# Diagnosed Type 2 10 years ago now facing increased HbA1c



## Nick Cliff (Oct 18, 2019)

I am an atypical Type 2 in that I have never had a weight problem.  Since diagnosis in 2009 have been able to control my condition by diet and exercise - so no medication.  My HbA1c was 53 when diagnosed, and has held stable at 50 or below mostly since.  Recently, however I've had a 57 and a 56.  Am hoping this is a blip, but something tells me it's deterioration with age, and medication beckons.
Be good to hear from anyone else out there who's been through something similar.

For the newly diagnosed who may read this.  10 years of declining cakes at work, steering clear of stuff with added sugar, and getting regular exercise has kept me off medication, and not ruined my life!   I realise I am very fortunate compared to a lot of other diabetics.


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## Docb (Oct 18, 2019)

Yep been there.  My HBA1c dodged round the low 50's for years before jumping, for reasons unknown, to 88 at last years annual check.  Medication and cutting carbs beyond the obvious sugars which I did not have anyway got it under 50 fairly quickly. 

Thank goodness for the annual check I say.


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## Drummer (Oct 19, 2019)

If you want to avoid medication perhaps assessing the amount of carbs you are eating could put it off for a few more years.
It is not just added sugar which is the problem but the naturally occurring sugar and all the starches - including the brown ones.
How much carb do you eat - what would be a typical daily menu?


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## Nick Cliff (Oct 20, 2019)

Docb said:


> Yep been there.  My HBA1c dodged round the low 50's for years before jumping, for reasons unknown, to 88 at last years annual check.  Medication and cutting carbs beyond the obvious sugars which I did not have anyway got it under 50 fairly quickly.
> 
> Thank goodness for the annual check I say.


Thanks Docb.  Good to find someone else in similar situation.  Let's hope mine is similar outcome.


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## Nick Cliff (Oct 20, 2019)

Anitram said:


> Hi, Nick
> 
> Although I was only diagnosed Type 2 in March we have much in common. I didn't have a weight problem either and through diet and exercise have brought my Hba1c down from 114 to 41 without medication. However, I am under no illusion that if I have a deteriorating pancreas function then I will eventually be on meds and beyond that possibly insulin. I average 120g of carbs per day, so I have carbs in the bank if I need to cut more.
> 
> ...


Thanks Martin.  I also got the level down to low-mid 40s quite qucikly, and since then have remained on the borderline for meds, which looks like I am about to cross.
Nick


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## Nick Cliff (Oct 20, 2019)

Drummer said:


> If you want to avoid medication perhaps assessing the amount of carbs you are eating could put it off for a few more years.
> It is not just added sugar which is the problem but the naturally occurring sugar and all the starches - including the brown ones.
> How much carb do you eat - what would be a typical daily menu?


Hi Drummer.  Thanks.  Am embarrassed to say I don't know my daily card intake in terms of an amount. I suppose it's a measure of my success until know that I haven't needed to.  However, I have found I need a decent supply of carbs, so tend to eat a large bowl of porridge or other cereal with seeds/nuts and fruit for breakfast, lunch is at least a sandwich, or some rice, but with salad and evening potatoes, pasta or rice with the family evening meal.  When I have tried reducing carbs, out come the oatcakes between meals!   
Perhaps I should make a more concerted effort now.
Thanks, Nick


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## rebrascora (Oct 20, 2019)

If you are going to cut back quite drastically on your starchy carbs as well, be sure to increase your fat intake, to provide an alternative energy source and also to make the menu more pleasant and therefore sustainable long term. I used to eat masses of bread and potatoes because I had spent my whole lifetime bulking out every meal with them. It takes quite a bit of getting your head around eating without them but once you learn it is a very enjoyable way to eat. Last night I had cottage pie made with mashed cauliflower instead of potato and of course cheese on the top. I cook for myself and my partner, who is not diabetic, and we both thoroughly enjoyed it. I served it with brussel sprouts and cabbage and swede and it was delicious. The beef mince had 20% fat which gave it so much more flavour and provided the extra calories to keep weight stable. I have cream in my coffee on a morning. Creamy Natural greek yoghurt with my Low Carb Granola and berries for breakfast. Omelettes with mushrooms and a salad work well for breakfast or lunch. Bare Naked noodles which are zero carb with stir fries, courgette instead of spaghetti and lots of homemade ratatouille in lovely tasty olive oil which goes great with burgers or steak or chicken or even salmon. Avocados with my salads. Nuts and/or cheese or olives for snacks. Lots of mushrooms go into my cooking and there are few things which are not improved by the addition of a knob of butter, so don't feel that you are being hard done to by having to cut back on carbs, there are lots of great things you can eat.


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## rebrascora (Oct 20, 2019)

Nick Cliff said:


> Hi Drummer.  Thanks.  Am embarrassed to say I don't know my daily card intake in terms of an amount. I suppose it's a measure of my success until know that I haven't needed to.  However, I have found I need a decent supply of carbs, so tend to eat a large bowl of porridge or other cereal with seeds/nuts and fruit for breakfast, lunch is at least a sandwich, or some rice, but with salad and evening potatoes, pasta or rice with the family evening meal.  When I have tried reducing carbs, out come the oatcakes between meals!
> Perhaps I should make a more concerted effort now.
> Thanks, Nick



Once you cut back on the carbs you stop craving them but it is important to eat plenty of other things to fill you up and fat is actually more filling than carbs, so try a chunk of cheese instead of an oatcake when you get the nibbles. Fruit also needs to be rationed. Learning which fruits and how much of them you can get away with BG wise is important. You would benefit from using a BG meter if you have not done so up until now. That will focus you on what is causing you most problems and help you to cut them out. They can be bought quite cheaply (approx. £15) but the ongoing cost of buying test strips needs to be factored in and it therefore makes sense to buy one which has the cheapest test strips. The SD Codefree is recommended for that reason as they are £8 for a pot of 50 as oppose to £20 for some other meters.


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## Nick Cliff (Oct 20, 2019)

rebrascora said:


> If you are going to cut back quite drastically on your starchy carbs as well, be sure to increase your fat intake, to provide an alternative energy source and also to make the menu more pleasant and therefore sustainable long term. I used to eat masses of bread and potatoes because I had spent my whole lifetime bulking out every meal with them. It takes quite a bit of getting your head around eating without them but once you learn it is a very enjoyable way to eat. Last night I had cottage pie made with mashed cauliflower instead of potato and of course cheese on the top. I cook for myself and my partner, who is not diabetic, and we both thoroughly enjoyed it. I served it with brussel sprouts and cabbage and swede and it was delicious. The beef mince had 20% fat which gave it so much more flavour and provided the extra calories to keep weight stable. I have cream in my coffee on a morning. Creamy Natural greek yoghurt with my Low Carb Granola and berries for breakfast. Omelettes with mushrooms and a salad work well for breakfast or lunch. Bare Naked noodles which are zero carb with stir fries, courgette instead of spaghetti and lots of homemade ratatouille in lovely tasty olive oil which goes great with burgers or steak or chicken or even salmon. Avocados with my salads. Nuts and/or cheese or olives for snacks. Lots of mushrooms go into my cooking and there are few things which are not improved by the addition of a knob of butter, so don't feel that you are being hard done to by having to cut back on carbs, there are lots of great things you can eat.


Thanks Barbara.  I had been wondering if eating more fatty foods was part of the answer.  When I was diagnosed I was also told my cholesterol was high and told to use statins.  I stopped them owing to side effects, but have had no problems with cholesterol since avoiding meat fat.  Hence I avoided increasing my fat intake.  However, I have more recently added Greek yoghurt and other more Mediterranean foods to my diet after reading a Michael Mosley book on low blood sugar diet.  Will discuss this with my GP - whether there is scope for me to try this before going on meds.  Thanks.  Nick


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## Nick Cliff (Oct 20, 2019)

rebrascora said:


> Once you cut back on the carbs you stop craving them but it is important to eat plenty of other things to fill you up and fat is actually more filling than carbs, so try a chunk of cheese instead of an oatcake when you get the nibbles. Fruit also needs to be rationed. Learning which fruits and how much of them you can get away with BG wise is important. You would benefit from using a BG meter if you have not done so up until now. That will focus you on what is causing you most problems and help you to cut them out. They can be bought quite cheaply (approx. £15) but the ongoing cost of buying test strips needs to be factored in and it therefore makes sense to buy one which has the cheapest test strips. The SD Codefree is recommended for that reason as they are £8 for a pot of 50 as oppose to £20 for some other meters.


Thanks - that's really helpful.
I used to test with the meter regularly, but then the GP said it really wasn't necessary for someone in my situation, so they stopped prescribing the lancets and strips.  I bought my own, but then I sort of agreed with her that testing was pointless as my blood sugars were stable.  But as you say, using the meter might help me analyse good and bad changes to my diet.  You've certainly given me plenty of (low blood sugar) food for thought!  Cheers.  Nick


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## rebrascora (Oct 20, 2019)

Some people on here have found that their cholesterol decreased after increasing their fat intake. Unfortunately the science is lagging a bit with nutrition. So many foods have been wrongly demonised (think eggs) based on poor research.The NHS is still lagging behind in relation to new thinking, so the doc will likely tell you to keep low fat and eat wholemeal bread and pasta etc.  ie the healthy eating plate. You will need to make your own mind up whether to experiment with fat in your diet or follow the accepted belief that low fat is best, but do bear in mind that GPs do not know everything.... some people on this forum have been told that they cannot be Type 1 diabetic by their GP even when they have tested positive, because they were taught many years ago at medical school that Type 1 only exhibits in children and young adults.... there are lots of us on this forum which prove that to be incorrect.


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## Drummer (Oct 20, 2019)

That is a heavy load of carbs - and really - we do not need carbs.
It goes against the accepted way to eat - but people have been trying to get the establishment to accept that we are healthier and happier, and often thinner and more active on a restricted intake of carbs - right back 100 years before Dr Atkins William Banting was able to lose weight and resolve persistent health problems by eating fewer carbs - so why we are told that there is not data on low carbs I do not know. It has been the latest diet fad for a couple of centuries.
If your diet has been similar to the list you gave, you have been very lucky to have remained at the levels you achieved.


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## Eddy Edson (Oct 20, 2019)

rebrascora said:


> Some people on here have found that their cholesterol decreased after increasing their fat intake. Unfortunately the science is lagging a bit with nutrition.



Just to note that there is no science lag.  Saturated fats and refined carbs will increase your LDL cholesterol. Unsaturated fats and unrefined carbs will not.  There's no controversy about this, except maybe at the fringes. Of course, you have to look at the totality of the diet.


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## Drummer (Oct 21, 2019)

It is - however - problematic to wish to reduce cholesterol, particularly targeting LDL cholesterol when analysis of LDL and age at death has shown either no impact, or a higher age at death was associated with higher levels of LDL, not lower. The article was on the BMJ Open site and the nurse I saw at my last visit had to read it twice before she understood what it implied.


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## InForum (Oct 21, 2019)

Nick Cliff said:


> I am an atypical Type 2 in that I have never had a weight problem.  Since diagnosis in 2009 have been able to control my condition by diet and exercise - so no medication.  My HbA1c was 53 when diagnosed, and has held stable at 50 or below mostly since.  Recently, however I've had a 57 and a 56.  Am hoping this is a blip, but something tells me it's deterioration with age, and medication beckons.
> Be good to hear from anyone else out there who's been through something similar.
> 
> For the newly diagnosed who may read this.  10 years of declining cakes at work, steering clear of stuff with added sugar, and getting regular exercise has kept me off medication, and not ruined my life!   I realise I am very fortunate compared to a lot of other diabetics.




Hi there,  not easy with high HbA1c results is it?


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## everydayupsanddowns (Oct 21, 2019)

Sounds like you have been doing pretty well so far @Nick Cliff - but diabetes has a habit of shifting the goalposts every so often!

I’d agree with the recommendations to use a BG meter to rake a look at how your metabolism is coping with your current diet, and then considering making some tweaks where BG is being negatively impacted by different foods.

Everyone is different in what they can tolerate, but moderating carb intake (to a greater or lesser degree) often offers benefits to members here - with or without the support of meds.

You can use AlanS’s ‘test review adjust’ framework to assess which meals might benefit from some adjustment.

http://loraldiabetes.blogspot.com/2006/10/test-review-adjust.html

Keep us posted and let us know how you get on


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## Docb (Oct 22, 2019)

Ah, the mods have removed the post I was referring to - and quite right to.  Was a pretty blatant ad for an HBA1c meter and as I suggest was a complete waste of money.


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## Bruce Stephens (Oct 22, 2019)

Docb said:


> Was a pretty blatant ad for an HBA1c meter and as I suggest was a complete waste of money.



I find the Freestyle Libre gives a pretty good HbA1c estimate, and I almost never look at it. I find Time in Range vastly more useful, day to day.


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## Nick Cliff (Oct 24, 2019)

*Thank you to everyone for your advice and suggestions* - in particular regarding dusting off my blood sugar meter and using it to review changes in my diet.  Sort of going back to basics.

I met with the GP in our surgery who specialises in diabetes. Concluded that I should start on Metformin, with my next test in 3-4 months, and review the impact.  It was hard to ignore that 3 of my 4 HbA1c readings in the last 15 months have been above threshold, without any obvious cause other than deterioration.  With my build, and no evident weight problem, my elevated background blood sugar is probably genetically induced - so "nature" not "nurture" - and there may not be much scope to continue to keep it down unaided.  My father was similar and managed his Type 2 with the lowest Metformin dose.  

So it looks like a reality I have to accept, despite it feeling like a defeat.  However, from information on this thread and reading other threads I see that using medication is nothing to fear, and maybe more friend than foe in this condition.

I intend to do some baseline finger-prick tests before starting the medication, and then when on it, and also use them to identify any good or bad foods as some of you suggest.  One way or another I'll get my blood sugar level back down to a more acceptable level.


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## Drummer (Oct 24, 2019)

Odd that the expert did not pick up that you are eating porridge, cereals, fruit, bread, potatoes, rice, pasta and oatcakes - but at least you have your meter to show you just how high you are spiking after eating them.

There's nothing like seeing double digits on the meter to motivate a change.


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## Nick Cliff (Oct 24, 2019)




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## Nick Cliff (Oct 27, 2019)

Drummer said:


> Odd that the expert did not pick up that you are eating porridge, cereals, fruit, bread, potatoes, rice, pasta and oatcakes - but at least you have your meter to show you just how high you are spiking after eating them.
> 
> There's nothing like seeing double digits on the meter to motivate a change.


Hi @Drummer Thanks again for your thoughts and comments, which have been very helpful.  They made me go back and look at my past results to try and make more sense of my situation and what may have caused the recent increase in blood sugar levels.

As mentioned previously in the thread, I'm of a body type where I can eat but not put on weight - basically I'm a skinny runt.  When diagnosed in 2009, I was a little overweight at 63Kg. It took a couple of years to lose 4Kg but from 2011 to now my weight has been stable at around 58Kg and HbA1C between 44 and 50 until recently.  Via the diet I mention, and exercise, I have maintained "remission", until recently.  My diet was scrutinised by both hospital nutritionist and doctor.  I checked back and, with this diet, only once have I had a double-digit finger-prick monitor reading on the '2-hour after eating' recovery test - that was 10.1 shortly after I was diagnosed.  More typically it's below 7 - though recently 8+ and 9+ coinciding with the higher HbA1Cs (tonight it was 7.0 after a meal of rice, veg, chicken, an apple and glass of wine).  These higher HbA1Cs are not associated with putting on weight.  It seems like my body needs a steady flow of carbs and there's not much I can do about it.  To be fair to my GP, it was in the knowledge of all this that she advised medication.

The mystery, is why now has my blood sugar gone up?  Regarding diet - not much has changed - you mention fruit - thanks - one thing that HAS changed in that time is adding a few raspberries or blueberries to breakfast to get more vitamin C - so maybe that's it? The other thing is exercise - I have always found this a very important tool.  Until summer 2017 I played football one hour a week, and now do fitness pilates instead, plus swim one lunchtime a week, walk a fair bit and do gardening.  My blood sugar increase didn't occur until a year after I gave up football, but I wonder if there is a latent effect and I need to find something more energetic?  Or maybe I'm just getting older and my body is less capable of managing...

Anyway, you kicked me back into more closely monitoring myself, which I will do for a bit, before starting the medication or going back to the GP if I see improvements via that monitoring.  Thanks.


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## grovesy (Oct 28, 2019)

I have found over the years I have had to make changes to what i can tolerate.


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## Docb (Oct 28, 2019)

Hi Nick, as I said earlier, similar sort of experience with me, even down to the weight!  

The thing which keeps coming back to my mind is wondering if my pancreas function is deteriorating with age. After all most other things do. The other thing i have been wondering about is whether there is something going on on the other side of the equation, that is glucose production and absorption in the gut.  The only thing I actually know is that keeping carb intake down and taking a minimal dose of gliclazide keeps me in single figures and HBA1c in a normal range.  Quite why is a mystery and other than a broad relationship between meal time and BG,  predicting the BG you will get from a test is all but impossible.  For example, I have been running a bedtime BG of between 5.5 and 6 for a while now yet last night it was 4.3.  No change in routine or food or anything. To me its a complete mystery largely because of a lack of characterisation of what is actually going on in my body.


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## Nick Cliff (Nov 20, 2019)

Thanks to everyone for your comments and advice.
I decided to proceed with Metformin, tracking my progress.
If interested - have started a new thread for this in the General Messageboard:
*My Metformin Journey*
*https://forum.diabetes.org.uk/boards/threads/my-metformin-journey.83870/
*


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