Is a good HbA1c all that matters?

[birchy66]

I suppose what I am asking is if I am achieving an HbA1c within the acceptable range of 6.5% to 7.5% (48 to 59 mmol/mol) do I need to worry when I get high pre-meal BG readings typically 10 to 12 sometimes? I get really angry with high readings - just can't help it.

 

[logindetails]

HbA1c is not the only thing you have to keep on top of to minimise the risk of complications. High glucose spikes should also be avoided. According to Dr. B', spikes are the main cause of diabetic complications in otherwise well controlled diabetics. Seeing when you are spiking is not easy with normal BG meters as you only get a point in time reading.

 

[Lamont D]

As above, what login said, control is the key.
Also if you want to lose weight or become healthier then diet and exercise is important.
Getting your average is important but control tells what you are achieving day to day. Using a meter gives you information about what spikes and what doesn't!

 

[birchy66]

HbA1c is not the only thing you have to keep on top of to minimise the risk of complications. High glucose spikes should also be avoided. According to Dr. B', spikes are the main cause of diabetic complications in otherwise well controlled diabetics. Seeing when you are spiking is not easy with normal BG meters as you only get a point in time reading.

Thanks logindetails, who is Dr B'. I don't do that many after meal tests as my GP restricts the number of test strips to 100 per month which is not enough as I test at least 4 times per day!

 

[birchy66]

As above, what login said, control is the key.
Also if you want to lose weight or become healthier then diet and exercise is important.
Getting your average is important but control tells what you are achieving day to day. Using a meter gives you information about what spikes and what doesn't!

Thanks nosher. My weight is pretty good and I do exercise every day by walking a couple of miles plus everyday jobs around the house etc. etc. Looks like I'll have to buy extra testing strips for after meals. Seems unfair.

 

[logindetails]

Thanks logindetails, who is Dr B'. I don't do that many after meal tests as my GP restricts the number of test strips to 100 per month which is not enough as I test at least 4 times per day!

Dr. Bernstein's Diabetes Solution

 

[Brunneria]

@birchy66

I would either buy more strips and test regularly (I do, using the very reasonably priced SD Codefree meter) on waking, and before and after each meal.

Or I would spend your 4 strips a day very wisely. By testing two meals or snacks a day. One test just before eating, the second two hours later.

However, I'm type 2, so that suggestion may not be practical for a type 1. You may HAVE to test at other times.

But by testing that way, we type 2s can work out which meals/foods are sending our BG up, and decide whether to reduce portions, avoid the food, or (in your case) adjust your insulin.

You'r ea type 1 - which makes it even more ridiculous that you don't get enough strips.
Do you drive?
They shouldn't be restricting your strips AT ALL

(This makes me so mad!)

 

[birchy66]

Dr. Bernstein's Diabetes Solution

Thanks login. Your HbA1c is really low for a Type 1, is this as a result of following Dr B's solution?

 

[beardie]

I also wonder about this. I am officially cured and passed a GTT yesterday. I did however hit almost 18 at one hour. Didn't feel good.

 

[birchy66]

@birchy66

I would either buy more strips and test regularly (I do, using the very reasonably priced SD Codefree meter) on waking, and before and after each meal.

Or I would spend your 4 strips a day very wisely. By testing two meals or snacks a day. One test just before eating, the second two hours later.

However, I'm type 2, so that suggestion may not be practical for a type 1. You may HAVE to test at other times.

But by testing that way, we type 2s can work out which meals/foods are sending our BG up, and decide whether to reduce portions, avoid the food, or (in your case) adjust your insulin.

You'r ea type 1 - which makes it even more ridiculous that you don't get enough strips.
Do you drive?
They shouldn't be restricting your strips AT ALL

(This makes me so mad!)

Thanks brunneria, Good suggestion but I do need to test before each meal and before bed i.e. 4 times.at least. I think after meal testing is a luxury at the moment and something the doctors/nurses don't seem to think is really that important.

Yes I do drive which is another reason for more strips - I expect the GP thinks I should use my free bus pass!!

 

[beardie]

Thanks brunneria, Good suggestion but I do need to test before each meal and before bed i.e. 4 timNo point testes.at least. I think after meal testing is a luxury at the moment and something the doctors/nurses don't seem to think is really that important.

Yes I do drive which is another reason for more strips - I expect the GP thinks I should use my free bus pass!!

Thanks brunneria, Good suggestion but I do need to test before each meal and before bed i.e. 4 times.at least. I think after meal testing is a luxury at the moment and something the doctors/nurses don't seem to think is really that important.

Yes I do drive which is another reason for more strips - I expect the GP thinks I should use my free bus pass!!

No point testing then. Ignore the nurse.

 

[birchy66]

@birchy66

I would either buy more strips and test regularly (I do, using the very reasonably priced SD Codefree meter) on waking, and before and after each meal.

Or I would spend your 4 strips a day very wisely. By testing two meals or snacks a day. One test just before eating, the second two hours later.

However, I'm type 2, so that suggestion may not be practical for a type 1. You may HAVE to test at other times.

But by testing that way, we type 2s can work out which meals/foods are sending our BG up, and decide whether to reduce portions, avoid the food, or (in your case) adjust your insulin.

You'r ea type 1 - which makes it even more ridiculous that you don't get enough strips.
Do you drive?
They shouldn't be restricting your strips AT ALL

(This makes me so mad!)

Hi Brunneria,
Just thought I would follow up on your mention of the SD Codefree meter which sounds good on the supplier blurb, but there is some worrying feedback on this site at the following link:
http://www.diabetes.co.uk/blood-glucose-meters/sd-codefree-blood-glucose-meter.html
How do you find the accuracy?

 

[Bluetit1802]

You are a Type 1 and therefore required to test 4 times a day before meals and bedtime. You also have to test each time you drive. How many times a day do you get in your car? I think you should demand more strips from your doctor. It's dangerous not to have enough strips.

 

[Bluetit1802]

....... and to answer your question. A good HbA1c test is not enough. Frequent spikes after food will cause complications in the long term, so you do need to learn to control your diet (by testing foods) to keep the spikes down until such time as you are fully aware of what is causing these spikes. Your present HbA1c of 6.6% equates to 7.9mmol/l as shown on our meters. That means your AVERAGE is almost 8mmol/l, and therefore you have a lot of readings higher than 8.

 

[birchy66]

You are a Type 1 and therefore required to test 4 times a day before meals and bedtime. You also have to test each time you drive. How many times a day do you get in your car? I think you should demand more strips from your doctor. It's dangerous not to have enough strips.

You are right bluetit, I will be a little more assertive, after all it's my health and life and surely my GP should be a little more concerned. I think the rule on driving a car is that I should test every 2 hours. That is 2 hours since the last test if I am about to drive or if on a journey stop after 2 hours and test, and so on.
I also get your point on averages and spikes - it has been worrying me.

 

[noblehead]

I suppose what I am asking is if I am achieving an HbA1c within the acceptable range of 6.5% to 7.5% (48 to 59 mmol/mol) do I need to worry when I get high pre-meal BG readings typically 10 to 12 sometimes? I get really angry with high readings - just can't help it.

If the pre-meal spike is a one-off then you don't need to worry as many factors can effect bg levels, however if your bg is regularly around 10-12 before eating then you need to find out why, the most obvious cause is too little insulin.

So, if the 10-12 reading is the norm, start with your basal insulin first, if it's not set at the right dose then you will always be chasing your tail, the following has a good explanation on how to do basal checks:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Should you find when you get the basal dose right you are still high pre-prandial then look at look at your insulin-to-carb ratio's, if you've not done a DAFNE course before take a look at the following which you should find useful:

http://www.bdec-e-learning.com/

 

[Brunneria]

Hi Brunneria,
Just thought I would follow up on your mention of the SD Codefree meter which sounds good on the supplier blurb, but there is some worrying feedback on this site at the following link:
http://www.diabetes.co.uk/blood-glucose-meters/sd-codefree-blood-glucose-meter.html
How do you find the accuracy?

I find the Codefree fine, but I'm a type 2 so the accuracy isnt as important as for you.

If a test looks unexpectedly high or low, I just test again - which isn't a problem with such cheap strips.

 

[barrym]

I know I've asked this before, but what is a "large spike"? I sometimes have 8s or 9s, even very occasionally 10s, at 2-3 hours postprandial. Is that a high spike? I do usually adjust at that level.

My last HbA1C was 39.

 

[pavlosn]

I know I've asked this before, but what is a "large spike"? I sometimes have 8s or 9s, even very occasionally 10s, at 2-3 hours postprandial. Is that a high spike? I do usually adjust at that level.

My last HbA1C was 39.

A spike is a sharp increase in sugar levels over a short period of time.

The size of the spike refers to the amount by which your sugars rise from a base level. For instance if your preprandial count was 7 and at two hour post prandial was a 12 then you had a 5mmol spike. If you visualize a chart tracking your glucose level over time then a spike would visually appear if there was a big increase in your levels such as after a meal heavy in high GI carbs.

Most t2s on this forum try to avoid spikes and try to limit postprandial count to no more than 2mmol of the corresponding preprandial count. I do not know if t1s use the same rule of thumb.

 

[barrym]

A spike is a sharp increase in sugar levels over a short period of time.

The size of the spike refers to the amount by which your sugars rise from a base level. For instance if your preprandial count was 7 and at two hour post prandial was a 12 then you had a 5mmol spike. If you visualize a chart tracking your glucose level over time then a spike would visually appear if there was a big increase in your levels such as after a meal heavy in high GI carbs.

Most t2s on this forum try to avoid spikes and try to limit postprandial count to no more than 2mmol of the corresponding preprandial count. I do not know if t1s use the same rule of thumb.

I guess I should have asked what LARGE meant. I know what a spike is, and I can do the maths, what I wanted to know was how much is a large one and what is acceptable given that some foods are likely to increase BG quicker than the insulin can reduce it. So assuming a preprandial of 7 (within the acceptable target range of 5-7), what would an acceptable 2 hour postprandial be? Ignoring T1/T2, your example of 12 would be an unacceptable spike and one of 9 would be OK, in relation to long term damage?

If the above is OK, then would a lower preprandial of 5 followed by the same postprandial of 9 be considered a spike?

Sorry if I'm labouring this point but I've never been able to get a quantitative answer to this.