Diabetes (type 2) Query

[Verbena17]

So for the past 3 months I’ve been trying to lower my HCA1C test of 49. Had my retest, having been really good, cut out almost all processed sugar and lowered carbs, walked more when my feet aren’t painful etc.

Got my results back and it’s literally gone UP to 50 😩.
What does this mean?
In the past week, I’ve been feeling shaky when exerting myself/dog walking, feeling like I need to eat to stop that ‘low blood sugar’ feeling but actually I just took my blood sugar 3 hours after brekkie and whilst having symptoms before I ate lunch, and it was 6.4.

Does this likely mean I’m diabetic? In addition I I’ve requested another blood test to check if my iron is still low (was 10 a year ago) because low iron can obviously affect the A1C test- making readings higher. My shaky/weak/no energy/slight cough symptoms are also the symptoms of having low iron….as well as being the same for low blood sugar.
Im overweight and losing any weight is really hard even though my diet is really quite good.

Really this won’t be full blown diabetes but I had a 2 week course of dexamethasone in 2021 and you can get steroid induced diabetes, either temporarily or long term. There is new research from the Recovery Trial saying patients who had dexamethasone whilst in hospital were prone to acquiring diabetes. When I was on it, they had to give me insulin injections to regulate my blood sugar.

That should have obviously typed HBA1C

Hi - no, it’s a ‘safe AQ’ one.

With that Hba1c you are at no risk of diabetes complications so that's good. If you take a snack when feeling shaky you will be fine. Everyone's blood sugar fluctuates, and if you aren't taking insulin the risks of low blood sugar are tiny IE you feel a bit shaky or hungry... that's it. The GP can figure out what your test results mean, it isn't something that worrying will fix. Just keep doing what you're doing, eating well and exercising.

Need to take it 2 hours after eating, if under 7 you're fine.
6.4 is normal though. Just keep doing what your doing, diet and excerise you'll soon get it back into normal range.

Thanks.
@NewtonsCradle but surely if I’m shaky & weak etc, my blood sugar would have been much lower than 6.4?

I’ll take it again at half 2…..2 hrs after eating.

When I called the GP yesterday to get retest A1C result, she said that the GP had already booked me in in 2 weeks time with diabetic nurse!

The GP didn’t even bother calling me to explain anything.
It was me who knew that low iron could affect the A1C test result giving a false high reading but they didn’t even suggest an iron test. When I rang to talk to the on call GP he was like “oh yes, that sounds like a sensible idea”.
Good job I sorted it!

I’m a clinical nutritionist and I work mainly with remission of type 2.

Do you want to share your food diary?

Thanks 😊
I don’t have a set food diary but I can tell you a typical day of eating for me.
This was even before I knew the result….

Breakfast
Porridge with blueberries & banana
or Violife vegan cheese spread with salad wrap
Cup of tea with oat milk

Lunch
2 poached eggs on 2 rounds of granary
or soup and 2 rounds of bread
or a cheese & salad wrap

Snack
Apple & 2 or 3 medjool dates

Tea
Jacket potatoes with avocado salad
or roast chicken & veg
or salmon with new potatoes and broccoli.

Multiple cups of tea through day (maybe 4) with oat milk.
my downfall - bowl of cereal sometimes before bed.

You could feel shaky at 6.4 because your body is used yo higher blood glucose levels meaning you are already diabetic but that's just one POV.
Essentially it doesn't really matter why you are diabetic now if you are but rather how to try and reverse it or manage it best.
It is quite common for diabetics to be low on iron and vitamin D3, B12 because insulin resistance can hinder the absorption of those vitamins and minerals.

@TomatoSandwiches thats interesting and also something I’ve been thinking…..that I might have been diabetic for a while (like 1- 2 years).
For the past year, my foot pain (thought was plantar fasciitis) has got worse and I do get peripheral neuropathy type symptoms in hands and feet.

Also interesting you mention how low iron can be caused by diabetes.

I get that shaky feeling and when I test my blood sugar it is never low at that time.
Isn’t 6.5 before meals potentially pre diabetic?
Your diet is relatively carb heavy, I wouldn’t expect you to be able to control pre diabetes or change your long range blood test result with that particular menu.
As mentioned above Zoe may really suit you. I have done it and no longer get the shaky jelly sensation. Foods are personalised depending on how your body processes sugars (which isn’t the same thing as whether you are diabetic/prediabetic) and fats as well as gut micro biome.

You’re still eating very high carb for someone trying to lower HbA1c. I’ve put all the sources of carbs in bold.

Breakfast
Porridge with blueberries & banana
or Violife vegan cheese spread with salad wrap
Cup of tea with oat milk

Lunch
2 poached eggs on 2 rounds of granary
or soup and 2 rounds of bread
or a cheese & salad wrap

Snack
Apple & 2 or 3 medjool dates

Tea
Jacket potatoes with avocado salad
or roast chicken & veg
or salmon with new potatoes and broccoli.

Multiple cups of tea through day (maybe 4) with oat milk.

You need to cut out everything in bold and replace with lower carb options. Start the day with protein and fat like bacon and eggs with avocado or smoked salmon and poached eggs.

It will keep you much more satisfied and help with cravings. You’re also better off with real full fat cheese, vegan food products are highly processed. This will drive inflammation and make insulin resistance worse.

Yes @Verbena17, your diet doesn’t sound unhealthy at all, just not suitable for someone trying to control diabetes

There's no such thing as 'full blown diabetes'.
You're either diabetic or you're not. 49 is in the diabetic range (just) so you should be monitored and screened accordingly going forward.
Even if your hba1c drops below 48 we wouldn't then say you're not diabetic. Just a very well controlled one.
Ask for a referral to a DESMOND programme if they are commissioned in your area. Structured diabetes education.

thankyou all for sharing your knowledge and insight - been invaluable - nit like my GP practice staff who gave been useless and obstructive to the detriment of my health 👍🏿☘️🙏🏽

If you have peripheral neuropathy it won't be due to diabetes, your Hba1c isn't high and you think you might have had diabetes for a maximum of 2 years. If you have feelings of lightheadedness and neuropathy you need to talk to the GP, it could be just one of those things, it could be a vitamin deficiency, it could be psychological or it could be something neurological. Your Hba1c isn't high enough and you haven't had diabetes long enough to get diabetic neuropathy... To me it sounds like you are mostly suffering from worry and excessive research. Regarding diet, you are a human and you need to have balance and enjoy your food. It's great to make positive changes but don't beat yourself up about it. Make a few low carb swaps but don't martyr yourself, find what's sustainable for you. Your GP isn't that bothered because your results aren't bad at all. If you felt hypo symptoms with a blood glucose of 6.4mmol/l you wouldn't have an Hba1c of 49 or 50 it would be much much higher again worry and research can cause symptoms. Please stop worrying and just show up to your nurse's appointment and listen to what s/he says.

Ooh you easily have over 100g there op in a typical day.
Have a read up about it, diabetes uk has a forum where you'll get lots of help.
Aim to cut those carbs down- to nearer 30/40g a day.

Hmm thanks (I think) @NewtonsCradle 😂. The foot pain and pins and needles in feet and hands is definitely not psychological - I’d been having physio and she knew how much my feet hurt (although I didn’t think it could be PN at that point). When I said maybe I’ve had actual diabetes for longer, I was meaning potentially…..I’m not saying for sure that I have had.

So @LMNT it’s odd that so many diabetic meal plan websites suggest whole wheat wraps/whole grain bread/rice etc - saying that whilst you need to monitor them and have as part of a controlled diet - not cut them all out completely. Just not to overdo it.

To get my A1C down, I specifically didn’t want to go full keto and didn’t feel I needed to in order to make quite significant changes.
I looked at a diabetic site showing you how to make small changes and I was already doing them all! I’m no longer eating biscuits, crisps, pasta, cake, more than 2 rounds of granary bread a day etc. Seems odd the result didn’t come down slightly.

I realise that the day meal plan looks quite carby but if say I had a wrap for brekkie, I wouldn’t have bread or a wrap for lunch. They were examples but I keep processed carbs as low as I can.

@HumourReplacementTherapy that wasn’t a typical day - sorry.
it was examples of foods I might eat for those meals - not necessarily all on one day.

So I wouldn’t have a wrap for breakfast, jacket potato for lunch and bread for tea.

But thanks for all the input - I will take more of a look at the carbs I eat.
Am slightly confused @LMNT - because the apple for example….it’s a low GI fruit. And whilst it’s a fibrous carb, if I totally no fibrous carbs, I’m massively risking nutrient deficiencies.

Oh and the vegan cheese was just an e ample. My vegan DD is home and I just happened to spread that on a wrap for brekkie with salad yesterday. I do eat full fat cheese.

You’re eating a lot of carbs. I would try low carbing and see if you feel better? I found it quite an easy way of eating, no faffing and no immediate cost.

I have t2 diabetes, I used to feel like you do, but never do now with low carbing and metformin.

My diabetes nurse encourages low carbing (not all do), and says a bowl of porridge or a jacket potato might as well be a bowl of sugar for a diabetic, fibre or no fibre.

Sticking with meat, veg, fats, some cheese can quickly improve things.
She sent me a links I’ll try and find it.

Diet sheet by Dr David Unwin
(Had to google it, will see if there’s more)