Need guidlines please

K

knittingnancy

New Member
Relationship to Diabetes
At risk of diabetes
Hi there. My name is Mary and am grateful to my health practioner for pointing me in this direction. I have been pre diabetic for about 4 years , admittedly the count has gone down but can't get it to 41 or under. My downfall is bread and potatoes, can anyone help on alternatives for those staple foods ?
 
Hello @knittingnancy and welcome to the forum.
As you are still in prediabetic numbers it might be just a case of restricting the amounts of carbohydrate foods, or rationing them to limit the number of servings per week.
My 'sandwiches' are crispy lettuce leaves filled with cold things or cheese waffles or wraps for hot fillings.
I choose lower carb vegetables as substitutes for potatoes.
 
knittingnancy said:
Hi there. My name is Mary and am grateful to my health practioner for pointing me in this direction. I have been pre diabetic for about 4 years , admittedly the count has gone down but can't get it to 41 or under. My downfall is bread and potatoes, can anyone help on alternatives for those staple foods ?
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Welcome to the forum
To be honest at your mature age and in accordance with more recent NICE guidelines an HbA1C of 41mmol/mol which is normal anyway is absolutely fine and no need to try to get it lower. So there really is no need to make changes to your diet if that is keeping you where you are.
If you really want alternatives to give you more variety then people often use butternut squash, swede, celeriac instead of potatoes but bread is more difficult but choose loaves with seed or smaller slices or just reduce the amount.
I suggest you look at this link for a few ideas https://lowcarbfreshwell.com/ but really I should not worry.
Maybe if they hassle you point them toward the NICE guidelines which came about because it was found people who were more mature were being over medicated or following too strict a dietary regime to keep them at lower HbA1C levels than was safe. It was recommended that people had a personalised plan taking into account any other medical condition which may make them at higher risk if blood glucose was high which yours isn't.
 
knittingnancy said:
Hi there. My name is Mary and am grateful to my health practioner for pointing me in this direction. I have been pre diabetic for about 4 years , admittedly the count has gone down but can't get it to 41 or under. My downfall is bread and potatoes, can anyone help on alternatives for those staple foods ?
Click to expand...
Hi, and welcome. I made some simple swaps - cauliflower mash, celeriac mash or celeriac chips for potatoes. I have also, on occasions, roasted celeriac after cutting it into roast-potato-sized chunks.

Bread's trickier but there are some low carb breads around - LivLife or HiLo, for example - but I prefer my wife's GF bread. I don't need GF but at 10.8g carb per slice it has fewer carbs than medium white (17.9g) or 50/50 (16.8) or medium wholemeal (14.7).
 
My cheese and pickle sandwich today was 2 slices of cheddar with a teaspoon of pickle in between. Not a crumb of bread in sight.

Mashed cauliflower works well as an alternative to mashed potato, with high meat content bangers or to top a cottage/shepherd's/frish pie, generously topped with grated cheese of course. I add a good dollop of full fat cream cheese to my cauli mash and a teaspoon of wholegrain mustard. Top tip is to drain the boiled cauli really well before you mash it.

Celeriac can be used to make lower carb chips which work nicely with steak and mushrooms and butternut squash can be roasted or boiled/microwaved and mashed and used to make bubble and squeak or rissoles.
 
Hi @knittingnancy and welcome to the forum.

As many on the forum will know I take a slightly different approach than most when it comes to blood glucose management for those, like us, of more mature years. I'm perfectly content that my HbA1c wanders around the high 40's and low 50's and have no intention of trying to drive it below the "at risk of diabetes" diagnosis limit. I have no short term problems from having blood glucose levels around the diabetes diagnosis limit and the potential for problems in the long term do not worry me much....it is much more likely that something other than complications from diabetes will get me first.

I am not overweight, so getting my blood glucose down to the sort of levels that the young whipper-snappers aim for will require a vast change in my diet and probably more medication. That would mean an awful lot of hassle, for, as far as I can see, no gain. In addition my DN pointed out that having had a couple of falls, lower levels of blood glucose might affect my general stability and that would be undesirable.

What was your last HbA1c? My thought for you is that if it was below, or even a bit above, the diabetes diagnosis level then push any concerns about diabetes down your priority list and review matters when you get your next HbA1c.
 
Hi Mary and welcome to the forum. Like you I really enjoy bread and potatoes and have put some substitutes in place to lower my carb intake. I make a mixed root mash using turnip, swede, celeriac and carrot. I also add a small potato to help bind it. As it makes several portions the potato doesn't add too much carbs. Butter rather than milk to add richness. Goes with pretty much anything you would have mashed potato with.
Bread is more difficult. I have reduced the amount I eat and will have a ryvita cracker with cheese or meat for lunch. Breakfast I find more challenging. Half an english muffin with poached egg or nut butter on a slice of toast. I tend to stick to seeded wholemeal. The carbs are about the same as white but I prefer the taste and it gives me added fibre and vitamins. I try and fill my plate up with veg and protein so I don't feel hungry.
The other suggestions on earlier posts are also good. I hope you find them useful. Your HbA1c is at the low end of the scale so whatever you are doing seems to be keeping you on an even keel.
 
Leadinglights said:
To be honest at your mature age and in accordance with more recent NICE guidelines an HbA1C of 41mmol/mol which is normal anyway is absolutely fine and no need to try to get it lower. So there really is no need to make changes to your diet if that is keeping you where you are.
Click to expand...

Soinds like you are doing a great job @knittingnancy - to my mind there’s no magic improvement by getting one digit below a cut-off from one digit above. It may help to make some small swaps and tweaks to your potato / bread intake, but it sounds like you are holding things nicely steady. Keep going!

These are snippets from the T2 in Adults NICE guideline which mention adjusting HbA1c targets for people who are older (very much along the lines that @Docb suggests

1.6.5 Discuss and agree an individual HbA1c target with adults with type 2 diabetes (see recommendations 1.6.6 to 1.6.10). Encourage them to reach their target and maintain it, unless any resulting adverse effects (including hypoglycaemia), or their efforts to achieve their target impair their quality of life. Think about using the NICE patient decision aid on weighing up HbA1c targets to support these discussions. [2015, amended 2022]

1.6.9 Consider relaxing the target HbA1c level (see recommendations 1.6.7 and 1.6.8 and NICE's patient decision aid) on a case-by-case basis and in discussion with adults with type 2 diabetes, with particular consideration for people who are older or frailer, if:
  • they are unlikely to achieve longer-term risk-reduction benefits, for example, people with a reduced life expectancy
  • tight blood glucose control would put them at high risk if they developed hypoglycaemia, for example, if they are at risk of falling, they have impaired awareness of hypoglycaemia, or they drive or operate machinery as part of their job
  • intensive management would not be appropriate, for example if they have significant comorbidities. [2015, amended 2022]

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk
 
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