Progress, but what caused it?

[Nielh123]

After my A1C remaining stubbornly in the 70-90 mmol/mol range for ages, I began taking meds and started doing cardio at the gym three times a week in addition to continuing to walk an average of 13k steps a day. Six months later and My A1C was 53. Still too high but a big improvement.

But ... I'm wondering what the primary cause of the drop was - the meds or the gym - given that they started at around the same time! I'm minded to continue both, get tested again in a few months, and IF I'm below the magic 48, come off my meds for three months pending another test to see whether going forward I can do it with exercise and continued weight loss alone.

I just wondered if this sounds like a plan to others or whether coming off the meds seems reckless? I know my nurse feels it's the meds doing the magic but I'd hate to think I'm popping pills if they were no longer necessary.

 

[Leadinglights]

After my A1C remaining stubbornly in the 70-90 mmol/mol range for ages, I began taking meds and started doing cardio at the gym three times a week in addition to continuing to walk an average of 13k steps a day. Six months later and My A1C was 53. Still too high but a big improvement.

But ... I'm wondering what the primary cause of the drop was - the meds or the gym - given that they started at around the same time! I'm minded to continue both, get tested again in a few months, and IF I'm below the magic 48, come off my meds for three months pending another test to see whether going forward I can do it with exercise and continued weight loss alone.

I just wondered if this sounds like a plan to others or whether coming off the meds seems reckless? I know my nurse feels it's the meds doing the magic but I'd hate to think I'm popping pills if they were no longer necessary.

Did you also make some dietary changes as that is usually as powerful as oral meds, the exercise also makes a difference. I would find it hard to believe that coming off meds without some dietary change would keep blood glucose at a Normal level of below 42mmol/mol.

 

[Nielh123]

The dietary changes over the period in question have been minimal. I did make changes a couple of years ago when I was diagnosed; these helped me lose 5 stone but had minimal impact on my A1C.

 

[Leadinglights]

The dietary changes over the period in question have been minimal. I did make changes a couple of years ago when I was diagnosed; these helped me lose 5 stone but had minimal impact on my A1C.

Reading your profile, the medication you are taking encourages the body to get rid of excess glucose in the urine so relies on somebody drinking plenty, I believe 3 litres per day is suggested but also making dietary changes. Medication is like bailing out an overflowing sink but unless you turn the tap off it will still overflow.
Slimming world meals can be too high carb for many to tolerate unless you substitute lower carb ingredients so you may still be having too many carbs for your body to tolerate which is why your HbA1C id still high.
Low carb is less than 130g per day but many do go less than that. You could make a food diary and estimate the Total carbs in everything you eat and drink and see how far away you are from that.
This link may help you with ideas for modifying your diet. https://lowcarbfreshwell.co.uk/

 

[Nielh123]

Reading your profile, the medication you are taking encourages the body to get rid of excess glucose in the urine so relies on somebody drinking plenty, I believe 3 litres per day is suggested but also making dietary changes. Medication is like bailing out an overflowing sink but unless you turn the tap off it will still overflow.
Slimming world meals can be too high carb for many to tolerate unless you substitute lower carb ingredients so you may still be having too many carbs for your body to tolerate which is why your HbA1C id still high.
Low carb is less than 130g per day but many do go less than that. You could make a food diary and estimate the Total carbs in everything you eat and drink and see how far away you are from that.
This link may help you with ideas for modifying your diet. https://lowcarbfreshwell.co.uk/

Many thanks for this.

I hadn't realised about the importance of drinking to assist this medication - that's useful, thanks.

I'll have a good look at the website you recommend now and try the food diary. At the time I started the medication I also virtually cut out all carbs and ended up in hospital with something called ketoacidosis - as usual I guess I'd gone to the extreme ... I didn't realise keto and Empagliflozin together carried this risk until someone told me on here after I explained what had happened. I need to try and get a balance and a food diary seems like a good starting point.

 

[Pumper_Sue]

But ... I'm wondering what the primary cause of the drop was - the meds or the gym - given that they started at around the same time! I'm minded to continue both, get tested again in a few months, and IF I'm below the magic 48, come off my meds for three months pending another test to see whether going forward I can do it with exercise and continued weight loss alone

What caused it was all the extra work you have put in to help yourself. You were given the tools (Meds) and look what you have achieved 🙂 Congratulations and well done.

 

[Leadinglights]

Many thanks for this.

I hadn't realised about the importance of drinking to assist this medication - that's useful, thanks.

I'll have a good look at the website you recommend now and try the food diary. At the time I started the medication I also virtually cut out all carbs and ended up in hospital with something called ketoacidosis - as usual I guess I'd gone to the extreme ... I didn't realise keto and Empagliflozin together carried this risk until someone told me on here after I explained what had happened. I need to try and get a balance and a food diary seems like a good starting point.

Sometimes people do go at reacting to their diagnosis like a bull in a china shop when a slower approach is better as it is something that is sustainable and a more steady reduction in blood glucose is less likely to cause issues with eyes and nerves. You have done amazingly well with your weight loss, it must be disappointing that your HbA1C is still a bit too high
I suspect it was high blood glucose and dehydration rather than purely cutting out all carbs was the cause of ketoacidosis, it is more commonly seen in Type 1.
Full blown keto is very hard to sustain long term though some do.

 

[Drummer]

Changing several things at the same time means that there is no way to apply scientific method or analysis, I'm afraid.
I started off at diagnosis by reducing my intake of carbs, and would have made other changed after the first retest, but I did not need to as that fixed the type 2 and several other problems too.

I'm afraid that your nurse advising taking tablets and paying no heed to the powerful effects, or consequences of diet changes is rather dangerous - as you found out.

 

[Nielh123]

What caused it was all the extra work you have put in to help yourself. You were given the tools (Meds) and look what you have achieved 🙂 Congratulations and well done.

Thank you! I do hope to get off the meds at some point though - maybe I'm being unrealistic!

 

[Nielh123]

Sometimes people do go at reacting to their diagnosis like a bull in a china shop when a slower approach is better as it is something that is sustainable and a more steady reduction in blood glucose is less likely to cause issues with eyes and nerves. You have done amazingly well with your weight loss, it must be disappointing that your HbA1C is still a bit too high
I suspect it was high blood glucose and dehydration rather than purely cutting out all carbs was the cause of ketoacidosis, it is more commonly seen in Type 1.
Full blown keto is very hard to sustain long term though some do.

It's disappointing but I am pleased that it's a lot lower than it was. Seem to have his a plateau with the weight loss but back at the gym next week after couple of months off through injury so hopefully that'll help. I'm trying to implement small changes re carbs, like changing rice for riced cauliflower - but beer is my downfall!

 

[Nielh123]

Changing several things at the same time means that there is no way to apply scientific method or analysis, I'm afraid.
I started off at diagnosis by reducing my intake of carbs, and would have made other changed after the first retest, but I did not need to as that fixed the type 2 and several other problems too.

I'm afraid that your nurse advising taking tablets and paying no heed to the powerful effects, or consequences of diet changes is rather dangerous - as you found out.

Yes, I need to be more systematic. Hence my plan to come off meds for a test period if and when my levels are under 48 to find whether meds or lifestyle are primarily responsible.

 

[Deleted member 21371]

Both worked for me.
I eventually reversed it by losing weight, by cutting calories, going low fat, exercising, then doing the Newcastle diet.

 

[everydayupsanddowns]

Well done on your great progress @Nielh123

Sorry to hear you had a brush with DKA - that must have been pretty scary! They have recently taken ‘gliflozins’ off the list for T1s because of the DKA risk.

It feels right to keep doing what you are doing, and then re-assess. Perhaps aim for your target, then aim for maintenance, then perhaps chat with your Dr about your wish to come off meds, and develop a plan between you?