Understanding readings

[Hevmc66]

Hi everyone,
I was diagnosed with type 2 diabetes about 4 years ago now and commenced on Metformin split into 3 doses of 500mgs each time. It seemed to be managing it fairly well. However i was admitted to hospital fir surgery last July and ended uo severely acidotic with dangerously high lactic acid levels. As a precaution the Metformin was stopped and i was commenced on stitaglyptin once a day but only a 50 mgs which is half the normal recommended dose for an adult (still not sure why) the nurse at my gps has debated about highering the dose as my bs levels are continuing to rise and the sleepiness I'm experiencing is ridiculous! I've had to keep a diary of alternate pre breakfast/ pre dinner and pre lunch/pre bed and the results are all over the place. In the morning they're in the high 7's and 8's and pre lunch has ranged from 5.8 to 12! Pre dinner between 5 and hugh 6's and pre bed between high 8's and high 10's? The thing i find most confusing is today pre lunch it was 12 but post lunch was 6.2? Anyone got any ideas what's going on? The diabetes specialist is looking at my results next week and taking it from there. But should my levels be swinging between low to high and vice versa so quickly? Thanks in advance

 

[Bluetit1802]

No, it isn't good for your glucose levels to be swinging up and down, and especially not up. It sounds to me that these swings are directly related to your food intake. The more carbs you eat the higher your levels will go and the sleepier you will feel.

All carbs convert to glucose once inside your system and this is just what we diabetics can't handle, so the answer is to reduce the amount of carbs you eat.

I suggest that in addition to testing pre meals, you also test post meal (around 2 hours after first bite). That rise in levels from before to after will show you what that meal has done to your levels. If the rise is more than 2mmol/l there were far too many carbs on your plate. (the 2mmol/l rise is generous, once more control is gained it is best to keep this rise under 1.5mmoll)

Keep a food diary including portion sizes and record your levels alongside. You will soon see patterns emerging and be able to repeat some of these meals but with smaller portions of carbs, and even eliminating some.

Perhaps if you tell us what you typically eat we can spot things to help you.

 

[Hevmc66]

Thanks for your reply. What I'm struggling with understanding the most is why are they high in the morning and before bed when it's been hours since I've eaten? And again why so high pre lunch and post lunch dropped right down? I do understand somewhat about the food affecting it but i thought it usually goes uo after eating and not down? A typical day's diet is cereal every moring with skimmed milk (anything from cheerios, weetabix, cornflakes etc wirh no extra sugar added. Lunch can be soup or sometimes a sandwich and evening meal for instance last night i had a greek salad or i eat things like homemade soup or regular meals like spaghetti bolognese or quiche, chicken, roast dinners etc. So not sure really?

 

[Resurgam]

Stitaglyptin is supposed to lower our blood glucose levels, so it is working against all the carbohydrate rich foods you are eating, so your levels will fluctuate according to when you take the medication and when you eat.
To keep my blood glucose levels down to normal levels I avoid grain, carb heavy vegetables, and most fruits, I use cream instead of milk so as not to have the lactose - it makes a huge difference to the BG levels and also to the amount of fluctuation during the day.

 

[Bluetit1802]

I don't know why your levels dropped from 12 to 6.2 post lunch, but I suggest one or the other reading was corrupted in some way. This happens to us all, and when we get unexpected or silly results it is wise to re-test immediately (wash hands again first). Any microscopic bit of food or other substance (even soap) on your fingers can affect results, and sometimes we get corrupted test strips. That drop is inexplicable other than a rogue reading of one or the other.

If you eat a lot of carbs for evening meal when you are not controlling your levels in general, bedtime readings can be high because they haven't come down from your post meal peak. Especially if your insulin isn't working as it should, due to insulin resistance.

Morning levels on fasting are notoriously unpredicatable, are the last thing to come down even for otherwise well controlled diabetics, and not only food but also things like stress, sleepless nights, disturbed sleep and the perfectly natural liver dumps come in play. Liver dumps are when our livers think we need extra glucose to get us going for the day or because we are exercising. Glucose is dumped in our bloodstreams and there isn't a lot we can do about it.

You are eating too many carbs I'm sorry to say.

Cereals especially with skimmed milk are very high in carbs (and sugar) Soups thickened with flour are also high carb. Bread, potatoes, rice, pasta and anything mad with flour such as pastry are all high carb and need to be limited in portion size or totally eliminated. Full fat milk is better than others, but still high, and we also need to be careful with fruit. I'm afraid to say that unless you seriously change your diet you won't get any sort of better control and things may get worse. The good news is you can eat lovely things like bacon and eggs, butter, cream and full fat yogurts, any meat or fish, many kinds of veggies and all salads, tomatoes and mushrooms. Eggs cooked any which way are excellent, but no quiche crusts!

If you do as I suggest with testing before and after and keeping a food diary, you will learn more than listening to me. If you eat to what your meter tells you, you won't go far wrong and will see vast improvements.

 

[wiseowl_123]

Good afternoon @Hevmc66 please listen to @Bluetit1802's advice I am relativly new to diabetes and its thanks to all of our friends on this forum that I have even suprised my doctor,diabetic nurse and myself,I followed all the advice and suggestions and my HbA1c when diagnosed was 114/12.6 in 3 months it is down to 50/6.7 and its down to the members here

 

[Hevmc66]

Thanks everyone for your advice i have asked to go on the diabetes education course numerous times, i will ask again when i go back in a few weeks. I also eat the other things suggested above in fact i have a bit of a thing for bacon and eggs. I very rarely eat bread and can go weeks without it. I had a sandwich for lunch today but that's not a regular thing and as for quiche i buy the crust less type as pastry gives me terrible heartburn/reflux. ( i have a hiatus hernia) unfortunately i have a catalogue of health issues including M.E, fibromyalgia, degenerative disc disease, cervical spondylitis, hypertension B12 deficiency, calcium and vitamin D deficiency and i can't absorb iron properly. The B12 and other deficiencies mean alongside my medications i have to have things like dairy and certain meats and fruit and veg. I don't add any thickeners to my soups i just put potatoes or lentils etc in it. I do need to get my diet right i know that for sure and i appreciate all advice given. I used to be a nurse (now medically retired) so I'm good with doing my readings correctly (washing hands etc) i have the monitor with the cartridge in it? Which i thought was accurate? But like you say maybe just a rogue reading. I have had readings as high as 16 and as low as 3.6!!! The nurse has talked about putting me on a drug which makes you pee the sugar out as my hba1c has just continued to slowly rise. It was ok on the Metformin, but i can't go back on that ever again because of acidosis just wish i could get it right, i feel so stupid sometimes

 

[CherryAA]

Thanks everyone for your advice i have asked to go on the diabetes education course numerous times, i will ask again when i go back in a few weeks. I also eat the other things suggested above in fact i have a bit of a thing for bacon and eggs. I very rarely eat bread and can go weeks without it. I had a sandwich for lunch today but that's not a regular thing and as for quiche i buy the crust less type as pastry gives me terrible heartburn/reflux. ( i have a hiatus hernia) unfortunately i have a catalogue of health issues including M.E, fibromyalgia, degenerative disc disease, cervical spondylitis, hypertension B12 deficiency, calcium and vitamin D deficiency and i can't absorb iron properly. The B12 and other deficiencies mean alongside my medications i have to have things like dairy and certain meats and fruit and veg. I don't add any thickeners to my soups i just put potatoes or lentils etc in it. I do need to get my diet right i know that for sure and i appreciate all advice given. I used to be a nurse (now medically retired) so I'm good with doing my readings correctly (washing hands etc) i have the monitor with the cartridge in it? Which i thought was accurate? But like you say maybe just a rogue reading. I have had readings as high as 16 and as low as 3.6!!! The nurse has talked about putting me on a drug which makes you pee the sugar out as my hba1c has just continued to slowly rise. It was ok on the Metformin, but i can't go back on that ever again because of acidosis just wish i could get it right, i feel so stupid sometimes

Unfortunately " just put lentils or potato - in as a thickener - is one of your problems, you probably needt o rethink the basics of your diet quite a lot, look around on here and visit diet doctor .com to get some ideas.

 

[Bluetit1802]

If I were you I would start with changing breakfasts. If you have insulin resistance, which most of us do have, then mornings are not a good time for carbs. Stick to protein and fats, especially fats. A coffee with cream is a good idea, and surprisingly filling. Our insulin resistance does improve as the day progresses for some reason, so leave any carbs for later. I think if you make this one change you may see improved results.

I don't make my own soup, although I did make some French Onion soup and it was delicious. From what I read on here, people use cream and/or a low carb stock cube. Spuds and lentils are high carb, and especially spuds when they are squashed/mashed, baked/stewed. The odd new spud is fine for me, but no more than 2 small ones boiled/steamed.

For fruit, berries have the least amount of sugar. Tropical fruits have the most. The advice is to eat fruit as part of a meal and not as a stand-alone snack, and add double cream or full fat yogurt to flatten out the spikes.

Veggies - in general, root veggies are problematic as they tend to be starchy. Above ground ones tend to be best.

Some of your medications for your other conditions may not be helping, especially if you are on steroids, but there is nothing you can do about that.

 

[Hevmc66]

It's all so complicated with all the added issues and medication. You think you're doing the right making homemade soup and eating loads of veggies but it's just a minefield. Like i said earlier i have asked to go on the diabetes course to get more educated about it all and so far not been referred. I will definitely push harder for that when i see the nurse. I take about 24 tablets a day plus inhalers, patches, liquids etc and i don't even know if any of the affect my diabetes?? But my pharmacist is really good with things like that so i think he would have said something. I really am grateful for all the comnents and suggestions (even if it doesn't come across that way) i just feel like with having a medical background and having it for 4 years or so i should be better educated about it!

 

[Bluetit1802]

@Hevmc66

I appreciate you were a nurse, and maybe because of this you are ingrained in the NHS way of thinking regarding diet, but I am almost certain you will be disappointed in your diabetes course when you attend. Some of it may be useful, such as an explanation of what diabetes is, but the majority will be on diet and self management.

The dietary advice will almost certainly be the NHS recommended Eatwell Plate - carbs with every meal, plenty of starchy ones, low fat. You will probably also find resistance to testing. Trust me - there are hundreds of threads on here about such courses. I actually refused the invitation to attend the course I was invited to because it was presented by my own diabetes nurse from my surgery, and I knew exactly what she would be saying. (have a jacket potato with baked beans for lunch was her favourite phrase.) Until the NHS (or should I say the British Nutrition Foundation which advises the government on food matters) catches up with the fact that carbs are the enemy, not fat, as far as diabetes is concerned, we won't get the official advice we need.

By the way, the British Nutrition Foundation is one of the main government advisory groups on nutrition. Have a look at its membership and sponsors.

https://www.nutrition.org.uk/aboutbnf/supporters/memberorganisations.html

(British Sugar PLC
Heinz
Kelloggs
Mars
United Biscuits.

Need I go on!!!!

All I can add is that the Eatwell Plate and its predecessors are what got most of us here in the first place, and it certainly won't get us out of it. There are 2 ways out of it - low carb with increased fats or more and more meds until insulin is the last resort.

You may be lucky. You may get an enlightened course presenter.

 

[Hevmc66]

@Hevmc66

I appreciate you were a nurse, and maybe because of this you are ingrained in the NHS way of thinking regarding diet, but I am almost certain you will be disappointed in your diabetes course when you attend. Some of it may be useful, such as an explanation of what diabetes is, but the majority will be on diet and self management.

The dietary advice will almost certainly be the NHS recommended Eatwell Plate - carbs with every meal, plenty of starchy ones, low fat. You will probably also find resistance to testing. Trust me - there are hundreds of threads on here about such courses. I actually refused the invitation to attend the course I was invited to because it was presented by my own diabetes nurse from my surgery, and I knew exactly what she would be saying. (have a jacket potato with baked beans for lunch was her favourite phrase.) Until the NHS (or should I say the British Nutrition Foundation which advises the government on food matters) catches up with the fact that carbs are the enemy, not fat, as far as diabetes is concerned, we won't get the official advice we need.

By the way, the British Nutrition Foundation is one of the main government advisory groups on nutrition. Have a look at its membership and sponsors.

https://www.nutrition.org.uk/aboutbnf/supporters/memberorganisations.html

(British Sugar PLC
Heinz
Kelloggs
Mars
United Biscuits.

Need I go on!!!!

All I can add is that the Eatwell Plate and its predecessors are what got most of us here in the first place, and it certainly won't get us out of it. There are 2 ways out of it - low carb with increased fats or more and more meds until insulin is the last resort.

You may be lucky. You may get an enlightened course presenter.

thanks again for your advice, to be honest though I've not had any dietary advice from anywhere. i did paediatric nursing on a renal ward so i know more about renal diets than any other. where would you advise I go to receive the best advice for diabetes? i appreciate that you have given me lots of useful tips but if i wanted something written down that i could refer to for instance. where is the best place for that? on here? online? i know so many questions but unfortunately the Fibro and the meds mean i struggle with my memory too and can't retain information very well. thanks again for your help.

 

[kokhongw]

where would you advise I go to receive the best advice for diabetes?

Many have found this to be a helpful starting point,
https://www.dietdoctor.com/low-carb

The fact that you are seeing occasional 5s-6s mmols would suggest that there's sufficient beta cells working. So one of the strategy is not to place too much demand on them...both carbs and proteins requires insulin...dietary fats less so.

 

[Hevmc66]

Ah thanks so much for your help I've seen the nurse specialust today and she has doubled my stitaglyptin dose so will keep a strict watch on that and also take a close look at your link

 

[miahara]

I hope the change in your medication helps @Hevmc66 , but looking at your diet I think that if you try to cut back on carbohydrates it will probably help considerably too. Cereals for breakfast are fairly high carb, your occasionalsandwich is high carb as is spag bol and these will all cause spikes in blood glucose.