How many limiting carbs can a Type 2 without any medication take in a meal (Breakfast, lunch, and dinner, no snacks)?

[CatsFive]

Also, which one defines Type 2, a fasting value of less than one hundred, or a two-hour after-meal value of less than 140?

In the UK and many other countries, the HbA1c blood test determines if one is T2. In the UK, 48 or more is T2 and pre-diabetes is 42-47. For most of us it was nothing to do with blood glucose levels. No test is completely accurate / repeatable, so the NICE guidelines include:

"If the person is asymptomatic, do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result. Arrange repeat testing, preferably with the same test, to confirm the diagnosis."

https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/

I was asymptomatic, I had a repeat blood test. And I get a repeat test every 6 months which is how I know 56 has turned into 44.

We have no idea how you were diagnosed unless it's in one of your other posts, but it's crucial to realist that:
1) No test is completely accurate / repeatable
2) We are all individuals and react to what we eat differently.

If you lose sight of these two facts you will tie yourself in knots trying to achieve perfection, when what you need to do is find what is 'good enough'. I still eat more carbs than many people here do, but in general I don't eat rice, potatoes, pasta, cous cous etc. with my evening meal That's done the trick for me.

 

[Paul_]

We have no idea how you were diagnosed unless it's in one of your other posts, but it's crucial to realist that:
1) No test is completely accurate / repeatable
2) We are all individuals and react to what we eat differently.

If you lose sight of these two facts you will tie yourself in knots trying to achieve perfection, when what you need to do is find what is 'good enough'. I still eat more carbs than many people here do, but in general I don't eat rice, potatoes, pasta, cous cous etc. with my evening meal That's done the trick for me.

@mysorian - Really good advice here from @CatsFive.

The bigger picture is always more important, one test reading on its own isn't that informative, it's all about trends over time. Generally speaking, trends for blood glucose (BG) measurements that are within range and stable for diabetics, or downward trends if currently high BG levels, are what you're looking for. A blood glucose meter is your only way to track these trends, so although there may be a margin of error on the results, you're not looking for 100% accuracy.

I'd also add that CatsFive is absolutely correct around individual tolerances for carbs. We all have different levels of insulin resistance, so for me I can tolerate up to 30g of carbs per day currently, whereas CatsFive can tolerate more. Without testing before and after eating, you'll never find where your sweet spot is for carb intake.

 

[KennyA]

As there are different values being used for measurements in this thread, attaching a graphic to show the read across from percentage (DCCT) to mmol/mol (IFCC) for glycated red blood cells for the Hb A1c; and the read across for blood glucose for fingerprick tests from mg/dl to mmol/litre. One point about this graphic - please ignore the colour, especially in the top row. 38-42 mmol/mol is "normal" blood glucose in the UK - that's where almost all non-diabetic people are.

 

[mysorian]

In the UK and many other countries, the HbA1c blood test determines if one is T2. In the UK, 48 or more is T2 and pre-diabetes is 42-47. For most of us it was nothing to do with blood glucose levels. No test is completely accurate / repeatable, so the NICE guidelines include:

"If the person is asymptomatic, do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result. Arrange repeat testing, preferably with the same test, to confirm the diagnosis."

https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/

I was asymptomatic, I had a repeat blood test. And I get a repeat test every 6 months which is how I know 56 has turned into 44.

We have no idea how you were diagnosed unless it's in one of your other posts, but it's crucial to realist that:
1) No test is completely accurate / repeatable
2) We are all individuals and react to what we eat differently.

If you lose sight of these two facts you will tie yourself in knots trying to achieve perfection, when what you need to do is find what is 'good enough'. I still eat more carbs than many people here do, but in general I don't eat rice, potatoes, pasta, cous cous etc. with my evening meal That's done the trick for me.

Thanks. Your link is UK-specific.

 

[mysorian]

In the UK and many other countries, the HbA1c blood test determines if one is T2. In the UK, 48 or more is T2 and pre-diabetes is 42-47. For most of us it was nothing to do with blood glucose levels. No test is completely accurate / repeatable, so the NICE guidelines include:

"If the person is asymptomatic, do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result. Arrange repeat testing, preferably with the same test, to confirm the diagnosis."

https://cks.nice.org.uk/topics/diabetes-type-2/diagnosis/diagnosis-in-adults/

I was asymptomatic, I had a repeat blood test. And I get a repeat test every 6 months which is how I know 56 has turned into 44.

We have no idea how you were diagnosed unless it's in one of your other posts, but it's crucial to realist that:
1) No test is completely accurate / repeatable
2) We are all individuals and react to what we eat differently.

If you lose sight of these two facts you will tie yourself in knots trying to achieve perfection, when what you need to do is find what is 'good enough'. I still eat more carbs than many people here do, but in general I don't eat rice, potatoes, pasta, cous cous etc. with my evening meal That's done the trick for me.

This is what my Bing AI assistant tells me:
There is no one definitive way to diagnose diabetes. The American Diabetes Association (ADA) recommends three methods: A1C, Fasting Plasma Glucose (FPG), and Oral Glucose Tolerance Test (OGTT) 1. Each test has its own advantages and disadvantages. The A1C test is more convenient as it does not require fasting or drinking anything, but it may not be as accurate in certain populations 2. The FPG test is simple and inexpensive, but it requires fasting for at least 8 hours before the test 1. The OGTT is the most sensitive test for diagnosing diabetes, but it is more expensive and time-consuming than the other tests 1.

I understand from this that the 'after 2 hr.' measurement is not that useful to establish the state of a person being a diabetic. I believe a large percentage of the population fast for 8 hours when they go to sleep and get their proverbial 8 hours of sleep.

 

[ianf0ster]

You misunderstand the 2hrs after eating BG test.
It isn't to diagnose diabetes, it's to determine whether what you ate was processed properly by your body.
So it is for the remission of T2 Diabetes, not the diagnosis!

 

[Resurgam]

This is what my Bing AI assistant tells me:
There is no one definitive way to diagnose diabetes. The American Diabetes Association (ADA) recommends three methods: A1C, Fasting Plasma Glucose (FPG), and Oral Glucose Tolerance Test (OGTT) 1. Each test has its own advantages and disadvantages. The A1C test is more convenient as it does not require fasting or drinking anything, but it may not be as accurate in certain populations 2. The FPG test is simple and inexpensive, but it requires fasting for at least 8 hours before the test 1. The OGTT is the most sensitive test for diagnosing diabetes, but it is more expensive and time-consuming than the other tests 1.

I understand from this that the 'after 2 hr.' measurement is not that useful to establish the state of a person being a diabetic. I believe a large percentage of the population fast for 8 hours when they go to sleep and get their proverbial 8 hours of sleep.

If all is going well the testing after eating will show both how the meal suited you plus your progress towards normal numbers.
I altered my meals until I was seeing under 8mmol/l at the 2 hour point, and kept to the same meals - but then I saw that my numbers were going down little by little. I assume that my metabolism was recovering as it was no longer under stress from too many carbs.
I still check from time to time and these days see under 7 at the two hour test.

 

[mysorian]

If all is going well the testing after eating will show both how the meal suited you plus your progress towards normal numbers.
I altered my meals until I was seeing under 8mmol/l at the 2 hour point, and kept to the same meals - but then I saw that my numbers were going down little by little. I assume that my metabolism was recovering as it was no longer under stress from too many carbs.
I still check from time to time and these days see under 7 at the two hour test.

Very sensible. I am trying to even out the peaks during the day so that they remain within the band. It's been 70-180 but going from 180-140 will be an uphill (?) task.

 

[CatsFive]

Thanks. Your link is UK-specific.

People are pretty much the same world-wide. The UK advice is based on the WHO advice which covers the world. I'd trust it over Bing AI - I have no idea what sources it used. I've also no idea what country you are in or what their health service advises. But the UK advice is all based in peer-reviewed evidence, and the link I posted references that evidence.

 

[Paul_]

Very sensible. I am trying to even out the peaks during the day so that they remain within the band. It's been 70-180 but going from 180-140 will be an uphill (?) task.

Having read a few of your threads I'm still not entirely sure, so thought it best to just ask. Do you know what type of diet you are aiming for? Low carb? Low calorie? Low GI?

Also, what are your goals in all of this? Do you simply want to control blood glucose levels? Do you want to lose weight? Do you want to better manage anything else?

 

[mysorian]

The capillary measurements tell me that I am diabetic. My healthcare provider did not prescribe medication. I am not sure whether I should persuade him to prescribe. I am trying to locate where I am in this diabetic profile. Pre-diabetes with making entry into the diabetic region, fully diabetic, diabetic that needs medication, etc.

On the other hand, recent CGM measurements indicate that my diabetes may not be serious. Is this reliable?
How good are venous measurements? How good are the measurements from pinpricks? They don't agree with each other (one done at 9:00 a.m. and the other on blood taken at 9:30 and analyzed in the laboratory.).

The only measurement is the capillary measurement (supplemented by HbA1C occasionally) which has not changed in 20 years. The latest measurement in the graphic is an outlier. In 2021, had a heart attack despite not departing from the standard lipid profile all these years except for one outlier just before the heart attack.
Being vegetarian carbos are a major part of the food. I am trying to see in what ways I can reduce carbos and gain weight.

Also, I want to research and see what all these measurements really mean. Make some sense out of these measurements and establish my base line.

Peaks in interstitial blood glucose measured with Freestyle Libre 1-day sensor
18th Aug. 2023

7:05 Day starts
7:35 BF1: apple(?) 75
8:35 120
9:50 89
-------------------
Peak after 1:25 hr
----------------------
10:05 BF2 145 gm cooked oats
107 gms Soya Milk
13 gms walnut (5)
Medicine 92
11:07 peak 143
13:07 94
-----------------------------------
Peak after 1:02 hr
--------------------------------

13:37 Lunch 97
15:07 Peak 164
16:23 84
------------------------------
Peak after 1:30
------------------------

4:23 snack 74 gms of banana
142 gms of white rind of water melon
82
5:23 Peak 114
7:09 96
----------------------
Peak after 1 hr
------------------------

7:09 Dinner
269 gms of Tofu, 49 gms of millet rice, cabbage in vinegar etc 96

8:41 Peak 153
21:26 92
21:56 105
23:26 93
-------------------
Peak after 1:32
--------------

 

[KennyA]

The capillary measurements tell me that I am diabetic. My healthcare provider did not prescribe medication. I am not sure whether I should persuade him to prescribe. I am trying to locate where I am in this diabetic profile. Pre-diabetes with making entry into the diabetic region, fully diabetic, diabetic that needs medication, etc.

On the other hand, recent CGM measurements indicate that my diabetes may not be serious. Is this reliable?
How good are venous measurements? How good are the measurements from pinpricks? They don't agree with each other (one done at 9:00 a.m. and the other on blood taken at 9:30 and analyzed in the laboratory.).

The only measurement is the capillary measurement (supplemented by HbA1C occasionally) which has not changed in 20 years. The latest measurement in the graphic is an outlier. In 2021, had a heart attack despite not departing from the standard lipid profile all these years except for one outlier just before the heart attack.
Being vegetarian carbos are a major part of the food. I am trying to see in what ways I can reduce carbos and gain weight.

Also, I want to research and see what all these measurements really mean. Make some sense out of these measurements and establish my base line.

View attachment 62997

Peaks in interstitial blood glucose measured with Freestyle Libre 1-day sensor
18th Aug. 2023

7:05 Day starts
7:35 BF1: apple(?) 75
8:35 120
9:50 89
-------------------
Peak after 1:25 hr
----------------------
10:05 BF2 145 gm cooked oats
107 gms Soya Milk
13 gms walnut (5)
Medicine 92
11:07 peak 143
13:07 94
-----------------------------------
Peak after 1:02 hr
--------------------------------

13:37 Lunch 97
15:07 Peak 164
16:23 84
------------------------------
Peak after 1:30
------------------------

4:23 snack 74 gms of banana
142 gms of white rind of water melon
82
5:23 Peak 114
7:09 96
----------------------
Peak after 1 hr
------------------------

7:09 Dinner
269 gms of Tofu, 49 gms of millet rice, cabbage in vinegar etc 96

8:41 Peak 153
21:26 92
21:56 105
23:26 93
-------------------
Peak after 1:32
--------------

It seems that it's being suggested in your graphs that 70-99mg/dl (3.9 to 5.6 mmol/l) is somehow a "normal" blood glucose range. I disagree - it's well below normal. I would suggest there's something off in a system that indicates these are high blood glucose figures.

Secondly you can't read directly across from the fingerprick readings to the long-term HbA1c results. They measure different things in different ways. In the UK anyway people are almost invariably diagnosed on the basis of the HbA1c which gives an estimate of BG over a three month period, rather than fingerprick tests which are subject to fluctuations and testing bias (you don't have any information for the periods when you didn't test).

In my opinion, fingerprick readings are most useful not for "seeing how high you go" but for assessing how quickly and efficiently your insulin responses dealt with the carbs (and resulting glucose) in what you ate. This is why the usual advice is to test before eating and at the +2hr point after eating. This gives you a baseline and therefore you can make an assessment of how well you dealt with the carbs in what you ate. Ideally you should be back close to baseline after the two hours. The "peak" figure is of little use as non-diabetic people also experience a similar peak after eating carb - the difference is that non-diabetics will see a dependable and rapid return to baseline.

My fingerprick blood glucose readings range (in the past week) between 4.3 and 5.6mmol/l . I am in T2 remission, and my last HbA1c was 34 (or 5.3%) . So there's not a great deal of difference between our readings, but I'm not being told that my readings are high, because they're not.

I'm attaching a blood glucose profile of nearly 3,000 non-diabetic people almost all of who fall into the standard UK 38-42mmol/mol (or 5.6%-6.0%) range.

It seems to me that you are possibly being encouraged to aim for blood glucose figures that are rarely seen in non-diabetic people. Perhaps somebody has something to sell?

 

[KennyA]

You might also find this web link useful - clearly there is something for Nutrisense to sell here as well, namely blood glucose measuring for people who aren't diabetic - but you may be interested to see the CGM graphs produced by a non-diabetic.

https://www.nutrisense.io/blog/cgm-blood-glucose-experiment-5-insights-from-a-non-diabetic

 

[mysorian]

It seems that it's being suggested in your graphs that 70-99mg/dl (3.9 to 5.6 mmol/l) is somehow a "normal" blood glucose range. I disagree - it's well below normal. I would suggest there's something off in a system that indicates these are high blood glucose figures.

Secondly you can't read directly across from the fingerprick readings to the long-term HbA1c results. They measure different things in different ways. In the UK anyway people are almost invariably diagnosed on the basis of the HbA1c which gives an estimate of BG over a three month period, rather than fingerprick tests which are subject to fluctuations and testing bias (you don't have any information for the periods when you didn't test).

In my opinion, fingerprick readings are most useful not for "seeing how high you go" but for assessing how quickly and efficiently your insulin responses dealt with the carbs (and resulting glucose) in what you ate. This is why the usual advice is to test before eating and at the +2hr point after eating. This gives you a baseline and therefore you can make an assessment of how well you dealt with the carbs in what you ate. Ideally you should be back close to baseline after the two hours. The "peak" figure is of little use as non-diabetic people also experience a similar peak after eating carb - the difference is that non-diabetics will see a dependable and rapid return to baseline.

My fingerprick blood glucose readings range (in the past week) between 4.3 and 5.6mmol/l . I am in T2 remission, and my last HbA1c was 34 (or 5.3%) . So there's not a great deal of difference between our readings, but I'm not being told that my readings are high, because they're not.

I'm attaching a blood glucose profile of nearly 3,000 non-diabetic people almost all of who fall into the standard UK 38-42mmol/mol (or 5.6%-6.0%) range.

It seems to me that you are possibly being encouraged to aim for blood glucose figures that are rarely seen in non-diabetic people. Perhaps somebody has something to sell?

"
So there's not a great deal of difference between our readings, but I'm not being told that my readings are high, because they're not. " I am not sure why you make this statement. My finger prick readings are very much above 100 mg/dL (5.55 mmol/mol). In the graph I uploaded they range from 101-150 mg/dL.

 

[KennyA]

"
So there's not a great deal of difference between our readings, but I'm not being told that my readings are high, because they're not. " I am not sure why you make this statement. My finger prick readings are very much above 100 mg/dL (5.55 mmol/mol). In the graph I uploaded they range from 101-150 mg/dL.

I make the statement because my readings are not high, and no-one has suggested to me that they are. My last HbA1c was 34mmol/mol (5.3%) , which puts me considerably lower than most non-diabetic people. I don't see anything in your results that suggests you are diabetic.

Your blood results, on the other hand, are described as "high", although your Libre (in my view correctly) says they are in target range.

Fingerprick readings of plasma glucose are not (in the UK anyway) generally used to diagnose diabetes. In general an HbA1c of 48mmol/mol (6.5%) or above is the most common.

In addition the Handbook of Diabetes (Bilous and Donnelly) gives a few other possibilities:
- a random plasma glucose level equal to or greater than 11.1mmol/l (200 mg/dl) in someone with typical symptoms of diabetes
- a fasting plasma glucose (FPG) level equal to or greater then 7.0 mmol/l (126mg/dl)
- a plasma glucose level equal to or greater than 11.1mmol/l (200 mg/dl) 2 hours after a 75g load of glucose - the oral glucose tolerance test

However the handbook says that while the FPG test is quick and cheap it can miss people (and I would expect, if done in the morning, might over-diagnose people with dawn phenomenon) and the preferred test in the UK is the HbA1c. I can't think of anyone recently diagnosed as T2 who has not been diagnosed via HbA1c.

 

[mysorian]

I quote "It seems that it's being suggested in your graphs that 70-99mg/dl (3.9 to 5.6 mmol/l) is somehow a "normal" blood glucose range. I disagree - it's well below normal. I would suggest there's something off in a system that indicates these are high blood glucose figures."

The 70-99mg/dl is the standard range in the USA. These are the numbers for a person diagnosed to be normal. I suppose every country has a different standard. Even so, my values (except for two) are off by large values. These are commensurate with the HbA1C values. Both the Glucose and the HbA1C measurements are carried out by the same laboratory using blood collected in the doctor's office.

I would appreciate your comment.

Another region that concerns me is, at times I take the measurements in the morning at home using the one-touch strips, they are consistently higher in the range (of 100-120) while the CGM measures only in the 70 to 90 range, sometimes (very few times) in the less than 70 regions.

Which of the measurements should I rely on?

Reference: My September 4 chart.

 

[sausage91]

I am a vegetarian. I eat cooked oats for breakfast with walnuts and soy milk). For lunch, I eat cooked Fos-Tail with Indian Rasam or Sambhar (not sure how much card is contributed), dry vegetable curry, 1 tbsp of yogurt, and sometimes roasted Okinawan sweet potato, Dinner is like lunch, and I may have a salad (Onion, avocado, spinach, or arugula with balsamic vinegar). After lunch, I may eat half of an orange or a kiwi fruit. I want to establish the quantities.

X-Pert diabetes says that you should not exceed 60g of carbs in any one meal.