A couple of queries.

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NickS

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Relationship to Diabetes
Type 2
Hi all,
I was diagnosed with an HBA1c of 115 last October. In January it was at 53 and last month, 48.
i‘ve done this with a combination of Metformin, diet and exercise.
I was so proud of myself in January and a little disappointed in April.
i‘m a little confused as to where the glucose is coming from! I’m eating low carb. No rice, pasta, flour, cakes, biscuits, potatoes, etc since October.
I see that some people on the Forum manage to get down to the 30’s really quickly.
I’m sticking with it and hope for a further drop next time.
If anyone has any advice or can help to explain the slow down, I’d be really grateful.
take care all.
Cheers Nick.
 
Congratulations @NickS. :D You should continue being proud of yourself! Sounds like you’ve been working really hard. Well done.
 
Hi Nick, glucose is made in the liver by it "burning" fat and glycogen stored within it, and it's in addition to any glucose you'd get from food.
You had quite a high starting point at 115, so 48 mmol/mol is great progress. It's still moving in the right direction.
Keep at it, it sounds like you're doing great to me.
 
Many congratulations on a fabulous achievement so far.

Diabetes is a bit frustrating because no two people experience it quite the same, so it can be quite unhelpful to compare your progress with that of anyone else. Our bodies are all slightly different and respond in different ways. The important thing is that your levels are going in the right direction and you have made massive progress so please don't lose sight of that. Wew often say diabetes is a marathon not a sprint, so you have to look at the long term, not race for instant success and then find you can't maintain that pace.
You ask about where the glucose is coming from.....It is important to understand that our bodies break down approx. 40% of protein and 10% of fat into glucose in the absence of enough carbs. This is why Keto diets are usually quite high in fat, because of the 3 macro nutrients (carbs, protein and fat), fat contributes least to our BG levels. Our liver will also release glucose throughout the day and night to keep our vital organs fueled, so it isn't just carbs which impact BG levels, but carbs are the biggest hitter.
If you have been carrying quite a bit of visceral fat around your liver and pancreas then the liver tends to churn out more glucose than is desirable and doesn't communicate well enough with the pancreas to provide insulin to deal with it. One of the functions of Metformin is to inhibit the liver from releasing so much glucose. If you suspect you have visceral fat around these organs still, then the Newcastle or Fast 800 diet may be helpful in burning off that fat and improving more effective functioning of the liver and pancreas. It is a short term very low calorie diet specifically targeted at burning off that visceral fat. If you want to know more about that, there are quite a few threads on the forum about it and Professor Roy Taylor has written books on the subject.
 
NickS said:
Hi all,
I was diagnosed with an HBA1c of 115 last October. In January it was at 53 and last month, 48.
i‘ve done this with a combination of Metformin, diet and exercise.
I was so proud of myself in January and a little disappointed in April.
i‘m a little confused as to where the glucose is coming from! I’m eating low carb. No rice, pasta, flour, cakes, biscuits, potatoes, etc since October.
I see that some people on the Forum manage to get down to the 30’s really quickly.
I’m sticking with it and hope for a further drop next time.
If anyone has any advice or can help to explain the slow down, I’d be really grateful.
take care all.
Cheers Nick.
Click to expand...
A process called "gluconeogenesis" ("glucose new creation") plays a big role in the most common form of T2.

This involves the production of glucose from bits of fats and proteins, mainly by the liver, when it thinks not enough is coming from elsewhere - mainly to keep the brain alive while you're asleep or whatever and not eating.

The liver decides whether or not it needs to fire up this process based on the amount of insulin it detects in the blood. If it doesn't think there's enough insulin, it takes this as an indication that more glucose is needed, and fires things up. (It may seem like a clunky mechanism, but hey, that's Nature!)

With reduced insulin sensitivity, the mechanism gets disordered - the liver doesn't detect insulin, and gluconeogensis keeps chugging away, flooding out glucose. If you see high waking/fasting BG levels, it's likely due to this. And the process is continuous, so it kind of sets a high background BG level for the rest of the day.

(Metformin's major effect is to increase insulin sensitivity and reduce gluconeogensis by a commonly-quoted one-third.)

Note that the process has absolutely nothing to do with carbs. Just reducing carbs will likely have no impact on excess gluconeogenesis, and if you focus just on carbs, things may be frustrating and confusing.

What can serve to improve the situation is weight loss. The reason for the liver's reduced insulin sensitivity is commonly a build up of visceral fat surrounding it. (Over time, this build up can also occur spread to the pancreas, reducing insulin production - so you get a double hit.) Losing weight can clear the visceral fat, and restore glucose regulation.

This seems to work for very very roughly 70% of T2's. It forms the basis for the "Newcastle Diet" and the DUK-funded, NHS-supprted work of Roy taylor at Newcastle University. You can read more here: https://www.diabetes.org.uk/researc...ht/research-spotlight-low-calorie-liquid-diet

Weight loss also works with the same general effectiveness for non-overweight T2's. Recent results here: https://www.diabetes.org.uk/about_us/news/dukpc-digest-day-5-retune-study-lower-body-weight

(This was my situation.)

Like I say, this may or may not be relevant to you, but worth checking out.
 
Eddy Edson said:
A process called "gluconeogenesis" ("glucose new creation") plays a big role in the most common form of T2.

This involves the production of glucose from bits of fats and proteins, mainly by the liver, when it thinks not enough is coming from elsewhere - mainly to keep the brain alive while you're asleep or whatever and not eating.

The liver decides whether or not it needs to fire up this process based on the amount of insulin it detects in the blood. If it doesn't think there's enough insulin, it takes this as an indication that more glucose is needed, and fires things up. (It may seem like a clunky mechanism, but hey, that's Nature!)

With reduced insulin sensitivity, the mechanism gets disordered - the liver doesn't detect insulin, and gluconeogensis keeps chugging away, flooding out glucose. If you see high waking/fasting BG levels, it's likely due to this. And the process is continuous, so it kind of sets a high background BG level for the rest of the day.

(Metformin's major effect is to increase insulin sensitivity and reduce gluconeogensis by a commonly-quoted one-third.)

Note that the process has absolutely nothing to do with carbs. Just reducing carbs will likely have no impact on excess gluconeogenesis, and if you focus just on carbs, things may be frustrating and confusing.

What can serve to improve the situation is weight loss. The reason for the liver's reduced insulin sensitivity is commonly a build up of visceral fat surrounding it. (Over time, this build up can also occur spread to the pancreas, reducing insulin production - so you get a double hit.) Losing weight can clear the visceral fat, and restore glucose regulation.

This seems to work for very very roughly 70% of T2's. It forms the basis for the "Newcastle Diet" and the DUK-funded, NHS-supprted work of Roy taylor at Newcastle University. You can read more here: https://www.diabetes.org.uk/researc...ht/research-spotlight-low-calorie-liquid-diet

Weight loss also works with the same general effectiveness for non-overweight T2's. Recent results here: https://www.diabetes.org.uk/about_us/news/dukpc-digest-day-5-retune-study-lower-body-weight

(This was my situation.)

Like I say, this may or may not be relevant to you, but worth checking out.
Click to expand...
Thanks so much for taking the time to reply. I wasn’t too overweight, or so I thought, but I have. Lost 2.5 stone and my BMI is now where it should be. I don’t really want to lose much more weight, but I have. Read about the Fast 800 and am considering it. I started at around 16 stone and a m now 13.5 stone. At 6’2” I don’t want to too much lower.
you seem to have absolutely smashed it. Amazing work and equally amazing knowledge.
Thank you.
 
Eddy Edson said:
A process called "gluconeogenesis" ("glucose new creation") plays a big role in the most common form of T2.

This involves the production of glucose from bits of fats and proteins, mainly by the liver, when it thinks not enough is coming from elsewhere - mainly to keep the brain alive while you're asleep or whatever and not eating.

The liver decides whether or not it needs to fire up this process based on the amount of insulin it detects in the blood. If it doesn't think there's enough insulin, it takes this as an indication that more glucose is needed, and fires things up. (It may seem like a clunky mechanism, but hey, that's Nature!)

With reduced insulin sensitivity, the mechanism gets disordered - the liver doesn't detect insulin, and gluconeogensis keeps chugging away, flooding out glucose. If you see high waking/fasting BG levels, it's likely due to this. And the process is continuous, so it kind of sets a high background BG level for the rest of the day.

(Metformin's major effect is to increase insulin sensitivity and reduce gluconeogensis by a commonly-quoted one-third.)

Note that the process has absolutely nothing to do with carbs. Just reducing carbs will likely have no impact on excess gluconeogenesis, and if you focus just on carbs, things may be frustrating and confusing.

What can serve to improve the situation is weight loss. The reason for the liver's reduced insulin sensitivity is commonly a build up of visceral fat surrounding it. (Over time, this build up can also occur spread to the pancreas, reducing insulin production - so you get a double hit.) Losing weight can clear the visceral fat, and restore glucose regulation.

This seems to work for very very roughly 70% of T2's. It forms the basis for the "Newcastle Diet" and the DUK-funded, NHS-supprted work of Roy taylor at Newcastle University. You can read more here: https://www.diabetes.org.uk/researc...ht/research-spotlight-low-calorie-liquid-diet

Weight loss also works with the same general effectiveness for non-overweight T2's. Recent results here: https://www.diabetes.org.uk/about_us/news/dukpc-digest-day-5-retune-study-lower-body-weight

(This was my situation.)

Like I say, this may or may not be relevant to you, but worth checking out.
Click to expand...
Thank you I will read those links. You’re right, frustrating, but I do find it all very interesting.
 
rebrascora said:
Many congratulations on a fabulous achievement so far.

Diabetes is a bit frustrating because no two people experience it quite the same, so it can be quite unhelpful to compare your progress with that of anyone else. Our bodies are all slightly different and respond in different ways. The important thing is that your levels are going in the right direction and you have made massive progress so please don't lose sight of that. Wew often say diabetes is a marathon not a sprint, so you have to look at the long term, not race for instant success and then find you can't maintain that pace.
You ask about where the glucose is coming from.....It is important to understand that our bodies break down approx. 40% of protein and 10% of fat into glucose in the absence of enough carbs. This is why Keto diets are usually quite high in fat, because of the 3 macro nutrients (carbs, protein and fat), fat contributes least to our BG levels. Our liver will also release glucose throughout the day and night to keep our vital organs fueled, so it isn't just carbs which impact BG levels, but carbs are the biggest hitter.
If you have been carrying quite a bit of visceral fat around your liver and pancreas then the liver tends to churn out more glucose than is desirable and doesn't communicate well enough with the pancreas to provide insulin to deal with it. One of the functions of Metformin is to inhibit the liver from releasing so much glucose. If you suspect you have visceral fat around these organs still, then the Newcastle or Fast 800 diet may be helpful in burning off that fat and improving more effective functioning of the liver and pancreas. It is a short term very low calorie diet specifically targeted at burning off that visceral fat. If you want to know more about that, there are quite a few threads on the forum about it and Professor Roy Taylor has written books on the subject.
Click to expand...
Thank you, really appreciate your response. I have read a bit by Michael Mosely and Roy Taylor. Now I’m going to read some more. Cheers.
 
My BG was 84 in March 2021 and I got to 48 in July 2022 through low carb diet and exercise. I had my HBa1c last week, along with FBC, cholesterol and kidney function. Apparently a dr will ring tomorrow to discuss my results which always makes me worry something is wrong! However there is no nurse at the practice at the moment so maybe thats why. Your results are good, we are all different and what works for one doesn't necessarily for another. Low carb has helped me the most
 
NickS said:
I have read a bit by Michael Mosely and Roy Taylor.
Click to expand...
Prof Tayor's books were the ones that encouraged me to lose weight to try and get my diabetes less out of control than when I was diagnosed. I can recommend looking up some of Taylor's talks on youtube, like you say, it's a fascinating subject.
Best wishes with your continuing exercise and weight loss plans, Sarah
 
Prof Taylor is the GP behind the low carb programme which is run in conjunction with the NHS. Its about 69.00 for 12 months and I found it invaluable. It helped to keep me on track because I was able to ask questions, join in with zoom meetings with others like me, log my food so I could see how much fat/ sugar/ carbs etc I was eating, find new recipes, read lots of good articles and get help from the health coaches. If I had done it all by myself I don't think I would have lost 2 stone and helped my diabetes.
 
I think 115 down to 48 is pretty good going. Well done!

I got mine down with a low carb diet - less than 50g a day, but it was mainly to reduce weight. (I was overweight, and not far from obese.)
 
pinkjude said:
Prof Taylor is the GP behind the low carb programme which is run in conjunction with the NHS. Its about 69.00 for 12 months and I found it invaluable. It helped to keep me on track because I was able to ask questions, join in with zoom meetings with others like me, log my food so I could see how much fat/ sugar/ carbs etc I was eating, find new recipes, read lots of good articles and get help from the health coaches. If I had done it all by myself I don't think I would have lost 2 stone and helped my diabetes.
Click to expand...
FWIW, I think maybe you mean somebody different - maybe Dr Unwin?
 
Unwin doesn’t charge or run a low carb program, but has been using low carb with his patents.

Diabetes.co.uk (Not sure what it is, but their office is on the same business park I work on) do run a low carb program and charge for it:

Low Carb Program - Sustainable Weight Loss and Blood Glucose Control

Low Carb Program is a digital solution for obesity, prediabetes, type 2 diabetes, NAFLD and PCOS that supports weight loss and blood glucose control.
www.lowcarbprogram.com www.lowcarbprogram.com

Nothing to do with Taylor or Unwin, but a commercial venture.

Unwin has worked with the Caldesis and has written about low carb in their recipes books.
 
harbottle said:
Unwin doesn’t charge or run a low carb program, but has been using low carb with his patents.

Diabetes.co.uk (Not sure what it is, but their office is on the same business park I work on) do run a low carb program and charge for it:

Low Carb Program - Sustainable Weight Loss and Blood Glucose Control

Low Carb Program is a digital solution for obesity, prediabetes, type 2 diabetes, NAFLD and PCOS that supports weight loss and blood glucose control.
www.lowcarbprogram.com www.lowcarbprogram.com

Nothing to do with Taylor or Unwin, but a commercial venture.

Unwin has worked with the Caldesis and has written about low carb in their recipes books.
Click to expand...
That looks like it might be the one.

FWIW, Unwin is or has been involved with it, at least as an author on their published research paper: https://diabetes.jmir.org/2018/3/e12/
 
Interesting, he never mentions this on any of his tweets or in any of the other stuff I've seen him write. When I was first diagnosed I looked at it, but couldn't see the point of paying for something that I could do myself.
 
harbottle said:
Interesting, he never mentions this on any of his tweets or in any of the other stuff I've seen him write. When I was first diagnosed I looked at it, but couldn't see the point of paying for something that I could do myself.
Click to expand...
Oh, fwiw, he's actually "Medical Advisor" to the program:

www.dietdoctor.com

Dr. David Unwin, MD - Diet Doctor

Interviews Presentations
www.dietdoctor.com www.dietdoctor.com

Additionally, Dr. Unwin is the medical advisor at the popular Low Carb Program
 
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