Partner

[Chrissie Wa]

Hi
Had a very disturbing meeting with our GP yesterday having waited 2 weeks for an appointment. Partners HbA1c is dangerously high and he has been threatened with having to go on insulin if he can't get them under control. He isn't testing before and after eating and I can't find the original paperwork which we filled in when he did the Expert course, we got him down to around 55. Now he is 135. He's now shouted, well screamed actually, that it's my fault as I cook his evening meal. Dr. thinks the screaming episodes are caused by being too high not too low as I originally thought. He's given him 3 months grace before insulin commences and an appointment is being made with a nutrionalist. Dr. says he should eat more carbs to try and put some weight on but I have no idea how many carbs he should be eating per day. Normal diet would be oat based cereal for breakfast, sandwich yoghurt etc at lunchtime and meat casserole/salad etc for dinner. I don't know what else he eats when I'm not about and it is a physical job. Oh and he GP has also prescribed statins Tia C

 

[Docb]

HBA1c of135 and Dr is suggesting eat more carbs and put on weight? Something does not compute.

 

[Lizzzie]

Hello! Not much help but I wanted to send hugs. You're obviously really worried about your partner and by the sounds of things, so is he! - or he wouldn't react in such an emotionally charged manner. It sounds very difficult for you, though. Before we get onto him, do you feel safe?
I am also confused by your Drs advice: what type of diabetic is your partner? How old is he? If I had BSs that high eating carbs without insulin would be the last thing I'd want to do - it would send them higher and make things worse, wouldn't it??? Can anyone else get their heads round whats going on? I wonder is it appropriate to try a different Gp?

 

[rebrascora]

Hi. Am I correct in thinking he is not overweight? The doctor is wrong in my opinion in advising him to eat more carbs to put on weight when his HbA1c is so dangerously high because those carbs will make it higher still. The screaming at you is likely due to high BG levels though so the doc got something right!....It can make you very ratty and unpredictable/volatile.

There is certainly room for improvement in his diet as regards carbs. Oat based breakfast cereals are usually loaded with sugars. The lowest carb one I have found so far is "Eat Natural" low sugar nuts and seeds granola which has about 34 g carbs per 100g. I weigh out 50g of it and have it with creamy natural greek yoghurt and a few berries like rasps and strawberries...... but I am Type 1 so I have insulin to cover it.... Eggs poached scrambled or in the form of an omelette or a full English minus any toast/bread hash browns or baked beans would be a better option. Sandwiches are not great either. Meat or fish and a salad would be better...Protein and fat will build muscle and supply him with energy and keep him fuller for longer but if he keeps eating carbs he will feel hungry and want more. You really need to cut them right back and fill up with protein fat and low carb veggies.

I do wonder if perhaps your partner may be Type 1. If he has lost weight (is slim) and his BG is steadily increasing but you are giving him the same amount of carbs as when he was originally diagnosed then I would be looking at that possibility and asking for Type 1 testing (C peptide and Gad antibody tests) and insulin may be an inevitability and he is at serious risk by delaying it. Many GPs do not know that Type 1 Diabetes can exhibit in mature adults or that it can have a slow onset, so do broach this with the GP and perhaps ask to be referred to a consultant or have Type ! testing performed if you think this may be the case.

 

[Chrissie Wa]

Well, they told us to see him as he was 'the expert' after the nurse gave us the high Hba1c readings. Yes he is scared as stroke was mentioned and he has scared me tonight. He is 64 and does a physical job mostly. He is looking up station side effects. He previously spent 5 days in hospital with possibly an allergic reaction to Metformin. He's not really a writing it down/chart type person (I am)! It's 3 years since he was diagnosed, he lost loads of weight without trying in the first place which is why he was tested in the first place. He a) Is struggling to keep weight on and b) is allergic to eggs also has been eating cream etc to fill up

 

[rebrascora]

I would say that you really need to push for Type 1 testing. The unintentional weight loss is a real indication of Type 1 and it sounds like he is reaching a critical point when he is going to need insulin urgently. Are you able to get some Ketostix from the GP or buy them from a pharmacy if you have to and test his urine.... I would guess he is weeing quite a lot with such a high HbA1c. If he has Ketones in his urine, then I would recommend you take him to hospital (A&E) since your GP is not making progress with this and make sure the hospital do testing for Type 1... ie C-peptide test and a GAD antibody test . With an HbA1c of 135 he should maybe be hospitalised anyway as he must be close to DKA (Diabetic KetoAcidosis)

 

[Chrissie Wa]

Well I don't know what to do. Apparently I am picking on him, anything I suggest I'm being shouted down and he says he feels fine. How much does stress contribute to elevated HbA1c we've had a fair share of that lately?
I'm very worried about diabetic keto acidosis now!

 

[rebrascora]

Stress sends my BG into orbit, and also makes me even more ratty, so that may definitely be part of the issue but I really feel that your GP is not giving you sound advice or taking the appropriate steps. He seems to be putting it onto you and your partner.... did your partner refuse to start on insulin straight away when you saw the doc or did the doc not offer it at that time?

 

[Pumper_Sue]

I suspect the reason he is struggling to put weight on is because his blood sugars are to high. So he needs to get them down ASP but not to quick as in overnight because his body will object as will his eyesight.

Have the Drs checked to make sure he isn't a slow onset type 1 (1.5)? Your partner also needs to own his condition and basically help himself by testing his blood sugars before and two hours after each meal. This way he can work out what he can and can not tolerate carb wise.

Perhaps if you can add up the amount of carbs in each meal this will give you an indication as to how much he is eating carb wise then think about what he can replace some of the carbs with.

Also think about having a conversation with your partner regarding his behaviour towards you and how it makes you feel. (The GP was quite right re the high bloods)

Bottom line is that he needs help to get his numbers down either by tablets or insulin. Insulin isn't so bad as it sounds so don't worry about that side of things, there are quite a few people on the forum who have been on insulin 50 years or more and one I believe has been on insulin for 74 years without any problems.

 

[rebrascora]

As long as he continues to feel fine he doesn't have DKA but if he starts to feel unwell, get him to hospital.

 

[Chrissie Wa]

TbhBarbara once we got it down to 55 after the Expert course I left him and the health professionals to it - GP said he will have to do insulin after next HbA1c if he can't get it down. He's on 2 lots of drugs and cannot tolerate Metformin. His temper is vile, we run our own business and the stress is tremendous

 

[rebrascora]

I am so sorry you are in this situation. Has his temper always been "vile" or does this just tie in with his high BG and stress. All you can do is be as supportive as you can and watch out for him becoming ill and ring 999 if that happens and tell them he is diabetic and you suspect DKA.... Either that or be prepared to walk away if you feel your own safety if compromised.

 

[Bruce Stephens]

I agree with the other comments: high HbA1c and weight loss don't seem like good reasons to increase carb intake. Not before a bit more investigation to try and rule out adult onset Type 1.

 

[Chrissie Wa]

Well he's just had something to eat cheese mainly, ham and some salad and bread, he's calmed down but his life is still not worth living! Not taking the statins immediately, leaving is not an option for me as this represents 30+ yrs of my life and nowhere to go, the NHS shouldn't be giving wrong advice, he is very confused and worried about what to eat!

 

[rebrascora]

Apart from the bread, his food choice was good, cheese ham and salad are all good. Sadly the bread will likely add to his already high BG for the next 4+ hours... if it was brown/wholemeal, probably a lot longer.... so much for so called "healthy choices".
It is hard to break the habits of a lifetime and a meal without or with minimal bread or pasta or potatoes or rice seems impossible to comprehend until you get into the swing of it, as well as cutting out the cakes and biscuits and scones and pies and breakfast cereals, it is very difficult. If he is under pressure with the business, he is probably not in the right frame of mind to tackle a very low carb diet and the sooner he is on insulin the better but he will need to devote time to learning how to carb count and figure out how much insulin to use once he starts, so either way, he is going to have to make some sort of commitment to his health or the business will have to learn to run without him.

It is very frustrating to us members here on the forum that the NHS continue to give bad dietary advice to diabetics. I and many other members here spend a lot of time responding to those people and trying to explain why the dietary advice they have been given is incorrect but the NHS are stuck with the "Fat is Bad" mentality and a low fat diet prevents Cardiovascular disease advice that has been spouted for the past 50+ years but is now being disputed by eminent scientists. If we ate more fats and less carbs we would feel fuller for longer and not be habitually craving food and eating more than we actually need. Now there is a whole food industry geared up to low fat products and the whole system is consequently very resistant of change particularly as the Health Organisations would have to start going against decades of their own advice.... It is a very frustrating situation for all of us....

 

[DaveB]

From what you say the GP hasn't a clue and was the same as my first diabetes GP. With BS that high and losing weight is a very strong pointer to late onset T1 (LADA) where the body burns it's own fat as it doesn't have enough insulin to digest carbs. He needs the two tests for LADA i.e. GAD and C-Peptide. Your partner needs to keep the carbs way down and if it was me I would avoid an NHS nutritionist as many also haven't a clue and push out bad NHS diet mantra. He needs to keep the carbs way down. If he doesn't have a glucose meter then get hold of one urgently and check levels each day 2 hours after a meal. If the BS goes into the 20s be very concerned and go to A&E if he feels unwell or becomes very agitated. When I was diagnosed I was told I was very agitated and going to the loo every 15 minutes. I suspect my BS was in the 30s and hyper. BTW statins should be prescribed when a lipids blood test shows the ratios are not good. Statins are not a diabetes drug. A total cholesterol figure has little meaning and there is no good evidence that diabetics should have statins earlier than non-diabetics. Yes, NICE says they should but it's based on data that has little scientific support. So, challenge the GP on the reason they have been prescribed and it's your choice not his/hers.

 

[ianf0ster]

Unfortunately, the 'official advice in the UK , the USA , Australia and all western countries tends to be wrong. They went overboard on this idea that dietary fat makes you fat and gives you heart disease - which lots of studies show just isn't the case!
It is Sugars and Carbohydrates (particularly refined ones) which are the biggest danger.

Most type 2 Diabetics understand that sugar is bad for them, so perhaps these Sugar Equivalent infographics will help. they show that what most people would expect was a 'healthy breakfast' is actually terrible for a Type 2 diabetics (equivalent of approx. 20 teaspoonfuls of sugar):
https://phcuk.org/sugar/
Statins also tend to raise Blood Sugars - so they aren't ideal if they are not absolutely required.
When I was diagnosed as Type 2, I was far more frightened of blindness and amputations than I was of the risks of Stroke or further heart disease (I'd already had a 3x Coronary Artery Bypass over 2 yrs before my T2D diagnosis).

Dr David Unwin is a GP in Southport and he has a Type 2 Diabetes remission rate of between 40% and 50 % in his patients who try a Low Carb diet. That means that they come off all diabetes medication and have blood sugar levels below diabetic levels - so no chance of those nasty complications.

I have used this myself, easier for me since I did it straight away, but it only took a few months with no calorie counting (I did count carbs) and no hunger.

I wish you some good luck, since things seem to be going the wrong way for you and your partner right now.

 

[Drummer]

Perhaps show these messages to your partner.
I also suspect that the doctor is making an assumption which might be proven wrong with the tests suggested.
However - to lower blood glucose levels for someone who is type two, and lucky, the dinners you are making seem fine - it is the cereal for breakfast and the sandwiches with ordinary high carb bread which would be the things to completely change.
A type two can eat meat, fish and seafood, cheese and eggs as they are low carb, which doesn't need insulin in order to be used by the body. We eat low carb foods with low insulin requirements in order to provide variety and micronutrients, and tweak the amounts of carbs to suit our own personal requirements and tolerances. To find out what they are we test before starting a meal and again two hours later - there is no other way to know if we are in the normal range. Even without eggs there are still lots of things to eat to try to lower blood glucose levels.
If your partner wants to try to avoid medication then the low carb option would perhaps be the thing to try, but that level of Hba1c is very high and indicates blood glucose levels which are very high too - cutting down gradually would be the safest option - replacing carbs with fat as a source of energy. This doesn't mean loads of oils butter and lard - I just eat meats which are not stripped of their natural fats - chicken thighs for instance, roasted on a rack so the skins are crispy, rather than skinless fillets, pork chops with the fat on cooked with mushrooms to absorb the fat and other low carb veges make a great stir fry.
I am 68 and have gone back to work as I found that I could once again cope with handling knitting machines, my energy levels are great and my muscular strength is still increasing, but I was not losing weight., quite the opposite. I was losing muscle though and had become quite feeble.

 

[Chrissie Wa]

Thank you all for your advice. I was doing low car myself at one point trying to lose weight but tbh I took my eye off the ball when he got diabetes. Also there are a few staples for when we get home late e.g fish fingers, chips and peas, which are hard to replace. I have got a spiraliser and have made lots of courgetti, carotetti meals in the last as well as moussaka which I freeze (I use cornflour for the sauce) not wheatflour. I have spelt in the cupboard instead of normal flour if I need a bit in cooking, this morning the pair of us have unloaded and reloaded a lorry with furniture, he did have a small bowl of cereal and I have just done a cooked breakfast - he had 3 sausages (6g carb ea) 2 X bacon, fried tomatoes and sorry but b beans and a small whole grain toast with butter. We're going back to buying sugar free jellies for his puddings so that's a small step. Thanks to all above for your help and support, my family is going through dark times and last night was the the final straw. It's good to know that I can come here for friendly help and advice.

 

[Docb]

Good that we have helped, Chrissie Wa. When things have settled a little, it would be sensible to get to the bottom of how the advice given to your partner seems to be so at odds with conventional wisdom. There is something wrong somewhere and getting that straight might well give you some insight into why things have been so stressful lately. Good luck.