Need your perspectives, thoughts, and help

Hello all,

New to the forum. I am still going through the rules and housekeeping but I wanted to get going straight away and tap the incredible resources here to manager my diabetes.

My apologies if this turns out into a long spiel. But I believe it will help those who can potentially help me with suggestions.

50 Year old male. Diagnosed with T2D in my 49th. My dad’s side family is completely diabetic based on which, I know many doctors would probably put me in the “hereditary-prone to diabetes”.

As long as I know and remember, my A1C levels have been under 5.9 up until age 38. A combination of bad diets, life’s stressful situations, and no physical activity pushed me towards A1C = 6.2. It was at age of 40 that I came to know that I lost one of my kidneys. Not because of T2D, not because of bad life style, not because of anything that I know of. Doctors said, I could be living congenitally with a shrinking kidney since my early 20s probably.

I think it was then that my health started going downhill, not like a roller coaster but slowly. I tried my best to balance everything (related to health) in life but always struggled. It was a walk on the blade. Low carbs are bad for kidneys but good for sugar control. Complex carbs are good for kidneys but still not good enough for sugar control. Healthy fats are good for sugar control but I would gain weight which in turn effected my kidneys.

Fast forward to 49th year last year. My A1C moved from 6.5 to 8.2. My doctor said I must be put on meds. I asked him for 6 months to see if I can do anything naturally. He agreed. Again, I tried everything but to no use. I did get my A1C down to 7.5. But that was not good enough for my doc. He (kinda) forced me to start on meds. So, I started taking Glumetza (extended release - 1000 mg).

What I observed is this. Before meds, my fasting numbers on the monitor was 6.5 or so. My 2 hour post-lunch (my biggest meal) was 7.5 to 9.0 (mostly the lower number). But since taking meds (now it’s been 2 months), my fasting numbers still show between 6.3 to 6.5 but my post-lunch number is between 9 and 13 and that is freaking me out.

I am a vegetarian. I eat brown rice for lunch (portion controlled) and I eat either a healthy sandwich or salad/soup for dinner. I walk 20 min a day but mostly sedentary with my job.

What can I do to get my numbers down? Why do I see numbers higher after meds compared to lower before meds? Am I doing something wrong?

From my side, I have decided to be more active and even more healthy in my diet.

Your insights and perspectives and suggestions are much appreciated! Thank you!

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What is your c-peptide? If high, then you are, indeed, a T2. If medium to low range, then you are LADA and should have been put on insulin.

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Please look at Mastering Diabetes where you will see that many type 2’s are able to stop their meds as long as they keep eating the way the plan suggests. This is a low fat vegan diet. Type 1’s are able to greatly reduce their insulin use.

Not many of us can eat rice. I am a type 1 mostly vegan who, now that I follow the info at Mastering Diabetes, can eat all fruits, and all vegetables including potatoes. I still cannot eat rice without an unacceptable rise in my glucose level. All of my numbers including TIR and A1c are great. My last A1c was 4.6. I also eat different whole grains, but I never eat rice.

I am sure you will get much good info from the people here. Welcome!

There is also a book called Mastering Diabetes at Amazon which explains this way of eating. This program was started by two very smart type 1’s who also have YouTube videos.

Marilyn
Type 1 dx 1959

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My doc never got me tested on C-Peptide. I have an appointment with him in 2 weeks time. I will ask him for this. Thank you!

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Thank you very much, @Marilyn6 !

You stressed so much on rice, speaking of which, many “diabetes expertise” websites say that Brown Rice is ok as long as portion control is done. And hence I have always had a little brown rice with lots of veggies and different types of lentils.

As mentioned above, I am South Asian with rice as a staple diet but I have stopped eating it as staple since the last 10 years.

I really hope I can get my A1C down. Thanks again!

Sorry, @Marilyn6 , “Mastering Diabetes” is a separate thread/topic in this forum? or is it an external resource that you are referring to? Thanks!

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Sorry Simplguy, I just saw your after lunch numbers and figured the high numbers were from rice. Maybe some people can eat a small portion of brown rice or have figured out someway to eat it without their glucose numbers rising too much. I just know that it is common for people with diabetes to have trouble with rice. You certainly may find a good way to eat it without bad numbers.

You mentioned lentils, I eat them quite frequently along with different types of legumes. I also eat quinoa every day, fruit and lots of vegetables.

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Hi, alleged type 2 Simpleguy, from a 32 year veteran with T2DM. A couple of possibilities come to mind.
You are misdiagnosed T2DM because of your family history and age. The use of Glumetza (metformin) is the normal first meds for T2DM. It could be you are type 1 LADA which is slower presenting then classic type 1.

A C-Peptide test should be in order. If it is even a bit on the low side, say <2BG/ml, I would think that you might start a long basal type insulin to begin with. If C-Peptide is <1st/dl then the antibody tests. The problem is that some people end up with a low C-Peptide without testing positive for any of the antibodies.

The other possibility is that insulin resistant T2DM is progressive. I was diagnosed at age 40. A carb restricted diet and daily bicycling keep me in the normal range for 10 years. Then BG and HbA1c began elevating that no amount of exercise or eliminated carbs helped. That is when I began Metformin. Over time the dose increased to 1,000mg twice daily.

This began the use of a daily injection of a long insulin, Lantus. This worked well until November 2021. My HbA1c increased a full percentage point in one quarter. I spoke with my doctor about going on multi daily injections, Lantus for basal and Humalog for bolus before meals. She agreed.

January 2022 I began using a Tandem X2 pump with C-IQ.

At 72 with 32 years since diagnosis, I consider myself fairly successful in managing type 2 diabetes. I am still very careful about what I eat and exercise nearly daily. That is the only way I can keep insulin resistance under control. Today I had a lot of sedentary work (image that for a retired person) and wasn’t able to get a bike ride in. I have done several small correction boluses to stay in range.

Here’s a couple of links to an Australian T2DM named Alan Shanley:

Eat to your meter:

Alan has written a book “What On Earth Can I Eat” I think it’s on Amazon if you care. @Marilyn6 mentioned rice. I, for one, cannot eat even a teaspoon of cooked rice. I can’t bolus correctly for it. It just spikes me high no matter what I do. Then I end up on a rollercoaster of going low, then high, then low, then high - no fun at all.

Good luck to you, and welcome to TU.

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I’m also a big fan of Mastering Diabetes. You are already a vegetarian, so in. My opinion you don’t have the conquer the most difficult part. I have a tough time getting enough protein, but the diet itself is pretty good and satisfying.

I’m not a big fan of rice, but I love potatoes and sweet potatoes and corn. All of those are big no no’s for low carbers.

I’m now eating 200 carbs a day and using slightly less insulin than when I was eating 90 carbs per day.
This diet is focused on limiting fat so carbs are ok as long as they are Whole Foods and not processed carbs.

I think I must have developed a little insulin resistance as I am aging on top of my type 1.
I am using around 47 units of insulin per day. I have no idea if that’s a lot or not. I’m 208 lbs and 6’3 no one has ever given me a range of what normal or average insulin consumption looks like. My c-peptide has been zero for 25 years.

I am always looking for ways to reduce insulin because I think insulin is not good for our heart and arteries. At least high levels.
Mild exercise makes insulin go twice as far. My pumps algorithm has a hard time figuring that out because my carb ratio can be 1-12 at rest and 1-20 if I walk or hike after. So I need to constantly adjust the suggested bolus.

It will take you some time to figure out how your own body works and you will eventually get there.

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https://www.diabetesdaily.com/blog/study-higher-insulin-doses-may-increase-cancer-risks-in-type-1-diabetes-703769/

Hi, @Simplguy

Welcome to TU!

First, I was also diagnosed last year with T2D. It’s great to hear you are vegetarian, that may help you a lot with your diet. I stopped eating white rice and have brown rice every meal. Not a lot, but for reference, my nutritionist recommended 3 to 4 table spoons a meal (I’m a male, 6’2", 32yo). I don’t care for potatoes, but rice is a must have for me.

Regarding your post prandial numbers, they are indeed a bit high. As it was already said, some further testing would be helpful, like c peptide and maybe a GAD. Talk to your doctor and see if you can get a hold of them. They will help you see what type of diabetes you have. Until then, trying something more on the low carb side can be an option. It’s also not the only one - another side sees a plant based diet with a fair amount of carbs to also have great results. Trying all these new things can be both overwhelming and fun. Regardless, I’ve noticed how important fiber is to me. I always have rice with beans and veggies so the fiber can control some of the carb ingestion =)

Third, maybe this medication is not enough for you or you do not respond well (enough) to it. I am not sure how exactly metformin works, but some diabetes medications can also rely on the kidneys, so this needs to be taken into consideration. There are many options we have to control our blood sugar and metformin is only one of them. If you have access, seeing an endocrinologist would be very helpful. If not, talk to your physician and see what else might be available for you.

Lastly, I was also very sedentary before my diagnosis, but today I wake up half an hour earlier and go for a 30-min walk and call myself an athlete :wink: My point is whatever exercise you can do would be great. Whatever fits you, your needs, your availability, your likes. For me, it’s walking with my earbuds so I can listen to music. For you, it may be something completely different.

One more time, welcome!

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With kidney problems you should not have ever been put on metformin. Metformin can be bad for people with kidney disease of any sort. Talk to your Dr. as soon as possible to either get on a kidney safe type 2 diabetes medication or go to insulin.

Get any tests you can for diabetes antibodies. If you test positive for any of the 6 (I think) antibody tests then you are type 1 and need to be on insulin. Get a c-peptide test as well. High c-peptide indicates type 2, low or normal c-peptide indicates type 1.

Rice drives my BG nuts, no matter what type or color. I can get away with 1-2 tablespoons of cooked rice on an occasional basis, just to taste what I have been missing for so long, but even that raises my BG to unacceptable levels and I find that I have lost my yen for rice over time.

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You might benefit from an SGLT2 Inhibitor, its a once a day pill. Besides lowering your A1C they are shown to help heart and kidney health.

Here is 1 resource related to it

I do not like medications in general and want to take as little as possible. However this one was worth it to me. I did try to stop taking it a couple times (I didn’t have side effects, just don’t like medication). Both times I went back on it because it was just to effective at helping manage by blood sugars.

Long ago I tried metformin but I have a very very lower tolerance for any gastrointestinal issues.

I am from India (settled in North America since the last 25 years). I can tell you one thing. There are a gazillion number of items and combinations in proteins that we can try. It’s just that I never cared to explore those options until life hit me hard. :slightly_smiling_face: :slightly_smiling_face:

@Firenza, My doctor is usually good in many things (the non-medicinal side of things). He told me that in my case, Metformin’s advantages far outweigh the kidney’s stress. Just to give another number, my current eGFR is at 58. In fact, that number increased from 54 since the last 2 years because of active kidney management with good drinks.

But, thank for raising the red flags. Definitely I will be discussing these factors with my doc soon.

My doctor is almost 50 km away and I did not want to change him for a long time. It is very hard to find such docs these days, not at least in my city. When I go to him, he takes time to ask about my lifestyle, current events, etc. And if there are any numbers (BP, eGFR, Tri, etc.) that are unfavorable, he will get irritated and he admonishes me.

Thanks @ChrisP! It is interesting that you brought this up. I met a visiting American doctor 2 months back and he also asked me to research on this and advised me to talk to my doc if this is right for me. Did you observe any side effects with it?

Met hasn’t given me any trouble so far. No gastric troubles as well. One of the reasons may be, is because I take natural yogurt with meds. Just half a cup of yogurt. And we make it at home with organic milk. So, no additives and preservatives.

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I haven’t had any side effects from SGLT2 other then needing a lot less insulin. I tried going off it for a week a couple times and my insulin needs doubled so I’m staying on it.

A normal lunch I take 4 units but if I’m off the SGLT2 for several days I might need 7-8 units for the same meal.