List of Questions - not being answered by my 'care team'

[aseret]

Hello all,
I am not a newbie, i was diagnosed way way back with type 2.

I am 63 years old, retired chef and events caterer (retired this year because there ARE no events) i am 1m54cm and weigh 75 kilos.
However, i live in France and language barrier plus the difference in the approach has really confused me as i am obviously not asking the right questions in the right way!

I first went to the doctor here asking for help to lose weight. I have been physically active all my adult life and follow a sensible diet most of the time, never eat processed foods etc. After years of following the prevailing dietary advice of 'Low fat, Low cal, High carb', i have steadily gained weight going gradually from 60 kilos to an all time high of 80 kilos. Now i understand the concept of 'eat less, move more' and am getting regular exercise. (Before the Covid lockdowns i was going to a zumba class twice a week as well as walking every day). I am a difficult eater in that i REALLY cant eat a lot of vegetables. For a start, i dont enjoy them, and they seem to cause me stomach problems, wind, cramps, (as does a lot of dairy). its a task to eat most of them and sometimes just the smell of them puts me off. I have tried all sorts of methods of cooking them, all sorts of sauces and additions and i simply dont LOVE them enough to make them the major part of my diet.

When first diagnosed i was given Metformin but had a very bad reaction to it so was switched to Januvia. After a year or so of no real change and a meeting with the nutritionist/dietician i was told that if i were to lose 20k this problem would go away - so i decided to try and deal with it by diet alone, with their agreement. To some extent that worked. Ha1bc went down from 9 average to around 6.2 and i lost 10 kilos by following a low carb diet. But, gradually, i drifted off the diet and the weight has almost crept back on. The blood test results have shown higher and higher levels and i now have a 'new' team supervising my treatment. i have been asked to keep a food chart and a Blood test chart in advance of my next blood test and follow up. i have been prescribed Januvia again and they added gliclazide to the mix. I have been on this medication for about eighteen months and was given 'diet guidance' (50% green vegetables, 25% carbs, 25% protein) very very low fat and LOADS more Calories than i had been consuming before. As a result i have gained 6 kilos over the last year and i CRAVE sweet stuff and carbs ALL the time and am always ravenous. i think this is side effect of the gliclazide - can anyone correct me? I have a blood test every three months and see either the nutritionist or the doctor every six months. They REALLY disapprove of Low Carb diets!

I usually get up, 7.30 ish, take the dogs for a quick walk down the lane - about 10 minutes, then come home feed dogs and test blood, put the kettle on and have a cuppa and take the daily meds. I dont usually eat breakfast because the thought of food makes me feel a bit nauseous at that time of day and i like to get out for my daily walk by about 8.30 or 9. I walk about 6-8 kilometres with the dogs each morning, fairly brisk pace, then come back and eat. I walk the dogs again in the late afternoon/early evening but only for about 30 minutes and at a much more leisurely pace. I have a light snack in the afternoon and eat dinner at around 7.30. I dont seem to have the energy for any other exercise, my sleep pattern is poor as i get up to urinate at least five times during the night.

Should i be testing as soon as i get out of bed?
Why are the morning fasting readings so high?
What would be a 'normal' reading?
Should i eat before walking?
Should i test again before walking?
Should i test after walking and before eating brunch?
What am i looking for in the BS test results? the numbers are very random.

Sorry, such a long post, i feel i should know better after all this time. Dreading my next meeting with the doctor/dietician.

 

[helli]

Why are the morning fasting readings so high?

This is due to something called Dawn Phenomenon.
At the start of the day, our helpful livers dump a load of glucose into our blood to give us the energy we need to start the day.
Anyone with a healthy pancreas, will release insulin and the sugar dump will not be noticed. Those of us pancreatically challenged may see a rise of blood sugars at the start of the day.
For some reason which I do not know (and I am not sure if anyone does), people with type 2 find their pancreas takes a while to wake in the morning so the morning reading is often higher. I have read that as you bring down your overall blood sugars, the morning reading will improve but it is usually the last to improve.

For some, the dump may happen whilst we are asleep and we wake with a high.
For others, the dump happens when we get moving. You may see this as "foot on the floor" or FoTF.

Some people find a small snack helps to reduce the morning blip.

 

[Drummer]

Perhaps you should get 'it doesn't seem to be working for me' translated into French.
A low carb diet is really effective, but 75% carbs 25% protein isn't going to benefit anyone as far as I can work out.
Eating meat, fish and sea food, eggs and cheese and adjusting the rest of your menu to what you can cope with is proving very effective for a lot of people. I have two meals a day, 40 gm of carbs from salad stir or stir fry, or now that the nights are drawing in, swede or cauliflower in some form. I sometimes have frozen berries with cream, or real custard or sugar free jelly, or even Greek yoghurt. I have 10 gm of carbs first thing, to stop the dawn rise and the rest in the evening, and a couple of mugs of coffee.
Unfortunately when taking gliclazide it can cause hypos, so you can't go low carb when taking it according to the usual instructions. That can be a bit of a whatsit as carbs are what cause type twos to go high in the first place.

 

[Ralph-YK]

But, gradually, i drifted off the diet and the weight has almost crept back on.

This is a common thing with diets, happens with lots of us.

i have been asked to keep a food chart and a Blood test chart in advance of my next blood test and follow up.

That's a good idea, as it will give both you and your team an idea of what's going on. Hopefully you'll be able to see patterns. If you test before and 1 - 2 hours after, it'll show you the affect food has on your BG.

and was given 'diet guidance' (50% green vegetables, 25% carbs, 25% protein) very very low fat and LOADS more Calories than i had been consuming before. As a result i have gained 6 kilos over the last year

Hmmm Use a smaller dinner plate?

and was given 'diet guidance' (50% green vegetables, 25% carbs, 25% protein)

That's actually lower proportion of carbs than I've seen in the standard advice, over here in England.

Should i test again before walking?
Should i test after walking and before eating brunch?

If you test before and after, you'll get to see the affect walking has on your blood glucose levels (BG). As well as before and after eating.

the numbers are very random.

Can seem like that at times. Looking at your levels over time may allow you to see patterns.

Unfortunately when taking gliclazide it can cause hypos, so you can't go low carb when taking it according to the usual instructions.

That's another reason to check BG levels, to avoid hypos.

 

[Inka]

Drummer, the carbs in green veg are negligible as I’m sure you know. I actually thought the 50% green veg sounded like a good strategy.

OP, you said you don’t “love” vegetables - are you actually eating the 50% green veg that was recommended or is this the bit of the diet you drifted off?

You’ve been given good advice about testing above. I’d second what Helli said about the Waking Rise. I assumed exercising first thing before eating n the morning would be good for my sugars, but actually my body prefers to have food pretty soon after waking or else it will pump out it’s own glucose and put my blood sugar up. You could experiment with a small snack before you do that early dog walk and see how that goes.

 

[everydayupsanddowns]

A low carb diet is really effective, but 75% carbs 25% protein isn't going to benefit anyone as far as I can work out.

The diet mentioned was 50% green/leafy veg, and 25% carbs?

 

[everydayupsanddowns]

What would be a 'normal' reading?
Should i eat before walking?
Should i test again before walking?
Should i test after walking and before eating brunch?
What am i looking for in the BS test results? the numbers are very random.

Welcome to the forum @aseret

The generally accepted guidelines for T2s are to aim for a BG of between 4-7 before meals and no higher than 8.5 by 2 hours after meals.

Do you have a UK meter? France uses mg/dl I think? So 70-125mg/dl before meals and no higher than 150mg/dl by 2 hours after meals.

There shouldn’t be any need to eat or check BG before walking, but as you are on meds which can cause hypos you should familiarise yourself with the symptoms of hypoglycaemia, and always take your BG meter and hypo treatment with you when you go out so that you can check and treat if you begin to feel a bit ‘waffy’.

It sounds like you found a lower carb diet worked well for you, but that very low fat approaches are difficult to sustain. Many members here find that a moderate-low carb diet with ‘normal’ levels of fats (high by some dietician standards) help a great deal because fat (and protein) increase the feeling of fullness.

One of the most practical ways to examine your reaction to foods, and to tailor an approach that suits your BG as well as your tastebuds is to use the ‘test review adjust’ framework with what you eat now... and moving towards a low or moderate-low carb menu by reducing types and amounts of carbs that cause BG spikes. Many people find fats, dairy, and leafy veg very helpful to build into this approach, so you may need to find things you can introduce if you find too much of that doesn't suit you.

Let us know how you get on 🙂

 

[Ditto]

Hello and welcome to the forum @aseret 🙂

 

[aseret]

Welcome to the forum @aseret

The generally accepted guidelines for T2s are to aim for a BG of between 4-7 before meals and no higher than 8.5 by 2 hours after meals.

Do you have a UK meter? France uses mg/dl I think? So 70-125mg/dl before meals and no higher than 150mg/dl by 2 hours after meals.

There shouldn’t be any need to eat or check BG before walking, but as you are on meds which can cause hypos you should familiarise yourself with the symptoms of hypoglycaemia, and always take your BG meter and hypo treatment with you when you go out so that you can check and treat if you begin to feel a bit ‘waffy’.

It sounds like you found a lower carb diet worked well for you, but that very low fat approaches are difficult to sustain. Many members here find that a moderate-low carb diet with ‘normal’ levels of fats (high by some dietician standards) help a great deal because fat (and protein) increase the feeling of fullness.

One of the most practical ways to examine your reaction to foods, and to tailor an approach that suits your BG as well as your tastebuds is to use the ‘test review adjust’ framework with what you eat now... and moving towards a low or moderate-low carb menu by reducing types and amounts of carbs that cause BG spikes. Many people find fats, dairy, and leafy veg very helpful to build into this approach, so you may need to find things you can introduce if you find too much of that doesn't suit you.

Let us know how you get on 🙂

Sorry, not been able to get on line for last week, have had touch of flu - not covid, had a test!

Meanwhile, i have been reading the advice offered. Yes, i have an English meter, i could probably get a new one free of charge if i ask the doctor on my next visit. It will make it easier, i have to convert each one before my check up.

Current meds Januvia - 50mg once per day and Gliclazide 30mg (its the slow release type) once per day.
I also take Lisinopril for blood pressure and Hydrea for a blood platelet problem i have.

I found an app which makes it much simpler to keep a food diary and keep track of carb grams, fat grams and protein grams. I still forget often to measure BS regularly enough but i am gradually getting into the habit. Still managing to walk every day, except last week when I was unwell. Getting in my 10000 steps on a regular basis now.

So, diet advice please.... If i follow the LCHF diet (my dietician will look at me with horror) i do lose weight. They told me a long while back that if i lost 20 kilos 'this problem would go away', so i would like to prove something to them. So far its going ok - have lost 2 kilos in 2 weeks, but i was poorly last week and ate quite a few comfort foods!

Most of my carb intake is in the two pieces of fruit I eat each day (I usually perm any two from apple, banana, blackcurrants, raspberries and strawberries, depends what is available). I know I don't eat enough vegetables - i REALLY don't like them and I suffer from diverticulitis and some veg just aggravates the condition. I do eat at least one portion of green veg per day and I don't want to cut out the fruit entirely as i could probably do with the vitamins. Also, it satifies the sweet tooth - i figure its better than biscuits or chocolate! At the moment i try and keep below 30g of carb per day, have cut out the pasta (which i really miss) and the rice, bread and cake, but i am having trouble balancing the rest - mostly the protein part. i cant seem to get enough protein whilst the percentage of fat is quite high. What sort of ratio of Fat to Protein should I be aiming for? Like i said, i dont get much help from the consultant here, or the dietician assigned to me. They keep thrusting the Pie chart at me - looks identical to the one NICE recommend.

 

[aseret]

The diet mentioned was 50% green/leafy veg, and 25% carbs?

Its a pie chart and it looks identical to the NICE guidelines. Quite low fat and high carb.

 

[aseret]

Hi. Welcome to the Forum.

As far as testing goes, it's a good idea to test on waking, before you eat or drink anything. This is a fasting test on the basis that you won't have eaten anything overnight, and will show how well your body is managing your BG in the absence of food or exercise. For a Type 2 the target range is between 4 and 7 mmol/L. Many of us also test immediately before eating and then 2 hours afterwards to see what our choice of meal did to our BG. A rise of no more than 2 or 3 mmol/L is the target.

Random tests won't show anything meaningful as your BG will rise and fall during the day, just as it does for non-diabetics. The fasting and before & after meals testing regime is what many of us stick to.

As far as testing in relation to exercise is concerned I believe this may be advised for those on medication that puts them at risk of hypos, but I don't know and I'll leave that to those who are in that position to answer.

Martin

Ok. Have started testing before walking and then after. See if i can see a pattern. The Metformin did NOT agree with me at all. I would love to be in a position to control this condition without meds. I am a bit concerned about the gliclazide but so far, i am not experiencing hypos. I have asked elsewhere on this thread I am limiting myself to 30g of carbs a day (i admit i have thrown their pie chart out of the window - it would mean i'd be eating about 100g of carbs per day) and now I am using an app to track the percentages - having a bit of trouble balancing the fat/protein. What should i be aiming for? I know that they will look at the diary in horror when they see the fat consumption but i hope that i will have lost weight and that my HbA1bc is lower by the next check up.

 

[Drummer]

Whilst 30 gm of carbs whilst on Gliclazide is quite low, if you are managing on it, then that seems OK. You could well be told to eat more carbs so you can cope with the medication, and I will leave it to you to decide just how to think about that.
I don't think that you need to struggle with the balancing of fat and protein, as to me is seems logical to consume the fat which comes naturally with animals as long as they have not been fed artificially. I roast a chicken, putting veges into the tray beneath the roasting rack similarly with joints of other meats - but I do not seek out the low fat cuts which we are advised to look for.

 

[rebrascora]

The problem with the recommended daily intake amounts is that they are based on you eating the recommended amount of carbs. If you are eating less carbs then you need to eat more fat and protein.
I treat myself to a chunk of cheese every day and I eat nuts and I have cream in my coffee every morning to start the day. I have creamy Greek natural yoghurt and I cook my veg with olive oil or a knob of butter or a dollop of cream cheese and I eat fatty cuts of meat and oily fish and eggs which are an even mix of protein and fat and highly nutritious. I also like olives, so I always have a tub of those in the fridge and have 3 or 4 whilst I am cooking dinner. There are lots of ways of incorporating more fat into your diet and it usually makes everything else taste a whole lot better.

 

[aseret]

Thank you everyone for your advice.

I was worried that calories from fat intake were making up too large a percentage of my daily intake.
I am not going to increase the carb content as, at the moment, I am not feeling the worse for it. The moment of truth will come mid December when i have my next blood test and check up. I know they will roll their eyes in horror when they see my diary, i hope that the blood test results support my choices.

I have struggled with my weight for about 20 years and have followed a low fat diet based around 'healthy carbs' and vegetables, as advised - and i have slowly got fatter and fatter. I am not sure at what point diabetes entered the equation but I suspect i had it long before it was detected. Feels a bit chicken and egg to be honest. Did the high carb diet cause the insulin resistance? Did the excess weight cause the diabetes or did the diabetes cause the excess weight. Why are diabetes 'experts' not willing to embrace low carb?

I am still finding it hard to do without the carbs, and after years of trimming off excess fat, doing without butter, oil and cream, the foods i am eating are a wee bit richer than in the past.

 

[aseret]

Whilst 30 gm of carbs whilst on Gliclazide is quite low, if you are managing on it, then that seems OK. You could well be told to eat more carbs so you can cope with the medication, and I will leave it to you to decide just how to think about that.
I don't think that you need to struggle with the balancing of fat and protein, as to me is seems logical to consume the fat which comes naturally with animals as long as they have not been fed artificially. I roast a chicken, putting veges into the tray beneath the roasting rack similarly with joints of other meats - but I do not seek out the low fat cuts which we are advised to look for.

That is good to know. I am eating a bit more red meat than i did before, but also lots of chicken (skin on), fish and eggs. After years of following a low fat diet, i was a bit concerned that the proportions were out of kilter but i wont overly concern myself with that now - just concentrate on losing weight, getting the blood sugars down and no more meds! f

 

[aseret]

Drummer, the carbs in green veg are negligible as I’m sure you know. I actually thought the 50% green veg sounded like a good strategy.

OP, you said you don’t “love” vegetables - are you actually eating the 50% green veg that was recommended or is this the bit of the diet you drifted off?

You’ve been given good advice about testing above. I’d second what Helli said about the Waking Rise. I assumed exercising first thing before eating n the morning would be good for my sugars, but actually my body prefers to have food pretty soon after waking or else it will pump out it’s own glucose and put my blood sugar up. You could experiment with a small snack before you do that early dog walk and see how that goes.

No, i struggle to eat enough veg. Don't like the smell taste or texture of most green veg. I am trying to address this. Slowly slowly..... i am eating more meat than before, less carbs and, it seems, more fat, which was my concern. But i actually feel BETTER without the carbs, less bloated, less 'sluggish'. Often, in the past if, for example, i ate a sandwich for lunch i had an overwhelming urge to sleep soon after. Now i do a small walk in the morning and the big walk in the afternoon. 8 kilometres today. Was pretty pleased with myself and seem to have no unpleasant wobbly moments. Lockdown is quite good for me, it seems!

 

[Inka]

It sounds like you’re doing well @aseret For the veg, have you tried some raw (eg broccoli or kale in a salad) or steamed or stir-fried? Not so much of a smell then. 🙂

Fortunately I love veg, but if I didn’t I’d be looking at new recipes and ways of cooking or eating raw. Veg is underrated - and usually over-boiled. But it’s fabulous stuff, and incredibly healthy and tasty prepared well.

 

[trophywench]

One veg I've never really seen in France, is a sprout. However if you stir fry them with chopped up streaky bacon, they are a far different kettle of fish than the overboiled ones my mom used to produce.

 

[everydayupsanddowns]

Glad to hear your experiments seem to be going well @aseret

Must be tricky if you aren’t keen on the go-to filler veggies that help to bulk out meals for many low carbers. How do you get on with things like cauliflower?

As has been mentioned - gliclazide can be difficult to manage on a low carb diet as it can cause hypoglycaemia, so do keep a careful eye on your BG levels, and keep hypo treatments close by. Have your doses been adjusted since you started low-carb eating?

 

[aseret]

One veg I've never really seen in France, is a sprout. However if you stir fry them with chopped up streaky bacon, they are a far different kettle of fish than the overboiled ones my mom used to produce.

We have sprouts! my other half loves them - I am a chef by trade ('locked out' due to lock down at the moment, which i actually quite like), so i have tried every possible way of cooking veg. I can eat cauliflower but have not yet 'acquired' the taste for Cauli rice but i am trying to develop that. I eat stuff like green beans, peas, broccoli and spinach so i can get a couple of portions of green a day, and i eat peppers and tomatoes. Most other stuff just takes like grass to me, particularly salad leaves! Its a work in progress!