What is an acceptable 'spike'?

[dawnb64]

Hi All

I realised I didn't introduce myself properly when I gatecrashed last week, so thought I should rectify that now (while also coming back to pick your brains).

I'm 47 and was diagnosed with impaired glucose tolerance, high cholesterol and high blood pressure earlier this year and prescribed Simvastatin with advice to try a low GI diet but little information on what that actually meant. I was also told the statins would be for life. I had a further blood test at the end of March with the report back as 'no action required'.

I've been struggling with my sight for years but put it down to needing varifocals due to age and therefore assuming it would settle in time. It got really bad just before I was diagnosed - to the point where my optician couldn't get a true reading. I went to see another GP at my practice a few weeks ago as my optician felt the problem was due to unstable blood sugars and I wanted a second opinion about the statins (I have an older brother with dementure and it's been suggested that there may be a link).

This GP didn't think my eye problems would be down to blood sugars but referred me to an opthamologist. She also agreed that it was up to me whether to take the statins and we agreed to re-assess following further blood tests in September.

The opthamologist said it was likely that my sight problems were caused by a number of factors. I have a very complex prescription; very early onset cataracts that can cause focusing issues before the clouding occurs; and unstable blood sugars. The first thing to sort out was the blood sugar. Following information gleaned from this forum, I've reduced my carb intake to around 150g per day and tried to spread it evenly through the day. I was going to wait until I'd seen the doctor before getting a BG monitor (she's been on holiday) but following a really bad day sight-wise on Friday I decided I really need to know what's going on so I can get it sorted. My SD Codefree arrived yesterday and per your very helpful advice I've been testing and recording as often as I can. My first test was 2 hrs after lunch yesterday when my level was 7.3. It went down to 6.3 before dinner then up again to 9.1 after one hour and down to 7 after two hours.

This morning it was 7 before breakfast, 11.8 after one hour and 5.5 after 2.
Pre lunch today it was 5.1, then 7.2 at one hour and 5.5 at 2.

xyzzy suggested aiming to be under 7.8 at one hour and 6.5 after 2 from an evening reading of 4.5. Does that mean that a rise of 3.3 is ideally the maximum our BGs should rise one hour after a meal? If that's the case I think I need to look at yesterday's lunch (poached eggs on toast) and today's breakfast (weetabix, tsp sugar and 2 clementines) and try some other combinations. I wanted to get some idea of what a normal diet did before making any radical changes to my meals although i have reduced my carb intake quite a lot already.

Any advice you can give will be gratefully received. (Would love to insert smilies but haven't worked how to yet - will have to get the kids onto it!)

Many thanks

Dawn

 

[Grazer]

The first target to aim for is to be below 7.8 two hours after eating, so in that respect you're doing fine. however, having achieved that most of us aim to keep it lower at the 2 hours, in fact as near to a non-diabetic as we can. most non diabetics will rarely be above 6.5 at the two hour stage, hence the second target xyzzy mentioned.
The 11.8 an hour after breakfast is a bit high, although you were fine at two hours so your insulin system seems to work pretty well. But weetabix, sugar and two clementines would be too much for most of us. That's the meal I'd most be looking to change if it was me. Your 7 before breakfast was a bit high for a non-diabetic as that's your fasting level - assuming you didn't eat before breakfast. I am right in saying you're not diagnosed diabetic? Looks to me that your blood sugars are high enough to warrant further tests, so perhaps see the doctor to arrange.

 

[dawnb64]

Hi Grazer

Many thanks for the reply. No, I haven't been diagnosed as diabetic and the pre-breakfast level was before eating anything - not even a cup of tea! It was at 6.4 at 4am though so could I have been hit by the 'dawn phenonomen' I've seen discussed?

Just taken another reading before dinner and it's risen to 6.6. I know I'm getting quite scatty but I don't recall having anything to raise it other than a diet lemonade (1g carb).

Seeing the doctor tomorrow so trying to get as many tests in as possible so I have something to discuss with her.

Thanks again

Dawn

 

[xyzzy]

Hi Dawn

What Grazer says is correct. The official 2 hour value is 7.8. The 7.8 one hour and 6.5 two hour target are my personal ones based on some research I came across a while ago. There is no issue just adopting the 7.8 after 2 hours. You may want to look here http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html Now I'm not sure as glucose intolerant if you count as non diabetic or T2. In any event the 7.8 level is the one to aim for in my opinion. It is actually what gets recommended if you follow the reference links through on that page so if you click on the little [19] above the table and then follow forward you'll get to this doc http://www.idf.org/webdata/docs/Guideline_PMG_final.pdf which says 7.8 and not 8.5. For some reason the UK didn't update back in 2007 so the NICE guideline remains at 8.5 but the IDF guideline says 7.8. Its why I end up saying 8ish in my welcome stuff as thats a load easier than explaining what I just did!

 

[dawnb64]

Hi xyzzy

Many thanks for the link. I was happy about the 7.8 level for 2 hours, and seem to be managing that OK. I wasn't happy with my one hour reading after breakfast and was after a bit of guidance about what increase at this stage would indicate that there were either too many carbs or the wrong combination in a meal. Your personal target for one hour seemed reasonable but was after a bit of reassurance.

Grazer's opinion that my breakfast contained too many carbs confirmed my suspicions so I'll try just weetabix tomorrow (though I'm not keen on the idea of no sugar) and see what effect that has. At the moment I'm really trying to 'stabilise' my BG levels which I'm assuming means keeping them fairly consistent through the day.

I think impaired glucose tolerance is borderline T2. I can't remember what my fasting levels were before my GTT and the repeat blood tests but think they were about 6.8/6.9 so very borderline. Will ask tomorrow what they were and see if I should have another test before September based on my readings.

Thanks again.

Dawn

 

[dawnb64]

Saw the doctor today. I was correct that my diagnosis of impaired glucose tolerance had been borderline – but at the lower end of the scale.
Fasting – 6.0 mmol/L
2 hr – 10.1 mmol/L
Cholesterol – 6.1 mmol/L
Triglycerides – 1.5 mmol/L

Six weeks later a fasting blood test showed:
Glucose – 5.9 mmol/L
Cholesterol – 4.7 mmol/L
Triglycerides – 1.3 mmol/L

I showed her my food diary and associated BG readings and she seemed quite impressed about the action I was taking. She wasn’t happy about yesterday’s 1hr post breakfast spike though. This is the sort of thing I need to control as my eyes seem particularly sensitive to fluctuations. Only had Weetabix for breakfast today which caused a 2.7 increase in BG at 1hr. She thinks it may just have been the tsp of sugar yesterday so suggests trying to add one Satsuma or clementine tomorrow to see what that does and try to keep levels as flat as possible during the day. Her advice seems to tie in with everyone here – try small adjustments and keep testing! I finally seem to have found a doctor I can discuss things with rather than feeling intimidated.

My fasting level this morning was 6.5. As I’m being proactive in tackling my own symptoms, and I’m not reporting any new ones, she doesn’t think I need an earlier repeat test for diabetes but to come back if I do have any concerns from my readings. Need to allow for some degree of inaccuracy from home monitoring devices and some people have naturally higher levels. Hopefully all readings will come down with a decrease in weight (at least 4 ½ stone to lose).

Had almost the same lunch today as yesterday but replaced smoked salmon with chicken. 1 hr reading yesterday was 7.2 from a pre-lunch reading of 5.1. Today was 10.1 from 6.5. Really don’t understand what’s going on but will keep testing. Could an hour out on my bike yesterday before lunch have had that much of an impact? Maybe without the ride I shouldn’t have had the apple today? So many variables…

Thanks again to everyone for sharing all their experience – I don’t know how long it would have taken me to understand the relevance of carbs without all your input.

Dawn

 

[Grazer]

Well done on progress, and on having a good doc! The bike ride would make a big difference. After 2 hours of golf post lunch, I could be in the 3's rather than the high 5's/low 6's. The apple is also quite a lot of carbs according to size - could easily be 20 so would have an impact, although i do seem to get away with apples ok.

 

[Etty]

Weetabix, like most cereals, is high GI and puts blood sugar up too much. Some people manage a small amount of porridge, many can't even do that. The best breakfast is one with protein and fat in it. YOurs is all carb. Some successful breakfasts are eggs as you like them, or a piece of cheese with coffee and cream, or cold cuts, or a mound of greek yoghurt with a sprinkling of nuts/seeds/berries.

 

[dawnb64]

Thanks Etty and Grazer
I've only been testing for a couple of days but had already reduced my carb intake quite a lot and swapped to things like wholegrain bread and wholewheat pasta (having cut out almost all of the rubbish previously). I think I was hoping that I would only need to make minor changes to the rest of my diet but realise that may not be the case. I know it's a case of trial and error and so many variables. I tried to split my carb intake evenly between three meals as I thought that would be the best way to keep BGs stable but have now read that may not be the case and I may need to have fewer carbs for breakfast.

Even the information on GI seems to vary so much. The list I was given by the doctor shows Weetabix as medium GI. I've also tried to increase my activity levels but need to make sure I try to do a little every day rather than larger chunks less frequently. Very difficult when it's raining!

I will get there. People on this forum have proved that making the necessary changes to improve your quality of life is possible.

 

[Grazer]

You're correct that for a type 2 on diet only/metformin, spreading the carbs evenly isn't necessarily the right way to go. Some can't handle carbs in the morning, so go carb free then and have more later. I'm opposite to most it seems. I can handle lots on the morning and few later. You need to test to see when is best for you to have your carbs.
With exercise, if you're doing it to keep BGs down rather than just losing weight, I find that exercising hard for just ten minutes about an hour after eating the main carby meal of the day, when BGs are probably peaking, brings them down quicker and further. As a bonus, it does also help with weight loss. If its raining, just go up and down stairs for ten mins as fast as you can!

 

[dawnb64]

Hi Grazer

When my eyes are playing up I'm very cautious coming down the stairs - went for a long (for me anyway) walk on Sunday and misjudged the kerb - lovely bashed knee to show for it but at least the traffic waited for me to move out of the way!

My husband has one of those contraptions that you put your bike on - I suppose I could try that though I'm not sure how safe I'd feel and the scenery would be a bit boring.

Do you play golf in the rain or only when its dry?

 

[Grazer]

Do you play golf in the rain or only when its dry?

Fair weather player! Like my motor biking, I only do it when it's sunny - except when I get caught out :thumbdown: