Newish. Good HbA1c results but anxious

[Iphigenia]

Hello, all.

I was diagnosed T2 in mid June, just after I'd started a weightloss diet. Oh the irony.

My HbA1c was 61. Yesterday it was 33. I've worked bloddy hard and restricted - but not cut out - my carb intake; eaten 1200 calories a day; walked a lot, lot more. I've lost 44.4lbs since the beginning of June.
My Diabetes Nurse is ecstatic, and says I can come off Metformin if the next test is as good. I'm only on 500mg, even with Slow Release, I can't tolerate more digestively, so I think the reduction is mostly my doing not Metformin's.

However, I went on the DESMOND course last week, which emphasized the negative role of fat in diabetes, and discovered for the first time that my cholesterol is 6.8. I want to bring that down. DN has prescribed atorvastatin, which I haven't picked up yet.

I had a previously scheduled first appointment with the dietitian today. She wants me to increase my calories to 1300 and to increase the carbs I eat. She wants me to use low fat yogurts/mayonnaises etc, despite my point that lower fat usually means higher sugar.

I was really happy when I got my results yesterday but that flopped a bit today with the realization that although it's very good, it's not a cure; I still have a lifelong condition to manage or it'll just roll back in. The dietitian session hasn't helped, I just feel utterly confused. She said that my HbA1c will have improved because I'd reduced my carbs so much - like that was a bad thing. I don't understand.

I'm just feeling a bit sorry for myself, I guess. Got one thing - BG - sorted, now got the cholesterol to sort, and I'm not convinced by the advice I've received today. Meh.

 

[Northerner]

Firstly, welcome to the forum, and what brilliant results you have achieved! Wow, well done! 🙂 Secondly, I've no doubt that reducing your carb intake has hugely contributed to your success - not only in reducing your HbA1c, but also your superb weight loss, and in my opinion (and that of many others) to increase your carb intake if you are happy with your current diet makes no sense whatsoever Many, many people find that a low carb diet, particularly as aa Type 2 on minimal medication, is precisely what is needed to gain good blood sugar control. It also needs mentioning that the role of dietary fat in raising cholesterol levels is much diminished by current research, it is more likely that carbs will cause it. Many dieticians are stuck very much in the old advice of 'eat plenty of starchy carbs with every meal' and are horrified that you might not be eating enough, whatever your HbA1c is saying. The statins will certainly help to reduce the cholesterol, but it's possible that levels are high not because of your diet but because you are still in 'recovery' mode as your body adjusts to the new and different 'you' since diagnosis. I would see how things go and perhaps review the cholesterol situation in a few more months.

How much carbohydrate do you normally eat in a day, have you calculated it? In practice, the amount of carbohydrate you consume should not be calculated by some general one-fits-all principle, but be based on what you can tolerate well. Are you able to test your levels at home?

Don't be dispirited by the responses you have had, you have done tremendously well and should be very pround of your achievements - keep up the good work and let us know if you have any questions or concerns! 🙂

 

[Iphigenia]

thank you for the reply and the welcome, Northener! And the praise!

I eat roughly between 60-100g carbs a day, average over the last 7 days 83g.

I eat carb + protein for breakfast - toast & scrambled egg/mackerel fillet/cheese/peanut butter. Tried porridge last week but a dry mouth came over me, which reminded me of when I was first diagnosed and frightened me, although realistically I know one bowl of porridge can't bump me out of BG33! Not that far, anyway!

I eat protein + carb for lunch - cold meat and salad, or hot meat and green veg, with new potatoes hot or cold at either.

I eat an afternoon snack of raspberries or strawberries and plain yogurt.

I eat hot meat and veg or cold meat and salad for evening meal. No starchy carbs, usually. She queried that and I said I didn't feel the need for starch at that meal because I don't generally do anything active in the evenings.

I eat a single oat cake in the evening - I take a tiny dose of amitriptyline about 21:00, and like to eat something on top of it to make sure it goes down!

Yes, I do tend to suffer from anxiety.

I can take her point about the calories. I'm due to start a council-sponsored gym programme on Friday, so would probably need more energy.
I suppose I could see needing a few more carbs before I go to the gym.
I cannot see eating starch in the evening.

On top of that, I'm waiting for a callback from the GP, because the Atorvastatin leaflet says it can raise BG, and I want his advice on that.

I can cope when the advice is do A+B+C - whatever it takes, I will do it. When the advice is contradictory, it makes me very anxious, which doesn't help any part of one's health!!

Sorry to moan.....

 

[Northerner]

Well, I am not a dietician, but that sounds a perfectly healthy regime to me, a really good mix of healthy food, and what many people would regard as a 'moderate' carb intake. 🙂 I'm a runner and have about 100-150g carbs a day, which is quite sufficient for my needs - a long run might require some top ups, but they are taken as needed, not built into my daily diet. You might like more carbs when exercising as carbs are more readily converted to glucose for energy, but since you'd be burning it up anyway it shouldn't present a problem for weight issues - it's just fuel! 🙂 As I mentioned earlier, current evidence suggests that taking extra calories from fat is not the problem that it has been seen to be over the past 30 years, so it might be worth exploring things that might be healthy, but fatty, rather than increasing carb intake 🙂

 

[Iphigenia]

thank you, that's helpful indeed 🙂

Not to pressure you but have you any suggestions for healthy fat things?

I admit to having eaten plenty of ham and the odd bacon and sausage and egg during the past 3 months, because I was focussed on the carb and sugar content of foods.

In answer to my question about good and bad fats, e.g. an avocado versus a sausage, she told me fat was fat. She did admit that prawns, high in cholesterol, were now OK to eat.

 

[Robin]

Fat may be fat from the point of view of pure calories, which is what I suspect dietitians and the like are worried about, ignoring the fact that fats tend to make you feel fuller so you eat less!
What are 'good' and 'bad' fats seem to go in and out of fashion. First it was polyunsaturated, like sunflower oil, then it was mono unsaturated, like Olive Oil, as in the Mediterranean diet, oh, and omega 6 as in fish, just recently there's has been some evidence published that, of the saturated fats found in animal products, those in dairy are better for you than those in the fat found in the meat itself. I expect they'll change their minds next week!
I've found the answer is, read up about it and make my own mind up, and everything in moderation, ( except I do tend, like you, to skip carbs in the evening, I don't feel I need them then, and it irons out worrying spikes before bedtime)

 

[Lindarose]

Hi Iphigenia and welcome!
You've done so well What impressive numbers you've achieved. Ive found it very difficult too when you do one type of diet/lifestyle for one problem but then are told you need to do something else for another illness or to reduce cholesterol etc. As others have said it's probably about moderation and trying to get a good balance. I think cholesterol is such a confusing topic I've read lots about it in my quest to avoid statins. Hope you keep up the good work 🙂