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Discussion Starter · #1 ·
I was dx'd in Jan 2010, and shortly found this forum and others and I followed low carb, high fat diet. I was able to get my A1c below 6 fairly quickly, and was very happy to accomplish that.

However, I lost what I, my dr, and others think is too much weight. I'm a 56 yr old male, 5'11", and typically weighed around 200. I got a tad below 140, and was having trouble trying to put some weight back on. I was on 1000 mg Metformin, which was affecting my appetite. My dr has cut me to 500 mg, and that seems to have helped some of my apetite return. My dr also argued that I could have a higher A1c, and that studies had shown that those w/A1c's in the 6's were not at a higher risk than those below 6. For now, I have been eating more carbs than I have in the past, and have been able to put on 6 or 7 lbs, and would like to put on more. I had tried, but wasn't successful increasing caleries to gain weight without increasing carbs. I will be interested to see what my next A1c is. I expect it to be a little higher, but wouldn't think it would be a great deal higher. I'd guess it would be in the low 6's.

Another reason I had balked at adding to my diet is that I have Peripheral Neuropathy, and drop foot, which is diabetes related. I am concerning that a higher A1c is not good for this. We all know D is a balancing act, and I do feel like I'm having to make tough choices. I'd be interested in thoughts about this predicament.

Bernard
 

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I agree you shouldn't lose more weight - so if I were you, Bernard, I'd be eating more bacon . . . adding more fat to the diet instead of more carbs. Do you like avocados? I often wrap bacon, avocado, tomato, etc., in a big lettuce leaf for a really tasty wrap with essentially no carbs but high fat with the bacon & avocado.
 

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Had you tried increasing protein along with the fat. Excess protein is turned into glucose which your body will store either as adipose tissue or lean muscle. It is slowly converted so you should not see a large spike from the increase.
 
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Hi Bernard - welcome to the forum.

I have no experience trying to gain weight, but know that on my low carb diet, if I over-indulge in my favorite macadamia nuts my weight ticks up. Agree on the balancing act, eating enough carbs with the high fat to keep your weight up but not affect your A1C. Sounds like a good place to put your energy, and I'd also want to keep my numbers as low as possible.

In your shoes, I'd ask my doc to point me to the 'studies that show' those with A1Cs in the 6s are not at higher risk than those with normal A1Cs (<5.6 or so) so to dig into them.

Glad you joined us.
 
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Another reason I had balked at adding to my diet is that I have Peripheral Neuropathy, and drop foot, which is diabetes related. I am concerning that a higher A1c is not good for this. We all know D is a balancing act, and I do feel like I'm having to make tough choices. I'd be interested in thoughts about this predicament.

Bernard
Have you been tested for vitamin deficiencies? Doctors are quick to blame Neuropathy and other problems on diabetes without checking for other causes.
I too had Neuropathy right from the start and it got worse even after I got my glucose well controlled.

I insisted my doctor test me for a variety of vitamin deficiencies that are common in diabetics and can cause neuropathy. Turns out I was Thiamine (Vit B1) deficient. Since I started taking thiamine supplements two months ago my neuropathy has significantly improved and I'm think it might actually go away.

If you haven't been tested yet I suggest you get tested for deficiencies in B1, B3, B6, B12 and Vit D.

My neurologist was surprised that I was Thiamine deficient because "Almost nobody gets that other than alcoholics" which is what the medical community has been taught for years.
However, several recent studies indicate that up to 75% of T2 diabetics are thiamine deficient.

P.s. My glucose levels dropped significantly once I started taking the Thiamine supplements.
 
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My dr also argued that I could have a higher A1c, and that studies had shown that those w/A1c's in the 6's were not at a higher risk than those below 6.
Bernard
I'm not sure what studies your doctor is reading, but the studies I've read say that A1C levels over 4.6% are tied to an increase in the chances of getting Coronary Heart Disease. This is true even for non-diabetics and doubly true for diabetics.

Those with A1C of 6.5% are twice as likely to get CHD as those with levels below 4.6%.

In fact A1C readings are a better predictor of CHD than cholesterol levels. There is even mounting evidence that high LDL levels aren't the real problem, but rather LDL that is sticky because it's coated with glucose due to high glucose levels in the blood.

Here is a page with links to several studies showing this:
A1c and High Post-Meal Blood Sugars Predict Heart Attack
 

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Welcome to DF. I think the study you doctor is referencing is something called the ACCORD study. It took a lot of older, sicker diabetic and basically through tons of med and insulins at them including the medication Avandia. Some got their HbA1c's very low because they were having many hypos. So a percentage of them with the lower HbA1c's died. But they didn't die from lower HbA1cs. It was how they got them. Hypos are not good. Using tons of meds is not good. Low carb/High fat diet is good to lower bgs. Many of us do the LC/HF diet. The trick is to get 1600-2500 calories in each day. The problem seems to be you are not eating enough because of the Metformin. Are you on the extended version of metformin. Some are very sensitive to Metformin and just cannot handle the effects. There are other D meds or even a long acting basal insulin would help you with weight gain. Also have you been tested for antibodies. Some type 2's are misdiagnosed and are really LADA or Type 1.5's. Ask your doctor for a GAD 65 Antibody test and a C Peptide test.
 

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If you don't already do some weight-training, START.

If you do, (or if you're going to be starting) you likely need to up your levels of FAT and Protein (you'll need more calories in that form). It sounds like you're able to metabolize your dietary fat properly, which means you need a higher intake to get your testosterone levels up. Protein also helps with building lean muscle tissue, so try that.

That's what I'd do in your case, anyhoo.
 

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Discussion Starter · #9 ·
Thanks all for the input. My dr has tested for deficiencies. My PN did get worse before it got better. I did go through a lot of pain, and now I don't have much pain.

I did try for a good while to increase protein, but wasn't successful in gaining any weight. My dr has been very pleased and surprised by my A1c getting below 6. I did let him know that my goal was to be much lower than that. He typically sees two types, ones who follow the diet the CDE's recommend, and those who don't try much or at all. That's why I am grateful to find forums like this one.

Bernard
 

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Discussion Starter · #10 · (Edited)
You may be right about my dr referencing the ACCORD study. And yes, some of my issues have been the Met. I am on the ER version, and have tolerated it pretty well. We discussed maybe lowering the Met to 500 mg and adding another med option as some have gaining weight as a possible side effect. I don't want to take something that will push my pancreas to produce more insulin as I don't want to burn out my beta cells. As I do have my first appt with an endo next week, he decided to cut my Met to 500 mg but not add anything, figuring the endo would have their own ideas about any other changes. The cut in Met has definitely helped my appetite. I do agree that if I can get enough calories from protein, then that would be better. I've said all along I could easily gain weight, if BG levels weren't an issue.

I have been pleasantly surprised that the cut in the Met hasn't greatly affected my fasting BG levels (I do test often).

Bernard
 
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He typically sees two types, ones who follow the diet the CDE's recommend, and those who don't try much or at all. That's why I am grateful to find forums like this one.

Bernard
Isn't that a shame? Maybe some of the ones who don't try, HAVE tried the ADA program & given it up as a lost cause, never having known of cutting carbs. I know your doc doesn't do this, Bernard, but I always feel for the patients who struggle valiantly with the ADA recommendations, and then their docs say they're non-compliant because those recommendations don't work!
 

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Discussion Starter · #12 ·
I had my first appt with the endo, and they did an A1c test in the office and surprisingly, it was 5.3! I was 5.9 in July, and 5.7 in May. In the last month I've cut Metformin from 1000mg to 500mg, and have been eating a few more carbs than I have in the past. Go figure! Could the result be from having the test done in the office versus the lab which does the tests from my PCP?

Endo didn't add any meds at this point but wants me to gain weight, and said we could add meds if needed (he mentioned Januvia) if BG goes up. He wants my A1c to remain below 6, which I was happy to hear him say. He is testing to make sure I'm not a T1, and a few other tests as well.

Bernard
 

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BPS, I would be concerned about needing to start Januvia since Januvia will initially cause weight loss. If you are trying to increase weight, not what I would want to go on. Also, read up on Januvia. Go to blood sugar 101 and read what Jenny Ruhl has to say about Januvia. She classifies this med as a dangerous med. Many here on the forum do take Januvia, so it may just be me who feels this way about this particular med. Great numbers by the way! I WISH I had the problem of gaining weight! I need to lose weight, but slowly but surely working on it. Slower is better...stays off that way!
 

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Discussion Starter · #14 ·
Thanks for that heads up. We aren't adding any meds now, but if we do, I'll go another route.

Bernard
 
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