Just been for my annual GP visit

[Andymurph]

Not a great week.

After 2 years of letters telling me I was pre-diabetic my HbA1c result was 39 and my GP informed me I was type II.

"Hang on wasn't the upper range 40 last you tested ?"

"Yes, but that was some time ago, and the've changed the range"

"We also need to do an echocardiogram "

"Oh, I was going to send that pulse oximeter back to Amazon. The alarm kept going off"

"You've put on some weight. Have you heard about the Newcastle diet ?"

"No, but I've a feeling I'm about to ..... "

Anybody tried it ?

My box is on the way.

[Koalajane]

With an hba1c of 39 you are not type 2 and not even pre diabetic.

I did have an ECG when diagnosed so nothing untoward.

I think your doctor should learn more about diabetes

[2Yellowdaffodilsx in reply to Koalajane]

Thankyou , I'm def not overweight & eat very sensibly, grateful for these answers, amazing!

[PMRpro Ambassador]

Call me sceptical/cynical/whatever - I think your GP is pushing his luck. At 39 you are NOT Type 2 - and it is even doubtful if you could be described at Type 2 because steroid-induced diabets isn't the same.

If the range has been changed, it seems diabetes.uk hasn't been told ...

diabetes.org.uk/guide-to-di...

A one-off ECG won't divulge a lot - like a finger-prick blood sugar level it is only a snap-shot. Even a 24 hr Holter ECG only spills the beans when whatever it is happens during the recording - scored a major fail for me!

The Newcastle diet is very effective - but it will be a hard few months I suspect. How much overweight are you?

[jinasc in reply to PMRpro]

Newcastle Diet, ( a little bit harder but works). It is progress from the same one which the lady from the Diet research section came and talked to the group about Pred and Weight. I still have the article and sometimes send it out by email (and then delete the addresses) when people seem to be struggling.

A couple of our Type 2's free of it around a year later and the others including a Type 1 just all lost weight. Even I tried it and the best tip was and still is:-

Dump the dinner plate and always use a ham sized plate - as your eyes over rule your signals that you are full - hangover from the days that if you came across food you stuffed yourself because you did not know when or where your next meal was coming from. The cave man/woman left in our genes..............grrr

Probably am I telling you something you already know - one day!!!!!

[PMRpro Ambassador in reply to jinasc]

The Newcastle diet now is based on shake supplements and a very low caloried amount of real food - but it worked in Glasgow so it must be do-able!

[jinasc in reply to PMRpro]

I am grinning from ear to ear (no emoji's of ears) 😄

[Suzita76 in reply to PMRpro]

... but if, (as you suggest, I think), often pre -diabetes is steroid-induced, it may be nothing to do with diet, or being overweight. Prednisolone caused me to become pre-diabetic whilst being technically underweight (BMI of 18, almost no carbs. in my diet). The GP surgery kept sending me brochures on diabetes clinic and weight loss programmes which was very distressing. Better education of our medics is needed!

[PMRpro Ambassador in reply to Suzita76]

I wasn't really suggesting that that wasn't possible. But the increase in average blood sugar when on pred is due to the fact that pred triggers the release of random spikes of glucose from the body stores in liver and muscle. That does 2 things - it increases the average BG level which is what Hba1c represents - and it also triggers the secretion of insulin to bring down the BG level. Over a long period that excess insulin has 2 effects, weight gain due to excess glucose being turned into body fat stores in particular places (midriff, back of the neck and around the face). The only balance that is possible is restricting dietary carbs, you can't control the pred effect, I do find it strange that GPs aren't more aware of the differences - high blood sugar levels over a long time aren't good for the body - but if the patient can't get off pred without a relapse of the symptoms their only approach is dietary. And sometimes, that may not be enough.

[tangocharlie in reply to PMRpro]

I've read a lot about the Newcastle diet in Michael Mosley's and Dr David Irwin's books (GP who piloted it in the Liverpool area)- which both inspired me to do low-carb way of eating. Thinking about it now you mention it, I'd quite like to do it, it is meal replacement shakes etc for 8 weeks I think, save all the hassle of meal planning and temptations to have 'just one' ice cream. Do you have to be in the Newcastle catchment area or can my GP prescribe it?

[PMRpro Ambassador in reply to tangocharlie]

No idea to be honest. You are supposed to have a BMI of over 30 to require it. I don't know if it is always prescribed as such - this is their pdf about it:

ncl.ac.uk/media/wwwnclacuk/...

england.nhs.uk/2020/09/thou...

has a list of Trusts and Integrated Care Systems offering it so it appears to be a limited pilot at least initially and there seem to be criteria to be met.

If you google it there are loads of links for suitable food products and I would think that a good GP would arrange monitoring and supervision for someone who wanted to have a go at it. It's been taken over by the 800 calorie a day storm by the looks of things

[tangocharlie in reply to PMRpro]

Thanks that's brilliant, West Yorks isn't on the list but I'll look into it. I've only had a quick skim through but it matches pretty much the low-carb approach I follow. I was trying to do keto but it didn't really suit me for various reasons so have added back a few complex carbs occasionally eg the odd slice of rye bread, brown rice, cooked and cooled new potatoes etc having read so much about how gut microbes like them for the fibre. I like the idea of following a prescribed plan for 8 weeks and seeing what happens. I've heard Huel mentioned a lot on TV diet shows and want to know more about that too as read a lot about how plant-based food helps bring inflammation down. There is no doubt everything I have done diet-wise these last few years has helped. I'm 2 stone lighter for a start, and even thogh I've been on high steroids for 9 months now the BS levels are staying below pre-diabetic, just. I feel if I could lose another 2-3 stone it would help. Weight raises inflammation and cytokines.

[tangocharlie in reply to PMRpro]

My GP offered me a T2D scheme in Leeds run by a private agency which looked nonsense - no mention of low carbs and went by the NHS balanced ie carb heavy plate/pyramid b*llocks.

[PMRpro Ambassador in reply to tangocharlie]

They need to get up to date - the NHS needs to weed out the dinosaurs but they have had other things to worry about I suppose.

But you always strike me as the sort of person who could work it out if you knew the right suppliers. OH gets the Meritene and co (other varieties available) bottles of supplements which do come in a wide variety of flavours and have the basic nutrients, Meritene is sold as an EXTRA for pensioners to have the energy to go to the gym which always makes me laugh! You just need the nutritional information, and if you are into home prep you can get loads of recipes for low cal smoothies and soups if you have a food processor/stick blender - the Newcastle bumph has some for a start.

[PMRpro Ambassador in reply to PMRpro]

This looks OK - even if whoever wrote it doesn't understand how to use "substitute for" and "substitute with"!!!!!

you.co.uk/professor-roy-tay...

[tangocharlie in reply to PMRpro]

I've tried 5:2,it works but I find it difficult to stick to. Many friends have had fantastic results on it, but being on high steroids I find the 'fast' days really hard with the BS hunger spikes. I have no problem doing intermittant fasting (IF - not eating between 6pm and lunchtime or later the next day) as I don't get the hunger pangs, and I quite like having just one meal a day early evening. Horses for courses and all that. Reading Tim Spector's books he reviews all the evidence and diet myths and concludes variety is best, eat mainly plant based, aim to eat 20 diferent veg a week and focus on you gut biome. IF seems to help the biome too, but fibre is key

[PMRpro Ambassador in reply to tangocharlie]

You may need to do some creative cooking for the 800 calorie days - or why not use the shakes for those 2 days? Especially since you say you have no problem with IF - combine 5:2 days IF and whatever split you do for 24 hours on the 2 fast days.I find enormous bowlfuls of salad leaves really fill me up as long as there is plenty of cucumber for crunch and there really are next to no calories in that (unless you dress it like I do ...)

[tangocharlie in reply to PMRpro]

That could well be a maintenance plan. I do fancy the idea of getting a head start/kick start and rapid initial weight loss in 8 weeks as mentioned in the Newcastle diet and other article you posted. I will read everything and work about he best way to go. I'm thinking July/August could be a good time as I'm not going anywhere. Much easier in summer than winter too. I'm more interested in tryng something resembling keto fasting as anecdotally many people claim it helps reduce inflammation and that for me is the ultimate goal even more than weight loss, though both would be great obviously. I never stick at one thing for more than a few weeks - keto, vegan, 5:2 - you name it - so I possibly give up too early before things have a proper chance to work. I've enjoyed this thead, it's given me new optimism and oomph! Let us know how you get on AndyMurph, go for it!

[tangocharlie in reply to PMRpro]

Thanks again. I do know what to do, I just fancy doing something where I don't have to think for a while and there is less leaway to have a day off and more motivation and accountability to stick at something! If I followed something exactly to the letter for 8 weeks then if it didn't work I'd know it wasn't my fault, and if it did work it'd be amazing, and contribute to research knowledge and promulgating the benefits - and shutting up the dinosaur GPs! There was a very interesting Prog on Channel 5 on Monday, how to lose a stone in a month. About 8 or 10 different diets, all worked or came close to the stone and most kept it off after a year, Huel, keto, low carb, sugar reduction, raw food and some odd ones I'd never heard of.

[PMRpro Ambassador in reply to tangocharlie]

Then write yourself a spreadsheet with destructions of what you are going to eat and only buy what you need for it. One of the links mentioned that concept - not having to worry about what you will eat and I could certainly ascribe to that, I am very disciplined about what I buy - just probably eat too much. And crrently really can't get my head around stopping wine again as I did in lent. Nice glass of rose goes well with 30C in the shade ...

[Andymurph in reply to PMRpro]

I think lockdown may have triggered the surgery obesity alarm as I waddled in.

[Sophiestree]

Nothing to really say as others have, but just you made me chuckle reading your post. You have a good attitude which has to be the first step.I don't know much about the Newcastle diet but wish you luck. I have found the low carb, no sugar diet is working really well for me.

Ps, maybe keep that oximeter!!

[Andymurph]

Started the Newcastle diet this morning. I've chosen to try a company called Exante, mainly due to the fact I've been a veggie for decades and the first company I looked at used fish oil in all its recipes.

There looks to be loads of vegan and veggie products so meal choices should be easy.

An 800 calorie diet seems severe but, I'll see how I go.

[Hearty21]

My HbA1c result was 41 last week. I had a call from my GP and he said all is normal and nothing to worry about. They will repeat tests in 3 months

Out of curiosity, I am doing some research. Does it mean I am also Pre-Diabetic ?

[Andymurph]

Hearty, as you might gather from my postings, I have a healthy scepticism when it comes to GP's. (even though I happen to like mine)

There are good ones and not so good ones. What they are all good at doing is pointing you in the right direction for specialist help.

All surgeries are managed with an eye on finance and most seek to satisfy their targets on diabetes and certain other conditions.

These initiatives are called Quality and Outcomes framework, or QOF's and surgeries are awarded points based on the diagnosis and outcome of these conditions.

As an example, 11 points is worth £1726 to an average (6k patient surgery)

I was diagnosed type II with a 39 result last week by a GP whose considered expertise within my practice is diabetes.

My daughter is a clinical specialist at my local hospital and uses 41 as a guide.

I accept I do have some chronic conditions which I trust my GP to treat and also accept that I will benefit from losing a bit of weight.

Although a high salt diet is accepted as being detrimental to health, taking something with "a pinch of salt" can sometimes be the best policy.