New T2 Diabetic Checking In

[Ollie1979]

Hi All,

Got diagnosed on Monday with an hba1c score of 86. I’ve been a smoker for 25 years and when I was tested last Thursday at the recommendation of my GP immediately quit and switched to vaping and have now been 5 days without a cigarette. The advice out there on vaping is so confusing though and I get the sense my GP recommended it just to get me off regular cigarettes and I genuinely have no idea how continuing to vape will impact my diabetes.

I got a referral to the London Diabetes Clinic and have an appointment on Friday, presumably where further tests for the eyes etc will be arranged and I can get more specific guidance about how to manage this. I have Initially been put on 500mg of Metformin per day which I started this evening.

Other complications I have are a high blood pressure of 135/91 and raised cholesterol of 5.2. GP mentioned I’d likely be put on meds for both of these as well as my Metformin dose being increased.

Additionally during Covid what was a very mild squint suddenly got much worse. I mentioned this to my opticians who basically said it’s nothing to worry about but my GP thinks it is likely caused by diabetes meaning I have probably had this for over 4 years.

I’d be very interested to hear from others who share similar issues to me as at the moment I am pretty down, I wasn’t surprised by the diagnosis and was initially quite upbeat as I’d been feeling pretty sick for quite a while and the bad squint also gets me down and I thought that at least with the diagnosis I can now make steps to fix things and feel better. But I am now quite frankly terrified that having almost certainly had this for many years untreated that it has caused irreparable damage and I’m likely to keel over with a heart attack or stroke at any point.

Thanks all.

 

[Leadinglights]

Your HbA1Cis pretty high so no wonder your GP prescribed metformin which is a medication which helps the body use the insulin it produces and reduces the out put of glucose by the liver but the most important thing you can do is to modify your diet to reduce the carbohydrate intake.
This link should help you with some ideas for doing that, https://lowcarbfreshwell.com/
At least you will be getting a foot check and be referred for eye retinal screening, I have not heard the developing a squint would be because of high blood glucose though people do often experience issues with their eyes because of high blood glucose but that is usually things being out of focus.
I would say there is no need to panic but look at the link and make a plan for a way forward.
Well done for stopping smoking but be careful of the vapes as some people have found they may increase blood glucose, I believe there is a thread about vapes.
You may be offered blood pressure medication but often dietary changes will have a beneficial effect on both blood pressure and cholesterol so you may want to hang off on those until you have given the dietary changes a chance to have an affect.

 

[Ollie1979]

Thanks for the response. I have had OCT scans regularly, last one last September which came back with no issues, not sure if these would pick up diabetic related issues?

Looking forward to getting some more guidance this week on how much weight I need to lose (6’1”, 92.5k and how best to go about it. I haven’t fully explored this forum yet but I’ve seen advice ranging from eat whatever you need to get your weight down, to chicken, fish, fruit and veg only, to also some mentioning you shouldnt cut carbs drastically in one go as this can cause problems, so a full Leto diet might not be best, but I thought that was broadly what the fast 800 is which seems to work.

I have lost 10kg over the last 3 months by following this diet, with cheat days for social events etc, not sure if this would be enough if I keep doing it and lose another 10kg in the next 3 months or whether more extreme action is needed:

Breakfast; Quaker original oat pot + 1 large cappuccino (no sugar)
Snacks; 1 x banana in am and 1 x apple in pm
Lunch; Meat + salad (we have a work canteen so whatever is on offer that day, usually things like chicken thighs, pork loin steak, gammon steak, salmon, cod)
Dinner; Some other grilled or air fried meat plus peas and broccoli
Drinks; 2-3 litres water, 1 can of Sprite Zero, 1 x tea with sugar

From what I’ve read continuing that diet, reducing the cheat days (typically 6 o so a month) and getting rid of the banana and tea with sugar would be the only changes really needed but it probably wouldn’t trigger rapid weight loss over 3 months.

 

[Leadinglights]

Thanks for the response. I have had OCT scans regularly, last one last September which came back with no issues, not sure if these would pick up diabetic related issues?

Looking forward to getting some more guidance this week on how much weight I need to lose (6’1”, 92.5k and how best to go about it. I haven’t fully explored this forum yet but I’ve seen advice ranging from eat whatever you need to get your weight down, to chicken, fish, fruit and veg only, to also some mentioning you shouldnt cut carbs drastically in one go as this can cause problems, so a full Leto diet might not be best, but I thought that was broadly what the fast 800 is which seems to work.

I have lost 10kg over the last 3 months by following this diet, with cheat days for social events etc, not sure if this would be enough if I keep doing it and lose another 10kg in the next 3 months or whether more extreme action is needed:

Breakfast; Quaker original oat pot + 1 large cappuccino (no sugar)
Snacks; 1 x banana in am and 1 x apple in pm
Lunch; Meat + salad (we have a work canteen so whatever is on offer that day, usually things like chicken thighs, pork loin steak, gammon steak, salmon, cod)
Dinner; Some other grilled or air fried meat plus peas and broccoli
Drinks; 2-3 litres water, 1 can of Sprite Zero, 1 x tea with sugar

From what I’ve read continuing that diet, reducing the cheat days (typically 6 o so a month) and getting rid of the banana and tea with sugar would be the only changes really needed but it probably wouldn’t trigger rapid weight loss over 3 months.

That sounds like a good start but many do find porridge is something not tolerated well so will have a breakfast of full fat Greek yogurt and berries or eggs with bacon, tomatoes, mushrooms. Snacks if you need them, things like nuts, veg sticks, protein bars like Nature Valley, fruits like berries as bananas are high carbs, apples not as much depending on the size and variety. But try to wean yourself off the sugar in your tea as it is empty carbs.

 

[Drummer]

@Ollie1979 Hello and welcome to the forum
your breakfast and smack choices are not what I would eat but other meals look good.
The usual choices of low carbers are any meat or fish, eggs, cheese, full fat dairy, low carb veges and fruits - mainly berries.
I was eating no more than50gm of carbs a day at first and got my HbA1c down to 41 at the 6 month test, from 91 to start with. I did not find it difficult, but I had done Atkins before and knew that I could cope with 50 gm a day from that.
These days I do not more than 40 as I dropped down hoping to lower my HbA1c into the 30s when I got a could of tests at 42. After a year of the lower carbs and seeing lower after meal numbers, my HbA1c was - 42, so these things are not an exact link.
Hopefully you will be able to cope with the Metformin. I had violent reactions to the medication and stopped taking the tablets as I was so very ill. Not everyone has side effects, some have them and then they subside, but mine were pretty spectacularly bad.
I had my eyes checked recently and was seeing double, so have got the 'prism' correction right in my new glasses - hopefully so when they arrive. I have not heard of it being caused by diabetes - and I have had normal blood glucose levels for years now - as far as I know.
Rather surprisingly I lost a lot of weight after diagnosis, without any effort really, but I think that once your metabolism gets back on an even keel lots of things start to return to normal.
Having never smoked, I have no experience of the effects of that on diabetes, but I have never heard of stopping smoking changing blood glucose levels, though it might improve circulation if there were problems there. My dad had circulatory problems and it was put down to his being a heavy smoker.

 

[Eddy Edson]

Hi All,

Got diagnosed on Monday with an hba1c score of 86. I’ve been a smoker for 25 years and when I was tested last Thursday at the recommendation of my GP immediately quit and switched to vaping and have now been 5 days without a cigarette. The advice out there on vaping is so confusing though and I get the sense my GP recommended it just to get me off regular cigarettes and I genuinely have no idea how continuing to vape will impact my diabetes.

I got a referral to the London Diabetes Clinic and have an appointment on Friday, presumably where further tests for the eyes etc will be arranged and I can get more specific guidance about how to manage this. I have Initially been put on 500mg of Metformin per day which I started this evening.

Other complications I have are a high blood pressure of 135/91 and raised cholesterol of 5.2. GP mentioned I’d likely be put on meds for both of these as well as my Metformin dose being increased.

Additionally during Covid what was a very mild squint suddenly got much worse. I mentioned this to my opticians who basically said it’s nothing to worry about but my GP thinks it is likely caused by diabetes meaning I have probably had this for over 4 years.

I’d be very interested to hear from others who share similar issues to me as at the moment I am pretty down, I wasn’t surprised by the diagnosis and was initially quite upbeat as I’d been feeling pretty sick for quite a while and the bad squint also gets me down and I thought that at least with the diagnosis I can now make steps to fix things and feel better. But I am now quite frankly terrified that having almost certainly had this for many years untreated that it has caused irreparable damage and I’m likely to keel over with a heart attack or stroke at any point.

Thanks all.

Vaping: I used to smoke a lot but managed to wean myself off it via vaping. I've read a lot of the science on the subject & talked about it with my vascular specialist ,and in a nutshell: vaping not as bad for your arteries & lungs as smoking, where you get all kinds of toxic crud from the burning; but on the other hand nicotine from vaping is also not great, just not as bad, and the goal really has to be to use vaping as an off ramp, not a permanent substitution.

You've got diabetes, probably elevated LDL cholesterol, somewhat elevated BP and a long history of smoking => you're almost certainly at elevated risk for cardiovascular disease and microvascular problems like retinopathy and IMO getting all the risk factors for those under control has to be the main priority. BG is one of the risk factors, but once you've reined it in a bit, BP and lipids generally become more important.

Anyway, onviously what your docs have to say about it is the important thing but I expect it won't be too far different to this. The good thing is that getting the risk factors under control isn't necessarily that hard, particularly if you can lose weight and keep it off.

My experience, FWIW: I probably had out of control T2D for years before finally going to a doctor after an optometrist detected signs of retinopathy when I was being fitted for new glasses. I smoked about a zillion cigarettes a day, had an HbA1c of 89, wasn't BMI-overweight but had a waist-to-height ratio > 0.5 (a better risk measure), had hypertension and LDL-C of 3.2 mmol/l.

Over time these factors had combined to give me a blocked femoral artery in my left leg, moderate background retinopathy (which after a while produced diabetic macular oedema), and a very large amount of plaque in my coronary arteries (though no actual blockage). Basically, a classic set of complications to be expected for somebody too stupid to go see a doctor until things had progressed a long way.

To turn this around I treated myself basically as if I were a recovering heart attack patient: lost 20kg, mostly plant based diet with very small levels of saturated fats and sodium, lots of exercise, high intensity statin. In other words, just what the expert guidance says you should do. Now all of my risk factors are "optimised", as my cadiologist says. I'm left with the legacy artery disease & retinopathy but none of this is particulalry lifestyle limiting and my "healthspan" expectation is probably pretty much average for a healthy individual of my age.

I say all this really to encourage you to follow expert guidance, which these days is easily accessible and supported by mountains of evidence.

 

[s'nic]

Welcome to the forum

I’ve seen advice ranging from eat whatever you need to get your weight down, to chicken, fish, fruit and veg only, to also some mentioning you shouldnt cut carbs drastically in one go as this can cause problems,

The huge range of solutions people choose can stem from simple individuality.
A food item may spike BG in one person, but another person may be able to tolerate it.
One person may be trying to watch cholesterol, another may have no such concerns
Some people may have a mindset that likes a specific set way of eating (a diet plan), others (including me) just concentrate on key dietary factors relevant to them.

You need to decide what works for you as you will need this to be a change of lifestyle. You can kick off weight loss with a specific diet, but at some point the diet ends - that's why the lifestyle change needs to be in place. Switching back to the old way of eating is likely to result in the weight returning.

 

[JITR]

Hi Ollie,

Looking forward to getting some more guidance this week on how much weight I need to lose (6’1”, 92.5k and how best to go about it.

In the Counterpoint and DiRECT studies, Profs Roy Taylor (see this talk) and Mike Lean established you need to lose 15kg-20kg to get your liver and pancreas back to normal, as near normal as you can. These targets apply to the overweight. You are well on track for that so I'd say continue with what you are doing and improvements. You may find this chart helpful.

Weight loss targets. My profile was similar to yours. 6'. 92kg, HbA1c 104, waist 38-40". I estimated losing 22kg would get me back into the 32" jeans I wore in my 20s. It did.

Good luck.

 

[s'nic]

Looking forward to getting some more guidance this week on how much weight I need to lose (6’1”, 92.5k and how best to go about it.

As a general guideline you would need your BMI to be under 25 (over 25 is counted as pre-obese). My BMI now has dropped to be 24.1 but I still have a bit to lose.
If your liver and pancreas are being impacted by fat (which is highly possible in any overweight person). The weight you need to lose depends on the weight you started at.

The American paper from the National Library of medicine - Nutrition Management Strategies for Nonalcoholic Fatty Liver Disease: Treatment and Prevention - shows that a weight reduction of more than 5% is usually necessary to reduce liver fat, 7–10% to improve liver inflammation and more than 10% to improve fibrosis/scarring (if present).

Fatty liver can also affect people who are not overweight. Papers I have viewed regarding this advise non-overweight people to reduce body weight by at least 3–5% to see improvement.

You may think, oh wow, over 10% of my weight sounds hard to lose, but take it one day at a time. Any weight loss which reduces your BMI to be closer to 25 will improve your health.
It's doable - so far I have lost 18.6% of my body weight. I just set myself mini targets and just focused on those. When I hit the target I set a new mini target. One day at a time is doable.