Can I get those numbers down further?


#1

I have been lowcarbing since July and lost about 30 pounds. I’m pretty much stalled, but avoided gaining anything over the holidays. As per UK NHS rules, I get enough free strips to test blood glucose twice weekly. ( they are expensive here, so buying many more would be hard on my meagre pension.) and I want to get my numbers down a bit more. I run at about 6mmol/l (108mg/dl) and would like to hold at nearer 5mmol/l (90mg/dl) with minimal medication and still lose weight. I’m fairly good about the low carbs and exercise an hour most days. I’m 60 years old and have survived a stroke, so some movements are difficult. Mainly I walk. I have a pedometer and do 10,000 steps a day. I use Metformin (glucophage) 500mg twice daily, but don’t want to take anything which will boost Insulin production, because that would totally halt the weight loss. I have to remember that the numbers are the most important. thing for my health. I’m not in bad shape for an overweight Senior. this morning i walked the 2.5 miles into town in about 45 minutes. If anyone has any ideas on how to break the stall and get those numbers down at the same time, I’m waiting eagerly.


#2

Hana,

Congratulations on the weight loss!

Stalling happens to most people on a LC diet after a while. You may have a month without weight loss and then pick up again, or you may be well and truly stalled. I’ve experienced both.

From my own experience cutting back on protein can be very helpful. You need a bit more protein than normal on an LC diet, but nowhere near as much as many people think. Protein boosts circulating insulin levels. Fat doesn’t.

If you are eating foods with hidden carbs especially foods marketed as “low carb” stop eating them and see if that helps. If that doesn’t help, I’m afraid you may have to get obsessive about calories. I did.

The second time I did a long low carb diet for weight loss, I used software and a food scale and ate to the calorie level that online metabolic calculators suggested would work for me. At that time it was about 1450 calories. I had dropped the first 15 lbs very quickly but the second took about 9 months.

Re the blood sugar, probably all that will help is eating even fewer carbs, but there’s a trade off point where it becomes impossible to do that long-term. I think it is the excursions up more than the fasting number that causes damage. Instead of checking fasting bgs, check your 2 hour after meal blood sugar and make sure it is staying under 7.7 mmol/L (140 mg/dl) and ideally have it be back to your fasting value. If it is, then look at the 1 hour post meal number and if it is under 7.7 mmol/L too, you probably are doing as well as you can do without more meds and should end up with A1cs in the 5% range.

I think it is better to focus on maintaining that kind of weight gain long term by not making yourself crazy and deprived than to strive for perfection. I’ve done both, and too much striving led to a dramatic crash off the diet after several years and regaining of weight. The next time I went into weight loss, I let myself occasionally eat off plan and found it a lot easier to maintain.

The only weight gain I’ve experienced since then was from going off hormones and stopping Metformin, both of which were hits to my maintenance, but I’m still a lot thinner than I would ever have imagined possible ten years ago.

So rejoice in your accomplishments to date, don’t expect to lose more than a pound or two a month and concentrate on maintaining the success you’ve had and keeping the A1cs in the 5% range. Doing the latter will astonish all your doctors. People with diabetes mostly don’t.


#3

The Canadian recommendations for Self Monitoring Blood Glucose (SMBG) would indicate a minimum of 7 test strips per week, and more in the case where you are trying to improve BG levels.

I now, as a T2, and after a run in learning period where I used up to 10 strips per day, use typically 3 strips per day. 1 for Fasting Blood Glucose in the morning and one strip each at 1 and 2 hours post prandial for the largest meal of the day, or where I am unsure of what my post prandial will be because I have not eaten that particular menu previously.

It may be worth trying to convince your doctor to increase the number of test strips prescribed to you.

From http://www.diabetes.ca/cpg2003/downloads/monitoringgly.pdf

"SMBG should be recommended as an essential part of daily diabetes management for all people using insulin or oral antihyperglycemic agents.

People with type 1 diabetes should measure their BG at least 3 times per day.

The frequency of SMBG in those with type 2 diabetes should be individualized depending on glycemic control and type of therapy.

For most people with type 2 diabetes treated with insulin or oral antihyperglycemic agents, BG measurement at least once daily is recommended [Grade C, Level 3 (3)].

In many situations, more frequent testing may be required to provide the information needed to make behavioural or treatment adjustments required to achieve desired BG levels [Grade D, Consensus]."
8689-monitoringgly.pdf (42.5 KB)


#4

I have to have an A1c done next week, before my annual review. I’ve always been in the 5s so far. I’m the doctor’s star patient even if they don’t like the low carb diet.
Thanks for your comments they are helpful. I was trained as a biologist and tend to think I know it all and sometimes miss the big picture. At the moment I don’t worry too much if I go off plan once in a while. Today I stole a few chips ( French fries) off my husband’s plate and didn’t beat myself up over it. I did choose not to have any on my own plate. He’s been unwell and really fancied fish and chips. Normally I’m a prepare it from scratch cook, but he likes the traditional take-away kind. Trouble is a sick type 1 husband who is fussy about food at the best of times isn’t easy to cope with. He hadn’t eaten in 3 days, so he had what he wanted. Number one priority of the week has been to keep his blood sugars as normal as possible with an infection. they went up to 17, but the antibiotics are kicking in now. I have to deal with his type 1 as well as my own type 2. I’ve cut his carbs down too. He grumbles, but agrees he feels better for it. The doctor sent him for an A1c today. His last one was 10! I can’t control him when he’s out of my sight and he doesn’t obsess about it like I do.


#5

Try convincing the NICE Board. It’s their prescribing guidelines not the doctor . I believe it’s the result of a Canadian study, where more testing didn’t improve results for type 2s which is the cause of this. What they didn’t explain was that these people hadn’t been taught how to use their results. I have an irregular patten throughout my week and so can’t do the same every day to keep everything as good as can be. when I moan to the doctor, he just says that I know what I’m doing now. I also know other type 2s who are happy with the twice weekly testing. I went out for a meal in a goup with one before Christmas, who ate all sorts of carbohydrates in generous amounts, whilst I was avoiding them and having greens instead. She actually said" I know I’ll be on 10 tomorrow, but I don’t care".
I did test tthe next day and was at 6.despite having profiteroles for dessert( without chocolate sauce, which i don’t like anyway)


#6

FWIW, here is someone who succeeded in increasing the number of test strips prescribed…

"The reply back was from Stephen Atkinson at the Department of Health who said that any Primary Care Trust which is automatically discouraging the use of blood glucose test strips is not acting in accoradance with NICE’s advice that self monitoring may prove useful to people in the overall approach to self care.

It appears that some Primary Care Trusts are misapplying the guidelines to save themselves some money at the expense of the health of some of their patients."

http://www.bbc.co.uk/dna/actionnetwork/A13985977