What should I aim for

[charon]

I was diagnosed type 2 with a HbA1c of 20.9 Mmol/l on 29 Apr.
After reading this site I've ignored the nurses advice not to change my diet too much and to only test once a day.
The first few tests were around 10-15 but by cutting out carbohyrates it went down over a few days.
Now I hover around the 4.0-5.5 mark before meals.
Nurse is happy for me control by diet - I'm sure if I'd followed her advice I'd be on metformin and not feeling so well.

After meals it goes up by well under 1.0. If I add a half baked potato it goes up by about 2.0 - still well under 7.8.

I'm looking to vary my diet a bit (will be another post) and would like advice as to what I should aim for.
Before meals I would have thought under 6.0 (usually well under) would be ok and keeping generally under 8.0 for the post prandial with an occasional 10.0 for special occasions - max once a week maybe.

Is this reasonable or should I be aiming for less than this - or is there no real recommendation and lowest possible is best.

Note: I find it's only really easy for me to control things by making a note of everything I eat and all tests with times. Might be just me but I've found that is the only way to stop doing things and pretending they don't count - works for saving money too.

 

[daisy1]

Hi Charon and welcome to the forum

Here is the information we give to new members which should be helpful to you. Ask more questions if you need to and someone will help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find well over 30,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips
The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

 

[charon]

I guess from that response the site doesn't allow any other advice about levels.

 

[teagan]

Hi and welcome i am no expert but those levels sound ok i try to not go above 9 after meals is you have to fund your own strips Supercheck2 and codefree monitors are a lot cheaper i pay £8.49 for 50 strips with the Supercheck2 also better to buy direct from them my last Hbaci was 6.5 so i am happy with that i find carb counting confusing the way i do it is to put out a normal dinner and anything that grows underground i take a third away rice in small amounts and not to much on the bread or pastry front

 

[Neil Walters]

I am being advised by my DN that between 5 and 9 is her target for me if possible.


Diagnosed type II 1998 2 x 80 mg Gliclazide, 4 x 500mg Metformin and 1 x 100mg Sitagliptin - HbA1c - 48 mmol/mol

 

[CathyN]

Hi there

Obviously everyone is different. After controlling my Type 2 with diet and exercise for 12 months, I can honestly say that every day is different too. Even if I eat exactly the same diet on 2 consecutive days, the results will usually differ!

Personally I aim for:

On waking, a fasting level of 6.0mmol/L ( under is great - over 7 I take very seriously and try to find out why).

Pre prandial - I am usually in the 6s or sometimes 5s. If at the top end of the 6s or if I have stayed in the 7s for some reason, I wait, re test and eat once I have dropped into the mid or early 6s.

Post prandial (+2 hrs after my last mouthful) I aim for under 7.8mmol/L. I don't have weekly treats, just occasional ones.

Like you, I keep a full diary of all food and drinks, my BG levels, my exercise, how I'm feeling ( ie if I have a cold etc), my weight and because I have an eptopic heart beat, I check my blood pressure too.

I occasionally work out a monthly average, which is very often quite close to my HbA1c.

My diet is lowish carb, choosing slower release carbs. I don't eat high fat or protein, just a balanced diet with less carbs. I avoid pasta, bread, pastry and eat sparing amounts of potato and basmati rice ( a tablespoonful would be my limit).

Anyway, it sounds as if you are doing great with those really good pre prandial readings. If you are lowish before you eat, that's a real bonus.

Good luck!

CathyN

 

[charon]

Thanks everyone - especially CathyN for detailing your experience.
I think my baseline is lower than yours but my swings are higher when I eat any carbs. I'm new to this so I hope things will settle down a bit.

Yesterday was very odd. Went out for my first meal (indian) since being diagnosed.
Had half a popadom, tandoori mixed grill with raw onions and a large glass of red wine coffee and an after eight mint.
Before the meal was 5.1, after 7.5, which I think is not too bad and better than expected.
The odd thing is that then I had a cup of tea and drove home - about 2 hours and my reading was 4.4.
Would you expect it to come down that far and that quickly?

Like you I find things change for no apparent reason but dinner with a potato seems to be consistent at 1.8-2.0 rise - but I wonder if my glucorx nexus monitor is that accurate.

Would the occasional spike to say 10 be a problem? By occasional I mean maybe every couple of weeks.

 

[Daibell]

Hi Charon. I think your targets are very sensible ones. Try to stay below 8'ish 2 hours after a typical meal and the occasional spike to around 10 is fine. Many things affect sugar levels for example having fat with carbs will slow-down absorption and so on, so don't worry too much about strange variations; we all have those. Alcohol will tend to push your sugars down as it reduces the liver's release of glucose. Your GP will use the HBa1C blood test as the main guide and if you can keep this to around 6.5% or less then you will be doing OK.

 

[charon]

Thought I would give an update.

I had a hba1c 3 months after diagnosis, 42 = 6.0% = 7.0.
Was told not to request a test myself but to wait for them to schedule it in future - didn't feel guilty about it though.
Just had a new one at 37 = 5.5 = 6.2.
I've been a lot less strict about diet and exercise so suspect the first one had some red blood cells left over from pre diagnosis.

Quite pleased about it anyway as I've stopped testing so much - every couple of weeks now. Highest test has been 7.2 (planned loose day) but is usually 4.3-5.5.

Wish people would stop saying I'm too thin but that's just because they remember what I was like a year ago. They'll get used to it.

 

[charon]

And just a note to say thanks to everyone on this site which helped me to ignore the nurse who told me not to change my lifestyle too much and rely on drugs.

 

[Brunneria]

Only just seen this thread.
What fantastic results - you should be very proud and pleased.
And I am very jealous.