Greetings and todays question.

[SadhbhFiadh]

Hi, I was diagnosed type 2 at the end of September, although it was a few weeks before I got the letter. My own GP met with me about 3 weeks ago to do the bloods and confirm it. There was a strong family history, so I was not surprised. My goal was to reach 60 without the diabetes, and I managed that (only just!) My question is about diet. I just want to know how many or in what percent to kcalories, of the macro-nutrients. I have read about spreading food evenly across the day, but even that I am unsure. We have three meals a day, about six hours apart. Is that ok?

It will be some time before I will be able to attend the class, and in the meantime the advice I've been given matches up with what we already do. For a few years we have been going along with smaller plates, traffic lights, rainbow vegetables, 5 a day and exercise 150 minutes a week. We haven't been strict, but fairly consistent. Since I retired in 2012 I have lost 2 stone.

I am worried that if I was following a reasonably healthy lifestyle, how will I improve it? I am on metformin and was already on blood pressure and water tablets. Yesterday she added an ace inhibitor because I had protein in my urine at 0.22 (and what does that mean?!)

Many thanks,
from Sunny Scotland

 

[Northerner]

Hi Sadhbh, welcome to the forum 🙂 Sorry to hear about your diagnosis You do sound well-equipped to manage things well though, as you are already following a pretty healthy diet and lifestyle, but it sounds like the diet may need some fine-tuning. Don't worry, this is perfectly achievable and doesn't necessarily require a sparse and limited diet to achieve! 🙂

Diabetes is actually quite a complex condition, and this is largely because it can affect people in quite different ways. Chiefly, it is about our body's ability to process carbohydrates, so rather than concentrating on calories, focus on these. I'd suggest starting a food diary initially, and recording the amount, in grams, of carbohydrates in everything you eat and drink for a week or two. So, things like bread, pasta, rice, potatoes, fruit, sugary items or anything made with flour, such as pastries. This will give you a good picture of your current preferred intake. You can then look for ways to modify your meals so that they have an improved impact on your blood sugar levels - perhaps by reducing or replacing portions of carby items with lower carb alternatives e.g. less potato, more green veg, sweet potato instead of ordinary, lower carb bread such as Burgen Soya and Linseed or Lidl protein rolls - you get the idea, I'm sure, and anything you are not sure about, please just ask and someone will be able to help 🙂

Ideally, you are aiming for a diet that will release its energy slowly and steadily rather than hitting your levels and then dropping them down quickly (the 'sugar rush' effect). I, and a lot of others, find that the GL (Glycaemic Load) diet can help with this - The GL Diet for Dummies is a very good introduction, so worth a look 🙂 Also you should ideally be able to monitor your tolerance for different meals by using a home glucose monitor - Test,Review, Adjust by Alan S describes how to do this efficiently and effectively. If you haven't been given a meter and a prescription for strips then it's worth asking for them. Many GPs don't give them to Type 2 patients as they say there's no need to test unless you are on certain medications, such as insulin, but really it's the best tool for discovering your personal tolerances for things - what you can safely keep in your diet and what you should exclude, or only have in moderation or as a treat 🙂 It's worth funding your own if you weren't given one, as an early understanding of your responses will really help you get to grips with things - once you are more confident with your diet you won't need to test anywhere near as often as you might do initially. The cheapest option we have come across is the SD Codefree Meter which has test strips at around £8 for 50 (High Street brands can charge up to £30 for 50 strips 😱)

As if I haven't given you enough to think about, I'd also recommend reading Jennifer's Advice and Maggie Davey's letter, and getting a copy of the excellent Type 2 Diabetes: The First Year by Gretchen Becker 🙂 There you go, you're all set! 🙂

Please let us know if you have any questions and we will be more than happy to help 🙂

 

[grovesy]

Welcome.

 

[Northerner]

P.s. Sorry, I didn't answer your questions directly! I find that spacing my meals about 5-6 hours apart works well for me. I wouldn't worry about the kidney thing for now, it's fairly standard to be put on a pill to help protect them when you are newly-diagnosed. The tiny blood vessels of the kidneys (and eyes) can be affected by diabetes and 'leak' protein. This will be closely monitored and nothing to be alarmed about 🙂

 

[SadhbhFiadh]

Thank you, Northerner, no- no one gave me the meter. My sister-in-law (in Kilkenny) said I should insist, but I thought I would wait a little to see how things evolved. I will speak to the Dr again in two weeks, so I may ask the nurse.

I have read the two articles (I've been looking around at posts for a couple of days.) I looked for the First Year book in our library, but no luck. That will need to wait a short while. But I did find the one for Glycemic Index there, so I'll pop round tomorrow when it's open.

You've been very encouraging.

 

[Northerner]

Thank you, Northerner, no- no one gave me the meter. My sister-in-law (in Kilkenny) said I should insist, but I thought I would wait a little to see how things evolved. I will speak to the Dr again in two weeks, so I may ask the nurse.

I have read the two articles (I've been looking around at posts for a couple of days.) I looked for the First Year book in our library, but no luck. That will need to wait a short while. But I did find the one for Glycemic Index there, so I'll pop round tomorrow when it's open.

You've been very encouraging.

Perhaps you can order the book from another library? My library allows you to search for a book in the library network, and they can borrow it from somewhere else if they don't have it, or even order it if it can't be found and they think there will be a demand for it 🙂 Worth asking when you go in for the GL book! 🙂

 

[grovesy]

I would recommend buying Gretchen's book if you can as I found it useful to go back and revisit, it is also written in monthly chapters of diagnosis.

 

[SadhbhFiadh]

I would recommend buying Gretchen's book if you can as I found it useful to go back and revisit, it is also written in monthly chapters of diagnosis.

Thanks.
I found a used copy on Amazon for under £3, but then postage so I ordered the kindle version. £7 is ok.
Our council doesn't have inter-library loans unfortunately. We are glad the library is still open a few days a week, in the recent economic climate!

 

[grovesy]

Thanks.
I found a used copy on Amazon for under £3, but then postage so I ordered the kindle version. £7 is ok.
Our council doesn't have inter-library loans unfortunately. We are glad the library is still open a few days a week, in the recent economic climate!

That is good you have got.
It is shame about the library services. We still have inter library loans here but the notification service is bizarre, my husband uses alot, he gets notification that it is at the library, but in fact 9/10 when goes in it is not, they send when it is sent out. We live in a city in Essex on a well established area, and had to wait over 30 years for a local library, that is only manned by volunteers a few days a week.

 

[SadhbhFiadh]

OK, here's a question. Why do the kidneys throw off protein? I understand the technical aspects of how, but is it due to the Metformin? Or the poor uptake of insulin? Or the elevated BP? I am only concerned because my kidney function is closely followed, has been for 40 years because of another static condition, and I just need to understands the risks.

 

[grovesy]

Kidney problems can be one of the complications of Diabetes.

 

[Northerner]

OK, here's a question. Why do the kidneys throw off protein? I understand the technical aspects of how, but is it due to the Metformin? Or the poor uptake of insulin? Or the elevated BP? I am only concerned because my kidney function is closely followed, has been for 40 years because of another static condition, and I just need to understands the risks.

This document (pdf) explains all about protein in relation to the kidneys:

http://www.nhs.uk/Livewell/Kidneyhealth/Documents/protein in urine.pdf

 

[SadhbhFiadh]

Excellent, that's clear. Many thanks.

 

[trophywench]

The infant school version of what the kidneys do is - they are a sieve, they filter stuff out. The can't do anything with glucose, so they pass this and other stuff it can't process out in the urine. Trouble is with glucose, the molecules are too big to pass through the teensy holes in the sieve. I always imagine them as coarse granulated sugar - the grains are rough, right? So - the glucose molecules keep abrading the surface of the sieve and eventually all the holes get bigger - hence they can now get into the kidneys and pass. But - if the holes are big enough for the Glucose - then they are also large enough for all sorts of other baddies - which the kidneys should never be exposed to in the first place - in there too. And that is BAD news ....... eventually they just pack up if it goes on long enough ......

 

[SadhbhFiadh]

Thanks for that. I have had CKD for some time, but I'm hardly out of the starting gate with the Diabetes. I guess I thought it would take longer. I would not be able to have dialysis, so it's the kidneys damage of the Diabetes I fear. In fact, it was the specialist in Glasgow who raised the diagnosis to my GP. My visit to him at the end of September had the random blood sugar of 17. My GP had done one in April and it was 5. So I was unprepared for the news. I thought Diabetes was like the tide coming in - not jumping off the boat! ⛵ Well, I hope the lisinopril is effective!

Many thanks for your word pictures.

 

[Amigo]

Thanks for that. I have had CKD for some time, but I'm hardly out of the starting gate with the Diabetes. I guess I thought it would take longer. I would not be able to have dialysis, so it's the kidneys damage of the Diabetes I fear. In fact, it was the specialist in Glasgow who raised the diagnosis to my GP. My visit to him at the end of September had the random blood sugar of 17. My GP had done one in April and it was 5. So I was unprepared for the news. I thought Diabetes was like the tide coming in - not jumping off the boat! ⛵ Well, I hope the lisinopril is effective!

Many thanks for your word pictures.

I've had a protein leak from my kidneys for at least 15 years and have been on lisinopril too. My kidney function which is regularly monitored is still doing fine despite the diabetes.

 

[SadhbhFiadh]

I've had a protein leak from my kidneys for at least 15 years and have been on lisinopril too. My kidney function which is regularly monitored is still doing fine despite the diabetes.

Thank you. That is encouraging!

 

[SadhbhFiadh]

Is there some recommendation in grams or percentiles for sugar? I know some foods are packed with sugar just the way God made them, but I have been drinking benecol in the mornings and that, on it's own, has over 3g. I think the recommendation for added sugar is 6 grams? but food by itself always goes over that mark. I think there is some difference between simple and complex carbohydrates. I am still waiting for the GI Index book I've asked for.

All the best,
S.

 

[Northerner]

Is there some recommendation in grams or percentiles for sugar? I know some foods are packed with sugar just the way God made them, but I have been drinking benecol in the mornings and that, on it's own, has over 3g. I think the recommendation for added sugar is 6 grams? but food by itself always goes over that mark. I think there is some difference between simple and complex carbohydrates. I am still waiting for the GI Index book I've asked for.

All the best,
S.

I would say that it's more important to look at the total carbohydrate content of things, as all carbs will convert to glucose and raise blood sugar levels. Things should become clearer when you get your GI book. It may surprise you to learn that white bread will generally raise your levels faster than table sugar, as there are fewer chemical processes to undergo during digestion! 😱

I'd suggest having a look at the Diabetes UK page 'Understanding food labels' to see how they need to be looked at a bit more closely than if you don't have diabetes - front of pack stuff isn't a lot of use to us, nor 'traffic light' symbols really, as we need to know the type and total of carbohydrates in the food 🙂

 

[SadhbhFiadh]

Thanks. I'll check out the labels food page. Mostly we shop based on the traffic light codes, for processed things, but I haven't paid much attention to the numbers. I did order some Kingsmill high protein bread that is new. that one is half the carbohydrate from the ordinary brown loaf Kingsmill does.
thanks very much.