type 2 Newbie - advice needed

[rosenkranzio]

Hi all,

I've been lurking around this forum ever since I was diagnosed with Type 2 diabetes on 17/12/13 but never got up the courage to post. I'd just like to share my 10-week experience of managing diabetes and ask for advice. It's a long post so bear with me.

I've been on Metformin 500g twice a day (though my GP advised me to take it three times daily). I'm due a follow-up appointment tomorrow with my GP but I got my blood test results today:
17/12/13: HbA1C 8.0% (64 mmol/mol) Weight: 99kg (BMI 31)
25/02/14: HbA1C 5.8% (40 mmol/mol) Weight: 89kg (BMI 28)

The nurse wouldn't divulge my cholesterol levels over the phone for some reason but she said they had returned to normal levels. I will quiz my GP further on this. When I was diagnosed, my GP said he might put me on statins the next time I saw him but I'm glad this prospect seems to be less likely now.


DIET over the past ten weeks:
Breakfast: gluten-free porridge and 1-egg omelette + more often than not 1 Ryvita with Philadelphia cream cheese
Lunch: Fresh salad: lettuce, tomatoes, cucumbers + tuna mayo/piece of ham + a pear
Dinner: Meat dish: beef/chicken/turkey cooked with carrots/onions/cauliflower/broccoli in spices/tomato sauce/rice milk. Eaten with half cup of quinoa or simply with fresh salad. I don't take fish very often.
At the weekends, I'd eat sausages for breakfast, with at most one slice of brown toast. We usually eat out at the weekends; I'd have a meat dish with the occasional small portion of boiled potatoes or fries or white rice.
Drink: Water mostly. Stopped drinking tea regularly (used to take it with 4 teaspoons of sugar!!!). I might have a decaf cappuccino (no sugar) when we eat out. I've cut out alcohol but I only used to drink occasionally.
Treats: I've essentially stopped indulging in store-bought treats containing refined white sugar. I had a leftover packet of Rich Teas (15 at most) and would help myself to one every time I felt a craving. In addition, my wife would bake a sponge cake using almond flour/brown rice flour and sweeten it with 3 teaspoons of xylitol and pear slices. I'd have a slice of it maybe three times a week after dinner. I do have a small pear almost everyday.

WEIGHT LOSS
I've lost 10kg in 10 weeks. I heard that weight loss is normal on Metformin, but I guess part of it was the diet. I personally feel it was too much too fast - just like my Atkins weight loss stint some 10 years ago where I dropped 20kg over 4 months. It was unsustainable of course and I regained it all back once I returned to my normal unhealthy diet. From young, I was a healthy weight right into my mid-twenties, after which I started gaining weight steadily. I have been yoyoing between a BMI of 29 and 31 ever since. I'm happy I've lost some inches around the waist and that the clothes feel looser. My BMI is 28 and I still need to bring it down to 25, which would involve another 10kg weight loss. I suspect it'll be harder to lose this additional 10 kg and that if I want it to be permanent, it'll take time. The initial weight loss in Dec/Jan was very quick but it has slowed down recently.

EXERCISE
When I was diagnosed, I bought an exercise bike and started off with the best of intentions by doing 30 minutes everyday, but that lasted a week and a half and I haven't really done much exercise since. I'm afraid the weight loss so far might actually involve some muscle loss. I was also probably carrying a lot of water weight too. I know I need to start thinking of exercise as a natural bodily need (like eating/sleeping) and not simply a lifestyle choice. I still need to reduce inches on my belly and diet alone probably won't be enough.

I still feel very tired at night and much to my wife's annoyance continue to drop off to sleep on the sofa by 8.30/9. But she's happy that I've finally stopped snoring and she doesn't need to wear ear plugs for the first time in our married life together. Is this because of Metformin? I stopped snoring almost immediately after I started the dosage so it can't be because I've lost weight. I've don't wake up clammy with sweat anymore.

ADVICE NEEDED
1. Could anyone give me some feedback on my diet. I think I probably should try to vary my diet more to make sure I'm getting enough vitamins/minerals/roughage from natural sources.
2. Is my HbA1c level in the "normal range" or should I aim to reduce it even further? I read from the BloodSugar101 website that diabetics shouldn't just be content with reaching 6%.
3. If I manage to maintain my HbA1c, do I nonetheless start testing my BG levels daily to see what foods cause a spike?
4. I know I should start exercising more. But should I stop taking Metformin and see whether exercise plus diet can maintain or reduce my HbA1c?
5. Any thoughts on the use of Xylitol as a sweetener? Does anyone use it regularly?

I feel I haven't been informing myself as much as I should be since the initial feverish spurt after my diagnosis so maybe these questions seem a bit naive. Thanks in advance for your input.

 

[Redkite]

Hi and welcome to the forum 🙂

You've done fabulously well in such a short space of time, so congratulations on your Hba1c, which is now in the normal non-diabetic range. Your diet sounds ideally suited to weight loss for a person with insulin resistance (very low carb), but in order for you to stay motivated I would suggest now broadening it to include small portions of carbs, otherwise if you feel restricted you may end up falling off the wagon! Do you have a BG meter to test your levels? It can be very useful for people with type 2 to experiment eating different carbs and checking their BG level before and two hours after eating, to see what effect a particular food has on them as an individual.

Re the exercise, you have to do something you enjoy! Even if it's just a daily stroll round the block, timing can help - doing moderate exercise straight after eating will help increase your body's sensitivity to the insulin you are producing in response to the meal, and thereby help bring your BG level back down to pre-meal figures more quickly.

 

[everydayupsanddowns]

Congratulations on your progress rosenkranzio

Regarding HbA1c levels... the best data we currently have seems to stem from the DCCT trial which suggests that in general lower A1cs are associated with fewer diabetic complications. The 'curve' especially for retinopathy rises pretty steeply above 7% or 7.5% but benefits continue to be seen at and below 6.5%. The challenge, of course, is achieving an A1c in the 6s without hypoglycemia, but if you are managing that - the lower the better.

Additionally there does seem to be some evidence that low A1c is only part of the picture. Two people with identical A1cs might have very different levels of chemical markers associated with some complications if one of them was constantly zig-zagging from crashing hypos to mega-highs, while the other was just wibbling along with a nicely narrow BG range. Doing some BG testing before and after meals would give you an indication of your own fluctuation. Some is inevitable, but it is better to keep the variation as low as you can manage.

Like Redkite I suggests I think it's important that you don't consider your new approach to food as a short term 'fix' after which you can revert to eating whatever you fancy. It's important that you find a diet that is enjoyable enough for you to sustain it long term, while being BG-friendly enough to maintain your current successes.

The good news, from what I've seen of other T2s, is that as weight (and associated insulin resistance) reduces - you may find you have a little more license with carbs and treats which can help.

As is often said here - it's a marathon not a sprint.

Good to see you posting. I'm sure your experiences will help others 🙂

 

[Pete H]

Welcome to the forum, and I take my hat off to you, you have achieved more in two months than I have in 12 years, all I can say is keep on the track your on now and that's half the battle, pop on here for any questions you might have and keep up the good work 🙂

 

[Mark T]

Welcome to the forum rosenkranzio 🙂

Your current regime is working for you so I would keep at it. Yes a HbA1c below 6% is very good, but with losing say 5kg of that remaining 10kg you may be able to bring it down another couple of notches - which can only be beneficial to your health.

 

[cardinalGT]

Hi rosenkranzio,

Here's what I did to encourage myself on my exercise bike;

I too bought an exercise bike (only somthing cheap from argos). I did it because the area I lived in at the time was not especially safe to be wandering around by oneself and whilst I can walk, I cant run.

I did acheive a 30mins per day routine on my bike and have increased it over time. However I absolutely loath exercise - in my head I consider it a waste of time i.e. I could be doing it with more interesting things. So I combine doing something I hate with something I enjoy - watching TV.

I arranged my bike in front of my laptop on which I can play DVDs. At first I exercised to Big Bang Theory (30 mins - be careful you might laugh too much and fall off the bike), then I went for CSI Vegas training (40 mins). West Wing and Game of Thrones took me to 45 mins and I now working up to either Foyles War or Frost - both of which are over an hour long.

I used to do it in the evening after dinner, and now (having returned to the UK) I do it in the morning - sometimes before/sometimes after breakfast or in the afternoon before partner gets home.

Exercise is perhaps one of the most useful treatments of this disease. It really is worth making an effort to incorporate exercise. I try to do an hour a day most days (no more than 2 days off in a 7 day week). I find that whilst you think it might not have a direct impact on the numbers, I see my numbers stablise to a much narrower range and on the whole I feel better.

If you dont have a laptop, little portable DVD players are quite cheap these days - or perhaps look on ebay / gumtree. Look on it as part of treatment of the diabetes

I think your progress is very good. (Slightly jealous here - I cant get my weight to go down - but then again it is not going up either!) This could be the cycling - muscle weight probably and I have lost a couple of inches on those curvy bits.

when my numbers are reasonably stable and I finally got a grip on what foods I could/could not eat (thanks to a meter), I started testing only every 3rd day - once before breakfast and then either side of dinner. I do this cause - strips are not cheap and I only get 50 to last me 2 months and becuase I need to teach myself to recognise when my sugars go high and to make myself behave responsibly with food choices!

Hope this helps and keep going, you are on the right track for you.
Good luck

 

[LeeLee]

Wow! Haven't you done well!

To answer your question about sweeteners, I've used most of them - except xylitol. My current supply is stevia, but usually just buy whatever is cheapest on the day.

As for exercise, rather than but an expensive clothes horse I got my bicycle out of the garage and bought some wet weather gear. I cycle most days to work, to shops, etc. I can get a whole week's shopping for one on the bike with two pannier bags, a basket and handlebars to hang carriers on.

I decided to stay on metformin after my BG returned to a healthy range, partly to keep the free prescriptions (I have a long list of medicines to keep other stuff under control), and partly because of its protective effects on certain nasties that lurk in my family history.

 

[rosenkranzio]

Thanks all for your encouragement & advice. Really appreciate it.

Redkite: yes I will look into including a broader range of good carbs and start self-monitoring

everydayupsanddowns & Mark T: your comments on HbA1c levels were very enlightening

Pete H: you're nonetheless 12 years wiser than me in this area!

CardinalGT & LeeLee: great advice on exercise. I now need to put my mind to it!

Thanks once again 🙂