Where to go from here.....

[Truffle]

Over the last 3 years my HbA1c has risen steadily although not hugely significantly from 5.3 to 7. I eat a LCHF diet and take 1000mg Metformin SR per day. I suggested to my GP that perhaps I could try the Newcastle diet to see if I could get the levels back down or give them a head start. She requested that I only try it for 6 weeks as I don't have a vast amount of weight to lose so I did.... I followed the programme completely drinking those wretched shakes etc.
My GP took my bloods last week and I went to see her on Friday to get the results. VERY disappointing.
Although I had lost just over a stone in weight my HbA1c had only gone down by .6 to 6.4. My GP was quite pleased as she said that all my other readings were brilliant but I expected more!
We had a lengthy chat (surprising I know for a GP) and she put forward the theory that as I already eat a low carb diet - eating around 50g per day - but drinking the shakes (slimfast) which have 26g in each, I was consuming 78g without counting the veg which is higher than my body is used to. Therefore although I lost weight the BS reduction wasn't that great.
To test this theory she asked if I wanted to do another 6 weeks, keeping the calories to 800 per day, but not drinking any shakes, just using homemade soups instead! She is willing to repeat the tests again at the beginning of May. I am happy to do this but the only issue I have is that I can only lose about another stone or I will be underweight.
Has anyone else had this problem? If the levels don't go down (and stay down) obviously I have the option of taking more Metformin but I would like to avoid that if possible as I reduced the Metformin 2 years ago and have enjoyed not having to run to the loo every few minutes!

 

[Lazybones]

It's just a thought, but over time it is fairly common for a Type 2 diabetic, despite everything that they do to improve or lower their HbA1c (Average Blood/Glucose Level) to have great difficulty in keeping the levels down low, as their Insulin resistance is known to slowly build up over time.
You are obviously doing the right things in your choice of diet (LCHF) and with exercise. Maybe increasing your daily exercise further will help you with your Blood/Glucose take-up as might an additional supplement possibly Chromium and/or Zinc if these minerals are low in your general diet.
I'm not sure what else to suggest, perhaps someone else might have some further thoughts that can help.

 

[Truffle]

Thanks very much Lazybones. I know I am a bit stumped too - I had such high hopes for the diet. I was so fed up on Sunday that I was tucking into the digestive biscuits (without chocolate) until my son wrestled them away from me!
I will up the exercise... and see where this new variation of the diet takes me!

 

[Yorksman]

I will up the exercise... and see where this new variation of the diet takes me!

Yes do. This is what Roy Taylor writes:

"The role of physical activity must be considered. Increased levels of daily activity bring about decreases in liver fat stores and a single bout of exercise substantially decreases both de novo lipogenesis and plasma VLDL. Several studies demonstrated that calorie control combined with exercise is much more successful than calorie restriction alone."

It's in Type 2 Diabetes Etiology and reversibility in the section near the bottom entitled, Implication for management of type 2 diabetes

 

[smidge]

Hey Truffle!

Any chance your GP would consider measuring your c-peptide? That way you'd know what you're dealing with. Insulin resistance is a very different scenario than low insulin production. While your diet, exercise and weight loss will all help with insulin resistance, they are far less effective if your condition has progressed to a point where you aren't producing enough insulin - in that case, more meds are pretty inevitable.

Smidge

 

[phoenix]

I agree with Smidge
Two other points, 1) the subjects in the Newcastle diet all had relatively higher BMIs than you (average BMI 33.4 at the start, 28.7 at the end) They may have had 'room' to both reduce weight and importantly reduced visceral fat You may have done that bit already. 2) They reduced HbA1cs by 1.4% but ended up with their HbA1cs being 6% +/-2 which isn't that much different to yours.

 

[Truffle]

Thanks for all the replies.
Smidge - I will ask for a c-peptide test when I go to be tested agin in 8 weeks - who knows, my GP has been pretty obliging so far!
Phoenix - you are probably right but I guess I just expected more - I should have realised there are no easy fixes!
Yorksman - I will up the exercise anyway - miracles might happen.

 

[Daibell]

Hi. I would just go for a straight-forward Low-carb (not high fat) diet rather than Newcastle; fad diets are often not kept up whereas making Low-carb a lifestyle it can be for life. Have some fats but go for protein, veg etc. Let us know some of your typical meals and may be we can suggest some tweaks. BTW you may want to ask for Metformin SR (Slow release) as it's much kinder on the stomach.

 

[trotskyite]

Over the last 3 years my HbA1c has risen steadily although not hugely significantly from 5.3 to 7. I eat a LCHF diet and take 1000mg Metformin SR per day. I suggested to my GP that perhaps I could try the Newcastle diet to see if I could get the levels back down or give them a head start. She requested that I only try it for 6 weeks as I don't have a vast amount of weight to lose so I did.... I followed the programme completely drinking those wretched shakes etc.
My GP took my bloods last week and I went to see her on Friday to get the results. VERY disappointing.
Although I had lost just over a stone in weight my HbA1c had only gone down by .6 to 6.4. My GP was quite pleased as she said that all my other readings were brilliant but I expected more!
We had a lengthy chat (surprising I know for a GP) and she put forward the theory that as I already eat a low carb diet - eating around 50g per day - but drinking the shakes (slimfast) which have 26g in each, I was consuming 78g without counting the veg which is higher than my body is used to. Therefore although I lost weight the BS reduction wasn't that great.
To test this theory she asked if I wanted to do another 6 weeks, keeping the calories to 800 per day, but not drinking any shakes, just using homemade soups instead! She is willing to repeat the tests again at the beginning of May. I am happy to do this but the only issue I have is that I can only lose about another stone or I will be underweight.
Has anyone else had this problem? If the levels don't go down (and stay down) obviously I have the option of taking more Metformin but I would like to avoid that if possible as I reduced the Metformin 2 years ago and have enjoyed not having to run to the loo every few minutes!

The first thing that sprung to my mind is the fact that a fairly large percentage (can't remember offhand) are misdiagnosed with type2 when in fact they have other forms of diabetes involving damage to the pancreas that will not react in the same way to weight loss. Another thing that I read was that even people of normal / low BMI (esp of Asian hereditary) can still have up to 20kg of visceral fat that would be unseen, unfortunately that would be difficult to diagnose. Some talk of some of that here:
http://www.ncl.ac.uk/magres/research/diabetes/documents/Diabetes-Reversaloftype2study.pdf
Also, further to earlier posts, increases in insulin resistance over time/age are entirely correlated with increase in fat/mass. e.g When a 60 year old is compared to a 20 year old with the same amount of muscle and fat they are seen to have identical insulin resistance. The "inevitable worsening" of type 2 is caused by "inevitable" increases in fat mass. Of course this is not inevitable but admittedly highly likely for most.

This newly published study may also be of interest as it "proves" rapid weight loss from a vlcd is in fact correlated with better outcomes than compared to slower weight loss."Myth number 3: Large, rapid weight loss is associated with poorer long-term weight-loss outcomes, as compared with slow, gradual weight loss."

http://www.nejm.org/doi/full/10.1056/NEJMsa1208051#t=articleBackground


"Within weight-loss trials, more rapid and greater initial weight loss has been associated with lower body weight at the end of long-term follow-up. 9,10 A meta-analysis of randomized, controlled trials that compared rapid weight loss (achieved with very-low-energy diets) with slower weight loss (achieved with low-energy diets — i.e., 800 to 1200 kcal per day) at the end of short-term follow-up (<1 yr) and long-term follow-up (≥1 year) showed that, despite the association of very-low-energy diets with significantly greater weight loss at the end of short-term follow-up (16.1% of body weight lost, vs. 9.7% with low-energy diets), there was no significant difference between the very-low-energy diets and low-energy diets with respect to weight loss at the end of long-term follow-up.10Although it is not clear why some obese persons have a greater initial weight loss than others do, a recommendation to lose weight more slowly might interfere with the ultimate success of weight-loss efforts.

 

[johnco]

You seem to be trying to solve your problem with one hand tied behind your back! Are you not testing your meals to see what they are doing to your BS? Rather than having to wait for the doc. to tell you your Hba1c - you will know exactly how you are doing.