Hi, recently diagnosed Type 2

[diabssd]

Hi,

I have been recently diagnosed with T2 with Hba1c reading of 68 and 62. I am not particularly overweight (5ft 7in and weigh 72Kg). I have lost 3Kg since the beginning of the year and trying to lose body fat and get my weight down by that magical 15Kg. I am not taking any meds as yet as I wanted to try and make some diet/exercise changes.My blood pressure is a little high at times and the nurse has informed me my cholesterol is high. Was this a sensible choice or should i have gone onto metaformin and cholesterol tablets?

I have acquired the freestyle libre sensor and been monitoring over the past few days. I have noticed that the sensor reading and the blood glucose reading can be quite different. I tested this by performing a check first thing in the morning (while blood sugar levels should be quite stable) and noticed my sensor is showing a 1.4mmol lower reading even taking into account the 15min delay. Is this common?

What kind of fasting glucose readings do people get in the morning. Mine is currently 7.3. Have they been able to reduce it and how?

Thanks for your help in advance.

 

[ianf0ster]

Hello diabssd,
When diagnosed I had an Hba1c of 53 and was just a little overweight at 170lbs. I got a BG meter, cut the carbs with a 'Low Carb Way Of Eating' - no initial calorie restriction. I was already doing 30min brisk walk every day, so I didn't even increase my exercise. I just ate real food 3 decent sized meals per day so I didn't get the urge to snack. I eat to my meter - so aim to keep any spikes below 7.8 (which is the conservative estimate of when the BG is high enough to start to cause complications). Despite no 'dieting' I still lost weigh at a rate of between 1lb and 2lbs per week.

Once I became 'fat adapted' I noticed that I was often not as hungry at mealtimes. This led to me skipping some breakfasts and currently I've not had any breakfasts since early December although I haven't lost any more weight since the end of August.

I lost a maximum total of 25lbs but then it stabilised at a loss of 23lbs.


I have no experience of Continuous blood monitors.

Fasting BG is affected both by what you ate thy prior day and by the Dawn Phenomenon (DP) which is sometimes called 'Foot on the floor' .
This is caused by the Liver being 'helpful' and dumping some glucose into the bloodstream in order to give you the energy to go out and hunt/gather your breakfast. This should slowly subside as your body gets used to lower levels of BG.

 

[grovesy]

The sensor and blood glucose are slightly differnt. The sensor measures intesistal fluid and lags by 15 mins from blood glucose.

 

[rebrascora]

Hi and welcome

If it was me. I would negotiate a 3-6 month hiatus with the nurse to see if you can improve things by diet and exercise before resorting to medication.

I would be interested to know what the Libre is showing you regarding your readings after meals? Fasting readings tend to be the last ones to come down, but 7.3 isn't too bad..... how soon did you take it after getting out of bed and have you checked it before you get up?

I am also an advocate of low carb eating to bring levels down. Things like wholemeal bread and pasta can continue to release glucose for 8-10 hours after you have eaten them, so if you have those 2 meals in a row, your BG doesn't get the chance to come down to normal levels before it goes high again... ie one spike piggy backs onto the previous one and your levels get progressively higher.

I would not worry too much about the Libre being 1.4 out from the meter as there is a potential error factor of something like 15% in a BG meter, so it is not worth getting too hung up on the numbers themselves unless they are silly high. Seeing trends is much more important, particularly after meals as you are looking to avoid spikes of more than 2mmol after a meal.

Basically all carbs break down into glucose and sometimes the starchy carbs can be worse because they continue to release glucose for many hours. For that reason, on a low carb diet, we avoid or dramatically reduce high carb foods including the obvious added sugar, cakes sweets and biscuits and surprisingly fruit and particularly fruit juice, but also bread, rice, pasta, potatoes, anything containing grains/flour like pastry, breakfast cereals, even that wholesome porridge can cause problems. It may seem like that doesn't leave much to eat but once you get the hang of it, eating low carb can be really enjoyable, especially once you increase your natural fat intake with the likes of butter, cream, cheese, olive oil, nuts, avocados etc.
Things to eat are meat, fish, eggs, nuts, mushrooms, Mediterranean veg like tomatoes, peppers, courgettes and aubergines, leafy green veg like salad leaves, cabbage, kale, spinach, brussel sprouts and broccoli and cauliflower which is a wonder veg as far as us diabetics are concerned as it can be cooked and mashed with a dollop of cream cheese to replace mashed potato either on it's own or as a topping for cottage pie or fish pie, liberally sprinkled with grated cheese of course, or grated and used to replace rice or couscous in dishes. And of course who doesn't love cauliflower cheese?
I appreciate that you also have high cholesterol so eating more fat and particularly dairy and meat fats may be a concern, but there is a school of thought that dietary fat does not necessarily relate to blood lipids. You will have to make that decision for yourself. My last cholesterol was 5.2 and they would like it lower but my ratio is good and it has not changed so far despite eating a lot more saturated fat but I have only increased my fat intake in the last 6 months so it is still early days for me. Some people have found that their cholesterol went down despite eating more fat. I think increasing activity levels is also an important factor and that isn't necessarily going to the gym or doing sport but perhaps just going for a good brisk walk each day or doing manual work like gardening (mucking out horses in my case) etc.

Anyway, good luck whatever you decide to do and let us know how you get on.

 

[diabssd]

Thanks for your response, very insightful.

My graphs from the libre sensor (see below) are a little distorted because I am in the middle of an intermittent fasting regime (OMAD) to reduce my body fat levels. I understand this is probably not sustainable, but just my main focus currently before moving to a low carb diet.

This morning at 7.15am I checked my blood sugar on the test machine and it was reporting 7.3. I then checked my sensor reading after 15 mins (7.30am) and it reported a value of 5.9. (I was awake from about 6.45am)

The inaccuracy could be down to the test strips/machine (borrowed from a family member) not calibrated properly so I have a new batch of test strips and will test this again tomorrow.

 

[Drummer]

As your Hba1c is not shriekingly high, by cutting out the highest carb foods, or at least reducing them drastically, you should see it dropping back towards normal without much effort - the contest being between cereal or toast or a low carb breakfast of bacon and eggs or steak and mushrooms LCHF usually wins hands down.
I can't advise on faasting BG as I have never bothered to take mine.
I started off testing to see how various meals affected me, then various foods - but dropped down to normal levels so quickly that I was no longer diabetic before I realised just how effective diet is.

 

[rebrascora]

There is a level of inaccuracy in both the BG meter and the Libre I believe so your true reading may be somewhere in between. The spike to 9 I would guess is your evening meal? What did you have? A smaller portion of carbs might be better next time as that is a significant peak but seems to have come down reasonably quickly suggesting possibly higher GI carbs rather than slow release..... or perhaps you did some exercise after eating to bring it down. Ideally you want a maximum rise of no more than 3mmols but ideally 2....

You gotta love the info a Libre provides.... so hope I can get authorised for one soon!

 

[diabssd]

It was quite a big meal. A large portion of chicken tikkha, brown rice and some salad. Too much rice I think and not enough salad. No exercise on that day.

That is just some of the basic information from Libre, online gives far more insight to daily patterns. I am just using it to see how my blood sugar reacts to certain foods. Too expensive to fund it privately.

Drummer, the nurse was not so confident i would get it under control through diet/exercise solely and softly trying to move me on to meds. I think she was just making a judgement on my body shape and that I was not that overweight so not much to lose. She showed me a Hba1c convertion table (Orange area) and gave the impression I was in a bad condition. She gave me a target of 49 after 3 months and to bring my cholesterol down from 5.6 to 4.

 

[rebrascora]

I am pretty sure that @Anitram was not significantly overweight when he was diagnosed and his HbA1c was 114 at diagnosis if I remember rightly and he brought it down to prediabetic range in about 3 months and he just posted his most recent HbA1c result in the normal range and whilst he did start on Metformin I believe, he stopped taking it after a few weeks and did it all with diet and exercise after that.
Health care professionals have been taught that a healthy diet contains a good portion of carbohydrates and that fats are bad. They cannot comprehend a low carb diet because if you are not eating carbs then you need to get energy from another source and fat is the obvious choice, but they have drummed into people all their careers that fat is bad, so they would struggle to do a U-turn now even if they wanted to. I don't think your cholesterol is excessively high at 5.6 and they certainly haven't offered me medication for mine at 5.2 (thankfully) even though they would like it to be 4.... because that is the guideline for diabetics.

There is of course the possibility that you are not Type 2 but perhaps Type 1 or 1.5 (LADA) but if that is the case you will eventually need insulin and even going extremely low carb and fasting your BG would slowly and steadily rise. Type 2 diabetes is just an assumption based on an HbA1c of 48 or more and usually your age as many HCPs believe that Type 1 only exhibits in children and young adults but many of us develop it in later life.... I was diagnosed last year at 55yrs with an HbA1c of 112

 

[Drummer]

I went from 91 to 47 in 80 days, using the low carb way of eating - I suspect that your nurse has got no idea about just how powerful a tool it is in controlling blood glucose.
You'll be able to make swaps such as cauliflower instead of rice, courgette or aubergine instead of potato, maybe mushrooms, or beansprouts to replace more carb heavy veges - more salads fewer, or lower carb desserts - weightloss isn't really a factor - diabetes is about controlling blood glucose. When your metabolism gets more into balance you might need to make adjustments, but for a lucky type two, it is a simple swap of low carb for high carb - job done

 

[everydayupsanddowns]

Welcome to the forum @diabssd

Just to go into a bit more detail about differences between Libre and BG. The sensor reads interstitial fluid, while. BG meter reads blood, and both have an expected level of accuracy. To meet the legal requirement BG meters need to be within 15% +/- for 95% of readings (and 5% of the time they can read anything!). Greater accuracy is required at low BG levels.

As you know, the glucose in interstitial fluid ‘lags’ behind capillary blood, and the sensor has an algorithm that attempts to reduce that lag to around 5 mins.

Additionally, the sensors are ‘factory calibrated’ to convert the raw data into an approximation of equivalent glucose values.

In short there are a number of steps between what values the sensor is receiving (which can be affected by the insertion of the sensor, as well as if it is under pressure (eg if you apply tape over the top). Plus different Sensors can perform slightly differently. So while it is very likely that you will get usable data from both BG strips and Libre, you can’t expect them to be exactly the same at any point, though they are likely to be fairly close much of the time.

 

[diabssd]

Thanks everyone. Sugar levels are now starting to stabilise around the 3.5 mark on libre sensor. Earlier on in the week, as shown in the earlier graph my BG levels were dropping slowly from 9am to 3pm. I will check with my contour monitor this afternoon to compare and make sure the libre sensor is still functioning properly. Am i starting to see some fruits of my labour?

I had a low carb omlette and salad yesterday evening followed by HIIT cycle for 35 mins.
I thought I would try some breakfast (1x weetabix and semi-skimmed milk) this morning.

 

[ianf0ster]

I thought I would try some breakfast (1x weetabix and semi-skimmed milk) this morning.

Obviously you have a much higher tolerance for Carbs than I do.

 

[diabssd]

Are how high the blood sugars peak important or how quick they return back to normal? What would you say tolerance levels are? Is it good to keep meals under 8mmol?

Forgive me if i am asking any silly questions.

 

[rebrascora]

You are looking at the difference between the before meal reading and the peak of the meal spike being ideally less than 2 mmols but certainly less than 3mmols. The rate that it returns to it's previous level can equate to the type of carbohydrate or the efficiency of your body to break down the carbs as well as your body's ability to remove it from the blood stream. Many Type 2 diabetics are insulin resistant but some don't produce enough insulin. It looks to me from those graphs that your body is doing a pretty reasonable job of removing the glucose from the blood stream so it may be that you are just not producing quite enough insulin to cope with higher carbohydrate levels but can manage on a moderate/low carb diet..... at least that would be my take on it. It may be that after a while of eating low carb, your pancreas will have benefitted from not being under pressure to produce a lot of insulin and as a result it is able to increase production a little enabling you to eat a few more carbs in the future, but you will probably always need to be careful in that respect..... I am no expert though, so that is just my take on it.

 

[trophywench]

Well - looks to me like you started brekkie about 08.00 and your BG had returned to pre-meal level within 90 minutes and then dropped some more. That is pretty darn good for a diabetic ! It isn't yet 'non-diabetic' because it appears your own 'first response' insulin isn't kicking in as quickly as it would, were you non-D.

Bearing in mind that the human body starts to absorb glucose through the cheeks with the action of saliva on the food before you even swallow it, the natural/normal first insulin response would start warming up at the same time, before revving up slightly as the food is swallowed and meets some more digestive enzymes on its way.

I would make a guess that when you get the weight off, you will no longer have such a problem.

I mean we're conditioned from birth virtually that gaining just an extra bit of weight won't really hurt us - but here you are proving that on the contrary it can and will. Also reiterates to me, yet again, how mega complicated the human body actually is and it is truly wondrous that it goes wrong so infrequently for most people!

 

[diabssd]

Thank you for your observations and comments. Not easy to see on the graph, but I had breakfast at 07.40.

I was reading the book by Professor Roy Taylor and it was talking about weight slowly creeping up over the years and that we eventually become "too big for our bodies to cope" and interesting information around "personal fat thresholds".

 

[Drummer]

Weetabix are about 2/3rds carbs so not something I'd even think of as food - two would be my entire days intake of carbs, maybe more - and with a sugary fluid poured over them - milk contains lactose, you are pushing the carbs even higher.

 

[diabssd]

Update.

Got my latest Hba1c result - 43. Not finished yet, but quite happy with that.

A mixture of better diet choices, intermittent fasting and regular light exercise. Still have some bad days giving into the carb cravings, but sticking to the 80/20 rule has served me well.

 

[rebrascora]

Many congratulations!... Great to see hard work and effort paying off.
I hope it was the same nurse you saw for the blood test who was so sceptical about diet and exercise being able to bring your levels down.