Should I be asking for meds?

[Jan1956]

I’ve been on a no sugar, low carb eating plan of lower calories of around 1000 a day. ( trying to reduce weight too)
Ive been following the Michael Moseley Fast 800 ( but around 1000 calories) in an 8 hr eating window. So I usually have first meal at 12 noon which is some form of protein and salad or a two egg omelette and salad. For my main meal ( before 6.30pm) I have meat - chicken or beef or fish with vegetables or salad. Also beans lentils or small portion sweet pots occasionally . No bread as it spikes me horrendously and nothing much white. Ryvita Rye is ok as a snack.
I think I’m doing everything possible and it’s over 2 months now with little change in my fasting glucose readings ( finger prick Contour monitor) which is 8.5 mol/L on waking and around 9 /10 towards 12 noon.
The other readings before lunch and main meal and after meals have dropped slightly but I still spike an hour after my main meal to 10mmol/L but it’s down to 8.5 mil/l by 2 hours after food.
To avoid the morning fasting high readings I’ve tried incorporating a portion of mixed nuts for breakfast which had the effect of spiking to 11.5 mmol/L and one weetabix which disastrously spiked me to 13 mmol/L ( I realise now Weetabix is high carbs and bad choice lol so won’t do this again!
My question is should I be taking meds to help tackle the high morning readings?? I was trying to reduce levels myself but I have a suspicion that even as a pre diabetic my fasting glucose has always been significantly higher than it should be.
I’m worried when I read about the awful damage being done to my organs with high glucose levels that I’m actually doing more damage to my body without meds than if I took them? ( I’m aware that I’ve probably been diabetic for much longer than my diagnosis but didn’t realise it or want to face it!!)
My current Hba1c is 55 ( taken over 2 months ago) The Dr now wants me to wait another 3 months before checking as I recently had a fasting glucose test which recorded 7.5.
Ive read an article recently by Prof Tim Spector who purports the value of low dose metformin even for pre diabetics as it is supposed to have additional health values in cancer / pancreatic issues as well as diabetes. Prof Tim Spector takes this himself.
Am I causing more harm to myself by continuing without meds and little progress forward ?
Or do I plod on without asking for meds and wait to see if it goes down on of its own accord??
The other factor is my weight is now static - my metabolism is sluggish and I’m struggling thank you in advance for Your advice .

 

[rebrascora]

The fact that your fasting reading is a bit on the high side and remaining high until lunchtime suggests to me that perhaps fasting longer does not suit your body. I think it may depend what issues your pancreas and liver are struggling with. ie. Are you just not able to produce enough insulin to bring your levels down, which I think is probably unlikely. Or is your liver churning out too much glucose because it thinks you are starving or is it just that, because food is not hitting your stomach until lunchtime, your pancreas isn't getting the message to release insulin to balance your levels during this long period of fasting. The liver and pancreas should work together to balance BG levels in the absence of food but if perhaps these organs are hampered by fatty deposits, they may not be communicating well enough, so the pancreas is not releasing glucose to bring your levels down. Food arriving in the stomach can be a stronger trigger for the pancreas to wake up and get working, so it maybe that fasting until lunchtime is not helping you and it might be worth experimenting with having a low carb breakfast and perhaps skipping lunch and see how that works out for another few weeks, before you make the decision to try medication.

Are you able to do any exercise. I find exercise on an evening particularly can reduce my morning waking levels because my muscles suck glucose out of my bloodstream during the night to replenish their stores whilst I sleep. Walking (or running in my case) up and down stairs as many times as you can an hour or so before bed or going for a walk after your evening meal can really help to lower those morning readings. It takes me about 15 mins to do 25 ascents and descents and that really gets my lungs and heart working and a bit of muscle burn. It took me a couple of weeks to build up to 25, so do set yourself a realistic target, even if it is just 5x at a walk. Obviously you can't do that if you don't have stairs and make sure to hold the handrail. I think of that elderly lady in Scotland who set herself a target of climbing the equivalent of her favourite mountain by walking up and down stairs during lockdown, in the same way as Captain Tom Moore walked in his garden. These things can really improve your fitness and BG levels and I think most people can find 15 mins a day to do something, even if you are unable to walk, there are seated exercises you can do.

Do you have much/any weight to lose? If so, how is that going?

 

[Jan1956]

The fact that your fasting reading is a bit on the high side and remaining high until lunchtime suggests to me that perhaps fasting longer does not suit your body. I think it may depend what issues your pancreas and liver are struggling with. ie. Are you just not able to produce enough insulin to bring your levels down, which I think is probably unlikely. Or is your liver churning out too much glucose because it thinks you are starving or is it just that, because food is not hitting your stomach until lunchtime, your pancreas isn't getting the message to release insulin to balance your levels during this long period of fasting. The liver and pancreas should work together to balance BG levels in the absence of food but if perhaps these organs are hampered by fatty deposits, they may not be communicating well enough, so the pancreas is not releasing glucose to bring your levels down. Food arriving in the stomach can be a stronger trigger for the pancreas to wake up and get working, so it maybe that fasting until lunchtime is not helping you and it might be worth experimenting with having a low carb breakfast and perhaps skipping lunch and see how that works out for another few weeks, before you make the decision to try medication.

Are you able to do any exercise. I find exercise on an evening particularly can reduce my morning waking levels because my muscles suck glucose out of my bloodstream during the night to replenish their stores whilst I sleep. Walking (or running in my case) up and down stairs as many times as you can an hour or so before bed or going for a walk after your evening meal can really help to lower those morning readings. It takes me about 15 mins to do 25 ascents and descents and that really gets my lungs and heart working and a bit of muscle burn. It took me a couple of weeks to build up to 25, so do set yourself a realistic target, even if it is just 5x at a walk. Obviously you can't do that if you don't have stairs and make sure to hold the handrail. I think of that elderly lady in Scotland who set herself a target of climbing the equivalent of her favourite mountain by walking up and down stairs during lockdown, in the same way as Captain Tom Moore walked in his garden. These things can really improve your fitness and BG levels and I think most people can find 15 mins a day to do something, even if you are unable to walk, there are seated exercises you can do.

Do you have much/any weight to lose? If so, how is that going?

Thank you @rebrascora
I didn’t mention that I’ve been incorporating exercise on alternative days when I have chance. I try to go for a brisk walk however I am a carer for my 101 year old mum who still lives in her own home so I’m so busy with caring and shopping. Definitely active though every day - if not always in the most beneficial way for my own needs . I’ve been trying to run up and down stairs too as I think this was mentioned previously but I can see I’m not a match on your efforts lol. So must try harder
I was put off eating breakfast as my previous attempts after eating nuts or weetabix sent readings higher and I’m not a breakfast person but I’ll give this another try with Greek yoghurt and berries to see if this improves the readings
Thank you for your suggestions.
I reckon that if I’d had the opportunity for a comparative Hba1c test it would’ve given me some reassurance I was doing something right as surely counts would’ve dropped a bit by now? But instead I got a fasting reading which wasn’t a surprise that it was high being a fasting reading.

My big question is - could Hba1c counts eventually drop to below diabetes levels but still be high for morning readings? Am I just unlucky? Re diet and weight. I have lost weight - I need to lose a stone and half more though to bring me into a normal BMI. I should be losing weight on what I’m eating but I’ve just plateu’d for weeks. I’ts just not shifting at all. Could this be related to insulin / diabetes ?

 

[JITR]

Hi Jan1956,
My thoughts are:

1. Some more background information would help: when diagnosed, HbA1c at diagnosis, weight lost since diagnosis, how long has weight been static.
2. I'd accept your GP's advice until your next HbA1c.
3. You may have reached an equilibrium point: metabolism attuned to 1,000 cal/day. If so a change of eating pattern/diet may help.
4. I lost 22 kg on something like 800 cal/day for 3 months (15kg), then 1,000 cal/day for 3 months (7kg with a plateau). Both lunch and dinner only like you: mainly protein and vegetables, no snacks except the odd slice of bread before going for a long walk.
5. What helped a lot was upping protein from 0.8g/kg body weight to 1.0-1.2g/kg.
6. Exercises, like streches and squats, also helped; they take a only a few minutes and may help morning glucose.
7. I read a study which showed a controlled 5:2 diet was as effective as a 7 day low carb diet. So I have been cutting out lunch (no breakfast) 2 days a week. That's helping me get of the 2-3 kg I've gained since reaching my target last year. I suggest you try that; I do exercise break, have midday coffee, and used to have a butter cocoa at teatime to keep me going to supper - until I realised I was not going to keel over.
8. My theory is the 20-22 hour fast gives more time for fat burning to get liver and pancreatic fat down a bit more.

Finally I'd have a look at Drummer's current thread on her shakes and dinner trial. It's got her losing weight again after being stuck at HbA1c at 43 for yonks after losing a lot of weight - <40 here we come?

 

[Leadinglights]

My HbA1C is now in normal range but I found that my morning reading are higher than one would expect but before meal and my 2hr post meal are all well below 7mmol/l. I just gave up doing morning readings as I didn't find it particularly useful or worthwhile.
It does look as if the fasting regime may not be suiting you and your liver is releasing glucose to give you energy to function.
Having something like Greek yoghurt and berries or seeds may trick your liver into not releasing glucose.
Some ideas for meals in the Freshwell link https://lowcarbfreshwell.com/ which may suit you. Your other meals may also be a too high in carbs so keep an eye on that. You could see how close you are to the suggested no more than 130g carbs per day but some people do need to go lower.

 

[everydayupsanddowns]

Those morning readings can be stubborn, and the last to come down @Jan1956

But on the other hand, some people find a very low carb menu may not help their insulin sensitivity. So a few menu tweaks to spread out the carbs you have allocated for the day might be worth trying.

Additionally, it can be worth keeping an open mind about diagnosis and classification if there were any atypical aspects to your diagnosis journey - were you overweight at diagnosis? Did your diagnosis come on quickly? Did you lose any weight without trying before you were diagnosed?

 

[Jan1956]

Those morning readings can be stubborn, and the last to come down @Jan1956

But on the other hand, some people find a very low carb menu may not help their insulin sensitivity. So a few menu tweaks to spread out the carbs you have allocated for the day might be worth trying.

Additionally, it can be worth keeping an open mind about diagnosis and classification if there were any atypical aspects to your diagnosis journey - were you overweight at diagnosis? Did your diagnosis come on quickly? Did you lose any weight without trying before you were diagnosed?

Thanks for the points you’ve raised @everydayupsanddowns .
My diabetes hasn’t come on quickly. I’ve been a decade fighting this and the last few years I’ve been going from around Hba1c 37 to 41/42/43/44. I’ve definitely had my eye off the ball over the last year though and i suspect I crept into diabetes about 9 months ago or more but just avoided being tested.
I had put on weight prior to recent diagnosis - and I was overweight when diagnosed. I definitely haven’t lost weight unintentionally . I’ve lost about a stone and half over the past 18 months in total . But weight has tended to yo yo a little . Since diagnosis I’ve lost about 8 pounds - I’ve now reached plateau though and just can’t seem to lose any more no matter what I try .
I have a family history of T2. My father and uncles were all T2. All of them very slender build - with low average BMI’s . History of strokes which is why I’m concerned.

 

[Jan1956]

My HbA1C is now in normal range but I found that my morning reading are higher than one would expect but before meal and my 2hr post meal are all well below 7mmol/l. I just gave up doing morning readings as I didn't find it particularly useful or worthwhile.
It does look as if the fasting regime may not be suiting you and your liver is releasing glucose to give you energy to function.
Having something like Greek yoghurt and berries or seeds may trick your liver into not releasing glucose.
Some ideas for meals in the Freshwell link https://lowcarbfreshwell.com/ which may suit you. Your other meals may also be a too high in carbs so keep an eye on that. You could see how close you are to the suggested no more than 130g carbs per day but some people do need to go lower.

@Leadinglights Thank you I’ll check my carbs level a bit more carefully. Good point and I’ll give the Greek yoghurt a try . Well done on maintaining normal levels. Thank you for the link. I’ll take a look at it.

 

[Jan1956]

Hi Jan1956,
My thoughts are:

1. Some more background information would help: when diagnosed, HbA1c at diagnosis, weight lost since diagnosis, how long has weight been static.
2. I'd accept your GP's advice until your next HbA1c.
3. You may have reached an equilibrium point: metabolism attuned to 1,000 cal/day. If so a change of eating pattern/diet may help.
4. I lost 22 kg on something like 800 cal/day for 3 months (15kg), then 1,000 cal/day for 3 months (7kg with a plateau). Both lunch and dinner only like you: mainly protein and vegetables, no snacks except the odd slice of bread before going for a long walk.
5. What helped a lot was upping protein from 0.8g/kg body weight to 1.0-1.2g/kg.
6. Exercises, like streches and squats, also helped; they take a only a few minutes and may help morning glucose.
7. I read a study which showed a controlled 5:2 diet was as effective as a 7 day low carb diet. So I have been cutting out lunch (no breakfast) 2 days a week. That's helping me get of the 2-3 kg I've gained since reaching my target last year. I suggest you try that; I do exercise break, have midday coffee, and used to have a butter cocoa at teatime to keep me going to supper - until I realised I was not going to keel over.
8. My theory is the 20-22 hour fast gives more time for fat burning to get liver and pancreatic fat down a bit more.

Finally I'd have a look at Drummer's current thread on her shakes and dinner trial. It's got her losing weight again after being stuck at HbA1c at 43 for yonks after losing a lot of weight - <40 here we come?

Thank you @JITR
I’ll check out Drummer thread.
Yes upping protein is something I’d wondered about.
A little more background
Hba1c at diagnosis was 57 - two weeks later 55.
diabetes hasn’t come on quickly. I’ve been a decade fighting this and the last few years I’ve been going from around Hba1c 37 to 41/42/43/44. I’ve definitely had my eye off the ball over the last year though and i suspect I crept into diabetes about 9 months ago or more but just avoided being tested.
I had put on weight prior to recent diagnosis - and I was overweight when diagnosed. I definitely haven’t lost weight unintentionally . I’ve lost about a stone and half over the past 18 months in total . But weight has tended to yo yo a little . Since diagnosis I’ve lost about 8 pounds - I’ve now reached plateau though and just can’t seem to lose any more no matter what I try .
I have a family history of T2. My father and uncles were all T2. All of them very slender build - with low average BMI’s . History of strokes which is why I’m concerned.

 

[JITR]

Thank you @JITR
I’ll check out Drummer thread.
Yes upping protein is something I’d wondered about.
A little more background
Hba1c at diagnosis was 57 - two weeks later 55.
diabetes hasn’t come on quickly. I’ve been a decade fighting this and the last few years I’ve been going from around Hba1c 37 to 41/42/43/44. I’ve definitely had my eye off the ball over the last year though and i suspect I crept into diabetes about 9 months ago or more but just avoided being tested.
I had put on weight prior to recent diagnosis - and I was overweight when diagnosed. I definitely haven’t lost weight unintentionally . I’ve lost about a stone and half over the past 18 months in total . But weight has tended to yo yo a little . Since diagnosis I’ve lost about 8 pounds - I’ve now reached plateau though and just can’t seem to lose any more no matter what I try .
I have a family history of T2. My father and uncles were all T2. All of them very slender build - with low average BMI’s . History of strokes which is why I’m concerned.

@Jan1956
Coincidentally I was only tested 2 years ago when I said I was concerned about having a stroke like my father at the end of my first 'annual' check up for 10 years. The Surgery was in Special Measures for not doing them.

Anyway I lost 22kg over 6 months following a real food version of the Newcastle Diet, protein and vegetables. The challenge was to maintain my new low weight. In the end I kept coming back to Zoe Harcombe's approach to weight loss as she explains in this article What should we eat? She devised her diet to avoid yo yoing which she had doe herself for years.

I was already doing 16:8 fasting, 2 meals a day and no snacks, to allow time between meals for fat burning. Still my weight and HbA1c started creeping up again, probably due to too much (uncounted) olive oil, mayonnaise, and whipped cream. Now I've cut back on those fats and cut out lunch 2 days a week, a sort of 5:2 diet. That seems to be effective.

In his ReTUNE study of weight loss of T2Ds of normal BMI, Professor Roy Taylor found two or three rounds of dieting were necessary in some cases. I think a 5:2 diet could be worth a try to gradually reduce visceral fat and restore liver function. The idea is your body gets used to a normal 5 days a week diet and then burns a bit of fat on the other 2 days.

One other thing that helps me is the free version of Cronometer (short video) which records my nutrition and weight.

 

[Lucyr]

I have a family history of T2. My father and uncles were all T2. All of them very slender build - with low average BMI’s .

Sounds worth reading about MODY and seeing if that fits