Well, this is a surprise.....

[Docb]

Thank you. I am all for pragmatism. Would it change your view if the figure had climbed from 37 two years ago?

Only a little and I personally would like to see something better than two points to declare a trend. I quite understand those who suggest early action, "just in case", it's just not my way of approaching things.

 

[JITR]

This is a very interesting question. But the issue is how do I get the daily 2,500ish calories into my system to keep a stable weight without quite a lot of carbs or protein?

... or healthy fat, some of which comes from protein.

BTW is your weight the same or less than two years ago? Or a bit more?

 

[Leadinglights]

I am a bloke who loves a piece of tech. How do people feel about something like https://www.freestyle.abbott/uk-en/products/freestyle-libre-2.html?

Some people find it very useful but it is an expensive bit of tech if self funding at about £50 for two weeks of use. It also has limitations which you need to be aware of. People can often over react to the information it gives.
It can be used for a trial period to see if there are any meals which cause particular problems but so can finger pricks as long as you do it strategically.

 

[snowball12]

Can I just correct you there @snowball12 - sugar does not turn into carbohydrate because it is already a carbohydrate! To be pedantic, the sugar we try to control in our blood, glucose, is also a carbohydrate.

The term carbohydrate covers a vast range of stuff from very simple compounds that we generally call sugar through to very complicated compounds that we generally call starches. All carbohydrates have the potential to be converted into glucose in the gut and be absorbed into the blood stream.

@NewDawn - my suggestion is that you don't panic and stop rushing about trying to solve a problem that maybe does not exist. My thought is that you carry on with life as normal and in 6 months to a year get another HbA1c and see if it has changed. If it has increased significantly, then begin to think about the changes you might make to stop it rising. If it is the same, then treat it as your natural HbA1c. But then, as many on the forum will know, I am a bit of a pragmatist.

I stand corrected. Diabetes continues to fry my brain on a daily basis. Sigh!!

 

[everydayupsanddowns]

Welcome to the forum @NewDawn

Hopefully you can find a few modest tweaks to your menu to help reduce your glucose levels and steer away from the diagnostic threshold of 48mmol/mol.

There are people who are not are normal weight at diagnosis with T2, partly it can depend on where you carry weight, and whether the body stores fat around organs - sometimes called TOFI “Thin Outside Fat Inside”. Professor Taylor who pioneered the DIRECT trial that showed the potential positive impact of substantial weight loss in T2 also studied the benefit of weight loss for people not usually considered overweight with the ReTUNE study.

Aside from weight loss, the other main strategy employed by forum members with T2 is a reduced carbohydrate menu, typically less than 130g a day (so far from ‘no carbs’).

Good luck finding an approach that suits you and your needs.

 

[everydayupsanddowns]

My question is how best to monitor whether these changes have any effect or not. There seem to be home monitors, some with paper strips, some with continuous monitoring.

I’ve taken the liberty of moving your posts into the same thread to keep replies together 🙂

One of the most cost effective methods of self monitoring glucose levels is with a fingerstick meter. Many T2s (unless on certain types of medication) need to self-fund their monitor, because research studies put more value on checking hypoglycaemia than managing/monitoring diet changes.

The most affordable and reliable meters members here have found are the SD Gluco Navii, the Spirit Tee2, or the Contour Blue - which all have test strips at around £10 for 50. Some other brands can be 3x that much!

You can use a BG meter, taking a reading before and again 2hrs after eating, to see what the differences are, and how your body coped with the meal (initially in a way it could be argued that the numbers themselves matter less than the differences between them). Ideally you would want to see a rise of no more than 2-3mmol/L at the 2hr mark.

Once you can see how you respond to different meals amd sources of carbs, you can begin experimenting with reducing portion sizes of the carbs where you see bigger rises. You might find that you are particularly sensitive to carbohydrate from one source (eg bread), but have more liberty with others (eg oats or basmati rice) - It’s all very individual! You might even find that just having things at a different time of day makes a difference - with breakfast time being the trickiest.

Over weeks and months of experimentation you can gradually tweak and tailor your menu to find one that suits your tastebuds, your waistline, your budget and your BG levels - and a way of eating that is flexible enough to be sustainable long-term.

Good luck! And let us know how you get on 🙂

 

[NewDawn]

BTW is your weight the same or less than two years ago? Or a bit more?

The same.

 

[Drummer]

This is a very interesting question. But the issue is how do I get the daily 2,500ish calories into my system to keep a stable weight without quite a lot of carbs or protein?

Well - in nature protein comes with fats, usually.
Foods which are processed to conform to modern dietary recommendations are out of kilter with what we Humans ate for all of our existence - I suspect that a lot of modern ailments are exacerbated by that if not caused by it.

 

[JITR]

My question is how best to monitor whether these changes have any effect or not.

Simon

I would track FBG with a finger prick monitor.

That's what I did when I followed Professor Taylor's advice to get my liver back to normal and put my T2D into remission. It was 17 mmol/l at diagnosis and 5.8 mmol/l after one week on a VLCD diet. That told me I was on the right track. As I hate finger pricks I didn't ask my wife to do it again. My HbA1c was 39 after 3 months on the diet and 32 after 6 months, BMI down to 21.

Your case is different as you seem to be a TOFI (see Mike's post above). That means doing regular tests to estabish the trend as Docb said..

 

[NewDawn]

That's what I did when I followed Professor Taylor's advice to get my liver back to normal and put my T2D into remission. It was 17 mmol/l at diagnosis and 5.8 mmol/l after one week on a VLCD diet. That told me I was on the right track. As I hate finger pricks I didn't ask my wife to do it again. My HbA1c was 39 after 3 months on the diet and 32 after 6 months, BMI down to 21.

Your case is different as you seem to be a TOFI (see Mike's post above). That means doing regular tests to estabish the trend as Docb said..

Thank you.

Unfortunately a VLCD diet is not an option as low blood sugar brings on migraines so I have to walk a bit of a tightrope.

But will definitely be giving Dr Taylor a long look.

 

[CliffH]

Following swiftly on the heels of @Bowbell, I have just been told that I am prediabetic, just over the line at 42 mmol/mol.

And this has come as a bit of a shock as my BMI is 21, waist size 33, other than at breakfast I don't eat sugary things, drink on average 3 units of alcohol a week, don't smoke, and exercise a lot. Doing a bit of reading, I am suspicious of the protein bars I eat when I am out and about as, while they have little sugar, they do have artificial sweeteners.

So the breakfast cereals are gone, as are the protein bars pretty much. I don't eat nuts, so seed trail mix it is. Which will be....dull.

My question is how best to monitor whether these changes have any effect or not. There seem to be home monitors, some with paper strips, some with continuous monitoring.

All advice gratefully received.

Thanks,

Simon

A thought: assuming that you decide that it's best to make a permanent dietary change rather than crash diet, it will need to not be too "dull", or you'll never stick to it. Do you have access to a dietician, who can advise you on the most important/helpful changes?

 

[NewDawn]

A thought: assuming that you decide that it's best to make a permanent dietary change rather than crash diet, it will need to not be too "dull", or you'll never stick to it. Do you have access to a dietician, who can advise you on the most important/helpful changes?

Thank you.

I am hoping that the changes which I have already made plus an increased awareness of carbs will sort it. If not, will start looking at options.

 

[JITR]

Unfortunately a VLCD diet is not an option as low blood sugar brings on migraines so I have to walk a bit of a tightrope.

Just to clarify, my BMI was 29 and my HbA1c was 117. I needed to lose weight as well as putting T2 into remission. So I went on a real food version of Roy Taylor's VLCD diet. His research predicted my blood glucose would come down to normal in 7 days. It did.

Your position is different. You do not need to lose weight and you are not diabetic. However, as you probably know from your reading, HbA1c of 42 suggests you are developing a fatty liver. This usually results in glucose and lipid (fat) dysregulation, insulin resistance and so on. If you are a 'TOFI' Prof Taylor's research also suggests you may have a very low personal fat threshold. That could lead accumulation of fat in the liver and pancreas and could explain an increase in HbA1c without weight gain.

You dietary changes may well do the trick. Maybe some 16:8 or 5:2 fasting might help a bit too.

 

[NewDawn]

Just to clarify, my BMI was 29 and my HbA1c was 117. I needed to lose weight as well as putting T2 into remission. So I went on a real food version of Roy Taylor's VLCD diet. His research predicted my blood glucose would come down to normal in 7 days. It did.

Your position is different. You do not need to lose weight and you are not diabetic. However, as you probably know from your reading, HbA1c of 42 suggests you are developing a fatty liver which usually results in glucose and lipid (fat) dysregulation, insulin resistance and so on. If you are a 'TOFI' Prof Taylor's research also suggests you may have a very low personal fat threshold. That could lead accumulation of fat in the liver and pancreas and could explain an increase in HbA1c without weight gain.

You dietary changes may well do the trick. Maybe some 16:8 or 5:2 fasting might help a bit too.

Thank you. I am afraid that fasting is not a possibility as low blood sugar brings on migraines.

 

[JITR]

I am afraid that fasting is not a possibility as low blood sugar brings on migraines.

@NewDawn
Given your concerns about low blood sugar, I think you should try a CGM.

It will quantify you how your glucose levels vary. You need to know when they are running too high (diabetes risk) and going too low (migraine risk).

Good luck with it.

 

[NewDawn]

@NewDawn
Given your concerns about low blood sugar, I think you should try a CGM.

It will quantify you how your glucose levels vary. You need to know when they are running too high (diabetes risk) and going too low (migraine risk).

Good luck with it.

Thank you. I have been granted a free CGM test patch for 14 days which is nice of Freestyle Libre. Hopefully that will give me enough information to see what food is doing what to my system. Should arrive in a few days.

I have also acquired a fingerprick device. When one is just monitoring, is the best plan to take a fasting reading every day? I know that when I have done a non-fasting glucose test in the past I was always high, but when I drove hypoglycaemically (therefore very slowly) in for the test it always came out fine.

 

[everydayupsanddowns]

Thank you. I have been granted a free CGM test patch for 14 days which is nice of Freestyle Libre. Hopefully that will give me enough information to see what food is doing what to my system. Should arrive in a few days.

Hope it provides you with some helpful information @NewDawn

Spot fingerstick checks can be informative, but one of Forum T2s favourite strategies is to ‘interrogate’ different meals by taking a reading just before and again 2hrs later, then look for the “meal rise”. Ideally you’d want this to be 2-3mmol/L rise or less from the ‘before’ reading.

Where a meal gives a larger rise, you can experiment with adjusting and adapting, incrementally reducing the portion size of carbohydrates, or trying a lower-carb swap.

When you say you’ve been seeing high readings - what sort of numbers are you seeing?

To give you some encouragement about your headaches with lower glucose levels - the body has a sort of internal ‘thermostat’ and can base it’s reactions on variance against your general running-range.

So if you can reduce your levels steadily and in a sustained way, you may find that your brain and body adapts, and doesn’t complain.

Low glucose (hypoglycaemia) can bring-on fierce headaches AKA “hypo hangover”, so the migraines may be hypo symptoms based on relatively low levels where your body is used to running higher?

 

[NewDawn]

Spot fingerstick checks can be informative, but one of Forum T2s favourite strategies is to ‘interrogate’ different meals by taking a reading just before and again 2hrs later, then look for the “meal rise”. Ideally you’d want this to be 2-3mmol/L rise or less from the ‘before’ reading.

Where a meal gives a larger rise, you can experiment with adjusting and adapting, incrementally reducing the portion size of carbohydrates, or trying a lower-carb swap.

When you say you’ve been seeing high readings - what sort of numbers are you seeing?

To give you some encouragement about your headaches with lower glucose levels - the body has a sort of internal ‘thermostat’ and can base it’s reactions on variance against your general running-range.

So if you can reduce your levels steadily and in a sustained way, you may find that your brain and body adapts, and doesn’t complain.

Low glucose (hypoglycaemia) can bring-on fierce headaches AKA “hypo hangover”, so the migraines may be hypo symptoms based on relatively low levels where your body is used to running higher?

Thanks. I plan to do the interrogation when I get the CGM monitor as it seems perfect for the purpose rather than sticking myself several times a day.

Now that I recall, the higher numbers were cholesterol, not glucose, sorry.

The migraines IMO are definitely migraines not hypo hangover. They are normally caused by lack of sleep or glare, but can come on with the same symptoms if I get hypo.

 

[everydayupsanddowns]

but can come on with the same symptoms if I get hypo.

What sort of numbers are you seeing when hypo?

 

[NewDawn]

What sort of numbers are you seeing when hypo?

Don't know. I only started testing myself 20 minutes ago(!) My tendency to get "hangry" has been well-noted by friends and colleagues. People wanting something from me would ask "has he eaten recently?". To the answer "no" they would come via the canteen. The hangry phase is closely followed by an advancing migraine.