Help please - Questions for my GP

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Kitty1

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Type 2
Hi.
I was diagnosed with type 2 approx 2 years ago. Initially I managed to put it in to remission and have been managing with diet only, but then my HbA1C has gradually crept up, the latest being 64. I saw a nurse practitioner today as I've been feeling unwell and my thyroxine also needed adjusting (which it never does) & I've also had to increase my statin. She spoke to one of the GP's who says I really need to start taking medication - metformin, and wants to speak with me over the phone. I've always resisted medication as I don't like taking it if I don't have to, but I don't think I can remain in denial any longer! It feels like it could be a slippery slope (to what, I don't really know!) so I feel like I should ask some questions - but I'm not sure what to ask. Should I be asking if there's anything else I can do? Or the benefits vs risks?
Sorry if I'm being vague, I was just hoping someone on here might understand my hesitation/worries. Sometimes it all feels a bit overwhelming and I need to have a bit of a vent!!
Thanks in advance.
 
Kitty1 said:
Hi.
I was diagnosed with type 2 approx 2 years ago. Initially I managed to put it in to remission and have been managing with diet only, but then my HbA1C has gradually crept up, the latest being 64. I saw a nurse practitioner today as I've been feeling unwell and my thyroxine also needed adjusting (which it never does) & I've also had to increase my statin. She spoke to one of the GP's who says I really need to start taking medication - metformin, and wants to speak with me over the phone. I've always resisted medication as I don't like taking it if I don't have to, but I don't think I can remain in denial any longer! It feels like it could be a slippery slope (to what, I don't really know!) so I feel like I should ask some questions - but I'm not sure what to ask. Should I be asking if there's anything else I can do? Or the benefits vs risks?
Sorry if I'm being vague, I was just hoping someone on here might understand my hesitation/worries. Sometimes it all feels a bit overwhelming and I need to have a bit of a vent!!
Thanks in advance.
Click to expand...
Welcome to the forum, I perfectly understand your fears, I was terrified about the idea of taking metformin maybe irrational but I have never been tolerant of some meds so was determined to make dietary changes and my GP was happy to allow me to do so. I know my HbA1C was not as high as yours at 50mmol/mol but I adopted a low carb approach following the principals in this link. https://lowcarbfreshwell.co.uk/
It could be your diet has slipped or you are now less tolerant of the carbs you are having.
You would benefit from having a home blood glucose monitor so you can do some strategic testing of your meals to see if any are causing a problem. Testing before you eat and after 2 hours will tell you your meal is OK if the increase is no more than 2-3mmol/l or no more than 8.5 post meal.
You may have to self fund as many GP will not prescribe but inexpensive ones can be bought on line. Those with the cheaper strips are the GlucoNavii or Spirit TEE2.
Keeping a food diary might help you identify where you can make some savings, people often feel they eat a healthy diet but if Type 2 it may still be too carb heavy.
If you would like to post some typical meals then people may spot some problem foods.
 
Leadinglights said:
Welcome to the forum, I perfectly understand your fears, I was terrified about the idea of taking metformin maybe irrational but I have never been tolerant of some meds so was determined to make dietary changes and my GP was happy to allow me to do so. I know my HbA1C was not as high as yours at 50mmol/mol but I adopted a low carb approach following the principals in this link. https://lowcarbfreshwell.co.uk/
It could be your diet has slipped or you are now less tolerant of the carbs you are having.
You would benefit from having a home blood glucose monitor so you can do some strategic testing of your meals to see if any are causing a problem. Testing before you eat and after 2 hours will tell you your meal is OK if the increase is no more than 2-3mmol/l or no more than 8.5 post meal.
You may have to self fund as many GP will not prescribe but inexpensive ones can be bought on line. Those with the cheaper strips are the GlucoNavii or Spirit TEE2.
Keeping a food diary might help you identify where you can make some savings, people often feel they eat a healthy diet but if Type 2 it may still be too carb heavy.
If you would like to post some typical meals then people may spot some problem foods.
Click to expand...
Thank you so much for the reply.
I think you might be right about my diet slipping. But then, I've never particularly liked sweet stuff so that's not a problem - more the bread and pasta, but again, I've always eaten wholemeal rather than white. So yes, it might be I'm less tolerant. My weight and fitness levels are also good, in fact a couple of doctors have said "you don't look like you should have diabetes" - which doesn't make me feel any better! Ha ha!
I'll definitely try the food diary and blood glucose monitoring, (appreciate many people will wonder why I haven't done that before - but as I say, I think I've been in denial!) it would certainly give me some clues.
Thank you again - it's good to know I'm not on my own with this. 🙂
 
bulkbiker said:
What kind of dietary protocol were you following?

Did anyone give you a decent reason why?
Click to expand...
Hi
Initially I did the Fast 800 under guidance from my GP and that put it into remission, but obviously that's not sustainable. Now I try and keep carbs low but I'm not sure how many grams a day/per meal that should be.
I feel a bit confused by the recommendations because full fat stuff supposedly keeps you fuller for longer (I'm talking plain yoghurt etc, although being veggie I do eat cheese!) - but now my cholesterol has gone up again (Serum total 5.4, HDL 1.6, LDL, 3.1 HDL ratio 3.4) and apparently the guidance has changed? To be fair, my GP said try the increased dose for 3 months then review. If it hasn't changed, they'll put it back down. I asked him if I could just adjust my diet but he said the evidence is it doesn't make any difference.
I just feel completely overwhelmed with all the differing advice.
Thanks.
 
Kitty1 said:
Now I try and keep carbs low but I'm not sure how many grams a day/per meal that should be.
Click to expand...
I went for ketogenic levels of sub 20g of carbs per day. I also reduced my eating window to about 8 and now to 6 hours.

Full fat everything, although as a meat eater (in large amounts) I never felt hungry.
Your cholesterol is pretty normal, did you get a triglycerides figure?

I'd never takes statins, firstly because they have been know to raise blood sugar levels which makes someone with T2 being given them slightly contradictory,

For older females higher cholesterol level have been shown to be protective so...

I'd start with a detailed food diary for a month including everything that passed my lips to get an honest picture of what I was eating and then make the necessary adjustments from there. Also Id definitely start monitoring my blood sugar levels to get a handle on the impact of my food intake and what food types I should remove from my diet.
 
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Kitty1 said:
Thank you so much for the reply.
I think you might be right about my diet slipping. But then, I've never particularly liked sweet stuff so that's not a problem - more the bread and pasta, but again, I've always eaten wholemeal rather than white. So yes, it might be I'm less tolerant. My weight and fitness levels are also good, in fact a couple of doctors have said "you don't look like you should have diabetes" - which doesn't make me feel any better! Ha ha!
I'll definitely try the food diary and blood glucose monitoring, (appreciate many people will wonder why I haven't done that before - but as I say, I think I've been in denial!) it would certainly give me some clues.
Thank you again - it's good to know I'm not on my own with this. 🙂
Click to expand...
I'm afraid that bread, or any carb, is still a carb no matter what its colour.
You might be able to get a delay if you explain that you have been eating high carb foods and would like to try to make adjustments before taking tablets.
If you are sensitive to Metformin the consequences can be pretty dreadful. I only lasted 4 weeks on it, and it took ages to recover from it and Atorvastatin. I thought I was heading for nappies and a care home after the first month.
 
By the way, low carb bread if you make it at home is a really good option - you can even make hot cross buns with the same mix plus sweetener and a little mixed peel and dried fruit.
 
bulkbiker said:
I went for ketogenic levels of sub 20g of carbs per day. I also reduced my eating window to about 8 and now to 6 hours.

Full fat everything, although as a meat eater (in large amounts) I never felt hungry.
Your cholesterol is pretty normal, did you get a triglycerides figure?

I'd never takes statins, firstly because they have been know to raise blood sugar levels which makes someone with T2 being given them slightly contradictory, secondly because their benefits are pretty sketchy to say the least.

For older females higher cholesterol level have been shown to be protective so...

I'd start with a detailed food diary for a month including everything that passed my lips to get an honest picture of what I was eating and then make the necessary adjustments from there. Also Id definitely start monitoring my blood sugar levels to get a handle on the impact of my food intake and what food types I should remove from my diet.
Click to expand...
Ooh! 20g - think I might struggle with that on the berries I have for breakfast alone!
My serum triglycerides were 1.6. & yes, I've always wondered about the statins pushing the blood sugars up. It's that conflicting advice thing again. Do you have any research about higher cholesterol levels being protective in older females? (I'm 59 so I don't know where that puts me? ha ha!)
I'm definitely going to go down the food diary/blood glucose route.
 
Drummer said:
I'm afraid that bread, or any carb, is still a carb no matter what its colour.
You might be able to get a delay if you explain that you have been eating high carb foods and would like to try to make adjustments before taking tablets.
If you are sensitive to Metformin the consequences can be pretty dreadful. I only lasted 4 weeks on it, and it took ages to recover from it and Atorvastatin. I thought I was heading for nappies and a care home after the first month.
Click to expand...
Hi
Yes, I might try for a stay of execution by suggesting I am going to keep the food diary and make some adjustments first.
Trouble is, making adjustments to one thing seems to throw other things out - my endocrine system is my nemesis, something wrong with every aspect of it. Being told it needs constant tweaking doesn't help with the confusion!
 
Kitty1 said:
My serum triglycerides were 1.6.
Click to expand...
So HDL and triglycerides were both 1.6 which gives you a Trig/HDL ratio of 1.
Can you remember if you had water only fasted for 12-14 hours before the blood was taken for the test?


" Do you have any research about higher cholesterol levels being protective in older females"

here's one with some other studies referenced.

academic.oup.com

High cholesterol may protect against infections and atherosclerosis

Many researchers have suggested that the blood lipids play a key role in the immune defence system.1–21 There is also a growing understanding that an inflammato
academic.oup.com academic.oup.com
 
If you are looking for a guidance about the amount of carbs then it is suggested that low carb is no more than 130g per day including meals, drinks and snacks but many find they do need to go lower and that is usually because they are home testing and will determine the limit of what they can tolerate for each meal. Essentially not overloading your system by having a large amount of carbs at their main meal and not much at the others. I went with approx 70g per day and have found that very doable and sustainable.
You mention being vegetarian which does make it more tricky as the carb free foods you won't have so probably more important for you that you do test so you can see if the foods you do have are OK.
Certainly many veggie meals are very rice and pasta based so finding some substitutes should help.
I have black bean or edamame bean pasta as that is much lower carb and use a lot of butternut squash instead of potatoes, cauliflower rice is not too bad with lots of herbs and spices in a stirfry and grilled halloumi or paneer is good in curries.
An internet search for low carb or keto veggie recipes is a good place to look for new ideas.
 
Kitty1 said:
Hi
Yes, I might try for a stay of execution by suggesting I am going to keep the food diary and make some adjustments first.
Trouble is, making adjustments to one thing seems to throw other things out - my endocrine system is my nemesis, something wrong with every aspect of it. Being told it needs constant tweaking doesn't help with the confusion!
Click to expand...
Since insisting on always eating a low carb diet my need to supplement with Thyroxine has reduced. Despite being stable for a couple of decades at 200 microgram I am now taking 125 daily.
 
bulkbiker said:
I went for ketogenic levels of sub 20g of carbs per day. I also reduced my eating window to about 8 and now to 6 hours.

Full fat everything, although as a meat eater (in large amounts) I never felt hungry.
Your cholesterol is pretty normal, did you get a triglycerides figure?

I'd never takes statins, firstly because they have been know to raise blood sugar levels which makes someone with T2 being given them slightly contradictory, secondly because their benefits are pretty sketchy to say the least.

For older females higher cholesterol level have been shown to be protective so...

I'd start with a detailed food diary for a month including everything that passed my lips to get an honest picture of what I was eating and then make the necessary adjustments from there. Also Id definitely start monitoring my blood sugar levels to get a handle on the impact of my food intake and what food types I should remove from my diet.
Click to expand...

Can I say @Kitty1, that going to your GP suggesting that some anonymous person on the internet says that his advice is bad is not a good idea. Your GP will have your full medical record at hand. He/she will be perfectly aware of the benefits and potential hazards of taking any particular medication. They do not need internet warriors intent on banging on with their extreme point of view telling them their job.

I claim no expertise in the subject but I can look at all the information that is sculling about and my take is that statins are on balance seem to be a very effective medication. Like all medications, they do not suit some but that is no reason for dismissing them altogether.

For older females higher cholesterol level have been shown to be protective so...
Click to expand...

Statements like that really are meaningless. It implies a lot but actually says nothing and it is really unwise to make any decisions based on it.

In answer to your question I would suggest that you ask your doctor what effects they expect to see as a result of the suggested medication changes and what tests need to be put in place to check that the expected effects are being achieved. You might also ask what side effects you might see and what to do if you are unfortunate enough to experience them.

CAVEAT. I have not made the above observations as a moderator on the forum but as somebody who has done a few miles and prefers to look for a balanced view of things rather than trotting out internet tropes on subjects in which I have no expertise. I have seen, both professionally and personally, the damage that can be done by keyboard warriors and I have no intention of giving any further attention to them by trying to refute their innuendo. That just ends up as trope ping pong and goes nowhere. In my world they are best ignored and left to find their own happiness conspiring amongst themselves.
 
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Docb said:
Can I say @Kitty1, that going to your GP suggesting that some anonymous person on the internet says that his advice is bad is not a good idea. Your GP will have your full medical record at hand. He/she will be perfectly aware of the benefits and potential hazards of taking any particular medication. They do not need internet warriors intent on banging on with their extreme point of view telling them their job.

I claim no expertise in the subject but I can look at all the information that is sculling about and my take is that statins are on balance seem to be a very effective medication. Like all medications, they do not suit some but that is no reason for dismissing them altogether.



Statements like that really are meaningless. It implies a lot but actually says nothing and it is really unwise to make any decisions based on it.

In answer to your question I would suggest that you ask your doctor what effects they expect to see as a result of the suggested medication changes and what tests need to be put in place to check that the expected effects are being achieved. You might also ask what side effects you might see and what to do if you are unfortunate enough to experience them.

CAVEAT. I have not made the above observations as a moderator on the forum but as somebody who has done a few miles and prefers to look for a balanced view of things rather than trotting out internet tropes on subjects in which I have no expertise. I have seen, both professionally and personally, the damage that can be done by keyboard warriors and I have no intention of giving any further attention to them by trying to refute their innuendo. That just ends up as trope ping pong and goes nowhere. In my world they are best ignored and left to find their own happiness conspiring amongst themselves.
Click to expand...

Well said that man.
 
Docb said:
Can I say @Kitty1, that going to your GP suggesting that some anonymous person on the internet says that his advice is bad is not a good idea. Your GP will have your full medical record at hand. He/she will be perfectly aware of the benefits and potential hazards of taking any particular medication. They do not need internet warriors intent on banging on with their extreme point of view telling them their job.

I claim no expertise in the subject but I can look at all the information that is sculling about and my take is that statins are on balance seem to be a very effective medication. Like all medications, they do not suit some but that is no reason for dismissing them altogether.



Statements like that really are meaningless. It implies a lot but actually says nothing and it is really unwise to make any decisions based on it.

In answer to your question I would suggest that you ask your doctor what effects they expect to see as a result of the suggested medication changes and what tests need to be put in place to check that the expected effects are being achieved. You might also ask what side effects you might see and what to do if you are unfortunate enough to experience them.

CAVEAT. I have not made the above observations as a moderator on the forum but as somebody who has done a few miles and prefers to look for a balanced view of things rather than trotting out internet tropes on subjects in which I have no expertise. I have seen, both professionally and personally, the damage that can be done by keyboard warriors and I have no intention of giving any further attention to them by trying to refute their innuendo. That just ends up as trope ping pong and goes nowhere. In my world they are best ignored and left to find their own happiness conspiring amongst themselves.
Click to expand...
Hi @Docb.
Thank you for your reply.
I think what gets me confused is that I always look for the evidence - but as you know, there's always a counter piece of research for everything!
I have the utmost respect for my GP's (seems this is rarity these days), and you are absolutely right, they know me and my medical history best. The GP I'm hoping to speak to tomorrow is the 'diabetes lead' for the practice and I've always found her very sensible.
Your question suggestions are pretty much what I had arrived at, so thank you for reinforcing that. The issue of statins pushing up blood sugars is something I've seen before though so I reckon it won't hurt to ask if it's really 'a thing'.
@Leadinglights - I looked at the Freshwell website. Very useful!

Thank you again for taking time to reply 🙂

​

 
No problem at all @Kitty1. As you might have guessed I worry when people come to the forum for support and sensible suggestions and get extreme views in responses. There is nothing wrong with extreme views, there is probably a tiny element of value in them, but to my mind they are unhelpful in a forum such as this where members are looking for the balance which will allow them to begin to understand things and move forward with some confidence. It is what I found when I first joined the forum, why I kept with it, and eventually agreed to help with moderation. I doubt that would have happened if my early posts had been derailed by what I would have seen as pointless argument of little value.

Hope your meeting with your Doc goes well and you get a decent perspective on things.
 
Kitty1 said:
Do you have any research about higher cholesterol levels being protective in older females? (I'm 59 so I don't know where that puts me? ha ha!)
Click to expand...

There are some studies published which make claims about increased cholesterol levels being less problematic as people get older, but these can have methodological weaknesses, and do not form the majority of expert opinion on the subject.

Flawed cholesterol study makes headlines​

A packet of statin tablets

A controversial study has argued that if you have a high LDL (bad) cholesterol level when you are aged over 60, you will live longer, there is no increased risk of cardiovascular disease and that statins will have little effect. But can we trust these bold claims?

https://www.bhf.org.uk/informations.../behind-the-headlines/cholesterol-and-statins

When attempting to have an open conversation about statins, and allow people to share their individual experiences, it’s important to remember that there is far more high quality evidence to support their use, than there is that casts any doubt over their efficacy.

https://twitter.com/x/status/1632394654485291008
 
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everydayupsanddowns said:
There are some studies published which make claims about increased cholesterol levels being less problematic as people get older, but these can have methodological weaknesses, and do not form the majority of expert opinion on the subject.

Flawed cholesterol study makes headlines​

A packet of statin tablets

A controversial study has argued that if you have a high LDL (bad) cholesterol level when you are aged over 60, you will live longer, there is no increased risk of cardiovascular disease and that statins will have little effect. But can we trust these bold claims?

https://www.bhf.org.uk/informations.../behind-the-headlines/cholesterol-and-statins

When attempting to have an open conversation about statins, and allow people to share their individual experiences, it’s important to remember that there is far more high quality evidence to support their use, than there is that casts any doubt over their efficacy.

https://twitter.com/x/status/1632394654485291008
Click to expand...
Thank you. It really is a mine field! This area seems more confusing to me than anything.
A lot of advice around low carb diets seems to promote full fat everything to keep you satisfied for longer - but my brain screams 'nooooooo'!! as it flies in the face of everything I've ever been told about low fat diets being good to keep your cholesterol down. Fully appreciate it's more complex, with 'good fats' (nuts, avocado, olive oil) vs 'bad fats', but then they advise full fat greek yoghurt etc. I fear I'll end up eating a very limited diet of things that seem safe - but end up malnourished!! ha ha! (only kidding, but I hope you get where I'm coming from).
 
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