First day

[Feesal]

Hi everyone,
I got diagnosed last month with type 2 after my long range blood glucose level came back at 94. I only saw the diabetic nurse yesterday and I’ve been prescribed metformin and gliclazide 40mg, and to test 3 times a day.

The nurse was lovely and I’m actually feeling pretty positive about things but my glucose readings are something I need some reassurance about.

So I took a reading this morning when I got up and it was 15.7, took my first metformin tablet and had some granola and milk for breakfast. Two hours later I thought I’d check again out of curiosity (I don’t know what I was expecting) and it was 21.5. Clearly one metformin tablet isn’t going to magically bring my sugar down but I think I’m just looking for someone who also has type 2 to tell me if I’m just over thinking things.

 

[Leadinglights]

Welcome Feesal
There is a lot to get your head around when first diagnosed and often very little is explained to you which is why this forum is very useful as you can ask the many questions which I'm sure you will have.
First of all metformin does not work directly on food, it helps your body to use the insulin it produces more efficiently.
You are starting with quite high levels at 15.7 in the morning but clearly your breakfast was far too much carbohydrate than you can tolerate. Breakfast cereals are a high carb food and many people find their body is more sensitive to carbs in the morning so would try to have a low carb breakfast.
With Type 2 diabetes your body cannot cope with carbohydrates and therefore it is important to reduce them in your diet.
It is ALL carbohydrates that convert to glucose so you need to reduce your intake of things like potatoes, rice, bread, cereals, pasta, pastry, tropical fruits, as well as the obvious cakes, biscuits, sugary drinks and snacks like crisps.
Basing meals on meat, fish, eggs, cheese, dairy, nuts and seeds, vegetables, salads and fruits like berries
Your 2 medications work in slightly different ways:
Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas.
As such the gliclazide may cause hypos so it is important to be aware of those symptoms and test to check if you feel unwell.
Have a look at the Learning Zone (orange tab at the top) as that will give you a better understanding of how to manage your condition.
As you have a monitor then make good use of it to find meals that you an tolerate without your blood glucose levels rising too much. The guide is no more than 2-3mmol/l increase 2 hours after your meal, as your premeal levels come down you would aim at no more than 8.5 mmol/l 2 hours after your meal. If it is more than that then the meals was too carb heavy so you need to cut out or reduce portions of the high carb foods.
Keeping a food diary of everything you eat and drink and an estimate of the carbs will really help you see where savings can be made.
Many people find a low carb approach works, that being less than 130g per day so your food diary will give you an idea of where you are compared to that.
Do come back with any questions you have.

 

[rebrascora]

Hi and welcome.

So sorry to hear about your diagnosis but good to hear that you have a supportive nurse.
Yes 94 is a lot higher than you want it to be and your readings of 15 and 21 are in the ballpark to correspond with that HbA1c of 94 so not surprising.
Things you need to know....
Metformin takes weeks to build up in your system to have any effect and the dose is slowly built up week by week to the full 4 tablets a day to allow your digestive system to get used to it, so 1 tablet will do absolutely nothing!
Gliclazide encourages your pancreas to produce more insulin so that will be a bit more effective, IF your pancreas is able to produce more insulin.
What will have a much bigger impact is what you put in your mouth..... and it is not all about sugar as many people believe. All carbohydrates break down into glucose in the digestive system and get absorbed into the blood stream and there are carbs in almost all foods to a greater or lesser extent. Reducing your intake of the foods which are high in carbs and eating more of the lower carb foods will have a significant impact on your BG levels and in fact your test this morning shows that because your BG levels jumped 6mmols as a result of eating granola with milk? Depending on the brand and variety, granola is about 60-65% carbohydrate. I am guessing that you didn't weigh your portion this morning but if you go back and tip a similar amount into the bowl you used and then weigh it, you will be able to calculate roughly how many carbs were in it. Add to that the carbs in the milk (lactose) which is the natural sugar in milk and you have glucose going into your blood stream from the granola and milk to push your levels up.
Obviously you want to cut down on the cakes and biscuits and sweets and added sugar in your diet but the other carb rich foods also need to be reduced in portion size. Theses are anything made with grains and grain products (flour etc) so bread, pasta, rice, breakfast cereals, couscous as well as starch veg like potatoes (including sweet potatoes) and parsnips and fruit is also high in carbs because they contain natural sugars (fructose) so reducing the amount of fruit you eat and limiting it mostly to lower carb options like a few berries which are nutrient dense and pack a lot of flavour for a small portion is a good choice and limiting the tropical fruits like banana and mango and pineapple and oranges (and grapes) to a very occasional treat.
I would stress that it is about reducing portion size and frequency of these foods rather than avoiding them although some of us do choose to avoid them. The key is to find a balance that you can maintain.

It is also very important to point out that if the Gliclazide does work, it needs some carbs to work on so drastically changing your diet overnight might cause you to hypo (your BG levels to drop below 4 and be potentially dangerous) so making small sustainable changes to your diet is vital. Also, because your HbA1c is pretty high you don't want to drop it too quickly as that puts pressure on the fine blood vessels in the eyes particularly which are very delicate. You may experience blurry vision anyway as your levels gradually come down and this will usually last a few months but coming down too fast can put you at risk of more permanent damage so do go steady with changes.

Having listed a massive range of foods which will likely cause you BG upheaval, I think it is only fair to mention the ones that almost certainly will not and some of them may surprise you.... Meat and fish and eggs and mushrooms and cheese and most nuts (beware peanuts and cashews as they are slightly higher carb) are pretty low/negligible carb. Veggies which grow at ground level are usually good, particularly leafy green veg like cabbage and kale, spinach and leeks (usually cooked with a knob of real butter or cream cheese) and salad leaves (usually served with a good dollop of full fat coleslaw) and cauliflower is an amazingly versatile vegetable and great for us diabetics.... can be mashed to replace potato with a good dollop of full fat cream cheese and a liberal sprinkle of hard cheese if you fancy. It can also be grated or chopped and used to replace rice of bought pre prepared as well as served as good old cauliflower cheese but instead of making a sauce with flour and milk, you just par boil it and then coat in full fat cream cheese and grated cheese and brown off in the oven. Dairy produce.... full fat is generally lower carb than low fat, so a better choice. Many of us have real double cream in our morning coffee instead of milk because it is lower carb and tastes luxurious! Berries as mentioned above are the lowest carb fruits, so many of us have a portion of those with some full fat Greek style natural yoghurt, mixed seeds and/or chopped nuts for breakfast instead of cereals or toast. There are lower carb granolas available but still about 50% carbs so if you want some we find it better to just have a sprinkle on our yoghurt rather than a bowl of granola with milk.

You will notice I am sure that higher fat products rather than low fat, feature quite a lot and there is a good reason for this, despite the NHS low fat advice. Fat is slow to digest so it keeps you feeling full for longer and provides much slower release energy that carbs. fat also slows the digestion of the carbs you eat with it, so having that very occasional banana with some full fat natural yoghurt or cream should mean it has less of a dramatic impact on BG levels. Only a very small percentage of fat can be broken down into glucose whereas about 40% or protein breaks down and pretty much 100% of carbohydrates. Carbs also break down very quickly to give you a spike in BG levels between 1-2 hours usually. After that, your BG levels start to drop and your body feels that drop and tells your brain that you are hungry because your BG levels are dropping rapidly, so you want a snack 2-3 hours after you just ate a meal. Once you cut the carbs and eat more fat, you don't get those spikes and drops and you stop getting the hunger pangs and you actually need less food as a result. I often just have one or two meals a day and don't feel hungry in between whereas before, I was ravenous all the time and looking for what I could eat next.... I love how easy it is to just eat what my body needs now instead of constantly craving and eating. I have control and I don't even need willpower!

Anyway, I have typed far more than I should have and really must stop because I have almost certainly overloaded you with info and we all know how overwhelming that diabetes diagnosis is in the early days and weeks.....So apologies for that but do come back to it and reread as you will no doubt take more in.

Any questions, just ask. That is what the forum is here for.

 

[Feesal]

Hi and welcome.

So sorry to hear about your diagnosis but good to hear that you have a supportive nurse.
Yes 94 is a lot higher than you want it to be and your readings of 15 and 21 are in the ballpark to correspond with that HbA1c of 94 so not surprising.
Things you need to know....
Metformin takes weeks to build up in your system to have any effect and the dose is slowly built up week by week to the full 4 tablets a day to allow your digestive system to get used to it, so 1 tablet will do absolutely nothing!
Gliclazide encourages your pancreas to produce more insulin so that will be a bit more effective, IF your pancreas is able to produce more insulin.
What will have a much bigger impact is what you put in your mouth..... and it is not all about sugar as many people believe. All carbohydrates break down into glucose in the digestive system and get absorbed into the blood stream and there are carbs in almost all foods to a greater or lesser extent. Reducing your intake of the foods which are high in carbs and eating more of the lower carb foods will have a significant impact on your BG levels and in fact your test this morning shows that because your BG levels jumped 6mmols as a result of eating granola with milk? Depending on the brand and variety, granola is about 60-65% carbohydrate. I am guessing that you didn't weigh your portion this morning but if you go back and tip a similar amount into the bowl you used and then weigh it, you will be able to calculate roughly how many carbs were in it. Add to that the carbs in the milk (lactose) which is the natural sugar in milk and you have glucose going into your blood stream from the granola and milk to push your levels up.
Obviously you want to cut down on the cakes and biscuits and sweets and added sugar in your diet but the other carb rich foods also need to be reduced in portion size. Theses are anything made with grains and grain products (flour etc) so bread, pasta, rice, breakfast cereals, couscous as well as starch veg like potatoes (including sweet potatoes) and parsnips and fruit is also high in carbs because they contain natural sugars (fructose) so reducing the amount of fruit you eat and limiting it mostly to lower carb options like a few berries which are nutrient dense and pack a lot of flavour for a small portion is a good choice and limiting the tropical fruits like banana and mango and pineapple and oranges (and grapes) to a very occasional treat.
I would stress that it is about reducing portion size and frequency of these foods rather than avoiding them although some of us do choose to avoid them. The key is to find a balance that you can maintain.

It is also very important to point out that if the Gliclazide does work, it needs some carbs to work on so drastically changing your diet overnight might cause you to hypo (your BG levels to drop below 4 and be potentially dangerous) so making small sustainable changes to your diet is vital. Also, because your HbA1c is pretty high you don't want to drop it too quickly as that puts pressure on the fine blood vessels in the eyes particularly which are very delicate. You may experience blurry vision anyway as your levels gradually come down and this will usually last a few months but coming down too fast can put you at risk of more permanent damage so do go steady with changes.

Having listed a massive range of foods which will likely cause you BG upheaval, I think it is only fair to mention the ones that almost certainly will not and some of them may surprise you.... Meat and fish and eggs and mushrooms and cheese and most nuts (beware peanuts and cashews as they are slightly higher carb) are pretty low/negligible carb. Veggies which grow at ground level are usually good, particularly leafy green veg like cabbage and kale, spinach and leeks (usually cooked with a knob of real butter or cream cheese) and salad leaves (usually served with a good dollop of full fat coleslaw) and cauliflower is an amazingly versatile vegetable and great for us diabetics.... can be mashed to replace potato with a good dollop of full fat cream cheese and a liberal sprinkle of hard cheese if you fancy. It can also be grated or chopped and used to replace rice of bought pre prepared as well as served as good old cauliflower cheese but instead of making a sauce with flour and milk, you just par boil it and then coat in full fat cream cheese and grated cheese and brown off in the oven. Dairy produce.... full fat is generally lower carb than low fat, so a better choice. Many of us have real double cream in our morning coffee instead of milk because it is lower carb and tastes luxurious! Berries as mentioned above are the lowest carb fruits, so many of us have a portion of those with some full fat Greek style natural yoghurt, mixed seeds and/or chopped nuts for breakfast instead of cereals or toast. There are lower carb granolas available but still about 50% carbs so if you want some we find it better to just have a sprinkle on our yoghurt rather than a bowl of granola with milk.

You will notice I am sure that higher fat products rather than low fat, feature quite a lot and there is a good reason for this, despite the NHS low fat advice. Fat is slow to digest so it keeps you feeling full for longer and provides much slower release energy that carbs. fat also slows the digestion of the carbs you eat with it, so having that very occasional banana with some full fat natural yoghurt or cream should mean it has less of a dramatic impact on BG levels. Only a very small percentage of fat can be broken down into glucose whereas about 40% or protein breaks down and pretty much 100% of carbohydrates. Carbs also break down very quickly to give you a spike in BG levels between 1-2 hours usually. After that, your BG levels start to drop and your body feels that drop and tells your brain that you are hungry because your BG levels are dropping rapidly, so you want a snack 2-3 hours after you just ate a meal. Once you cut the carbs and eat more fat, you don't get those spikes and drops and you stop getting the hunger pangs and you actually need less food as a result. I often just have one or two meals a day and don't feel hungry in between whereas before, I was ravenous all the time and looking for what I could eat next.... I love how easy it is to just eat what my body needs now instead of constantly craving and eating. I have control and I don't even need willpower!

Anyway, I have typed far more than I should have and really must stop because I have almost certainly overloaded you with info and we all know how overwhelming that diabetes diagnosis is in the early days and weeks.....So apologies for that but do come back to it and reread as you will no doubt take more in.

Any questions, just ask. That is what the forum is here for.

You have no idea how happy I am to hear that I can eat cauliflower cheese, if I just make it differently!

Thank you so much for such a comprehensive reply, you’ve actually helped an awful lot as although my nurse was lovely, hearing from someone who actually lives with this every day is very helpful. I’ve got a lot to learn but I’ll get there.
Thank you

 

[Feesal]

Welcome Feesal
There is a lot to get your head around when first diagnosed and often very little is explained to you which is why this forum is very useful as you can ask the many questions which I'm sure you will have.
First of all metformin does not work directly on food, it helps your body to use the insulin it produces more efficiently.
You are starting with quite high levels at 15.7 in the morning but clearly your breakfast was far too much carbohydrate than you can tolerate. Breakfast cereals are a high carb food and many people find their body is more sensitive to carbs in the morning so would try to have a low carb breakfast.
With Type 2 diabetes your body cannot cope with carbohydrates and therefore it is important to reduce them in your diet.
It is ALL carbohydrates that convert to glucose so you need to reduce your intake of things like potatoes, rice, bread, cereals, pasta, pastry, tropical fruits, as well as the obvious cakes, biscuits, sugary drinks and snacks like crisps.
Basing meals on meat, fish, eggs, cheese, dairy, nuts and seeds, vegetables, salads and fruits like berries
Your 2 medications work in slightly different ways:
Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas.
As such the gliclazide may cause hypos so it is important to be aware of those symptoms and test to check if you feel unwell.
Have a look at the Learning Zone (orange tab at the top) as that will give you a better understanding of how to manage your condition.
As you have a monitor then make good use of it to find meals that you an tolerate without your blood glucose levels rising too much. The guide is no more than 2-3mmol/l increase 2 hours after your meal, as your premeal levels come down you would aim at no more than 8.5 mmol/l 2 hours after your meal. If it is more than that then the meals was too carb heavy so you need to cut out or reduce portions of the high carb foods.
Keeping a food diary of everything you eat and drink and an estimate of the carbs will really help you see where savings can be made.
Many people find a low carb approach works, that being less than 130g per day so your food diary will give you an idea of where you are compared to that.
Do come back with any questions you have.

Thank you for all of this. It is going to take some getting used to - and some real effort to get into a routine and good habits. But I’m willing to put the work in

 

[rebrascora]

Pleased to give you some good news in amongst all the things you need to cut down on and that hopefully I haven't totally swamped you with info.

Just out of curiosity.... Can you tell us a bit more about how your diagnosis came about? I am guessing you may have been symptomatic with those sorts of levels? What symptoms did you have and did they come on suddenly if you did. Also have you lost or gained weight recently and if it isn't too much of a personal question or two, do you have much/any weight to lose and how active are you generally? It just gives us a bit of a better picture about your diabetes and it can be very individual.

 

[Inka]

Welcome @Feesal 🙂 Are they sure you’re Type 2 rather than Type 1? Do you have any of the Type 2 risk factors? Sometimes adults are assumed to be Type 2 when they’re actually Type 1. It happens far more often than you might think so it’s always good to keep it in mind as a possibility.

 

[Feesal]

Pleased to give you some good news in amongst all the things you need to cut down on and that hopefully I haven't totally swamped you with info.

Just out of curiosity.... Can you tell us a bit more about how your diagnosis came about? I am guessing you may have been symptomatic with those sorts of levels? What symptoms did you have and did they come on suddenly if you did. Also have you lost or gained weight recently and if it isn't too much of a personal question or two, do you have much/any weight to lose and how active are you generally? It just gives us a bit of a better picture about your diabetes and it can be very individual.

I don’t mind at all

I actually originally contacted the doctor about a lump in my throat which turned out to be a thryroglossal cyst. I asked to check my long range sugar as well as I’ve been over weight for many years but over the last 18 months I’ve lost around 6 stone. I’m now 117kg which is still obese. I was also getting up in the night 1-2 times to go for a wee, felt tired and just like there was something wrong. I have been a lot more active over the last year but I think the damage was already done to be honest, I was just in denial over it

 

[Feesal]

Welcome @Feesal 🙂 Are they sure you’re Type 2 rather than Type 1? Do you have any of the Type 2 risk factors? Sometimes adults are assumed to be Type 2 when they’re actually Type 1. It happens far more often than you might think so it’s always good to keep it in mind as a possibility.

I’ve been overweight for many years and until this year far too inactive so I think I’ve bought type 2 on myself really. I think now I’ve on a treatment plan we will see how my body reacts and find out what I’ve done to myself lol

 

[Inka]

Ah, ok. That does fit with Type 2. Be positive though. With a few changes, I’m sure you can greatly improve your HbA1C 🙂

 

[Leadinglights]

I make my cheese sauce for cauli cheese by adding strong grated cheese to philadelphia with a spoon of mustard so no flour added. you can then sprinkle with grated cheese and popped in the oven or under the grill.

 

[Drummer]

My Hba1c was 91 at diagnosis, and blood glucose 17.1 mmol/l but that was 5 years ago now and I have been back in normal numbers for well over 4 years.
An ordinary type 2 should be able to lower their numbers by not eating carbohydrate at the expected rate.
A 'healthy' diet just isn't for a type 2.
I make cauliflower cheese by cooking the cauliflower in a steamer whilst warming a bowl in the oven at a mediumish heat.
When almost done, I put the cauliflower in the bowl, cover with cream cheese, add any herb or spice I fancy, then cover in red Leicester and put it back in the oven until the cheese is just getting melty with a light tan.
I use cauliflower instead of rice with curry, roughly chopped - I don't reduce it to rice size.
Bubble and squeak made with mashed swede is tasty.
I actually prefer the low carb options.

 

[rebrascora]

Wow! 6 stone is a massive weight loss! Well done! How difficult did you find it?
The reason I ask is that the stereotyping can work in both directions and sometimes people who are overweight or obese are assumed to be Type 2 when in fact they could still be Type 1 although the misdiagnosis usually happens to people who are not overweight but assumed to be Type 2 because of their age. It is more common for Type 2 to develop when people are actively gaining weight I believe as the surplus insulin they are usually producing to overcome insulin resistance keeps laying down more fat stores and making the body more hungry. If the weight loss was easier than expected then that might suggest Type 1 or perhaps that your body is no longer able to produce enough insulin for some other reason and it is starting to use up it's own reserves. Basically unexpected/ unexplained weight loss is usually associated with Type 1.

There is just something about the information you have provided so far which suggests to me there may be a question mark over your Type, but for the moment, all you can do is take the medication and gradually adjust your diet so that your meals don't spike your levels so high (you are looking for the rise in BG between the premeal reading and the 2 hrs post meal, to be less than 3mmols and if you can adjust the carbs in your meals to achieve that by keeping a food diary along with your pre and post meal readings, you should gradually see your premeal readings start to come down towards the normal range...... It feels great when you get your first reading in single figures..... I was over the moon when I got below 10 the first time but it took a few weeks.

 

[Feesal]

Wow! 6 stone is a massive weight loss! Well done! How difficult did you find it?
The reason I ask is that the stereotyping can work in both directions and sometimes people who are overweight or obese are assumed to be Type 2 when in fact they could still be Type 1 although the misdiagnosis usually happens to people who are not overweight but assumed to be Type 2 because of their age. It is more common for Type 2 to develop when people are actively gaining weight I believe as the surplus insulin they are usually producing to overcome insulin resistance keeps laying down more fat stores and making the body more hungry. If the weight loss was easier than expected then that might suggest Type 1 or perhaps that your body is no longer able to produce enough insulin for some other reason and it is starting to use up it's own reserves. Basically unexpected/ unexplained weight loss is usually associated with Type 1.

There is just something about the information you have provided so far which suggests to me there may be a question mark over your Type, but for the moment, all you can do is take the medication and gradually adjust your diet so that your meals don't spike your levels so high (you are looking for the rise in BG between the premeal reading and the 2 hrs post meal, to be less than 3mmols and if you can adjust the carbs in your meals to achieve that by keeping a food diary along with your pre and post meal readings, you should gradually see your premeal readings start to come down towards the normal range...... It feels great when you get your first reading in single figures..... I was over the moon when I got below 10 the first time but it took a few weeks.

I changed for the birth control injection which had helped me gain a few stone and it started dropping off. Walked a bit more. But I think it was a lot to do with the high blood sugar! Will just have to do the best I can with my diet and keep waking the dog a bit further and see what happens. Thank you for being so welcoming