Is a good HbA1c all that matters?

Brunneria

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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.

I think we all differ with how large is large.

Someone following Dr Bernstein's Diabetes Solution eating might call a rise from 4.6 up to 7.1 a massive spike.
While others, on a much higher carb intake might regularly run in the mid teens and spike to the high 20s.

Ideally, the lower the pre meal figure the better (excluding hypos, of course) and the smaller/shorter the rise, the better. Less than 2mmol/l for type 2s is often quoted as a good number to aim for.
 

pavlosn

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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.
I don't think I have an answer that will satisfy your question.

As a t2 who is on Metformin only and so at a low risk of hypos I personally like to keep a tight rain on my levels and generally aim to be under 7,8 at one hour post prandial under 6,7 at two hours and under six at all other times. As I also stated I usually like to keep the two our rise of any meal within 2 mmol. These targets are stricter than NICE guidelines but I find I can meet them so I aim for them.

The 7,8 mmol ceiling is not arbitrary, I use it because there are studies that suggest that at sugar levels below that threshold internal organ damage is minimized. So I prefer to stay above this level for as little as possible.

I hope that even in a roundabout I have answered your questions.

The reason I differentiated between t1 and t2 is because I do not know if it is realistic for a t1 or insulin dependent t2 to aim this low because of the increased risk of hypos

Regards

Pavlos
 

phoenix

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Going back to your original question, do spikes matter ?
The answer is that no-one has the real answer, or at least no-one has any real evidence that they matter more than the average glucose levels in the long term. It is a matter of huge debate and too complicated to answer in a quick post.
If your spikes lead to higher overall glycemia then they must be detrimental. If your average levels are higher than you 'want' then focusing on reducing spikes may help to lower the average .
On the other hand, since you are fasting for longer periods, it's also a very good idea to get the basal insulin right so that you start eating at a reasonably low level and don't wake up to too high a level either.

If you want figures, then from a personal point of view, as someone on insulin ,my doctor wants my two hour level target of an increase of not more than 50mgdl which is 2,7mmol/l . I may well have a higher level in the period before that but bolus insulin keeps on working for another 2+ hours.

If you want to read some of the debate on what is called glucose variability. Here are two recent papers.
Glucose Variability, does it matter? http://press.endocrine.org/doi/full/10.1210/er.2009-0021
Glycemic Variability, both sides of the story http://care.diabetesjournals.org/content/36/Supplement_2/S272.full
There is no answer from either paper.
Here is part of the conclusion from the second one.
This article brings into focus how the role of glucose variability in the development of vascular complications in diabetes remains unresolved. Translating into hard clinical end points the laboratory evidence that implicates glycemic fluctuations in complication risk has thus far proven difficult. We are also in no position to know whether reducing this variability will lead to a reduction in excess risk—if it exists in the first place. Knowing whether there is benefit in reducing variability beyond that of simply reducing the risk of hypoglycemia is of utmost importance, as it raises the possibility of allowing patients to help avoid hyperglycemia-related vascular disease without running the same risk of hypoglycemia that a strategy focusing purely on lowering HbA1c (by whatever means) might cause. It may therefore guide preferred future therapeutic approaches to treating hyperglycemia
 

birchy66

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As a type 1 if my BG was less than 9mmol/L 2 hours after every meal (NICE guidelines) I would be chuffed to say the least.
Here's an example of my mid-day meal readings today (not necessarily typical):
Preprandial 5.6mmol/L (a good reading for me).
I ate smoked mackerel, tomatoes, small portion of cheese with a total carb content of 8 grams, for which I took 1 unit of Novorapid. After 2 hours my BG was 9.7mmol/L.
Now how do I account for such a high BG after 2 hours??
 

barrym

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As a type 1 if my BG was less than 9mmol/L 2 hours after every meal (NICE guidelines) I would be chuffed to say the least.
Here's an example of my mid-day meal readings today (not necessarily typical):
Preprandial 5.6mmol/L (a good reading for me).
I ate smoked mackerel, tomatoes, small portion of cheese with a total carb content of 8 grams, for which I took 1 unit of Novorapid. After 2 hours my BG was 9.7mmol/L.
Now how do I account for such a high BG after 2 hours??

Like you I have weird, unexplainable readings. Two consecutive days I can do pretty much the same things, eat the same stuff, take the same doses and get different readings. That is why my DN tells me not to focus so much on BG but more on HbA1C. Easy to say, but when you see those high numbers it makes you want to scream when you have been trying so hard.

Mind you my carb intake is much higher. I generally go for 160-190g per day. My high carbs meals are breakfast (Muesli), and lunch (a sandwich plus fruit). Evening meal is normally protein, veg and minimal carbs, unless some roots. I don't very often do postprandial checks, unless I suspect something. I normally wait to do the next pre-meal reading. So breakfast has a long time to sort itself, lunch slightly less, and tea not too much time, so I occasionally check after 2.5-3 hours and do an adjustment if required. Mostly it works out OK. My 14, 30 & 90 day averages are all within range despite the occasional 'spike'. I'm reluctant to use that term as I think they are more likely sustained highs due to either incorrect dosing or poor carb calculation.

Rambling now - sorry.
 

Paul59

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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!!
In my opinion the post meal/snack is more important as it shows how what you eat affects the bg, the lower the better below 7.7 is what I work on personally.
 
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etmsreec

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Like you I have weird, unexplainable readings. Two consecutive days I can do pretty much the same things, eat the same stuff, take the same doses and get different readings. That is why my DN tells me not to focus so much on BG but more on HbA1C. Easy to say, but when you see those high numbers it makes you want to scream when you have been trying so hard.

Mind you my carb intake is much higher. I generally go for 160-190g per day. My high carbs meals are breakfast (Muesli), and lunch (a sandwich plus fruit). Evening meal is normally protein, veg and minimal carbs, unless some roots. I don't very often do postprandial checks, unless I suspect something. I normally wait to do the next pre-meal reading. So breakfast has a long time to sort itself, lunch slightly less, and tea not too much time, so I occasionally check after 2.5-3 hours and do an adjustment if required. Mostly it works out OK. My 14, 30 & 90 day averages are all within range despite the occasional 'spike'. I'm reluctant to use that term as I think they are more likely sustained highs due to either incorrect dosing or poor carb calculation.

Rambling now - sorry.

My DSN suggests that BG before meals is more important than 2 hours after. If I could get even close to achieving the NIHCE guidelines then I'd be over the moon!
I've pretty sure that much of the variability in my BG results is down to insulin absorption. Having been T1 for 33 years and stupidly listened to all of the advice of being able to re-use needles and disposable syringes again and again, my injections sites vary from ok to lumpy to do not use. If you're anything like me, BarryM, it could be that you're dosing correctly and calculating correctly, but just not getting all of the insulin that you think you are.
Different discussion that I've still not settled or come to a conclusion on is post-exercise peaks. After swimming for an hour, my BG might be pretty good after the swim but then go sky-high. If I correct that, I end up hypo overnight. There are no easy answers in the T1 game...
 

barrym

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That sounds like a description of me too. I'd never really thought about the absorption issue. Interesting. Something to think about. Thanks.

Oh, to put it in perspective I've been on insulin for just over a year so a bit of a baby really, despite my 60+ years.

Cheers
Barry

Sent from my Nexus 7 using Tapatalk
 

Arab Horse

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What is Dr Bs diabetic solutions? I am a fairly newly diagnosed type 2 who was found to be diabetic on the free NHS health check and everyone was gobsmacked that I had not had any symptoms givn my glucose and HbA1c levels (18.6/10.4). i have already bought a few books and do a lot of internet trawling so don't really want to spend any more unless it will bve really useful.
Thanks
 

jack412

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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!
that is no where near enough strips, 300 a month for a few months sounds more like it for a new T1
I'd get a referral to a consultant at a hospital clinic, he will set your targets and strips
 

noblehead

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What is Dr Bs diabetic solutions? I am a fairly newly diagnosed type 2 who was found to be diabetic on the free NHS health check and everyone was gobsmacked that I had not had any symptoms givn my glucose and HbA1c levels (18.6/10.4). i have already bought a few books and do a lot of internet trawling so don't really want to spend any more unless it will bve really useful.
Thanks


It's a book by Dr Bernstein called the Diabetes Solution, he is a type 1 himself and has been for over 50 years I believe.
 

debbieobbie

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Living with diabetes now for 2 years plus, and i must say i've had a lot of help and support from Dr / hospital,
But i'm still struggling to get some kind of level, I read books, ask people I now for advice, but my son I think as given me the best advice.
And that is, you have listen to your body, work things out for yourself.
I;m not saying other people can;t help, but like now reading through some of your comments, we all have diabetes, but our boddies seen to respond
differently.
I have so many highs and lows you would not believe. I now use a bolas adviser, up to now no great help.
That was my reason to join this sight my question was to be. Has anyone struggled for this long,and become depressed
like me.
I don;t have wieght issues, i;m very active I eat reasnably healthy, but I can;t get this thing under control.
I guess my son maybe right, I will work it out for myself one day. ( unless someone out there knows better)
 

Arab Horse

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Hi Debbie, I was diagnosed a few months ago after a routine NHS health check; was gobsmacked to find I had diabetes although I do have some risk factors although I am a healthy weight; Didn't eat all day, just breakfast and then nothing until late evening quite often and then when I did I didn't really eat the right things, not enough sleep and a stressful job. I had no symptoms (to everyone's surprise). I was put on metformin and then sitaglyptin added and statins although I didn't really have a high cholesterol and my HDL cholesterol was high and LDL low but the only thing that keeps my glucose low is no carbohydrates (well, very little). No bread, potatoes, rice, pasta etc. It is difficult to stick to and I do have the odd thing such as my usual bran flakes for breakfast.. Reading on the internet I was aghast at what siaglyptin does to you so I have stopped taking it and the statins.

If you have been struggling for 2 years you need some sort of new approach. I have just ordered Syntra5 tablets from the States as I have read a lot about them, all very positive, hope they work as they are expensive. I will let you know how I get on. If you google SYNTRATECH you will get all the details. If they are half as good as the trials show it will be amazing!!!!