Newbie needing some help to understand newly diagnosed T2

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LadyRara

LadyRara

Member
Relationship to Diabetes
Type 2
Good morning,

Sorry if there are multiple posts similar to this, but I guess this is personal to me and I am wondering if someone can explain something to me. I was diagnosed with T2 diabetes a year ago (HBA1C was 53) and I managed to get it back to pre-diabetic (HBA1C dropped to 47 or 48, I can't quite remember). However, I had another blood test the other day and my HBA1C has jumped up to 79. I am not overly surprised because I feel I got a little complacent and went straight back to my pre-diabetes diet. I am now testing my blood sugars daily with a Nexus machine and they have been as follows:14.1, 9.8, 10.4, 8.0,11.1, 10.6 and today 11.1. I have not consumed any 'white' carbs at all in the last 6 days and have not had much in the way of alcohol, so these readings are confusing me. My diabetic nurses are helpful, but no-one has explained to me why my readings are high considering I have significantly changed my diet since last seeing one of them last Tuesday. Can someone please explain to me a) why my readings are so high and b) what do I need to do to bring them down if diet is not changing things? Am I being a little premature and impatient? I am not presently on any medications and would prefer to try and reduce my HBA1C with diet if at all possible. I am testing first thing in the morning before eating or drinking anything.

Thank you for reading my ramblings and if anyone would prefer to PM me to give me a little guidance, I would very much appreciate it.
 
If you went back to your previous way of eating that would explain the increase in HbA1C so not good but brilliant you have a monitor to be checking at home. Those readings are consistent with a high HbA1C. When did you take them?
You may be misunderstanding the 'white carbs' as it is all carbs that convert to glucose so the brown version of bread, rice and pasta is not really any different in carbs to the white variety. But there are a lot more foods that are high carb and need to be treated with caution, breakfast cereals, potatoes, starchy veg and tropical fruits as well as the more obvious cakes, biscuits, sugary drinks and fruit juice. Make sure you are looking at the total carbs in the nutritional information.
It does take a while for changes in diet to take effect but it is better to reduce your glucose levels gradually to avoid issues with your eyes and nerves that some people can get.
It sounds as if you are trying a low carb approach, that being no more than 130g per day and this link may help you with some ideas and so do's and don'ts. https://lowcarbfreshwell.co.uk/, this has been successful for many people.
There are also some meal plans on the DUK main site for low carb and other approaches.
Whatever you choose has to be enjoyable other wise it will not be sustainable long term. It really has to become your new way of eating and as you have experienced it is easy to slip back if it isn't.
 
Welcome to the forum @LadyRara

Sorry to hear your HbA1c has jumped up a bit, despite your best efforts :(

Good to hear you have been avoiding white carbs, but I wonder if you may have swapped some of them to brown or wholegrain versions? These can have a slightly slower absorption than their white counterparts (though not always!) but unfortunately are only very slightly lower in carbs than their more processed white versions :(

Great to hear you have a BG meter to help you understand how you are reacting to the meals you are eating. This can be so useful!

Many members here use a technique of checking immediately before eating a meal, and again 2hrs after the first bite. This gives an indication of the ‘meal rise’. Ideally you’d want to see a rise of 2-3mmol/L or less at the 2hr mark.

Initially it can be argued that the numbers themselves are less informative than the differences. If you tweak and tailor your meals, reducing carbohydrate portions and looking for sources of carbs that give you less dramatic rises, then your overall levels can come down gently over time because each meal has less of a ‘spike’. 🙂

It may well be that the changes you have already made are beginning to have an effect, sometimes it can take a while for the reductions in glucose levels to settle. But actually changing average glucose levels over a more extended period is easier on the fine blood vessels and nerve endings, so keep gently nibbling away at it 🙂

Hopefully with a little ‘eating to your meter’ and some further modest changes to your meals you will end up with a flexible and sustainable way of eating that suits your individual tolerance to different types of carbs.

Good luck, and let us know how you get on 🙂
 
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Are you only testing in the morning?
What sort of meals are you having and are you testing before eating and two hours after starting eating?
 
Just to add as you have a monitor you may find it useful to do some before and 2 hour post meal tests to check your tolerance to the meals you are having, you would be looking for no more than a 2-3mmol/l increase and as levels come down mo more than 8-8.5mmol/l
 
everydayupsanddowns said:
Welcome to the forum @LadyRara

Sorry to hear your HbA1c has jumped up a bit, despite your best efforts :(

Good to hear you have been avoiding white carbs, but I wonder if you may have swapped some of them to brown or wholegrain versions? These can have a slightly slower absorption than their white counterparts (though not always!) but unfortunately are only very slightly lower in carbs than their more processed white versions :(
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Good morning,

Thank you so much for taking the time to reply. No, I have not swapped the white for brown/wholemeal/wholegrain. In fact, I have eaten no bread, no rice, no pasta and no potatoes for the last 6 days at all. My diabetic nurse recommended fasting until lunchtime, then eating full-fat Greek yoghurt and strawberries/raspberries at lunch, I then have a chicken & bacon salad and something along the lines of stir-fry for dinner. If I do have a drink, I have vodka & soda with a squeeze of fresh lime juice but I am not drinking to excess. I have entirely cut out sugar from my tea drinking and cannot recall eating anything processed or with refined sugar in. No sugar substitutes either.
 
harbottle said:
Are you only testing in the morning?
What sort of meals are you having and are you testing before eating and two hours after starting eating?
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At present I am only testing once a day and that is straight after I wake up and before consuming anything at all. The diabetic nurse said to test for 2 weeks and if no significant difference, she wants me to go on medication.
 
Leadinglights said:
Just to add as you have a monitor you may find it useful to do some before and 2 hour post meal tests to check your tolerance to the meals you are having, you would be looking for no more than a 2-3mmol/l increase and as levels come down mo more than 8-8.5mmol/l
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How often per day would you recommend testing? Sorry for all of the questions. What reading should I give to the nurse? Would it be an average per day?
 
LadyRara said:
Good morning,

Thank you so much for taking the time to reply. No, I have not swapped the white for brown/wholemeal/wholegrain. In fact, I have eaten no bread, no rice, no pasta and no potatoes for the last 6 days at all. My diabetic nurse recommended fasting until lunchtime, then eating full-fat Greek yoghurt and strawberries/raspberries at lunch, I then have a chicken & bacon salad and something along the lines of stir-fry for dinner. If I do have a drink, I have vodka & soda with a squeeze of fresh lime juice but I am not drinking to excess. I have entirely cut out sugar from my tea drinking and cannot recall eating anything processed or with refined sugar in. No sugar substitutes either.
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Ah OK. I was posting in ‘chunks’ editing as I went, so have added some other thoughts.

It sounds like you have made some significant changes, and may just need to let them bed in a little?

If your glucose levels don’t seem to respond in a week or two, and you are seeing stubbornly high BGs despite very low carbohydrate intake, you may want to ask about checks for cPeptide and GAD antibodies, just in case your diabetes is one of the more exotic flavours than just a regular T2. There are autoimmune versions that come on more slowly in adults that can look a bit like T2 to begin with, but as beta cells and insulin production is lost will need other treatment options to manage glucose levels effectively.
 
LadyRara said:
How often per day would you recommend testing? Sorry for all of the questions. What reading should I give to the nurse? Would it be an average per day?
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It depends on why you are testing, If you are only having 2 meals a day then test before and 2 hours after each.
But many find their morning readings are the last to come down and can remain stubbornly high. Taking a reading whilst still in bed can eliminate what some people get which is referred to as foot on the floor phenomenon.
Fasting can help some people but in other is causes the liver to release glucose so will give higher readings. The thing that will effect spot tests the most is the food you eat.
 
I have changed my diet quickly, in the vain hope that this will bring my HBA1C down to save me going onto medication. Maybe I just need to be a little more patient or maybe I have gone in too fast cutting out the carbs. It's certainly a bit of a minefield.

I really, really appreciate all of your help and comments, though 🙂
 
Leadinglights said:
It depends on why you are testing, If you are only having 2 meals a day then test before and 2 hours after each.
But many find their morning readings are the last to come down and can remain stubbornly high. Taking a reading whilst still in bed can eliminate what some people get which is referred to as foot on the floor phenomenon.
Fasting can help some people but in other is causes the liver to release glucose so will give higher readings. The thing that will effect spot tests the most is the food you eat.
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Just out of interest, why would first thing in the morning readings be high? If I have essentially fasted for 8/10 hours while being asleep. Maybe I'll try the testing before I get out of bed. I just thought first thing in the morning would be the best time, but that is me assuming.
 
Our liver trickles out glucose day and night to keep our vital organs fueled in the absence of food. On a morning particularly out liver starts to ramp up that glucose release to give us energy for the day ahead. This is referred to as Dawn Phenomenon or DP. For some people this starts to happen as it gets light even whilst we sleep. For others like myself, it happens as soon as I swing my legs out of bed and stand up (often referred to as Foot on the Floor Syndrome or FOTF) This surge of glucose can be quite significant. My BG levels rise several mmols in the space of 20-30 mins after getting up, so I always do that test of my waking reading before I get out of bed and I inject my insulin to cover it whilst still in bed..... obviously you can't do that as you don't have insulin, but it helps to know what is going on if you can see when that rise is happening and perhaps it may be some small comfort if your levels do rise suddenly in the morning to know that they haven't been that high all night.
If your diet is as low carb as it sounds then I too wonder if you may actually be LADA (a slow onset Type 1) rather than Type 2. The diagnosis of Type 2 is largely just a presumption based on age and weight etc rather than a specific diagnosis based on tests. The HbA1c just tells you that you are diabetic and there is no specific test for Type 2. The 2 tests mentioned by @everydayupsanddowns are to test for Type 1 diabetes but are not routinely done as they are more specialized tests and really need to be authorized and the results interpreted by a diabetes consultant. Most people are Type 2 so GPs often don't even consider it might be something else and some GPs and nurses are under the misguided opinion that Type 1 only develops in children, which is absolutely not the case, as many of us were diagnosed in later life..... but still the myth persists with some health care professionals. 🙄
 
rebrascora said:
Our liver trickles out glucose day and night to keep our vital organs fueled in the absence of food. On a morning particularly out liver starts to ramp up that glucose release to give us energy for the day ahead. This is referred to as Dawn Phenomenon or DP. For some people this starts to happen as it gets light even whilst we sleep. For others like myself, it happens as soon as I swing my legs out of bed and stand up (often referred to as Foot on the Floor Syndrome or FOTF) This surge of glucose can be quite significant. My BG levels rise several mmols in the space of 20-30 mins after getting up, so I always do that test of my waking reading before I get out of bed and I inject my insulin to cover it whilst still in bed..... obviously you can't do that as you don't have insulin, but it helps to know what is going on if you can see when that rise is happening and perhaps it may be some small comfort if your levels do rise suddenly in the morning to know that they haven't been that high all night.
If your diet is as low carb as it sounds then I too wonder if you may actually be LADA (a slow onset Type 1) rather than Type 2. The diagnosis of Type 2 is largely just a presumption based on age and weight etc rather than a specific diagnosis based on tests. The HbA1c just tells you that you are diabetic and there is no specific test for Type 2. The 2 tests mentioned by @everydayupsanddowns are to test for Type 1 diabetes but are not routinely done as they are more specialized tests and really need to be authorized and the results interpreted by a diabetes consultant. Most people are Type 2 so GPs often don't even consider it might be something else and some GPs and nurses are under the misguided opinion that Type 1 only develops in children, which is absolutely not the case, as many of us were diagnosed in later life..... but still the myth persists with some health care professionals. 🙄
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I really appreciate your post. I will bear all of this in mind when I have a chat with my diabetic nurse next Tuesday.
 
I should also say that our body would normally release a steady trickle of insulin to deal with that glucose release from the liver, but as diabetics. for whatever reason, it struggles to do so. With Type 2 diabetes it is usually because there is fat in and around the liver and pancreas (visceral fat) which prevents them from signaling effectively to each other to balance insulin and glucose or in advanced cases of Type 2, the insulin production gets burnt out from being over worked to overcome insulin resistance. In Type 1 the insulin producing beta cells have been mistakenly attacked and destroyed by the immune system. This is often a slow steady process in mature adults and can happen over months or years, so the onset of diabetes is slower than the often more sudden and critical situation experienced by children. Eventually the situation reaches a tipping point where there are no longer enough beta cells left to manage glucose levels and you get a sudden rise.... which may be what you have experienced with your sudden rise in HbA1c.

There are also other types of diabetes like Type 3c which is associated with damage to the pancreas from disease, trauma or surgery. People with cysts or tumours or pancreatitis or surgery to treat these issues should be considered Type 3c, so it might be worth asking for a scan to check this is not an underlying cause too. I am not meaning to scare you with that but if you don't get classic presentation of type 1 or Type 2 diabetes or you have a history of gall stones (which can cause inflammation of the pancreas) , that would be worth investigating.
 
rebrascora said:
I should also say that our body would normally release a steady trickle of insulin to deal with that glucose release from the liver, but as diabetics. for whatever reason, it struggles to do so. With Type 2 diabetes it is usually because there is fat in and around the liver and pancreas (visceral fat) which prevents them from signaling effectively to each other to balance insulin and glucose or in advanced cases of Type 2, the insulin production gets burnt out from being over worked to overcome insulin resistance. In Type 1 the insulin producing beta cells have been mistakenly attacked and destroyed by the immune system. This is often a slow steady process in mature adults and can happen over months or years, so the onset of diabetes is slower than the often more sudden and critical situation experienced by children. Eventually the situation reaches a tipping point where there are no longer enough beta cells left to manage glucose levels and you get a sudden rise.... which may be what you have experienced with your sudden rise in HbA1c.

There are also other types of diabetes like Type 3c which is associated with damage to the pancreas from disease, trauma or surgery. People with cysts or tumours or pancreatitis or surgery to treat these issues should be considered Type 3c, so it might be worth asking for a scan to check this is not an underlying cause too. I am not meaning to scare you with that but if you don't get classic presentation of type 1 or Type 2 diabetes or you have a history of gall stones (which can cause inflammation of the pancreas) , that would be worth investigating.
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I am overweight (around 12st when I should be approx. 9st), so am working on that. At the same time as being diagnosed as T2, I was told I had high blood pressure, high cholesterol, non-alcoholic fatty liver and a scan showed I also have gallstones, so I assume it may be a culmination of a lot of things. I will have a chat with the diabetic nurse about all of these things next week. Thanks again.
 
LadyRara said:
in the vain hope that this will bring my HBA1C down to save me going onto medication.
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Might not be such a vain hope.. cuttings carbs to a minimum and some restricted eating times brought my HbA1c down to pre diabetic levels within 4 months. Lost weight and put a host of other conditions into reverse too.
 
It is sometimes better to take it steadily with a regime that you can maintain otherwise all the hard work can easily be undone and is kinder on your eyes and nerves.
You do have a number of other things going on but the good news is that low carb can have a positive effect on cholesterol and losing weight can improve blood pressure.
 
Leadinglights said:
It is sometimes better to take it steadily with a regime that you can maintain otherwise all the hard work can easily be undone and is kinder on your eyes and nerves.
You do have a number of other things going on but the good news is that low carb can have a positive effect on cholesterol and losing weight can improve blood pressure.
Click to expand...
I am an all or nothing kinda gal, so I need to go hard or go home.

I have the wake-up call and I am now overhauling my entire diet and plan to stick to it no matter what.

I do miss pizza, though :(
 
LadyRara said:
I am an all or nothing kinda gal, so I need to go hard or go home.

I have the wake-up call and I am now overhauling my entire diet and plan to stick to it no matter what.

I do miss pizza, though :(
Click to expand...
I reduced my carbs to 70g per day when I got my diagnosis which lowered my HbA1C from 50mmol/mol to 42mmol/mol in 3 months but I had a problem with my vision, near focus was awful, my eyes felt as if they were in different heads and it was only reading here on the forum that I found out it could be an issue in reducing blood glucose too quickly.
There are some recipes on the website sugarfreelondoner for low carb things like cakes, biscuits and savoury foods like pizza.
 
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