Diabetic Consultant review not enough carbs

[Newbie777]

Hello,

Today I met up with the Diabetic Consultant. Last time I saw him 2 years he wanted to put me on insulin, but instead let me try out Ozempic, but unfortunately bu doing affected my eyes badly.

He was happy with my Hba1c dropping from 113 to 76. He was happy with the medication droo and agreed at last that I do not need insulin.
He was also happy with my weight loss, and lower protein levels in my urine. He told me eGFR 55 for kidneys was better too and my Chlorestorol levels were fine and also my Triglerides were oy slightly raised, what a great start I thought.

He also agreed to do the Pancreas test/scan and at my request the Hba1c test in 1 month so it would 8 weeks since last one. Very happy so far.

Then the bad news. He was not happy with the low BG levels and the amount of daily carbs.

He told me the 3.7 read on CGM which is about 4.1/4.2 reads were not acceptable and should be aiming for 4.5 or above, he also thought my 60g of daily was too low and possibly dangerous due to keto acididosis?

He also realised my objective to get Hba1c down to a healthy level but he thought I was going too fast and too soon.

So will slowly increase my carb intake, so keep BG 7 - 9, 2 hours after food, and between 4. 5- 7 fasting. (I was hitting an average of under 6.0 all day).

Still hoping for Hb1ac of 60 or lower, which we both agreed would be a good target. He told not worry about this so called 48 number as it not ideal( I had in my mind it was a perfect figure).

Learnt a big lesson, that sometimes it is about slowing down, taking a breath, reflecting and being patient.

 

[Lucyr]

he also thought my 60g of daily was too low and possibly dangerous due to keto acididosis?

That’s correct, if youre on canagliflozin then it’s dangerous to low carb due to a side effect being DKA with normal bgs. It can make you very ill and there was a case shared on the forum where a relative had unfortunately passed away due to DKA caused by a flozin drug. You dont have to eat high carb but getting above the low carb bracket would be safer.

 

[Leadinglights]

I can understand your consultant wanting you to reduce your blood glucose level slowly as doing so can allow your body to adjust to lower levels and minimise any issues with your eyes and nerves which some people get. Those are often transient but not pleasant.
Increasing carbs to a safer amount, somewhere nearer the low carb 130g per day if you are continuing with the flozin medication may slow down your reduction in blood glucose levels though.

 

[Newbie777]

That’s correct, if youre on canagliflozin then it’s dangerous to low carb due to a side effect being DKA with normal bgs. It can make you very ill and there was a case shared on the forum where a relative had unfortunately passed away due to DKA caused by a flozin drug. You dont have to eat high carb but getting above the low carb bracket would be safer.

Thsnka and you are right, very sad news too. It's a difficult one for me as I have been very displined 5 months, (really wanted to eat my norm of 300g carbs a day, what I was used to) . Somehow need to strike a fine balance, so deep breath let see what I can do.

 

[Lucyr]

Somehow need to strike a fine balance, so deep breath let see what I can do.

If you want to stick to current level of carbs go back to the doctor and ask to swap the flozin for something that’s safe to low carb with

 

[Newbie777]

I can understand your consultant wanting you to reduce your blood glucose level slowly as doing so can allow your body to adjust to lower levels and minimise any issues with your eyes and nerves which some people get. Those are often transient but not pleasant.
Increasing carbs to a safer amount, somewhere nearer the low carb 130g per day if you are continuing with the flozin medication may slow down your reduction in blood glucose levels though.

Thank you and yes it is a tricky one, the Consultant did not worry when I told him that if I increase my carbs and my BG goes high I will take another Glicizide!
I will try to go upto 120g per days but realise my reads could be 12+, which I don't think I had for months.

Will be gutted if Hba 1c does not get lower than 60 though

 

[mashedupmatt]

Sound like you are doing very well @Newbie777 you should be proud of what you have acheived - good luck, and don't beat yourself up, you are doing a great job

 

[Newbie777]

If you want to stick to current level of carbs go back to the doctor and ask to swap the flozin for something that’s safe to low carb with

No I actually need Canagilflorizin for my heart and prevent stroke/angina, but it is now down from 300mg to 100mg. Don't get me wrong would love to increase carbs, issue is can't stop, love bread and butter, jacket potatoes etc etc

 

[Newbie777]

Sound like you are doing very well @Newbie777 you should be proud of what you have acheived - good luck, and don't beat yourself up, you are doing a great job

Thank you so much for your kind comments.

Just the bit about not needing insulin is a very big one for me, as quite some time that's all I heard from everyone.

Never give up and onwards and upwards it is

 

[saffron15]

I had replied to this then my Internet dropped off. You have had several replies in the same vein

@Newbie777 I don't think I had previously taken on board that you were taking canagilflorizin. I assume it is the same family of drugs as dapaglifozin which is a SGLT2. I was put on it in September and have worried about eating enough carbs. I read through the leaflet and asked the pharmacist but no one would give me a figure. I had been eating between 88 and 120 and if I went to a cafe more as I would usually have bread. The concensus on the forum was I shouldn't go below 130. I have found it has blown me off course. I am not using a meal plan and keep adding bread or even a chocolate biscuit ( 10 carbs) to boost my figures. It didn't help having 14 days of oral steroids and dealing with a uveitis flare but the weight loss which had bouyed me of 10 kgs has stopped. Unlike you I could do with losing another 15 kgs.

I am thinking of dropping back to 120 on basis once or twice a week if I go to a cafe I usually have bread. I was buying it occasionally but have stopped

What carbs is he expecting you to eat? My HCP gave me a pack of ketosticks and warned me about ketoacidosis.

 

[Leadinglights]

It does seem to be one of those questions about how many carbs is advisable which in QI fashion, the answer is 'NOBODY KNOWS' just that very low carb is not a good plan but there are certainly a few people here who seem to have between 60 and 100g per day.
It may be a case of trial and not too much error and keeping a good eye on blood glucose levels, amount of carbs and ketones.
There is no need to think that you need to go back to that massive 300g per day, but just be sensible and make the additional carbs have value rather than just extra empty carbs.

 

[Newbie777]

You have been so unlucky as you became ill but have down a lot if hard work work, so am sure it will all work out. Bread is a difficult one and you are looking at least 20g per slice.

Not so long ago at the cafe (Bold St) I used to have a cafe latte and two slices of sourdough bread with free range egg and butter, will try that again now, but as a treat.

I think my figures are not ideal, he sees that low BG on the CGM of 3.4 or 3.7 or even if they equate to 4.0 using blood strips, added to the average daily between reads 5. 7 to 6.0, this is all lower than the ideal range. So too fast too quick.

So I will increase my carbs to say add 1 apple a day, eat almond flour roti with a curry at lunchtime and eat a biscuit at night, does not have to be exact, but needs to more than what am on at the moment.

Will up breakfast too, so more than 2 just boiled eggs, maybe some baked beans and mushrooms, got to be careful and not over do it, trial and error

 

[Newbie777]

It does seem to be one of those questions about how many carbs is advisable which in QI fashion, the answer is 'NOBODY KNOWS' just that very low carb is not a good plan but there are certainly a few people here who seem to have between 60 and 100g per day.
It may be a case of trial and not too much error and keeping a good eye on blood glucose levels, amount of carbs and ketones.
There is no need to think that you need to go back to that massive 300g per day, but just be sensible and make the additional carbs have value rather than just extra empty carbs.

Yes I agree the 300g was mainly two rotis at lunchtime!

Yes I agree defibeyky trail and error, plus am going to the gym every few days so can legitimately increase my carbs for the energy.

Living in an Asian household, nothing is straight
forward food wise and most if it is carb heavy so finding the right balance is going to be tricky.

 

[mashedupmatt]

I love Asian food but agree it can be tricky - I love the breads (which spike my BG big time) but rice is a slow burner for me so not too much of an issue - there are also a lot of vegetables which are really good for you (try and avoid the potatoes though!) - Daals are a good, as although they contain carbs they also have plenty of fibre so are slow release - I actually find it easier to calculate carbs etc. (and their release) than a roast dinner for example - and as I said earlier, you are doing a great job @Newbie777

 

[Newbie777]

Thank you very much.

Rice is a no go so when I go to an Asian wedding, just eat teg chicken and meat starters and then pick the lamb from the rice.

The nearest I come to naan bread orctoti is home made almond flour roti, low in carbs, very brittle and you can't eat much, not the same as the real stuff but I get by.

I do eat lentil, cauliflower, chicken and my favourite lamb with cauliflower curry.

Vegetables it is green beans and mushrooms, but am sure can try courgettes, okra, aubergine etc.

But always ready to try out new foods.

 

[Leadinglights]

Thank you very much.

Rice is a no go so when I go to an Asian wedding, just eat teg chicken and meat starters and then pick the lamb from the rice.

The nearest I come to naan bread orctoti is home made almond flour roti, low in carbs, very brittle and you can't eat much, not the same as the real stuff but I get by.

I do eat lentil, cauliflower, chicken and my favourite lamb with cauliflower curry.

Vegetables it is green beans and mushrooms, but am sure can try courgettes, okra, aubergine etc.

But always ready to try out new foods.

One of my favourite curries is cauliflower, butternut squash and chickpea with either paneer or boiled eggs. Adding aubergine to a lamb curry is also good. My son in law who is from Pakistan makes some mean curries if a little spicy. Considering he couldn't cook when he met my daughter he now pretty well does all the cooking.

 

[mashedupmatt]

Can I have your Lamb and Cauliflower curry recipe please (two of my favourite ingredients!) - Okra is a tricky one to cook but beautiful if you get it right - parathas are better than naans (diabetes-wise - not the enjoyment grr!!) as they have more fibre as use wholemeal flour - Love your positive attitude @Newbie777 and determination to get your Hba1c down to where you want to be be - top work fella

 

[Newbie777]

One of my favourite curries is cauliflower, butternut squash and chickpea with either paneer or boiled eggs. Adding aubergine to a lamb curry is also good. My son in law who is from Pakistan makes some mean curries if a little spicy. Considering he couldn't cook when he met my daughter he now pretty well does all the cooking.

Thank you am impressed, also very fortunate my wife is an excellent cook ao will try aubergine with lamb,
Chickpeas I love but spike my BG so yesterday I had homemadevchicken soup with chick peas, my BG was over 10 after 2 hours!

I think if I started cooking, it would be only me eating, my wife and kids will run a mile. Lol

 

[Newbie777]

Can I have your Lamb and Cauliflower curry recipe please (two of my favourite ingredients!) - Okra is a tricky one to cook but beautiful if you get it right - parathas are better than naans (diabetes-wise - not the enjoyment grr!!) as they have more fibre as use wholemeal flour - Love your positive attitude @Newbie777 and determination to get your Hba1c down to where you want to be be - top work fella

Thank you for your kind comments, you have to be positive as you go through so many can't do, but I try to focus on the good stuff.

We always room for a guest, in fact anybody who comes to our house fatten up, that included the goldfish, cat and love finch birds. Lol.

My daughter in law is from Lahore, Pakistan and IMHO they make the best food, totally gutted to find out she cannot cook! Cauliflower and lamb is one of their trademark dishes!

All this food talk is making me hungr

 

[everydayupsanddowns]

Hope your adjustments help to keep you safe from DKA, without throwing you too far off track with your BG / HbA1c reduction.

It can be much easier on the body (particularly eyes and nerve endings) to make these adjustments a little more gently as people have said.

One of the mindsets I’ve picked up from T2s over the years is the importance of transitioning to a new ‘way of eating’, rather than attempting a ‘diet’ for a short time with the plan of just going back to eating as they did before once their targets were met. In that sense, finding a menu with a little more flexibility carb-wise may be a help - as you’ll be more able to adjust and adapt your meals to be more sustainable long term 🙂