T2 - any advice whilst waiting for referral?

[Ekbeks14]

Hello everyone! Recently diagnosed T2. History of Gestational Diabetes in two pregnancies 10 and 5 years ago resulting in metformin an Insulin treatment. Both times Hba1c went back to normal range.

Long story short diabetes has been diagnosed as a result of finding hypertension (had a stressful job- thought it was anxiety etc turns out not the case!!!) I had a career change in September thankfully so have been much more active and eating much better since then. However, most recent Hba1c was 90 (10.4%). Really cross with myself for not seeing the signs sooner - put symptoms down to other things. You live and learn…

Anyway. I have been given metformin, sent on my merry way with diet advice and have been told I have been flagged as ‘urgent’ for a diabetes nurse referral.

I’ve gone back to the Freshwell style of eating (essentially what I used during my GD pregnancies) as I could never tolerate bread / rice / pasta in any quantity.

What should I expect from the appointment with the diabetes nurses?

Any advice whilst I’m waiting?

Thank you for listening to the ramble - it feels good to get it out! Really struggling with a lack of clear direction.

 

[silver minion]

Hello @Ekbeks14 and welcome to the forum. You have made a very good start with managing your diabetes by reducing the carbs in your diet.
I was diagnosed early last year. I had 2 follow up appointments with the practice nurse who looks after the type 2 Diabetics at the surgery. First appointment was reviewing general health, weight, blood pressure, diet and asking how I was adjusting to metformin. Bit of an anomaly as I was her only patient that didn't need to lose weight. Given information about Diabetes UK website.
2nd appointment Had both feet checked for pulses and nerve sensitivity and referral for diabetic retinopathy check. Also asked more questions after doing a bit more research. As my blood glucose was so high I was seen every 3 months and medication increased. Now things are much improved although I have had some blurred vision and pins and needles in my feet while blood sugars reducing. If next review in Feb goes well I will go onto annual reviews.
Eye and feet checks were both fine. You will get these done annually as part of routine reviews.
Wishing you well with your future appointments. Let us know how you get on. Lots of knowledge and experience on the forum so ask away if you have any questions. I have found people on here so helpful and supportive. It's good to talk to people who get the whole living with diabetes thing.

 

[Lucyr]

What should I expect from the appointment with the diabetes nurses?

Hello and welcome. You should expect some general advice about improving diet, increasing exercise, and to lose weight if needed. They may check your feet (just touching them to see if can feel it), explain that you need an eye check every 2 years (in some areas every 1 year), and with a hba1c of 90 they’ll probably offer you metformin.

If you start medication for diabetes you’ll need to ask for the paperwork to apply for a medical exemption certificate if needing prescriptions in England.

They may offer you a referral to an education course about diabetes or they may not, that varies by area.

 

[Leadinglights]

Many people have found the Freshwell approach works well for them and is substantially better than the NHS advice they were given by their GP or diabetic nurse. Finding a way of eating that works for you, is enjoyable and therefore will be sustainable for life.
The Freshwell approach seems to have a good bit of flexibility to choose from their suggested menu plans or just do your own thing following the principals of reduced carbs and avoiding low fat unless you need to for other conditions.
As it is based on real food easier to fit in with family meals with maybe a few substitutions for what they would have.

 

[Ekbeks14]

Thank you so much for your replies! Really helpful - thank you! I had the first appointment with GP signposting to here, diet advice and prescription for metformin so now waiting for Diabetic nurse.

are there recommendations for how many carbs/ fat / protein etc? I have researched but find it all conflicting. I’m really conscious to make changes that are sustainable.

With my gd pregnancies I was provided with a blood testing kit - reading around I will need to self fund one for T2?

 

[beating_my_betes]

Many people have found the Freshwell approach works well for them and is substantially better than the NHS advice they were given by their GP or diabetic nurse.

In which ways is Freshwell substantially better than NHS advice?

 

[Leadinglights]

Thank you so much for your replies! Really helpful - thank you! I had the first appointment with GP signposting to here, diet advice and prescription for metformin so now waiting for Diabetic nurse.

are there recommendations for how many carbs/ fat / protein etc? I have researched but find it all conflicting. I’m really conscious to make changes that are sustainable.

With my gd pregnancies I was provided with a blood testing kit - reading around I will need to self fund one for T2?

You will find the Freshwell approach is based on a no more than 130g carbs not just sugar per day as a good starting point and people will focus on that rather than the other things though it is important to have enough protein and healthy fats along with veg and salads and fruit like berries. Some people do track those things because that is their choice not because it is needed as it can be too mind blowing to have to consider too many things and as it is the carbs that convert to glucose that is the important one.

 

[Ekbeks14]

You will find the Freshwell approach is based on a no more than 130g carbs not just sugar per day as a good starting point and people will focus on that rather than the other things though it is important to have enough protein and healthy fats along with veg and salads and fruit like berries. Some people do track those things because that is their choice not because it is needed as it can be too mind blowing to have to consider too many things and as it is the carbs that convert to glucose that is the important one.

Thank you! I’ve been tracking using the carbs & Cals app (hello my old friend) and I’m well under 130.

As I had insulin during my GD pregnancies, do you think it’s likely that this will be the case now or is it completely different?

Sorry for all the questions!

 

[Lucyr]

With my gd pregnancies I was provided with a blood testing kit - reading around I will need to self fund one for T2?

When you see the nurse I’d say you found it very helpful to test to adjust your diet with gd can you have a meter and strips again now please.

The most common response would be for them to then say no but if you don’t ask you don’t get

 

[Lucyr]

As I had insulin during my GD pregnancies, do you think it’s likely that this will be the case now or is it completely different?

There’s close to 0% chance they will start you on insulin now. If there are any signs you may be T1 (rapid weight loss, low body weight, ketones in urine) then you’d need more tests and may need insulin, but if it’s seeming more like standard type 2 (which gestational diabetes can be a risk factor for) then there’s no chance of them suggesting insulin without first trying diet, exercise, and various tablets till taking at least 3 different diabetes medications first.

Of course if you’d prefer insulin as you used that previously then you can ask for that and have the discussion.

 

[goodybags]

hi @Ekbeks14 welcome to the forum, good that you already have an idea of food changes that might benefit you having previously had Gestational Diabetes (although I see you said on the occasions you had that you were treated with insulin) whereas initially now Oral meds & Diet.
when you get that referral to DSN if they arnt happy to supply you with a BGM for FP testing
like many others on here I’m a firm believer in testing to see how things are going
so definitely worth it
do some research on cost, not of the testing device but the strips (they are the expensive part of the kit)

One good thing about this forum is, so many people pop along and are happy to share their experiences and offer advice, so your always welcome to come on even if it is to .. Rant & Ramble

 

[Ieva DUK]

Hi @Ekbeks14 and welcome to the forum!

I think a lot of folk are guilty of the 'it's probably nothing or X Y Z' thoughts, pushing symptoms and their wellbeing away, especially if (as you mentioned) they lead busy lifestyles in terms of work and other things. I'm glad to hear the switch in your career path has lead to you doing much better for yourself

I'll leave the 'advice' bit to our helpful users, but as many have noted - do feel free to rant and ask questions in the meantime.

 

[JimmyBlue]

Welcome to the forum @Ekbeks14 and the steps you are taking are all similar to the ones I picked up from here when I was diagnosed at the end of September '24. My diabetes nurse suggested that they had seen good results from people moving to a diet of no more than 130g carbs/day although she forgot to mention making sure you make up the calories with fats and proteins which resulted in a reasonable level of weight loss I didn't need! They also prescribed Metformin for me but I was very reluctant to take them wanting to do everything with diet and exercise. Three months on I am taking 1 500mg table a day which in reality is not really doing that much but, as I now get back into a routine after Christmas, I can see my BG tests moving back more into the range I saw in the first two months (92% within the range 3.9-8.5%). I also had access to two Libre2 sensors and I have a third which is a free trial just waiting to be used.

Before my initial meeting with the diabetes nurse, I sat down with my wife and we went through a load of questions that I/we wanted to answers to and I took them with me to my appointment. It really helped to focus my mind and to get the right information from the nurse. She also advised that my retinopathy appointment would be sent separately and I had the test just before Christmas. No one has looked at my feet but as I have a follow up appointment next week and a further HbA1c test as well, they might do it then. I also pushed for the nutritionist appointment as they didn't offer that and have that next week also.

My advice is discuss what you want to do with them and let them explain why you might need to do something different. The diabetes nurses I have seen have always been open to my wishes although they do keep trying to push the Metformin. This is because my first and second HbA1c tests at the onset of the diagnosis where both considered very high (92 and 86) and they see Metformin as a way to bring it down quickly. I on the other hand hope that the outcome of next week's test will show that exercise and diet have done exactly the same.

 

[Drummer]

@Ekbeks14 I had a couple of rather large babies - over 9lb, but it took until I was 65 to be diagnosed type 2.
My HbA1c was 91, but using a meter and getting my blood glucose down to normal by eating low carb - no more than 50 gm of carb a day, I was down to normal in 6 months.
I found it easy to avoid high carb foods and eat anything else. I wasn't counting the amount of protein or fats, only carbs and my blood glucose after meals. Still going strong after 8 years.

 

[Ekbeks14]

Thank you so much for all the helpful advice - really appreciated! Thank you for making me feel welcome - its feels good to have a space to rant with people that understand.

 

[everydayupsanddowns]

Welcome to the forum @Ekbeks14 🙂

 

[Mark72]

Hi Ekbeks14, welcome to the forum.

My experience with the checks with the diabetes nurse were very similar to silver minions with an additional blood test to check on kidney function.

The eye testing referral was fairly quick, a week or two further on and I was told no driving for a few hours afterwards because of the drops they put in your eyes potentially impacting vision for some time after, I didn't notice any impact but some people have. It was late summer and sunglasses helped with the glare though.

Hope they go well!