Target for glucos control with medication

san-777

Member
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19
Hello

Did anyone get told by their doctors of the target of BG levels they should aim for (with medication such as Metformin)? What are your told targets?

Yes I have read https://www.diabetes.co.uk/features/pre-and-post-meal-testing.html
that NICE guideline says the aim for fasting is <7 mmol/l, for 2 hr post meal < 8.5.

This is week 4 on medication and my husband's post meal level is far off 8.5 (usually around 10, these a few days it even went back to 13~16.3! Tonight it's 9.1 but he ate a very small meal), and he is already on relatively low carbs diet. Somehow I have a feeling that the doctors may say this is fine, no need to strictly follow the NICE targets . And do the doctors rely on hbA1c solely?

PS: I just read on a piece of article (a case in Asia, where self-testing is greatly encouraged) that an elderly man heard that hbA1c is the gold standard so he stopped finger prick testing, and only went to have his blood tested every 6 months. Due to the lack of track of his BG level and reacting in timely manner, in only 2 yrs time he got bad complication with his eyes - too late to really do anything to reverse the tragedy.

I have to say I am a bit worried about my husband not getting near the target and nothing else will be done to help him get there....
 
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LittleGreyCat

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@san-777 Most GP practices don't encourage finger prick testing for T2s on diet only or diet and Metformin.
So they won't be providing any targets.

The linked article you have read is a good guideline.

If your partner isn't achieving those targets then it would be good to work out why.

If you could, for a start, post some details of what he is eating we might be able to help.

"relatively low carb" can mean different things to different people.
 
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RFSMarch

Well-Known Member
Messages
676
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hello

Did anyone get told by their doctors of the target of BG levels they should aim for (with medication such as Metformin)? What are your told targets?

Yes I have read https://www.diabetes.co.uk/features/pre-and-post-meal-testing.html
that NICE guideline says the aim for fasting is <7 mmol/l, for 2 hr post meal < 8.5.

This is week 4 on medication and my husband's post meal level is far off 8.5 (usually around 10, these a few days it even went back to 13~16.3! Tonight it's 9.1 but he ate a very small meal), and he is already on relatively low carbs diet. Somehow I have a feeling that the doctors may say this is fine, no need to strictly follow the NICE targets . And do the doctors rely on hbA1c solely?

PS: I just read on a piece of article (a case in Asia, where self-testing is greatly encouraged) that an elderly man heard that hbA1c is the gold standard so he stopped finger prick testing, and only went to have his blood tested every 6 months. Due to the lack of track of his BG level and reacting in timely manner, in only 2 yrs time he got bad complication with his eyes - too late to really do anything to reverse the tragedy.

I have to say I am a bit worried about my husband not getting near the target and nothing else will be done to help him get there....

No - initial GP did not say anything other than “you are officially diabetic”, prescribed me Metformin and told me to come back in 3 months because my levels were so high.

I looked up levels on this site and from there found the forums and started in a more proactive journey.
 

Andydragon

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Retired Moderator
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3,324
Type of diabetes
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Diet only
When I was diagnosed many years ago I seem to recall hba1c < 6.5% was viewed favourably by the nurses. Not exactly sure what this maps to on the finger. But for me, personally, I would be content with fasting and pre-meal < 6.5 mmol/L. Currently I’m mostly < 5 so feel happy

I have found that the doctors for the most part do only look at hba1c. You can, many argue should, self-monitor but it only does a snapshot but is still helpful

Being on this site will help a lot, lots of info
 

ianf0ster

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Staff Member
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2,398
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exercise, phone calls
Like most (all?) other Type 2's I was not given targets because i was told not to test!
I was also told to keep eating the same (healthy heart way of eating) but to try to lose a little weight.
Immediately I knew this was bad advice because my weight my CVD and my T2 Diabetes had all come about after over 10yrs on that high carb low fat whole grain, more than 5 a day lifestyle! Before then I had always been slightly below normal weight!

I found this forum, knowledgeable members who'd already reversed or controlled their T2D and through them videos and info from doctors who had done the same for many of their patients with Los Carb and testing. This is where all my targets and knowledge came from.in addition to my own experience
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi. I'm on insulin as a LADA (T1) but the targets are similar. The HBA1c should be kept below 6.5% as far as possible; I hover above a little bit. Those NICE finger-prick figures are sensible. We all need to do finger-prick tests, at least some of the time if T2, to know how we are doing between reviews. If your husband has excess weight then a low-carb diet is essential to get both weight and BS down as it will reduce insulin resistance. If he is slim it's always possible he is T1 and not T2 so ask the GP for the two tests for that.
 

san-777

Member
Messages
19
@san-777 Most GP practices don't encourage finger prick testing for T2s on diet only or diet and Metformin.

So they won't be providing any targets.


The linked article you have read is a good guideline.


If your partner isn't achieving those targets then it would be good to work out why.


If you could, for a start, post some details of what he is eating we might be able to help.


"relatively low carb" can mean different things to different people.


No - initial GP did not say anything other than “you are officially diabetic”, prescribed me Metformin and told me to come back in 3 months because my levels were so high.

I looked up levels on this site and from there found the forums and started in a more proactive journey.
When I was diagnosed many years ago I seem to recall hba1c < 6.5% was viewed favourably by the nurses. Not exactly sure what this maps to on the finger. But for me, personally, I would be content with fasting and pre-meal < 6.5 mmol/L. Currently I’m mostly < 5 so feel happy

I have found that the doctors for the most part do only look at hba1c. You can, many argue should, self-monitor but it only does a snapshot but is still helpful

Being on this site will help a lot, lots of info
Like most (all?) other Type 2's I was not given targets because i was told not to test!
I was also told to keep eating the same (healthy heart way of eating) but to try to lose a little weight.
Immediately I knew this was bad advice because my weight my CVD and my T2 Diabetes had all come about after over 10yrs on that high carb low fat whole grain, more than 5 a day lifestyle! Before then I had always been slightly below normal weight!

I found this forum, knowledgeable members who'd already reversed or controlled their T2D and through them videos and info from doctors who had done the same for many of their patients with Los Carb and testing. This is where all my targets and knowledge came from.in addition to my own experience



Hi! Just came back from hospital with him today, and thx for all your comments.





So his diet and numbers:



Just after getting up in the morning, Glucos usually is: 6.0 ~ 7.5.

  • Also tested him once at 3am: 6.7, so, no Somogyi effect yet.


Breakfast: 2 pieces of wholemeal bread, +salami, +coffee with milk, +peanut small amount, +roasted sunflower seed a little bit (in future it will be raw), + half walnut x 2 or so.
Glocus mid morning: only a few tests have been done for this time point and it's usually ~ 7. So, not gonna cut down on wholemeal bread yet.


Lunch: pasta ≦50g (cut further and further down from ~80), meat or 2 eggs or fish, vegetables.
Glucos 2 hr after meal: have seen ~7/8/9, all sorts.


Supper: rice ~50g or even less since this Wednesday (cut further and further down from ~80g); Red meat or poultry or fish. Vegetables.
Glucos 2hr after: started off 15/16, then with immediate change of diet right after his diagnosis + Metformin, he soon came down to ~10.
Then suddenly jumped back to as high as 16.3 (and to rule out accidental error, we did a 2nd test on another finger) /but maybe he was stressed up inside?/
Yesterday it came down to 9.1 but he only ate a very small portion of everything.


Snacks between meals when hungry: can be anything like carrots or cucumber (salted + garlic + vinegar, cos raw carrot is really not in our list of favourites),
low fat natural yogurt with no sugar (occasionally with a pinch of microwaved frozen sweetcorn which does not seem to impact his blood much but maybe we need to check on it again),
soy milk unsweetened,
nuts.
Just started to try canned beans/chickpeas (1/4 of a tin).
Fruits like a small apple.
We are still on whole milk, maybe we should move to semi-skimmed (?)
Sometimes he eats a bit of Tesco bran (yes there’s sugar in it but when very tired, we have to give in to convenience).


His BMI is sitting on the upper end of the healthy range. But due to his other symptoms/illness and back pain and his sedentary work and all that, its hardly possible to exercise away his glucos… hence I suspect he may need some other medication… (at the beginning I really wished Metformin would reduce his sugar level magically as it does for some patients.. But it is not happening...
 
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Resurgam

Expert
Messages
9,849
Type of diabetes
Type 2 (in remission!)
Treatment type
Diet only
It would really be of more use to go low carb, so he isn't putting the glucose in in the first place.
 

san-777

Member
Messages
19
Hi. I'm on insulin as a LADA (T1) but the targets are similar. The HBA1c should be kept below 6.5% as far as possible; I hover above a little bit. Those NICE finger-prick figures are sensible. We all need to do finger-prick tests, at least some of the time if T2, to know how we are doing between reviews. If your husband has excess weight then a low-carb diet is essential to get both weight and BS down as it will reduce insulin resistance. If he is slim it's always possible he is T1 and not T2 so ask the GP for the two tests for that.

I totally agree, self-testing is needed, unless the patients or their family don't care. And we are not being obsessive ie. doing many tests everyday (so that his fingers don't get stabbed too much. In some countries it is greatly encouraged by medical staffs to self-monitoring.

Now I am suspecting my other half could be T1.5.. but that's for the medical staff to find out much later on...
 
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RFSMarch

Well-Known Member
Messages
676
Type of diabetes
Type 2
Treatment type
Tablets (oral)
At my time of diagnosis I was very much a greek yoghurt type of gal and I was using the full fat variety with honey, so swapped that out, a few berries and some flax/chia/cinnamon seed sprinkled on top so that wasn't a complete bust.

Out went Breville toasties for lunch but something like an omelette with a couple of slices of ham and a generous dollop of cream cheese is a decent filling lunch, or a homemade soup and Keto bread rolls (see the diet doctor for those - they are YUM)

-> https://www.dietdoctor.com/recipes/the-keto-bread
I think you need to look for BLOND Psyllium use else your bread rolls turn out purple!

Maybe sub out wholemeal bread for those rolls... seriously they are gorgeous. Another go to lunch for me is to brush some melted butter on a pan, fry up some bacon, an egg, some mushrooms and some cherry tomatoes and a splash of balsamic vinegar.

Dinner tonight for example will be salmon oven-baked with red onions, courgette, asparagus tips and any other beg that might be running around my fridge with reckless abandon.

If that seems too daunting at first, then maybe look at the Glycemic Index lists first and move to low GI and then from there naturally step towards low carb. You won't see changes overnight, but over time those numbers will stabilise and come down. You are making a massive change to your way of eating. I lost a work acquaintance who saw LC as a fad diet so she could lose a few pounds and she tried them all - Atkins, IF, you name it, she got on the bandwagon, lost pounds, then troughed as before and put it all on again. WE don't have that luxury anymore with a wonky pancreas!

Once things stabilise then maybe try and see how much you can tolerate of the 'bad' stuff but you might find that with spiralising veggies as a pasta/noodle alternative you don't want to go back.
 

san-777

Member
Messages
19
At my time of diagnosis I was very much a greek yoghurt type of gal and I was using the full fat variety with honey, so swapped that out, a few berries and some flax/chia/cinnamon seed sprinkled on top so that wasn't a complete bust.

Out went Breville toasties for lunch but something like an omelette with a couple of slices of ham and a generous dollop of cream cheese is a decent filling lunch, or a homemade soup and Keto bread rolls (see the diet doctor for those - they are YUM)

-> https://www.dietdoctor.com/recipes/the-keto-bread
I think you need to look for BLOND Psyllium use else your bread rolls turn out purple!

Maybe sub out wholemeal bread for those rolls... seriously they are gorgeous. Another go to lunch for me is to brush some melted butter on a pan, fry up some bacon, an egg, some mushrooms and some cherry tomatoes and a splash of balsamic vinegar.

Dinner tonight for example will be salmon oven-baked with red onions, courgette, asparagus tips and any other beg that might be running around my fridge with reckless abandon.

If that seems too daunting at first, then maybe look at the Glycemic Index lists first and move to low GI and then from there naturally step towards low carb. You won't see changes overnight, but over time those numbers will stabilise and come down. You are making a massive change to your way of eating. I lost a work acquaintance who saw LC as a fad diet so she could lose a few pounds and she tried them all - Atkins, IF, you name it, she got on the bandwagon, lost pounds, then troughed as before and put it all on again. WE don't have that luxury anymore with a wonky pancreas!

Once things stabilise then maybe try and see how much you can tolerate of the 'bad' stuff but you might find that with spiralising veggies as a pasta/noodle alternative you don't want to go back.


Thanks.. Our concern is that things like rice noodles pasta all sorts of bread are what his body is used to. Our diet above is already a drastic change from before, the portions of starchy food are much, much smaller, let alone ditching those deserts...
my concern is his body may not be able to deal with even more drastic change at the mo since he is SO used to those for decades, including his bacteria inside guts. Some advice I saw elsewhere is that it's best to move to keto diet 'with help from an expert and with tests' to avoid risks.

I have just ordered some ketone test strips to check if he is OK on the new diet. If it shows ok then maybe we can cut down a bit further, and further...

talking about bacteria, I just remembered I came across a short article a few days ago that one hospital tried flora reconstruction approach to improve diabetes: firstly use herbal medicine to 'flush out' the patient's intestines (diarrhea), then some other medicine to suppress certain bacteria, then vegan diet for 2 weeks, then back to normal healthy diet. It reported good improvement after the treatment....
 

RFSMarch

Well-Known Member
Messages
676
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Thanks.. Our concern is that things like rice noodles pasta all sorts of bread are what his body is used to. Our diet above is already a drastic change from before, the portions of starchy food are much, much smaller, let alone ditching those deserts...
my concern is his body may not be able to deal with even more drastic change at the mo since he is SO used to those for decades, including his bacteria inside guts. Some advice I saw elsewhere is that it's best to move to keto diet 'with help from an expert and with tests' to avoid risks.

I have just ordered some ketone test strips to check if he is OK on the new diet. If it shows ok then maybe we can cut down a bit further, and further...

talking about bacteria, I just remembered I came across a short article a few days ago that one hospital tried flora reconstruction approach to improve diabetes: firstly use herbal medicine to 'flush out' the patient's intestines (diarrhea), then some other medicine to suppress certain bacteria, then vegan diet for 2 weeks, then back to normal healthy diet. It reported good improvement after the treatment....

Firstly - all very valid points. I remember my results and I had high BP, high BG, high cholesterol and I remember wailing to my cousin that one thing to fix one was catastrophic to the other and I had NO idea where to start. She suggested to me to start with moving from the High GI foods (as you say rice, noodles, pasta etc) to medium to low GI foods.

There really is no way to sugar (ha) coat this but to get those blood sugars down he will need to make a change. There just is no way around it. The good news is that MANY MANY people on here have been where you two are. And we have all had to come to the realisation that for better, not for worse, we have to make a change. The trick is finding what works for YOU & HIM - we can all advise and throw in what we have done and how superb we are but honestly... we all know exactly how you feel right now at this time.

I can't tell you the right way, mate. All I can tell you is how I started.
High GI to Med GI to Low GI
LCHF
Also have had to manage with meds where others have been able to come off meds completely, but I have made my peace with the fact that for now I need to do both.

It might feel insurmountable now but you are making the right steps - we would all be more worried if you were insisting on doing the same things as before regardless and not caring about the numbers. You do care about the numbers. So you are on the right track.

Hang in there... Hugs!
 
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