Friday, October 27, 2006

Getting Started

Diagnosis Day

I had two options here. A chat about my own D-day, or some ideas for people reading here who just got the news.

I’ll leave the chat for some other time.

So, you’ve just found out you have type 2 diabetes? Or Impaired Glucose Tolerance? Or Pre-diabetes? Or the doctor said "you’ve got a touch of sugar" or something similar?

And you’re in shock?

Why me?

Well, I don’t really have an answer for that. To me it seemed bloody unfair. Why me? And I railed against the world for a while – but then I decided to get on with it. Because I can’t change the past, and how do I correct the mistake of choosing the wrong grand-parents? Particularly as I liked mine:-)

So my first suggestion to any newly diagnosed person reading this is the most important one of all:

It’s NOT your fault. Take a deep breath, sit back, and relax.

Forget the hype and the TV ads about obesity (10-15% of type 2’s are normal or underweight at diagnosis), lifestyle, whatever – that’s in the past, even if it was relevant, and there’s not a damn thing you can do about it.

OK – so you’ve got a flawed glucose/insulin system. I don’t care what label they put on it, or what stage you’re at – what matters is what you intend to do about it. So first, the good news. Unless you’ve been diagnosed at a very late stage, this is a slow-moving disease – you have time to learn, time to correct things, and time to improve your health for a long-term future. And there is more good news: nearly every person I’ve met who used this diagnosis as a kick-start to get fitter and healthier has improved all sorts of other aspects of their health at the same time.

What to do next? I’ll give some detailed ideas based on what I did in the next post. But there are some general points first. In everything I say, I assume that anyone reading here will always be seeing their doctor on a regular basis, be taking the medicines prescribed by their doctors, and checking any suggestions here with their doctors.

However, never forget that the person who will be most affected by poor advice from any source will be you – not me, not your doctor, but you. In my opinion, more than nearly any other condition, the success of management of diabetes depends on the diabetic. So, while your medics can advise and prescribe – it’s your decisions and your actions that will decide your future.

In broad terms, this is the plan, in addition to anything the docs prescribe:

1. If you are overweight – lose it. I’ve posted some ideas on what I did as my Weight Loss Cooking and Eating Plan

2. Obtain a blood glucose test meter. Until you do, here are some tips on What to Eat Until You Get Your Meter.

3. Learn how to test your blood glucose (BG). I’ve posted some hints on painless testing methods as Painless Pricks

4. Use those tests to adjust your menu to get those blood glucose numbers into the non-diabetic range. I've given some ideas on how to do that in the next post titled Test, Review, Adjust

5. Add at least half an hour of moderate exercise to your day. That’s a minimum, not a maximum. If that’s a new activity for you, start easy and work up slowly – but do it.

6. Later, as your diet for optimum weight and optimum BG’s starts to work, review it and adjust to ensure you aren’t missing anything vital.

There’s more – but that’s enough to start with. So stop reading, go and have a glass of wine or a diet soda and think about something else for a while:-)

And remember my sig:

Alan, T2, Australia

Everything in Moderation - Except laughter

38 comments:

Vickie said...

Hi Alan...
I have been an insulin diabetic for about 3 years now, and have not been able to get control or get real answers about what to do, etc. You are a GODSEND, this has helped me so much in just a short time, given me great ideas and tips, ESPECIALLY with a REAL goal to aim for readings wise. I am not up on all the terminology even, but I will be reading your blog frequently, and maybe posting to it with how I am doing.
THANK YOU THANK YOU THANK YOU!!!

Alan said...

Thanks for the kind words Vickie, I hope it helps.

I'll just repeat my words of caution from the top of the page - I'm not a doctor, just a patient, so if in doubt check first.

Best wishes, Alan

RodS said...

Hiya Mate

Found this from your postings in the newsgroups. good to see another Aussie being the voice of reason and solid advice.

Great stuff keep it up

Cindy Breninger said...

Hi,
Great page! I am glad I checked it out. I will be back soon!
Cindy

EmilyBroccoli said...

Great Page Allan. Thanks for all you do to contribute your knowledge. Have a wonderful weekend!

Emily Broccoli :-)

Premlata said...

Hi Allan
This sure is a great page with lots of helpful info for the much needy Diabetics. Do keep your spirits going
My best wishes to you.
PremLata

xanthra said...

Just had to post. You read Terry Pratchett?!! He is a scream.
Do you have a gold suit (can you tell I'm in the middle of Making Money)
Your diabetes info. is priceless in value. Sorry this diverges.
I adore P. G. Wodehouse as well.
xanthra
(from the ADA D2 board)

Alan said...

G'day xanthra

No gold suit I'm afraid:-)

I caught Terry Pratchett from my son; he started the Terry Pratchett Appreciation Society at Melbourne University about 20 years ago and I've been hooked ever since.

I'm afraid PG Wodehouse whooshed by me...

Thanks for the appreciation. I hope you get some benefit out of the blog.

Anonymous said...

Oh my gosh, I would hug you if I could. Thank you so much for saying, "It's not your fault, forget the TV ads about obesity. . ." I am overweight and that has been on my mind. Finding your blog is such a blessing!

Leslie

people a dogs best friend said...

WoW! so very glad I found you! This is new to me and I was just in a spin over it. Who ME! T2 not me!!!...Haven a heck of a time re-thinking my life and how to even start I will be back. thank you for takeing the time to write this stuff. Beth, Upton wyoming

angeluv1948 said...

Hi Alan,Thank you for all the positive information.It has given me a boost.I have just spent a week in the hospital,a prob with my heart now,So I've been kind of down in the dumps.Its hard trying to controll my sugar,carbs and salt and cholesteral.I've always been a big eater,so dieting is not easy for me.So again,thx for all the positive thinking,Barb

Anonymous said...

Much of what was said is beautiful info for a newbie in type 2.

In my own case (unlike wife) I was diagnosed but per docs Im so borderline that my efforts to lose weight are paying off.

Though its been thru 70pds in 11 months I have 100 to go..(was 350 at my worse and 330 at visit to doc 2 months later).

For me it is weight and lifestyle.

But like everybody have the same fustrations and stress's.

Its always good to read what others go thru and learn so that we can learn in addition.

My only real gripe is hearing, you can get the meter free, which is true, but its not the meter that matters but the strips.

I could care less about the meter cost as its one time.
Strips for wife & me are what matter and I find decent strips at unbelievably low cost at Walmart.
Meter: $8 strips at most $32 for 100.

Alternative I liked:
Meter free
strips: $125 for 100.

Forget that I would rather buy the meter and manually track stuff (I am a computer buff so pc access would be cool, but Im not paying to get whats needed (not yet).

Anonymous said...

Alan
I have very much enjoyed reading yous blogs! I commend you for your directness. I am noticing that the writers who are knowledgeable do two things in their initial writings - they make the statement "Its Not Your Fault", and "The Past Can't be Changed". The wording may vary and the order presented, but they are wanting to put the reader at ease. Once this is accomplished, the reader is more likely to absorb what is needed to help them.

Continue the good cause, you have earned my support. I appreciate your inclusion of other writers about diabetes.

Bob (arrived here via your link in dLife) Thanks

Mary said...

Alan

I appreciate finding your site. I too have CLL, high chloestrol, and now have been diagnosed as prediabetes (and I am very active and slender)all compliments of my grandparents. I found some information about those with CLL that get diabetes it is often called diabetes 1.5 or Latent Autoimmune Diabetes (LAD). Apparently it mimics type 2 and then turns to type 1. I am in shock and can't believe this keeps happening to me. My cancer Dr. didn't evern tell me what I needed to begin doing. I was a little surprised. Do you suggest to start blood monitoring in the pre-stage as well. I will be following youf blog regularly. Mary

Alan said...

Hello Mary.

You wrote "I found some information about those with CLL that get diabetes it is often called diabetes 1.5 or Latent Autoimmune Diabetes (LAD). Apparently it mimics type 2 and then turns to type 1."

I think that information is flawed. You can read more about LADA here: http://www.diabetesmonitor.com/lada.htm It is actually a late-developing form of type 1; unfortunately some doctors mis-diagnose it as type 2 in the early stages. As far as I am aware there is no link between LADA abd CLL. What was your source?

Ask your doctor for a clear diagnosis of your own diabetes.

Most of the people I met with diabetes on the ACOR CLL list were type 2; some had Prednisone-induced diabetes which is similar to type 2. You might find it valuable to join the CLL list; this is their "Help" page: http://cll.acor.org/help.htm
Another useful CLL source is the CLL Forum: http://www.cllforum.com/

Yes, I do believe you should start applying "Test, test, test" at the pre-diabetes stage. The earlier the better. Just possibly that may mean that you never go past that stage.

Anonymous said...

I wish to disagree with the notion that regarding Type 2 diabetes "It's not your fault". Reading the history of Type 2 you find little mention of it until sugar and refined flour became widely available to the average person. This happened in the late 19th century, say approximately 125 years ago. Until then Type 2 was seen only among the wealthy who did use copious amounts of sugar and other refined carbs. The same observation is made when Bushmen and other primitives "move to town" and gain access these refined carbs. Diabetes explodes among them.
Now, I guess that you can say its "not their fault" because they were not warned about refined carbs. Or you can say refined carbs do not matter, then include more refined carbs in your diet and see what happens regarding progression. Alan, do you have an opinion regarding this idea?

Alan said...

On "it's not your fault" I have an opinion but I think I'll leave it to a later post to go into a lot more detail.

Suffice to say that I concur with Jenny's assessment in the link I provide and that I consider your historical reference can be seen from both sides of that argument. It becomes a debate about the chicken and the egg. Did obesity cause the diabetes or is there a genetic or similar cause for both obesity and diabetes? Does that gene lead to first a tendency to obesity which may then trigger the other aspects of diabetes? The answer is that nobody knows yet.

I agree that obesity is a growing problem in Western Society (no pun intended); I also agree that the changes in availabilty and promotion of processed carbs over the past century have been part of that problem. But I don't agree that obesity is proven to be causative of diabetes nor do I see diabetes as a self-inflicted condition.

Anonymous said...

Hi there. I am lost. Just got diagnosed last week. I had a fasting blood sugar (though I told the doc that I had nearly a cup of milk that morning) of 113. She then ran the other test and it was 6.3....just past the 3-6 normal range.
She put me on metaformine 1,000 mg pills times 2 per day (so 2,000 mg). I have not begun them yet. Her nurse called me today asking if I wanted to be on Byetta instead. Threw me for a loop!
I am now researching what I should do, WHAT I should eat to be ok and lose weight, and try and make an informed decision on picking a drug. I sorta wish my Doc didn't give me an option.... I now question the whole thing.
Any insight would be helpful!

Alan said...

G'day Anon

I have a feeling I may have replied to you on the ADA forum just now. You gave a bit more detail there, so rather than repeat the reply here I'll give a link back to that thread.

http://community.diabetes.org/n/pfx/forum.aspx?tsn=19&nav=messages&webtag=adatype2&tid=31060

musecal said...

Alan,

I have a question about drinking a glass of wine. I was diagnosed early this month with a glucose level of 490 and a stay in the hospital. I am still having vision problems, but there may be some slight improvement. The week or more before, I was having cravings for sweets, fruit and fruit juice. Before that I drank alcohol on occasion, a few drinks at a time. If I drank more than that I would get a weird tension, so not sure if it had something to do with BG fluctuations. A similar feeling would happen after eating.

Usually, I have enjoyed a glass of wine in the evening, but after D diagnosis, I have been afraid to try it. Today my BG levels were 105 am and 110 pm, best yet. (Taking Metforman and Glyburide)

I lived in Sydney when I was a kid for about five years, before moving back to U.S.

Paul

musecal said...

Alan,

I have a question about drinking a glass of wine. I was diagnosed early this month with a glucose level of 490 and a stay in the hospital. I am still having vision problems, but there may be some slight improvement. The week or more before, I was having cravings for sweets, fruit and fruit juice. Before that I drank alcohol on occasion, a few drinks at a time. If I drank more than that I would get a weird tension, so not sure if it had something to do with BG fluctuations. A similar feeling would happen after eating.

Usually, I have enjoyed a glass of wine in the evening, but after D diagnosis, I have been afraid to try it. Today my BG levels were 105 am and 110 pm, best yet. (Taking Metforman and Glyburide)

I lived in Sydney when I was a kid for about five years, before moving back to U.S.

Paul

Alan said...

Hello Paul

First, congratulations on your improvement from 490 to the low hundreds.

On wine, with your background I must be absolutely clear. Do not contemplate adding wine to your menu until you have discussed it with your doctor.

If, and only if, your doctor confirms that there is no medical reason for you to abstain from wine then read these two pages that I wrote earlier:

Red, Red Wine
http://loraldiabetes.blogspot.com/2007/03/red-red-wine.html

Wine and Serendipity
http://loraldiabetes.blogspot.com/2007/04/wine-and-serendipity.html

Cheers, Alan

bpete said...

Alan - I started reading your blog when diagnosed in October 2008. Since them my A1C has dropped from 14.5 to 4.8, dropped 50lbs and have slowly progressed to just diet and exercise for control. I appreciate you and all the other people who have written words of advice/wisdom to share with others. It's been two months without meds, just hope I can keep the numbers down.

Thanks again

Catherine said...

Hi Alan--

I was diagnosed with Type 2 just two days ago. I am still in a lot of shock and can't believe this has happened. I find it very difficult to eat at all now. I was prescribed Metformin and instructed to take it every other day for the first week so that I get used to it. I have read your other entries about testing your blood glucose level - my question is: if my blood sugar level is within acceptable range (that is, within the ADA and ACE ranges), should I be taking the metformin? My fear is that the metformin will reduce my blood sugar too much. When I read my blood sugar readings, at what point do I NOT have to take the medicine? For example, this morning my blood glucose was at 118. I did not want to take the metformin because I was afraid my level would drop TOO MUCH. Are there any guidelines you can help me with in terms of when to take my me when I know what my glucose level is? Thank you so much for everything you've shared. I find it very comforting.

Alan said...

Q1. "if my blood sugar level is within acceptable range (that is, within the ADA and ACE ranges), should I be taking the metformin?"

First - follow your doctor's advice and take your metformin. Increase the dose slowly in accordance with your doctor's advice. Your doctor is wisely introducing it gradually to minimise the risk of gastro-intestinal side-effects, not as a precaution against going low.

Metformin is claimed to work in a couple of ways; first by reducing excessive release of glucose from your liver and secondly by improving your insulin resistance. It can take several weeks to become fully effective and will NOT cause low blood glucose levels.

Separate to that, I do not totally agree with the ADA and AACE ranges; see http://loraldiabetes.blogspot.com/2009/04/test-test-test.html and http://loraldiabetes.blogspot.com/2006/12/hi-all-one-of-things-that-becomes.html for a longer commentary on that.

Q2. "When I read my blood sugar readings, at what point do I NOT have to take the medicine? For example, this morning my blood glucose was at 118."

Well, definitely at a point significantly below that. As to which exact point, only your doctor could answer that because your doctor will be aware of all the other factors.

I wouldn't consider asking the doc until you are a lot closer to 100.

brown.ruth said...

Hi Alan,

musecal said that he has a problem with cravings for things that we are not supposed to have.

I have the same problem. I know it is wrong to give in. My doctor has never tried me on metforim. I am allergic to all of the other medications. In fact, my doctor has given up on me. That is discouraging.
Ruth Brown

Alan said...

Ruth, find a new doctor.

The best way I found to overcome cravings was my meter. The numbers I saw on my meter at my peak after giving in were a reminder to not give in next time. For foods that do not affect my meter the bathroom scales were also useful.

Alan said...
This comment has been removed by the author.
brown.ruth said...

Hi Alan,

You have a great idea, about finding another doctor. However, I live in a small town. It is unfortunate that we have the best doctor in town.

We cannot afford to move. I am trying to stick to my diet. My husband is trying to buy foods that I can eat.

Ruth

brown.ruth said...

Hi Alan,

I do test 3 times a day before meals. I try to exercise in the afternoon. That is when my numbers are the highest. Your idea is great about finding another doctor.

However, she is the best doctor in town. I live in a small town in CA.

I do not need to weigh myself, because I am losing weight even when I overeat. My doctor is worried about that. She will not give me a copy of my lab work, even though I insist on it.

Ruth

brown.ruth said...

Hi Alan, thank you for the e-mail address.

I did read that the final decision is ours. Not the doctors, not my friends or my husband and son. I am going to have to take things into my own hands.

Since I had pneunomia, my doctor, husband and son have not wanted me to do anything. I was very active and now I am going to have to build myself up again.
Ruth

Michael said...

This is a very nice site Alan. I have been reading a lot about your own journey. As you know from ASD, I did not take my own diagnosis very calmly. It really freaked me out. I am a lot more accepting of my condition now and have put in a lot of work to keep my numbers in the normal range. I have still not achieved normal for my morning FBG. These numbers are almost always above 100 and below 130. Lately they have been between 100 and 110. During the day I can easily regulate my BG with diet exercise, and alcohol. I realize that using alcohol to lower BG is pretty controversial. However, I never exceed two beers in a day. Each beer represents 2.6 grams of carbs. I get a 20 point knock down from each beer. One day a drank my beer and it went from 97 to 74.

My wife and I both have type 2. This makes it easy to only have foods in the house that are safe for us. It must be a pain for someone with type 2 to have to eat at the table and watch someone else consume huge quantities of carbohydrates. I think I would find that somewhat difficult.

I took Metformin for a few months and it did nothing to improve my numbers, so I dropped it.

Thanks for the nice Blog site.

Ruth said...

Hi Michael,

That is great that you and your wife can work on your diabetes together.

My husband and son do not have diabetes. They try to buy foods that I can have. Lunch and dinner are excellent for my diabetes. It is there desserts that are very tempting. I am not suppose to have them.

Tony said...

Hi Michael

Isn't Alan's blog great? I've learned a lot from it, and he's given me great support in my quest to stay off tablets and insulin as long as possible as well.

I thought I was the only one using alcohol as a medication ;>) I too found that my numbers go down after a pint or two, so have been sticking religiously to that diet.

Unfortunately, though, I can't quite pluck up the courage to try it first thing in the morning, which is when my numbers are stubbornly high.

John aka Wallycorker said...

Alan,

You have certainly helped me over the last two years with my Type 2 diabetes improvement programme - HbA1c down from 9.4% to 5.0% and metformin medication halved recently from 2000mg to 1000mg per day. Hoping to get of it altogether very soon.

Ten years after diagnosis and my blood glucose levels are almost always within normal levels.

I no longer fear diabetic complications!

Your way is the way to go!

Best wishes from England.

John aka Wallycorker

Alan said...

Thanks very much for the feedback John.

Congratulations on your success. I only made some suggestions - you did all the work. Well done.

Cheers, Alan

Mark Drake said...

HI, Recently ID'ed as a Type II. Still working to adjust my food menus to bring the BG down. It feels like a monkey on the back lingering from trouble. Most before readings of the BG is 120 or less now. Taking Janumet 2x a day and reading a lot about this condition. I am already down 8 pounds since OCT at 183# now. Nothing fits but that is good. No longer thristy all the time now. Too bad I do not really live veggies. Thanks for the opening information on this disease.

MLD

ornurse said...

Very nice blog Alan. Too many patients never question their doctors advice. Always ask the whys and what fors when speaking to your doctor. When I was diagnosed 2 years ago, my doctor acted as if it were not a big deal. Take the meds and check your level twice a day. So I thought if he didn't think it was a big deal then it must not be. He was not only my doctor but my co-worker as well. He wouldn't steer me wrong. So I swam in De Nile. This time around, I've had vision changes and now he thinks it's a big deal. Still only wanted me to check BG twice a day. I check 5-8 times a day. He is not the one whose eyeglass prescription has doubled. Thanks for all the good information.