I’m confused!

[Devondumpling]

Good morning.
I was recently diagnosed with type 2 and was told they were putting me on Metformin 500mg one at breakfast and one with evening meal. I didn’t tolerate it well so at my first appointment with the diabetes nurse, she changed it to the slow release Sukkarto 500mg and the instructions were to start off with just one at breakfast and step up weekly to a max of 2 with breakfast and 2 with evening meal. This means in 4 weeks I’ll be taking 2000mg as opposed to 1000mg of Metformin. Does this sound right? I’ve also read that the slow release only needs to be taken just once a day in the evening??
I was given no literature or information whatsoever, just told to make another appointment in 3 months time.
I really don’t have a clue what I should and shouldn’t be doing!
I had to ask what my levels were and she said I’d been 55 on my first blood test but this had dropped to 52 by my second, which was when they phoned to say I was diabetic. Up until then I’d been thinking it was my cholesterol which was bad (it was so I’m on statins too! ) and had no idea they were testing for diabetes as there’d been no mention of it.
I‘m cutting out carbs so am losing weight but have no idea if I should be testing myself for sugars etc and If so, how do I do this?
Also, are there varying degrees of type 2 diabetes or is it a case of once you’ve got it, you’ve got it? I don’t know how “bad” a reading of 52 is.
I said I’d found this forum and she said there’s lots of useful advice on here (there is!!) but added that I should take into account that many of the folk here have very severe diabetes….so does this mean mine is just a mild case, if that makes sense?
Apologies for all the questions, but I really don’t have much of a clue what it’s all about!!
Thanks

 

[everydayupsanddowns]

Does this sound right? I’ve also read that the slow release only needs to be taken just once a day in the evening??
I was given no literature or information whatsoever, just told to make another appointment in 3 months time.
I really don’t have a clue what I should and shouldn’t be doing!

Sorry you’ve been having such a confusing time @Devondumpling - I would rely on your GP or nurse for dose suggestions. It’s unfortunate that you weren’t given any information with your tablets. I think you can download the Sukkarto Patient Information Leaflet here:

Sukkarto SR 500mg prolonged release tablets - Patient Information Leaflet (PIL) - (emc)

Sukkarto SR 500mg prolonged release tablets - Patient Information Leaflet (PIL) by Morningside Healthcare Ltd

www.medicines.org.uk

Or perhaps pop into your chemists and ask to speak to the qualified pharmacist?

I had to ask what my levels were and she said I’d been 55 on my first blood test but this had dropped to 52 by my second, which was when they phoned to say I was diabetic. Up until then I’d been thinking it was my cholesterol which was bad (it was so I’m on statins too! ) and had no idea they were testing for diabetes as there’d been no mention of it.

That will be your HbA1c which tracks glucose levels over 3-4 months. 52 - 55 are a little over the ‘diagnosis line’ of 48, but we have some on the forum who start with an HbA1c over 100 of that helps give you a sense of your starting point. Sounds like the changes to your menu and weight loss are helping already 🙂

I‘m cutting out carbs so am losing weight but have no idea if I should be testing myself for sugars etc and If so, how do I do this?

Lots of members on the forum find a BG meter is a very helpful way of fine-tuning their foods to make them as BG-friendly as possible. The most affordable meters members here have found are the SD Gluco Navii or the Spirit Tee2 - which both have test strips at around £10 for 50

You can use a BG meter, taking a reading before and again 2hrs after eating, to see what the differences are, to identify any carbs that seem to be spiking BG (initially in a way the numbers themselves matter less than the differences between them). Ideally you would want to see a rise of no more than 2-3mmol/L at the 2hr mark. Once you can see how you respond to different meals you can begin experimenting with reducing portion sizes of the carbs where you see bigger rises. You might find that you are particularly sensitive to carbohydrate from one source (eg bread), but have more liberty with others (eg oats or basmati rice) - It’s all very individual! You might even find that just having things at a different time of day makes a difference - with breakfast time being the trickiest.

Also, are there varying degrees of type 2 diabetes or is it a case of once you’ve got it, you’ve got it? I don’t know how “bad” a reading of 52 is.
I said I’d found this forum and she said there’s lots of useful advice on here (there is!!) but added that I should take into account that many of the folk here have very severe diabetes….so does this mean mine is just a mild case, if that makes sense?
Apologies for all the questions, but I really don’t have much of a clue what it’s all about!!
Thanks

I’m not sure I like the phrase ‘severe diabetes’, and neither would I like ’mild diabetes’. I think all diabetes is serious, and needs careful attention and management. What that involves can vary from person to person. But all cases and types of diabetes are serious.

There is research that shows that some people either through significant weight loss, or by carefully reducing the carbs in their diet, can put their T2 diabetes into remission, and may even be able to kickstart normal responses from their pancreas if abdominal/visceral fat is lost.

 

[Leadinglights]

Good morning.
I was recently diagnosed with type 2 and was told they were putting me on Metformin 500mg one at breakfast and one with evening meal. I didn’t tolerate it well so at my first appointment with the diabetes nurse, she changed it to the slow release Sukkarto 500mg and the instructions were to start off with just one at breakfast and step up weekly to a max of 2 with breakfast and 2 with evening meal. This means in 4 weeks I’ll be taking 2000mg as opposed to 1000mg of Metformin. Does this sound right? I’ve also read that the slow release only needs to be taken just once a day in the evening??
I was given no literature or information whatsoever, just told to make another appointment in 3 months time.
I really don’t have a clue what I should and shouldn’t be doing!
I had to ask what my levels were and she said I’d been 55 on my first blood test but this had dropped to 52 by my second, which was when they phoned to say I was diabetic. Up until then I’d been thinking it was my cholesterol which was bad (it was so I’m on statins too! ) and had no idea they were testing for diabetes as there’d been no mention of it.
I‘m cutting out carbs so am losing weight but have no idea if I should be testing myself for sugars etc and If so, how do I do this?
Also, are there varying degrees of type 2 diabetes or is it a case of once you’ve got it, you’ve got it? I don’t know how “bad” a reading of 52 is.
I said I’d found this forum and she said there’s lots of useful advice on here (there is!!) but added that I should take into account that many of the folk here have very severe diabetes….so does this mean mine is just a mild case, if that makes sense?
Apologies for all the questions, but I really don’t have much of a clue what it’s all about!!
Thanks

Welcome to the forum
52mmol/mol is only just over the diagnostic threshold of 48mmol/mol so it is surprising that they have wellied in with such a high dose of metformin. Many would be given the opportunity to make some lifestyle changes, diet and exercise for 3 months before being prescribed metformin.
It is usual to build up the dose gradually as it help with the stomach issues many get but also taking mid meal can help.
You say you are reducing carbs which is a good approach and this link may help you with some ideas. https://lowcarbfreshwell.co.uk/
There are many here who have been in triple figures with their HbA1C and have managed to reduce it to normal below 42mmol/mol by a variety of means diet being the main thing that people need to address even if they need help with medication as well.

 

[EmmaL76]

For a comparison, although I’ve been recategorised as a LADA (slow onset type 1) initially I was diagnosed type 2. My starting hba1c was 52 firstly followed by 55 a few weeks later. I was told to change my diet and instructed to take 1 metformin a day. I’m not suggesting you change your dose without talking to your doctor/ nurse but I would certainly be asking a few questions.

 

[Dragonheart]

I was diagnosed at 55mmol. It was suggested to make lifestyle and diet changes before medication was started. I went very low carb and tested before and after meals and by 3 months was in remission (non diabetic levels without drugs). Metformin is a fairly mild drug and most find diet changes do far more than it does.

If your preference and choice is to do similar I would tell the nurse that and suggest it’s reviewed at the 3 month mark to see how it’s working. You can always change your course at that point. (All diabetics should have an hba1c 3 monthly til stable and as a newly diagnosed they can’t call it stable yet, and then 6 monthly according to NICE. Not all surgeries follow this though).

 

[Devondumpling]

I was diagnosed at 55mmol. It was suggested to make lifestyle and diet changes before medication was started. I went very low carb and tested before and after meals and by 3 months was in remission (non diabetic levels without drugs). Metformin is a fairly mild drug and most find diet changes do far more than it does.

If your preference and choice is to do similar I would tell the nurse that and suggest it’s reviewed at the 3 month mark to see how it’s working. You can always change your course at that point.

This is definitely the route I would prefer too! Did the testing clearly show which foods you needed to avoid? I honestly don’t think I could sustain a diet long term with virtually no carbs whatsoever!
I know I was overweight and eating too much of the wrong thing. Bread and shortbread biscuits are my downfall, so it’s definitely given me a good kick up the rear to lose a couple of stone and was hoping that would do the trick

 

[Leadinglights]

This is definitely the route I would prefer too! Did the testing clearly show which foods you needed to avoid? I honestly don’t think I could sustain a diet long term with virtually no carbs whatsoever!
I know I was overweight and eating too much of the wrong thing. Bread and shortbread biscuits are my downfall, so it’s definitely given me a good kick up the rear to lose a couple of stone and was hoping that would do the trick

Low carb is NOT NO carbs but it is suggested that people start at no more than 130g carbs per day (not just sugars) as all carbs convert to glucose. It is important to have a regime that is sustainable long term so what you choose has to be your new normal way of eating. As long as you factor in the foods you like into your daily carb allowance then you can still have some of those things but perhaps not everyday.
That is where having a home testing blood glucose monitor helps you identify not only foods which it is not wise to have but also the ones that are safe for you.
Everybody is different in how their body tolerates carbohydrates so very hard to say yes have this but don't have that.
I look upon it as it is no good eating the things which push up your blood glucose and having to take more and more medication. It is a bit like having an overflowing sink (high blood glucose), but keep bailing out the water (taking medication), you will still have an overflowing sink unless you turn the tap off ( reducing the carbs you eat).
I know for some people that does not work and they will need medication but at the place you are at dietary changes hopefully will crack it, but then you need to maintain it otherwise you will be back to square one.

 

[Leadinglights]

Just had a thought that you can make low carb shortbread using ground almonds instead of flour, recipe on the website Keto Kitchen which also has good low carb recipes, I have the book and there are some good ideas in it.

 

[Jarralad]

I was also told to take medication with no advice I think I started at 68 but wasn’t told anything from my GP. I’m wondering why some Drs give no information with the diagnosis when they prescribe medication.

 

[rebrascora]

I was also told to take medication with no advice I think I started at 68 but wasn’t told anything from my GP. I’m wondering why some Drs give no information with the diagnosis when they prescribe medication.

It is because diabetes is so complex and individual and most doctors have no idea how powerful the correct diet can be but what may work for one person may not work for another.... and also, I imagine, because many people do not want to change their diet. There are cultural issues with diet and tradition as well psychological issues and other health issues, so it isn't easy or straight forward to advise someone on diet, even just to lose weight let alone to also manage diabetes. The NHS is also committed to the low fat advice that has been pushed for the past 70years. If you go low carb, you usually need to eat more fat to give you energy and stop you from feeling hungry and that goes against their whole career advice of low fat advice. I know I personally found it really challenging to go against the NHS advice and eat more fat and that is just me experimenting on me and I personally take responsibility for that. Imagine a doctor recommending that for their patients, contrary to NHS guidance.... they would be going out on a limb big style. Most however simply do no know what to recommend other than the usual low fat, wholemeal/wholegrain carbs and plenty of fruit and veg, which will not work for many Type 2s. The problem is that most GPs have been taught that diabetes is progressive and probably see that with many of their patients who need progressively more medication to manage it, when it doesn't need to be if people were given the right advice. Even if they do have more knowledge, how do you advise someone on their diet in a 10 min appointment slot. How much time have you spent on the forum asking questions and we have spent answering them and you have lots more to learn... as we all do as we are all learning. Those of us here have a vested interest to learn because our future health depends on it. Your GP has the next 20-30 patients to consider.

There are now private companies that the NHS contract out to to provide education for Type 2 diabetics but many of these are still obliged to stick to NHS dietary advice of the "Eatwell" plate and wholegrains being a good choice. Ideally people would be given the tools to test themselves and encouraged to experiment to see how different foods affect the as an individual, which is what we encourage here because that really is the best way to approach it in my opinion and you can then tailor your diet to your tastes and your body's response to foods.

 

[Leadinglights]

It is because diabetes is so complex and individual and most doctors have no idea how powerful the correct diet can be but what may work for one person may not work for another.... and also, I imagine, because many people do not want to change their diet. There are cultural issues with diet and tradition as well psychological issues and other health issues, so it isn't easy or straight forward to advise someone on diet, even just to lose weight let alone to also manage diabetes. The NHS is also committed to the low fat advice that has been pushed for the past 70years. If you go low carb, you usually need to eat more fat to give you energy and stop you from feeling hungry and that goes against their whole career advice of low fat advice. I know I personally found it really challenging to go against the NHS advice and eat more fat and that is just me experimenting on me and I personally take responsibility for that. Imagine a doctor recommending that for their patients, contrary to NHS guidance.... they would be going out on a limb big style. Most however simply do no know what to recommend other than the usual low fat, wholemeal/wholegrain carbs and plenty of fruit and veg, which will not work for many Type 2s. The problem is that most GPs have been taught that diabetes is progressive and probably see that with many of their patients who need progressively more medication to manage it, when it doesn't need to be if people were given the right advice. Even if they do have more knowledge, how do you advise someone on their diet in a 10 min appointment slot. How much time have you spent on the forum asking questions and we have spent answering them and you have lots more to learn... as we all do as we are all learning. Those of us here have a vested interest to learn because our future health depends on it. Your GP has the next 20-30 patients to consider.

There are now private companies that the NHS contract out to to provide education for Type 2 diabetics but many of these are still obliged to stick to NHS dietary advice of the "Eatwell" plate and wholegrains being a good choice. Ideally people would be given the tools to test themselves and encouraged to experiment to see how different foods affect the as an individual, which is what we encourage here because that really is the best way to approach it in my opinion and you can then tailor your diet to your tastes and your body's response to foods.

Most of the people who come on here have a positive attitude to changing their lifestyle, there are still a few who for one reason or another feel there is NO WAY can they change.
Talking to my son in law who is a GP and daughter an Obstetric consultant who deals with people with gestational diabetes, they say they can tell very quickly who will and who won't engage with lifestyle changes so even when they have not too high Hba1C that is when they will prescribe medication. However I suspect many doctors just don't have the time to spend explaining to people who are struggling with just day to day living and this is the last straw to get a diagnosis.

 

[Lucyr]

Sounds normal to me, standard advice is start with 500mg once a day, increase by 500mg a week until on 2000mg. For slow release metformin you can take it all once a day, or take it twice a day if you prefer, it makes no difference.

 

[DiabloT2]

This is definitely the route I would prefer too! Did the testing clearly show which foods you needed to avoid? I honestly don’t think I could sustain a diet long term with virtually no carbs whatsoever!
I know I was overweight and eating too much of the wrong thing. Bread and shortbread biscuits are my downfall, so it’s definitely given me a good kick up the rear to lose a couple of stone and was hoping that would do the trick

Ultimately it is obviously your choice. My HBA1c was much higher at diagnosis than yours. Predominantly through dietary change (together with attention to exercise, sleep and stress) I managed to get it to the normal range (below 42) so I think you'd stand a fair chance of doing the same.