My GP: After eating blood sugar of 19 doesn't matter...only A1C matters

[Patrick Johnson]

Hello:

My family doctor (GP) here in Canada has been insisting for the past fifteen years that my after-eating blood sugars don't matter. He gave me the classic line, "It's not how high your blood sugars go, it's how quickly they come down."

My typical A1c test result for the past five years has been between 7 and 8. For the past fifteen years, my typical after eating blood sugar has been 14, but I recently hit a 19, and that alarmed me.

I recently started urinating frequently and getting a metallic taste in my mouth. I "googled" these symptoms, and I found out they may be a sign of early kidney failure! I am going to see my family doctor on Wednesday.

So, I was wondering what people thought about this situation? Is it possible to have such high after-eating blood sugars but a stable A1c? Is my doctor's belief that "only the A1c matters" correct?

 

[cold ethyl]

HbA1c tests whilst a good indicator of overall control can mask a lot of highs as they just equate to an average BS level. I'm surprised that your GP was ok with levels as high as 14 as the UK post meal recommendations are 8.5 I think for a diabetic and most will aim up be under the 7.8 non- diabetic figure at 2 hrs post prandially as this appears to be the point at which damage can occur if at those levels for sustained periods of time. I'd be asking to see a different doctor personally!

 

[Brunneria]

Having read bloodsugar101 (see link in my signature), I am firmly convinced that it isn't so much the severity of the spike, or the length of the spike, it is the area under the spike.

Imagine a graph.
You drink Full sugar cola. Your BG flies up, then drops down sharply. The graph shows that as a very steep, pointy mountain.
You eat a pizza. Your BG rises slowly, then drops slowly. The graph shows that as a wide, gentle hill.

But they both have the same amount of space under the line.

There is considerable evidence that having your BG above a certain level (roughly equivalent to an HbA1c of under 6.0%) means that the body's organs are exposed to blood glucose that damages the organs causing the longterm complications that we all dread.

Follow the link in my sig. Read the studies and the commentaries and make up your own mind.

I aim to have a BG level of below 6.6 at all times (though I'm not there yet!). I think that translates to about 120 in US units), and an A1c of 5.9 or below (that's below 40 in new money).

And I think your doctor is an ill informed idiot.

 

[Heathenlass]

Hello Patrick, and welcome
A couple of quick queries - are you Type 1 or 2 ?

How soon post meal do you test ?

Signy

 

[Patrick Johnson]

Hello Patrick, and welcome
A couple of quick queries - are you Type 1 or 2 ?

How soon post meal do you test ?

Signy

Hello Everybody:

Thanks for the quick answers. I have to admit, the times I test are very "scattered". It can range anywhere from thirty minutes to two hours. I actually test my after-eating blood sugars quite regularly. This causes a lot of frustration for my GP, who goes on insisting they don't matter.

Of course, it depends on the food. I've noticed that foods with direct sugars, such as chocolate, can cause a spike up to 13 after thirty minutes, but will come down to 7 or 8 after two hours. Two or three slices of pizza can cause a blood sugar of 10 after one hour, but will go up to 16 after three hours. However, once I peak at 16 I've noticed that my blood sugar goes down quite rapidly, typically 3 points every hour. Hence, after five hours, I will be back at 9 or 10.

I don't know if that helps. I really should focus on testing my after-eating blood sugars at a regular time. But, as I've said, the reading can vary greatly depending on the food I eat. Foods high in flour seem to be the "kiss of death" for me, while things like chocolate seem to cause only a quick spike.

 

[Patrick Johnson]

I aim to have a BG level of below 6.6 at all times (though I'm not there yet!). I think that translates to about 120 in US units), and an A1c of 5.9 or below (that's below 40 in new money).

And I think your doctor is an ill informed idiot.

Oh ****...I read the page you recommended (http://www.bloodsugar101.com/) and it confirmed my worst fears. I was wondering whether the A1c was merely a result of the "highs" and the "lows" balancing out!

 

[Brunneria]

Oh ****...I read the page you recommended (http://www.bloodsugar101.com/) and it confirmed my worst fears. I was wondering whether the A1c was merely a result of the "highs" and the "lows" balancing out!

Sorry.

I dont want to worry or depress you. But I think your doc is scarier than the info on 101!

The good news is that there is masses of info on that site, this one, and all over the web.

It really isn't too late to make changes which can make huge improvements. Don't worry. Take some time to read, hang out on the forum, test the foods you are eating, map out what works and what doesn't (you already know that wheat is a bad 'un), and gradually introduce a few changes.

You will be amazed at the difference it will make.

Oh, and welcome to the forum!

 

[PaulinaB]

The difference you see between different foods is caused mainly by fat. Things high in fat (pizza) will raise you bg much slower. Things low in fat (and high un carbs) will raise your bg much faster.

 

[phoenix]

I recently started urinating frequently and getting a metallic taste in my mouth

Frequent urination is certainly a symptom of high glucose levels . Some people also report a metallic taste in the mouth when they have ketones present.. It might be a very good idea to purchase and test for ketones with urine strips at these levels. If they are moderate/ high then you must seek medical advice.
19mmol/l is high and so is 9-10mmol/l after 5 hours . . .
An HbA1c of 7- 8% is higher than most guidelines suggest. The Canadian guidelines say that in most but not all circumstances people should aim for it to be at least below 7% http://guidelines.diabetes.ca/BloodGlucoseLowering/A1CrefGuide
The guidelines also give a daily blood glucose targets to achieve this
Fasting or preprandial PG target of 4.0–7.0 mmol/L and a 2-hour PPG target of 5.0–10.0 mmol/L
(ie even if it is 10mmol/l after meals it should have certainly gone back to below 7mmol/l before the next meal
http://guidelines.diabetes.ca/Browse/Chapter8


.

 

[jack412]

Hello Everybody:

Thanks for the quick answers. I have to admit, the times I test are very "scattered". It can range anywhere from thirty minutes to two hours. I actually test my after-eating blood sugars quite regularly. This causes a lot of frustration for my GP, who goes on insisting they don't matter.

Of course, it depends on the food. I've noticed that foods with direct sugars, such as chocolate, can cause a spike up to 13 after thirty minutes, but will come down to 7 or 8 after two hours. Two or three slices of pizza can cause a blood sugar of 10 after one hour, but will go up to 16 after three hours. However, once I peak at 16 I've noticed that my blood sugar goes down quite rapidly, typically 3 points every hour. Hence, after five hours, I will be back at 9 or 10.

I don't know if that helps. I really should focus on testing my after-eating blood sugars at a regular time. But, as I've said, the reading can vary greatly depending on the food I eat. Foods high in flour seem to be the "kiss of death" for me, while things like chocolate seem to cause only a quick spike.

you have very good awareness of how carbs work in your body,
the BS101 is a good site and helped me a lot
http://www.phlaunt.com/diabetes/14045524.php

I also cut down on high carb foods and went LCHF diet
you can read and watch the video
http://www.dietdoctor.com/lchf

I also found the first week of LC was hard
http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm

 

[Scardoc]

HbA1c tests whilst a good indicator of overall control can mask a lot of highs as they just equate to an average BS level. I'm surprised that your GP was ok with levels as high as 14 as the UK post meal recommendations are 8.5 I think for a diabetic and most will aim up be under the 7.8 non- diabetic figure at 2 hrs post prandially as this appears to be the point at which damage can occur if at those levels for sustained periods of time. I'd be asking to see a different doctor personally!

I don't have the time to go searching for the biological evidence to back this up but, from memory, Hba1C is a measure of glycated haemoglobin. During periods of high glucose concentration in the blood, glucose molecules bind to haemoglobin in red blood cells, and it becomes glycated. Once glycated, it stays glycated until the end of it's life cycle. So, high blood glucose levels which cause the haemoglobin to become glycated cannot be ironed out by having low blood glucose levels.

I guess this is why the quacks get upset at Hba1C's in the low 6's and beyond. Yes, it indicates that you are not being exposed to prolonged periods of high blood sugar levels but by the nature of diabetes.........BG levels go up......it does indicate that there may be prolonged periods of low BG levels.