Newbie - potentially in denial?

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Sagz

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Type 2
Hello,

I have recently joined. I was diagnosed with type 2 diabetes in 2018. I made some lifestyle changes lost some weight and reduced sugar intake. Haven't been back to the doctors until recently (since the pandemic).

My recent Hba1c reading is 119. Had other blood and urine tests and the only other abnormality was a serum alanine aminotransferase level of 43 iu/L. My blood pressure is also high at around 140 / 96.

I think I'm going to need medication but a little reluctant. Don't know if I'm in denial, but very surprised that my Hba1c is 119 as I eat better than when I was first diagnosed. Is it possible for a human error when working out or noting Hba1c?

I'd like to have another Hba1c test before taking medication to support with type 2 diabetes. Anyone else been in a similar position? Is there scope for human error - (don't deny the reliability of the test).

Thanks

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Hba1c
July 2018: 49 mmol/mol
January 2019: 57 mmol/mol
November 2019: 49 mmol/mol
December 2022: 119 mmol/mol

Weight
August 2018: 107 kg
December 2022: 101 kg (36 years old)
 
What sort of things do you eat?

119 is very high indeed. I imagine you will be recommended some medication for sure.
 
Hi. That HBA1C is far too high and you will need medication. When you say you eat well what does that mean? I think you will find that it's rare for the HBA1C test to have any significant error. It's always possible you are a LADA (late onset T1) but you would probably need to be slim and have been losing wieght recently without trying.
 
It is worrying that you only mention having reduced 'sugar' intake whereas it is all carbohydrates that people with Type 2 diabetes struggle to cope with. So it is things like potatoes, rice, pasta, breakfast cereals, bread, pastry, tropical fruits, starchy vegetables that people need to watch their intake of as well as cutting out cakes, biscuits, sugary drinks including fruit juice.
People often think they eat a healthy diet because those foods are pushed as being healthy but sadly they are no if diabetic. Basing meals on meat, fish, cheese, eggs, dairy, veg and salads with only small portions of the higher carb foods will still give plenty of options for tasty meals. This link may give you some ideas for modifying your diet https://lowcarbfreshwell.co.uk/. Many following a low carb approach keep their total carb intake to less than 130g per day.
However with such a high HbA1C medication alongside the dietary changes are most likely to be needed.
 
Thanks for your replies. When I say eat better I mean in comparison to when I was first diagnosed 4 years ago. Although I'm 4 years older and less active since the pandemic as I work from home more often. So perhaps that is a factor?

I have set out below what I typically eat and there are certainly areas I can cut back on and improve. On reflection (this is a helpful exercise), I probably have too many carbohydrates and will stop a take away once a week as well as the zero drinks. There is perhaps improvements I can make on portion size too.

I was having full sugar drinks before my diagnosis and take away 2 to 3 times per week and mainly ate white bread. I think what I'm struggling to comprehend is how it has drastically shot up despite not living the same way. But it is a test from 3 years ago so probably of little relevance.

Breakfast:
  • Skip most of the time
If I do have breakfast it is one of the following:
  • 2 slices of toast (wholemeal) and 2 eggs (boiled or scrambled)
  • Porridge
  • Pancakes (made from blended oats)
Lunch:
  • Tuna Sandwich (wholemeal)
  • Scrambled egg, beans and toast (wholemeal)
  • Cheese toasties (wholemeal)
  • Jacket potato
Dinner:
  • Basmati rice with chicken and vegetables
  • Currys (lamb, mutton, chicken, fish or vegetable such as aubergine or corgette) with wholemeal chapattis
  • Wholemeal wraps with chicken and salad
  • Do have chips and the occasional pizza or takeaway (once per week)
Drinks:
  • Water
  • Fizzy drinks (zero)
  • No hot drinks or alcohol
Snacks:
  • Fruit (apples, oranges, strawberries, blue berries and occasionally pineapple)
  • Chocolate (probably 2 x 40g bars per week)
  • Cake (perhaps once a month)
 
You do seem to be having quite a few things which are high carb foods but it will depend on the portion size you are having that may be a factor. It is very hard for people to be prescriptive about what you can or can't eat as everybody reacts differently to different high carb foods, some people can tolerate 1 slice of bread but not rice or pasta and for others it will be vicaversa.
You would benefit from having a blood glucose monitor to check the effects of various foods as testing before you eat and after 2 hours will give you an idea that that meal is OK if the increase is less than 2-3mmol/l or less than 8 - 8.5mmol/l. You can then look to reducing the carb component of the meal.
The book or app Carbs and Cals is really useful for giving carb values for various portions of a whole range of foods so allows you to make better choices and you could see what would keep you to less than 130g per day.
Good selection of takeaways as a treat should not do too much damage and diet drinks are fine as it is important to stay hydrated.
 
Often insulin resistance is more in the morning, so it may be worth considering switching your breakfast (when you have it) to just the eggs (unless you get prescribed a medication that means you have to be more careful regarding dropping carbohydrate intake). Though checking your individual response using a blood glucose meter could be very useful, as @Leadinglights said, you might find that your body can cope with the toast as well.

Your dinners maybe just consider what proportion is the carbohydrate and have a bit more veg and a bit less rice/chapatti/potato depending how much you're having at present.

Snacks - the occasional chocolate and cake sound OK as it sounds like you are having them as treats not all the time. How much fruit are you having each day? Fruits in general tend to be higher in carbohydrates including sugar than most vegetables, though berries are a bit lower than some other fruit. If you're having multiple portions a day then reducing those may be a way to cut carbohydrate intake also. (I mostly have nuts if I want a snack, or sometimes a piece of cheese.)

Lunch again some BG testing to see how well you're tolerating those lunches might be useful. Some simple changes to reduce carbs for lunches could include having a bowl of vegetable soup with one slice of cheese on toast, having a smaller jacket potato and having salad with it, etc.

(I won't be offended if you don't like any of my suggestions or they don't work for you 😉.)
 
With an HbA1c of 119 and that menu, which whilst not desperately low carb is probably a pretty healthy diet for a non diabetic and by the sound of it a great improvement on your previous diet, I would say that there is likely something else going on than regular Type 2 diabetes and I would be surprised if you see any significant improvement even if you dropped the bread and spuds altogether
I think you should be going back to your GP and show them the sort of things you are eating and drinking and ask if it's possible you might be LADA (Latent Autoimmune Diabetes in Adults) a slow onset form of Type 1 rather than Type 2 and could they arrange testing (GAD antibody and C-peptide tests) or ideally a referral to a specialist diabetes clinic.

The chances of that result being wrong are unlikely but errors do happen and results can get mixed up. Do you do any home testing of your levels? That will give you an idea of whether your levels really are that high. I thought I read somewhere that you were testing but I wonder if I am getting mixed up with another thread.
 
Me being a type 2 sensitive to carbs my first thought was - wow - just - wow.
That is so high carb.
As your Hba1c is so high it would not be wise to try to reduce down to low carb quickly, but you really do need to make changes - assuming that you are an ordinary type 2 of course.\
Maybe shift the eating of fruit to a dessert and have berries, which are the lowest carb fruits. I eat them with sugar free jelly and cream maybe a couple of times a week.
The bread, oats, rice, potatoes are probably the highest carb choices.
Ordinary chocolate bars are high in sugar. I get high cocoa chocolate and eat very small amounts, like one square and not every day.
If you get a glucose testing meter - they are fairly cheap online, then you can see if your blood glucose is reducing as you lower the amount of carbs in your diet - that is almost diagnostic of an ordinary type 2.
If you start to feel unwell, check the symptoms of DKA - diabetic ketoacidosis, and if that is the problem then seek help at once, as it can indicate some other sot of diabetes.
 
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