Controlling BG with Diet and Exercise

[happydog]

I'm trying to control my BG levels with diet and exercise. Have come from 85 to 46 since September. Will they continue to drift down or is there an end point below which they will not go? Fasting are still not good but getting better average now 6.5, used to be over 8.0 about a month ago. Dr said that they will go back up and that this is only an interlude, is that necessarily so? All answers gratefully received. Thank you 🙂

 

[Northerner]

Oh dear, more doctor negativity! You are there feeling good about the fact that you are getting much-improved numbers and they shake their heads and say, 'Well, don't get too excited because it won't last' 🙄😡

There is no timescale for when or if your numbers will begin to deteriorate if you maintain your efforts to stay healthy and manage your diabetes well. Some people go indefinitely without the need for medication, and some may gain a respite for a limited amount of time - who's to say where any one particular individual's future lies? Whilst you wouldn't want to be given false hope, there's no need to shoot you down at the first sign of succcess!

The lowest HbA1c I have read of has been in the mid-4% range (26 mmol/mol), but more frequently I think around 5-5.5% (30-40 mmol/l) is as low as people go. 🙂

 

[everydayupsanddowns]

I'd echo what Northerner said, plus by reducing carb intake to moderate or low levels some forum peeps have not only maintained an a1c in the 5s, but in some cases come off medication and then reduced those levels.

Of course, if your Drs advice to his patients is that they should base every meal on lots of 'starchy' carbs - I expect he is used to seeing high A1cs despite ever increasing meds. 🙄

 

[PattiEvans]

Hi

As Northerner says, what a negative Dr. You can only do your best and many people can go indefinitely without progression to worse numbers. Alan Shanley who's often quoted here has been in the 5% club for over 10 years.
A normal non-diabetic person will have an Hba1c in the region of 3.5-5.5%.

 

[LeeLee]

Is weight a factor for you? It is for some of us T2s (me included).

 

[happydog]

Thank you for your responses. I will keep working on it and hope for the best. I feel really well and am positive about how I am getting on 🙂 No weight is not really a factor for me as I was not overweight but apparently my waist is 1 1/2 inches too big so the nurse prescribed statins which I refused. I have never had a small waist even as a teenager, but I will try to get it into the right place to keep them all happy and stave off the heart attack and stroke that they have warned me about. I could not have done any of it without the help that I have had on this forum 🙂

 

[DeusXM]

apparently my waist is 1 1/2 inches too big so the nurse prescribed statins which I refused.

Please, please, PLEASE don't tell me that a nurse tried to prescribe you statins on the basis of your waist size!!!!

Dear god, what is wrong with these people? Did they even bother to do a full cholesterol (trigs/LDL/HDL) before throwing out prescription medicines like sweets at a pantomime?

 

[happydog]

These are my cholesterol results in Dec which she said were way too high

Triglyceride 0.8 mmol/l 0.40 - 1.54
T. Cholesterol 4.0 mmol/L
HDL Cholesterol 1.62 mmol/L >1.7
LDL Cholesterol 2.0 mmol/L
T. Chol/HDL Ratio 2.5 ratio

These plus my waist size = statins as a must

 

[PattiEvans]

These are my cholesterol results in Dec which she said were way too high

Triglyceride 0.8 mmol/l 0.40 - 1.54
T. Cholesterol 4.0 mmol/L
HDL Cholesterol 1.62 mmol/L >1.7
LDL Cholesterol 2.0 mmol/L
T. Chol/HDL Ratio 2.5 ratio

These plus my waist size = statins as a must

What absolute tripe - those figures are just perfect! Your trigs to HDL ratio is brilliant. You wouldn't want a total chol less than 4.0 as it causes damage to your body. Cholesterol isn't a poison, it's a very necessary building block in our body for many many functions, not least to ensure your brain is working properly. It's a bit late and I'm off to bed but can find links for you if you wish.

 

[happydog]

Thank you for your offer of some links. It is always useful to have information. I don't think that my GP practice is good on diabetes. After I had said no to the statins the DN went to the doctor and got her to prescribe them. I have not collected the prescription. Without this forum I would have just gone along with everything and be on medication including statins and eating 60% carbohydrate. I dread going to the doctor and nurse now as I find it stressful as they have a go at me about what I am trying to do. They have told me that I will in future only have one check up a year. Still have a non-working thyroid to fix though. Thanks again for everyone's help and apologies for the rant. 🙂

 

[Northerner]

Don't apologise for the rant, I would be ranting too! I know many GPs would be appalled to hear about how you are being treated, might be an idea to change practices if it is feasible. What is the point of prescribing drugs you have no intention of taking? I agree with Patti, your chol numbers are better than mine and I wouldn't take statins with those pretty near-perfect results!

 

[DeusXM]

Your nurse is an idiot.

Not in the sense "oh, look, they're being daft." More in the sense of "they can't read or count".

I had my cholesterol results done last month and I've still got the sheet of paper with the reference ranges on it.

Trigs - 0.2-1.7
Cholesterol - 0-5.2
HDL - 1.1-2.2
Total cholesterol:HDL ratio - 0-6
LDL - 0-4

"Theraputic targets for those at high risk of CVD eg. diabetes are total cholesterol <4 and/or LDL <2"

Now, I'm not a medical expert. I didn't go to special doctors and nurses school. I did, however, go to playgroup when I was three and thus can recognise when one number is larger or smaller than another...which evidently, your nurse can't.

Basically, all your results are slap bag in the middle of all the reference ranges AND beat the stricter targets suggested for people with diabetes.

And they want to prescribe you statins.

I'd ask her how much commission she's on to prescribe those because clearly she is NOT prescribing them on the basis of clinical need.

 

[mcdonagh47]

These are my cholesterol results in Dec which she said were way too high

Triglyceride 0.8 mmol/l 0.40 - 1.54
T. Cholesterol 4.0 mmol/L
HDL Cholesterol 1.62 mmol/L >1.7
LDL Cholesterol 2.0 mmol/L
T. Chol/HDL Ratio 2.5 ratio

These plus my waist size = statins as a must

Hi there,

Diabetic Dyslipidemia ( raised total cholesterol, raised LDl etc) is a common complication of Type 2 Diabetes and threatens heart disease and heart attack
The recommendations for Type 2 Diabetics from NICE are Total Chols under 4, HDL under 1.4 and LDL under 2.
As you can see from your numbers you are teetering on the edge of these numbers and it seems that diabetic dyslipidemia might well be developing there. 4 Total Chols isn't a "perfect " score for T2s - its just an easy number and a low hurdle to aim for. Its the point at which heart disease and heart attacks accelerate significantly in diabetics.
Waist circumferemce is an important independent predictor of heart disease and is increasingly being factored into the decision about whether or not a Type 2 needs a statin.
You will have to see what the numbers are like in your next M.O.T. but the suggestion of a statin looks like a sensible precautionary measure at this stage. Statins are only ever an insurance policy ; best to stop the problem developing rather than slamming the stable door shut after the horse has bolted.

 

[DeusXM]

I'm sorry but that advice sounds absolutely insane.

Firstly, this person was told that their cholesterol was 'way too high'. There is not a single reading in this person's portfolio that exceeds ANY target whatsoever. Granted, yes, LDL and total cholesterol are at the top end of the target but they are still on target. And why is there a recommendation that HDL should be UNDER 1.4? The higher your HDL, the LESS likely you are to have cardiovascular problems! I know the American Heart Association says HDL levels over 1.55 are optimal for preventing CVD - how on earth can NICE get this so wrong?

I find it absolutely astonishing that this would be grounds to recommend a prescription drug rather than suggest minor lifestyle changes although again I'd query whether these are even necessary. It is known that heart disease risk is influenced by the total Cholesterol:HDL ratio, with anything under 3.5:1 being 'optimal' protection. The OP has a ratio of 2.5:1!

Waist circumference is only relevant if it is associated with being overweight. The OP has already stated they are not overweight which means waist circumference is far less relevant to statin prescriptions - particularly as (and I really can't make this clear enough), the OP's full cholesterol readings comply perfectly with overall NHS recommendations for someone with Type 2 diabetes.

I know I'm not a doctor but I really cannot see the point in adding a statin at this stage, particularly given statins have an association with muscle wastage, liver problems and neuropathy. Granted, these side effects may be rare but based on the NHS's own guidelines there seems very little reason to prescribe a statin given the OP already appears to have good cholesterol health and is not overweight.

To put it in perspective, this sounds like the equivalent of putting someone not suspected to have diabetes with an FBG of 5.0 on multiple daily injections, because the numbers say they're at the top end of the fasting range. If the nurse was really that concerned, couldn't she in the first instance recommend lifestyle changes to see if that makes a difference, rather than just blithely giving out statins because Pfizer pay a lot to ensure diabetes advocacy groups recommend them?

 

[PattiEvans]

Here is a link I recommend everyone read http://people.csail.mit.edu/seneff/why_statins_dont_really_work.html
Another link worth reading from Uffe Ravnskof - a well known and very well qualified Dr http://www.ravnskov.nu/cholesterol.htm#a
Statins come with a lot of risk. I've suffered side effects and decided to take myself off them. I discussed this with my GP who was kind enough to do her own research and who agreed with me at my next appointment a week later that my HDL being high and trigs low it pointed at my LDL being fluffy and benign. She has never asked me to go on them again.

I must also point out that NO woman of childbearing age, or who is likely to get pregnant should EVER be put on statins which are Teratogenic i.e. cause malformation of fetuses.

In addition it isn't cholesterol that's responsible for CVD it's inflammation of the arteries which cholesterol then attempts to plaster over in an attempt to heal the inflammation.

 

[happydog]

Thank you for the information and the links. I'll follow it all up. Am away on a course this weekend so it will be next week. I am very grateful to all of you for taking the time and trouble to reply. 🙂

 

[Lizzzie]

First, congratulations on those improved levels. You must be really pleased.

v interesting about the statins. Worth asking for the nurse (or the doctor) why statins were recommended and what the research was they were basing this opinion on, in order that you have definitely included that in you reading and are not missing anything before we brand them incompetent?

I don't know the first thing about statins so won't venture an opinion, I think it's good you're reading around and hope you'll tell us where you end up.

Again, there seem to be a lot of people out there whose control is handled by GPs who they don't trust. Are there any other options available to you? Can you call up your local specialist diabetic department if only for a generalised chat? If you really don't trust your GP, can they refer you?