Total newbie!

[BTSfan2196]

Hello, I was diagnosed with type 2 last week. My HbA1C was 53. I’ve been prescribed metformin but haven’t started it yet. I’m a bit worried about the possible side effects! I have two main questions though, firstly, how often do people tend to check their blood sugar? I’ve got a kit from the nurse and she said to do it about once a month but do people do it more often or is nothing going to change much month to month? This leads me to my second question - realistically, how quickly can you bring this number down? All advice appreciated! Thank you.

 

[gail2]

i check on waking two hours after meals and just b4 i go to bed. im type 2 but on insulin
with tablets including metformin it is possible to get side effects from it , its not knowen as Mcfarting for nothing but effects soon wear off
once a month is not enough you need to check it regurley to know wot levels you are and to see how food effects you
Wellcome to forum

 

[BTSfan2196]

Thank you, I appreciate the reply! I shall take your advice.

 

[Leadinglights]

Hello, I was diagnosed with type 2 last week. My HbA1C was 53. I’ve been prescribed metformin but haven’t started it yet. I’m a bit worried about the possible side effects! I have two main questions though, firstly, how often do people tend to check their blood sugar? I’ve got a kit from the nurse and she said to do it about once a month but do people do it more often or is nothing going to change much month to month? This leads me to my second question - realistically, how quickly can you bring this number down? All advice appreciated! Thank you.

Welcome to the forum, one cautious note is what people might do is very individual as it will depend on what medication they may be taking and how they manage their condition.
With an HbA1C of only 53mmol/mol you are not very far over the diagnostic threshold of 48mmol/mol and many GP would give somebody the opportunity for 3 months to make dietary changes and try to get more exercise before starting medication and it is up to you whether you are prepared to give that a shot and you would need to modify your diet anyway even with the medication.
Many find a low carbohydrate approach successful and this link should point you in the right direction, https://lowcarbfreshwell.com/, it is based on the suggested no more than 130g carbs not just sugar per day. A bit of a hard time to start this but use the time to learn all you can, there is no great rush but do something you must.
As far as testing is concerned then people do test to enable them to have control over their condition rather than waiting for the periodic Hba1C. But the testing has to be for a purpose otherwise it is a waste of time. To learn what meals you are able to tolerate people test before eating and after 2 hours and if the increase is no more than 2-3 mmol/l then the meal is fine, as your levels come down then 4-7mmol/l before eating and no more than 8-8.5 2 hours post meal is what to aim at.
People also test in the morning /fasting to check progress day to day, week to week etc or if they feel unwell.
This means quite a bit of testing initially but the meal testing will reduce once you establish how many carbs per meal will keep you within those limits.
It is unlikely your prescription will cover enough strips and you are lucky to have even been given a monitor but many self fund a monitor and strips so if you want to buy more do check the price as they may be more expensive that those for a different monitor so in the long run you would save money.
Sorry for the ramble but I hope it is helpful.

 

[Mark72]

Welcome to the forum!

With regards Metformin we're all a bit different. If you're like me the doctor started you on one 500mg tablet per day with the dose increasing over time? I'm pretty lucky it seems, I sometimes get a bit of a for want of a better description, heavy stomach and more gas than the North Sea with it not really changing as I increased the dose from 1 in the morning to 2 twice per day. If you do struggle with side affects there's a slow release version you can ask the doctor to put you on that gets rid of a lot of the worst effects for many people.

With regards checking blood sugar it's really up to you. If you know what you where when you were diagnosed then maybe a week or two of checking when you wake up and maybe again once or twice later in the day around one of your meals might help you understand if your levels are reducing and how certain foods affect you.

 

[Proud to be erratic]

Hello @BTSfan2196, others will be along to answer your questions more knowledgeable. In fact @Leadinglights has beaten me to it! And far more competently.

With an HbA1c I would have expected your GP to propose a period without medications, first. You might feel able to adjust your diet and lifestyle a certain amount before pushing meformin at you. Are there other medical reasons that meant it was necessary to plunge straight in to oral meds?

 

[BTSfan2196]

@Leadinglights Ah that makes a lot of sense thank you so much! I had already started changing my diet before I had the initial blood test so cutting down carbs is already something I’m doing. But I’ve started reading up on it all and looking at the carbs in the foods I’m eating. I’ve also already lost 8lbs since the first blood test so I’m hoping I’m going in the right direction. I’ve also got slightly high blood pressure and slightly high cholesterol so I’m trying to make sure the food choices I make address those things too! I need to start exercising next, which I plan to start today.
Thanks so much for taking the time to reply so thoroughly - it’s really helpful and I can now see how the glucose level checks are used. I definitely don’t have enough strips (the nurse warned me about that) so I’ll purchase some. Thanks again!

 

[BTSfan2196]

Welcome to the forum!

With regards Metformin we're all a bit different. If you're like me the doctor started you on one 500mg tablet per day with the dose increasing over time? I'm pretty lucky it seems, I sometimes get a bit of a for want of a better description, heavy stomach and more gas than the North Sea with it not really changing as I increased the dose from 1 in the morning to 2 twice per day. If you do struggle with side affects there's a slow release version you can ask the doctor to put you on that gets rid of a lot of the worst effects for many people.

With regards checking blood sugar it's really up to you. If you know what you where when you were diagnosed then maybe a week or two of checking when you wake up and maybe again once or twice later in the day around one of your meals might help you understand if your levels are reducing and how certain foods affect you.

Thanks for the reply! Yes they suggested one a day for a week then building up to 4 a day eventually over a few weeks.

 

[JITR]

IMHO (and of the World Health Organisation!) at 53 GPs should offer the option of diet and exercise. Medication to follow only if that fails. All things equal I'd suggest you target HbA1c of 35-38 and aim to keep down there for good.

I followed a real food version of the Newcastle diet to get my FBG down from three figures to normal in 7 days and my HbA1c down to 39 in 3 months. Now I know there are easier ways to go about it. And so does Prof Roy Taylor, watch this talk.

Suggest you have a look at these:
1. https://phcuk.org/wp-content/uploads/A_5_page_low_carb_diet_leaflet_Unwin_2021-converted.pdf
(maybe all you need to know)
2. What should we eat? https://www.zoeharcombe.com/2021/08/what-should-we-eat/
(read the weight loss section)
3. https://www.lowcarbfreshwell.com/documents/8/Freshwell_Red_Amber_Green.pdf
(explore the website, great graphics, app not for me)
4. https://drive.google.com/file/d/1zfenN1cLfGNHa7qBp9KDh1u1iqxvTGJF/view
(more comprehensive than #3)
5. https://realmealrevolution.com/the-books
(get the original RMR book on Abe Books for the price of a coffee. Well presented with simple recipes from a master chef, and an excellent essay on the science from Prof Tim Noakes)

These are all variations on the same theme. I track my nutrients with Cronometer (free version) and eat low GL foods so no need to track my BG all the time. Get rid of your excess visceral fat and you should be good to go.

 

[Mark72]

That sounds like really good progress, both losing weight and cutting carbs. Hopefully by your next test you'll be seeing the numbers improve.

 

[BTSfan2196]

Hello @BTSfan2196, others will be along to answer your questions more knowledgeable. In fact @Leadinglights has beaten me to it! And far more competently.

With an HbA1c I would have expected your GP to propose a period without medications, first. You might feel able to adjust your diet and lifestyle a certain amount before pushing meformin at you. Are there other medical reasons that meant it was necessary to plunge straight in to oral meds?

Hi thanks for replying. She gave me the option of lifestyle changes or medication and I asked what she recommended. She said the medication would bring my blood sugar level down quicker. But I might get in touch with her and see if I can hold off on the meds and see what I can achieve on my own first. I was a bit overwhelmed at the appointment and just wanted to get it right! But she was really helpful and supportive so I have no problems going back to her and checking.

 

[BTSfan2196]

IMHO (and of the World Health Organisation!) at 53 GPs should offer the option of diet and exercise. Medication to follow only if that fails. All things equal I'd suggest you target HbA1c of 35-38 and aim to keep down there for good.

I followed a real food version of the Newcastle diet to get my FBG down from three figures to normal in 7 days and my HbA1c down to 39 in 3 months. Now I know there are easier ways to go about it. And so does Prof Roy Taylor, watch this talk.

Suggest you have a look at these:
1. https://phcuk.org/wp-content/uploads/A_5_page_low_carb_diet_leaflet_Unwin_2021-converted.pdf
(maybe all you need to know)
2. What should we eat? https://www.zoeharcombe.com/2021/08/what-should-we-eat/
(read the weight loss section)
3. https://www.lowcarbfreshwell.com/documents/8/Freshwell_Red_Amber_Green.pdf
(explore the website, great graphics, app not for me)
4. https://drive.google.com/file/d/1zfenN1cLfGNHa7qBp9KDh1u1iqxvTGJF/view
(more comprehensive than #3)
5. https://realmealrevolution.com/the-books
(get the original RMR book on Abe Books for the price of a coffee. Well presented with simple recipes from a master chef, and an excellent essay on the science from Prof Tim Noakes)

These are all variations on the same theme. I track my nutrients with Cronometer (free version) and eat low GL foods so no need to track my BG all the time. Get rid of your excess visceral fat and you should be good to go.

That’s really helpful, thanks so much!

 

[Proud to be erratic]

Hi thanks for replying. She gave me the option of lifestyle changes or medication and I asked what she recommended. She said the medication would bring my blood sugar level down quicker. But I might get in touch with her and see if I can hold off on the meds and see what I can achieve on my own first. I was a bit overwhelmed at the appointment and just wanted to get it right! But she was really helpful and supportive so I have no problems going back to her and checking.

As I understand this topic (oral meds vs lifestyle changes) on its own metformin will do very little to help and it needs clear (and enduring) lifestyle changes before a difference will become apparent. It may be that if you are already making changes then the metformin might speed things up; but there can be side effects from any oral med, certainly from metformin. You are, in the final analysis, eating chemicals that might not otherwise be part of a natural diet and might be viable to forego!

Also the "enduring" component means that lifestyle changes need to be things that YOU can sustain for the foreseeable future. To my mind better those changes are not dependent on taking meds in perpetuity. At your age of 43, I think [my non-medical opinion] you ought to at least try increased exercise, reduced carbs (probably with more fats and proteins) and [if appropriate] weight loss. Those sort of measures will, over time, become part of your metabolic memory. If in years gone by you used to be more fit and active than you are today, then also at 43 that metabolic memory of former years is still recent enough for it to be rekindled and thus reactivated.

Of course these sentences are easily written by me from a distance, with no awareness of how busy or distracted you might be with keeping a roof over your head, perhaps endless chauffeuring of children and generally very "time short". My start point has been, for decades, avoid ingesting unnecessary chemicals if you can; so I have an instinctive resistance to meds from the outset. I am also part of the generation now allergic to penicillin after it was the "cure-all" answer in my childhood and teens. Too much in those formative years has not only made it useless for me today, but actually gives me a dreadful reaction if I mistakenly take it. At the very least I would hold off on the metformin until you have time to assess the options and have a further dialogue with your GP. An Hba1c of 53 is a clear diabetes decision point, but today it's not a serious way above the threshold of 48.

 

[BTSfan2196]

As I understand this topic (oral meds vs lifestyle changes) on its own metformin will do very little to help and it needs clear (and enduring) lifestyle changes before a difference will become apparent. It may be that if you are already making changes then the metformin might speed things up; but there can be side effects from any oral med, certainly from metformin. You are, in the final analysis, eating chemicals that might not otherwise be part of a natural diet and might be viable to forego!

Also the "enduring" component means that lifestyle changes need to be things that YOU can sustain for the foreseeable future. To my mind better those changes are not dependent on taking meds in perpetuity. At your age of 43, I think [my non-medical opinion] you ought to at least try increased exercise, reduced carbs (probably with more fats and proteins) and [if appropriate] weight loss. Those sort of measures will, over time, become part of your metabolic memory. If in years gone by you used to be more fit and active than you are today, then also at 43 that metabolic memory of former years is still recent enough for it to be rekindled and thus reactivated.

Of course these sentences are easily written by me from a distance, with no awareness of how busy or distracted you might be with keeping a roof over your head, perhaps endless chauffeuring of children and generally very "time short". My start point has been, for decades, avoid ingesting unnecessary chemicals if you can; so I have an instinctive resistance to meds from the outset. I am also part of the generation now allergic to penicillin after it was the "cure-all" answer in my childhood and teens. Too much in those formative years has not only made it useless for me today, but actually gives me a dreadful reaction if I mistakenly take it. At the very least I would hold off on the metformin until you have time to assess the options and have a further dialogue with your GP. An Hba1c of 53 is a clear diabetes decision point, but today it's not a serious way above the threshold of 48.

Thank you. You make a lot of sense! I’m definitely on board with the lifestyle changes being sustainable. I’ve always struggled with my weight but this has given me a real kick to take things seriously and I have accepted that making the wrong choices in the past has led me to this point. I’m ready to completely change my approach to food and have actually already started and am losing weight. I’ve got a long way to go but this has motivated me in a way that nothing has before. I think I needed this to happen to make me face up to how bad things are. I have an appointment in 3 weeks to see how I’m getting my head around everything and my aim is to be more clued up and in control by then. I think I’m going to hold off on the medication for now, check my blood sugar regularly and see if I can make a difference by myself. I really appreciate everything you have said. I don’t feel so scared now I’ve had so much helpful advice from so many wonderful people! Thank you.

 

[Proud to be erratic]

I forgot to talk about BG testing from finger pricks. Clearly it is your choice whether to do this. My (non-medical) opinion is if someone doesn't test then it's akin to driving a long distance without ever checking one's speedometer (or worse with a filthy windscreen!). It's in my DNA somewhere to know what is going on and check that is happening whenever possible.

If you decide to test, the Nurse's advice is total nonsense. Once a month unspecified make less than zero sense. Every morning, immediately after starting to get up, would provide a series of reference results about your BG at the end of one's natural fasting period; or once every week; even only once a month for 12 months - BUT always 1st THING. However an even better use of finger prick tests is immediately before a meal and then exactly 2 hrs after the 1st mouthful would provide facts about how well (or badly) your body is managing that particular meal. Structured meal checks, done systematically, would allow you to find your optimum breakfast, then lunch choices that are fine for you both weekdays and weekends; then narrow down evening meals, including from social outings as well as when home.

@Leadinglights has spelt out suitable target numbers. Don't get dispirited if it takes a while to find YOUR great meals; it's a complex business in practice finding what food item works well enough for you when in combination with any other food item. We are all different so what works for one person, may not work for you. Porridge is an excellent example of that: for some it provides the lasting nourishment without spiking your BG; for others it's plain rocket fuel!

Structured testing is essential, otherwise you have random numbers that tell you nothing. Being systematic makes it easier: work out one meal type at a time, then move onto the next meal type. A single result is an indicator; 2, better 3, fp tests for each meal that seems great for you gives you some reassurance that you don't need to check that particular permutation in the short or medium term.

 

[BTSfan2196]

I forgot to talk about BG testing from finger pricks. Clearly it is your choice whether to do this. My (non-medical) opinion is if someone doesn't test then it's akin to driving a long distance without ever checking one's speedometer (or worse with a filthy windscreen!). It's in my DNA somewhere to know what is going on and check that is happening whenever possible.

If you decide to test, the Nurse's advice is total nonsense. Once a month unspecified make less than zero sense. Every morning, immediately after starting to get up, would provide a series of reference results about your BG at the end of one's natural fasting period; or once every week; even only once a month for 12 months - BUT always 1st THING. However an even better use of finger prick tests is immediately before a meal and then exactly 2 hrs after the 1st mouthful would provide facts about how well (or badly) your body is managing that particular meal. Structured meal checks, done systematically, would allow you to find your optimum breakfast, then lunch choices that are fine for you both weekdays and weekends; then narrow down evening meals, including from social outings as well as when home.

@Leadinglights has spelt out suitable target numbers. Don't get dispirited if it takes a while to find YOUR great meals; it's a complex business in practice finding what food item works well enough for you when in combination with any other food item. We are all different so what works for one person, may not work for you. Porridge is an excellent example of that: for some it provides the lasting nourishment without spiking your BG; for others it's plain rocket fuel!

Structured testing is essential, otherwise you have random numbers that tell you nothing. Being systematic makes it easier: work out one meal type at a time, then move onto the next meal type. A single result is an indicator; 2, better 3, fp tests for each meal that seems great for you gives you some reassurance that you don't need to check that particular permutation in the short or medium term.

Ah ok thank you. Yes I have decided that it makes sense to do this regularly or I won’t really know what’s happening. I would hate to think I’m getting it right and actually be causing more damage! I’ve ordered more test strips from Amazon so I’ll have a good stock. Im going to have my first go at it before my evening meal tonight. Do I do it literally just before my first mouthful?

 

[Leadinglights]

Bringing blood glucose gradually is actually kinder on the nerves and eyes rather than a quick fix which many then find is not a sustainable new way of eating.
I certainly found the approach in the Freshwell link is a very sustainable new way of eating.

 

[BTSfan2196]

Bringing blood glucose gradually is actually kinder on the nerves and eyes rather than a quick fix which many then find is not a sustainable new way of eating.
I certainly found the approach in the Freshwell link is a very sustainable new way of eating.

That’s really helpful to know thank you

 

[Leadinglights]

Ah ok thank you. Yes I have decided that it makes sense to do this regularly or I won’t really know what’s happening. I would hate to think I’m getting it right and actually be causing more damage! I’ve ordered more test strips from Amazon so I’ll have a good stock. Im going to have my first go at it before my evening meal tonight. Do I do it literally just before my first mouthful?

Yes and then 2 hours after that, nothing to eat or drink in between.

 

[BTSfan2196]

Yes and then 2 hours after that, nothing to eat or drink in between.

Not even water?