea on a typical day?

 

[Goonergal]

What's very low carbs for you? A rough idea on a typical day?

20g or less.

 

[Lamont D]

The most important thing in dietary control and metabolic management is to discover what works for you!
Depending on how you metabolise certain foods, your weight management will vary from everyone else.
It is a personal balance of protein, fats and carbohydrates. Also how much you eat and how much you exercise and how your body is effective in how you exercise. Calories only play a part in how much you eat.
Eating the right balance of foods and exercise tailored to you is the best method.

I do intermittent fasting, it's really surprising how your body may be able to cope without food for most periods of a day. Eating in a small window once or twice a day, small portions, in the right balance is so healthy.
I eat only to give me the nutritional necessity needed. In other words, I please myself when and how I eat. I can't do breakfast, lunch, dinner, it's too much. I eat very little, my body seems to like it that way.
I am also in permanent ketosis. I very low carb, I don't do carbs, as they make me ill!

 

[AdamJames]

20g or less.

Ha! I've just noticed that's in your signature. I presume it was there before you answered, sorry I didn't think to look! Thank you.

 

[Goonergal]

Ha! I've just noticed that's in your signature. I presume it was there before you answered, sorry I didn't think to look! Thank you.

No worries. I agree with what @Lamont D says - it’s trial and error to find what works for you.

I usually find that I am no hungrier pre dinner when eating one meal a day than if I also eat lunch (I stopped eating breakfast in May). It’s surprisingly easy - and you’re totally in control, so if you do get very hungry while fasting, just eat!

 

[AdamJames]

The most important thing in dietary control and metabolic management is to discover what works for you!

Absolutely! I have two week-long tests planned to experiment along these lines and do a double-check that calorie deficit is such a big factor for me personally (at the moment) that it should be my main focus rather than the specific things I eat (within reason of course, i.e. no crazy single-sitting carb intakes).

I appreciate your insight re your own experiences, it gives me extra things to put on my list to try. It really seems that I need to try fasting!

Thank you.

 

[AdamJames]

It’s surprisingly easy - and you’re totally in control, so if you do get very hungry while fasting, just eat!

Sold! Thank you.

 

[Lamont D]

Absolutely! I have two week-long tests planned to experiment along these lines and do a double-check that calorie deficit is such a big factor for me personally (at the moment) that it should be my main focus rather than the specific things I eat (within reason of course, i.e. no crazy single-sitting carb intakes).

I appreciate your insight re your own experiences, it gives me extra things to put on my list to try. It really seems that I need to try fasting!

Thank you.

Caloric deficit! (Well I never!)
That sounds like some dieticians mumbo jumbo!
A sound bite to focus on something that isn't applicable to certain dietary controlled condition.

Yes, if you eat too much, of course calories count, that is common sense.
But not triggering the glucose spike and having your pancreas working overtime to give you enough insulin for that level of glucose. The excessive insulin, insulin resistance causes, will add more visceral fat than any amount of food that does not trigger the glucose/insulin response.

It is what you literally eat! How your body stores fat! How your body handles high blood sugar levels and how much your pancreas creates to get rid of the glucose.

The effect of just walking will help your blood sugar levels.
How strenuous exercise can spike you.
Finding the right balance is crucial.

As I said it is about you!

As a newbie T2, I would recommend, reducing your carbs, reducing your plate size, reducing your calories.
Increase your gentle exercise. Increase your testing, experimenting and increase your knowledge about how to get good control of your blood sugar levels.

Knowledge is king!

 

[AdamJames]

Caloric deficit! (Well I never!)
That sounds like some dieticians mumbo jumbo!
A sound bite to focus on something that isn't applicable to certain dietary controlled condition.

Yes, if you eat too much, of course calories count, that is common sense.
But not triggering the glucose spike and having your pancreas working overtime to give you enough insulin for that level of glucose. The excessive insulin, insulin resistance causes, will add more visceral fat than any amount of food that does not trigger the glucose/insulin response.

It is what you literally eat! How your body stores fat! How your body handles high blood sugar levels and how much your pancreas creates to get rid of the glucose.

The effect of just walking will help your blood sugar levels.
How strenuous exercise can spike you.
Finding the right balance is crucial.

As I said it is about you!

As a newbie T2, I would recommend, reducing your carbs, reducing your plate size, reducing your calories.
Increase your gentle exercise. Increase your testing, experimenting and increase your knowledge about how to get good control of your blood sugar levels.

Knowledge is king!

That's the surprising thing, though, and hence why I wondered if anyone else had noticed this about themselves: the ONLY time I appear to be able to get a combination of good fasting numbers and good control of spikes, is when losing weight!

Re walking to lower blood sugar levels, I've done quite a lot of experiments with that also. If I eat an amount of calories that allows me to do the exercise I enjoy and maintain weight, then I can't keep my fasting numbers good. I can literally go on a blast around a local walk, up and down hills with a heavy rucksack, after the last thing I eat at night, and my bg levels are always around 7 in the morning (I don't get dawn phenomenon, I've checked throughout the night). This is true regardless of whether I'm having 40 or 300g of carbs in the day. But if I aim for calorie deficit, the effect of that exercise changes quite radically! I can reliably get 5s in the morning when I really go for them.

Anyway as you say, we must all find our own way. I'm hoping what with diabetes being all the rage these days somebody somewhere will have noticed something similar about themselves, just to reassure me I'm not looking for patterns that aren't there.

I'd love to increase my testing! Right now I've got fingertips like pin-cushions and am considering one of those continuous monitors. In fact I've been doing so much testing I'm starting to wish I'd got one months ago, oooooh all that lovely extra data I'd have

 

[Lamont D]

That's the surprising thing, though, and hence why I wondered if anyone else had noticed this about themselves: the ONLY time I appear to be able to get a combination of good fasting numbers and good control of spikes, is when losing weight!

Re walking to lower blood sugar levels, I've done quite a lot of experiments with that also. If I eat an amount of calories that allows me to do the exercise I enjoy and maintain weight, then I can't keep my fasting numbers good. I can literally go on a blast around a local walk, up and down hills with a heavy rucksack, after the last thing I eat at night, and my bg levels are always around 7 in the morning (I don't get dawn phenomenon, I've checked throughout the night). This is true regardless of whether I'm having 40 or 300g of carbs in the day. But if I aim for calorie deficit, the effect of that exercise changes quite radically! I can reliably get 5s in the morning when I really go for them.

Anyway as you say, we must all find our own way. I'm hoping what with diabetes being all the rage these days somebody somewhere will have noticed something similar about themselves, just to reassure me I'm not looking for patterns that aren't there.

I'd love to increase my testing! Right now I've got fingertips like pin-cushions and am considering one of those continuous monitors. In fact I've been doing so much testing I'm starting to wish I'd got one months ago, oooooh all that lovely extra data I'd have

The other thing that I have come to figure out is as I've done very low carb, not caloric deficit, though one helps the other, I that my body is happier and fitter and healthier eating very little, my body is almost saying to me that, if I don't eat too much, everything else I will look after, because I have a rare condition, my body doesn't work like yours as such. I don't have to worry about insulin production as such, even though through my experience of having hyperinsulinaemia, it is a horrible condition, it makes you realise how much the wrong foods for you, I'm intolerant to anything with ose on the end of a noun! So being glucose intolerant, I have to avoid them.
And my body has Ketone adapted to burn fat as a source of energy rather than carbs!
It has changed my health dramatically and doing so has saved my health and my life!

Even doing labour intense work, I am a manual worker, my body provides for me, wether I eat or fast, I have no loss of energy or lethargy.

I was obsessive about my testing and experimentation, my food diary really helped me decide my balance, I wish that I would have had a CGM. It would have been easier on my fingers, I think my fingers have become so used to my testing, it doesn't hurt (much)!

 

[ickihun]

I expect to a lot of people this may all be a case of "No [surprise] Sherlock!", but it's quite a new way of looking at things for me.

Does any of this ring true for other overweight Type 2s here who have monitored their diet, weight and blood glucose for a while? Not the precise numbers, but the general picture.

It's too early to be sure for me yet but this is the picture I'm building from my recordings:

* Maintaining weight by eating a lot of calories and exercising results in me having a fasting bg of about 7.

* It doesn't matter whether those daily calories contain 300g of carbs or 40g of carbs and more fat, the fasting bg reaches the same level.

* If I choose the high carb approach, I can get the best effect in minimising the 2hr postprandial rise - very noticeably so.

* If I choose the LCHF approach, I could *possibly* get the same effect in minimising the spikes but I'd need to reduce the carbs in any single meal a heck of a lot more than the high-carb approach, as my carb tolerance reduces.

* If I were willing to practically eradicate carbs, presumably this would be even better at controlling bgs than the common LCHF diet I've tried?

* Neither of the weight-maintenance approaches are good for where I am at right now. I don't want a fasting level of 7, even after putting in the effort of an hour's walk the night before! I've been able to get as low as 4.5 in the recent past, and I had been restricting calories at that time.

Conclusions:

* I cannot safely (i.e. with good blood sugar control) maintain my current weight by either of these diets and the kind of exercise which is manageable on a daily basis.

* The only thing which seems to enable me to get great fasting readings is calorie restriction and/or exercise to the point of weight loss.

A perspective based on the above:

* "Lose weight and your blood sugars may improve" is often what overweight Type 2 diabetics are told. However, right now for me it seems more appropriate to view it the other way around, especially since diabetics should try to get blood sugar under control ASAP, so: "Eat and exercise so that I get good fasting readings and reduce blood sugar spikes. By necessity this will involve too few calories for maintenance, so as a consequence I will lose weight.".

* There will be probably an ideal amount and timing of daily carbs (in terms of avoiding big long spikes) to eat while doing that. There may be more than one magic number - it could be something close to zero ( = don't tax your metabolism with carbs), AND something moderate (regularly give it about the amount of carbs it can just safely cope with).

I'm really more interested in people's personal observations about their own management rather than any theory, though any insight would be interesting!

Good bgs are one thing but.....
Losing weight whilst diabetic is something else.

Two seperate aims for some.

None overweight diabetics still have to find good bgs but no weight loss.
Overweight diabetics still have to diet but keep their bgs in good state doing so.
All diabetics.

Then there are diabetics with IR. Some who have it severe and some not as severe.
Most who are made aware of what it is want to improve there IR status.
Which of course exercise is good for it but not a full solution, nor lasting one as depending on activity levels will depend on exercise levels.
Fasting is like exercise as in its only good for IR whilst your fasting.
Weight loss in obese insulin takers find is very beneficial in lowering their insulin needs.
Its generally thought weight loss for everyone helps IR. I disagree. Metformin in my opinion is more helpful for the diabetic gut and IR. However of course I could be wrong. What do I know I've only lived with this diabetes 40yrs+ but only diagnosed for 15yrs, now?

I feel most for diabetics who are type2 and not overweight. What are they suppose to do?
If I ever get there I will be taking either basal insulin and metformin or just metformin.
I wonder why dr bernstein says we should still make sure type2s are supported with insulin as on-going treatment rather than stress their beta cells out?
Is it because one day they do burn out after been overworking all the years?
Please look after yourself by not stressing your body out over fasting and searching for the golden chalice.
Of course lose weight as best you can but don't damage your body aiming for reversal which is even harder to maintain that reaching reversal in the first place.
Stay well. Everyone.

 

[AdamJames]

The other thing that I have come to figure out is as I've done very low carb, not caloric deficit, though one helps the other, I that my body is happier and fitter and healthier eating very little, my body is almost saying to me that, if I don't eat too much, everything else I will look after, because I have a rare condition, my body doesn't work like yours as such. I don't have to worry about insulin production as such, even though through my experience of having hyperinsulinaemia, it is a horrible condition, it makes you realise how much the wrong foods for you, I'm intolerant to anything with ose on the end of a noun! So being glucose intolerant, I have to avoid them.
And my body has Ketone adapted to burn fat as a source of energy rather than carbs!
It has changed my health dramatically and doing so has saved my health and my life!

Even doing labour intense work, I am a manual worker, my body provides for me, wether I eat or fast, I have no loss of energy or lethargy.

I was obsessive about my testing and experimentation, my food diary really helped me decide my balance, I wish that I would have had a CGM. It would have been easier on my fingers, I think my fingers have become so used to my testing, it doesn't hurt (much)!

I think the main thing I want to say to that is: congratulations on "finding your way" for your particular condition.

I'm beginning to wonder if I'm only playing at LCHF by getting it down to 40g (haven't finished working out the last few days foodstuffs yet, it may be a bit lower). I did once go down to less than 20g without adding the fat - I knew nothing about LCHF and was just reducing the carbs to avoid spikes at the time!

One thing I really like about this forum is every time I read people's descriptions of what's worked for them, such as your story, it's another thing to add to my list of "backup plans" to try for myself. I've still got fasting to try, and I've still got extremely low carbs (with a correct amount of fat!) to try. For now it seems I may get reasonable results if I just continue with the weight loss, but if I get down to a normal BMI and still have trouble, then there's these other things to try. And medication, of course.

 

[AdamJames]

Good bgs are one thing but.....
Losing weight whilst diabetic is something else.

Two seperate aims for some.

None overweight diabetics still have to find good bgs but no weight loss.
Overweight diabetics still have to diet but keep their bgs in good state doing so.
All diabetics.

Then there are diabetics with IR. Some who have it severe and some not as severe.
Most who are made aware of what it is want to improve there IR status.
Which of course exercise is good for it but not a full solution, nor lasting one as depending on activity levels will depend on exercise levels.
Fasting is like exercise as in its only good for IR whilst your fasting.
Weight loss in obese insulin takers find is very beneficial in lowering their insulin needs.
Its generally thought weight loss for everyone helps IR. I disagree. Metformin in my opinion is more helpful for the diabetic gut and IR. However of course I could be wrong. What do I know I've only lived with this diabetes 40yrs+ but only diagnosed for 15yrs, now?

I feel most for diabetics who are type2 and not overweight. What are they suppose to do?
If I ever get there I will be taking either basal insulin and metformin or just metformin.
I wonder why dr bernstein says we should still make sure type2s are supported with insulin as on-going treatment rather than stress their beta cells out?
Is it because one day they do burn out after been overworking all the years?
Please look after yourself by not stressing your body out over fasting and searching for the golden chalice.
Of course lose weight as best you can but don't damage your body aiming for reversal which is even harder to maintain that reaching reversal in the first place.
Stay well. Everyone.

I especially agree about not getting carried away with weight loss. That's actually one of the many reasons I'm trying to maintain weight at the moment - I lost 3 stone pretty quickly and my body already doesn't feel quite right - I think it needs to "settle in" a bit so that my bones are in the right place and that my eyes are roughly level! I can afford to lose another 3 stone very safely, so it's perhaps a good idea not to lose all 6 stone in one quick go!

Re the thing about non-overweight Type 2 diabetics not having much wiggle room to try weight loss, I just wanted to highlight this as I've noticed in several threads on this forum, people saying that the Newcastle studies don't apply to them because they are not overweight.

This may well be true for some, and of course there is a danger of someone taking weight loss too far for safety especially if they start out at a normal weight, but a bit of weight loss can have the desired effect on even 'normal weight' people. There is an article online by a journalist Richard Doughty who had great success, he started thin and finished thin, and it took just 11 days to hugely improve his condition. So it's worth everyone giving it a go if it's safe to do so. Sensibly, as you say!

 

[Lamont D]

Totally agree, it is your journey!
It is your responsibility to your health.

No one in the medical industry thinks us as individuals, but as a disease!
And unless (like me) we are grouped together and told in no certain terms that it is a degenerative disease!
It's not!

I have had to battle with doctors and nurses who think they have a clue about endocrinology, they don't!
They don't get the training and don't have the tools or the funding for prevention.
Only in most cases, the advice given to T2s who can achieve great control for the rest of their lives.
Prediabetes is a food condition, why treat it with meds when finding out which foods are the cause?
When it's too late, that is when meds are required, but even then, dietary control will help ease the symptoms.

But, usually, this is not the treatment recommended by our health care!

It is criminal!

 

[AdamJames]

Totally agree, it is your journey!
It is your responsibility to your health.

No one in the medical industry thinks us as individuals, but as a disease!
And unless (like me) we are grouped together and told in no certain terms that it is a degenerative disease!
It's not!

I have had to battle with doctors and nurses who think they have a clue about endocrinology, they don't!
They don't get the training and don't have the tools or the funding for prevention.
Only in most cases, the advice given to T2s who can achieve great control for the rest of their lives.
Prediabetes is a food condition, why treat it with meds when finding out which foods are the cause?
When it's too late, that is when meds are required, but even then, dietary control will help ease the symptoms.

But, usually, this is not the treatment recommended by our health care!

It is criminal!

I know, it's crazy. It feels like there are thousands of people getting great results and sharing their experience on forums like this, some scientists in various places also getting great results, but the people on the front line who deal with patients are putting their hands over their ears and ignoring it all, carrying on with what seemed right decades ago.

 

[ickihun]

I know, it's crazy. It feels like there are thousands of people getting great results and sharing their experience on forums like this, some scientists in various places also getting great results, but the people on the front line who deal with patients are putting their hands over their ears and ignoring it all, carrying on with what seemed right decades ago.

?...just so they don't get sued

 

[archersuz]

@AdamJames

Hi, I am following lchf but I don't calorie, fat or protein 'count'. I tend to eat to my meter and walk for at least an hour every evening. Since diagnosis my weight has steadily decreased as has my BG across all readings. I haven't changed what I eat at meal times for probably 6 weeks but the BG levels are all decreasing. I have lost a total of 29 lb and reduced my HbA1C from 52/53 to 35. I have only worried about the three meter readings per day and the rest has just happened! I have noticed that when I ate more fat (for example extra cheese and or nuts when the weather was really cold) I didn't lose any weight. So I guess for weight loss I really need to watch the calories. My BG readings all tend to be between 5 and 6 nowadays.

I don't know if this helps you or not! I couldn't work out if you want to lose weight or maintain.

Suz

 

[AdamJames]

After going on a walk and thinking about this observation, I think it probably is a 'No [surprise] Sherlock' moment!

Hugely simplifying things:

* There is no reason to feel sure I am maintaining weight; everyone is going to be gaining or losing a bit all the time. And entering ketosis and the water loss makes weight due to fat very hard to judge. If anything, I feel like I'm putting on weight based on how my stomach feels!

* If I'm increasing my energy stores then that can only make adding fat and glycogen to my liver likely, I certainly can't imagine either of those things being reduced. Granted ketosis does some unusual things, but it's not 'on or off' - I'm still taking on plenty of carbs.

* As the Newcastle studies show so clearly, if you radically decrease energy input, even on quite a high carb (~100g) diet, your fasting numbers are likely to get down close to normal pretty **** quickly. This is what I will have observed in myself when I've been losing weight in the past. Stop losing weight and the fasting numbers climb again.

Really I don't think I'm experiencing anything unusual, I've just framed it in an unusual way.

In fact I'm going to make this wild guess about the state of my metabolism: A few months ago I couldn't get my fasting levels below 9.5 while maintaining weight. After losing about 3 stone, my fasting levels may now have settled at 7.5 while maintaining weight. So that's progress. 3 stone to go!