Please, Please Help

[siamese]

Hello

I desperately need as much advice as possible. I have been a type 2 diabetic for maybe 10 years. Until July last year I was taking insulin and empagliflozin. The reason for taking insulin, I was told, was because of the heart drugs I was taking and that these would interfere with diabetic medication. Just over a year ago my GP surgery had a new diabetic nurse and she questioned why I was taking insulin. I explained about the heart medication. She said that the heart medication I was now taking would not interfere with current diabetic medication. She said she wanted me to come off insulin and try metformin. Anyway, I started taking metformin but was getting stomach problems. I was put on another diabetic medication but was still getting stomach problems. Then I tried third medication but again, stomach problems. I found out several months ago that my stomach problems seemed to be down to irritable bowel syndrome. My wife and I had tremendous stress and it seems this is what was causing the problem.

About mid April this year I started taking Gliclazide because my stomach problems seemed a lot better. I was told to start taking 40 mg at teatime. About a week later I took another 40 mg but in the morning. Now for the last couple of weeks I have been taking 80 mg in the morning and 80 mg at teatime. My lifestyle is somewhat sedentary due to other health reasons and other problems. In the last few weeks, I have tried to be more active and this has helped my blood sugars. I take three readings a day. My averages for the three readings have been about 8MMOL/L. The problem I have and where I need advice is that my morning readings are anywhere between 9.5 and 10.4. Even when I was taking insulin and empagliflozin my readings in the morning were between 7 and 8.

I am coming up to 63 and feeling a complete mess. This is due to health and outside problems. My wife is diabetic and on metformin and her figures in the morning are around 6. She also takes medication for numerous health problems.

I really would appreciate as much help as possible. I don’t mind giving more information if it helps. I feel that with a little more exercise and maybe an extra 40 mg of gliclazide morning and teatime then my blood sugars would come down. But I don’t think the morning readings will improve that much. I do not eat a great deal for supper. Usually, supper consists of a round of toast or a couple of sugar-free biscuits. This is about 9 pm. I also usually have a snack around 8 pm but this is because I take blood thinning medication. If I don’t have something small to eat I usually get indigestion caused by the blood thinning medication. Having something small to eat, i.e. some nuts etc, stops the indigestion. So, from around 9:15 pm in the evening until about 7.30 or 8 am I do not eat. In the past when, on the very odd occasion, I have not eaten supper, I still have high figures in the morning. I realise that the medication I am on probably doesn’t help with the readings but as I have said, my wife is on numerous medications and her blood readings on Metformin are ok. I have heard of the dawn phenomenon but I think my problem is more than that. With everything else going on in my life I really need to get this sorted. Your advice will be helpful. Thank you.

 

[everydayupsanddowns]

I really would appreciate as much help as possible. I don’t mind giving more information if it helps. I feel that with a little more exercise and maybe an extra 40 mg of gliclazide morning and teatime then my blood sugars would come down. But I don’t think the morning readings will improve that much. I do not eat a great deal for supper. Usually, supper consists of a round of toast or a couple of sugar-free biscuits. This is about 9 pm. I also usually have a snack around 8 pm but this is because I take blood thinning medication. If I don’t have something small to eat I usually get indigestion caused by the blood thinning medication. Having something small to eat, i.e. some nuts etc, stops the indigestion. So, from around 9:15 pm in the evening until about 7.30 or 8 am I do not eat. In the past when, on the very odd occasion, I have not eaten supper, I still have high figures in the morning. I realise that the medication I am on probably doesn’t help with the readings but as I have said, my wife is on numerous medications and her blood readings on Metformin are ok. I have heard of the dawn phenomenon but I think my problem is more than that. With everything else going on in my life I really need to get this sorted. Your advice will be helpful.

Hello @siamese

Welcome to the forum

Sorry to hear you are having difficulties with your diabetes management at the moment. Thanks for describing them so carefully, that will help members here offer tips and suggestions.

The first thing I was thinking about was Dawn Phenomenon, but then I read about your evening snack, and wonder if that is contributing too.

Your snack seems quite carb-heavy, and I wonder if the first thing to try might be some more BG friendly alternatives. Do any of your other conditions mean you struggle with things like eggs or cheese? Many T2 members here who need a late snack to help with DP choose something like an oat cake with a few decent sized chunks of cheese, or a hard boiled egg.

The greater proportion of fat and protein will keep you feeling fuller for longer, and take more effort to digest. they also don‘t have much if any effect on Bg levels unless eaten in large quantities, so are much easier on blood glucose than a snack that‘s high in carbs and low in fat.

For example, in the biscuits, you are getting the vast majority of the BG upheaval just from the flour, and relatively little from whether they do or dont contain sugar.

Its also difficult to compare results directly between you and your wife as many things with diabetes are frustratingly individual, including reactions to the same foods, and how much or little glucose the liver dumps overnight or on waking.

Hopefully soon some of our friendly and knowledgeable T2s will be along to offer their experiences and thoughts.

 

[siamese]

Hello @siamese

Welcome to the forum

Sorry to hear you are having difficulties with your diabetes management at the moment. Thanks for describing them so carefully, that will help members here offer tips and suggestions.

The first thing I was thinking about was Dawn Phenomenon, but then I read about your evening snack, and wonder if that is contributing too.

Your snack seems quite carb-heavy, and I wonder if the first thing to try might be some more BG friendly alternatives. Do any of your other conditions mean you struggle with things like eggs or cheese? Many T2 members here who need a late snack to help with DP choose something like an oat cake with a few decent sized chunks of cheese, or a hard boiled egg.

The greater proportion of fat and protein will keep you feeling fuller for longer, and take more effort to digest. they also don‘t have much if any effect on Bg levels unless eaten in large quantities, so are much easier on blood glucose than a snack that‘s high in carbs and low in fat.

For example, in the biscuits, you are getting the vast majority of the BG upheaval just from the flour, and relatively little from whether they do or dont contain sugar.

Its also difficult to compare results directly between you and your wife as many things with diabetes are frustratingly individual, including reactions to the same foods, and how much or little glucose the liver dumps overnight or on waking.

Hopefully soon some of our friendly and knowledgeable T2s will be along to offer their experiences and thoughts.

Thanks Mike
It's a good point about the sugar. I suppose I was looking at it from the point of view that it was two small biscuits and about 10 hours later when I take my blood reading. I was/am worried that because it the readings have been so high in the morning for around 10 months it will be doing damage to my body. But I haven't got a clue about that. I will certainly look at reducing my carbs at night. Thanks again.

 

[trophywench]

Carbs in general - not specifically just from sugar - are the only thing any diabetic's body can't handle no matter where they happen to come from. (there are even a tiny amount of carbs in eg flipping cucumber but such a negligible amount they aren't likely to matter!)

Interested in what you said about 'blood thinning' medication - is it Clopidrogel perchance?

 

[rebrascora]

Hi and welcome from me too.

Carbohydrates are both sugars and starches, so there is not just carbohydrate in the flour in the sugar free biscuits, but also in the toast since bread is also made with flour. If this is just a bed time snack and you are also having a significant portion of carbs with your evening meal like pasta or potatoes or rice then that will all be contributing greatly to your BG being high. Medication on it's own will struggle to effectively control diabetes and in fact dietary changes are a significantly more powerful tool in reducing blood glucose levels along with increased activity and it doesn't have to be anything strenuous.

Many of us find that following a low carb way of eating helps us to lose weight, feel healthier, stops the craving to eat between meals and is actually quite enjoyable once you get your head around it.

The readings you are getting are not significantly high but you would benefit from taking action now to lower them. It can become a progression as your body becomes more resistant to the insulin you produce (or inject). The pancreas responds to the carbs you eat by producing insulin so by eating less carbs, the body produces less insulin and after a while and some weight loss, it can sometimes result in better sensitivity to the insulin you do produce and perhaps even, less medication required.
Unfortunately, NHS advice on diet for diabetics is not ideal and most people assume that if they cut down on sugar that is enough but the starchy carbs are as much a problem, maybe more so because we tend to eat a lot of starchy carbs with every meal... Like breakfast is usually toast or breakfast cereal for most people which are both high in carbs.... even brown/wholemeal bread. Lunch is often a sandwich and some crisps or even a piece of fruit all of which contain carbs... and then dinner on an evening is another plate of carbs with potatoes or rice or pasta and often pastry or batter or breadcrumbs as well. If you add in a bedtime snack like toast or biscuits it is another load of carbs that your body needs to try to deal with.

We can give suggestions for alternative low carb meals if you are interested? Obviously you would need to take into consideration what effect some foods would have on your other ailments.

Also beware that some sugar free products contain artificial sweeteners which can cause tummy upsets, so they are not always a good choice.

I would second eating a chunk of cheese or a boiled egg with a dollop of mayonnaise if you need a snack at bedtime.

 

[Ralph-YK]

I take three readings a day. My averages for the three readings have been about 8MMOL/L. The problem I have and where I need advice is that my morning readings are anywhere between 9.5 and 10.4. Even when I was taking insulin and empagliflozin my readings in the morning were between 7 and 8.

Are you're moring readings before or after food (breakfast etc)? How long after, and what did you eat?
What time do you take you're other readings & what are they? Again, before or after food?
One thing you can do it test before and 1 - 2 hours after eating. This will allow you to see what affect food has on your BG levels, along with any changes you make.
Keep a food diary, along with any a record of your BG. After a couple of weeks, hopefully you'll start to see a pattern.

I feel that with ... maybe an extra 40 mg of gliclazide morning and teatime then my blood sugars would come down.

I don't know about glicazide doeses. One thing to keep in mind is what you're lower BG levels are. Gliclazide makes you more at risk of hypos (going too low).

 

[siamese]

Carbs in general - not specifically just from sugar - are the only thing any diabetic's body can't handle no matter where they happen to come from. (there are even a tiny amount of carbs in eg flipping cucumber but such a negligible amount they aren't likely to matter!)

Interested in what you said about 'blood thinning' medication - is it Clopidrogel perchance?

Hi Jenny
Thanks for the reply. I'm on dabigatran.

 

[siamese]

Hi and welcome from me too.

Carbohydrates are both sugars and starches, so there is not just carbohydrate in the flour in the sugar free biscuits, but also in the toast since bread is also made with flour. If this is just a bed time snack and you are also having a significant portion of carbs with your evening meal like pasta or potatoes or rice then that will all be contributing greatly to your BG being high. Medication on it's own will struggle to effectively control diabetes and in fact dietary changes are a significantly more powerful tool in reducing blood glucose levels along with increased activity and it doesn't have to be anything strenuous.

Many of us find that following a low carb way of eating helps us to lose weight, feel healthier, stops the craving to eat between meals and is actually quite enjoyable once you get your head around it.

The readings you are getting are not significantly high but you would benefit from taking action now to lower them. It can become a progression as your body becomes more resistant to the insulin you produce (or inject). The pancreas responds to the carbs you eat by producing insulin so by eating less carbs, the body produces less insulin and after a while and some weight loss, it can sometimes result in better sensitivity to the insulin you do produce and perhaps even, less medication required.
Unfortunately, NHS advice on diet for diabetics is not ideal and most people assume that if they cut down on sugar that is enough but the starchy carbs are as much a problem, maybe more so because we tend to eat a lot of starchy carbs with every meal... Like breakfast is usually toast or breakfast cereal for most people which are both high in carbs.... even brown/wholemeal bread. Lunch is often a sandwich and some crisps or even a piece of fruit all of which contain carbs... and then dinner on an evening is another plate of carbs with potatoes or rice or pasta and often pastry or batter or breadcrumbs as well. If you add in a bedtime snack like toast or biscuits it is another load of carbs that your body needs to try to deal with.

We can give suggestions for alternative low carb meals if you are interested? Obviously you would need to take into consideration what effect some foods would have on your other ailments.

Also beware that some sugar free products contain artificial sweeteners which can cause tummy upsets, so they are not always a good choice.

I would second eating a chunk of cheese or a boiled egg with a dollop of mayonnaise if you need a snack at bedtime.

Thanks Barbara. I was under the impression that 10 hours after eating would result in low readings. Obviously I am wrong. I need to look at this carb situation. There is very little support at my GP surgery.
You said, "We can give suggestions for alternative low carb meals if you are interested?". I would be very interested. Do you know if low carbs result in a lack of energy? The brain, as I understand, is a carb hungry organ. I wonder how much a person needs. There seems to be a lot of contradictory advice or there. What chance does an ordinary person stand? Thanks again.

 

[trophywench]

Ah - just wondered cos it's instant heartburn with Clop which always waits until head's on pillow and relaxing in bed (from taking it in the morning) - they want me to take Omeprazole to counteract that - but I hate needing to do it or chew Rennies. I mean they take you off aspirin when they cause indigestion cos they don't want to damage your stomach - so how the hell can it be considered OK for a prescribed drug to do that instead?

 

[trophywench]

Nooooooo the brain isn't carb demanding!

The body turns any of all three food groups ie carb, protein and fat - into glucose cos glucose it what every single cell in the body, uses for fuel. The brain's demand for glucose is greater than eg the heart, or the lungs or the bowel or anything - but it isn't picky whether the glucose starts off as a cream cake, a ton of cucumber (LOL) a carrot or a T-bone steak - thing is though when it gets fed more than enough carb to feed all its cells, it doesn't bother so much with the protein and fat so it stores that as fat, either under the skin before the muscle or deposits the fat around the organs which ain't at all heathy,

So absolutely anybody can reduce the amount of carbs they eat with no hazard to health as long as they maintain a proper balanced diet with all the necessary vitamins and trace elements, and an adequate supply of calories for their needs.

 

[Gruers]

Hi I’m very new to this journey and use an app on my phone to track my carb intake
The Low Carb Programme it might help you
Also recipes and video help
Good luck

 

[rebrascora]

The brain is powered by glucose which can be released from protein and fat.... both dietary and stored. If you cut right back on carbs in your diet, your body switches to burning fat and if you keep your fat intake moderate, then you burn body fat. I follow a very low carb high fat diet now, as I am at a normal BMI. I don't struggle for energy or mental agility and I eat much less food than I did before because I was always hungry whilst eating carbs.... the more you eat, the more you want, even though your body doesn't need them. If you eat more fat and protein, it takes longer to break down and release it's energy and therefore keeps you feeling full for longer.
I no longer eat bread, rice or pasta. I have a small portion of potatoes maybe once a week, or have sweet potatoes the other week. Don't eat cakes or biscuits. I will have a square of 70%+ dark chocolate with a spoon of peanut butter if I fancy a sweet treat and I really enjoy that now that I have overcome my sweet tooth. Other treats/snacks include boiled eggs with a spoonful of mayonnaise, cooked high meat content sausages (cheap sausages contain a lot of rusk which is carbs) a pot of olives, a nice chunk of good quality cheese, a handful of nuts.... brazils, hazel nuts and walnuts are the lowest carb nuts, (peanuts and cashews are higher so need to be rationed more) and when I want to be really naughty, a packet of pork scratchings.... (bad girl!)... so satisfying though and all fat and protein, no carbs!

For breakfast I often have creamy Greek natural yoghurt (not low fat as it is higher in carbs) with a few berries... rasps, strawberries, blackberries, blackcurrants etc (these are the lowest carb fruits as is stewed rhubarb, currently in season, with a little sweetener) and mixed seeds and chopped nuts added
or I have a 2 egg omelette with any combination of mushrooms, onions, peppers, courgettes, ham, cheese, aubergine, spinach fillings with a side salad and creamy or cheese coleslaw. That is really filling often keeps me going until tea time without the need for any lunch or I might have a chunk of cheese or a pot of olives for lunch.... or an omelette if I had yoghurt for breakfast.
Bacon, egg, sausages and mushrooms is another option, but avoid the baked beans, toast and hash browns as they are all high carb foods.

In the evening I will have meat or fish with lots of veg (mostly leafy green veg like cabbage, kale, spinach, broccoli, leeks... many of those taste great cooked in a little butter instead of water or roasted in olive oil and a small portion of new potatoes occasionally, which are lower carb than mature potatoes But often I will use cauliflower as a substitute.... it tastes really good cooked and mashed with a dollop of full fat cream cheese and a spoon of mustard. Goes really well with high meat content sausages or gammon or burgers. Cauliflower is much lower carb than potatoes and can also be grated and used in place of rice or couscous or made into a lovely cauliflower cheese of course by part boiling and then coating in cream cheese and then grated cheese and browned off in the oven or under the grill. Easier than making a cheese sauce with flour and milk, less carbs and tastier. I usually mix some sour cream and chive dip or crème fraishe into the cream cheese to make it a bit softer and easier to coat the cauli.
I also love ratatouille topped with cheese and I am currently experimenting with lentils, although they are moderate carb foods, but provide other nutrients and fibre which makes them beneficial in moderate portions and they usually release glucose more slowly than grains..
I probably have somewhere between 50 and 70 g carbs a day. That is at the lower end of low carb and you would certainly not aim for that initially, but just maybe replace just one meal a day with a low carb option and see how that affects your figures.

Anyway, just some ideas. As others have said, use your BG meter to test before and 2 hours after eating a meal to see the effect it has on your BG readings. If it increases by more than 3mmols then reduce the carb content of that meal for next time.

 

[trophywench]

Used to be very friendly with a traditional pork butcher who made 'proper' pork sausage with a lot less rusk and even Auntie Joan's recipe for tomato sausage using whole catering cans of Libby's 100% tomato juice, hence containing some flesh and seeds became outlawed by Public Heath regulations in favour of 'tomato flavouring' Yuk, no comparison, hence if you had a large freezer, we were still able to pre-order X lbs of it cos about twice a year he'd do a run of Auntie Joan's and ditto the family garlic saus one when it was all hands to the pump to press enough real garlic beforehand LOL - on the basis a 'run' was a stone of sausage, you need to have a big family and lots of like minded friends who kept their gobs shut!

I strongly suspect from his name that his grandad who started the shop, may actually have been Jewish cos coincidentally I knew someone else who was definitely that religion whose parents owned a 'Businessman's Guest House' who was famed for her excellent cooked breakfasts …….

High meat sausage is available in most supermarkets these days though cos an awful lot of people have more recently discovered the pleasures of eating what was commonplace when we were young!