Type 2, two months after diagnosis; need help

Just need to set some realistic goals to start with and go from there. Right now you’re acting like a guy who has never lifted weights before trying to bench press 500 lbs… It just doesn’t work that way.

I think it leaves you in a similar position to me: not really a “classic” Type 2, not really a “classic” Type 1. There is something called “Type 1b” which presents as a (sometimes milder) form of Type 1 without antibodies associated with autoimmune diabetes. You could be MODY, some of which present closer to Type 1 than Type 2, and most present somewhere in the middle.

But none of that really matters. Find what is working for you, adjust as needed, and then stick with it til you need to change. My doctors think that I’m early LADA or Type 1b (I had detectable but lower than reference antibody results for Type 1), but Metformin ER, diet, and exercise are working to control my BG for now. So, until something changes (which I’m sure it will at some point), I’m sticking with my treatment plan: 2,000mg of Metformin ER a day; less than 30g net carbs a day; and five workouts a week plus biking to work (3 strength, two long rides, daily rides to work/town). It’s working, and I expect my next A1c to be sub-5.0.

I still stress and obsess over numbers (see my posted thread this week :slight_smile: ), but overall what I’m doing is working. I don’t like eating low-carb, and I’m not sure at my age, with my job, and a 3 month old kiddo that I can keep working out as consistently and as often as I do now. But…I’ll keep doing what works until it doesn’t. And then find something else to do that works.

Dealing with diabetes is a long-haul proposition, no matter what variety of the disease you get.

Meant to reply to @John_R’s comment above, in re:

GAD was negative. I don’t know where this leaves me. Just an update.

All I know is that it’s 39 degrees here and I feel 20 below. I’m so cold it’s hard to describe.

I believe I’m below 30 grams of carbs a day I’m not work because I don’t feel like I have the energy. I don’t feel like I can eat high-fat it’s making me ill. I still have to find out what works for me. If anything.

Maybe it’s worth considering insulin at some point, even if you aren’t a T1, in order to eat more carbs, if the LCHF diet is making you feel so sick. It’s worth knowing that that’s a possibility anyway. I would strongly encourage in the meantime using a calorie counter for a few days to track nutrients as people have suggested—in addition to Myfitnesspal, there’s also LoseIt (designed/named for weight loss, but can be used for whatever). One reason people tend to lose weight on LCHF is that it’s harder to eat as many calories on it—maybe you aren’t eating enough.

Also, maybe getting a therapist familiar with diabetes, if there are any available in your area? It’s a reasonable thing to need in a stressful time like this, and might help provide more support and help you manage the stress as you figure things out.

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Apologies in advance for raining on the parade, but . . .

GAD is a useful test but it’s not entirely conclusive. Two reasons. (A) antibodies don’t always appear right away but sometimes only later, and (b) GAD is only one of several antibody tests used to diagnose T1. The fact that one of them is negative doesn’t mean they all will be. All of this is easily researched, but HERE is a starting point.

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here is another complete description of all the antibody tests

Both my doctor endocrinologist and my wife are convinced that I am not type 1. I don’t want to be type 1 and I genuinely believe that I am type 2.

There is a great deal of marital Strife right now. I’m having conflicts with my wife who believes that because the metformin has been increased I should now be able to expand my diet. This blossomed into a huge argument and I won’t get into the details.
I’m also not feeling well today but still at work.
I do blame myself for this continued weight loss but I don’t know how to level it off without making myself physically ill. Either by raising my glucose which I have been commanded to increase during my lunch or dinner as an experiment…or continue.
Most of the drugs it would follow metformin seem to be geared toward a reduction in weight or so I understand.
A diabetic person I know was just put on Januvia… he’s quite big though. Not sure that would be right for me. I’ll have to let the endocrinologist decide when I see her on Dec 9th. I suspect my A1C will be near normal so no new prescription to what I’m expecting.
… things are out of my control this point. Thank you all for your knowledge so far and your support.
I know that you all mean well.
I understand I’m under duress. Time progresses and I just have to play this out. Don’t know what else to say.

I kind of wish the forum would try to stop convincing a person who’s clearly in a dark place right now that they have more or different diseases than the two actual doctors who actually examined him as a patient and diagnosed him… think that might be in the persons psychological best interest

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Eat more protein and fat. Have you even tried this as a solution? Weight loss or gain is determined by total calorie intake (over a longer than 24 hour period), not the macros (fat, carbs, protein, alcohol, etc.). If you are losing weight and you don’t want to, you need to increase your calorie intake to match your TDEE. If you don’t want to eat fat, eat more protein. If you don’t want to eat protein or fat, and somehow think eating more carbs is your only possible solution, then you need to look into different medications than Metformin. Metformin isn’t going to help you too much with carb-processing, since it doesn’t affect your insulin production.

So, eat more calories (protein and fat), deal with higher Blood Glucose (which you clearly are concerned about), or ask for different medications if you aren’t willing to eat low-carb. There is no shame in asking your doctors for help. If you can’t manage your BG through diet and exercise and metformin, it doesn’t matter what type of diabetes you have. You need to change something: diet, exercise, or medication.

Simplest solutions, speaking from experience since I’ve been in a very similar situation (seriously, low insulin production, carb “sensitivity,” negative on initial antibody tests, losing weight rapidly and undesirably):

  1. Increase daily calorie consumption while keeping your carb intake the same.

  2. Reduce your daily energy expenditure (probably not recommended).

  3. Ask for medications which will help you to metabolize higher carb consumption without raising your average BG. The medications that do that include insulin, incidentally… And they all require careful management and experimentation to get working properly. See pretty much every thread on this forum not specifically devoted to Type 2s on diet and exercise.

Edit: I even have a wife who is annoyed by my dietary restrictions and tight blood glucose targets, and thinks I should just have higher blood sugars and eat closer to a “normal” diet.

Edit 2: And since I know you’re concerned about cholesterol and diet, you can always stick to eating chicken breast with no skin, baked or broiled fish, and low-carb tofu. There are many options to get more protein (and fats) without increasing your dietary cholesterol.

I’m trying to do all the calories I can. I’m physically backed up and having restroom emergencies. I am consuming as much fat as I can and it is making me ill.
I’m eating as much protein as I believe I can.
Had baked fish tonight. Chicken last night. Thanks!

Best of luck then. I sincerely wish you well, but I certainly don’t have any answers. Hopefully the doctors can help you out. I’d highly encourage you to see a counselor: you sound despairing, which is just going to make management of diabetes and your weight ever more difficult. Talking through issues with a disinterested third party has been enormously helpful to me over the years, and doesn’t require taking another pill.

Thanks. I know. I’m just telling you what I know. Talking isn’t going to take away the physical things I’m dealing with. I am seeing a councillor.

John, If you need to take family leave from work until you get a handle on this, it’s been explained that that’s an option and a right you have.

It’s also been suggested repeatedly that you count calories to ensure you’re getting enough. I sincerely doubt you are getting enough. Have you tried this? Wouldn’t it be a relief to see that the reason you’re losing all this weight is because you’re only eating 1/3 of the number you need to maintain weight? A guy like you or me probably need at least 2400/ day to maintain especially if you’re active at work.

I understand how tough this is but you’re really making it as difficult as possible. eat normal balanced healthy meals that allow your body to digest food correctly. Your blood sugars are going to not be perfect for a while… that’s life. You’re going to see your endo in a few days and figure out what an appropriate treatment plan is… and even after that your blood sugars aren’t going to be perfect-- because you have diabetes. So does half of the rest of the country. At this point your psychological problems are a lot more alarming to me than your metabolic ones.

You managed to do your job just fine when you were 70lbs overweight and had an A1C of 14. I’m pretty sure you’re going to figure out how to do it just fine at a healthy weight with controlled blood sugars-- and I’m pretty sure you’ll feel a hell of a lot better doing it at the end of the day.

Take a deep breath. And take some more Metamucil. And when you look around your mailroom at work— realize that A LOT of your coworkers have diabetes too. It’s not like you are dying of cancer, this is long term condition that just requires some management.

Ditto.

I know what I’m about to say will result in some folks thinking I’m cold and unsupportive (and even worse) but:

When you repeatedly do not take advice from the knowledgeable PWD on this Forum or come up with reasons why you can’t follow this advice, people begin feeling dismissed and frustrated.

And when you make it sound like your D is all but a death sentence, it eventually annoys the PWD that work hard each day to live a “normal” life and are repeatedly trying to help you do the same.

I can’t help but wonder whether there is some secondary gain involved here…

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I didn’t mean to dismiss anybody. I’m frustrated with my situation.
The people here are knowledgeable…
That’s it. Thanks.

While metformin is associated with weight loss, most thinking is that this is due to loss of bodyfat (which probably is due to increased insulin sensitivity and decreased preference for storing bodyfat).

With few exceptions (GLP-1), none of the T2 medications really have been found to result in weight loss. Most experts will tell you to lose/gain weight by modifying your diet.

You also need to develop a perspective. This is a marathon and none of us with diabetes should expect we will have perfect blood sugars. I would encourage you to develop achievable expectations with your blood sugar control. Reduce the friction with the wife. Maybe you can set some looser after meal targets? Simply keeping your 2 hour after meal blood sugar below 180 mg/dl and keeping your fasting blood sugar at 100 mg/dl can still result in an A1c of 6.5%.

Would this not be perfectly reasonable and help your life right now? It would expand what you can eat, help you gain back weight and make your household more harmonious. Most importantly it will reduce the stress and anxiety you feel because you are not perfect.

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That would be nice.
I didn’t get much help from the dietician…all I know is 1/4 apple and a slice of bread brings me to 180+…with an omelette.
When I had what I thought was a balanced diet before … I was averaging 355 glucose according to the initial A1C. I got to a point where I couldn’t stay awake a half hour after a meal.
I used to think I ate a ‘balanced diet’…definitely the most multi-grain …etc guy in the house.
My replies to other people’s questions are just making people angry. I’m trying to listen to divergent opinions…and questions. I’m imperfect at this. Thanks for giving me non-judgemental advice.
I feel directionless outside of this forum at times.

I’ve been asked how many calories I’m taking in. I’ve only been able to estimate 1400 to 1500 at most. That’s with trying to cook with coconut oil…using olive oil on salads …butter on veggies…eating eggs and chiken…beef. You name it. I have difficulty estimating things that my wife has cooked for us.
I’m aware I’m not taking in enough calories.
I’ve looked online to see what 2000 calories actually looks like and I can’t imagine I was eating that many before…but obviously I was.

Concerning counciling. I’m seeing a guy on Tuesday. He wants to hypnotize me to address my ringing in my ears. That’s the best I can get here. I’ll talk to him about these emotions.

This forum is mostly geared to people already living and understanding pumps …mdi…cgm…
I don’t know where else to go. I’m sorry.

My fasting on 2000mg metformin has finally Gone down to the 99/100 range. It was moving up in the 110s. That number seems to move up slowly. Don’t know what to do about that.

I have to be honest. I don’t think much of most nutrition advice from dieticians. In my case, after I was diagnosed I had conflict with my wife. I could not tolerate the amount of carbs in her cooking. Over that first year after diagnosis I eventually took over cooking and even shopping. My wife would still have tantrums at some meals asking “where are my carbs!” Over time we have worked through the issues. I learned to offer carbilicious selections for those in my family that want and could eat them. And over the years my wife has adopted low carb eating and lost weight.

I dramatically up my calories by eating lots of fat. For instance, if you have fish, then top it with this sauce which can add a add another 500-1000 calories per serving. I know you are saying that you are having digestion problems with fat. It may be that you have had some sort of gut isses. I might suggest trying to use probiotics and fermented foods to see if you can get your gut working better. You can get some basic probiotics in the vitamin aisle at the grocery store. I also eat all kinds of fermented foods like sauerkraut, pickles and yogurt. Another thing to do is up your fiber. On really good source of fiber is a type of noodle called shirataki (search the forum for this term). Shirataki has no carbs and is basically all fiber. It can be substituted for noodles, it makes a passable replacement for spaghetti noodles and really shines in pan fried noodles or in noodle soups.

Just some thoughts.

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1500 cal, there is your problem, no matter what diabetes you have, you will lose weight on that.
to put on weight, I would be eating a lot more. 100-120g protein content of food.per day…I would be eating 200-240g of fats, including fat bombs and bulletproof coffee.
I would eat enough carbs to bring me up to 140-160 2hrs after a meal, it will also stay a bit high at 3 hrs because of the proteins and fats take longer to digest.

240g fats = 2100 cal …provide energy. and 10% or 24g …goes to glucose
120g protein = 480 cal build flesh, (provide heat, I read that and it made sense), and 58% about 70g …goes to glucose
30g low carb veg and salad… = 120 cal and 30g to glucose
starch carbs, ?? = xx cal and all the grams to glucose

without what starch carbs you can eat added…that’s 2600 cal, and 120g of glucose …
example…when you have 30g protein meal and veg… you work out how much fats are in it with one of the counters and top it up to 60g fats and then add the starch you can have
you will soon get the idea of how much fats are added to what is already in your diet… a tablespoon/dobb/patt of butter on your veg is 15g

OR

You go onto oral meds/insulin to let you eat a lot more carbs, I would choose insulin, as I think it’s safer and will help preserve what pancreas function is left. If I went down this path.

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jack16 pretty much hit the nail on the head! :+1:t3: