How do I get more detailed info on my blood sugars?

[sheenacat]

Hi everyone, this is my first post here. I'm not even sure if I am posting to the right place, my apologies if this should be posted somewhere else.

My GP diagnosed me with type 2 diabetes in June 2016. This was via a HbA1c blood test which came back as 50. 12 months before in June 2015 my HbA1c was 33. I had gone to the GP with symptoms of mood swings and hair loss. I had no symptoms of diabetes and did not even know that the GP had tested for it. The surgery nurse gave me the results, she gave me some written information about type 2 diabetes, gave me some advice about healthy eating, booked me onto a diabetes education course and for eye and foot screening. She did give me another appointment for about 4 weeks' time so when I went back I had some questions, but the answers I got were rather vague, and she was trying to get me to start medication which I refused. Since then I went on a strict diet and lost 3 stone. 3 months after the initial diagnosis my HbA1c was retested with a result of 39. I have had 2 further tests since then and the result both times was 36.

At no stage have I ever been offered equipment to test my blood sugars, in fact the GP and the nurse both said I would not need to do that and a 6 monthly or even yearly blood test for HbA1c levels was sufficient.

But everything I read about diabetes seems to emphasise that it is the spikes in blood sugar levels that cause damage. So how do I know whether my blood sugar levels are going too high after a meal? Should I be insisting that I want a monitor and testing strips - and do I have the right to insist on this?

I asked to be referred to a dietitian - this took 9 months, I had one appointment 7 months ago with a student dietitian and that was it, I've heard no more since. She was useless, didn't tell me anything more than the little I had already been told.

I still eat more healthily than I did before the diagnosis, but I admit that I am eating biscuits pretty much every day now (malted milk or rich tea normally as they are low in sugar) and I do sometimes eat other things that are higher in sugars too. I still find it really hard to accept that this is going to be for the rest of my life, and that even the small amount of bad foods I do eat could be causing long-term damage.

Any help or advice would be very welcome.

 

[miahara]

The important measure of blood glucose is the HbA1c average and yours looks very good indeed. We all (diabetic or not) experience ups and downs in blood glucose levels and eating does push them up for short periods but if your average is as low as you have said your spikes are probably nothing to be concerned about.
See this chart :
http://www.diabetes.co.uk/what-is-hba1c.html

 

[Alexandra100]

Hi everyone, this is my first post here. I'm not even sure if I am posting to the right place, my apologies if this should be posted somewhere else.

My GP diagnosed me with type 2 diabetes in June 2016. This was via a HbA1c blood test which came back as 50. 12 months before in June 2015 my HbA1c was 33. I had gone to the GP with symptoms of mood swings and hair loss. I had no symptoms of diabetes and did not even know that the GP had tested for it. The surgery nurse gave me the results, she gave me some written information about type 2 diabetes, gave me some advice about healthy eating, booked me onto a diabetes education course and for eye and foot screening. She did give me another appointment for about 4 weeks' time so when I went back I had some questions, but the answers I got were rather vague, and she was trying to get me to start medication which I refused. Since then I went on a strict diet and lost 3 stone. 3 months after the initial diagnosis my HbA1c was retested with a result of 39. I have had 2 further tests since then and the result both times was 36.

At no stage have I ever been offered equipment to test my blood sugars, in fact the GP and the nurse both said I would not need to do that and a 6 monthly or even yearly blood test for HbA1c levels was sufficient.

But everything I read about diabetes seems to emphasise that it is the spikes in blood sugar levels that cause damage. So how do I know whether my blood sugar levels are going too high after a meal? Should I be insisting that I want a monitor and testing strips - and do I have the right to insist on this?

I asked to be referred to a dietitian - this took 9 months, I had one appointment 7 months ago with a student dietitian and that was it, I've heard no more since. She was useless, didn't tell me anything more than the little I had already been told.

I still eat more healthily than I did before the diagnosis, but I admit that I am eating biscuits pretty much every day now (malted milk or rich tea normally as they are low in sugar) and I do sometimes eat other things that are higher in sugars too. I still find it really hard to accept that this is going to be for the rest of my life, and that even the small amount of bad foods I do eat could be causing long-term damage.

Any help or advice would be very welcome.

You are very unlikely to succeed in getting a meter and strips from the NHS. However you can get a free TEE2 meter from Spirit Healthcare
.http://spirit-healthcare.co.uk/product/tee2-blood-glucose-meter/
It comes with 10 free strips, lancets, lancet gun and carrying case - everything you need to try out home testing. You can then try testing just before eating and 1 & 2 hours after. That should give you an idea whether what you are eating is giving you blood glucose spikes. You don't want to see a rise of more than 2, preferably not more than 1 mmol/L. I suggest you make sure to test before and after those biscuits! I envy you your A1c result, but you are correct in thinking that it is also important to keep your bg "flat" rather than showing big ups and downs. If you then decide you don't need to test, you will have lost nothing, and if you want to continue testing you can just order more strips. Personally, I find testing very motivating. Just getting that feedback makes it easier for me to make the effort/sacrifice to cut back on carbs.

Another strategy you might like to try is walking (or doing some other exercise) straight after meals. Many people find that even 10-20 minutes can lower bg then. (Some research has shown that AFTER a meal is more effective than BEFORE, though ANY is helpful. In the longer term building more muscle by resistance training can lower bg.

Everyone has a different capacity to cope with carbohydrates in their diet, both over the day and at any one time. With any luck your limit is a high one. Testing will enable you to establish where you need to draw the line.

 

[Bluetit1802]

Hello and welcome,

The HbA1c is an average. It does not show the roller coaster swings from high to low that cause the damage. The variability is important. Two people can have an identical excellent HbA1c, but one can be "flat" most of the time, and the other up and down.
The only way to see where you fit is to test before and after eating and see what happens to your levels.

http://care.diabetesjournals.org/content/40/8/994
http://www.diabetes.co.uk/forum/thr...ed-with-alzheimers-in-type-2-diabetes.125081/

 

[sheenacat]

Hello and welcome,

The HbA1c is an average. It does not show the roller coaster swings from high to low that cause the damage. The variability is important. Two people can have an identical excellent HbA1c, but one can be "flat" most of the time, and the other up and down.
The only way to see where you fit is to test before and after eating and see what happens to your levels.

http://care.diabetesjournals.org/content/40/8/994
http://www.diabetes.co.uk/forum/thr...ed-with-alzheimers-in-type-2-diabetes.125081/

Yes, that is what I am worried about. All I get told by the GP and the surgery nurse is that my HbA1c level shows I have "excellent control". But as you say it is an average. I have never even had the blood test that gives the results as a single figure like 7 or 8 as I have seen mentioned on here. I just get told that it is not necessary and it would only give a reading of what my blood sugars are at that precise time, whereas the HbA1c gives a longer term figure. But I just think surely they should check (or I should check if they won't) whether I have large spikes so I can try and change if that is the case.

Thank you all for your helpful comments and advice.

 

[Resurgam]

The only way to see just how those high carb foods are affecting you is to buy a meter and test strips and see what your levels are before and after meals.
To be able to eat biscuits and get such low Hba1c results is impressive.
Sugar, by the way, is not the problem, it is carbohydrates in general - they all become glucose in the blood stream when digested, so just because something is low sugar doesn't make it diabetes friendly.

 

[Bluetit1802]

Yes, that is what I am worried about. All I get told by the GP and the surgery nurse is that my HbA1c level shows I have "excellent control". But as you say it is an average. I have never even had the blood test that gives the results as a single figure like 7 or 8 as I have seen mentioned on here. I just get told that it is not necessary and it would only give a reading of what my blood sugars are at that precise time, whereas the HbA1c gives a longer term figure. But I just think surely they should check (or I should check if they won't) whether I have large spikes so I can try and change if that is the case.

Thank you all for your helpful comments and advice.

These single figures you talk about are exactly what you were told - just a snapshot of what your blood sugar levels were at the time the test was taken. My surgery doesn't do them at all. They just do the HbA1c. They don't mean anything.

To see how much you fluctuate you have to test before and after a meal, regularly for every meal until you are satisfied. You really need to buy your own meter and test strips. We will help you and advise you when to test and what the numbers mean.

The most popular meters for self funding T2's are the Codefree and the Tee2 because the strips are much cheaper than other meters, and you need a lot of strips. You can't buy them in pharmacies.

Try here for the Codefree meter
http://homehealth-uk.com/product-category/blood-glucose/blood-glucose-monitor/

and here for the extra strips
http://homehealth-uk.com/all-products/sd-codefree-test-strips-to-be-used-only-with-the-sd-monitor/

There are discount codes if you buy in bulk.
5 packs 264086
10 packs 975833

The Tee2 is here and the meter is free.
http://spirit-healthcare.co.uk/product/tee2-blood-glucose-meter/

Don’t forget to check the box that you have diabetes so you can buy VAT free. (for either meter)

 

[Daibell]

Hi. As Resurgam says, don't just worry about sugar but try to reduce all carbs and that means don't eat biscuits other by exception. I would avoid any NHS dieticians as they often haven't a clue about diet; crazy but true. Yes, get hold of a meter and test occasionally 2 hours after a meal but your figures are good.

 

[sheenacat]

Ok, so this is what I was worried about, that I am getting it wrong despite the good HbA1c levels. And from your answers it seems I was right to be worried. There are a few questions that I have asked the nurses at the surgery and when I attended the diabetic education course, but haven't felt like the answers have been very clear, or they have been contradictory. Maybe I could get answers here.

I was told I should eat healthily and have a low sugar diet. I should still have my 5 a day but no more than 2 should be fruit. But what about the sugars in fruit, they are quite high in sugar aren't they?

Also what about the sugar in milk or yoghurt? I was told that I should still have milk but when I read the label it says there is almost 10g of sugar in 200 ml, so isn't that bad?

A couple of days a week I make overnight oats with porridge oats, low fat natural yoghurt, a small amount of low fat strawberry flavoured yoghurt (about half a small pot) and sometimes throw in a few blueberries or raspberries. I have to use a small amount of low fat flavoured yoghurt because otherwise I found it too sour with just the natural yoghurt. I will normally use one like Muller Fruitopolis which the nutrition information says 100g contains 7.1 carbs and 5.8g sugar. I only use half a pot to add to the natural yoghurt. The other days I either don't have breakfast or I have weetabix. Are these bad, and if so which is the worst and why please?

I was advised by the nurse to have weetabix, shredded wheat or porridge for breakfast, a sandwich made with seeded bread for lunch and a "healthy evening meal", which was clearly not very specific. What would your advice be on healthy evening meals, which would also make me feel full and less likely to snack?

 

[miahara]

To back up some of the responses already made:
If you really want to understand the impact of specific foods on your blood glucose then the only way is to test before and after eating.
The standard NHS dietary advice based on the "Eat Healthy Plate" is subject to considerable criticism from the aspect of a diabetes-friendly diet and is often called "The Eat Badly Plate".
Your breakfast choices advice - weetabix,shredded wheat, porridge are all high carb I know they all elevate my blood glucose, but some folk can tolerate some of them. You only know what they do to you if you test.
Bread, seeded or otherwise is high carb, though carb levels do vary.
For evening meals there's nothing wrong with fish, fowl or meat dishes with low carb veg, but avoid potatoes and rice.
Snacks are OK if you choose wisely. For example peanut butter or some pates with celery or wrapped in crispy lettuce you can add gherkins, olives or various cheeses.
It's early days for you and there's a lot to learn. Take it a day at a time, it's a marathon not a sprint.
This video may help you understand diet and saturated fat.

Here's another about diet in general and diabetes

 

[Bluetit1802]

@sheenacat

It is a fact that all carbohydrate will convert to glucose once inside the system. Nobody disputes this. We diabetics already have too much glucose inside our system and our natural insulin is unable to push this into cells for energy (either because we have low insulin production or because we have enough insulin production but it is prevented from doing its job because our cells have become resistant to it.)
You need to ask yourself .... as we already have too much glucose in our system, what is the sense in adding even more?
Weetabix, shredded wheat, porridge, bread, as recommended by the nurse are all very high in carbohydrate. She is advocating the NHS "Eatwell Plate" which is not suitable for most of us T2s. The reason for these particular foods being recommended is because they are easy and full of fibre - but they are also full of glucose! We can get plenty of fibre from other foods.

I really do urge you to get a meter and you can see for yourself exactly what your food choices, and what the nurse advised, do to your blood glucose levels. I have a feeling you may be horrified, but you need to see for yourself and then you can make up your own mind.

 

[lowedb]

It will vary between people, and your A1c looks good. But I learned very very quickly that I cannot go near shredded wheat. I had started measuring before and after each meal as people have described. I realised that shredded wheat (and the mini wheat versions) are one of the very few cereals without any added sugar (check ingredients, weetabix have added sugar) so assumed the mini wheats would be OK. I had a small portion of the mini wheats, five to be precise. Have a look how sad that looks in the bottom of a cereal bowl with a splash of milk. I was still just as hungry having eaten them. 2 hours later when I checked my BG had shot up. I don't remember how far but it was the one time I really thought I would cry because if I couldn't even eat that much breakfast I thought I'd be permanently hungry and miserable. But reading around here and other places I discovered I could eat something different. I no longer feel hungry after breakfast, nor feel desperate to have my lunch before lunchtime. I enjoy what I eat, my BG is down massively (although I'm expecting my next A1c to be up now I have stopped taking Gliclazide) I'm still losing weight and trouser sizes, my cholesterol is now healthy as well. So do I miss breakfast cereals? Not one bit. Full fat greek yoghurt works for me most days, and a nice cooked breakfast (without the beans, hash browns and toast) on the odd morning.

The moral of the story? You might be fine with your breakfast cereals and so on, but you may not. Testing will tell you what you can't possibly know without testing. Oh, and what the dieticians tell you may not actually work for everyone.