Type 2 - CGM and ‘Official’ Advice

[Dynamic Penguin]

Hi, this is my first thread and I wanted to have a rant/make some observations about my general experiences with Type 2. Sorry it might be a bit long.

I was diagnosed just before lockdown, I can’t remember what my first HA1c was but it was high. I had the usual stern talk about not eating cakes and sweets and losing weight and was packed off with some metformin and a link to an online course.

To be fair, I was a bit on the podgy side (even though cakes and sweets are not really my thing) so I did the course, tweaked my diet to be more like the Mediterranean diet, switched white bread, pasta and rice to whole grain and upped my exercise. And lost a couple of stone. By my next review my A1c was back in the pre diabetic range. Happy days, or so I thought. Still I was told to keep on the metformin and given a statin as my cholesterol was a little high.

Then I hit menopause. Still doing the same stuff, kept all but half a stone of the weight off but my next review A1c was up again. Same lecture about cakes and sweets, to look at the online stuff, exercise, and to up the metformin to two a day. I was miffed at the assumptions about my diet and exercise ( I’m generally pretty active) but did what they asked.

The next few reviews there was no change or the A1c was slightly higher - same patronising lectures each time. A brief trial of 3 metformin a day, which left me feeling like ****, so I stuck at 2. Nothing appeared to have much of an impact, and now it was increasingly hard to lose weight - I would literally gain and lose the same 4-5 pounds. I was massively frustrated and annoyed that every review was the same.

Then a month or so ago I was offered to take part in a study looking at T2 and diet and jumped at the chance. Partly because I had read Invisible Women which highlights how rarely women are included in medical studies, and partly because they would give me a CGM.

I had my bloods done and again, despite there being no major changes to my diet, my A1c was up to 68. I got a CGM and was told for the first 2 weeks to eat more or less normally, so I decided to run some experiments of my own to see what spiked my blood sugar by tracking what I ate against the CGM output. It was interesting - two bits of whole grain toast spiked higher than a couple of beers on a night out. Any bread, whether white, whole grain, previously frozen, with or without fats and protein it made no difference massive spikes every time.


For those first two weeks my blood sugar was all over the place, early morning spikes, spikes after each meal and staying high most of the time.

Then I was switched to a low calorie (1k calories per day) low carb diet for the next 4 weeks. Part of the idea was to look at the impact of weight loss vs diet alone. This was supported with a booklet of guidelines and some menu suggestions.

The difference was pretty much instantaneous, you could see the impact on my blood sugar dramatically from day 1.


I am just over 2 weeks in and the difference is staggering. While I have lost weight (difficult not to on 1k cals per day), more importantly in my second week my levels have dropped to the normal range and they are more stable.


There are still a couple of weeks to go and a final set of bloods but I am seriously considering self-funding a CGM for a couple of weeks while I up the calories to a more sustainable level.

Now here is my main issue, for the past 3 years at least I have gone in for my review, my numbers have slowly risen but nothing different has been suggested. All I get told is to stop eating things I don’t really eat, to eat whole grains and wholemeal, and to keep taking the tablets. What is the point if it is clear that this is having no effect at all? Was the plan that I just drift along with everything getting gradually worse and more medications being thrown at me? Why were there no alternatives suggested? Even a noncommittal have your tried x, some people have found it helps would have been better than nothing. I wonder what this may have cost me health wise over the past few years.

If I had been given a CGM for a few weeks three years ago I could have seen the impact of the supposedly healthy choices I was making. And while they are expensive, so is multiple years of increasing medication and worsening outcomes.

 

[Rosie9876]

Hi, this is my first thread and I wanted to have a rant/make some observations about my general experiences with Type 2. Sorry it might be a bit long.

I was diagnosed just before lockdown, I can’t remember what my first HA1c was but it was high. I had the usual stern talk about not eating cakes and sweets and losing weight and was packed off with some metformin and a link to an online course.

To be fair, I was a bit on the podgy side (even though cakes and sweets are not really my thing) so I did the course, tweaked my diet to be more like the Mediterranean diet, switched white bread, pasta and rice to whole grain and upped my exercise. And lost a couple of stone. By my next review my A1c was back in the pre diabetic range. Happy days, or so I thought. Still I was told to keep on the metformin and given a statin as my cholesterol was a little high.

Then I hit menopause. Still doing the same stuff, kept all but half a stone of the weight off but my next review A1c was up again. Same lecture about cakes and sweets, to look at the online stuff, exercise, and to up the metformin to two a day. I was miffed at the assumptions about my diet and exercise ( I’m generally pretty active) but did what they asked.

The next few reviews there was no change or the A1c was slightly higher - same patronising lectures each time. A brief trial of 3 metformin a day, which left me feeling like ****, so I stuck at 2. Nothing appeared to have much of an impact, and now it was increasingly hard to lose weight - I would literally gain and lose the same 4-5 pounds. I was massively frustrated and annoyed that every review was the same.

Then a month or so ago I was offered to take part in a study looking at T2 and diet and jumped at the chance. Partly because I had read Invisible Women which highlights how rarely women are included in medical studies, and partly because they would give me a CGM.

I had my bloods done and again, despite there being no major changes to my diet, my A1c was up to 68. I got a CGM and was told for the first 2 weeks to eat more or less normally, so I decided to run some experiments of my own to see what spiked my blood sugar by tracking what I ate against the CGM output. It was interesting - two bits of whole grain toast spiked higher than a couple of beers on a night out. Any bread, whether white, whole grain, previously frozen, with or without fats and protein it made no difference massive spikes every time.
View attachment 72963

For those first two weeks my blood sugar was all over the place, early morning spikes, spikes after each meal and staying high most of the time.

Then I was switched to a low calorie (1k calories per day) low carb diet for the next 4 weeks. Part of the idea was to look at the impact of weight loss vs diet alone. This was supported with a booklet of guidelines and some menu suggestions.

The difference was pretty much instantaneous, you could see the impact on my blood sugar dramatically from day 1.
View attachment 72964

I am just over 2 weeks in and the difference is staggering. While I have lost weight (difficult not to on 1k cals per day), more importantly in my second week my levels have dropped to the normal range and they are more stable.
View attachment 72965

There are still a couple of weeks to go and a final set of bloods but I am seriously considering self-funding a CGM for a couple of weeks while I up the calories to a more sustainable level.

Now here is my main issue, for the past 3 years at least I have gone in for my review, my numbers have slowly risen but nothing different has been suggested. All I get told is to stop eating things I don’t really eat, to eat whole grains and wholemeal, and to keep taking the tablets. What is the point if it is clear that this is having no effect at all? Was the plan that I just drift along with everything getting gradually worse and more medications being thrown at me? Why were there no alternatives suggested? Even a noncommittal have your tried x, some people have found it helps would have been better than nothing. I wonder what this may have cost me health wise over the past few years.

If I had been given a CGM for a few weeks three years ago I could have seen the impact of the supposedly healthy choices I was making. And while they are expensive, so is multiple years of increasing medication and worsening outcomes.

Much sympathy. I also blindly followed official advice - same as yours - but in my case for over a decade, resigned to the fact that it was just my fate to gradually get worse. I was shaken into proaction when I was refused an essential operation because my diabetes was uncontrolled.

Only recently, after I'd already gone onto a low carb diet, was I prescribed a CGM, after having been told for years that Type 2 didn't need to monitor their glucose, not even with finger prick testing.

I haven't managed to be as stable as you are on the CGM, but my HbA1c is substantially improved. Btw, which CGM are you on? Very well done.

 

[JoKalsbeek]

Hi, this is my first thread and I wanted to have a rant/make some observations about my general experiences with Type 2. Sorry it might be a bit long.

I was diagnosed just before lockdown, I can’t remember what my first HA1c was but it was high. I had the usual stern talk about not eating cakes and sweets and losing weight and was packed off with some metformin and a link to an online course.

To be fair, I was a bit on the podgy side (even though cakes and sweets are not really my thing) so I did the course, tweaked my diet to be more like the Mediterranean diet, switched white bread, pasta and rice to whole grain and upped my exercise. And lost a couple of stone. By my next review my A1c was back in the pre diabetic range. Happy days, or so I thought. Still I was told to keep on the metformin and given a statin as my cholesterol was a little high.

Then I hit menopause. Still doing the same stuff, kept all but half a stone of the weight off but my next review A1c was up again. Same lecture about cakes and sweets, to look at the online stuff, exercise, and to up the metformin to two a day. I was miffed at the assumptions about my diet and exercise ( I’m generally pretty active) but did what they asked.

The next few reviews there was no change or the A1c was slightly higher - same patronising lectures each time. A brief trial of 3 metformin a day, which left me feeling like ****, so I stuck at 2. Nothing appeared to have much of an impact, and now it was increasingly hard to lose weight - I would literally gain and lose the same 4-5 pounds. I was massively frustrated and annoyed that every review was the same.

Then a month or so ago I was offered to take part in a study looking at T2 and diet and jumped at the chance. Partly because I had read Invisible Women which highlights how rarely women are included in medical studies, and partly because they would give me a CGM.

I had my bloods done and again, despite there being no major changes to my diet, my A1c was up to 68. I got a CGM and was told for the first 2 weeks to eat more or less normally, so I decided to run some experiments of my own to see what spiked my blood sugar by tracking what I ate against the CGM output. It was interesting - two bits of whole grain toast spiked higher than a couple of beers on a night out. Any bread, whether white, whole grain, previously frozen, with or without fats and protein it made no difference massive spikes every time.
View attachment 72963

For those first two weeks my blood sugar was all over the place, early morning spikes, spikes after each meal and staying high most of the time.

Then I was switched to a low calorie (1k calories per day) low carb diet for the next 4 weeks. Part of the idea was to look at the impact of weight loss vs diet alone. This was supported with a booklet of guidelines and some menu suggestions.

The difference was pretty much instantaneous, you could see the impact on my blood sugar dramatically from day 1.
View attachment 72964

I am just over 2 weeks in and the difference is staggering. While I have lost weight (difficult not to on 1k cals per day), more importantly in my second week my levels have dropped to the normal range and they are more stable.
View attachment 72965

There are still a couple of weeks to go and a final set of bloods but I am seriously considering self-funding a CGM for a couple of weeks while I up the calories to a more sustainable level.

Now here is my main issue, for the past 3 years at least I have gone in for my review, my numbers have slowly risen but nothing different has been suggested. All I get told is to stop eating things I don’t really eat, to eat whole grains and wholemeal, and to keep taking the tablets. What is the point if it is clear that this is having no effect at all? Was the plan that I just drift along with everything getting gradually worse and more medications being thrown at me? Why were there no alternatives suggested? Even a noncommittal have your tried x, some people have found it helps would have been better than nothing. I wonder what this may have cost me health wise over the past few years.

If I had been given a CGM for a few weeks three years ago I could have seen the impact of the supposedly healthy choices I was making. And while they are expensive, so is multiple years of increasing medication and worsening outcomes.

I was into a low carb way of eating relatively quick, and the endo told me I didn't have the spine to keep such a diet up, ten years ago. It was working and had brought my blood glucose down into the normal range within two months or so, but still... She didn't believe I could do it. My GP keeps telling me I can eat normally, and even have a piece of cake at birthdays as not to feel left out. (Because feeling included it more important than keeping my legs and eyesight?) She doesn't realise the spike'll make me feel decidedly unwell quite immediately, and keep me going to the loo every 45 minutes for 18 hours or thereabouts, as my kidneys kick into overdrive. I've talked to a whole lot of people over the years, specialists and general, and none of them, not one, came up with proper low carb as a solution for high blood glucose. Not. One. In my GP's practice, I'm the only patient who got her numbers down through diet. You'd think they'd clue in, right? Guess again.

So, yeah... They basically either don't know, or have no faith in the ability of us gluttenous T2's (love the prejudice!) to follow a diet for any length of time.

I do have to say though, perimenopause made my hormones go even wonkier than usual, so I'm back to being big, and my bloods aren't what they used to be... Not bad, but not stellar either. Like you though, a CGM gave me some much needed answers: it wasn't what I was eating/drinking, it was stress, hormones, and bad sleep. Those things can tell you what's going on more than others who'll just erroneously blame it on massive overeating.

Would the NHS do better, and be more cost-effective long term, if an initial CGM was issued to everyone,maybe once or twice a year on repeat, and people informed about what a diet can do and whatnot? Heck yeah. Changes take a long while though. I doubt it'll be in our lifetime...

 

[Dynamic Penguin]

Much sympathy. I also blindly followed official advice - same as yours - but in my case for over a decade, resigned to the fact that it was just my fate to gradually get worse. I was shaken into proaction when I was refused an essential operation because my diabetes was uncontrolled.

Only recently, after I'd already gone onto a low carb diet, was I prescribed a CGM, after having been told for years that Type 2 didn't need to monitor their glucose, not even with finger prick testing.

I haven't managed to be as stable as you are on the CGM, but my HbA1c is substantially improved. Btw, which CGM are you on? Very well done.

Thank you. It is the Libre 2 plus. I have been using an app to plan my meals to make sure I stay under the 1k and also to try to keep the total carbs at about 50 or even under.

 

[Dynamic Penguin]

The interesting thing about this study is that it wants to see if it is the low carb or the weight loss that has an impact on the figures, so it sounds like the official view may be changing, albeit slowly. I was just so glad I got this offer as it seems to have really changed things.

What I want to see when the study is done is what happens if I up the calories to 1200-1500, and the impact of adding some gym sessions on top of the walking I already do. I also want to see if I can stop the meds, they don’t seem to be doing anything.

 

[Taighnamona]

For decades I followed their low fat carby advice and got worse and worse till I needed insulin. Huge wake up call. Told to just eat normally and the insulin would take care of it.
Self funded CGM. First Libre now Dexcom1+.
Very informative. Now on low carb high fat and never felt better. I’ve lost 12k. Got my readings into normal range and maintained that for over a year. Slowly weaning off all meds and reducing insulin. I hope to be off it in a few months.
Still getting advice to eat carbs and let the meds deal with it. Not listening to them any longer.
Best of luck on your journey to health.

 

[Rosie9876]

The interesting thing about this study is that it wants to see if it is the low carb or the weight loss that has an impact on the figures, so it sounds like the official view may be changing, albeit slowly. I was just so glad I got this offer as it seems to have really changed things.

What I want to see when the study is done is what happens if I up the calories to 1200-1500, and the impact of adding some gym sessions on top of the walking I already do. I also want to see if I can stop the meds, they don’t seem to be doing anything.

It will be interesting to see the results of your study, and especially if it will have an effect on NHS advice. I am what is called a TOFI - an acronym I'd never heard of until recently. I am quite thin generally, except my once tiny waist expanded over the years and I suspect high visceral fat accounts for my glucose intolerance and diabetes. If I lose weight, my legs and arms become stick-like but my waist hardly changes . As I understand it, a woman having subcutaneous fat around her hips, thighs, etc. might not be harmful, so while losing weight would be beneficial for some, it's hardly the be-all and end-all.

I'd love to stop the meds when my A1c gets to normal levels, but we'd need to know if our insulin tolerance improves, and the HbA1c doesn't test for that. I suppose checking CGM while increasing carbs would do it, but there are blood tests, which are also useful for assessing the risk of diabetes even when A1c is normal. I asked my GP if I could get a HOMA IR as and when my A1c drops to normal. The answer was 'not on the NHS'.

 

[Resurgam]

@Rosie9876 I think that I have got improvement in my ability to deal with glucose over the years - it is creeping towards 9 years from diagnosis, but almost 20 since a test showed problems - dealt with by not testing again for a decade.
I had a tiny waist in my teens and 20s, as my mum put me in corsets at 11, but almost half a century of low fat high carb insistence and I was just about spherical.
The prescribed tablets made me so ill so I stick to eating low carb and all seems well - I am sure that in old age I would have become just about immobile and risking infection from bedsores and all that comes with excess weight.
I spent yesterday out doing morris and maypole - my husband was looking for my return rather anxiously - I almost had to throw my hat in first to see if I'd overstepped the mark....

 

[Melgar]

The interesting thing about this study is that it wants to see if it is the low carb or the weight loss that has an impact on the figures, so it sounds like the official view may be changing, albeit slowly. I was just so glad I got this offer as it seems to have really changed things.

What I want to see when the study is done is what happens if I up the calories to 1200-1500, and the impact of adding some gym sessions on top of the walking I already do. I also want to see if I can stop the meds, they don’t seem to be doing anything.

I believe weight loss brings down blood sugars due to loss of visceral fat which biologically has an effect on your metabolism. To keep your blood sugars in range, hence thereafter, sticking to low carbs for most people is the most attainable. The sad fact is once you are diabetic it remains with you despite being on a low carb diet.

 

[louisew2605]

I was into a low carb way of eating relatively quick, and the endo told me I didn't have the spine to keep such a diet up, ten years ago. It was working and had brought my blood glucose down into the normal range within two months or so, but still... She didn't believe I could do it. My GP keeps telling me I can eat normally, and even have a piece of cake at birthdays as not to feel left out. (Because feeling included it more important than keeping my legs and eyesight?) She doesn't realise the spike'll make me feel decidedly unwell quite immediately, and keep me going to the loo every 45 minutes for 18 hours or thereabouts, as my kidneys kick into overdrive. I've talked to a whole lot of people over the years, specialists and general, and none of them, not one, came up with proper low carb as a solution for high blood glucose. Not. One. In my GP's practice, I'm the only patient who got her numbers down through diet. You'd think they'd clue in, right? Guess again.

So, yeah... They basically either don't know, or have no faith in the ability of us gluttenous T2's (love the prejudice!) to follow a diet for any length of time.

I do have to say though, perimenopause made my hormones go even wonkier than usual, so I'm back to being big, and my bloods aren't what they used to be... Not bad, but not stellar either. Like you though, a CGM gave me some much needed answers: it wasn't what I was eating/drinking, it was stress, hormones, and bad sleep. Those things can tell you what's going on more than others who'll just erroneously blame it on massive overeating.

Would the NHS do better, and be more cost-effective long term, if an initial CGM was issued to everyone,maybe once or twice a year on repeat, and people informed about what a diet can do and whatnot? Heck yeah. Changes take a long while though. I doubt it'll be in our lifetime...

When I first got diagnosed, my diabetic nurse told me to eat 60g of carbs. No problem for me because I never ate a very high carb diet. Being a slim, very active diabetic with a healthy diet, losing weight for remission, had not been possible. I’m still on low amounts of insulin, but I have an hbac1 of 38. So there’s obviously some members of the medical profession who know about low carb diets

 

[JoKalsbeek]

When I first got diagnosed, my diabetic nurse told me to eat 60g of carbs. No problem for me because I never ate a very high carb diet. Being a slim, very active diabetic with a healthy diet, losing weight for remission, had not been possible. I’m still on low amounts of insulin, but I have an hbac1 of 38. So there’s obviously some members of the medical profession who know about low carb diets

They're few and far in between though... I haven't actually found one yet. It does speak for their level of knowledge, I think, so... Hold on tight to this one. It's kind of like finding a unicorn in the park across the street. It doesn't happen often.

 

[louisew2605]

They're few and far in between though... I haven't actually found one yet. It does speak for their level of knowledge, I think, so... Hold on tight to this one. It's kind of like finding a unicorn in the park across the street. It doesn't happen often.

Yes, I asked her why she hadn’t sent me to on the diet course and she said because they give all her patients the wrong information. So she’s aware of this.

 

[tonyglover6861]

Interesting conversation here. I was diagnosed T2 in November 2024, HBA1C of 51. I weighed 97.6kg, and at 165cm in height was best described as 'rotund'. My diabetes nurse however was a ray of sunshine...even after diagnosis I left the surgery almost skipping. She advised a low-carb diet and metformin, and getting a free Libre 2 CGM trial. I went to York for a city break that first weekend and the info I got from the Libre 2 was eye-opening. Beer didn't hit as hard as I expected, but bread did...the worst was rice and chips. I was so impressed I bought 2 for a Far East cruise as the thought of finger pricking on holiday wasn't to my liking. The cruise team were superb at helping the low carb aspect of the meals, but again the sensors were superb. I hold the authors view that these should be available to all T2 people irrespective of insulin or not. Keeping sugars at decent levels and seeing a reduction in HBA1C surely saves money in the longer term for the NHS, especially for those who are willing and committed to using such technology. At £55 per sensor for 15 days this is out of reach for many including me, meaning I only buy them for use on holidays. I'm sure the Pharma companies could reduce the price and increase the duration.....but I'm cynical about their desire to. My nurse said she'd love to be able to prescribe the sensors as I'm doing all the right things to head towards remission, but the 'insulin' only restriction for T2s prevents her from doing so. The diagnosis was a kick up the backside though, and my HBA1C is down to 40 , my weight is down to 80kg and I've rarely felt better. I have 3 unboxed sensors ready for my next 2 holidays (I am retired) and will buy one whenever I have spare money to do so. But the case remains, many people with T2 on Metformin but not on insulin would benefit hugely from being able to use these sensors on prescription.

 

[louisew2605]

I’m type 2 on insulin on low carb and I don’t get one on prescription. I have to self fund. I have very tight control, and my hbac1 is ‘normal’. But I am very active so my blood sugar can go pretty low after exercise, and I’ll need to bring it up. There’s no way I could have such good bloods without my cgm and yes I think I should get it on prescription. But even on insulin, I don’t meet the criteria, as it’s only for people who have difficulties monitoring their blood via finger pricks

 

[KennyA]

One of the issues facing health professionals in the UK is that all treatments are supposed to conform to the NICE guidelines. These are supposed to be "best practice" and as an HCP if you step outside them, you might find that your employer, your professional body, and your professional insurance might be less than sympathetic should any problems occur. Defensive medicine.

When they were introduced it was said (mainly by doctors) that they would stifle development and the ability of medics to treat patients as individuals, rather than the one size fits all approach common with guidelines. The problem was compounded for UK general practice by the Quality and Outcomes Framework payments (which reward activity, rather than quality or outcomes) being linked to activities derived directly from the NICE guidelines. Again, there were many medics who said that this would reduce the ability to tailor solutions for patients etc, and I think they were right.

Low carb is nowhere to be found in the NICE guidelines, which envisage managing T2 basically by medication regimes. There's general advice about diet and exercise, so if you wanted to be creative, you could find scope there: but the advice is very pessimistic about the "small" proportion of T2s who are thought to be able to control the condition by diet.

I don't think the treatment guidelines for T2 diabetes have been substantially altered for well over 20 years. A lot has happened in that time in the T2 field (regular blood testing, CGMs, low carb etc) that is simply not reflected in what the system tells the health service to do. And that won't change until the guidelines change.

 

[tonyglover6861]

I’m type 2 on insulin on low carb and I don’t get one on prescription. I have to self fund. I have very tight control, and my hbac1 is ‘normal’. But I am very active so my blood sugar can go pretty low after exercise, and I’ll need to bring it up. There’s no way I could have such good bloods without my cgm and yes I think I should get it on prescription. But even on insulin, I don’t meet the criteria, as it’s only for people who have difficulties monitoring their blood via finger pricks

Wow. I thought it was automatic. Every day is a school day

 

[louisew2605]

One of the issues facing health professionals in the UK is that all treatments are supposed to conform to the NICE guidelines. These are supposed to be "best practice" and as an HCP if you step outside them, you might find that your employer, your professional body, and your professional insurance might be less than sympathetic should any problems occur. Defensive medicine.

When they were introduced it was said (mainly by doctors) that they would stifle development and the ability of medics to treat patients as individuals, rather than the one size fits all approach common with guidelines. The problem was compounded for UK general practice by the Quality and Outcomes Framework payments (which reward activity, rather than quality or outcomes) being linked to activities derived directly from the NICE guidelines. Again, there were many medics who said that this would reduce the ability to tailor solutions for patients etc, and I think they were right.

Low carb is nowhere to be found in the NICE guidelines, which envisage managing T2 basically by medication regimes. There's general advice about diet and exercise, so if you wanted to be creative, you could find scope there: but the advice is very pessimistic about the "small" proportion of T2s who are thought to be able to control the condition by diet.

I don't think the treatment guidelines for T2 diabetes have been substantially altered for well over 20 years. A lot has happened in that time in the T2 field (regular blood testing, CGMs, low carb etc) that is simply not reflected in what the system tells the health service to do. And that won't change until the guidelines change.

Luckily I have a brilliant DN who immediately told me to go onto 60g carbs a day, and when I asked after a while why she hadn’t referred me to a dietitian which I am entitled to, she said it was because all the information they give is incorrect. My diabetes has not gone into remission as I had no weight to lose, had a healthy diet and was very active. However the low carb approach means that my insulin requirements are pretty low and my blood sugar control is excellent 94% in range, with the 6% being lows (not hypos) So there are some medical professionals who know what they’re talking about.

 

[KennyA]

Luckily I have a brilliant DN who immediately told me to go onto 60g carbs a day, and when I asked after a while why she hadn’t referred me to a dietitian which I am entitled to, she said it was because all the information they give is incorrect. My diabetes has not gone into remission as I had no weight to lose, had a healthy diet and was very active. However the low carb approach means that my insulin requirements are pretty low and my blood sugar control is excellent 94% in range, with the 6% being lows (not hypos) So there are some medical professionals who know what they’re talking about.

I had a very good dietitian who stressed the advantages of low carb. this didn't go down well with the DN who was co-running the course, and who did the "base all your meals round starchy carbs" line.

Interestingly my BG was normal within four months on 20g/day, long before I lost a substantial amount of bodyfat. I lost around 90lbs since, but it wasn't the trigger for normal BGs or remission. I suspect there's no single solution. After all, a low calorie diet of 800kcals/day is inescapably also going to be a low carb diet.

 

[Melgar]

Then I hit menopause. Still doing the same stuff, kept all but half a stone of the weight off but my next review A1c was up again. Same lecture about cakes and sweets, to look at the online stuff, exercise, and to up the metformin to two a day. I was miffed at the assumptions about my diet and exercise ( I’m generally pretty active) but did what they asked.

As an aside from your CGM question @Dynamic Penguin I read an interesting study the other day about the effects of declining estrogen on blood sugars in menopausal women . Here is a quote from the paper:

"The decline of the metabolic functions is not due only to the lack of progesterone, but also to the hypoestrogenic state. As women shift from the “perimenopause” status to the “postmenopausal”, hypoestrogenism worsens insulin resistance, which is also triggered by the slow but progressive cortisol increase typical of aging. It is well known that cortisol induces gluconeogenesis and, this, further promotes insulin resistance. At the same level, hypoestrogenism also partly induces a significant reduction of growth hormone (GH) plasma levels, which predisposes to more storage of abdominal fat mass with a reduction in lipid metabolism."

That may be the reasoning behind "Then menopause hit" , and why doing the same thing for controlling your blood sugars no longer is sufficient. Metabolic syndrome, to which insulin resistance plays a major part, is the likely reason what you did before menopause no longer had the same impact on your blood sugars.

Here is the full paper.

https://gremjournal.com/journal/02-...-body-structure-and-the-therapeutic-approach/

 

[Melgar]

I control my blood sugars with exercise. I tried the very low carb diet, but lost too much weight which I could ill afford to lose. My blood sugars barely budged for whatever reason. On reflection my extreme weight loss on the very low carb diet was likely down to insufficient fat consumption as a replacement for carbs. I am and have been very iffy with fats for decades. I'm fat intolerant. I can eat some, but I quickly reach my limit before nausea sets in. The level of nausea from too much fat consumption is intolerable. In short I am unable to replace the carbs with sufficient fats in my diet to achieve the successes of a very low carb diet. So I exercise. My Dr here recommends very low carb diets and exercise.

I have very recently discovered that bursts of aerobic and anaerobic exercise in my morning exercise routine significantly reduces my morning fasting blood sugars. I found this out by accident whilst performing a 400 meter sprint. I confirmed this the following day with a similar result. Instead of my usual 6.5 - 8 mmol/l fasting blood sugars they are down to 5.1 - 5.2 in my short 2 day trial. So the type of exercise is important.

I have found CGMs invaluable for monitoring my blood sugars. I still have my finger prick device though. CGMs are expensive. They are the same price here in Canada as they are in the UK. I do have an Abbots discount card which they sent me. So now I can get 2 CGMs for $152 instead of 1 for $96 (Roughly £50 for 1, depending on exchange rate) I'm not sure if this discount card is available in the UK.