Medication problems.

[brettr]

I had never thought of smoked salmon in an omelette but it was on offer as a pub lunch choice and it was very nice and we have made it since and added broccoli but will try spinach as that sounds good.

As a kid, I used to eat Salmon, but ever since we had that scare many years ago about Salmon, I have never eaten it since. I can be a fussy devil with some foods, but I do love omelettes, I would normally put mushrooms and some cheese in with it, but not the Salmon, I would have had that on the side with the omelette folded, see what I mean about being a fuss pot with foods lol. I adore broccoli though, have had that in a beef chow mein, luckily chow mein is mostly veg, beansprouts etc.

 

[Leadinglights]

As a kid, I used to eat Salmon, but ever since we had that scare many years ago about Salmon, I have never eaten it since. I can be a fussy devil with some foods, but I do love omelettes, I would normally put mushrooms and some cheese in with it, but not the Salmon, I would have had that on the side with the omelette folded, see what I mean about being a fuss pot with foods lol. I adore broccoli though, have had that in a beef chow mein, luckily chow mein is mostly veg, beansprouts etc.

The crackers I sometimes get are Karg Emmental and Pumpkin seed which are 12g carb per 25g cracker, a bit less like sawdust than Ryvita.
I think there is better quality control on salmon now and it is a good low carb option. I'm a bit fussy about fish and only eat salmon, tuna, cod or haddock, can't bear things that just say 'fish' and don't like any shell fish or things like prawns.

 

[brettr]

You won't like this but I'd urge you to reconsider insulin for four reasons:

• Your fears of weight gain are likely unfounded.
• Your fear of losing your driving licence is completely unfounded.
• It should help you control your levels quicker than oral meds alone.
• It isn't necessarily a life sentence.

I was started on both basal & bolus insulin in May last year. After 10 years of good control on Metformin, Covid sent my levels into overdrive & I ended up in A&E with DKA. That was with an HbA1c of 117 & I suspect you may well over that, so definitely keep an eye on ketones.

By December I had weaned myself of the bolas completely with the reintroduction of Metformin & addition of Empagliglozin. I'm still on a small daily dose of basal but that really isn't a chore. Notwithstanding that we're all different, I've experience two hypos in that time.

So an initial hit with a bolus/basal routine while you experiment with oral meds could get you back on track. Hopefully with a similar reduction in insulin that I experienced as the oral meds took effect. You would almost certainly be started on very conservative doses, both to see how your body reacts & to minimise the chances of hypos.

You don't need to respond as I won't be pushing it further, but do at least be prepared to discus it with your DSN.

I am happy for you guys on here to challenge me, so please don't stop or hold back.

I will attach the PDF document to this message before I send it, I ask you to look at the 3rd page, it tells you the current medications that are available, it also includes the effect on weight and hypoglycaemia risks. Please note this information if from NICE, so it is validated and true. It's also worth printing off so you can see what I mean.

I don't actually have a fear of insulin etc, but what I won't do is just be pushed onto taking something if I don't need to. Unfortunately for me Empagliflozin caused me renal discomfort on my right side, so I stopped taking it after 3 months, it's one of the side effects, but at the same time there are 3 other Flozin medications that are available, one of which might work fine for me, compared to the Empagliflozin. It's the same when I started on Statins, Simvastatin made me feel ill, so I couldn't take it, but I am fine on Atorvastatin, the same goes for the Flozin medications, they are all of the same group, but each has a slightly different drug makeup/structure.

With regards my driving, as I am the carer for my parents, I have to take them to appointments, shopping etc, as well as deal with my own health problems and appointments, so for me and my parents, my car is essential, again, I don't have a fear of losing my licence, but I will not take risks with the lives of my parents with regards to possibly taking insulin and having a possible hypo while driving, who's to say I will know if a hypo is starting or one comes on very suddenly !

I have no idea what basal/bolus means with regards to you taking insulin ! I have been T2 for almost if not a year now, you state that you had really good control with Metformin, but because of Covid, it messed everything up for you. My last HBA1C reading was mid 60's, I was told they want it below 58 within the first 2 years here. Hence the change in my diet and carb watching. I am also one of those people who try a new medication and find it takes a few moths to realise it's not the one for me, depending on exactly what that medication is !

When I take my BG reading in the morning, if my monitor flashes the Ketones word, I will check to see if I have any ketones in my blood, I had to buy a 10 pack of the ketone sensor strips, as my BG monitor has the Ket (ketones) function built in, of my BG are over 13.0 mmols, it flashes to let me know I might have ketones in my blood.

One thing that I heard a lot of when I worked for the NHS as a Renal Dialysis Nurse was, Patient Choice. It's down to the patient to decide what does or does not go into their body, and that is the reason I will be using when I see my Diabetes Nurse next Tuesday, as I am the patient and it is my choice. Please don't think I am being bolshy with or to you, that is not the case, this is just because I won't be forced into something I don't want or need at this time. It would just be my luck to have a damn hypo everytime I took insulin or something like Gliclazide, I know there are risks involved with my diabetes, but that does not negate the fact that one of the other Flozin meds might work for me.

I welcome any and all chats with all of you, so please don't feel as though you are forcing me to listen to what you say. All of you on here have given me valuable information.

 

[brettr]

The crackers I sometimes get are Karg Emmental and Pumpkin seed which are 12g carb per 25g cracker, a bit less like sawdust than Ryvita.
I think there is better quality control on salmon now and it is a good low carb option. I'm a bit fussy about fish and only eat salmon, tuna, cod or haddock, can't bear things that just say 'fish' and don't like any shell fish or things like prawns.

I have never heard of Karg Emmental crackers before, I am assuming they are an imported brand ? I find with Ryvita's, it depends on which ones you have, the sesame seed ones are actually quite good compared to the dark rye ones.

I also like Cod and Haddock, but like you won't touch seafood or prawns lol, and certainly not things like oysters 😱

 

[brettr]

Hi,

I have learnt not to look at eating less food as being on a diet. I don't personally think Keto is good for diabetics, the risk of going into Ketosis is the problems there I feel. I am happy to eat less carbs, realising the max per day is 130g. My problem with feeling so hungry it makes me feel sick, I end up feeling faint, so have to eat something.

I buy packets of nuts to help compensate, as well as the fact they are good fats to eat, as long as I am not eating the whole packet. I am starting to realise just how many foods are low carb, luckily some of them I enjoy, but like yourself, Avocado and seafood are well off the menu. I like chicken and fish, mainly tuna, but will eat a proper piece of fish.

I took a look at the link you provided and mostly they were great, except for a few that I would not eat, simply because I don't like certain foods that are in there, and they all included snacks as well, such as yogurt and fruit etc.

For me, it's not a case of being scared of insulin, but the main point is, if I don't need to take it, I don't want it ! I will not just be told that it the only alternative I have when I know that is not the case and that there are alternatives to just being told that is what I will have to do, I don't care if they moan about costs. It's a case of "why fix something when it's not broken". There is also the point of I used to work for the NHS as a dialysis nurse, did that for 18 years, and the one thing I was told about is that it's the "Patient's Choice", as to what does or doesn't go in their body, or what medications they can use, what is available to them etc.

Having had the recent shock of a high BG reading of 32.7, that shocked me back into pulling my finger out of my backside and sorting myself out with regards to my diabetes and health, if I only lose 2 pounds a week, I will be happy with that.

I found taking statins at night gave me really heavy legs, so took it during the day instead, I don't have a problem now with that, I was gutted that the Empaglifozin didn't work for me, but as there are 3 alternatives, I am going to ask about those, I don't care if they take a bit longer to work, I am willing to try them.

My biggest difficulty is cutting bread down, but I have also realised with that, that if I have only one slice of the sourdough bread I use, it's 22g of carbs out of the max of 130 a day, so it still gives me the chance to have a decent breakfast if I have the one slice of toast and have 3 eggs scrambled, which is only 2g of carbs, yes, I realise that slice of bread is going to raise my carbs, but hopefully it will be a bit slower with having had the scrambled egg as well.

my next HBA1C is in December, so I will be happy to see how eating less carbs has affected that from this point.

It's like the food I have eaten today, I had 2 slices of Ryvita (sesame seed 6.0g carbs per slice, buttered with 2 slices of tomato, which was a total of 14g carbs, my evening meal was a 3 egg plain omelette 0g carbs and a 200g plastic carton of baked beans (no added sugar) 19.5g cards, so up to this point I have had 33.5g of carbs in total, I will be making something for my supper, but it will be mostly low in carbs, I will work out what amount from either my book or from what is stated on the foods themselves.

I want my BG down to a decent level. I need to sort myself out.

I will keep in touch.

You won't like this but I'd urge you to reconsider insulin for four reasons:

• Your fears of weight gain are likely unfounded.
• Your fear of losing your driving licence is completely unfounded.
• It should help you control your levels quicker than oral meds alone.
• It isn't necessarily a life sentence.

I was started on both basal & bolus insulin in May last year. After 10 years of good control on Metformin, Covid sent my levels into overdrive & I ended up in A&E with DKA. That was with an HbA1c of 117 & I suspect you may well over that, so definitely keep an eye on ketones.

By December I had weaned myself of the bolas completely with the reintroduction of Metformin & addition of Empagliglozin. I'm still on a small daily dose of basal but that really isn't a chore. Notwithstanding that we're all different, I've experience two hypos in that time.

So an initial hit with a bolus/basal routine while you experiment with oral meds could get you back on track. Hopefully with a similar reduction in insulin that I experienced as the oral meds took effect. You would almost certainly be started on very conservative doses, both to see how your body reacts & to minimise the chances of hypos.

You don't need to respond as I won't be pushing it further, but do at least be prepared to discus it with your DSN.

I forgot to add the PDF Doc !

 

[brettr]

Hope you can find a med or meds that works for you @brettr

And like @Proud to be erratic I have not found insulin to be independently associated with weight gain, it’s only when I am eating too much (and the insulin is facilitating the metabolism of the carbs involved) that I gain weight.

I’ve been taking insulin for over 30 years and my weight has remained roughly stable.

I wonder, perhaps, if insulin’s reputation for weight gain is because people go onto insulin because their metabolism cannot deal with the menu they are eating, and some of the energy involved can’t be processed and stays in the bloodstream causing havoc. By adding insulin those carbs can then be absorbed, so people observe weight gain when they have not changed what they are eating - but in reality it’s only that the body now has access to absorb the energy into cells that was previously ‘stuck’ in the bloodstream (causing damage).

Just a theory - but it ties in with T1’s being unable to gain weight, and often dramatically losing weight until they are given insulin to help process the food energy that was unavailable to them.

Hi,

I have been looking at the Dexcom and other sensors that can be bought to help with BG, I have looked on Amazon and the price is horrendous just for the sensors, anything between £113 to £235 I have seen, can they be obtained any cheaper ? No wonder the NHS won't fund them, although if they did, the price should come down, making them more affordable.

 

[brettr]

The difference between those numbers is well within a meter's margin of error though, so to all intents and purposes they're the same.

Yes, there is a 15% difference between one BG monitor to the next whether that +/-, it seems one has to take the reading at face value or mess about adding or subtracting the 15% difference.

 

[Martin.A]

Yes, there is a 15% difference between one BG monitor to the next whether that +/-, it seems one has to take the reading at face value or mess about adding or subtracting the 15% difference.

The margin of error doesn't refer to the difference between one meter and another, all meters have to give a result that's between a defined lower and upper level, 95% of the time. That's the ISO standard for meters. A reading might be absolutely bang on or it could, in reality, be a little lower or a little higher.

 

[askeelsepttype2]

Warburtons do a wholemeal loaf of bread that is only 8g carbs per slice and costs £1 compared to a normal wholemeal loaf bread at 18g per slice and more expensive. I got some in Sainsbury's whereas Keto bread can be £5 per loaf and has to be delivered with a minimum £40 order. I too find giving up bread very hard.

 

[Martin.A]

Warburtons do a wholemeal loaf of bread that is only 8g carbs per slice and costs £1 compared to a normal wholemeal loaf bread at 18g per slice and more expensive. I got some in Sainsbury's whereas Keto bread can be £5 per loaf and has to be delivered with a minimum £40 order. I too find giving up bread very hard.

That's the 400g loaf, I think. Most breads come in two sizes - 800g and 400g - and I always buy the smaller one, usually a seeded variety like Seed Sensations. If you find bread hard to give up, switching to the small size makes sense as by definition it's half the carbs or thereabouts. I also share my wife's GF seeded bread, which is just under 10g per slice, although it lacks the body of normal bread.

 

[Leadinglights]

I have never heard of Karg Emmental crackers before, I am assuming they are an imported brand ? I find with Ryvita's, it depends on which ones you have, the sesame seed ones are actually quite good compared to the dark rye ones.

I also like Cod and Haddock, but like you won't touch seafood or prawns lol, and certainly not things like oysters 😱

The crackers are made in the UK, I have bought in Sainsbury's and a couple of other places which I can't remember.
Apologies, misinformation they are made in Germany
Once you get to grips with a lower carb way of eating then it should be very possible to make a big difference to your HbA1C and rather than spending lots of time finding reasons not to go on the second or third line meds then concentrate your efforts on that.

There is always different opinions about diets as I am finding out, my other half has Crohns and there are all sorts of ideas about what diet, low fibre, low residue, normal just avoiding trigger foods, some lists of foods say something should be avoided and another list says that food is fine.

 

[everydayupsanddowns]

Hi,

I have been looking at the Dexcom and other sensors that can be bought to help with BG, I have looked on Amazon and the price is horrendous just for the sensors, anything between £113 to £235 I have seen, can they be obtained any cheaper ? No wonder the NHS won't fund them, although if they did, the price should come down, making them more affordable.

I’ve only ever bought sensors direct from Medtronic, Abbott and now I buy my Dexcom G6s direct from them.

There are sometimes subscription deals you can opt into if you know you’ll be using long-term, or other deals like starter packs or 3-month bundles. Some sensors can be ‘stretched’ by restarting them (not Libre) if you are happy to accept the risk of possible occasional performance degradation and keep an eye on the data.

I can only afford full-time self-funded Dex by restarting the sensors to get up to 20 days out of most of them. I use a combination of 3 month bundles and occasional additional transmitters/sensors. It’s about £1400 a year I think.

Having said that, a couple of DSNs at my clinic have been making noises about me being able to get funding under the new guidance, so that may change.

The NHS negotiates very different prices because of their purchasing power. I think they buy each Libre 30% cheaper than us mere mortals can

 

[brettr]

I’ve only ever bought sensors direct from Medtronic, Abbott and now I buy my Dexcom G6s direct from them.

There are sometimes subscription deals you can opt into if you know you’ll be using long-term, or other deals like starter packs or 3-month bundles. Some sensors can be ‘stretched’ by restarting them (not Libre) if you are happy to accept the risk of possible occasional performance degradation and keep an eye on the data.

I can only afford full-time self-funded Dex by restarting the sensors to get up to 20 days out of most of them. I use a combination of 3 month bundles and occasional additional transmitters/sensors. It’s about £1400 a year I think.

Having said that, a couple of DSNs at my clinic have been making noises about me being able to get funding under the new guidance, so that may change.

The NHS negotiates very different prices because of their purchasing power. I think they buy each Libre 30% cheaper than us mere mortals can

I went on Dexcom's site yesterday but it only said I could get the sensors if I was using insulin, which I think is unfair personally ! I did read about the NHS starting to fund these sensors, like you say, the NHS has a certain purchasing power that others don't because they are so large.

I think it's unfair that you have to restart the sensors to get more out of them, although I understand your reasoning behind doing that ! £1400 a year is a lot of money, £116 a month or so.

I just think the price of the sensors is ridiculous, when the technology of today doesn't actually cost that much to make.

 

[brettr]

The crackers are made in the UK, I have bought in Sainsbury's and a couple of other places which I can't remember.
Apologies, misinformation they are made in Germany
Once you get to grips with a lower carb way of eating then it should be very possible to make a big difference to your HbA1C and rather than spending lots of time finding reasons not to go on the second or third line meds then concentrate your efforts on that.

There is always different opinions about diets as I am finding out, my other half has Crohns and there are all sorts of ideas about what diet, low fibre, low residue, normal just avoiding trigger foods, some lists of foods say something should be avoided and another list says that food is fine.

I will have a look for those crackers next time I am out shopping.

I have been carb counting for the last few days, although on Wednesday I didn't do much carb counting because I was helping to move washing machines about in my mum's kitchen and tired myself out, forgetting that I had a heart attack in Jan of 2022, so should not have been doing that, so subsequently, I didn't eat much at all on Wednesday as I felt so tired and run down, I just wanted to sleep.

I am finding counting carbs is not as boring or mundane as it sounds, plus with the carbs & calorie book I have, that gives me a better idea of some of the foods I can eat that are good for me but will help lower my HBA1C and bring my weight down. I may still have to go on an additional medication to help bring my BG levels down more, but I will discuss that next Tuesday with the Diabetic Nurse.

I also suffer with Diverticulitis, so sometimes have to be careful of what I am eating because of that, it can set of the Trotters for me sometimes lol. The main thing I am looking for with my meals is to feel fuller more often, so I don't snack, even though some one else I am talking to on here said that I should not starve myself if I do feel really hungry, but it then comes down to choosing something good for me that is not going to throw my BG through the roof.

I find it very confusing when one list contradicts the other with regards to certain foods we should be eating, such as Sweet Potato, compared to normal spuds, I have been told many times that a small quantity of Sweet Potato is better than the same of normal spuds. Who's actually right ?

I am looking forward to my HBA1C reading when it comes back after 5 December, to see if I have reduced it, I am hoping, as long as I keep carb counting it's going to have made a difference by the time that blood test is taken.

 

[brettr]

Warburtons do a wholemeal loaf of bread that is only 8g carbs per slice and costs £1 compared to a normal wholemeal loaf bread at 18g per slice and more expensive. I got some in Sainsbury's whereas Keto bread can be £5 per loaf and has to be delivered with a minimum £40 order. I too find giving up bread very hard.

Hi, thanks for the information. Is that Warburtons loaf a small one or a standard one at 8g carbs per slice ? What's the difference with Keto bread ? £5 a loaf, I want it gold framed for that price lol.

My problem with bread is that, say for example I have scrambled egg and a small carton of no sugar beans for breakfast, I find the full combination fills me for long so that I won't snack in between say having a can of soup for my dinner (soup being Morrisons own, lower carbs and sugars compared to a can of Heinz). I won't have any more bread that day if I have it with my breakfast. The only other time it bothers me is if I feel like having a sandwich for supper, again as long as I am not eating half a load of bread, and as long as I put things like cucumber or salad on the sandwich, I am at least countering some of the carbs with the addition of the good foods such as the salad.

 

[brettr]

That's the 400g loaf, I think. Most breads come in two sizes - 800g and 400g - and I always buy the smaller one, usually a seeded variety like Seed Sensations. If you find bread hard to give up, switching to the small size makes sense as by definition it's half the carbs or thereabouts. I also share my wife's GF seeded bread, which is just under 10g per slice, although it lacks the body of normal bread.

It makes sense buying the smaller loaf, plus, a proper seeded variety is better for you. you are right that by definition it should be half the carbs and sugars. I will have a look when we next go shopping, to see if there is a difference, plus I do or did enjoy the seeded bread more.

I can cut down on using bread during the day, but I just find if you are having say, fried eggs and a few beans, that slice of bread makes all the difference to having a breakfast. I am finding carb counting easier than I thought it might be, trying to stay within the 50-80g per day.

 

[Leadinglights]

I will have a look for those crackers next time I am out shopping.

I have been carb counting for the last few days, although on Wednesday I didn't do much carb counting because I was helping to move washing machines about in my mum's kitchen and tired myself out, forgetting that I had a heart attack in Jan of 2022, so should not have been doing that, so subsequently, I didn't eat much at all on Wednesday as I felt so tired and run down, I just wanted to sleep.

I am finding counting carbs is not as boring or mundane as it sounds, plus with the carbs & calorie book I have, that gives me a better idea of some of the foods I can eat that are good for me but will help lower my HBA1C and bring my weight down. I may still have to go on an additional medication to help bring my BG levels down more, but I will discuss that next Tuesday with the Diabetic Nurse.

I also suffer with Diverticulitis, so sometimes have to be careful of what I am eating because of that, it can set of the Trotters for me sometimes lol. The main thing I am looking for with my meals is to feel fuller more often, so I don't snack, even though some one else I am talking to on here said that I should not starve myself if I do feel really hungry, but it then comes down to choosing something good for me that is not going to throw my BG through the roof.

I find it very confusing when one list contradicts the other with regards to certain foods we should be eating, such as Sweet Potato, compared to normal spuds, I have been told many times that a small quantity of Sweet Potato is better than the same of normal spuds. Who's actually right ?

I am looking forward to my HBA1C reading when it comes back after 5 December, to see if I have reduced it, I am hoping, as long as I keep carb counting it's going to have made a difference by the time that blood test is taken.

You seem to have made a good start with getting a handle on things, I fully appreciate your feeling about contradictory info and it comes down to the fact that everybody is different in the way their body cope with carbohydrates and you may see mention in many posts that some people can tolerate some carbs better than the same amount of carb if it is something else. Some may cope with 20g carb if it is potatoes but not rice or pasta and for others it is the other way round. If you look at the difference between the carbs of potatoes and sweet potatoes there is little difference but for some people they will tolerate one better than the other. The only way you will know as an individual is by testing before you eat and after 2 hours by finger pricking.
These glucose monitors like the Dexcom or Libre have revolutionised the management for those on insulin but if you are not then they can almost be an overload of detail and strategic finger prick testing can be equally as useful and much less costly.

My other half has been advised to have a low residue/fibre regime and we are finding lists from different sources include or exclude certain foods.

 

[brettr]

One drug you haven't mentioned is Linagliptin, which is what I was put on after I refused Gliclazide, for the same reason you did. Also my GP surgery has stopped prescribing Canagliflozin due to adverse reports, and has switched to Dapagliflozin.

Hi,

Thank you for your message. I have not yet looked at Linagliptin, but will after I have sent you this message. The last time I saw my diabetic nurse, I refused point blank to be put on insulin or something like Gliclazide, simply because I am not going to start having hypo's when there is no need for me to have them.

The PDF information that I linked to from here is more than a little interesting, seeing as I was not told of the other meds in the same group. From this PDF information, it states that if necessary I could use double or triple medication to help with my BG. I am not going to be swayed or told that I can't try something else because of cost, that is not going to wash with me. I worked for 18 years in the NHS as a Dialysis Nurse, so Patient Choice is something I heard every day, which I will be applying to myself with the diabetes nurse.

Having started Carb Counting properly now, I find it's helping to regulate more of what I eat and how much, so for myself, I am not risking my health becoming worse and hopefully will start losing some weight.

I will attach the PDF file for you to look at and print of you so wish, it's worth reading, as this information was only meant to be for practitioners and nurses, not the general public like yourself and I.

 

[brettr]

One of our favourite omelettes is smoked salmon and spinach served with a salad, but there are a host of things you can add to an omelette that barely add any carbs to it.

Hello again,

I took your advice with regards to Warburtons Wholemeal bread, 400g small loaf, and you were spot on per slice it's only 9g carbs. So well worth reading the information.

 

[RBZ5416]

Warburtons Wholemeal bread, 400g small loaf, and you were spot on per slice it's only 9g carbs.

As @Martin.A alluded to, it's only "low" carb because there's less of it. It's exactly the same carbs per 100g as the full size loaf. So you could just cut a normal sized slice in half & save the 50% premium on the small loaf.