underweight T2 getting depressed

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Pookie

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Type 2
I am officially underweight. Or I am back to the weight I was when I was 20 (I'm now in my 60s), having lost 2 stone since being diagnosed with T2 (went to the doc for tests as I was so constantly exhausted). Even then I was not overweight. And always a healthy diet so can't understand why I got diabetes unless it was stress!
Anyway my point is that I have cut out just about all low fibre carbs and sugars and eat incredibly healthily so was very satisfied when my HbA1c came down and I stopped Metformin. But 6 months later, same v healthy diet, and the HbA1c went up again and I'm back on the Metformin. The only area I can improve things is I guess eating more but I'm not hungry and I'm totally bored of even thinking about food.
Is it possible to find a diabetic nutritionalist to analyse everything I eat for a week or so and tell me what I'm still doing wrong? I feel I should be able to sort this but maybe I need personalised advice. I want to get on with my life but the diabetes is obsessing me and making me miserable because I don't know how to move it on.
Has anybody got any practical advice?
Sorry to be such a moaning minnie but I can't moan to my family and thought maybe this forum was the place to do it?
 
Can your Doctor or Diabetes SN point you in the right direction?
 
If you post up exactly what you eat and drink (and the proposed weights) for each day then maybe some analysis can be done which might help you.
 
Can you give us an idea of the sort of things you typically eat at the moment for breakfast lunch and evening meal? The reason I ask is that you mention that you have cut low fibre carbs but just wondering if you are still eating wholegrains and legumes. Some of us are particularly susceptible to the carbs in lentils etc and things like porridge which are supposed to be slow release are like rocket fuel. Have you invested in a BG meter and done some testing around the meals you have to see how your body responds?
I had a cauliflower and halloumi curry last night made from scratch and no rice or bread of any sort with it but I add a tin of chickpeas and my levels went up to 10 and stayed there all night because of those chickpeas and I didn't even have a big portion. I love them but they really don't love me and my diabetes! Even with insulin at my disposal they are a pain in the backside to manage. It was a rare treat so I accept the hit to my levels, but annoying that I can manage an ice cream better than a few chickpeas in a vegetable curry! 🙄 Diabetes isn't always logical when it comes to healthy eating!
 
Thank you to anyone who is reading this (Gwynn!) and a bigger thank you to anyone who can advise....
I'm 5'7 and weigh 8stone 2lbs. Last week I was told I have some diabetic retinopathy. No explanation of what that means...
Breakfast is normally overnight pinhead oatmeal with some berries and greek yoghurt with chopped nuts and seeds. Cup of expresso coffee with a little full fat milk.
Lunch is one slice toasted multigrain sourdough with a bowl of salad and some protein (prawns, salmon, cheese).
Cup of rooibos tea.
Supper: haddock or mince or steak or tuna with big pile of mixed cooked veges and maybe a little mixed grains or lentils. A couple of squares of 85% dark chocolate.
I tend to drink fizzy water or H&B kombucha and maybe have a gin & low sugar tonic.

Very occasionally I'll have half a pint of guinness or a ginger oatcake. If I'm hungry I'll eat a piece of cheese or some salted peanuts or an oatcake with peanut butter on.

I think I should maybe be having a savoury breakfast but I really don't want to change and start cooking eggs first thing....

Any advice anyone?
 
rebrascora said:
Can you give us an idea of the sort of things you typically eat at the moment for breakfast lunch and evening meal? The reason I ask is that you mention that you have cut low fibre carbs but just wondering if you are still eating wholegrains and legumes. Some of us are particularly susceptible to the carbs in lentils etc and things like porridge which are supposed to be slow release are like rocket fuel. Have you invested in a BG meter and done some testing around the meals you have to see how your body responds?
I had a cauliflower and halloumi curry last night made from scratch and no rice or bread of any sort with it but I add a tin of chickpeas and my levels went up to 10 and stayed there all night because of those chickpeas and I didn't even have a big portion. I love them but they really don't love me and my diabetes! Even with insulin at my disposal they are a pain in the backside to manage. It was a rare treat so I accept the hit to my levels, but annoying that I can manage an ice cream better than a few chickpeas in a vegetable curry! 🙄 Diabetes isn't always logical when it comes to healthy eating!
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Thank you for replying to me. I have a Libre2 coming. Do you just test 2 hours after eating rather than every hour of the day? I do remember from last time I used one that I actually wake up registering about 9.
 
Whilst there are a few carbs you could still pare down, I don't think it would necessarily be reasonable to do so and I do wonder if you might be a slow onset Type 1 rather than Type 2. Was your HbA1c at diagnosis very high and what has it gone up to now?
 
Pookie said:
Thank you for replying to me. I have a Libre2 coming. Do you just test 2 hours after eating rather than every hour of the day? I do remember from last time I used one that I actually wake up registering about 9.
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You can scan Libre as many times a day as you like, (I average about 30 scans a day, but I need to keep a closer eye on my levels because I use insulin.) but the guidelines for Type 2 are to be no more than 2-3mmols higher 2 hours after a meal and ideally between 4 and 7 before a meal and no more than 8.5 2 hours afterwards. Obviously, if you are getting waking readings of 9 then you will not expect to achieve those target ranges, but if you can keep the increase from each meal below 3mmols you should see that waking reading gradually come down. If you are a slow onset Type 1 then your body is reaching the point where it cannot produce enough insulin to keep your levels in check and insulin therapy may soon be required. I know that is something that you will perhaps not want to contemplate but it allows you more freedom with your food and whilst it does take a lot of headspace initially, you get used to it, much like learning to drive a car. More importantly, you will start to feel better once your diabetes has the right treatment and your levels are better managed.
 
rebrascora said:
Whilst there are a few carbs you could still pare down, I don't think it would necessarily be reasonable to do so and I do wonder if you might be a slow onset Type 1 rather than Type 2. Was your HbA1c at diagnosis very high and what has it gone up to now?
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The highest it got to was 50, then it went down to 43 and now its up to 50 again.
 
rebrascora said:
You can scan Libre as many times a day as you like, (I average about 30 scans a day, but I need to keep a closer eye on my levels because I use insulin.) but the guidelines for Type 2 are to be no more than 2-3mmols higher 2 hours after a meal and ideally between 4 and 7 before a meal and no more than 8.5 2 hours afterwards. Obviously, if you are getting waking readings of 9 then you will not expect to achieve those target ranges, but if you can keep the increase from each meal below 3mmols you should see that waking reading gradually come down. If you are a slow onset Type 1 then your body is reaching the point where it cannot produce enough insulin to keep your levels in check and insulin therapy may soon be required. I know that is something that you will perhaps not want to contemplate but it allows you more freedom with your food and whilst it does take a lot of headspace initially, you get used to it, much like learning to drive a car. More importantly, you will start to feel better once your diabetes has the right treatment and your levels are better managed.
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Thank you Barbara. I'm turning into a real miseryguts, very tearful. Maybe its the weather. But I really thought I had the diabetes on the run when it came down to 43 and I came off the Metformin. I will get the tester and try to be logical about all this. The trouble is that there doesn't seem to be a lot of logic. I can't believe you tolerate chick peas worse than ice cream. So basically I have to test everything...
 
My first thought was slow-onset Type 1 too @Pookie Your BMI is 17.8. You mention 2 stone weight loss when you weren’t overweight to start with. The other possibility is that you are Type 2 but your insulin-producing cells are depleted or losing function. @Jenny105 is/was in a similar situation with weight loss and is now on insulin.

One thing you could do is use an app like MyFitnessPal to tot up your daily calories, carbs, etc so you know exactly what you’re eating and if your calorie intake is sufficient. That would be a good starting point for any investigations. It might be that you need more calories and/or carbs, and if the carbs push your blood sugar up, then some medication to support your body in eating the food it requires.
 
Diabetes is very individual and you have to find what works for your body which is why the Libre is so wonderful, but straight forward finger pricking can be helpful for most dietary and oral meds managed Type 2s provided you use an appropriate strategy of testing.

The sugar in an icecream is relatively easily burnt off. The chickpeas just keep on giving for hours and hours! Might be fine if I was a marathon runner.... but I am not and certainly not in my sleep. :( Not stopping me eating some more of the curry today though and I am really playing fast and loose now as I have added sweet potatoes to the mix! I have hit it with 4 units up front but my insulin pen will be close to hand and getting some work to do this afternoon. Absolutely love next day curry though!
 
@Pookie I also suspect that you are not an ordinary type 2 who will go back to normal on low carb - but, you are eating grains - which I avoid and would not eat oats, nor bread, lentils, oatcake, and peanuts are legumes which some people have to count as almost double the listed carb content (I go for 180% for accuracy)
I suggest as a stopgap measure eating more protein and fats, avoiding grain and legumes and go for low carb veges, but getting back to your GP with thoughts of slow onset insulin requiring types would be my advice. Very ordinary type 2s can put on weight just by taking a deep breath outside a baker's shop.
 
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Pookie said:
Thank you Barbara. I'm turning into a real miseryguts, very tearful. Maybe its the weather. But I really thought I had the diabetes on the run when it came down to 43 and I came off the Metformin. I will get the tester and try to be logical about all this. The trouble is that there doesn't seem to be a lot of logic. I can't believe you tolerate chick peas worse than ice cream. So basically I have to test everything...
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It is hard, when you put a lot of effort into managing your diabetes well and it doesn't reward you with good numbers and I can understand not wanting to contemplate needing insulin..... it was the only time I cried after my diagnosis, because I felt like I had failed. That wasn't the case of course and I tried incredibly hard with my diet and exercise to bring my levels down but even with oral meds it wasn't happening and I later tested positive for Type 1, so I was never going to be successful at managing my diabetes that way, but now I have the right tools to manage it, I mostly manage it very well (apart from chick peas and lentils of course) I should say that an ice cream is a very rare treat and usually when I am working very hard and burning off glucose.
 
This sounds a similar situation that a friend has, she was diagnosed with a high Hba1C and put on metformin and told to cut carbs which she did but lost loads of weight and muscle strength, she then had gliclazide added but still losing weight. Just recently has had once a day, I assume basal insulin, added but is now eating a lot of carbs to try to halt the weight loss. But I feel without bolus insulin that is not going to help. For example for lunch she had a massive jacket potato with prawns and a carton of orange juice. She does have a self funded Libre but is seeing levels of 17 even before eating.
I advised her to get some Ketosticks. I do feel really worried for her as she looks really unwell.
I am hoping with her Libre data the diabetic clinic will see what may be going on. @TinaD you saw her didn't you.
 
Ice cream is a frozen custard - so I make a real custard, with cream and eggs, and freeze it, either whipping i every few minutes or getting the icecream maker out if it is a large batch, and I eat it with fruit as the sweetener, or sometimes add a little alcohol for real rum and raisin.
 
Leadinglights said:
This sounds a similar situation that a friend has, she was diagnosed with a high Hba1C and put on metformin and told to cut carbs which she did but lost loads of weight and muscle strength, she then had gliclazide added but still losing weight. Just recently has had once a day, I assume basal insulin, added but is now eating a lot of carbs to try to halt the weight loss. But I feel without bolus insulin that is not going to help. For example for lunch she had a massive jacket potato with prawns and a carton of orange juice. She does have a self funded Libre but is seeing levels of 17 even before eating.
I advised her to get some Ketosticks. I do feel really worried for her as she looks really unwell.
I am hoping with her Libre data the diabetic clinic will see what may be going on. @TinaD you saw her didn't you.
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I did. Like a wraith - desprately thin.
 
I will do some analysis based on guessed weights of food. Could be interesting. I am particularly interested in the vitamins and minerals too.

No fruit?

I will have a look tomortow as I have guests today
 
It must be very frustrating, but it looks like you may be one of the 'lean' types for which the traditional progression of diabetes is not based on insulin resistance leading the beta cell failure. I don't believe they know why it happens, but there are theories that beta cells fail for some reason and there are none of the Type 1 anti-bodies present (Lean T2s don't produce a lot of insulin, whereas a 'classic' type 2 will produce a fair amount, even though cells are failing and the mass of beta cells has shrunken).

They used to call it 'Jamaican diabetes' as it was prevalent there, and linked to childhood malnutrition and birth weight.

A family history of diabetes does seem to make it more likely, and I believe there are genes present in 'lean type 2s' that aren't present in 'classic' T2s (i.e. those of us who were 'rotund' on diagnosis) that have been linked to beta cell dysfunction.

This info is not very helpful to you. Metformin may well have helped out in getting it down to the 42, as the max dose of metformin can improve hba1c by around 12 (or 1% in the other measurement.). Your diet looks pretty good, to be honest, I'd push for more help and tests if possible from the medical people. I know someone in the same boat as you and they did all the tests to rule out T1.

Do you smoke or drink? These have both been linked to 'lean diabetes'.
 
Hi. You are very likely to be late onset T1 (LADA) as you have not been overweight. You appear to be having the right diet. I went down the same route and realised I was not the T2 my GP had diagnosed me with and after going thru all the tablets I ended up, thankfully, on insulin. Insist your GP refers you to the diabetes clinic for GAD and C-Peptide tests. The former tests for one but only one of many possible antibodies and the latter measures your insulin level. In general if the latter is high you are T2 and if low you would be T1 but it's a very loose guide. Having a negative GAD does not prove your beta cells are in a good state. Do you have a glucose meter; this is essential? You should probably be on one of the other diabetes tablets.
 
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