New to the forum - not great GP experience so far

[Pepper1]

Hi, I’m new to the forum. Was diagnosed late March with Type 2. Think level was 93. Came as quite a shock, though I knew I needed to lose weight, I didn’t think I had it as no symptoms. Had a stressful couple of years with work and family illness.
Was put on Metformin twice a day, but I advised the GP I already suffered with IBS was put on slow release. It hasn’t worked out as upsets my stomach too much and impacting my life so went back to the doctors this week.
GP said would look into alternatives and ring me back. Was called later to advise would be put on Gliclazide. Have been told nothing about risk of Hypos or nothing mentioned re needing to self test, etc. Was just advised see how it goes for a few weeks.
Also wasn’t advised re not drinking alcohol which it states on the leaflet - I don’t drink much but it’s nice to have the option.
I’m feeling a bit lost with it all. Not handling it well anyway, but the fact neither GP has fully gone through options and pros/cons re medication and what’s required is making me feel worse. What should I have been told and what should I do? Only been reading up on Gliclazide once prescription was delivered, and obviously now docs are shut for the weekend

 

[Abi]

Gliclazide is a rather outdated option for most people although it has it uses. There are other options which do not carry the same risk of hypoglycaemia and are more beneficial in terms of weight loss- if excessive weight is a problem and and offer various other benefits such as protection to the heart and kidneys. You certainly should have been given a meter with this medication owing to the hypo risk and encouraged to check before driving. I wonder what dietary advice you have received. There is no need to completely avoid alcohol- but advisable to keep within sensible limits

 

[Pepper1]

Gliclazide is a rather outdated option for most people although it has it uses. There are other options which do not carry the same risk of hypoglycaemia and are more beneficial in terms of weight loss- if excessive weight is a problem and and offer various other benefits such as protection to the heart and kidneys. You certainly should have been given a meter with this medication owing to the hypo risk and encouraged to check before driving. I wonder what dietary advice you have received. There is no need to completely avoid alcohol- but advisable to keep within sensible limits

I just feel totally confused and disappointed that it doesn’t feel options and risks have been discussed with me. I certainly wasn’t told about the risk of hypos and nothing mentioned around driving. I think I’ll carry on with the Metformin until I can speak to someone on Monday. He did mention a 2nd option but looked into it and said he was going to go with the 3rd But no reasoning why (I assumed it was due to my stomach issues). No new dietary advise - nurse appointment advised better to exercise/lose weight but exercise has been hampered by the stomach issues on metformin. Was looking forward to new medication to help me get back into exercising however the worries around Gliclazide and lack of info from gp have hampered that

 

[Windy]

Hi, can you phone the surgery when it's open next and ask if they have a diabetes nurse that you can see for some support? You might be able to ask the pharmacist about blood glucose monitoring and gliclazide too, if you can't get in to see the nurse.
Also, ask if they can book you onto a course on diabetes, or see if you're eligible and in an area that offers the Newcastle low calorie diet. The support you've has so far seems poor, but I'm mindful of the pressures that the NHS is under, even though that doesn't help you at all.
I echo what Abi says - you should have been given a blood glucose monitor and told to check that you're not going hypo glycemic, and also what signs to look for when having a hypo and how to treat it.
There's information on diabetes and driving here.
There's things you can address with your diet to reduce the amount of glucose you're eating, like obvious things like not having much cake/biscuits/chocolate etc, and limiting the amount of other carbs you have, like potatoes, pasta, bread so that they're a minor part of each meal, but if you're on gliclazide, you need to eat enough carbs to stop hypos, so something to discuss with your GP/nurse when you see them.
I hope you get some more support from your GP/nurse than you've had so far, Sarah

 

[Felinia]

I refused Gliclazide due to the risk of hypos and my need to drive in my rural location. Instead I was put on Canagliflozine (there are several "gliflozin" drugs). Apart from thirst and needing to double my fluid intake to 3 litres a day, I have been fine, and my HbA1c is slowly coming down. It's a bit more information for you to think about. Good luck

 

[Pepper1]

Hi, can you phone the surgery when it's open next and ask if they have a diabetes nurse that you can see for some support? You might be able to ask the pharmacist about blood glucose monitoring and gliclazide too, if you can't get in to see the nurse.
Also, ask if they can book you onto a course on diabetes, or see if you're eligible and in an area that offers the Newcastle low calorie diet. The support you've has so far seems poor, but I'm mindful of the pressures that the NHS is under, even though that doesn't help you at all.
I echo what Abi says - you should have been given a blood glucose monitor and told to check that you're not going hypo glycemic, and also what signs to look for when having a hypo and how to treat it.
There's information on diabetes and driving here.
There's things you can address with your diet to reduce the amount of glucose you're eating, like obvious things like not having much cake/biscuits/chocolate etc, and limiting the amount of other carbs you have, like potatoes, pasta, bread so that they're a minor part of each meal, but if you're on gliclazide, you need to eat enough carbs to stop hypos, so something to discuss with your GP/nurse when you see them.
I hope you get some more support from your GP/nurse than you've had so far, Sarah

I haven’t started the Gliclazide yet as was waiting for delivery - think I will continue the Metformin (despite the side effects) until I can speak to someone. I wanted it to be discussed what the options were and what the pros and cons are. Aside from diet/exercise from a mental health perspective I didn’t want to be reminded all the time about this so don’t want to have to be doing multiple testing every day and have concerns about driving so I’ll need to discuss this again. Frustrating as I thought I was getting somewhere changing meds that was giving me issues, but seems I’ll just be taking on different ones

 

[Pepper1]

I refused Gliclazide due to the risk of hypos and my need to drive in my rural location. Instead I was put on Canagliflozine (there are several "gliflozin" drugs). Apart from thirst and needing to double my fluid intake to 3 litres a day, I have been fine, and my HbA1c is slowly coming down. It's a bit more information for you to think about. Good luck

Thank you - these are the discussions I need my GP to be having with me. I just don’t understand why he didn’t tell me about the hypo situation which is alarming. I‘m going to carry on with the poop tablets until I can speak to someone on Monday. I don’t feel happy taking Gliclazide now knowing the risks, without options being explained to me

 

[Drummer]

Thank you - these are the discussions I need my GP to be having with me. I just don’t understand why he didn’t tell me about the hypo situation which is alarming. I‘m going to carry on with the poop tablets until I can speak to someone on Monday. I don’t feel happy taking Gliclazide now knowing the risks, without options being explained to me

A most effective way to control type two - as long as you are an ordinary type two and nothing more interesting - is to eat fewer carbohydrates. Make up the deficit by eating protein and fats.
My Hba1c was 91 at diagnosis and 47 after 80 days, 41 at 6 months. I do not need medication. I did need a whole new wardrobe as I lost weight, but that just happened I did not make any effort to do so.

 

[Pepper1]

A most effective way to control type two - as long as you are an ordinary type two and nothing more interesting - is to eat fewer carbohydrates. Make up the deficit by eating protein and fats.
My Hba1c was 91 at diagnosis and 47 after 80 days, 41 at 6 months. I do not need medication. I did need a whole new wardrobe as I lost weight, but that just happened I did not make any effort to do so.

I asked if I could not go on meds straight away and do the diet/exercise route instead, but was advised my Hba1c was too high. I had already started exercising before diagnosis, but was trying to do one thing at a time and felt the exercise was a priority as it helped my mental health. Then I’m confused as I asked the nurse if low carbs was necessary as I had successfully lost weight on Slimming World previously, and she advised weight loss was the main, not how it’s done. I’m so confused with it all, but it’s good you got yours down with no meds

 

[NotWorriedAtAll]

I asked if I could not go on meds straight away and do the diet/exercise route instead, but was advised my Hba1c was too high. I had already started exercising before diagnosis, but was trying to do one thing at a time and felt the exercise was a priority as it helped my mental health. Then I’m confused as I asked the nurse if low carbs was necessary as I had successfully lost weight on Slimming World previously, and she advised weight loss was the main, not how it’s done. I’m so confused with it all, but it’s good you got yours down with no meds

I used a change in ingredients to change my food choices to very low carb and I have been controlling my type 2 diabetes successfully without medication for years now. I actually enjoy the new way fo eating much more and my health has improved to the point I no longer take medication for any of the conditions I had at the same time as my diabetes diagnosis as they have also all cleared up since I reduced carbs down to around 20g a day.

Not a good idea to go that low to start with - I did low carb first with metformin and then reduced down after three months to 20g per day of carbs and stopped the metformin as I wasn't eating enough carbs to justify it.

Each year my numbers have improved. I haven't lost much weight at all over three years because I eat a high calorie diet but I have lost some even so and I do not gain any more. I am happy to lose slowly as long as I am healthy and fit.

I wouldn't change back to eating carbs now if someone paid me - I like the no carb/zero carb food I make much better and it is more fun.

 

[Pepper1]

I used a change in ingredients to change my food choices to very low carb and I have been controlling my type 2 diabetes successfully without medication for years now. I actually enjoy the new way fo eating much more and my health has improved to the point I no longer take medication for any of the conditions I had at the same time as my diabetes diagnosis as they have also all cleared up since I reduced carbs down to around 20g a day.

Not a good idea to go that low to start with - I did low carb first with metformin and then reduced down after three months to 20g per day of carbs and stopped the metformin as I wasn't eating enough carbs to justify it.

Each year my numbers have improved. I haven't lost much weight at all over three years because I eat a high calorie diet but I have lost some even so and I do not gain any more. I am happy to lose slowly as long as I am healthy and fit.

I wouldn't change back to eating carbs now if someone paid me - I like the no carb/zero carb food I make much better and it is more fun.

I must admit I’m a carby person. I’d much rather eat potatoes, rice etc than chocolate etc. I find it difficult to not feel hungry. I remember the nurse saying about Metformin and it could suppress appetite but no such luck for me. I hate the texture of chickpeas, lentils, etc. What have you managed to subs for carbs to make you feel full (and for the full feeling to last)? The ideal would be no meds - I’m willing to diet/exercise. They just said when they put me on the tablets that it could be reviewed if I lost weight, but the side effects had put me off exercising regularly (not wanting to be on a walk and urgently needing to go) hence me going back to the docs but being put on something potentially worse

 

[Leadinglights]

Metformin is known for causing stomach issues especially of you have IBS so not too good for you.
Dietary changes are the most powerful thing you can do to reduce your blood glucose, people imagine that just taking the pills will be enough but sadly not for most people.
Many people find a low carb approach successful in both losing weight and reducing blood glucose, low carb is suggested as being less than 130g TOTAL carb per day.
It is helpful to keep a food diary of everything you eat and drink and estimate how many carbs there are in what you are having, I suspect you may be shocked. That gives you an idea of where you need to be cutting out things or reducing portions of the high carb foods. Things like lentils and chick peas are still high carb so just as well you are not too keen on them. Basing meals on meat, fish, eggs, cheese, vegetables, salads and fruit like berries will still give options for filling tasty meals. Protein and Healthy fats do not convert to glucose whereas ALL carbohydrates do.
This link may give you some ideas for making some dietary changes. https://lowcarbfreshwell.co.uk/
I would also recommend the book or app Carbs and Cals as it gives pictorial info on portions and carb vales of a whole range of foods. Or of course you can Google food x and total carbs or look on packets or shop websites for the nutritional information.

 

[rebrascora]

It may shock you to learn that it is the carbs which are making you hungry, not stopping you from being hungry. The carbs spike your BG levels very rapidly and then your body has to work hard to lower those levels and as diabetes sets in, it becomes less efficient at reducing them so your body can't access the energy and it gets used to those high Blood Glucose levels and wants to keep them high, so it sends out messages to tell you to eat more ie hungry.
What many of us found amazing is that once we cut the carbs and ate more fibre and full fat products, the hunger stopped. Some of us happily just have one or two meals a day and don't get cravings or hunger anymore..... it has really been quite a revelation to me. Unfortunately the occasions that I go back to eating bread in particular, the cravings start again and it is like a torment. Much as I loved bread and spuds I no longer want them and I have found lots of other lovely tasty foods to compensate for those actually rather bland beige foods. The combination of too many carbs and not enough fat, which slows the digestion down and provides slow release energy, is most likely the major contributor to obesity and type 2 diabetes.... and yet the NHS still recommend wholemeal/wholegrain carbs and low fat particularly to diabetics. It is like tying your hands behind your back and then expecting you to play tennis!

You say that you don't want to have to finger prick because you don't want to be reminded of this condition all the time, but knowledge is power and a BG meter will give you power to make good food choices. It will show you what your body can tolerate and what it can't and enable you to "see" your diabetes, which is often easy to ignore or not take seriously if you don't have any symptoms, so you can't otherwise see or feel it. I can assure you that the long term complications that are risked by uncontrolled diabetes are far more of a reminder of the condition than a few finger pricks each day.

An HbA1c of 90 is high and you do not want to be remaining at that level for any length of time...as we don't know how long you have been undiagnosed, so taking control sooner rather than later would be wise. You can learn more from this forum and the members here who have been there and got the T-shirt, than you ever will from your GP or nurse because they just know a bit of text book stuff whereas we live with it day by day and meal by meal and moment by moment.

I agree that the support you have had from your GP is poor but if you stick around this forum you will learn what you need to manage this condition well. Dietary changes are far more powerful than most oral medication and need to be used in conjunction with any medication you do take anyway.

As regards the Metformin, taking it mid meal with a substantial amount of food (mostly protein, fat and fibre) will help to reduce the digestive upheaval. If you can't envisage a meal like that, then how about a 2 egg omelette with whatever filling you fancy apart from potato with a noice big side salad and a big dollop of full fat/cheese coleslaw. Or high meat content sausages (cheap sausages contain a lot of rusk which is carbs) with cauliflower mash.... No pealing spuds required, cooks quicker than tatties and mashes nicely with a good dollop of cream cheese and a spoon of wholegrain mustard. You can serve it topped with grated cheese if you like and maybe some green beans or broccoli. It is surprising how good mashed cauliflower is and use can use it to top a cottage/shepherd's pie as a low carb alternative. These are just some of the simple swaps but @NotWorriedAtAll is an Olympic Gold Medalist when it comes to adjusting both sweet and savoury recipes to low carb. Cakes, biscuits, batter, crisps, pies, pizza.... you can apparently have it all if you have the right ingredients and the motivation to make it yourself.

 

[Pepper1]

Metformin is known for causing stomach issues especially of you have IBS so not too good for you.
Dietary changes are the most powerful thing you can do to reduce your blood glucose, people imagine that just taking the pills will be enough but sadly not for most people.
Many people find a low carb approach successful in both losing weight and reducing blood glucose, low carb is suggested as being less than 130g TOTAL carb per day.
It is helpful to keep a food diary of everything you eat and drink and estimate how many carbs there are in what you are having, I suspect you may be shocked. That gives you an idea of where you need to be cutting out things or reducing portions of the high carb foods. Things like lentils and chick peas are still high carb so just as well you are not too keen on them. Basing meals on meat, fish, eggs, cheese, vegetables, salads and fruit like berries will still give options for filling tasty meals. Protein and Healthy fats do not convert to glucose whereas ALL carbohydrates do.
This link may give you some ideas for making some dietary changes. https://lowcarbfreshwell.co.uk/
I would also recommend the book or app Carbs and Cals as it gives pictorial info on portions and carb vales of a whole range of foods. Or of course you can Google food x and total carbs or look on packets or shop websites for the nutritional information.

Thank you - “Protein and Healthy fats do not convert to glucose whereas ALL carbohydrates do.” This is interesting and helpful. So these types of food are good for filling up on? I’m not vegi but don’t eat a lot of meat, so are there non meat protein that are good for filling meals? I do like lots of veg, just don’t find it filling.
I actually don’t want the pills if I can help it. Because my reading was high, they wouldn’t let me start with diet/exercise but the pills so far with the side effects I feel have made me worse at the moment and I’ve been exercising less than pre diagnosis

 

[Drummer]

Thank you - “Protein and Healthy fats do not convert to glucose whereas ALL carbohydrates do.” This is interesting and helpful. So these types of food are good for filling up on? I’m not vegi but don’t eat a lot of meat, so are there non meat protein that are good for filling meals? I do like lots of veg, just don’t find it filling.
I actually don’t want the pills if I can help it. Because my reading was high, they wouldn’t let me start with diet/exercise but the pills so far with the side effects I feel have made me worse at the moment and I’ve been exercising less than pre diagnosis

You might be used to 'feeling full' but - honestly - if you eat less carbohydrate and so your meals are less bulky, you could find that you don't actually like the feeling of a full stomach. I eat two meals a day and sometimes stop eating simply because the urge to eat has gone. Being fully nourished is very different from being full up.
Breakfast can be a steak or chop with mushrooms or stir fry, but it can also be three eggs, a bit of cheese and a tomato. I am then not hungry for 12 hours, even though my stomach probably empties an hour or so after the meal.

 

[Pepper1]

It may shock you to learn that it is the carbs which are making you hungry, not stopping you from being hungry. The carbs spike your BG levels very rapidly and then your body has to work hard to lower those levels and as diabetes sets in, it becomes less efficient at reducing them so your body can't access the energy and it gets used to those high Blood Glucose levels and wants to keep them high, so it sends out messages to tell you to eat more ie hungry.
What many of us found amazing is that once we cut the carbs and ate more fibre and full fat products, the hunger stopped. Some of us happily just have one or two meals a day and don't get cravings or hunger anymore..... it has really been quite a revelation to me. Unfortunately the occasions that I go back to eating bread in particular, the cravings start again and it is like a torment. Much as I loved bread and spuds I no longer want them and I have found lots of other lovely tasty foods to compensate for those actually rather bland beige foods. The combination of too many carbs and not enough fat, which slows the digestion down and provides slow release energy, is most likely the major contributor to obesity and type 2 diabetes.... and yet the NHS still recommend wholemeal/wholegrain carbs and low fat particularly to diabetics. It is like tying your hands behind your back and then expecting you to play tennis!

You say that you don't want to have to finger prick because you don't want to be reminded of this condition all the time, but knowledge is power and a BG meter will give you power to make good food choices. It will show you what your body can tolerate and what it can't and enable you to "see" your diabetes, which is often easy to ignore or not take seriously if you don't have any symptoms, so you can't otherwise see or feel it. I can assure you that the long term complications that are risked by uncontrolled diabetes are far more of a reminder of the condition than a few finger pricks each day.

An HbA1c of 90 is high and you do not want to be remaining at that level for any length of time...as we don't know how long you have been undiagnosed, so taking control sooner rather than later would be wise. You can learn more from this forum and the members here who have been there and got the T-shirt, than you ever will from your GP or nurse because they just know a bit of text book stuff whereas we live with it day by day and meal by meal and moment by moment.

I agree that the support you have had from your GP is poor but if you stick around this forum you will learn what you need to manage this condition well. Dietary changes are far more powerful than most oral medication and need to be used in conjunction with any medication you do take anyway.

As regards the Metformin, taking it mid meal with a substantial amount of food (mostly protein, fat and fibre) will help to reduce the digestive upheaval. If you can't envisage a meal like that, then how about a 2 egg omelette with whatever filling you fancy apart from potato with a noice big side salad and a big dollop of full fat/cheese coleslaw. Or high meat content sausages (cheap sausages contain a lot of rusk which is carbs) with cauliflower mash.... No pealing spuds required, cooks quicker than tatties and mashes nicely with a good dollop of cream cheese and a spoon of wholegrain mustard. You can serve it topped with grated cheese if you like and maybe some green beans or broccoli. It is surprising how good mashed cauliflower is and use can use it to top a cottage/shepherd's pie as a low carb alternative. These are just some of the simple swaps but @NotWorriedAtAll is an Olympic Gold Medalist when it comes to adjusting both sweet and savoury recipes to low carb. Cakes, biscuits, batter, crisps, pies, pizza.... you can apparently have it all if you have the right ingredients and the motivation to make it yourself.

Wow so much information there thank you, especially re the carbs making me hungry. Do you find then by having a low carb but high fat diet people lose weight and at a good pace? I’d never think of cream cheese, grated cheese etc as part of a diet. I’m lucky that I love fruit and veg, however not as great with protein. I’ll definitely try the cauliflower mash. Are some fruits better than others?
Looks like I’ll need to look for new recipes - previous diet that I lost weight on was slimming world, but it allows use of carbs so will need to look for alternatives.
I was taking the Metformin immediately after a meal but was still having issues, where I didn’t want to go out or I’d be scoping out toilets etc but I don’t like the sound of Gliclazid. I’ll go back to the gp. I’d really rather do it via diet/exercise than tablets if I could.
the info from gp/nurse/online is so confusing re best diet for T2
I struggle with a good breakfast though so will start looking into alternative breakfast options

 

[Deleted member 21371]

The carbs cause all the problems, excess weight doesn't, is one theory.
I just went low calorie, lost five stones of fat, reversed my diabetes, and now eat normally.
No need for dollops of fat, no dollops of cheese, and to be honest, I like food, (I'm not into substantial amounts to be fair, just reasonable portions) I like cooking, I like spending time in the kitchen. I lime food prep.
Each to their own here through.

 

[Leadinglights]

Wow so much information there thank you, especially re the carbs making me hungry. Do you find then by having a low carb but high fat diet people lose weight and at a good pace? I’d never think of cream cheese, grated cheese etc as part of a diet. I’m lucky that I love fruit and veg, however not as great with protein. I’ll definitely try the cauliflower mash. Are some fruits better than others?
Looks like I’ll need to look for new recipes - previous diet that I lost weight on was slimming world, but it allows use of carbs so will need to look for alternatives.
I was taking the Metformin immediately after a meal but was still having issues, where I didn’t want to go out or I’d be scoping out toilets etc but I don’t like the sound of Gliclazid. I’ll go back to the gp. I’d really rather do it via diet/exercise than tablets if I could.
the info from gp/nurse/online is so confusing re best diet for T2
I struggle with a good breakfast though so will start looking into alternative breakfast options

Breakfast is something people find hard to envisage changing but a couple of alternatives I have are full fat Greek yoghurt with berries and about a 15g portion of a low sugar granola and that keeps me going for 4 hours, boiled eggs or scrambled eggs or cheese on toast with poached egg, bacon, egg and mushrooms or tomatoes. I seem to be Ok with a thin slice of toast.
The problem with non meat protein is it is often higher carb so if you have that then check out how much carb it is.
You don't need to use lots of meat which is of course pretty well zero carb but add to veg as in stirfry or curries.
Good potato substitutes are butternut squash or celeriac.
If people are used to having deserts then sugarfree jelly with berries and cream or strawberries and cream, I make a fruit crumble with the topping make form almond flour, low sugar granola and butter.
There are some good recipes on the website sugarfreelondoner which a few people use.
I went down to 70g carb per day, and just didn't have low fat products unless I actually preferred them, I lost 12kg and reduced HbA1C for 50 to 42 in 3 months no meds.
The meals I have I enjoy so I feel it is sustainable long term. I don't feel hungry.

 

[Pepper1]

Breakfast is something people find hard to envisage changing but a couple of alternatives I have are full fat Greek yoghurt with berries and about a 15g portion of a low sugar granola and that keeps me going for 4 hours, boiled eggs or scrambled eggs or cheese on toast with poached egg, bacon, egg and mushrooms or tomatoes. I seem to be Ok with a thin slice of toast.
The problem with non meat protein is it is often higher carb so if you have that then check out how much carb it is.
You don't need to use lots of meat which is of course pretty well zero carb but add to veg as in stirfry or curries.
Good potato substitutes are butternut squash or celeriac.
If people are used to having deserts then sugarfree jelly with berries and cream or strawberries and cream, I make a fruit crumble with the topping make form almond flour, low sugar granola and butter.
There are some good recipes on the website sugarfreelondoner which a few people use.
I went down to 70g carb per day, and just didn't have low fat products unless I actually preferred them, I lost 12kg and reduced HbA1C for 50 to 42 in 3 months no meds.
The meals I have I enjoy so I feel it is sustainable long term. I don't feel hungry.

Luckily I’m not much of a desert person, but I am a snacker. Thanks for the recipe advise - I’ve bookmarked to read later. Interesting breakfast options - I’m too used to just doing easy toast pre diagnosis. May have to mix up fruit and yogurt with eggs whatever way or with bacon, mushrooms, tomatoes, etc. Will def give low carb a go to see if it the carbs causing the hunger. That’s a key thing as well isn’t it re enjoying the food you’re eating so you don’t feel you’re on a diet or missing out. Thanks for the info

 

[Leadinglights]

Luckily I’m not much of a desert person, but I am a snacker. Thanks for the recipe advise - I’ve bookmarked to read later. Interesting breakfast options - I’m too used to just doing easy toast pre diagnosis. May have to mix up fruit and yogurt with eggs whatever way or with bacon, mushrooms, tomatoes, etc. Will def give low carb a go to see if it the carbs causing the hunger. That’s a key thing as well isn’t it re enjoying the food you’re eating so you don’t feel you’re on a diet or missing out. Thanks for the info

Nuts are good snacks, Nature Valley protein bars, KIND or shop own protein bars are less than 10g carb per bar and are good as snacks. Veg sticks with avocado dips or cheese are OK