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rad66

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Hi - I just joined the forum hoping to understand more about managing my blood sugar over the long-term.

I had a T2 diagnosis end of 2019 with successive HbA1C readings of 48 and 49. I know this is just in the range but it got me to make big changes to my diet and I lost a lot of weight. I have not been put on any diabetes medication (I have taken statins for years and my cholesterol is fine).

I have stayed in the prediabetic range since then but am finding my HbA1C creeping up even with my improved diet. After losing weight I got to 41 and 42 but recent tests have been at 43 and 45. With finger-prick tests I can see that I will spike up to 8 mmol 2 hours after the low carb meals I mostly eat but will go up to 12-13 mmol if I ever have a 'normal' meal with bread/rice/chips etc.

I am wondering whether it is OK to carry on like this with HbA1C around 44/45 and these spikes after some meals or if I should be asking my GP to consider a drug like metformin. Any advice on when to consider drugs vs just managing with diet would be very helpful.
 
rad66 said:
Hi - I just joined the forum hoping to understand more about managing my blood sugar over the long-term.

I had a T2 diagnosis end of 2019 with successive HbA1C readings of 48 and 49. I know this is just in the range but it got me to make big changes to my diet and I lost a lot of weight. I have not been put on any diabetes medication (I have taken statins for years and my cholesterol is fine).

I have stayed in the prediabetic range since then but am finding my HbA1C creeping up even with my improved diet. After losing weight I got to 41 and 42 but recent tests have been at 43 and 45. With finger-prick tests I can see that I will spike up to 8 mmol 2 hours after the low carb meals I mostly eat but will go up to 12-13 mmol if I ever have a 'normal' meal with bread/rice/chips etc.

I am wondering whether it is OK to carry on like this with HbA1C around 44/45 and these spikes after some meals or if I should be asking my GP to consider a drug like metformin. Any advice on when to consider drugs vs just managing with diet would be very helpful.
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Welcome to the forum
Going up to 8mmol/l 2 hours after meals is pretty well in the range expected once you have had a diabetes diagnosis but it is really only by sticking to those meals which do not increase blood glucose up to 12/13 (other than on the odd occasion) will your HbA1C stay below the diagnosis level.
I take the attitude that a low carb approach taken to reduce HbA1C has to become a new way of eating.
Have a look at this link to see if there are any ideas for tweaks to your diet which may help https://lowcarbfreshwell.com/
 
Leadinglights said:
Welcome to the forum
Going up to 8mmol/l 2 hours after meals is pretty well in the range expected once you have had a diabetes diagnosis but it is really only by sticking to those meals which do not increase blood glucose up to 12/13 (other than on the odd occasion) will your HbA1C stay below the diagnosis level.
I take the attitude that a low carb approach taken to reduce HbA1C has to become a new way of eating.
Have a look at this link to see if there are any ideas for tweaks to your diet which may help https://lowcarbfreshwell.com/
Click to expand...
Very helpful, thanks. The vegetarian meal planner on the site looks very useful for me. The sheer discipline needed to keep this under control is daunting, hence curious about how others manage this long-term, but worth doing.
 
Welcome to the forum @rad66

Some people find their diabetes changes and evolves over time, and they need to adjust and adapt their approach, which may include giving their metabolism a bit of a helping hand with medication.

Unfortunately, I think some people with T2 get the impression that medication is somehow an indication of some sort of personal failure - which is not the case as all IMO, and just doesn’t happen with a T1 diagnosis. With T1 you just need medication from the off, and that’s just because it’s what your body needs to keep glucose in balance. Personally I see it exactly the same for T2. If your body needs the help of medication, that’s just what it needs. 🙂

Some meds can cause side effects in some people, which can act as an encouragement to try to manage glucose levels by diet and exercise alone, but there are many classes of diabetes meds these days, and the chances are there will be one or other type that suits each individual well.

Readings of 8 after meals are perfectly healthy and exactly what you would see in a population without diabetes (CGM results in non-diabetes users show many have brief excursions above 10 from time to time).

You might find the results of this CGM trial helps put your low carb levels in perspective?

And well done on your great HbA1c reduction!
 
rad66 said:
Hi - I just joined the forum hoping to understand more about managing my blood sugar over the long-term.

I had a T2 diagnosis end of 2019 with successive HbA1C readings of 48 and 49. I know this is just in the range but it got me to make big changes to my diet and I lost a lot of weight. I have not been put on any diabetes medication (I have taken statins for years and my cholesterol is fine).

I have stayed in the prediabetic range since then but am finding my HbA1C creeping up even with my improved diet. After losing weight I got to 41 and 42 but recent tests have been at 43 and 45. With finger-prick tests I can see that I will spike up to 8 mmol 2 hours after the low carb meals I mostly eat but will go up to 12-13 mmol if I ever have a 'normal' meal with bread/rice/chips etc.

I am wondering whether it is OK to carry on like this with HbA1C around 44/45 and these spikes after some meals or if I should be asking my GP to consider a drug like metformin. Any advice on when to consider drugs vs just managing with diet would be very helpful.
Click to expand...
Although you lost a lot of weight do you still have some excess weight? The HbA1c creep could be owed to there still being some excess fat in the pancreas, compromising the beta cells. If so, getting BMI down to around 21-22 would probably eliminate it and the beta cells might revive if not already too battered.
 
childofthesea43 said:
Although you lost a lot of weight do you still have some excess weight? The HbA1c creep could be owed to there still being some excess fat in the pancreas, compromising the beta cells. If so, getting BMI down to around 21-22 would probably eliminate it and the beta cells might revive if not already too battered.
Click to expand...
Thanks. I've got my BMI down to 23/24 (from 29). And I am holding a steady weight now that only goes up and down a kilo or so depending on the week. I could try to drop a few more kilos now to see if that will make a difference.
 
rad66 said:
Thanks. I've got my BMI down to 23/24 (from 29). And I am holding a steady weight now that only goes up and down a kilo or so depending on the week. I could try to drop a few more kilos now to see if that will make a difference.
Click to expand...
When I was first diagnosed as prediabetic in 2017 I spent around 5 months getting my BMI down to about 23, but my A1c subsequently rose to 74 over the next three years. So I embarked on more ruthless weight loss to bring my BMI to just under 21 where I have kept it for two and a half years, throughout which my A1c has not gone beyond 42. So I’d encourage you to do the same. Low carbs may help, but ensure caloric deficit as well, don’t leave that to chance. Dr Unwin stresses this latter point as does Roy Taylor.
 
childofthesea43 said:
When I was first diagnosed as prediabetic in 2017 I spent around 5 months getting my BMI down to about 23, but my A1c subsequently rose to 74 over the next three years. So I embarked on more ruthless weight loss to bring my BMI to just under 21 where I have kept it for two and a half years, throughout which my A1c has not gone beyond 42.
Click to expand...

Really interesting that you found that personal tipping point @childofthesea43 , and how effective it has been for you.

Reminds me somewhat of the ‘personal fat threshold’ concept hypothesised by Taylor.
 
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