Type 2 out of control, .......or not.....

[mymate]

Hi

I have been diagnosed with type 2 diabetes for some six or seven years now. I currently take 2 x 30mg gliclazide, 2 x 850mg metformin, 1 x 75mg soluble aspirin, 1 x 5mg ramipril, 1 x 4mg candesartan and 1 x 40mg simvastatin daily in order to keep it under control. I work for myself and have a fairly sedentary job. The problem that I currently have is that my initial bg reading on waking is in the region of 10.5 having risen from what used to be about 5.5 at the same time in the morning. Slightly worried about this I visited my local GP to explain my concerns and they duly took blood only for my HBA1C to come back as 6.4 which the doc says is well within limits. I have some doubts over this however as my readings, according to me, during the day are never lower than 9.4 and have not been for some four months now. I eat very little, half portions at the best of time and try to reduce carbs wherever possible. A typical menu would be two griddled eggs on bread in the morning. Half a ham sandwich at lunch, fish cooked in the oven, peas and one ice cream scoop of mashed potato in the evening. I don't regard this as excessive but would be grateful for thoughts. For exercise I try to walk my kids to school both morning and afternoon pushing all the way once the kids aren't with me, i.e. one way. I have never once received any advice from any form of medical practioner since my diagnosis and it has always been left to me to trawl the web to find out what is needed at any time.

I have two questions: How can my HBA1C be so low given my own personal readings (thought is may be a faulty meter but it isn't because I now have two and they have similar readings at the same time)? How do I convince my GP that there is something not quite right when she gets results like that? I have only one kidney and I would prefer to keep that healthy and I have this feeling that if all is left unchecked I may suffer complications of one sort or another.

 

[cugila]

The simple fact is that your HbA1c is an average......over a period of around 3 months. It is and should only be used as a trend indicator.

The most effective way to know what is actually happening from day to day is to test frequently at various times of the day, particularly 2 hrs after meals. This is the only way to know how good your Bg levels are.

Anybody who only relies on HbA1c readings could be in for a shock when they start to test. It will be hiding high and low levels.

Bread, Mash, Ice Cream.......not good for Bg levels.

Have a look at the basic advice my pal Sue and I hand out.......

Here is the advice we usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, Diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

The main carbs to avoid OR reduce are the complex or starchy Carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of Insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause Insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting Carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total Carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a Diabetic.

As for a tester, try asking the Nurse/Doctor and explain that you want to be proactive in managing your own Diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !!

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l........(Type 1 & 2)
2 hrs after meals......no more than 8.5 mmol/l.....( Type 2)

2hrs after meals....... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Ken / Sue.

 

[Sweet enough]

As I read you post I wondered for a second if I had actually written it and forgotten ( except for the medicines)

My morning readings are depressingly high 10's and 11's my last HBA1C came back as 6.4 ( up a little after changing as an experiment to NHS recommended diet ) which again I was told were ok and nothing to worry about. I honestly thought my samples must have been mixed up with someone elses. So it does seem to be quite possible after reading your post that the average is a lot lower than the morning readings. Ive give up taking blood readings myself as its just too confusing and causes nothing but worries if your levels seem high, then you discover your HBa1c is "ok"

What really confuses me is although my hba1c are within accepted limits I am feeling more and more changes in my toes and occasionally fingers. Im on slow release metformin 2x 500 and withdrew from simvastatin after walking problems Next HB later this month. Im interested to see what the results are after going on the recommended nhs diet. I have a feeling Ill be back to low carb after the blood tests get back.

 

[Hobs]

Your HbA1c is really a midway indicator ...an average display gauge .. an overall summary.

Look upon it as the mid point on a graph of all your highs and lows over that past 12 weeks, and you should be finger testing on a regular basis to understand how different foods will give sharp spikes ..some sooner and some later after eating.

 

[mymate]

Hi

Thanks for the replies, explanations and advice.. I do understand that the HBA1C is an average reading but I am a fairly regular tester of my BG throughout the course of the day. Luckily I have a GP who is happy to let me have the strips when I ask for them. My reading throughout the course of a day are much higher than the HBA1C and, this being the case, I am somewhat confused over the results that they have supplied. As stated I do eat fairly meagerly although there are some carbs in my diet. I have recently tried swapping my slice of bread with 2 x wholegrain Ryvitas as they have less carbs but it appears that there is little or no effect on my BG. I have started to keeps notes of meals vs readings so that my GP has some knowledge of what is going on. I still dispute the HBA1C reading and cannot understand why it is so low. My next test will not now be until April this year. An instance this morning. My waking up measurement was 8.4. I ate one x ryvita with butter and marmite on it, took my meds, and two hours later my BG was 12.4. Complete confusion reigns.

 

[catherinecherub]

Have you considered that your BP meds may be raising your blood sugars. This can happen to some people. If you look at this article, some people experience hyperglycemia with candesartan.

http://www.drugs.com/sfx/candesartan-side-effects.html If you go through this article look at the heading Endocrine.