Some people who are newbies are not new to diabetes.Some people who are newly diagnosed may have had undiagnosed diabetes for a long time .
As Indy says beta cells can be lost . And of course there are people who may have been labelled as T2 but who actually produce less insulin. Beta cells may have been destroyed by the immune system (LADA), they may have a defect in the signalling system( some types of MODY) or something else entirely.
If insulin levels are low then glucagon levels will rise and gluconeogensis will increase .The liver will use protein or break down body muscle to make glucose (that's what happens in T1 before diagnosis but it can also in longstanding T2. It may also be that people are actually producing far more glucagon than they should do (so more glucose is being made/released.
In some of these cases then people may not be able to lower their levels with diet , of any kind ,without some form of medication ( for example metformin acts,in part, to reduce the glucagon response)
Can you imagine how someone in this situation would feel if they were told that they somehow weren't doing it right?
(in any case I can give examples where people use other diets successfully but that isn't the thrust of this thread.)
My second point is that in a minority of cases getting levels down as quickly as possible isn't necessarily a good thing.
In someone who has developed some degree of retinopathy, a rapid reduction of HbA1c may lead to a more rapid progression of the existing retinopathy. In the long term a lower level is certainly better but taking many months to get there may , according to this hospital website, be sensible .
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
also from the same website :
Late diagnosis " is very common, even in wealthy areas such as North Birmingham. 15% of patients have retinopathy at presentation, and diabetes may have been present 5-9 years previously"
In this situation, I'd be reading the labels for any additives to see if they contain wheat. Wheat can be murder on people's BG levels. Soy sauce (unless it's Tamari) will almost always contain wheat, even if the label says gluten free. Not all problems with wheat are related just to gluten, unfortunately.This happened to me all the time. Example, this afternoon I was 8.2, I had 2 crispbreads (13.4g carbs) with butter and cheese and a green tea, nothing else, and an hour later I'm 15.9.
Last night I had a prawn stir fry, no-carb noodles, veg 9g carbs, no stir fry sauce, just a little soy sauce. I went from 8.9 to 19.8 in an hour! An hour later I'm back down to 10.1, then an hour after that 8.4. Yes if course there's definitely something wrong there, but there's no misunderstanding in what I ate.
I learnt nutrition in Doemstic Science at school and altough I'yv not alwasy stuck to it in the past I do know what's what.
I eat pretty much the same sort of thing most days, no processed ready meals, and I'm not experimenting with foods I'm not sure about until my levels stabilise, but at the moment they're all over the place. And it's not becasue I'm doing it wrong, and I'm sure I'm not the only person on here who is struggling. And having people insist that if you're doing it right your levels will go down is not helpful, it's not always that simple.
In this situation, I'd be reading the labels for any additives to see if they contain wheat. Wheat can be murder on people's BG levels. Soy sauce (unless it's Tamari) will almost always contain wheat, even if the label says gluten free. Not all problems with wheat are related just to gluten, unfortunately.
There are other issues with gluten beyond just coeliac - there's a condition call non-coeliac gluten sensitivity as well. Food sensitivities can also apparently cause BG spikes. Be interesting to see if wheat containing foods spike your BG higher than you'd expect for the amount of carbs consumed.I read all labels. The soy sauce has 0.5g carbs per tsp, which is about all I use and that wouldn't raise BG from 8 to 19. I don't bother with gluten free, I don't have coeliac disease, I just eat very little wheat of any sort (or oats) because they spike me too much, and never eat bread now, just occasional crispbreads, or low carb crackers, and that's about it.
I would 'go back to/or change' your Dr. you may need your insulin increased. I know an insulin resistant T2 that is on 100U a day basal/bolus to get controlThank goodness ...someone who understands at last !! I was diagnosed in September 2013 .My Bg was up in the 20's and so i came home ,read up ,changed my diet and took my meds ......nothing ...not a jot did they lower .I managed to get the occasional 10 or 11 back then but that was eating nothing .My diabetic eye screening confirmed I had diabetic retinopathy .
Two years on and i'm under the hospital diabetic team ...on insulin and an assortment of meds and I'm still in the 20's ! I watch my carbs constantly and take my insulin and meds religiously but they aren't working ! It really isn't always that diet can solve everything.I stopped reading after a while because I felt like everyone thought I must be chomping down carbs but was in denial or something .
I would 'go back to/or change' your Dr. you may need your insulin increased. I know an insulin resistant T2 that is on 100U a day basal/bolus to get control
I also wonder why you are on 1000 metformin when I'm on 2000 metformin?
these are the general info to talk to your Dr about
is supper USA for dinner?
http://www.gnb.ca/0053/phc/pdf/2012/diabetes/Insulin Prescription Form.pdf
Premixed Basal + Bolus Insulin before breakfast and before dinner (Humalog® Mix25®, Humalog Mix50®, NovoMix® 30, Humulin®
30/70, Novolin® ge 30/70)
• May be considered for patients where less aggressive targets may be appropriate (eg frail elderly)
• Most patients with type 2 diabetes will need 40-50 units twice a day to achieve target but there is no maximum dose
• Start at a low dose of 5 to 10 units twice daily (before breakfast and before supper)
• Patient can gently self-titrate by increasing the breakfast dose by 1 unit every day until the presupper BG is at target
• Patient can gently self-titrate by increasing the supper dose by 1 unit every day until the fasting BG target is at target
• Beware of hypoglycemia post-breakfast or post-supper. Stop increasing dose if this occurs
• Premixed analogue insulins (Humalog® Mix 25, ®Humalog Mix 50® NovoMix® 30) should be given 5 to 20 minutes before eating
• Premixed regular insulins (Humulin® 30/70, Novolin®ge 30-70) should be given 30 minutes before eating
• Continue Metformin and consider stopping secretagogue
ask your Dr, don't play with doses without medical support,Thank you Jack .That is very interesting and helpful indeed .I was not made aware that NovoMix® 30 should be taken before or with food or that those kind of levels would be necessary to have some effect .I shall increase my dose to 30 and self-titrate up accordingly.I was told to stop Metformin completely as it was having dire consequences on my bowels but I've added it back myself to see if helped with my levels
ask your Dr, don't play with doses without medical support,
a 10U rise at once may be too much, the highest I've seen in 10% which would be 2 units and the info posted to ask your Dr about is is 1U at a time
ask your Dr about slow release metformin, it may be better on the gut
change Dr, you are going to need proper ongoing care. keep going till you find a Dr/nurse that knows about diabetes.Medical support ?? It is absolutely useless and one of the reasons I've now been walking around with an Hba1c of 14+ for months . If I don't take some form of charge over this It isn't going to get much better I'm afraid .I shall of course be testing constantly as I titrate but with a fasting bg of 17.6 this morning I don't think hypos are much of a worry at the moment . I do have slow release Metformin in both 500mg and a 1000mg .It was replaced with Januvia after stool samples were taken as I was running to the loo 20 times a day .
change Dr, you are going to need proper ongoing care. keep going till you find a Dr/nurse that knows about diabetes.
ring the care line
http://www.diabetes.org.uk/careline
I read all labels. The soy sauce has 0.5g carbs per tsp, which is about all I use and that wouldn't raise BG from 8 to 19. I don't bother with gluten free, I don't have coeliac disease, I just eat very little wheat of any sort (or oats) because they spike me too much, and never eat bread now, just occasional crispbreads, or low carb crackers, and that's about it.
I would still ring the care line for advice..do you have a general GP that can act on your behalf with the 'team' ? ..it doesn't alter that you need proper care.I was just telling Lucy on another thread that i am under a so called specialist team Jack (http://www.uhcw.nhs.uk/wisdem ).I've seen the consultant twice and they have taken my Hba1c themselves and it was over 14 on both occasions yet they don't seem in any hurry to sort this out .
I would still ring the care line for advice..do you have a general GP that can act on your behalf with the 'team' ? ..it doesn't alter that you need proper care.
to me there is a real problem somewhere.
ask Dr..with an a1c 14, are you getting your feet and retinopathy checks as well
It is so frustrating isn't it @rowan to be told it MUST be what we are eating and that we must be doing something wrong .The assumption always seems to be that we are "ignoring" hidden carbs and when your measuring and reading every label and it isn't working it gets you angry and depressed .
this is why it's best to work with your Dr and team..It may be they want your eyes sorted first, with a big drop they say you need 3 mth checks because the retinopathy may increase for the first year or two and need treatment.Yes I have my feet checked yearly and i've just had my second diabetic eye screening which shows yet again that I do have Diabetic Retinopathy for which I have now been referred to a consultant sometime in July .I called my GP a few days ago and he told me to up the Novamix from 15 to 20 which i've done and still ....no change .
Yes you're so right. It's hard enough coping with this without feeling you're not being believed by the people you turn to for support, which a few people here are feeling.
As I've said before, if it really was as simple as 'eat the right food and your BG levels WILL go down' then a lot of us wouldn't be having the problems we are having, we're not stupid and we know how to read labels and look things up in books or internet if we're not sure.
this is why it's best to work with your Dr and team..It may be they want your eyes sorted first, with a big drop they say you need 3 mth checks because the retinopathy may increase for the first year or two and need treatment.
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
I would ring the consultant for advice on reducing you BG..or get your gp to sort it out with the consultant. or start with the careline
do you have the leaflet on novomix?
http://www.novonordisk.com/images/diabetes/pdf/novomix_dosing_guidelines_60317.pdf
If it was me..I'd be asking to see another consultant, or even go for a new Team..it really sounds like 3rd world stuff to me.Thank you Jack .I have contacted the team just now and asked for a call back .It's time to get something done I agree and no I didn't have a dosing guideline...I only had the injection leaflet that came in the box .I wasn't even shown how to inject ,just handed the box and i even had to ask them for the needles as they weren't added to the prescription.
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