Type 2 and new here

[RichardH54]

Hi. I’m 67 and have been T2 for 16 years. For about 10 years, I’ve been relying on metformin, gliclazide and exenatide (Byetta).
I thought I was doing pretty well. My hba1c was 48 last March and then 54 in August. Last week it was 67 so I’m seeing my diabetes nurse tomorrow to see what we can do.
AFAIK, my diet is good and I exercise (yoga, walking) regularly.
I’m expecting to be put onto insulin which I’m ok with, if it reduces my blood sugar. Currently around 14 mmol/L at lunchtime each day.

Richard

 

[adrian1der]

Hi @RichardH54 and welcome. Sorry to hear about your rising levels. Hopefully you can get it sorted

 

[rebrascora]

Hi and welcome

Sorry to hear about your increasing levels. Since you have been diagnosed quite a while I wonder if your idea of "healthy eating" may not be in line with current thinking for Type 2 diabetes. Unfortunately the NHS dietary advice is rather behind the times with regard to diabetes still as they recommend higher levels of carbohydrate than many Type 2 diabetics can tolerate and rely on advocating wholegrains to reduce the impact of those carbs but many people break down brown carbs almost as quickly as white and find that reducing or avoiding those carb rich foods enables them to control their blood Glucose levels much more effectively in conjunction with using a BG meter to test the impact of those foods on their levels so that they can adjust portion size and tailor their diet to their individual diabetes. If you read around the forum you will find that many people have success with this regime of testing and cutting carbs to get their levels down sometimes to normal (non-diabetic) levels

It may be something to think about before you start on insulin or insulin may be the right next treatment for you.

If you have any questions be sure to ask, either in relation to starting on insulin or dietary changes and testing.

 

[RichardH54]

Hi Barbara

I've been following a low carb high fat diet for some years now and ignore the NHS dietary advice so generally salads, occasional rice, homemade wholemeal or sourdough bread, homemade soups, etc. and plenty of fruit and vegetables.

I've certainly noticed a dramatic increase in BS levels since the new year. Up to then, I was between 8.0 and 11.0 most days but more recently 14.-20.0 or higher for no apparent reason.

Most of my breakfasts are shredded wheat and semi-skimmed milk, and then my BS can be 22 four hours later.

very frustrating!

 

[rebrascora]

Some of the foods you mention are not what I would consider as low carb or high fat (wholemeal bread, shredded wheat, fruit and semi skimmed milk) but I appreciate that you have been eating "lower carb" and if you have been eating like that for a while and things have suddenly changed then I wonder if you might not be Type 2 but perhaps a slow onset Type 1 like LADA (Latent Autoimmune Diabetes in Adults) That often exhibits as Type 2 and may respond to Type 2 treatment for weeks, months or even many years until more of the remaining beta cells are killed off and you are no longer able to produce enough insulin to keep things under control. I also wonder if this might have coincided with your Covid vaccination or perhaps a mild Covid infection as that obviously stimulates/triggers the immune system and Type 1 diabetes is about the immune system "getting uppity" and targeting our own insulin producing beta cells for some crazy reason.

Can you tell us a bit about how you came to be diagnosed... ie the circumstances like were you symptomatic. What was your HbA1c at diagnosis etc. Were you significantly overweight and/or underactive at the time?

 

[trophywench]

One thing you haven't yet mentioned Richard is the third part of the treatment triad for diabetes - ie diet, exercise and drugs if you need them - so that's exercise?

 

[RichardH54]

Hi, Richard.
I think that a couple of Shredded Wheat comes to around 30g carb, that's before adding any milk. How many are you having?
Martin

Hmm. Just two. Maybe I need to change that.

 

[Drummer]

You might see an entirely different set of readings if you avoid high carb foods - I find that the time of day is important as well as the carb content. I am more sensitive to carbs in the mornings.
Grain products in a sugary liquid do not appear on my menu, no ordinary bread either - I have protein and fat at breakfast time, and no more than 10 gm of carbs, as a salad or stir fry - or often one tomato thinly sliced on top of scrambled eggs with cheese. I eat again 12 hours later, and have protein and fat with up to 30 gm of carbs then, though most often 25gm.
That gives me normal numbers - and I am never hungry.
I do eat a little fruit, but not often, and all from berries, as they are low carb, and I chose low carb vegetables too. I set 10 percent as my limit for everyday foods, though I do have high cocoa chocolate, but only one square, and not every day.
I have coffee with cream twice a day, otherwise water, though sometimes fruit flavoured tea, or mint and liquorice in the colder months.
I usually do not go much over 7mmol/l after meals.

 

[RichardH54]

I’ve just calculated that I’m probably having 70-80 g carbs each day.
So maybe I need to be stricter with myself.

 

[Leadinglights]

When people talk of low carb that is usually less than 130g per day but many people find that they need to go much lower than that, even as little as 40g but you are on quite a bit of medication in particular the gliclazide which if you go too low with carbs could give you hypos so be careful and make sure you are testing especially if you are driving.
Maybe a review of your diet would be worthwhile and some testing of meals to see if anything in particular is giving you the high readings. Peoples sensitivity to carbs does change over time and quite a few people have found their blood glucose levels have been unstable after Covid vaccines.
So your 70-80g carb per day does seem reasonable but your breakfast is accounting for nearly half of them. Full fat Greek yoghurt and berries and seeds or bacon and egg indeed eggs in any form would be a much lower carb breakfast.

 

[PattiEvans]

I know few diabetics who can get away with cereals in the morning, the time most people are most insulin resistant. Milk also contains lactose, a form of sugar. It's better to have whole milk rather than skimmed milk as the fat can slow down absorption of the carbs. Your breakfast alone, 2 x weetabix = 36g carb, 200ml skimmed milk = 20g so total 56g carb, more than half the carbs you say you eat in a day. Bread, wholemeal or not is also a culprit. You don't say when it is you test. For example do you test before your meals and again 1.5 - 2 hours after, because the absolute rise may not be as much as you think if you are generally running high.

However it may be that you are producing less insulin now as your poor pancreas has been working too hard. Needing insulin isn't unusual in long term T2s. Not necessarily LADA which is actually an autoimmune disease. There are tests for LADA but in reality they are rarely done.

Keep a detailed food diary for a week and weigh your portions - it's so easy to "carb-slip" - I sometimes find myself bolussing for 20g carb when in fact weighing the food would tell me I'm actually eating nearer 40g.

 

[RichardH54]

When people talk of low carb that is usually less than 130g per day but many people find that they need to go much lower than that, even as little as 40g but you are on quite a bit of medication in particular the gliclazide which if you go too low with carbs could give you hypos so be careful and make sure you are testing especially if you are driving.
Maybe a review of your diet would be worthwhile and some testing of meals to see if anything in particular is giving you the high readings. Peoples sensitivity to carbs does change over time and quite a few people have found their blood glucose levels have been unstable after Covid vaccines.
So your 70-80g carb per day does seem reasonable but your breakfast is accounting for nearly half of them. Full fat Greek yoghurt and berries and seeds or bacon and egg indeed eggs in any form would be a much lower carb breakfast.

Thanks. I’ll try eggs tomorrow

 

[RichardH54]

I know few diabetics who can get away with cereals in the morning, the time most people are most insulin resistant. Milk also contains lactose, a form of sugar. It's better to have whole milk rather than skimmed milk as the fat can slow down absorption of the carbs. Your breakfast alone, 2 x weetabix = 36g carb, 200ml skimmed milk = 20g so total 56g carb, more than half the carbs you say you eat in a day. Bread, wholemeal or not is also a culprit. You don't say when it is you test. For example do you test before your meals and again 1.5 - 2 hours after, because the absolute rise may not be as much as you think if you are generally running high.

However it may be that you are producing less insulin now as your poor pancreas has been working too hard. Needing insulin isn't unusual in long term T2s. Not necessarily LADA which is actually an autoimmune disease. There are tests for LADA but in reality they are rarely done.

Keep a detailed food diary for a week and weigh your portions - it's so easy to "carb-slip" - I sometimes find myself bolussing for 20g carb when in fact weighing the food would tell me I'm actually eating nearer 40g.

Thanks. I tend to test before lunch and supper. I’m used to it being high in the morning as per the dawn phenomenon.

 

[PattiEvans]

You might find this helpful - Test, Review, Adjust Also have a look at "Jennifer's Advice" but I'd add to that a test before meals to compare and see the rise. It may be that you need nothing more than a basal insulin to get the numbers down generally if the rises after meals are minimal. Different people's insulin production is broken in different ways.

Oh and here is an article that might help you to ameliorate the dawn phenomenon https://www.diabetes-support.org.uk/info/?page_id=143

 

[RichardH54]

You might find this helpful - Test, Review, Adjust Also have a look at "Jennifer's Advice" but I'd add to that a test before meals to compare and see the rise. It may be that you need nothing more than a basal insulin to get the numbers down generally if the rises after meals are minimal. Different people's insulin production is broken in different ways.

Oh and here is an article that might help you to ameliorate the dawn phenomenon https://www.diabetes-support.org.uk/info/?page_id=143

All very interesting. Thank you. I’ll try the Jennifer route and see what happens

 

[RichardH54]

Well, after following the Jennifer route and discussing the results with my DN, I'm now on Novomix 10ml twice daily. I start tomorrow.

I've been warned that my BS may rocket for the first couple of days so it will be interesting to see what happens.

 

[PattiEvans]

Oh, I wonder why she says BS may rocket. I hope the Novomix helps. You have to remember with the mixed insulins that you will need to eat roughly the same amount of carbs per day and at the same times. Some people find that a bit restrictive, but a lot of people are fine with it.

 

[RichardH54]

Thanks for the advice. My DN said a number of things which contradicted what the Novomix leaflet and website says do I generally take her advice with a pinch of salt

 

[PattiEvans]

Thanks for the advice. My DN said a number of things which contradicted what the Novomix leaflet and website says do I generally take her advice with a pinch of salt

Hmmm... before replying perhaps it would help if you told us what she said that contradicted what the Patient Info leaflet said? I presume this is the nurse at your GPs practice?

 

[RichardH54]

She said I need to keep the pen in my fridge at all times. And keep it in a chiller bag when out during the day. According to the patient info leaflet, the pen in use needs to be at room temperature in order to resuspend properly