Hello

[Simon69]

Hi everyone I am type 2 diabetic on insulin, I drive a minibus for a living and at present I am going through hell trying to get my D1 back for my licence. I now have to go to addenbrooks for a DVLA medical it's been a rollercoaster of a ride so far and 4 months in. I've been diabetic for 4 years but only recently gone on to insulin which is a learning curve in itself but getting there. Enough of me brabbing and big hello to everybody

 

[Martin62]

Hi Simon , Hopefully you will get your licence issue sorted soon .

 

[rebrascora]

Hi and welcome.

Really sorry to hear the insulin is causing you problems with your job. In view of that, I think my first question would be.... Do you definitely need insulin? I know that may sound odd, but unfortunately there are many Type 2s who are not given appropriate dietary advice and just take whatever medication is prescribed and end up on stronger medication and ultimately insulin, because they have continued to overload their system with carbs. Following a low carb way of eating can be an extremely powerful tool in managing Type 2 diabetes and there are cases where people have been able to come off insulin by changing their diet, so that may be worth considering.
The other thought, is that perhaps you may be a misdiagnosed Type 1, in which case you definitely need insulin (it happens all to often unfortunately) or an atypical Type 2.

Would you mind telling us a bit about how you came to be diagnosed with diabetes 4 years ago? Was it found via a routine blood test of were you symptomatic and if so which symptoms and did they come on quite suddenly? Was your HbA1c very high at diagnosis?
Obviously it has been high recently to warrant insulin?
Also what, if any modifications have you made to your diet since diagnosis?

Apologies if any of my questions appear critical. They are not intended to be but here on the forum we know only too well that proper support and advice for Type 2s is very rare and sadly the NHS official dietary advice is often not helpful to them, so it is certainly possible that many people end up needing progressively stronger medication when that may not have been necessary and it can sometimes be possible to reverse that situation with the right guidance.

As regards your insulin usage, which insulins do you have and if you don't mind saying so, what doses are you using? Do you have Freestyle Libre or other CGM (Constan t Glucose Monitor) to help you monitor your levels? I appreciate that as a commercial driver you will also have to keep records of finger prick results, but CGM can be a game changer as to helping you see what happens between the finger pricks and therefore manage your levels better. They also incorporate alarms to warn you if levels are going too low or high, although obviously we can't totally rely on this and we should also be listening to our bodies, but setting that alarm higher can really help to head off any hypos before they happen or you even feel the warning signs. Libre is available on prescription for some Type 2s on insulin and it is available for all Type 1s, so having the right diagnosis can make a difference as regards support and technology you have access to.

Anyway, the above are just some of my thoughts on reading your post. I wish you lots of luck with the medical and hope that some of the points I have mentioned above are helpful.

 

[Inka]

Welcome @Simon69 🙂 Sorry to hear about your driving licence stress. Like @rebrascora, I’d be interested to hear a bit about how and why you were put on insulin and whether you have other options.

 

[JITR]

Agree with rebrascora and Inka, particularly people have been able to come off insulin by changing their diet. The question is could that be a simple solution for you?

 

[Simon69]

Welcome @Simon69 🙂 Sorry to hear about your driving licence stress. Like @rebrascora, I’d be interested to hear a bit about how and why you were put on insulin and whether you have other options.

Hi I was put on metfomin several different types but gave me major stomach cramps and norsia so came off them, had another blood test and the DN phoned me and said my Hbalc had rissen again I think it was 78. We had a face to face and she asked me to try insulin which I'm now on 4 times a day. I have a very sensitive stomach and gluten free I think that's maybe why I couldn't tolerate the tablets, I've been insulin for 3 months and struggling to get used to it all. My diet is pretty good I watch my cards and sugars and exercise when I can. I would love off insulin but my DN doesn't seem to think that will happen at the moment.

 

[rebrascora]

Can you give us an indication of the sort of things that you typically eat in a day ie a normal breakfast lunch and evening meal and any snacks and drinks, just so we can assess if there is room for dietary adjustment.

I know when I was first diagnosed I had no real idea about low carb and it took months to get my head around it but once I did it has been a real eye opener as to what people consider a healthy diet which might not be healthy for a Type 2 diabetic. For example, porridge and whole grains/brown versions of grains and fruit are all considered healthy but may not be suitable for Type 2s to manage their condition. I had to give up porridge because it was like rocket fuel to my blood Glucose (BG) levels and most wheat products send me into orbit even with insulin. (I was a misdiagnosed Type 2) so I am now insulin dependent, but still follow a low carb way of eating.

 

[Simon69]

Can you give us an indication of the sort of things that you typically eat in a day ie a normal breakfast lunch and evening meal and any snacks and drinks, just so we can assess if there is room for dietary adjustment.

I know when I was first diagnosed I had no real idea about low carb and it took months to get my head around it but once I did it has been a real eye opener as to what people consider a healthy diet which might not be healthy for a Type 2 diabetic. For example, porridge and whole grains/brown versions of grains and fruit are all considered healthy but may not be suitable for Type 2s to manage their condition. I had to give up porridge because it was like rocket fuel to my blood Glucose (BG) levels and most wheat products send me into orbit even with insulin. (I was a misdiagnosed Type 2) so I am now insulin dependent, but still follow a low carb way of eating.

My general day would be breakfast 5:30am which is granola but that makes me spike high so going to try shredded wheat as of tomorrow, tried bran flakes that causes a high spike to though. For lunch 12pm one sandwich with gluten free bread( can't tolerate normal or white bread) an apple and a biscuit. I mainly drink lemon juice during the day, for dinner a typical meal is pork chops baby potatoes and 2 veg. I have read about a slow release metformin which is easier on the stomach but need to speak with DN about that, Im finding it all a bit daunting and with my licence its starting to get me down.

 

[ianf0ster]

OK, so you may have cut down a bit on carbs and sugars, but it still seems like you eat a fair bit of carbs.
All the normal commercial breakfast cereals are too high in carbs for the average Type 2 diabetic without medication.
I somehow doubt you drink pure squeezed lemon juice, so I guess there is some added sugar in there as well as the carbs in the lemon juice itself.
Gluten free bread is still carbs, baby potatoes are also carbs, as are parsnips and several other veg.

There are many Type 2's in this and the other forum who have come off insulin, some even off all diabetes medications and into diet controlled remission. Many had an initial HbA1C of over 100, so you are by no means in a worse position than they were. However, I'm aware that once on insulin, you can't cut your carbs without adjusting your insulin to match.

Here is the blog post which got me started on my own path to remission (in remission for nearly 4 yrs now):

The Nutritional Thingy

There’s a few things you should know. 1. Practically all carbs turn to glucose once ingested , so not just straight sugars, but starches...

josekalsbeek.blogspot.com

 

[Inka]

@Simon69 You might already realise this but it bears saying: you need to be very careful about reducing carbs if you’re on insulin. If you reduce your carbs you risk having a hypo.

Which insulin(s) do you take?

 

[Simon69]

OK, so you may have cut down a bit on carbs and sugars, but it still seems like you eat a fair bit of carbs.
All the normal commercial breakfast cereals are too high in carbs for the average Type 2 diabetic without medication.
I somehow doubt you drink pure squeezed lemon juice, so I guess there is some added sugar in there as well as the carbs in the lemon juice itself.
Gluten free bread is still carbs, baby potatoes are also carbs, as are parsnips and several other veg.

There are many Type 2's in this and the other forum who have come off insulin, some even off all diabetes medications and into diet controlled remission. Many had an initial HbA1C of over 100, so you are by no means in a worse position than they were. However, I'm aware that once on insulin, you can't cut your carbs without adjusting your insulin to match.

Here is the blog post which got me started on my own path to remission (in remission for nearly 4 yrs now):

The Nutritional Thingy

There’s a few things you should know. 1. Practically all carbs turn to glucose once ingested , so not just straight sugars, but starches...

josekalsbeek.blogspot.com

Hi @ianf0ster thanks for that i just had a read and i am a world away from being on a low carb diet one thing i see a lot of people commenting on is having something i cant stand unfortunately but not a deal breaker. Yes it is lemon cordial i drink the only drink i really like, i love all fruits but i know they are full of natural sugar and not great for you.

I need to have a serious look at what im eating and drinking and change my ways, i would love to be off insulin and even tablets one day. The last seven years i have gained weight and been on a lot of painkiller medication ( 4 major back opps ) but am now at the stage where i can exercise again and with a good controlled diet i hope to eventually get my HbA1C down and turn my life around.

Seems a great forum for help and advise so glad i joined

 

[Simon69]

@Simon69 You might already realise this but it bears saying: you need to be very careful about reducing carbs if you’re on insulin. If you reduce your carbs you risk having a hypo.

Which insulin(s) do you take?

Hi @Inka at present the lowest my levels go are 5.5 my DN said that my levels where to high between 18/22 so insulin would bring them down to a better level. Im on Humalog fast release Breakfast 12units, Lunch 10 units, Dinner 14units, and Lantus slow release for bed time 26 units.

 

[JITR]

Here is the blog post which got me started on my own path to remission (in remission for nearly 4 yrs now):

The Nutritional Thingy

There’s a few things you should know. 1. Practically all carbs turn to glucose once ingested , so not just straight sugars, but starches...

josekalsbeek.blogspot.com

HI Ian,

The blog post you link is great, but it is a tad misleading about weight gain and fatty liver. The author who appears to be Dutch may not be aware of Professor Roy Taylor's work. The breakthrough came in c.2008 when his team discovered T2D goes away (in most cases) when patients lose the excess fat in their fatty livers and pancreases; especially the newly diagnosed.

Here is Professor Taylor to explain:
1. Briefing for Doctors
2. Achieving T2D remission (May 2023)

BTW at the end of Achieving T2D remission Professor Taylor emphasises that people can lose weight by any means, not only on a diet of 'Soups and Shakes' in packets.

 

[Drummer]

The insulin is dealing well with all the carbs you eat, so your blood glucose is around normal.
I could not deal with the metformin , but I went low carb - with a vengeance - and by eating under 50 gm of carbs a day I needed no medication.
I lost my C1 at 70, but got a VW LT 46 panel van downplated to drive on a normal licence as a camper van. People do smile to see me climbing down from the cab, though. I now qualify as a little old granny.
Oh yes - my point is that if you can't get the D1 back whilst taking insulin, is it worth giving up the bread, potatoes, apple and biscuit, oh, and the breakfast cereals for a really low carb diet - which might help with weightloss too, I am so much thinner these days.
You'd need to be really really careful - having hypos could mean no licence at all, but I have read of people able to stop insulin after reducing carbs - stopping all medication actually - as a plain ordinary uncomplicated type 2 doesn't lack insulin, it is just that they are overwhelmed by the carbs in the modern diet and their metabolism is sinking under the burden - to put it really simply.
I felt several decades younger after a few months eating low carb, and I was no longer classed as diabetic. Only disadvantage is needing new clothes as I keep shrinking.
I'd move Hell and high water rather than give up the 6 wheeler.

 

[Inka]

Hi @Inka at present the lowest my levels go are 5.5 my DN said that my levels where to high between 18/22 so insulin would bring them down to a better level. Im on Humalog fast release Breakfast 12units, Lunch 10 units, Dinner 14units, and Lantus slow release for bed time 26 units.

That’s a fair amount of insulin. I know you’re eating some carbs but it doesn’t sound like you’re eating excessive amounts. If your blood sugar goes down to 5.5 (a great level) then if you were to reduce the carbs in your meals but not reduce your Humalog, you could have a bad hypo as the insulin would potentially push your blood sugar down too low.

 

[ianf0ster]

HI Ian,

The blog post you link is great, but it is a tad misleading about weight gain and fatty liver. The author who appears to be Dutch may not be aware of Professor Roy Taylor's work. The breakthrough came in c.2008 when his team discovered T2D goes away (in most cases) when patients lose the excess fat in their fatty livers and pancreases; especially the newly diagnosed.

Here is Professor Taylor to explain:
1. Briefing for Doctors
2. Achieving T2D remission (May 2023)

BTW at the end of Achieving T2D remission Professor Taylor emphasises that people can lose weight by any means, not only on a diet of 'Soups and Shakes' in packets.

Both the author of the Blog and I were well aware of Prof Taylor's work, its limitations and the fact that its medium term success is pathetic (approx 13% after 5yrs). Prof Taylor only expanded his views in Achieving T2D remission after he had assisted with the statistical analysis of Dr David Unwin's GP Surgery T2D patients' superior remission figures which were achieved via Low Carb 'Way of eating' without calorie counting or calorie restriction.

 

[Simon69]

The insulin is dealing well with all the carbs you eat, so your blood glucose is around normal.
I could not deal with the metformin , but I went low carb - with a vengeance - and by eating under 50 gm of carbs a day I needed no medication.
I lost my C1 at 70, but got a VW LT 46 panel van downplated to drive on a normal licence as a camper van. People do smile to see me climbing down from the cab, though. I now qualify as a little old granny.
Oh yes - my point is that if you can't get the D1 back whilst taking insulin, is it worth giving up the bread, potatoes, apple and biscuit, oh, and the breakfast cereals for a really low carb diet - which might help with weightloss too, I am so much thinner these days.
You'd need to be really really careful - having hypos could mean no licence at all, but I have read of people able to stop insulin after reducing carbs - stopping all medication actually - as a plain ordinary uncomplicated type 2 doesn't lack insulin, it is just that they are overwhelmed by the carbs in the modern diet and their metabolism is sinking under the burden - to put it really simply.
I felt several decades younger after a few months eating low carb, and I was no longer classed as diabetic. Only disadvantage is needing new clothes as I keep shrinking.
I'd move Hell and high water rather than give up the 6 wheeler.

Wow a VW LT camper van not heard that name in some time, i used to be a motor mechanic and worked on several of them if im not mistaken they have the straight six diesel engine. I need my D1 for my job so its a no brainer for me, im going to start lowering my carb intake but taking care to watch my numbers and start lowering hopefully the insulin aswell, its very frustrating as the DVLA have taken 4 months so far and now want me to have a medical at Addenbrooks Hospital but the Dr secretary is on long term sick leave, my anxiety is through the roof which dont help blood sugars either.

 

[Simon69]

That’s a fair amount of insulin. I know you’re eating some carbs but it doesn’t sound like you’re eating excessive amounts. If your blood sugar goes down to 5.5 (a great level) then if you were to reduce the carbs in your meals but not reduce your Humalog, you could have a bad hypo as the insulin would potentially push your blood sugar down too low.

I want to reduce carbs but also the insulin over time, i wont lie it worries me as i dont suffer from hypos it will be a very slow process of reduction of both carbs and insulin. I have a libre 2 so can keep a good eye on things aswell but it does worry me. So much information to absorb aswell as trying to sort my Driving licence out for my job is overwhelming at times.

 

[Inka]

If you start by counting the carbs in your meals, that will be a good first step. Don’t reduce them, just count them and record the number. This will give you an idea of how many grams of carbs each of your Humalog doses covers at each meal. You can then begin to work out your insulin to carbs ratio which will allow you to make safe changes to your carbs and insulin.

 

[Simon69]

If you start by counting the carbs in your meals, that will be a good first step. Don’t reduce them, just count them and record the number. This will give you an idea of how many grams of carbs each of your Humalog doses covers at each meal. You can then begin to work out your insulin to carbs ratio which will allow you to make safe changes to your carbs and insulin.

Fantastic advice ❤️ I would never of looked at it like that thankyou so much for your help and advice today and everyone else that has commented on my post feeling a lot more positive than i did this morning.