23 November 2021

On 27 October 2021, my doctor called to tell me that my recent fasting blood test put my in the diabetic range based on an elevated HbA1c reading (54mmol/mol). On the plus side, my overall cholesterol numbers had improved (4.7 average compared to last year’s 5.4).

Since then, I’ve researched and corresponded and made some changes, but have only recently realised the good thing about the approach of my doctor(s) and our local Health Board – there has been no talk at all of medication: everything has turned on lifestyle and, crucially, changes with the potential to knock the diabetes into remission.

The initial advice was very general: reduce or eliminate added (free) sugar, avoid sugary foods except for occasional treats, eat an unlimited amount of veg., and watch out what kind of fruit I’m eating. By the time I went back for my first clinic appointment with the specialist diabetes nurse, I’d already lost 3Kg (6.6lb).

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My initial approach was to take the same approach I took to salt when my BP was uncontrolled: I aim for the least amount of free sugar and high-glycaemic index (‘GI’) carbs at breakfast and lunch, leaving me more leeway at suppertime. The single biggest change has, I suppose, been the near-elimination of commercially-made bread from my diet (I’ve eaten some homemade bread made with low-GI spelt flour), but I’ve also been ruthless at reading labels and cutting out disguised sugars. Chocolate, and chocolate biscuits have gone.

This has worked.

In fact, I think I shifted almost overnight to a very low-carb diet. This had some unexpected digestive consequences, but has had a clear impact on my weight. I’ve significantly upped my exercise rate too, but diet has had the biggest short-term effect. My weight loss is now 4.2kg (9.3lb) since 29 October making – I think – an overall weight loss since 11 October of 7kg (15.4lb): I’m a little vague about the exact number because of the differences between the scales at the clinic and our bathroom scales, but 7Kg in the right ballpark.

I will be refining my diet approach to be more systematically ruthless, and looking to reduce portion size as well.

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The issue before me now is how to structure my approach over the coming months, and to set myself some challenging but, I think, achievable targets. Christmas is in sight, of course, but that isn’t a reason to hold back on the target setting. I will also be looking at a more comprehensive exercise programme, but I’m not up to speed on that yet, so that will be another post at a future date.

I haven’t set dates on the targets because I’m not entirely sure what a reasonable rate of change is to measure them against. They are all interlinked.

HbA1c 52mmol/mol is in the diabetic range. My interim target is to get it down to 48 (pre-diabetes) and thereafter to the normal range of 20-41. The number is an average measure of glucose in blood over the 120 days prior to the test, and it is therefore, in part, a lagging indicator. I’d like to see progress towards 48 by the time of my next clinic appointment in February 2022.

Weight Loss I’ve set myself the challenge of losing around 30 Kg (66lb) which would get me to the weight I was forty years ago. I don’t expect this to happen overnight, and I certainly don’t expect it to be easy, but that’s the target. Once I have a feel for my rate of change, I’ll put some dates around this. In my head, I’ll be micro-targeting it in 5kg increments.

Waist Size I recently dropped from a UK 38” waist to a UK 36”.  My next target is 34”, and thereafter 32”. I have dates in mind for these, but I’m keeping them to myself for the moment.

BMI My BMI is currently 34.2. My interim target is 30, my end target is 25 or lower.

BP Meds The driver of my hypertension is complex (excess of aldosterone), but the meds I take for that are supplemented by BP meds that ought to be susceptible to the targets I’m setting here. Clinical judgement is involved, obviously, but I’d like to lose at least one of the supplemental BP meds. I can measure this through my existing home-monitoring of my BP (BP this morning was 125/68)

Running I used to enjoy running, particularly when I found the zen-state that often comes with it. Right now my fitness has attenuated and my knees are older than they were. Nevertheless, in conjunction with proper advice, I’d like to get back to being able to run 5k and to do it in under half an hour. I’m making no plans beyond that.

Tai-Chi At the turn of this year, I wrote that I’d like to sign up for beginner’s Tai-Chi. Covid has continued to get in the way of that, but it remains an aim.