3wks in and advice please

[Sweetmadriana]

Hi, I posted on the forum nearly 3 weeks ago and received some excellent responses and advice to my preliminary questions. Now I have some more specific questions that I would love help with please:

Quick recap: After feeling pretty rough for approx 6 months and having several bouts of covid/flu, I went to GP just feeling washed out and rubbish. Blood tests came back with HbA1c at 81. This was first blood test in 5 years. Previous HbA1c was 41. Started on 30mg of glicalozide daily with breakfast. Was given a BGM to check for hypos pre driving - after advice from thsi forum that I should have been given one alongside gliclazide prescription. Advised not to use the BGM too much by DN and just told to try and reduce carbs a bit and referred to DESMOND. Next blood tests etc. due in May. CT-scan early March.

I have removed bread,rice, pasta, potatoes, sweets, cake, chocolate etc from my diet almost completely. An occasional single roast potato with a roast dinner, an occasional slice of wholemeal, sugar-free or seeded bread with a lunch, a single square of 90 per cent chocolate on some nights after dinner.
I have moved to eating proteins - eggs, meat, fish with salad or vegetables mainly; avocado, nuts, apple and peanut butter, berries and natural yoghurt - no bananas. I am trying to limit my eating day to between 9.30am and 8pm.
My only real symptoms are fatigue and blurred vision -which I kept thinking was due to glasses needing cleaning! No excessive thirst or urination.
I have not started counting calories or carbs. Thought I would just take some time to get used to a low carb diet and alternative meal options.

I am putting on weight instead of losing weight. Only a couple of pounds but definitely not what I expected after eliminating carbs - but I can understand that maybe I am taking in more calories than I realise from proteins and know that the next step needs to be calorie watching - I have cook books from Hairy bikers, Michael Mosley and glucose goddess.

Getting into a set routine to include extra exercise has been a little tricky over the last couple of weeks as we are nursing a v sick dog.

My main concern is that from the BGM readings that I am taking, I start each day between 10.00-12.00 and come down to between 7.00-9.00 by the end of my eating day. I have read about the Dawn effect etc and know that a lot of people, diabetic and non-diabetic, experience this so do not know how concerned I should be.

My questions therefore are:

1) How concerning are morning BGM readings of 10-12 and evening readings of 7-9 at this stage. Would they account for me still feeling pretty lousy.
2) Is it worth asking for a GP appointment to review meds to try and reduce morning BG so soon after starting meds or wait for CT results?
3) Should I start calorie counting asap or give my body a bit more time to adjust to a low carb regime?

One of the things that I am finding a bit difficult in the literature atm are the terms, 'high' and 'very high' for BG readings alongside the warnings of how much damage they can cause in the body if they remain 'high' or 'very high' for 'too long' -but then you are also told not to stress as that isn't good for your BG either! How high is 'high' and how long is 'too long'? The literature seems to urge that you seek to address your issues 'urgently' then you are given some pills, a glucose monitor and see you in 4 months? Not wanting to be facetious - just genuinely a bit bemused by it all atm.

Thank you in advance.

 

[silver minion]

Hi, I posted on the forum nearly 3 weeks ago and received some excellent responses and advice to my preliminary questions. Now I have some more specific questions that I would love help

My questions therefore are:

1) How concerning are morning BGM readings of 10-12 and evening readings of 7-9 at this stage. Would they account for me still feeling pretty lousy.
2) Is it worth asking for a GP appointment to review meds to try and reduce morning BG so soon after starting meds or wait for CT results?
3) Should I start calorie counting asap or give my body a bit more time to adjust to a low carb regime?

One of the things that I am finding a bit difficult in the literature atm are the terms, 'high' and 'very high' for BG readings alongside the warnings of how much damage they can cause in the body if they remain 'high' or 'very high' for 'too long' -but then you are also told not to stress as that isn't good for your BG either! How high is 'high' and how long is 'too long'? The literature seems to urge that you seek to address your issues 'urgently' then you are given some pills, a glucose monitor and see you in 4 months? Not wanting to be facetious - just genuinely a bit bemused by it all atm.

Thank you in advance.

Hi there, you are doing well at only 3 weeks after diagnosis and the changes to your diet will help. It looks very sustainable to me.
1. Your BG levels are a bit high but expected given the HbA1c result. What you need to look at is the trend over weeks/months. As long as it keeps reducing you are on the right track. It took me several weeks before I started feeling better.
2. I would wait for the results of the CT scan before speaking to your doctor but also check to see if you are experiencing side effects from the gliclazide. Having said that. You seem to be on quite a low dose. Is it being increased at all (titrated) over the next month?
3. You may find carb counting and reviewing portion size if you want to lose weight. I found the Carbs and Cals book very helpful for this. Aim for third to half plate of veg which apart from some root veg tend to be low carb. Although you were advised not to test too often, probably to reduce anxiety over the numbers. It is helpful initially to test before and 2 hours after meals to see if you need to tweak the contents so the post meal rise is less than 3 mmol. You can then build up a menu of meals you can enjoy without spiking your bg.

We are all very individual and how your blood glucose behaves depends on many things, only some of which you can affect. It's recommended to bring your bg down slowly as it is kinder to the fine blood vessels and nerves. At your next review you should be looking at a lower HbA1c if the medication and dietary changes are working well. Did your doctor/nurse give you a target to aim for?
Finally if your diabetes remained untreated it is high enough to cause long term complications, but it can be managed and it's mostly down to the lifestyle changes you make and sustain. The doctors can't do much other than prescribe appropriate medication, monitor your bg and check eyes and feet for possible complications.

 

[JimmyBlue]

Hi @Sweetmadriana sounds like you have made some key steps to address the diet side of the triangle with respect to managing your diabetes. As @silver minion says over time you should see a sustained fall in BG levels. Weight gain does suggest that possibly your calorie intake is still a little high but that may simply be that you are not getting a regular amount of exercise due your ill dog. Once your exercise regime becomes more regular, the weight gain will hopefully stop.

 

[HayleyR]

Hi @Sweetmadriana it does takes a while to feel better but you'll get there; you've certainly made a great start in trying to improve your BGs. As mentioned , The Carbs and Cals book is really useful as it shows photos of various foods and portion sizes to give you an idea of meal planning Carbs & Cals | Dieting & Calorie Counting Books & App.

 

[JITR]

I have found Cronometer (free version) invaluable for tracking nutrients. Worth a look. Dietitians and nutritionists use the pro version to track diets synced by their patients.

 

[Leadinglights]

You certainly have made some good choices in reducing those high carb foods and usually people do lose weight when they reduce carbs but if on gliclazide you still need to eat some carbs as that is how the medication works in that the pancreas is stimulated to produce more insulin in response to carbs. When are you testing in the morning as you could be one of the people who get an increase as soon as they get out of bed as the liver releases glucose to give you energy in the absence of food.
Some strategic meal testing may help identify some meals which are still too high carb and will be the reason for still some high readings.
You may need an increased dose of gliclazide or a second dose in the evening, prior to your evening meal. Worth discussing with your nurse or GP

 

[Docb]

@Sweetmadriana, I'm not happy with the terminology and describing things as high or very high either and try to avoid their use although sometimes it is unavoidable.

I prefer thinking about the risks from sustained high blood glucose in terms of a chart like this which I pinched off the internet.



The top scale is your Hba1c and the bottom an "average" blood glucose from a finger prick. The colour change illustrates that there are no cut off points. The risk (not the certainty) of problems increases as the numbers increase. You slowly move from the green "no action needed" zone to the red "urgent action needed" zone.

Take your HbA1c of 81. That puts you into the amber zone- essentially saying that you need to do things to bring you back towards the green zone to reduce the risks of problems in the future. Your finger prick results - averaging 9 or so- suggest you are in the yellow zone. Neither is right or wrong, it just illustrates the problem of getting a perspective on the numbers. You can get a different picture depending on which number you use and how you look at it. Either way, doing things to get nearer the green zone is a good idea.

For myself, I had both HbA1c and finger pricks that put me in the yellow, going on amber zone. I took measures (low carb +medication) and now hover around the green/yellow zone transition. It my age I'm happy with that, the hassle needed to get well into the green zone is not worth the small reduction in risk it would achieve.

Hope that helps you to get a bit of a perspective. Your results are not the end of the world but you would be well advised to take measures to reduce your blood glucose levels. The nearer the green zone you can get, the lower the risks you are running.

 

[everydayupsanddowns]

Well done on the changes you have made @Sweetmadriana

I think you have made a great start, and you are clearly determined to actively manage your diabetes and to try to reduce your long term risks of developing diabetes nasties. In general I think the ‘long term’ in long term complications risk refers to years rather than days. There are things which can happen more rapidly (months) in certain circumstances, eg temporary changes to eyes and nerves following very rapid improvements in BG levels. And occasionally diabetes can move terrifyingly quickly (DKA), but on the whole, the things we are aiming to reduce our risk of seem to be things where risk builds up cumulatively over months and years, more than hours and days.

If I were in your shoes I think I might aim for a period of consolidation for the next couple of months, then see if I could get an updated HbA1c to see how things were going, any overall changes in weight, and how sustainable it was all feeling.