More questions

[cornylady]

A follow up to my earlier post. I have seen the diabetic nurse and tbh although she was very nice the whole appointment was less than helpful. The nurse never even discussed testing/levels/ etc or really made any helpful/useful suggestions. No advice on what to do just signposting me to other services for "education", eye checks etc. After a couple of weeks of trying to get my head around things myself and lots of reading, I decided that to understand what was happening I would invest in a Freestyle Libre2 as a short term measure with a view to then reverting to finger pricking when I was more confident about what I can eat. I have now had a CGM since Sunday eve so this is my 4th full day. I have reduced my carb intake (since learning my diagnosis) and currently varying between 70g and 130g per day as I'm figuring out what I can eat. So my questions currently are:

-If my levels spike after eating but are back within the 2/3 increase 2 hours after eating is this OK or a problem? (I wouldn't know about the higher reading if I didn't have a CGM?)

-Do you measure 2 hours after starting eating or finishing eating - sometimes I'm quite slow
I have noticed that some days (not every day)

-I have a spike in the morning as I wake up. I understand why this happens but then why not every day? Does it matter? What can I do to improve it (if anything).

-Is time in range a good indicator?

-Is the range correct? I didn't change the settings and used the default which was 3.9-10.0.

-What if you consume things slowly? Does that make a difference? Does it just avoid a spike but put you generally up?

-Nurse basically said that even if my numbers are looking good that could be because I am overproducing insulin to make it look like that so I will still wear out my pancreas early and therefore recommends that I start on medication as that increases your sensitivity to insulin. I didn't as I wanted to try the diet approach first but don't understand how if this is the case, that type 2's are not automatically put on meds straight away.

-Nurse also said she would see me in 6 months and would do a full check (feet etc) then. That is also when they will do the next Hb1Ac. I queried this but she said they don’t do it before because I haven’t had enough time to make changes. Is this normal?

Sorry, I know there are lots. Feel like I'm falling down a rabbit hole of numbers although I am a tech person so that’s how I work. However also all the counting/working out is a bit triggering for me but I don't see how I can work out what works for me without this as I am asymptomatic and don't feel any different. Also trying to lose weight which is also an issue for me.

Any help/guidance/answers/advice would be very appreciated.

 

[LivingLightly]

Evening @cornylady.

At this stage, you’ll learn most from blood glucose levels just before you start a meal and then two hours later. (That's two hours after your first bite, not two hours after finishing your meal).

The post-meal reading should be no more than 2 mmol/l higher than the first and not higher than 8 mmol/l. If that's the case, your body dealt with the arrival of glucose in your bloodstream and cleared it relatively quickly.

If you can achieve that consistently (by reducing your carbohydate intake where necessary), your blood glucose readings when you wake up in the morning should gradually improve, but those numbers are often the last to stabilise.

I'm afraid eating more slowly will not affect BG numbers. The carbohydrates you swallow will still end up as glucose in your bloodstream.

A review and HbA1c check after six months is normal. By then, you'll be able to assess the effects of the changes you've made.

Hope this answers some of your questions.

 

[Keith Saunders]

Well I came here to hopefully help and answer but it looks like @LivingLightly has answered pretty much everything in the same way I would of done. I'll go back to sleep now

 

[Outlier]

I try to eat slowly not because I have no option but because I therefore eat less and find what I do eat more satisfying. A bit like "eating mindfully". Though you have no choice but to eat slowly, you can harness it as a helper to get maximum enjoyment out of your new eating regime. That really helps in sticking to it rather than wishing you could eat other things which are not good for T2 diabetics.

 

[AndBreathe]

A follow up to my earlier post. I have seen the diabetic nurse and tbh although she was very nice the whole appointment was less than helpful. The nurse never even discussed testing/levels/ etc or really made any helpful/useful suggestions. No advice on what to do just signposting me to other services for "education", eye checks etc. After a couple of weeks of trying to get my head around things myself and lots of reading, I decided that to understand what was happening I would invest in a Freestyle Libre2 as a short term measure with a view to then reverting to finger pricking when I was more confident about what I can eat. I have now had a CGM since Sunday eve so this is my 4th full day. I have reduced my carb intake (since learning my diagnosis) and currently varying between 70g and 130g per day as I'm figuring out what I can eat. So my questions currently are:

-If my levels spike after eating but are back within the 2/3 increase 2 hours after eating is this OK or a problem? (I wouldn't know about the higher reading if I didn't have a CGM?)

-Do you measure 2 hours after starting eating or finishing eating - sometimes I'm quite slow
I have noticed that some days (not every day)

-I have a spike in the morning as I wake up. I understand why this happens but then why not every day? Does it matter? What can I do to improve it (if anything).

-Is time in range a good indicator?

-Is the range correct? I didn't change the settings and used the default which was 3.9-10.0.

-What if you consume things slowly? Does that make a difference? Does it just avoid a spike but put you generally up?

-Nurse basically said that even if my numbers are looking good that could be because I am overproducing insulin to make it look like that so I will still wear out my pancreas early and therefore recommends that I start on medication as that increases your sensitivity to insulin. I didn't as I wanted to try the diet approach first but don't understand how if this is the case, that type 2's are not automatically put on meds straight away.

-Nurse also said she would see me in 6 months and would do a full check (feet etc) then. That is also when they will do the next Hb1Ac. I queried this but she said they don’t do it before because I haven’t had enough time to make changes. Is this normal?

Sorry, I know there are lots. Feel like I'm falling down a rabbit hole of numbers although I am a tech person so that’s how I work. However also all the counting/working out is a bit triggering for me but I don't see how I can work out what works for me without this as I am asymptomatic and don't feel any different. Also trying to lose weight which is also an issue for me.

Any help/guidance/answers/advice would be very appreciated.

I’ll just cover a couple of things.

Time in range is a decent indicator of how things are going, without focusing on any blips. I would suggest an ideal range would be a bit lower at the top end; say 8. It can always be adjusted later.

in terms of wearing your pancreas out, I remain skeptical on that, if you can achieve decent control. No guarantees of course, but uncontrolled numbers do give the old pancreas a bit of a kicking, so bringing them down to a decent range eases that anyway. How much insulin resistance you continue to have remains to be seen, but I can’t imagine your nurses offer of meds is a one time offer.

In terms of monitoring, NICE Guidelines state 3-6 months until numbers stabilise. It used to be a flat 3 months, but has changed.

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk

Personally, I’d ask for a test nearer the (3 months) time. If you have bloods done for other conditions, like thyroid, or whatever, it can be easy to just add an HbA1c. I have never been declined a test, provided I have a fair reason.

 

[KennyA]

-If my levels spike after eating but are back within the 2/3 increase 2 hours after eating is this OK or a problem? (I wouldn't know about the higher reading if I didn't have a CGM?)

-Is time in range a good indicator?

-Is the range correct? I didn't change the settings and used the default which was 3.9-10.0.

-Nurse basically said that even if my numbers are looking good that could be because I am overproducing insulin to make it look like that so I will still wear out my pancreas early and therefore recommends that I start on medication as that increases your sensitivity to insulin. I didn't as I wanted to try the diet approach first but don't understand how if this is the case, that type 2's are not automatically put on meds straight away.

I have a particular bee in my bonnet about calling a perfectly normal BG rise after eating carbs a "spike". If you eat carbs, diabetic or non-diabetic, you will see a BG rise. The T2's rise might be a bit higher and last a bit longer. As you'll have noticed already, you hit the highest BG post-meal level somewhere in the first hour. For me it depends what I ate and what with. The lactose from hot milk will be in my blood in under 30 minutes, for example.

The Libre comes with a range set. The "time in range " is of more use to people who are adjusting their insulin to match carb intake, and it gives (so I understand) an estimate of how successful the adjustment has been. Us diet-controlled T2s don't do that, and the range is whatever you set it to be - so you would need to know what your "normal" daily pattern was intended to be, and then use the range to work out how successful you were.

As above, a rise after eating carb is normal. I don't want it to be too high or go on too long - which is a sign that it's too much for my system to cope with. Personally, I'd rather have a higher rise that was over in minutes rather than a lower rise that lasted hours, but that's me.

I have to say that I'm not sure what your nurse is on about. Your body produces insulin in response to glucose triggers. In non-diabetic people, the insulin produced matches the body's requirement and deals with the glucose. For T2s, generally, we have insulin resistance/ impaired glucose tolerance (essentially the same thing) and our systems often over-produce insulin to deal with the equivalent glucose load. Prolonged high levels of insulin are generally thought not a good thing and seem to contribute considerably to IR/IGT progressing.

So - the key here is to reduce the glucose load, to consequently reduce the need for insulin production. You can do this eg by not eating glucose/carbohydrate, or by taking metformin, which lowers blood glucose by inhibiting your liver from topping up your BG with its own self-made glucose. But unless they're going to run an C-peptide test on you to establish how much insulin you actually are producing - your current level of insulin is just speculation.

 

[coby]

I have a particular bee in my bonnet about calling a perfectly normal BG rise after eating carbs a "spike". If you eat carbs, diabetic or non-diabetic, you will see a BG rise. The T2's rise might be a bit higher and last a bit longer. As you'll have noticed already, you hit the highest BG post-meal level somewhere in the first hour. For me it depends what I ate and what with. The lactose from hot milk will be in my blood in under 30 minutes, for example.

The Libre comes with a range set. The "time in range " is of more use to people who are adjusting their insulin to match carb intake, and it gives (so I understand) an estimate of how successful the adjustment has been. Us diet-controlled T2s don't do that, and the range is whatever you set it to be - so you would need to know what your "normal" daily pattern was intended to be, and then use the range to work out how successful you were.

As above, a rise after eating carb is normal. I don't want it to be too high or go on too long - which is a sign that it's too much for my system to cope with. Personally, I'd rather have a higher rise that was over in minutes rather than a lower rise that lasted hours, but that's me.

I have to say that I'm not sure what your nurse is on about. Your body produces insulin in response to glucose triggers. In non-diabetic people, the insulin produced matches the body's requirement and deals with the glucose. For T2s, generally, we have insulin resistance/ impaired glucose tolerance (essentially the same thing) and our systems often over-produce insulin to deal with the equivalent glucose load. Prolonged high levels of insulin are generally thought not a good thing and seem to contribute considerably to IR/IGT progressing.

So - the key here is to reduce the glucose load, to consequently reduce the need for insulin production. You can do this eg by not eating glucose/carbohydrate, or by taking metformin, which lowers blood glucose by inhibiting your liver from topping up your BG with its own self-made glucose. But unless they're going to run an C-peptide test on you to establish how much insulin you actually are producing - your current level of insulin is just speculation.

 

[coby]

That's a great, and very informative answer @KennyA x