Thank you. I’m trying.
Dietitian took one look at me and my info concerning c-pep and challenging my diet. Her reverence to LADA and ‘possible other medications’ weren’t lost on me.
Heading now to have my blold drawn for the GAD.
1 Like
Good luck! It’s best to know, really. You’ll be OK! There aren’t many more afraid of needles - and, for that matter, most medical procedures/processes! - than I am, yet, somehow, I’ve been managing it. Does diabetes “get in my way” sometimes? Sure - even more often than I’d like to admit. But, mostly, I’ve been doing OK – and so will you!
2 Likes
And if you’re GAD positive-- that’s good news because you’ll immediately be put on a treatment plan that’ll make you feel better
And if you’re not GAD positive, that’s good news because it means you won’t necessarily require insulin.
Point is more information is a good thing not cause for more alarm.
2 Likes
John, it really is a lot of information! You’ll get it figured out 
You can just estimate body fat percentage. It’s actually not unlikely that you are around 20-25%, which is normal for a not obese (but not physically very fit) man your age. I’m at 17%, but I’m on the fit side of things for my age range and have a lot of muscle from working out and playing competitive sports my entire adolescent and adult life.
Also, you don’t have to get things right at first when it comes to TDEE. Try inputting 22.5% bodyfat (you’d be amazed how much your body stores in liver, around the belly, etc. even if you otherwise look and feel ‘gaunt’), your regular activity level (most of us are ‘sedentary’ or ‘light’) and see what the calorie goals for the day are. Should probably be somewhere in the 2,000-2,300 kcal range I’d guess. So pick the high-end of the range and start tracking what you eat! Try to hit that TDEE goal every day for 7 days straight and then weigh yourself. If you’re gaining weight, great! If not, try upping by 100 calories a day or re-calibrating with the online calculator.
You don’t have to eat bacon to get fats in your diet I won’t argue with you about cholesterol and what you eat, other than to say many of us that eat high fat low carb have improvement (or no issues) with our serum lipids. I don’t avoid bacon,and I eat a ton of eggs, but I get the bulk of my fats from vegetable sources. You can avoid even worrying about it by eating unquestionably good fats! Avocados, coconut oil, olive oil, fish oil, fatty fishes, etc. are good sources of fat and calories that won’t budge your cholesterol at all (except perhaps raising your HDL). They definitely want your total cholesterol lower than yours, and statins may help. But exercise and losing weight (which you’re already doing!) will help even more most likely. You can also eat “clean” proteins if you’re super worried about cholesterol.
But, again, if you want to stop losing weight you have to eat more calories! Since you know you don’t process carbs well (you’re a diabetic of some type), that means you have to get your calories from protein or fats. I personally (since I work out) get a lot from protein. I eat chicken, eggs, vegetable protein, whey protein, on a daily basis. There are plenty of other ways to do it as well. Tofus which are low-carb and low-fat are good sources. Some (not all) kinds of other fermented bean-products. It sounds to me like you really are going to have to start counting your calories along with your carbs if you want to meet the goals you outlined above.
The reason I check 1 hour post meals is because I’m trying to catch my “peak Blood Glucose” rather than whether I’ve returned to baseline. It’s really about how much you want to know! I test frequently and systematically, because I want to know how my body is reacting to what I eat and exercise. I test fasting, and then usually two to three more times during the day. My normal routine is: fasting, before and after breakfast on Monday; fasting, before and after lunch on Tuesday; fasting, before and after supper on Wednesday; fasting, at beginning and 1 hour into exercise on Thursday; etc. That way, in the course of a week I hit all of the “major events” in my life. If I test higher or lower than I want to during exercise or 1 hour after eating, then I’ll re-test after another hour. So there are days where I test five to eight times, but average about three times per day.
Testing that often is how I found a diet plan that works (now) for me. I started with the ADA-approved (and doctor and dietitian suggested) dietary plan of 50g carbs per meal and 15g carbs per snacks. I couldn’t get my BG under 140 mg/dL 2 hours after eating, so I decided to read online about other options. I read about lower-carb eating and how you don’t magically die if you eat fewer carbs, so I started doing that. I cut down to about 20g carbs per meal, and then started experimenting with different amounts at different times. That’s how I got my fasting and postprandials consistently under 100 mg/dL, by cutting carbs. I now eat between 30g and 50g gross per day.
I also started testing sooner after meals (1 hour) when I started to read about how insulin works in the body and how “normal” human responses to eating meals works. I decided I wanted to mimic as close as possible a “normal” curve of BG and insulin production, and in order to see the peak (and not just what my body returned to) I had to test 1 hour after meals. Not suggesting everyone should do it (I’m far stricter in my management goals than most diabetics are), but it works for me. I also lowered my “maximum” limit based on what I read about the development of complications. I decided the 180 mg/dL and 140 mg/dL suggestions from ADA were not appropriate for a diet/exercise controlled diabetic (I can understand why they might work for many Type 1s on exogenous insulin therapy). So I found an (arbitrary) limit of 126 mg/dL one hour after meals (in some scientific papers I can’t remember exactly where) associated with not developing complications, and have been trying to follow that. It’s working for me, so I’m sticking with it.
I’m not offering advice: I’m not in your shoes, and I can’t determine what is right or best for you. I am a doctor, although not of people But I don’t give medical advice. I’m just sharing my experience as someone who is experiencing a diabetic pattern very similar to what you’ve described here: diagnosis as Type 2; low-fasting insulin; rapid and hard to control weight loss; provisional re-diagnosis as LADA (for me); etc. Right now, I’m doing diet and exercise and metformin as long as it works. It works pretty well, although my fasting numbers are creeping back towards 100 mg/dL pretty consistently and steadily right now. If they break 100 mg/dL without me changing my diet, exercise, or medicine, then I’ll re-evaluate. And hey, at least you’re seeing an endocrinologist in the next month! That’s the kind of expert medical advice that can really help
Remember, this is a life long disease that will change along with you. You’ll need to keep an eye on it, but you have time to figure it out. Higher than desired blood sugars probably aren’t going to kill you tomorrow (unless you go into DKA and refuse to go to the hospital, of course), and while you’re not on insulin you’re pretty unlikely to have a really bad hypoglycemic event. So take a deep breath (and eat more protein). It’s going to be OK, and you’ve come to a good place to hear other peoples’ experience.
Cheers
Results will be back in 7 to 10 days.
They upped my metformin to 2000mg daily.
I’m a realist and a believer in “tough love” (when it’s appropriate). So here goes:
The fact of the matter is that if you do have LADA (a form of Type 1) [and I suspect that there’s a good chance that you do have Type 1 in light of all this weight loss you’ve talked about], you will eventually (maybe a lot sooner than later) have to take insulin if you want to stay alive. There is no other way around it. Period. So you can (and will) “do this” because you will not have a choice if you want to keep living. Not many PWD are mathematical geniuses or brilliant award-winning scientists. But they survived being diagnosed with D, learned what they needed to do, and have continued to just do it, day after day, one foot in front of the other, etc. You don’t strike me as someone with an IQ that is more than two standard deviations below the mean. I’d put money on the fact that you have the smarts to handle this. Right now you need to get a grip, stop catastrophizing, and start thinking about how you are going to get used to a “new normal” with diabetes (regardless of Type). An unfortunate bunch of little kids have to deal with this disease daily, likely for the rest of their lives. And they are doing quite well. You will, too.
4 Likes
I understand. The feelings are there regardless.
I’ve been trying to conceptualize how it would fit in my current life/work etc. I don’t know enough (or have walked in your shoes) to understand and factor in variables…so it just leaves me with the feelings. …I can only wait for the results and go from there…and whatever training that might follow.
John, for proteins and fats I recommend:-
Cream (on everything), butter, cream cheese (you can blend this in with your omlete), cheese, eggs, sausages (all meat not the cheap ones with carb fillers), pork belly, fatty nuts such as macadamia, coconut oil, fatty cuts of meat - minced meat is high fat (and don’t drain the fat), avocado, coconut cream, chicken with the fat, etc.
For the constipation make sure you are eating plenty of green leafy vegetables - these are only about 1 g of carb / cup and you can certainly eat 3 or 4 cups or more of these each day. I would also suggest that you should try increasing your salt and water intake. I am eating ketogenic diet (this is very low carb < 20 g /day, moderate protein, high fat) and on this low carb diet one has to take more salt to feel good and avoid constipation - the amount of salt on this diet is 4 - 6 g, preferably rock salt which has trace minerals (I use Himalayan rock salt).
A magnesium supplement may also help with constipation.
If you are taking the statin recommended to be taking CoQ10 as the statin drug depletes this in the body.
I would think you should actually check how many calories you are eating each day. There is an application called my fitness pal for smart phones. The free version is good and easy to use. Log your food and see how many calories you are actually eating. Given your current situation I would think you should be eating about 3000 calories / day.
If you are not eating enough fat and protein you will not be getting enough calories. Not getting enough calories will be the primary reason for losing weight.
For example:-
Let’s say you are eating 30 - 50 g of carbs / day. This is only 30 x 4 calories / gram = 120 - 200 calories
Let’s say you are eating 150 - 200 g of protein / day. This is only 200 x 4 calories / gram = 600 - 800 calories
(not this is actually a really high protein intake considering 1 egg is about 6 g of protein, 1 oz of steak is about 7g of protein).
To make up to 3000 calories, you now need to eat about 220 g of fat. Fat = 9 calories / gram.
I think you are not eating enough! Your breakfast should probably be 4 eggs plus sausages or bacon or steak, plus 2 a few cups of spinach / vegetables sautéed in fat.
Idea for lunch is to get the sushi sheets. Put inside cheese, salad greens, cream cheese, avocado and wrap. USe this as a side to a heft portion of protein.
Dinner again large portion of low carb vegtables, drowned in butter, with salt. Soup, lamb chops, etc.
Snack on cheese, nuts, salami, meat cold cuts, etc.
I hope the dietician can at least help you work out how many calories you should be eating. And how to get them. Tell them you are eating low carb, high fat, and get them to help you come up with adequate calories. If they try to sell you the high carb diet plan insist that they give you what you need.
That’s great news john. Proper testing and results will make everything clearer. A clear diagnosis can be very helpful.
You are in the overwhelmed stage. But just breathe. This is going to get easier as you go along.
We’re also here to help you.
3 Likes
Dear John,
Just catching up here. So very sorry that you are having to go through this journey–and all the stress with it!
Sorry to be vague here, and not meaning to cause you any further stress. I believe I learned that the C-peptide test is most accurate if you still have carbs in your diet. Anyone, please, please correct me if I’m wrong! I only want to help John get an accurate diagnosis.
I feel for your stress and depression over this diagnosis. Please trust that it gets less overwhelming with time. Be kind to yourself. You’ve done an amazing job of lowering your A1C already! You’ve done an amazing job of changing your diet to fit your situation! You’ve done an amazing job of finding information and educating yourself about what to do to deal with this!
You’ve gotten an overwhelming amount of information here and elsewhere. Please keep in mind that we care, we want to help, and we will help. Each person’s experience is different, so you receive many opinions and suggestions. The bottom line is that you are not alone and you have lots of comrades here who want to help and support you.
Sending warm wishes your way,
marty1492
1 Like
Dear John,
And not to load you with one more thing. Just a suggestion. And please forgive me if this has already been suggested. Are you living in any area where you might possibly be able to go to a diabetes support group or meet up with a diabetic who uses insulin? I know that work is overwhelming and this diagnosis is overwhelming for you right now. And I remember that you said that your personal trainer is type 1. Is he someone who can help you understand how he works deals with diabetes in his own life? It just seems like being in the same room with someone else who truly understands and has the time to listen might help you.
Best wishes,
marty1492
1 Like
I haven’t heard anything from the trainer I tried to hire. He’s a good guy…but we all have lives to live.
A supervisor of mine has given me the phone number of a rectory at his parish where a priest friend of his wears an insulin pump. Said I could call and talk to him or set something up.
Thanks…You’re a ‘good egg’ Marty. Did I say that? Eggs…eh!
-John
1 Like
GAD was negative. I don’t know where this leaves me. Just an update.
It leaves you a good old fashioned type 2 diabetic. Just like as many as 50% (by some measures) of the middle aged men in America. So take a deep sigh of relief that you don’t have some rare and exotic disease. You just have plain old diabetes that’s going to be manageable no matter what medications you have to take… It’s not going to affect your career or any of that… You’ll have to do your part but this doesn’t have to occupy a tremendous portion of your life. You don’t have it figured out yet the role this will play in your life, and I understand that’s disturbing, but I can assure you it will ultimately be no larger a role than you let it be. Same could be said for all other forms of diabetes too.
Who is so carb intolerant…
I can barely eat much of anything. I’m also too thin. Still…Probably good news. Thx.
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 ), 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.
2 Likes
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.
1 Like