Ageing with Type2

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Wendiferous

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Hi folks. I've joined the forum as I've found forums helpful in the past and managed my Type2 for many years with diet alone because of the wonderful supportive advice I found. I am now needing medication and so far not getting the HbA1c scores I want. I'm also finding all sorts of problems with side-effects that the health professionals seem to know little/not be concerned about. I'm hoping some of you can help with moderating the less pleasant effects or with which meds are more likely to work.
 
Hi and welcome.

Well done on managing your diabetes for so long through diet. Have you also increased your activity levels as that might be something else to explore if you are having problems with side effects of medication. Also, is there possibly any further room for dietary changes. Not knowing what sort of dietary restrictions you currently employ it is hard to comment know and views on dietary approach have changed over the years, so you may be following outdated advice with that and therefore be able to push things back with a new dietary approach.

As regards meds, the first line medication, Metformin is well known for causing digestive upset. If that is what you are experiencing, there are several things to know....
1. It is important to start with a low dose usually 1x500mg tablet a day for a week, building it up slowly to the full dose of 4 as necessary over the following weeks.
2. Taking it mid meal with a reasonably substantial amount of food, ideally low carb.
3. Digestive upset usually settles after a week or two and giving it longer between the dose increases ie 2 weeks instead of just one week or dropping back down to the previous weeks dose for longer can help.
4. There is a slow/modified release version available for those who suffer significant digestive upset with the regular Metformin.
5. Sometimes even with the slow/modified release version, one brand of tablets can affect people far worse than others. This is believed to be down to the binding and coating agents rather than the Metformin itself, so it can be worth asking to try different brands to find one that your body will tolerate.

There are also other diabetes meds and some are used in conjunction with Metformin or alone. There are supposedly over 100 combinations of meds to treat Type 2 diabetes so there should be an option if the first ones you try don't agree with you.

If you can tell us which medication you are on and the problems you are experiencing, we should be able to advise you more specifically.
 
Hi, and welcome to the forum. For how many years did you manage with diet alone? Reason I ask is that I've managed 5 years so far and my latest HbA1c (last week) confirms that I'm still below pre-diabetes range, so - so far, so good.
 
I managed about 11 years without meds and the dietary control can work well as long we you can keep motivated enough to keep going and make adjustments when needed. I do regular BSG readings 2x daily +, so am aware if baselines are creeping up or higher than usual. I do now have osteoarthritis so have had to give up the long walks I did daily as my knees will now only manage very short distances - I'm thinking about joint replacement but not yet. I miss the big muscle exercise but keep going with resistance bands and sitting exercises which helps a bit.

On GPs advice I have reduced the amount of red wine I consume in evenings (which had a good analgesic effect on my arthritis for sleeping) and my BSGs have risen as well as sleeping less well - there is a direct correlation on a day to day basis - no alcohol, 1mmol/l higher BSG baseline.

As far as meds go, I've tried and abandoned Metformin - just feeling lousy in many ways and gut very badly affected when on it. I tried Trajenta but it had little positive effect and I think made joints worse. I did Semaglutide for a year till it became available. It helped to start, and I lost some weight as well, but had little effect after the first three months. I can't get it now anyway. So I am on Forxiga, which is helping a bit but not enough. GP has now prescribed Pioglitazone in addition and I find looking at the info that it causes swelling and pain in joints, can cause increased weight and can't be used with Ibrufprofen - my one relief from the arthritis. This had not been said before prescription was issued. I'm about to go back and discuss this again...HbA1c is currently at 62.

Any suggestions welcome.
 
I wonder what your diet is like and whether there is any movement there which could help. The dietary advice from your GP may not have been to best if he is suggesting not having red wine which as it is pretty low carb generally people tolerate OK.
A bit more strategic testing of your meals may reveal some which are not helping as they are too high in carbs.
Testing before you eat and after 2 hours when an increase of no more that 3mmol/l would suggest the meal is OK, more than that the meal is too carb heavy. OK that will use more test strips but will give you better information on which to make changes.
Have a look at this link for some ideas but whether it is suitable being a low carb approach will depend on what medication you might end up on. https://lowcarbfreshwell.com/
 
Wendiferous said:
I managed about 11 years without meds and the dietary control can work well as long we you can keep motivated enough to keep going and make adjustments when needed. I do regular BSG readings 2x daily +, so am aware if baselines are creeping up or higher than usual.
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11 years is pretty good going and gives me some hope that I may not be done with diet control for a while yet. I test daily, always on waking and, these days, sometimes post-meal, with my results on a spreadsheet and a trend line inserted. So far no suggestion of an upward trend.

Sorry to hear about the things that have impacted your exercising. Can you swim? Swimming isn't load-bearing so it doesn't put pressure on the joints.
 
Was there a particular reason for the doc telling you to stop the red wine? Quality of life is also important and if you enjoyed it and it helped you sleep and gave you some relief with the arthritis, then unless it was excessive, I would want a good reason to stop. Maybe using a smaller glass or every other night might be a good compromise? It is a shame that you can't walk so much anymore, but it sounds like you are doing what you can to keep active. Have you considered swimming as being more gentle on the joints.

As regards diet, if you can give us an idea of what you currently eat we might be able to suggest lower carb alternatives which would be tasty and filling. I get what you are saying about losing motivation but in many respects that is one of the biggest benefits of this forum. You get new ideas for foods/meals/recipes to try and inspired by other people's successes. I am no great cook and mostly cook veg in the microwave and most other stuff in the frying pan, but can still turn out some tasty low carb food thanks to the suggestions from people here and being inspired just to experiment with new foods. Sometimes I just modify conventional meals and other times I try things that I have enjoyed when eating out or making my own low carb takeaways. Who would have known that curried cabbage (cabbage bhaji but not a bhaji as you know it) is irresistible when it sounds pretty yuk! I have it left over for breakfast the next day.... if there is any leftover. 🙄Lots of more appetising sounding meals though if curry isn't your thing. How about steak and mushrooms for breakfast. It doesn't have to be all sack cloth and ashes by any means.
 
I eat no major carbs at most meals. I eat very regularly - three meals a day and everything pretty well is cooked from scratch - I am a foodie and good cook ,so we eat very well but a lot less of things than we used to. I do have some very good low-carb recipes which I'm always happy to share.... I never eat pasta, and only very small quantities of bread, potatoes or rice on rare occasions (usually when I'm cooking for family and they are on the table for them). I eat no "sugar" foods at all - one square of very dark chocolate being my only naughty treat once or twice a week.

I did a lot of testing before and after meals in the first year or two to work out what caused spikes and not, and my diet has kept to what seemed best at the time. I now only test before and after meals if I think there is a particular problem, but it may be worth doing that again for a while.

Since going on the meds I have not been able to avoid the carbs totally as I used to - I feel really ill sometimes if I've had no carb in a meal, so I've been having small portions once or twice a day. Up till then and as much as I can now I basically live on high quality proteins - fish, meat, some legumes and cheese with and lots and lots of veg. I have avoided most fruits in the past - mangos, pineapples etc as they cause big spikes, but now am using those now and again rather than carby foods when I can't tolerate no carbs at all. Strawberries and blueberries in small quantities work fine. If I snack it's usually nuts or seeds (and pork scratchings are good) and I'm reasonably well disciplined at not snacking between meals most of the time. I eat dinner at 5pm and rarely snack in the evening if I have a glass of red wine or two. If it's a no wine evening I usually finish up with a low-alcohol beer - (much more sugar) - and some snacks as well. Before the meds it worked well - only occasionally going to bed with BSGs higher than 8, but since going onto meds that is much more frequent. I am having to have a small slice of bread or a potato with a meal sometimes, or between meals as I can no longer manage without. I am wondering if I am now just not producing enough insulin, but have no idea how to test that out.
 
Martin, just seen your post - I used to swim a mile a couple of times a week in my forties and fifties, but after that got fed up with the effort of getting to pool, the horrible changing environment, grotty kids and then the chlorine affecting my skin and hair badly. I now only enjoy the occasional splash when on holiday with a private pool to enjoy. After your prompt, I'll put it on the list to see if there is a private pool somewhere in the vicinity I could use and enjoy, but the knees are now so bad I'm not sure I'd enjoy it... Thanks for the idea though.
 
It sounds like you have very much followed the advice we would give here on the forumregarding low carb. The other option would be to try a short term 8-12 weeks very low calorie diet like the Newcastle/Fast 800 diet to see if you can burn off any visceral fat around your liver and pancreas and restore pancreatic function that way assuming you are actually Type 2. Just to clarify, it is not unknown for people to be misdiagnosed as Type 2 in later life when they are in fact a slow onset Type 1 often referred to as LADA. 11 years would be a long time to keep it under wraps but not impossible especially as you have adopted a low carb approach throughout that time. Or it could possibly be Type 3c although if you had a diseased pancreas you would likely not find it comfortable to drink red wine regularly.

Could you tell us a bit about your original diagnosis? How it came about? Things like.... were you symptomatic and if so which symptoms or was it discovered via a routine blood test? Do you know what your HbA1c was at diagnosis? Maybe not the actual figure unless you have access to your notes, but if it was especially high all of a sudden or if it was just slightly elevated. Were you overweight at diagnosis and progressively gaining a bit of weight or was there some notable weight loss.

To answer your question, a C-peptide test would show how much insulin you are actually able to produce an it is one of the tests used to try to identify Type 1 patients. There is no specific test for Type 2, people are just assumed to be Type 2 unless there are clinical factors which suggest something else and even then those are often overlooked at primary care level where many GPs still believe that Type 1 only develops in children and young adults, so if you are a mature adult, it simply must be Type 2. This is totally incorrect but because most people developing diabetes later in life are Type 2, it is an easy assumption to make based on outdated ideas or teaching.

Anyway a C-peptide test on a Type 2 diabetic who has been diagnosed 11years might ordinarily indicate that they are now low on insulin production perhaps because their pancreas has had to overproduce insulin for many years to overcome insulin resistance, so a C-peptide test at this stage might not point to Type 1. It may however indicate if insulin might be the necessary treatment for you now.... although generally they are reluctant to start people on insulin until levels get very high and all other options have failed.
 
Hi @Wendiferous Isn’t Forxiga dapaglifloxin? I was concerned when you said you felt ill without carbs as there’s a risk of DKA with dapaglifloxin and a low carb diet isn’t recommended for that reason. Do you have the means to test for ketones?
 
Wendiferous said:
I am wondering if I am now just not producing enough insulin, but have no idea how to test that out.
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Assuming you are not underweight, you could try the Newcastle diet soups and shakes or the NHS Path to remission ones for a week or so. You would have to measure your fasting glucose before and after to see how far it comes down.
Professor Roy Taylor explains it all in this video, Achieving T2D remission (May 2023). With luck yours will come down and you will need to lose some weight. Consult your GP first.
 
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These all look like possible ways forward. My initial diagnosis was in 2009 following me asking for investigation as I was suddenly feeling very tired and lacking in energy. I thought I may be anaemic. I had never had a test before that. HbA1c was 52 when blood tests came back and i was offered meds, but said I'd rather try to do dietary management. Dr laughed and said it was not easy but that was when I started to learn very fast from others who'd been working on it for years - the forums were very helpful. I brought down HbA1c to 49 within three months and took it from there. I kept it around 41-52 swinging around a bit till 2018 when it crept up to 57 then by 2021 it was up to 77. That was when I started meds - three months later I was down to 67 and was down to 58 the following year. But it has not dropped further and was back up to 73 by 2022 but we put some of that down to lockdowns and a serious reduction in exercise that followed. By then the knees were really sore! Now back to 62...

I am overweight - have been for many years, but lost 3stone when I was first diagnosed and went back up a bit over the next couple of years. My body drives maintenance at the overweight level and always creeps back up a bit after serious effort. I have lost 7lb this year since starting the Forxiga with serious dietary control but am finding it almost impossible to keep the weight loss going - my body just really objects to dropping any further! I decided when I went onto the Forxiga my body was seriously objecting to low carb but no-one and the blurb did not mention risks with low carb diet - all my health professional advisors know that is what I use to manage the diabetes. I have gone with the body and had more small portion carbs since going onto it, so suspect I am not seriously at risk of DKA but I have never tested....

I have considered asking about the Newcastle, but not sure I have the willpower or inclination - I do like my food and drink!

I do have detailed data from day 1 of diagnosis (a research background....) so have all the patterns and daily readings since then - a good data set which clearly indicates the positive red wine effect! But if I can find out if insulin production is now low that may help find ways forward without lots more testing of other drugs which don't work......
 
To avoid any misunderstanding, my suggestion is to do soups and shakes for 7-10 days only. For weight loss and maintenance another diet would be preferable from my experience.
 
Depends on what you mean by ageing.....

If you are in real wrinkly territory like me - approaching 80 - then to my mind there is good case to set targets which are more relaxed than if you are talking 30 years younger. Systems are beginning to creak generally and the long term becomes shorter by the day. For me, and the DN at the surgery, having a HbA1c a bit above the diagnosis level is likely to be the least of my problems and quite acceptable. Trying to drive it down is always going to be a hard slog that I can do without, and success might bring with it risks of low blood glucose and the effects that might have on somebody who might be getting a bit doddery for other reasons. The increased risk of long term problems from the higher HbA1c I will just let pass me by.

My only other thought is that losing excess weight is a good idea at any age. It's best to head into wrinkly territory without excess baggage limiting your physical capabilities and putting strains on all your systems - including the poor old pancreas trying to control your blood glucose levels.
 
Docb said:
My only other thought is that losing excess weight is a good idea at any age. It's best to head into wrinkly territory without excess baggage limiting your physical capabilities and putting strains on all your systems - including the poor old pancreas trying to control your blood glucose levels.
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I agree. My diagnosis came weeks after my 80th. Lost 22kg to get back to where I was 50 years ago. Transformational, very lucky.
 
JITR said:
To avoid any misunderstanding, my suggestion is to do soups and shakes for 7-10 days only. For weight loss and maintenance another diet would be preferable from my experience.
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What I had in mind, as its principles have helped me avoid weight gain for 6 months so far, is Zoe Harcombe's diet as described in this article: What should we eat?

From a research point of view, if you haven't seen it, you may find Marty Kendall's optimisingnutrition.com of interest. His database indicates nutritiously dense protein and vegetable diets are a good choice. It also supports Harcombe's separation of 'fat meals' from 'carb meals'. Tim Spector says that too, in 'Food for Life'.

Grist to the mill.
 
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