Second Opinion?

[Pat N]

My background is of a very fit, 68 year old, non-smoking, sports playing, running male. I had a heart attack in 2016 brought on by an unknown birth defect. Since then, due to medication, I've not been able to train as hard as I'd been used to however, I've maintained a very fit and healthy lifestyle but developed into a Pre, Type2 Diabetes condition. 4 months ago my 'score' went up to 48 on the Diabetes scale and I refused medication. Since then I have trained (run/walk/ex) or played golf every day, followed a low blood sugar diet and lost 11 kgs and weigh 72 Kgs (Height 1.74m). My score last week dropped by just point and I remain a 'Type 2 Diabetic'. The Surgery Nurse says we'll check it again in 3 months but I don't have any more weight to lose even though I'm happy to maintain the diet. I don't have any confidence in the surgery; what should I do?

 

[Ralph-YK]

I'd suggest self testing to see what affect food and exercise has on your blood glucose (BG) levels. Along with any changes you make. Keep a food and exercise diary along with a record of your levels. After a couple of weeks, hopefully you'll start to see a patter.

dropped by just point and I remain a 'Type 2 Diabetic'.

No matter what your HbA1c drops to, once you've been diagnosed as diabetic, that's it. You're diabetic.

 

[rebrascora]

Hi and welcome.

Firstly the HbA1c reading which diagnoses you as diabetic is usually a blood sample sent off to a lab, so the result is unlikely to have anything to do with the competence of your surgery. They are just acting on the results they get back. Checking again in 3 months is valid as the reading is a measure of the amount of glucose which has stuck to the red blood cells and they have an average lifespan of 3 months, so testing any sooner than that, particularly for a borderline reading of 48 is unlikely to show any change.

You say that you are following a low blood sugar diet. Can you give us an idea of the sort of things you are eating and drinking on a daily basis as unfortunately advice in that respect can sometimes be less than ideal. There is a lot of hype in the media about sugar but all carbohydrates are broken down into glucose and absorbed into the blood stream causing levels to rise in those of us who are diabetics.
Many here on the forum find that using a Blood Glucose meter to test their BG levels before and 2hrs after food enables them to see which foods most affect their levels and tailor their diet around their particular body's tolerances which can be very individual, even amongst diabetics..... so some can manage a couple of pieces of potatoes but porridge sends their levels rocketing whilst others need to avoid potatoes but can manage a small portion of pasta, or they can have a few chips or roasties but not mashed potato. Having fat with carbs can often slow down the rate at which they are digested and help to reduce the spike they cause to BG levels, but many people see fat as unhealthy and often NHS advice is low fat which doesn't help. Many of us who follow a low carb way of eating to help control our diabetes find that fat is our friend and contrary to what you would expect, we don't put on weight and our cholesterol levels have reduced in many cases, so a healthy diet for a diabetic is not always what you would expect.

 

[Ljc]

Hi @Pat N ,welcome to the forum. Sadly the media would have us believe that T2 is only about being an unfit couch potato with a bad diet. though obviously it doesn’t help.
We come in all shapes and sizes and have a number of athletes in our midst.
With T2 genetics are involved too n

With an Hb1ac of 48 you have only just crossed the threshold into diabetes ,to join the club that no one wants to join the number is.

48 .

You’ve obviously done a lot to try to put it into remission but please do not give up hope.

Ask all the questions you need to about diabetes.
It will help you if you can afford to self fund a glucose meter , as that will help you find out which carbohydrates your body can and can’t tolerate as we are all different in this respect.
It’s the cost of the testing strips you have to watch out for, some ,in fact lots have strips that cost £15 plus for a pot if 50 and when your testing before and two hours after eating plus other times too, cost is important.
Many here use Gluco navii meter and it’s test strips , their £8 for 50

Could you give us an idea of a typical days meals and snacks as we may well be able to offer some suitable changes .

 

[Ljc]

@rebrascora , I must learn t type faster

 

[trophywench]

Have a read of the following link - if it makes sense - invest in a blood glucose meter to do fingerprick tests as described. We can recommend a couple of pretty reliable ones if you decide you're worth the investment!

Test, Review, Adjust

Managing blood glucose levels for type 2 diabetes. Learning how to achieve long term control by testing and diet.

loraldiabetes.blogspot.com

 

[rebrascora]

@rebrascora , I must learn t type faster

Just shows that we are all on the same page!

 

[DaveB]

Hi. That's a good reduction in weight but I suspect you could lose just a little bit more? What is your BMI? I'm 61Kg and 1.67m. The blood sugar diet is one of Dr Mosely's favourites for this or last year and is based around measuring Calories if I remember correctly. You need to forget Calories and think Carbs. Just follow a low-carb diet with enough fats and proteins to keep you feeling full. The problem with measuring Calories is that it isn't a food group and you can end up reducing Fats rather than Carbs to achieve the lowest calorie measure and that's not the best approach to minimise weight and BS gain. Anyway your HBa1C figure is pretty good and as someone else has said the test will have been done in an NHS Path lab and not the surgery.

 

[Pat N]

Thank you all very much for your thoughts and guidance.

My BMI is 23.8 but I don't have much faith in BMI as I was a very muscular rugby player and always told to lose weight despite being very fit.

The test was done in the surgery and when I questioned it I was told that it was just as accurate as a lab?

I follow Michael Mosely's book and a subsequent follow-up book.

I don't snack between meals but if I do it's usually nuts or fruit (I suspect I may have too much fruit!). I also use 'Slimfast' shakes with water or Almond Milk.

I have been using an 'SD Codefree' meter but my GP casts doubt on the results (Highest: 7.4mmol/L - .24mmol/L) because they're only an indication of that particular moment whereas the lab results indicate the state of blood over 3 months or so.

There is no history of diabetes in my family. Mind you neither is there a history of cardiac issues!!

 

[Pat N]

I'd suggest self testing to see what affect food and exercise has on your blood glucose (BG) levels. Along with any changes you make. Keep a food and exercise diary along with a record of your levels. After a couple of weeks, hopefully you'll start to see a patter.

No matter what your HbA1c drops to, once you've been diagnosed as diabetic, that's it. You're diabetic.

I thought it could be put into remission and therefore lose the tag and any stigma (insurance loading etc) associated with T2?

 

[rebrascora]

I find it really surprising that a GP surgery would have an HbA1c machine. It must be a huge surgery! Some diabetes clinics don't even have them.

I don't understand your readings ..... (Highest: 7.4mmol/L - .24mmol/L) ??
7.4 is ok but what do you mean by .24 and when were these readings taken? ie before food or after? First thing in the morning, after exercise.

Fruit is something that we certainly recommend rationing on a low carb diet and suggest a few berries as a fruit portion rather than other hgher carb fruits as most berries are lowest carb... think rasps, strawberries, blackberries, gooseberries, blackcurrants etc.
The Slimfast shakes look to consist mostly of skimmed milk so will contain lactose, which is another sugar of course. So it may be possible to make some further dietary changes to bring your HbA1c down. I think it is possible to have an HbA1c done privately if you feel the need to double check the result.

It is however also possible that you are not Type 2 but possibly LADA (Latent Autoimmune Diabetes in Adults) but just in the very early stages. This is actually a form of Type 1 diabetes which occurs later in life and has a slower onset than normal Type 1. It can take years for the pancreas to eventually be overwhelmed and require insulin therapy and it may respond to Type 2 medication in the early stages. There is nothing to indicate this at the moment but with you being a normal BMI and pretty fit, it is something to bear in mind, particularly if weight loss and a low carb diet doesn't lower your HbA1c.

 

[Pat N]

I find it really surprising that a GP surgery would have an HbA1c machine. It must be a huge surgery! Some diabetes clinics don't even have them.

I don't understand your readings ..... (Highest: 7.4mmol/L - .24mmol/L) ??
7.4 is ok but what do you mean by .24 and when were these readings taken? ie before food or after? First thing in the morning, after exercise.

Fruit is something that we certainly recommend rationing on a low carb diet and suggest a few berries as a fruit portion rather than other hgher carb fruits as most berries are lowest carb... think rasps, strawberries, blackberries, gooseberries, blackcurrants etc.
The Slimfast shakes look to consist mostly of skimmed milk so will contain lactose, which is another sugar of course. So it may be possible to make some further dietary changes to bring your HbA1c down. I think it is possible to have an HbA1c done privately if you feel the need to double check the result.

It is however also possible that you are not Type 2 but possibly LADA (Latent Autoimmune Diabetes in Adults) but just in the very early stages. This is actually a form of Type 1 diabetes which occurs later in life and has a slower onset than normal Type 1. It can take years for the pancreas to eventually be overwhelmed and require insulin therapy and it may respond to Type 2 medication in the early stages. There is nothing to indicate this at the moment but with you being a normal BMI and pretty fit, it is something to bear in mind, particularly if weight loss and a low carb diet doesn't lower your HbA1c.

It's a small machine in the corner of the surgery that seems to agitate the small amount of blood taken and a few minutes later produces a print out.

Sorry, finger trouble it is 4.7mmol/L! I usually take the readings a couple of hours after a meal, no specific time. I obviously need to take a more scientific approach!

The nurse did mention the possibility of T1 (no mention of LADA) but only in passing and said it could be investigated further at a later date if I didn't improve. I may speak to my GP for guidance.

I do eat some of the berries you suggest and have done so for many years.

Thank you for your time.

 

[grovesy]

Not everyone achieves remission! In even in the research that was done at Newcastle University.
Were you tested for Diabetes when you had your Heart Attack?

 

[grovesy]

It's a small machine in the corner of the surgery that seems to agitate the small amount of blood taken and a few minutes later produces a print out.

Sorry, finger trouble it is 4.7mmol/L! I usually take the readings a couple of hours after a meal, no specific time. I obviously need to take a more scientific approach!

The nurse did mention the possibility of T1 (no mention of LADA) but only in passing and said it could be investigated further at a later date if I didn't improve. I may speak to my GP for guidance.

I do eat some of the berries you suggest and have done so for many years.

Thank you for your time.

Your GP may not be any more knowledgeable than the nurse, at least she is open to the possiblity of Type1, some think of as LADA as a sub Type 1 category . I would be suprised if your GP has had heard of LADA.

 

[Ralph-YK]

I thought it could be put into remission and therefore lose the tag and any stigma (insurance loading etc) associated with T2?

Yes, there are people who get into remission. They're still counted as diabetic. A doctor who gave a talk at a diabetes support group said he'd consider remission is someone had multiple "normal" HbA1c results, on no meds.

 

[Ralph-YK]

I have been using an 'SD Codefree' meter but my GP casts doubt on the results (Highest: 7.4mmol/L - .24mmol/L) because they're only an indication of that particular moment whereas the lab results indicate the state of blood over 3 months or so.

The GP is sort of right. A couple of self testing results don't help much. (Unless you're going Hypo, or well into double figures.)
This is where the testing regime matters. You've to do multiple tests to find out what affects your BG. The HbA1c gives you an average over 3 months. It doesn't tell you what affect your breakfast specifically has.

Sorry, finger trouble it is 4.7mmol/L! I usually take the readings a couple of hours after a meal, no specific time. I obviously need to take a more scientific approach!

2 hours after eating is the commen time given to test.
If you also test before, the two readings tell you the affect breakfast ceriel has on your BG. Do this over a period of time for several meals and you can see a pattern.
If that's 4.7 two hours after dinner or tea, that's quite low. A good figure.

 

[Pat N]

Not everyone achieves remission! In even in the research that was done at Newcastle University.
Were you tested for Diabetes when you had your Heart Attack?

Not as far as I know. It was in the USA and were very thorough so maybe I was. There was definitely no mention of it and there's no reference to it in the document I brought home with me. I handed them into my GP so they'd surely have picked it up?

 

[grovesy]

Not as far as I know. It was in the USA and were very thorough so maybe I was. There was definitely no mention of it and there's no reference to it in the document I brought home with me. I handed them into my GP so they'd surely have picked it up?

I know of someone who had a heart attack here in the UK about 20 years ago and one of the things they were tested for, they did not at time, but has more recently been diagnosed. We have had a number of members who I discovered being Diabetic following a Heart attack.

 

[Pat N]

I know of someone who had a heart attack here in the UK about 20 years ago and one of the things they were tested for, they did not at time, but has more recently been diagnosed. We have had a number of members who I discovered being Diabetic following a Heart attack.

Yes, statins, betablockers etc. Never had high cholesterol or high blood pressure but having to take the NHS package "just in case". I did confim with the diabetes nurse that she was aware of my medication. Do you think the meds will have an effect?

 

[grovesy]

There is some suggestion that they can increase the risk of Diabetes, but then you already have a history of heart disease.