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Advice regarding managing Type2 without medication.

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maredcam18

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Type 2
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My Type 2 was diagnosed during 2012 at the same time that I was training at the gym for a six-day hike in Iceland. I continued training at the gym for several months after returning from Iceland and eventualy reduced my glucose from 6.9 to 6.4.
I have never been obese, there is a family history of Type 2, and my weight at my recent annual check-up was 60kg; it rarely fluctuates.
However my HbA1c has increased from 48 to 49 and the note from the lab suggests that I discuss with my health provider the need to start taking Metformin. My telephone review will take place on Thursday 24th and I am tempted to ask for another review in six months time instead of rushing into the medication solution.
I have googled the subject of pre-diabetes and read how long-term exposure to glucose even at those levels can be just as damaging
so I would like to ask advice from the Community. I am approaching my 74th birthday and still active, recently completing 16.5 miles on the moorland surrounding my home town.
I no longer attend the gym but wonder if it would be a good idea to resume the activity. As my physique is 'skinny' it occasionally raised a few eyebrows of the 'pump-it-up' group inside the gym. I have weights and stress bands at home and do the occasional plank etc. but I tend not to be disciplined.
 
maredcam18 said:
My Type 2 was diagnosed during 2012 at the same time that I was training at the gym for a six-day hike in Iceland. I continued training at the gym for several months after returning from Iceland and eventualy reduced my glucose from 6.9 to 6.4.
I have never been obese, there is a family history of Type 2, and my weight at my recent annual check-up was 60kg; it rarely fluctuates.
However my HbA1c has increased from 48 to 49 and the note from the lab suggests that I discuss with my health provider the need to start taking Metformin. My telephone review will take place on Thursday 24th and I am tempted to ask for another review in six months time instead of rushing into the medication solution.
I have googled the subject of pre-diabetes and read how long-term exposure to glucose even at those levels can be just as damaging
so I would like to ask advice from the Community. I am approaching my 74th birthday and still active, recently completing 16.5 miles on the moorland surrounding my home town.
I no longer attend the gym but wonder if it would be a good idea to resume the activity. As my physique is 'skinny' it occasionally raised a few eyebrows of the 'pump-it-up' group inside the gym. I have weights and stress bands at home and do the occasional plank etc. but I tend not to be disciplined.
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Welcome to the forum
For someone who is fit and active and the age you are the NICE guidelines are that the diagnostic threshold of 48mmol/mol should be more lenient and therefore they should find where you are acceptable.
However there is no need even for someone who is younger with an HbA1C so close to the diagnostic threshold to be prescribed medication and they should be given the opportunity to make some dietary changes which should bring their level down.
In your case and only if you want to reduce it a bit then just making some modest changes in reducing your carb intake, so maybe not so many cakes, biscuits or sugary drinks and reducing your portion of a couple of big hitters like potatoes, rice and pasta and making sure you have plenty of protein and healthy fats as it sounds as if you don't need to lose weight.
It sounds as if it was a generic summons without looking at your personal circumstance.
 
Thank you for the feedback. I do have a healthy diet and rarely eat cake etc. Only at coffee shops with my latte; most times large latte only. My wife loves bread and there is always some in the house so it is tempting, when busy, to spread hummus on two slices of sourdough. I mostly eat fish when not preparing a vegetarian meal, and add vegetables instead of rice or potatoes. I think there is occasionally portion-creep but usually I keep an eye on it.
 
maredcam18 said:
My Type 2 was diagnosed during 2012 at the same time that I was training at the gym for a six-day hike in Iceland. I continued training at the gym for several months after returning from Iceland and eventualy reduced my glucose from 6.9 to 6.4.
I have never been obese, there is a family history of Type 2, and my weight at my recent annual check-up was 60kg; it rarely fluctuates.
However my HbA1c has increased from 48 to 49 and the note from the lab suggests that I discuss with my health provider the need to start taking Metformin. My telephone review will take place on Thursday 24th and I am tempted to ask for another review in six months time instead of rushing into the medication solution.
I have googled the subject of pre-diabetes and read how long-term exposure to glucose even at those levels can be just as damaging
so I would like to ask advice from the Community. I am approaching my 74th birthday and still active, recently completing 16.5 miles on the moorland surrounding my home town.
I no longer attend the gym but wonder if it would be a good idea to resume the activity. As my physique is 'skinny' it occasionally raised a few eyebrows of the 'pump-it-up' group inside the
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blimry you put a lot of people to shame who are half your age. good luck and welcome to the forum Remember no question to small or to silly Let us know how it goes
 
I was going to add some words of wisdom, but I think @Leadinglights has pretty much said what I would have.

Sometimes, I think it's too easy for a doctor to follow the guidelines in order not to be wrong and to be seen as doing right without understanding the patient's needs and circumstances ??
 
We are the same age, but I'd never drink a latte, eat high carb bread, or legumes, as they would cause spikes in blood glucose.
I am a very carnivorous eater, with very low intake of carbs to keep my HbA1c in the low 40s - I was left with high glucose levels for years before diagnosis and I think it broke something.
Before your appointment I'd suggest totting up the amount of carbs in various drinks and foods to see if there is room to reduce them with reductions or swaps, and putting your plan forward. You aren't far into the diabetes range, so it shouldn't require all that much alteration, unless it is an indication of you developing into something more complex than a very ordinary type 2.
 
Welcome to the forum @maredcam18 This is definitely the right place to ask questions. You appear to be in great health and if I can get my bg levels to match yours I will be a very happy lady. Hope your appointment goes well. Don't be bullied into medication if you would rather use diet and exercise to manage your diabetes as your blood glucose is not significantly high. My doctor wanted to put me on stating 18 months ago as my cholesterol was a little high. Blood pressure etc was all fine so I said I would manage with diet and exercise and review in 6 months. Levels back down to normal range for LDL and HDL increased a bit so nurse happy at annual review.
 
Thank you all for your responses back in October 2024. The outcome of my annual Type2 diabetes review was that I requested a further six months before deciding on whether to consider taking Metformin. Therefore I have a further three months before giving the blood sample.
I would like your opinions on my breakfast regime which is a daily serving of 70gms of organic oats {Flahavan's) or the Scotts Old Fashioned Oats; both quite coarse. I add a handful of Almonds, Brazils, Walnuts and Pecans, then a teaspoon of ground linseed, a teaspoon of Chia seeds, half a teaspoon of ground Cardomam,the same with ground Cinnamon, a teaspoon of Green & Blacks Cocoa. I usually eat a small apple with approximately ten blueberries after the oats.
Before the oats I rehydrate with a tall glass of warm water and a teaspoon of organic Ashwagandha.
At the review I asked if a savoury breakfast would be a better start to the day. I have a book 'Glucose Revolution' by the author Jessie Inchauspe, who recommends savoury breakfasts rather than grains. I have doubts about certain claims of hers, such as eating vegetables first, proteins and fats second, starch (carbs) last. I am not convinced that the first layers will slow down the absorption of the starches; what are your opinions? I would also like your opinions on drinking diluted Apple Cider Vinegar before a meal.
The GP also commented that as I am quite thin my pancreas is probably tiring and my diet will not necessarily control the HbA1C without the medication. One last point: I drink a few cups of coffee after breakfast and occasionally when out of the house. What are your thoughts?
I look forward to your comments
 
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@maredcam18 I don't eat oats, or any grain, no more than a dozen or so apples in a year, off my own trees, when I have berries I eat a mixture usually after adding them to sugar free jelly and adding cream. My usual carb intake is under 40 gm a day, which keeps me in the very close to normal range.
My experience with the slimming shakes makes me suspect that I spike when carbs are easily accessible so raising my last Hba1c to 48. I have read a lot about almost magical ways to eat along with claims of lowering all sorts of things - but I did CNAA Biology and then got a degree from the Open University. Having been asked to provide links when making statements, you may find that this website answers the question of the effectiveness of eating things in a certain order.

Digestion, absorption and transport of carbohydrates

Whenever we eat something, not only are we eating a delicious snack or meal, we’re also ingesting the molecular compounds and elements that make up those f...
www.sugarnutritionresource.org www.sugarnutritionresource.org
 
maredcam18 said:
Thank you all for your responses back in October 2024. The outcome of my annual Type2 diabetes review was that I requested a further six months before deciding on whether to consider taking Metformin. Therefore I have a further three months before giving the blood sample.
I would like your opinions on my breakfast regime which is a daily serving of 70gms of organic oats {Flahavan's) or the Scotts Old Fashioned Oats; both quite coarse. I add a handful of Almonds, Brazils, Walnuts and Pecans, then a teaspoon of ground linseed, a teaspoon of Chia seeds, half a teaspoon of ground Cardomam,the same with ground Cinnamon, a teaspoon of Green & Blacks Cocoa. I usually eat a small apple with approximately ten blueberries after the oats.
Before the oats I rehydrate with a tall glass of warm water and a teaspoon of organic Ashwagandha.
At the review I asked if a savoury breakfast would be a better start to the day. I have a book 'Glucose Revolution' by the author Jessie Inchauspe, who recommends savoury breakfasts rather than grains. I have doubts about certain claims of hers, such as eating vegetables first, proteins and fats second, starch (carbs) last. i am not convinced that the first layers will slow down the absorbtion of the starches; what are your opinions? I would also like your opinions on drinking diluted Apple Cider Vinegar before a meal.
The GP also commented that as I am quite thin my pancreas is probably tiring and my diet will not necessarily control the HbA1C without the medication. One last point: I drink a few cups of coffee after breakfast and occasionally when out of the house. What are your thoughts?
I look forward to your comments
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If you are trying to manage your condition by diet only then the breakfast you are having would be way too high in carbohydrates for many people to tolerate, the oats are going to be 50g carbs, the apple and blueberries another 20g ish at a time when many people are more sensitive to carbs.
Many people have something like full fat Greek yoghurt ,berries or nuts and seeds with a very small amount of a low sugar or keto granola. Eggs in any form are also a good option.
If you are following a low carb regime which would be less than 130g carbs per day you are blowing more than half your carbs for the day on breakfast which is almost all carbs with little protein or healthy fats.
 
As far as breakfasts go for diabetics, you can't actually beat a "full English" but obviously without hash browns or toast. While your current breakfast sounds really healthy, it's not perfect for a diabetic.
For weekday breakfasts I usually have a 2 egg cheese and mushroom omelette. At the weekends I push the boat out and have 2 boiled eggs with a slice of wholemeal toast cut into soldiers as a treat. I stick to berries for my fruit intake and top up my 5+-a-day with loads of green leafies at tea time.
I drink a lot of coffee, but make sure I count the milk as part of my daily carbs.
 
Breakfast for me is either
Two rashers of back bacon and a poached egg or
Smoked salmon in scrambled eggs
Plus two cups of coffee minimum with oat milk (no added sugar)
 
In winter I have oat porridge a few times a week but only 40g with 80ml whole milk and a little cinnamon. Summer is usually full fat yoghurt with seeds and berries. Other options are two small slices seeded toast with either nut butter (currently cashew) marmite or poached eggs. Enjoy a full English a couple of times a month, bacon,scrambled eggs, mushrooms, beans and tomatoes. Bear in mind I eat to a medium carb level because of the gliclazide, but plan to reduce medication and carbs at next review in Feb.
 
@maredcam18

About glucose levels
maredcam18 said:
I have googled the subject of pre-diabetes and read how long-term exposure to glucose even at those levels can be just as damaging so I would like to ask advice from the Community. I am approaching my 74th birthday and still active ...
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On this subject:
Leadinglights said:
For someone who is fit and active and the age you are the NICE guidelines are that the diagnostic threshold of 48mmol/mol should be more lenient and therefore they should find where you are acceptable.
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Please open NICE Type 2 diabetes, Patient decision aid: agreeing myblood glucose (HbA1c) target and scroll down to the last page. Looking at the text box to the right of the bottom arrow, you will see what Leadinglights says is correct when Thinking about my age and my health overall, my quality of life in the shorter term is more important to me.

On the other hand, you seem to be in good health and you may decide Thinking about my age and my health overall, my quality of life in the long term is important to me, as I did aged 80. If that is the case, as your concern about the effect of prediabetic levels suggests, your target should be to get HbA1c down below 39. To do that diet is the priority, along with all the exercise you can manage.

If your waist measurement is more than it once was, you may need to lose a bit of weight to get it down. The reason is fat in your liver and your pancreas, watch this short video of Prof Roy Taylor's advice to doctors.

Given that you are slim, and your GP's advice that your pancreas does not produce so much insulin, your level of carb intake is most probably the critical factor. Drummer indicates her carb threshold is about 40g per day. Yours may be more or less. Perhaps Leadinglights will let us know the daily limit that got her down to HbA1c 35. Mine was around 55g per day during weight loss eventually resulting in HbA1c 32. My last two test results were upset bad stomach infection and I now need to find out whether 80g per day is low enough for weight maintenance.

As you have had diabetes for many years it is quite possible your carb limit will be similar to Drummer's. or even less. The authority on carbs at keto levels (roughly 20-50g per day) is Prof Tim Noakes. He was a marathon runner who damaged his pancreas by carb overloading before races. He says his threshold can be 25g on some days and zero on other days. He contributed an essay on the science of dieting to the first Real Meal Revolution book (superbly produced, with excellent recipes as is the later cookbook, and well worth getting via AbeBooks for the price of a Latte, if interested). You can download their Red, Orange, Green food lists with sample recipes foc here.

I think Jessie Inchauspe's hacks you mention are sensible. Eating some vegetables first is supported by some research. ACV is a no-no for me, affects iron levels.
 
Hi @maredcam18 I am about 10 years younger than you and can only hope to be as fit and active as yourself, well done. In terms of the gym, I have a friend who is also my PT and I was discussing the issue of weights with him due to some issues I had around inadvertent weight loss. His position is that as you get older you will naturally lose muscle mass whether you are diabetic or not and therefore some exercise involving weights is a good think as a)it will maintains and potentially enhances your muscle mass which means maintaining balance and you health generally are maintained and b)as a diabetic the more muscle mass you have, the greater the absorption of BG in your body. My diabetes nurse has also confirmed that I should look to improve my muscle mass for the same reason.

It doesn't necessarily mean you need to go to the gym, but walking/running only gets you so far and therefore doing your planks, push ups, sit ups and carrying heavy shopping bags, etc will all support your generation of more muscle. That said if you have gym membership, use it and get the benefit. I have just joined a gym and enjoy my hourly sessions amid the 10 & 12 year olds (probably older than that but they do look younger). As for the muscle men/women I ignore them. Let's see of they are still coming when they are our ages :D
 
Welcome to the forum @maredcam18. There are some good nuggets of information from posters above, but i will add my thoughts.

I am a Type 2 Diabetic, diagnosed in May with a hba1c of 84 - my last blood test in early Dec, some 7 months later was 39 - my 2nd reading below 40 which puts me in the remission category. Without ever using any medication, 100% lifestyle changes. So it can be done.

The first thing i would say is that there is no such thing as a one size fits all approach, i learned that within the first few months - what i would suggest is sponge data and information, I self fund a CGM and log my food/nutrients per meal religiously - this gives me data so i can understand what different meals, portion sizes, timing of exercise etc do to my blood sugar.

Taking oats as an example, i went from instant (spike) to steel cut oats. And there was a discenable drop in my blood sugar spikes and baseline. Adding chia seeds, nuts (almonds and walnuts), blueberries and raspberries as well as using sugar free almond milk saw that drop even further, as the healthy fats delay the release of glucose into your blood stream - my portion size of said oats is 40g. The fruit, nuts and chia seeds dampen any spike and are an excellent source of fibre. Granted this may not work for all, but it worked for me. And makes the meal more filling without needing to up your oats portion size - fibre is your best friend, so use it.

On exercise, even if you are (As you describe) slender, do not underestimate the benefit to your whole body of regular exercise - even daily walks, 2 times a day x 30 mins, is excellent for your wellbeing.

Other things i found dampen things further, turmeric infused milk in the evening as a snack (barista almond milk) is anti-inflammatory and does virtually nothing for my blood sugar in the evening (averaging around 5 - 5.7mmol/l) and when waking. Kefir (fermented milk) in the morning or as a snack does wonders for your guys biome - and also helps, with regular use, a more protracted release of blood sugar even with carb heavy meals.

I was petrified when i was first diagnosed that my love of food would be gone - far from it, i am eating better, feel better and have way more choice than ever before. So do take the time to sponge your own data and use it.
 
maredcam18 said:
I would like your opinions on my breakfast regime which is a daily serving of 70gms of organic oats {Flahavan's) or the Scotts Old Fashioned Oats; both quite coarse. I add a handful of Almonds, Brazils, Walnuts and Pecans, then a teaspoon of ground linseed, a teaspoon of Chia seeds, half a teaspoon of ground Cardomam,the same with ground Cinnamon, a teaspoon of Green & Blacks Cocoa. I usually eat a small apple with approximately ten blueberries after the oats
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If you find it would be helpful to reduce your carbs further at breakfast, you could try a switch from oats to quinoa flakes. For me this reduced the spikes that I get if I eat oats. Like you I add nuts and seeds to this along with some coconut flakes. When I make it I roast the nuts and flakes which makes it a bit crispier. I then add berries and natural yogurt, or milk if I am going to have it hot.

Like you I am a coffee drinker, but as I have it black it does not seem to impact my glucose levels, and for me nothing beats the smell of a good cup of coffee in the morning after breakfast.
 
SB2015 said:
Like you I am a coffee drinker
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Yeah I love a coffee and I'm surprised how much a dash of oat milk affects my BG. Don't like it black though except an espresso after a good meal out.

Like your idea of coconut flakes. Will explore that...
 
Welcome to the forum @maredcam18

And well done for keeping yourself so slim and active. HbA1c levels do tend to gradually rise as we get older, and as yours are just hovering around the diagnostic threshold it may be that a few relatively modest tweaks and changes are all that are required to gently nudge your HbA1c back down a little.

There is no ‘one size fits all’ approach to managing diabetes, and you can see a lot of variation in the details of different people’s approaches. Some find a slightly lower carbohydrate way of eating (eg less than 130g per day) very effective. Others find very low carb suits them better. Still others find that very low carb (less than 50g per day) actually increases insulin resistance, and slightly higher carb is better for them.

It’s all about finding an approach that is sustainable, enjoyable, and steers your results in the right direction. 🙂
 
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