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[Woody57]

Evening all,

Just wanted to say hi and introduce myself to the community.
I was diagnosed with type 2 a couple of years ago and it has been a bumpy ride (especially at the moment) trying to keep on top of my blood sugar levels.
I was initially started on metformin but it wasn't doing anything and I was put on Glimeperide. That worked well and along with more exercise and losing weight (and stopping smoking) I managed to half the dose. All good until the sugars started to rise again, so back to the original dose. Then towards end of last year my sugars started to be high again. With all the usual delays it took a while to see a GP and then get blood tests, he put me on Metformin on top of the Glimeperide. Nothing changed, so he doubled the dose, this all took several weeks as you will understand. I had a bad reaction to the Metformin. Stomach cramps, lethargy tired etc. The Metformin was stopped and I've now been prescribed Sitagliptin.
My blood sugars remain high.
My questions are: Is it common for people to have to try several medications before the right one is found?
I stopped smoking, stopped drinking alcohol, exercise more and lost a couple of stone and things seems to be getting worse. Who said life was fair eh?
Sorry for the moan and I look forward to spending some time learning on this forum. Thanks for having me.

 

[Leadinglights]

Welcome to the forum
Not an easy task to get blood glucose under control when medications aren't tolerated or appear to lose their effectiveness. You mention giving up alcohol but have you made any other dietary changes as that is usually required along side medications.
Reducing ALL carbohydrates in your diet not just sugar, many people think they are eating a healthy diet but often it is still too high in carbohydrates for you to tolerate.
Making a food diary noting everything you eat and drink noting quantities and estimating the TOTAL carbs will help you see where some savings can be made.
What is your HbA1C and are you testing your blood glucose at home so you can see the effect of meals as that is a very powerful tool in giving you more control.
If you want to post some typical meals the people could make some suggestions on what might be an issue with carbs.
People have success with a low carb regime which is less than 130g per day so by looking at your food diary you could see how far off that you are.

 

[Woody57]

Many thanks for your comments,
I have no sugary drinks. We have really reduced all processed flour, pasta couscous etc. Though I do still eat all of these. Bread I have found difficult to limit. I could cut out more carbs. We generally have a healthy processed food free diet.
I do not have my last two HbA1C readings and should get them from my GPs. I do test my BG at home, though irregularly ( hence I didn't notice the levels rising towards the end of last year).
I have much to learn on all aspects of treatment of this condition, but I am not understanding why all my efforts to lose weight (over two stone) stop smoking (three years) stop drinking alcohol and all sugary drinks, improved diet and increased my exercise levels seems to have been for nought! Oh well, maybe it would have been much worse had I done nothing.

 

[Leadinglights]

Many thanks for your comments,
I have no sugary drinks. We have really reduced all processed flour, pasta couscous etc. Though I do still eat all of these. Bread I have found difficult to limit. I could cut out more carbs. We generally have a healthy processed food free diet.
I do not have my last two HbA1C readings and should get them from my GPs. I do test my BG at home, though irregularly ( hence I didn't notice the levels rising towards the end of last year).
I have much to learn on all aspects of treatment of this condition, but I am not understanding why all my efforts to lose weight (over two stone) stop smoking (three years) stop drinking alcohol and all sugary drinks, improved diet and increased my exercise levels seems to have been for nought! Oh well, maybe it would have been much worse had I done nothing.

You are probably right in that it may have been a lot worse.
If you are not testing and don't know what your HbA1C is how do you know your blood glucose is high?
It is easy to underestimate how much carbs you are having and might have gradually increased what you have so maybe time to review your diet and do some testing to identify any particular problem foods.
It is very disheartening not to see results of your efforts. Now is the time to renew that effort.

 

[grovesy]

Over the years I have had to reevaluate what I eat and make adjustments accordingly.

 

[Woody57]

Since realising I had a problem again I have been testing my BG regularly. Yesterday 12 on waking and 24 a couple of hours after lunch. Has been like since then this despite extra Metformin and simagliptin as explained before.
I agree it is easy to underestimate the carbs I’ve been having and will definitely have to be more attentive. It seems that the diabetes diet advice on the website and elsewhere does not preclude all carbs though. Was hoping to make Spanish omelette today which includes 150g potatoes per portion.

 

[Leadinglights]

Since realising I had a problem again I have been testing my BG regularly. Yesterday 12 on waking and 24 a couple of hours after lunch. Has been like since then this despite extra Metformin and simagliptin as explained before.
I agree it is easy to underestimate the carbs I’ve been having and will definitely have to be more attentive. It seems that the diabetes diet advice on the website and elsewhere does not preclude all carbs though. Was hoping to make Spanish omelette today which includes 150g potatoes per portion.

That is were your problem is then 150g potato is 25g carbs, so maybe a third of that and extra of the other veg.

 

[everydayupsanddowns]

I agree it is easy to underestimate the carbs I’ve been having and will definitely have to be more attentive. It seems that the diabetes diet advice on the website and elsewhere does not preclude all carbs though

Yes absolutely right! Low and moderate carb doesn’t mean no carb (there are small amounts of carbohydrate in lettuce after all!). One of the reasons why dietary advice is so ’fuzzy’ I think, is because people’s tolerances are so varied. Both in terms of portion sizes, and also the sources of carbs that are ‘fine’ and which ones cause a dramatic and rapid rise in BG. And many of these differences seem to defy logic, and any reputation for things being ‘slow release’ (brown is better than white… fibre slows absorption… porridge releases slowly etc etc - well, not necessarily for you as an individual!)

One of the most powerful ways you can begin to examine your menu, is by checking BG immediately before and again 2hrs after the first bite of a meal (some say 1hr, but perhaps start with 2hrs). To begin with the numbers themselves are arguably less important than the differences between them. You are looking for the ‘meal rise’, and trying to keep that to 2-3mmol/L or less. If the rise is bigger than 3, reduce the portion of carbs, try a low carb swap, or switch to a different carb source. You may even find it makes a difference what time of day you eat - mornings are often trickiest.

By concentrating on reducing the meal rises, you allow your overall levels to come down more gradually (which is easier on the fine blood vessels). Plus you will be able to find that you are OK with basmati rice, but no good with bread (or vice versa), so you’ll build up a database of foods that you need to reserve for special occasions.

It must be very frustrating to have worked so hard, lost all that weight, and made positive changes only to have seen your BGs rising Did your diabetes come on quite suddenly? Another thing to bear in mind, if you continue to make big changes but don’t see the results you’d expect, is that you might want to get checked in case you have a different type of diabetes (eg LADA a slow-onset T1 that emerges in adulthood over several years).

Good luck with it all, and keep us updated with how thungs are going 🙂

 

[Woody57]

Hi

My BG levels are still persistently high ( in the high teens ) I am struggling with understanding what damage this might be doing as we try different medications to get things under control. I am doing what I can to maintain a low carb diet, but with maybe only the slightest effect at the moment. Do these efforts usually take time to show or are they normally immediate?
Any help much appreciated.

 

[Woody57]

Sorry, My diabetes came on gradually and could be linked, or at least the onset, linked to a pituitary condition I have. I have to say that I was was warned some years before I was diagnosed as type 2 diabetic that I was at risk. This I didn't really follow up on because of other health issues I suppose. All that said we are where we are, but it seems that since initial diagnosis haven't had a decent period of stability.

 

[Leadinglights]

Sorry, My diabetes came on gradually and could be linked, or at least the onset, linked to a pituitary condition I have. I have to say that I was was warned some years before I was diagnosed as type 2 diabetic that I was at risk. This I didn't really follow up on because of other health issues I suppose. All that said we are where we are, but it seems that since initial diagnosis haven't had a decent period of stability.

If you post the sort of meals you are having which you think are low carb people may spot things that may be causing a problem.

 

[Woody57]

I have been taking recipes from the low carb diet plan on the main website. In fact the Spanish omelette came from there.

 

[rebrascora]

I can understand your frustration, especially when you have really pulled out the stops to get on top of this. You must feel like you are being kicked in the teeth despite your best efforts.

Those numbers are very high.... not massively dangerous yet... high 20 or over 30 you should be seeking medical advice urgently and drinking lots of water to bring them down, but you don't want them mid teens to low 20s to continue for too much longer.
A regime of testing before and 2 hours after a meal and keeping a food diary and adjusting carb portions helped me reduce my levels and getting into single figures was a real day to celebrate although ultimately it turned out I was Type 1 and needed insulin to manage my levels and of course keep me alive, but it is not an easy solution and comes with it's own set of difficulties, so it is worth playing around with your diet a bit more first and cutting the carbs further. So your Spanish omelette could be just a normal omelette without the potatoes. Plenty of whatever other fillings you like (cheese, mushrooms, onions, ham, courgettes, aubergines, tomatoes etc and don't stint on the eggs, they are a great food for us diabetics. I have my omelettes with a large side salad and a big dollop of cheese coleslaw..... Not reduced fat coleslaw, but premium creamy coleslaw. The fat in the omelette and coleslaw will provide you with calories and slow release energy rather than the potatoes which will act as rocket fuel to your BG levels.
What do you normally have for breakfast? It can be the meal that has the most significant impact on BG levels, so finding a good low carb alternative that you enjoy can make a huge difference to the rest of your day BG wise and it is usually a meal where we tend to have the same thing most mornings so if you can find something which agrees with your tastes and your body can tolerate better than your current breakfast, then you should see a notable improvement in your levels. Porridge was the last carb rich food I gave up as of course they all tell us how healthy it is but I have tested it and the glucose from a bowl of the best jumbo porridge oats made with into porridge with water and a little cream added (less carbs in cream than milk and tastes so much better and the fat helps to provide energy in the absence of carbs) can get from my mouth to my finger tip in 20 mins and start spiking my BG levels...... Not what I consider slow release!!
Now I have creamy Greek style natural yoghurt with a few raspberries (these are one of the lowest carb fruits.... best to stick with berries and avoid exotic fruits like bananas and pineapple and mangoes and oranges even or just have half of one at a time. Same with apples and pears... Half an apple is a real treat for me these days with a chunk of cheese) and mixed seeds and a cup of coffee made with real double cream is my breakfast and has much less impact on my levels. This might not appeal to you and maybe you might prefer eggs for breakfast, with or without bacon and sausages and mushrooms, but go steady on the baked beans, hash browns and toast or fried bread.
It takes a whole rethink on your way of eating to follow a low carb diet because culturally it is so different and logistically of course, bread is a carrier for so many foods, so restricting that is difficult at first.

Despite my above comments about dietary changes, I also think it is likely that you might be a slow developing Type 1 considering that your levels haven't responded to the efforts you have made. Can I ask if your pituitary condition is autoimmune? Type 1 diabetes is an autoimmune condition and these things are gregarious and seem to like to hang out together in the same body. How easy or difficult was your weight loss.... again that can be an indication of Type 1 if it was perhaps easier than you expected, especially if you have given up smoking which often makes weight loss more difficult. A huge WELL DONE on that alone by the way! If you are a slow developing Type 1, then it might be a good idea to acquire some Ketostix to check your urine when your BG levels are persistently high. You can ask your GP or nurse for these but if they are difficult about it, then they can be bought over the counter for about £5. Ketones develop when your body is running on fat instead of carbohydrate. On a low carb diet it would be normal to have a low level of ketones, (hence keto diets) but the combination of ketones and high BG levels can turn your blood acidic and make the ketones harmful and if you are not making enough insulin perhaps because your immune system has killed off your beta cells in your pancreas which produce it, this can rapidly become a very serious/life threatening issue and you should seek urgent medical advice if your ketone levels go above 1 and your BG levels are high, particularly as you have no way of bringing them down. If you had insulin then it would be less of a worry as you could use more insulin to bring your BG levels down, unless they went over 3 and then it would be time to attend A&E. I know this all probably sounds a bit complicated but keeping yourself safe with diabetes is important and being able to test for ketones when your BG levels are mid teens and above, especially when they are persistently high despite a low carb diet means you are at risk.

I do think you should broach the subject of Type 1 testing (GAD anitbodies and C-peptide tests) with your GP but better still, ask to be referred to a specialist diabetes clinic where a consultant can authorize these tests and interpret the results as they can be less than straight forward to draw conclusions from and most GPs have little knowledge of the tests let alone interpreting the results.
These high levels should not be allowed to persist too much longer, so if dietary changes with testing before and then 2 hours after meals and adjusting/trimming carbs down further, doesn't show an improvement in a couple of weeks I would push for different treatment and I think you probably need insulin.

 

[Leadinglights]

I have been taking recipes from the low carb diet plan on the main website. In fact the Spanish omelette came from there.

I just looked at a couple of the recipes on there and per portion they are still higher carb than some people can tolerate, and you can only make that judgement from your before and after meal tests.
Just because something is purporting to be low carb, it might not be so for you. Some people are more sensitive to some carbs than others so for the same amount of carb their reaction may be different.
A portion of something which has 40g plus of carbs would be too much for many Type 2 people.

 

[Woody57]

Here are three BG tests done today.
The first after a porridge breakfast (16.8) and I thought porridge was good! Two glimeperide tablets
The second before lunch (18.4) one Sitagliptin tablet at lunch
The third just now two and a bit hours after lunch 11.5 ( my lowest in weeks)

My Pituitary condition was/is a tumour that was removed along with the gland. I take full hormone replacement because of this. This should not affect my diabetes directly according to my endocrinologist

 

[Woody57]

BTW
I really appreciate the time you are all taking to reply. I have had little to no real help with this journey ( compared to my pituitary one for example ) I might try and find a self-help group in the area.

 

[Woody57]

Usual for breakfasts

2 to 3 * weekly porridge, made on semi-skimmed milk with dates and seeds on top
The rest of the week 1/2 pear-1/2 banana 30g of mixed bran muesli with greek yoghurt

 

[Leadinglights]

Usual for breakfasts

2 to 3 * weekly porridge, made on semi-skimmed milk with dates and seeds on top
The rest of the week 1/2 pear-1/2 banana 30g of mixed bran muesli with greek yoghurt

Those are all pretty high carb breakfasts, 30g plus for the muslei. depends on how much porridge and dates (any dried fruit) high carb.
But the proof of the pudding is in the levels you are getting after those foods.
You could try full fat Greek yoghurt with some berries and maybe just 15g of the muesli
Or omelette or boiled eggs or cooked meats and cheese with 1 small slice bread/toast, that would be less than 20g carb

 

[rebrascora]

Dates are very high carb.... of the dried fruits, probably the highest in sugar.... I used some the other day to treat low BG levels and they were like pure sugar and added to porridge (important to weigh the porridge oats to get an idea of the portion you are currently eating and thereby the carb content in grams) so that you can then accurately reduce the portion size if you decide to stick with it. Portion size of high carb foods really is key, so weighing or having a container or scoop marked so that you know how much you are having is going to be important...If it turns out you are Type 1 then you will need to do this anyway, so not a bad habit to get into and it is only necessary for carb rich foods. Skimmed milk actually has slightly more carbs than full fat and cream has even less, so feel free to treat yourself unless you have a lot of weight to lose but it doesn't sound like it. You need to get energy from somewhere and if you are cutting right down on your main source of carbs then you need to get it from another source and fat and protein are the only other options. The seeds are a good addition but I would sub the dates with a small hand full (about 10-12 blueberries or raspberries)

Bananas are high carb and pears moderate so not a great choice, but half is better than a whole one. Do you mean one or the other or a half a pear and a half a banana. Is that 30g of mixed bran plus some muesli or is that a mixed bran muesli.... not heard of that option before. Again high carb foods, so best to weigh and calculate carbs, so that you can reduce as necessary depending upon how your body responds.

With testing, what you may not realise is that BG fluctuates quite significantly throughout the day and night and is affected by about 42 different factors, many of which are beyond your control, so it is important to test just before you start to eat and then 2 hours afterwards. This is the closest you can get to isolating the response your body has to the food you ate. To help you understand..... I can wake up with a reading of 5.6 but my liver will start to dump glucose into my blood stream as soon as I get up and set foot on the floor. This is to give me energy to start my day and in prehistoric times it would give me enough fuel to go out and hunt or gather my first meal of the day, rather than just walk to the fridge and reach in. This liver dump of glucose can increase my BG levels by 5 or 6mmols in the space of an hour whilst I am getting showered and dressed etc, so my premeal reading could be 10-11, so if I don't test at that point just before I eat and use that reading I took when I woke up, any food i eat is going to smash through the 2-3 mmol rise I am looking for. The other thing to note is that food hitting your stomach flicks a switch which turns off the liver from dumping more glucose, so taking a reading just before eating and then again 2 hours after my breakfast will tell me how my body coped with the breakfast I ate, rather than encompass some or all of that liver dump as well. Basically, that premeal reading is important so don't skip it. Record pairs of BG data for each meal as well as an estimate of the carb content in your food diary and this will help you to adjust the food you eat and the portion size to what your body can cope with. I know it seems like a real faff but once you get into a system of it it gets easier and once you get regular meals sorted out so that they don't give you too much of a spike you can reduce the testing to more intermittent checks and just new meals that you haven't tried and adjusted before. It becomes second nature after a while.

As regards the recipes on the site, they are suggestions but to be honest the main site and the forum are not always in agreement. The forum was originally independent, but we are fortunate and grateful that the main site now hosts the forum with all the associated costs, which enables the forum to continue to grow and support people but we may not agree with the dietary advice it gives. The Diabetes UK website is very much tied to the NHS "eatwell" plate which is a healthy diet for none diabetic people or people who have the use of insulin, but may not be low carb enough for many people who use dietary changes and oral meds to control their diabetes. The forum is where people who live with the challenges of diabetes day to day and meal by meal exchange their personal experiences and find best practices to enable individuals to learn what works for them and their diabetes rather than just following general "healthy" dietary advice. Sadly many of us feel that the NHS dietary advice is very behind the curve both in terms of diabetes and perhaps the general population too particularly in respect of the low fat advice, which may be doing us all a disservice..... hence the increase in obesity and diabetes since the low fat advice was brought out. Fat takes longer to digest and slows the digestion of any carbs that you do eat, so that you feel full for longer and don't end up reaching for a snack between meals and it provides slow release energy over many hours. Cutting the natural fat from our diet and in many cases replacing it with cheaper carbs and sugar (which are addictive) leads to over eating because our body burns those carbs and sugar or stores them away as fat and then we have nothing left to back it up so we want to eat again and we end up with our BG levels going up and down and then down can create a need to eat again. In your case unfortunately they are not going down again because you are unable to utilize that glucose in your blood very effectively either because you are not producing enough insulin (usually Type 1) or your body is resistant to it (usually Type 2)

 

[Woody57]

Thanks very much. Lots to learn and will take some digesting if you'll excuse the pun. I did follow WWatchers up until the first lockdown , but it seems that that advice, although geared towards losing weight, is not necessarily geared towards helping the diabetic. They did indeed help me lose weight and I thought I was doing all the right things as WW was recommended by our GP practice diabetes nurse ( who I see once a year).