tablets or not

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Marmite

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At risk of diabetes
It is two years since I was informed I was pre-diabetes, HbA1c 43. I have followed much of your advice - thankyou - and my last test after 18 months my level was 41.
As everyone here will appreciate it is "hard going" to adapt to these big changes. My question is; at 85 years is it a good idea to start on tablets and enable me enjoy all food as previous to my diagnosis. I spoke to my Dr who said at my age it isn't necessary to deprive of ALL things we enjoy. Another Dr speaking to his patient (my friend, similar age ) also said "at your age , why bother to make changes, - enjoy what you love".
So is it tablets and freedom - or is it not that simple.
Thank you for any help, Marmite
 
I tend to agree with the second Dr. Why care if your next HbA1c is 43 again? Or 50?

You won't want to go crazy because high blood glucose doesn't feel right, but if you want to go back to what you were doing a couple of years ago I don't see that as a poor choice.
 
Doing what you have been doing has managed to keep your blood glucose level at normal so why take metformin, a medication which potentially has side effects and still requires keeping an close eye on carbohydrate intake as it only helps your body use insulin you are producing more effectively.
As long as you are careful with your dietary regime the majority of the time there is no reason not to have the occasional treat.
What is it that you are wishing you can have that you feel you can't.
I think you might be surprised that your tastes will have changed and many things will taste far too sweet.
When in hospital I chose a choc eclair for pudding but had to scrape off the chocolate as it was just too sweet.
I assume from your name you are more of a savoury person. I cut my teeth on marmite.
 
Hi. I think you may have an unrealistic expectation of what tablets can do. They are unlikely to keep your levels low if you eat lots of carbs and most people would need dietary restriction alongside medication to manage their diabetes effectively.

How restrictive has your current diet been in order to achieve that slightly reduced HbA1c?
Just wondering how much room there is for treats etc.
What I suppose I am asking is.... Can you give us an indication of the sort of things you currently eat for breakfast lunch and evening meal.....
How many grams of carbs do you normally eat in a day now? Do you know?
What sort of things would you like to go back to eating?
Maybe we could suggest low carb foods that you might enjoy more than those you are currently eating....

I have Type 1 diabetes so I manage it slightly differently although I do follow a low carb way of eating. I have to find a balance using insulin between being too high and too low. My HbA1c for the past couple of years has been about 50 which my consultant is very happy with. I am 58years old and if I can maintain this sort of level for the rest of my life I will be doing pretty well I believe. I would like it to be a little lower but realistically this current level is OK/pretty good even. I think if I was 85yrs old, I wouldn't be too concerned as long as I could keep my levels under 55 and still enjoy my food. Diabetes is about finding a balance and a way of eating which is sustainable long term.
 
Thanks for all your replies. My current carbs are approx 120 /day, and according to my fitbit walk average 10 miles/ week. Weight 62kg.
I half the amount of (normal portion) breakfast cereal (eg 1 shredded wheat), 1 egg or mushrooms on half slice toast, half slice toast (yes, with marmite) or peanut butter.
Coffee break with HALF a biscuit. (don't laugh)
Lunch 2 slices bread (always brown) with cheese/salad/fish.
Dinner is varied but does include potato, rice (bn) or pasta (bn) plus a desert (yoghurt & fruit)
Now , what would I like to change. A doughnut or cream cake with coffee, and a choc biscuit with afternoon tea, ice cream in place of yoghurt for desert.
Also to avoid any mention of carb counting.
I have already established from your comments that more meds (I take BP & statins) and their side effects are to be avoided if possible - but what about my desires!
 
You sound to be doing pretty well on what you are having but you could swap butternut squash for potato as it is much lower carb and that would allow you some ice cream but you could have cream with your fruit for desert. I make a sugar free jelly with berries in and have that with cream for desert.
There are some protein nut bars which are low carb which you could have instead of biscuits Nature Valley or shop own.
Carb counting is important for people taking insulin but for people who are Type 2 dietary managed being aware of the carbs in food enables better choices and help to avoid the 'hidden ' carbs.
I know you don't want to carb count as such but the book Carbs and Cals is very good ads it has carb values and portion sizes of a whole range of foods.
You will see that berries are good fruits whereas tropical fruits are not so good. Things like rice and pasta are often misleading as to how many carbs there are as are potatoes.
As said the occasional treat of a cream cake or scone with jam and clotted cream will do no harm.
 
As a general thing, I recommend paying more attention to what yr doctor says, versus unqualified people posting on message boards.

But FWIW, I doubt that you need to stress much about BG levels unless they are quite high - say an HbA1c > 60. Below this, generally any small risks of diabetes-type complications only develop over many years.
 
Marmite said:
I have already established from your comments that more meds (I take BP & statins) and their side effects are to be avoided if possible - but what about my desires!
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Well, BP meds probably help you to feel better so I'd keep those (I'd be loath to drop mine, or my beta blocker). Statins I'd guess are neither here nor there. If you get significant side effects maybe discuss them with your GP but most people don't.
 
I think you can treat yourself to a whole biscuit and I have to say, I like a bit of cake myself. Some years ago I 'discovered' supermarkets sell fresh cream chocolate eclairs, in boxes of 4, for just over £1 - so the two of us can have 1 each with our cup of tea in the afternoon, 2 days running. These eclairs are only about 10g each and successfully fool me into thinking I've been very indulgent. Also fresh cream meringues don't have masses of carb.

But of course - it's what YOU would like to eat that counts - so what do you like?
 
Folks of a more mature age are generally given higher a1c targets to meet due to the level of action needed to take to reduce it vs quality of life vs long term benefit. The target would be something to discuss with your doctor.

Metformin can be beneficial and its not like oh hey, I can eat what I like with no impact on bg but it might just give you some wiggle room to loosen the reins a little (just don't let them go). (its designed to be in combination with a healthy diet).
I actually know plenty of people who are T2, take metformin and get on business as usual without making huge changes to their diet apart from cutting out a lot of the excess sugars (like in tea and coffee, fizzy non diet drinks, excess treats etc). No massive carb changes done at all. Everyone is individual as to what works and what path people choose to maintain control of their blood glucose levels.
Metformin can lessen the risks of some other things such as stroke, dementia and heart problems and more which may be of benefit to you.
Unfortunately, there are some side effects associated with it (mostly tummy/digestive) but you shouldn't be put off trying it at least if that is the path you choose to take.

My personal opinion would be to try metformin if it is on offer and be sensible vs super strict. If it all goes too far out of control, dial it back in a little bit if it imposes health concerns or puts your hba1c too high.
Enjoy life and eat more marmite :D (I'm in the love it camp)
 
I don’t want to refer to your age as old but, I’d agree with your doctor and follow their advice over random strangers on an Internet forum who are overly pushy on low carb. Don’t do too extreme on eating anything you want in any portion, but honestly the long term benefits of reducing complication risk with an a1c of 41 vs one a bit higher, are minimal as we age.
 
I was going to advise chucking what I consider the boring stuff - the Weetabix, the bread and potatoes, and if you need to eat more eat something lower carb, then use your carb 'allowance' to have cake and biscuit - more fruit if you fancy that. The only problem might be that it tastes too sweet if you are not used to lower levels of sugariness.
Personally I make my own icecream from cream and eggs as it is low carb and I only have 40 gm of carbs a day if I am to stay in normal numbers - I make sugar free jellies and add in frozen berries - as there is little difference as far as I can see in how my insides deal with bread, potatoes or cereal than with cake or apples, I don't bother about the boring things.
I have to watch my weight, as I put on the pounds so easily and I don't want to push up my glucose levels or Hba1c, but I was a full blown type 2 and you don't seem to have got into the high numbers.
You could have another decade at least, with luck - it would be a bit of a whatsit to find yourself fading in a few years from things associated with high glucose levels.
I have meat or fish for breakfast these days and then don't need to eat for 12 hours so I can go out for the day without needing to find or take things to eat. For a long day out I take a flask with real coffee and a supply of cream in a chiller wrapping I keep in the fridge.
 
An occasional treat is good for the soul.

We often have an M&S eclair mid afternoon as a treat. Thankfully it never upsets my blood glucose.
 
Take the tablets.
Eat a few things you fancy.
Get your hba1c checked again in three months.
 
I may be wrong but isn’t age associated with higher hba1c independent of diabetes anyway? Chances are a lot of people your age if tested would have a similar score who are not diabetic or pre diabetic
 
EmmaL76 said:
I may be wrong but isn’t age associated with higher hba1c independent of diabetes anyway? Chances are a lot of people your age if tested would have a similar score who are not diabetic or pre diabetic
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My husband was 74 in January this year. Just had a 'whole armful of blood' tests - BG at that moment was 5.5, and his HbA1c 39. Test was between breakfast - 2 slices of Tesco sliced Brioche spread with Nutella, and lunch.
 
EmmaL76 said:
I may be wrong but isn’t age associated with higher hba1c independent of diabetes anyway? Chances are a lot of people your age if tested would have a similar score who are not diabetic or pre diabetic
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The "non-diabetic" data I benchmark against look like this for average HbA1c by age group:

20-39 yrs: avg HbA1c = 33
40-59: 34
60+: 35

So it looks like a slight uptick with age but nothing much.
 
Hope you find a new happy balance between wellbeing and risk reduction and a bit more of a sense of freedom around food.

Reading between the lines it feels like you feel rather too restricted, and perhaps even a little joyless around food currently, and I think there’s a lot to be said for treating your whole person.

I don't think there’s anyone who doesn’t feel a bit restricted around food (because most of the things that are delicious tend also to be not great for you in excess!), but I still think everything in moderation is a more viable option for me than constantly trying to satisfy all the competing and sometimes contradictory advice around what and what not to eat. 🙂
 
Marmite said:
I am very grateful to all of those taking the trouble to reply.
Good to see varied opinions, and even better now it's agreed I can have the odd eclair!
Thank you.
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Hi @Marmite - I'm a bit further down the road / along the spectrum than you are, but also controlling by diet and avoiding meds. I understand that for a pre-diabetic or Type 2 with controlled blood glucose levels, the occaisional high carb or sugary treat shouldn't be a problem. I've always been advised to have the sugary treat at the end of a meal, rather than on it's own, as the impact will be less, likewise fruit. That's a bit counter-intuitive, but seems to work in my case. Regarding your current diet, it might help you to swap out the Weetabix or other processed cereal for a more protein-based breakfast, like eggs, or have porridge with nuts/berries or low sugar content nutty muesli. I have found this to help. Likewise seeded wholemeal bread in place of plain wholemeal, malted wholemeal or white bread. I'd avoid medication - but that's a personal choice. Good luck, Nick.
 
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