BG without insulin - cause for hope?

[dannybgoode]

So, long story short - I was very stressed yesterday and operating on far far less sleep than I would like. In my haste to get to work very early for a much needed 'get stuff off my chest' chat with colleagues (which went really well thankfully) I forgot to restock my bit bag with needles.

In the end I decided a few hours eating without my NR wouldn't hurt and I could keep an eye on my BG anyway in case so ended up very much going through a couple of hours of comfort eating. Well, the best I could given the supplies available in the office.

Ended up having 2x slices of fruit bread toast, 2x crumpets, a large Cornish pasty and a spiced chai latte. The 'spice' was basically a flavoured syrup sauce. So, not exactly what you would call carb-lite

Anyway, I tested my BG after 3 hours or so and it was only(?) 12. Am I right to think a relatively low reading like this gives cause for hope that I can do something with my own in-house insulin? More experimenting needed perhaps...

 

[Leadinglights]

I wouldn't be overly optimistic as after 2 hours which is what time many would look at it would probably have been 15 plus which when we would be aiming at no more than 8.5 would be very high but you did have a huge amount of carbs, I would estimate what you had as more than 100g carbs. Seeing what would happen with a more sensible amount of carbs for a meal like 30-40g would give you a better idea.

 

[rebrascora]

I would say, yes that is cause for a little optimism. I would have been mid 20s or probably higher after that lot and especially if I was stressed as that also pushes my levels up. Obviously if you are looking to come off insulin, you will need to manage your diet better, as the oral medication alone will struggle to keep your levels in bounds long term.

 

[dannybgoode]

I would say, yes that is cause for a little optimism. I would have been mid 20s or probably higher after that lot and especially if I was stressed as that also pushes my levels up. Obviously if you are looking to come off insulin, you will need to manage your diet better, as the oral medication alone will struggle to keep your levels in bounds long term.

Oh yesterday was a blip - I've been much more sensible than that by and large! Just yesterday was one of those days!!

In with the DSNs on Monday so will see what they say...

 

[rebrascora]

Yes, sorry, it wasn't intended as critical. We all have days where we struggle from time to time. Was more meant to say that if you were only on 12 3 hours after that lot, then there is some hope that you may be able to manage at least without bolus insulin.

 

[dannybgoode]

Yes, sorry, it wasn't intended as critical. We all have days where we struggle from time to time. Was more meant to say that if you were only on 12 3 hours after that lot, then there is some hope that you may be able to manage at least without bolus insulin.

Oh no criticism taken 🙂. I know I need to work on diet a bit. Got to be mindful of fueling appropriately for my training too.

See what the DSNs say on Monday and plan from there...

 

[goodybags]

Just a suggestion I’m thinking about something that might help you @dannybgoode
but are you still using CGM ?

 

[dannybgoode]

but are you still using CGM ?

That's a sore point!! . No is the quick answer...

 

[goodybags]

I didn’t mean to rub salt into the wounds, BUT wanted to make you aware of something - I’ve recently been made aware of, there is something where they (DSN/ GP) can for some of us now access funding to try and get us T2 D’s off Insulin that was all
might be worth a check out that was my thoughts that’s all,

 

[dannybgoode]

I didn’t mean to rub salt into the wounds, BUT wanted to make you aware of something - I’ve recently been made aware of, there is something where they (DSN/ GP) can for some of us now access funding to try and get us T2 D’s off Insulin that was all
might be worth a check out that was my thoughts that’s all,

No offence taken 🙂. My DSNs are much more supportive of the idea of a CGM even for T2's than the consultant so it is a battle I am prepared to revisit.

Just right now I have so much going on with my son that I need to focus on that more than anything. However, if there is an opportune moment to raise it on Monday I will as it would be useful whether I stay on insulin or not.

 

[dannybgoode]

So, I have a bit of a better comparison to stay digging into things a little bit.

Two graphs from yesterday and today at lunchtime. Pretty much identical meal - 1 small chocolate bar (dieticians orders!) @ 10g carbs, a protein shake (protein powder, half a banana and whole milk) and yesterday was an apple, today a pear. Total carbs around 45g.

Forgot to take my insulin to work today so an enforced 'experiment'. Not a great result but BG did ultimately come down to 6.5 but was way over 2hrs to get to <8 without insulin.

Even with it took 2hr30.

But, at least I can now see this kind of thing much better than just from FP readings and it'll be interesting to do more comparisons if I can tolerate the Metformin.

 

[rebrascora]

Is this menu for your stoma? I just find it really odd that a dietician is recommending you eat a chocolate bar! Especially when you are having other sweet foods like a banana and apple/pear.

 

[dannybgoode]

Is this menu for your stoma? I just find it really odd that a dietician is recommending you eat a chocolate bar! Especially when you are having other sweet foods like a banana and apple/pear.

Both dieticians and DSNs I have seen as part of my diabetes follow ups are very insistent that yes you need to be sensible but also that you should still enjoy life. I agree.

Conversation went

Me: I used to really enjoy chocolate and probably ate too much of it.
DSN/Dietician - Do you still have any?
Me: Yes, just a small 'fun sized' bar a day
Them: Good

This seems very sensible - no point depriving oneself of small treats IMO. Life becomes dull otherwise.

 

[rebrascora]

Both dieticians and DSNs I have seen as part of my diabetes follow ups are very insistent that yes you need to be sensible but also that you should still enjoy life. I agree.

Conversation went

Me: I used to really enjoy chocolate and probably ate too much of it.
DSN/Dietician - Do you still have any?
Me: Yes, just a small 'fun sized' bar a day
Them: Good

This seems very sensible - no point depriving oneself of small treats IMO. Life becomes dull otherwise.

But this is how people achieve remission, with or without Metformin. A half a banana would be considered a great treat OR an apple or a square of 70+% dark chocolate and not every day. You learn to find other lower carb treats once you consider these things as no longer everyday food items. It isn't easy at first, but it gets easier with time. Metformin is no where near as effective as a low carb diet, so it isn't going to work miracles on it's own.
I just want you to have a realistic understanding of what Metformin can be expected to do and what you may need to do to help it, especially if you are looking to come off insulin.

Have they told you how much Metformin typically lowers HbA1c because it isn't a lot. I really hate to be negative but it just doesn't make sense to me at all. I still think you are an unlikely Type 2 and you are not in any way an obvious candidate for insulin resistance, which is what the Metformin helps with. None of it makes sense!

 

[dannybgoode]

My carb intake is down to c.130-150g per day even whilst I've been on insulin.

The DSNs, dieticians (2 of each) are very happy with where I'm at and so am I.

Looking at the stats, Metformin can knock 1-2% off your Hba1c. That's a big reduction in my book.

The DSN expects my Hba1c to currently be around 65 which is 8.1%. So with Metformin that has the potential to be between 6 & 7%.

And yes, I'm aware that Metformin in and of itself can't do everything on its own. Don't forget I'm also running 150-200km a month, and as I say - now eating 130-150g of carbs a day. 10g of which is chocolate. And staying chocolate!

As to whether I'm T1 or T2. That for now will remain a mystery. My c-peptide and all 4 antibody tests came back normal so they can only go on that.

If I make the move to oral meds only and my BG rises despite a very sensible diet (and at that stage I may cut the chocolate, at least at first) then I'll be raising that with the team.

As it happens, the DSN I saw on Monday is pretty certain I'll not be able to stop the insulin, particularly the basal. Not entirely sure on her reasoning!

 

[helli]

But this is how people achieve remission, with or without Metformin.

Forgive me if I missed it but I don’t remember @dannybgoode mentioning he wants to achieve remission.It is not the goal for everyone and we need to ensure no one feels pressure.
It sounds as if he has other health issues to manage along with diabetes.

I can’t speak for him but, for me, it is important for diabetes not to control my life and take away the things I enjoy.
I have mentioned it before : balance is important.

 

[dannybgoode]

Forgive me if I missed it but I don’t remember @dannybgoode mentioning he wants to achieve remission.It is not the goal for everyone and we need to ensure no one feels pressure.
It sounds as if he has other health issues to manage along with diabetes.

I can’t speak for him but, for me, it is important for diabetes not to control my life and take away the things I enjoy.
I have mentioned it before : balance is important.

Right now I want to find a regime that gets my Hba1c down to something sensible and is sustainable in the long run.

And like you say, I also want to live life and enjoy it. Of course balancing the need to be sensible and not put myself at risk of any diabetes related complications too but equally I ain't never been a saint and I'm not about to start now!

For reasons I'm not quite sure of my consultant seems to think that remission could be possible if I wanted. The DSN I saw on Monday disagreed and stated quite bluntly that even if I managed to come off the insulin for now I'd be back on it at some point.

And yes, as per other threads - managing an ileostomy without diabetes is physically and mentally hard going. Managing both is err... Interesting.

Chuck in the stress of everything going on with the boy (another challenging day today at school for example but at least the new support measures seemed to get implemented without me having to get involved)... Your use of the word balance is very apt!

Regardless, getting some control over things is the immediate goal. If later on remission looks a realistic target then we'll see...

 

[rebrascora]

Forgive me if I missed it but I don’t remember @dannybgoode mentioning he wants to achieve remission.It is not the goal for everyone and we need to ensure no one feels pressure.
It sounds as if he has other health issues to manage along with diabetes.

I can’t speak for him but, for me, it is important for diabetes not to control my life and take away the things I enjoy.
I have mentioned it before : balance is important.

My comment about remission was because the consultant was keen for Danny to try for it and that is part of the reason for trying to come off insulin and hence the experiment with Metformin.

@dannybgoode My thoughts coincide with the DSNs that you will likely still need insulin. I also agree that balancing the two conditions must be incredibly challenging and there has to be some enjoyment in life, I am just pointing out that Metformin usually needs dietary help.
I wish you luck with the experiment and I really hope it doesn't aggravate your stoma.
Take it slowly with building up the Metformin dose and I found it best to take it mid meal with a substantial amount of food. I got up to 4 a day reasonably OK, with some loose stools but not really what I would call diarrhoea and some very occasional cramping and occasional flatulence, but it was the sort of flatulence that you were never quite sure whether you dared let rip, unless you were on the loo. Just to give you an insight into what I consider moderate Metformin effects.

 

[dannybgoode]

@rebrascora - and no offence taken at anything you've written. It's all useful information and is useful for others too who may be looking at remission as an option.

I'm not sure whether my consultant was just saying that though to nudge me to try it. Much like I'm convinced she wouldn't sign the Libre off as she thought there'd be no incentive for me to try coming off the insulin also.

Luckily(?) I'm used to life throwing things at me one after the other and have got used to dealing with multiple things at once but this is proving quite a lot to handle. I'll get there though and I'm extremely lucky the diabetes team is so good here. Even the consultant I think has my best interests at heart - I just didn't need her to be quite so pushy at this stage of things.

The DSN wants me on 500mg for 2 weeks instead of the usual 1 week and they'll see me again at that point. If I'm ok on the 500 then we'll go to 1000mg - again for two weeks.

The modified release version isn't an option due to the stoma so if it doesn't work out for me then that will be that.

Luckily I don't need to worry about following through accidentally! There are some benefits to have a stoma after all