Diagnosed Type 2

[Leadinglights]

@Leadinglights

That is a salutary warning. Do you say that on the basis of your experience and/or the following note on the Diabetes UK retinopathy page?

There is evidence to suggest that reducing blood sugar levels too quickly if they have been high for a long time may increase the risk of diabetic retinopathy. So it is important to work with your diabetes team to help you to reduce your blood sugar levels gradually over a few weeks or months.
See: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/retinopathy

My GP said nothing about that when I told her about the VLCD I intended to follow. I had read Prof Roy Taylor's book and wanted to see if my FBG would come down from 17 mmol/L to around 6 mmol/L in 7 days. It did.

Thanks to Google AI, I have seen that studies indicate:

A rapid HbA1c reduction of more than 2% points within a period of 3 months is specifically noted in relation to worsening DR and TIND [Diabetic Retinopathy and Treatment Induced Neuropathy of Diabetes]

I have put worsening in bold as pre-existing DR is a stated risk factor. Early worsening (EWDR) in some cases is well documented.

@Leadinglights, would you agree everyone should have their eyes checked for signs of retinopathy before starting any ambitious glucose and/or weight reduction programme? Or, on the precautionary principle, does your advice apply even when there are no signs of retinopathy?

P.S. As it happened the retinal images taken at my annual visit the opticians showed no sign of retinopathy before or after diagnosis.

From personal experience, I had been prediabetic for a number of years and had had annual retinopathy checks. When I crossed that threshold to an HbA1C of 50mmol/mol I immediately cut my carbs to 70g per day and my HbA1C dropped to 42 in 3 months but it was after about 2 months that my eyesight was all over the place. Distance vision was fine but close my eyes just didn't seem to be working together. It was only when I read on here about the danger of rapidly reducing blood glucose that I realised what must have been going on. It took probably the best part of 6 months to improve. So in hindsight it would have been better to have gradually reduce the carbs. There was no sign of retinopathy.

 

[everydayupsanddowns]

A rapid HbA1c reduction of more than 2% points within a period of 3 months is specifically noted in relation to worsening DR and TIND [Diabetic Retinopathy and Treatment Induced Neuropathy of Diabetes]

Just worth mentioning perhaps, that the 2% here is referring to the old-fashioned way of reporting HbA1c, and relates to a reduction of HbA1c of 22mmol/mol in IFCC numbers.

 

[JimG]

Hello. There is already a lot of good information. The points I would emphasise is, as it says on The Hitchhiker's Guide to the Galaxy, don't panic. My HbA1c was 111 when I was diagnosed. Six months later, with diet metformin and exercise, it was down to nearer 50. Secondly, if you are looking on the Web, restrict yourself to reputable sites such as this one and NHS sites. Finally, I echo the comments about talking to the GP and speaking with a diabetes specialist nurse, DSN. There are more things than blood sugar that need talking about. Look on the learning zone about the annual tests you should be entitled to.

 

[LeighB]

Hello. There is already a lot of good information. The points I would emphasise is, as it says on The Hitchhiker's Guide to the Galaxy, don't panic. My HbA1c was 111 when I was diagnosed. Six months later, with diet metformin and exercise, it was down to nearer 50. Secondly, if you are looking on the Web, restrict yourself to reputable sites such as this one and NHS sites. Finally, I echo the comments about talking to the GP and speaking with a diabetes specialist nurse, DSN. There are more things than blood sugar that need talking about. Look on the learning zone about the annual tests you should be entitled to.

Thank you for your message. How do I register with a specialist diabetic nurse? Unfortunately, my GP was not helpful at all.

 

[Leadinglights]

Thank you for your message. How do I register with a specialist diabetic nurse? Unfortunately, my GP was not helpful at all.

Your GP will usually have a nurse with a special interest or training in 'looking after' people who are Type 2 mainly who would normally give advise about diet, medication and would be the person who would do your foot checks, blood pressure, weight on a regular basis following diagnosis. They may be based at your surgery or be a visiting nurse.
It really depends on how your surgery operates.

 

[LeighB]

Your GP will usually have a nurse with a special interest or training in 'looking after' people who are Type 2 mainly who would normally give advise about diet, medication and would be the person who would do your foot checks, blood pressure, weight on a regular basis following diagnosis. They may be based at your surgery or be a visiting nurse.
It really depends on how your surgery operates.

Thanks, I will go back to the surgery and hopefully this time the GP will be more helpful.

 

[Lucyr]

My GP said nothing about that when I told her about the VLCD I intended to follow.

You’re expecting way too much from your GP. They’re a generalist, they know very little about the details of diabetes.

 

[Lucyr]

Your GP will usually have a nurse with a special interest or training in 'looking after' people who are Type 2 mainly who would normally give advise about diet, medication and would be the person who would do your foot checks, blood pressure, weight on a regular basis following diagnosis. They may be based at your surgery or be a visiting nurse.
It really depends on how your surgery operates.

This type of nurse is not a DSN though. A DSN has extra training and is usually based in the hospital, their training is much more than the “nurse who looks after the diabetics at the GP practice” has. You’re unlikely to see a DSN as a T2 unless you need a referral for specialist hospital input to your diabetes for some reason.

 

[JITR]

From personal experience, I had been prediabetic for a number of years and had had annual retinopathy checks. When I crossed that threshold to an HbA1C of 50mmol/mol I immediately cut my carbs to 70g per day and my HbA1C dropped to 42 in 3 months but it was after about 2 months that my eyesight was all over the place. Distance vision was fine but close my eyes just didn't seem to be working together. It was only when I read on here about the danger of rapidly reducing blood glucose that I realised what must have been going on. It took probably the best part of 6 months to improve. So in hindsight it would have been better to have gradually reduce the carbs. There was no sign of retinopathy.

Thank you @Leadinglights for your clear description, thank goodness it improved in the end.

From what you say, it appears your may have been 'eye coordination' and/or 'convergence insufficiency' rather than retinopathy. The causes of these conditions seem to be hard to pinpoint.

Good to hear your eyesight was not affected.

 

[Leadinglights]

Thank you @Leadinglights for your clear description, thank goodness it improved in the end.

From what you say, it appears your may have been 'eye coordination' and/or 'convergence insufficiency' rather than retinopathy. The causes of these conditions seem to be hard to pinpoint.

Good to hear your eyesight was not affected.

I did need a new prescription when I eventually went to the optician as my eyes had changed a bit anyway and even that one has needed changing recently. A bit ouch on the pocket as my lenses are expensive.
I have a macular scan at my optician and that has actually improved.
When blood glucose changes the environment in your eye changes from being 'sugary' back to more normal 'salty so the shape of the eye changes so altering the focal length and the brain has to adjust to a rapid change. Whereas when it changed in the first place it was slow and the brain was able to compensate.

 

[JITR]

You’re expecting way too much from your GP. They’re a generalist, they know very little about the details of diabetes.

Actually, I would not have expected my GP to say a VLCD might result in retinopathy. AFAIK there is no evidence for that. If it were so there would plenty of cases among participants in the NHS Pathway to Remission programme which now treats about 20,000 T2Ds a year!!!

There is evidence that a VLCD or LCD may result in EWDR (Early Worsening of Diabetic Retinopathy) in those who alrdy have retinopathy. That's why the programme requires all referrals to have been screened for DR and not to have untreated proliferative retinopathy.

 

[JITR]

@LeighB
To bring all this back on track, general advice on avoiding T2D complications is to get your blood glucose down. Ideally your HbA1c should be less than 40 mmol/mol. That is at least 66 mmol/mol lower than your HbA1c of 106 mmol/mol at diagnosis.

The maximum reduction you can expect from metformin is probably less than 2 HbA1c percentage points, that is less than 22 mmol/mol as @everydayupsanddowns pointed out. The rest is basically down to you and your diet, and as much exercise as you can manage.

 

[silver minion]

@LeighB
To bring all this back on track, general advice on avoiding T2D complications is to get your blood glucose down. Ideally your HbA1c should be less than 40 mmol/L. That is at least 66 mmol/L lower than your HbA1c of 106 mmol/L at diagnosis.

The maximum reduction you can expect from metformin is probably less than 2 HbA1c percentage points, that is less than 22 mmol/L as @everydayupsanddowns pointed out. The rest is basically down to you and your diet, and as much exercise as you can manage.

Just to clarify for Newbies. HbA1c is measured in mmol/mol. Finger prick testing is in mmol/l

 

[JITR]

Just to clarify for Newbies. HbA1c is measured in mmol/mol. Finger prick testing is in mmol/l

Thank you for spotting the typo !!!

 

[JITR]

When blood glucose changes the environment in your eye changes from being 'sugary' back to more normal 'salty so the shape of the eye changes so altering the focal length and the brain has to adjust to a rapid change. Whereas when it changed in the first place it was slow and the brain was able to compensate.

@Leadinglights, I did not know that; although I now see you have mentioned it before.

Do the Diabetes UK or NHS websites explain the condition? The clearest reference I found was here from St John & St Elizabeth Hospital, London’s leading charitable hospital:

1. Diabetic Retinopathy ...
   
2. Blurred Vision

High blood sugar levels can cause the eye lens to swell, leading to blurry vision.

This is often a temporary condition and will rectify itself when blood sugar levels return to the target range (for diabetics this is 4 to 7 mmol/L before meals and under 9 or 8.5 mmol/L two hours after eating). However, it can take as long as three months for vision to return to normal.

It’s always best to seek medical advice if there are any changes in your eyesight. A doctor can ascertain the cause and recommend the most appropriate treatment.

 

[Leadinglights]

@Leadinglights, I did not know that; although I now see you have mentioned it before.

Do the Diabetes UK or NHS websites explain the condition? The clearest reference I found was here from St John & St Elizabeth Hospital, London’s leading charitable hospital:

1. Diabetic Retinopathy ...
   
2. Blurred Vision

High blood sugar levels can cause the eye lens to swell, leading to blurry vision.

This is often a temporary condition and will rectify itself when blood sugar levels return to the target range (for diabetics this is 4 to 7 mmol/L before meals and under 9 or 8.5 mmol/L two hours after eating). However, it can take as long as three months for vision to return to normal.

It’s always best to seek medical advice if there are any changes in your eyesight. A doctor can ascertain the cause and recommend the most appropriate treatment.

It never occurred to me at the time as my vision hadn't changed when my HbA1C had crept up to 50 but there was certainly an effect when it dropped again. I knew about changes in vision when blood glucose was very high and it could happen quite suddenly but never realised it was an issue if it dropped quickly.

 

[Jodee]

Welcome Leigh, hope you will be well looked after by your surgery and with the help of meds, diet and exercise you will soon have your blood glucose levels way down.

 

[Lisaaa]

Hi. Please don’t panic. It’s a natural response. I was weighing myself about 5 times a day and doing a finger prick about every 3 hours in my first month. I became overwhelmed. The carbs and calories app helped me understand. This forum is a great place for support and advice. Good luck on your journey.

 

[Leadinglights]

Hi. Please don’t panic. It’s a natural response. I was weighing myself about 5 times a day and doing a finger prick about every 3 hours in my first month. I became overwhelmed. The carbs and calories app helped me understand. This forum is a great place for support and advice. Good luck on your journey.

It might be reasonable to weigh yourself each morning but bear in mind your weight will vary throughout the day depending on how much fluids you have drunk and how often you visit the loo. 1litre of water weighs 1kg. Finger prick testing needs to be for a purpose and be strategic otherwise it tells you nothing.0
Testing before you eat and after 2 hours will give you an idea of whether your meal is tolerated and testing first thing in the morning can keep a check on progress day to day, week to week, etc or if you feel unwell./