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A technical question on blood sugar measurements

Discussion in 'Ask A Question' started by DavidE54, Jun 20, 2016.

  1. DavidE54

    DavidE54 Prediabetes · Member

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    Hi
    I am trying to understand my blood tests and sugar levels.
    I eat fairly healthily, am not over weight, but I do graze, and always have.
    My blood tests, as measured in HbA1c, come out at 4.9 so I am told I am pre-diabetic and very nearly diabetic. My own blood tests, with a Contour next test strips, average at 6.6 and mostly vary between 4.8 and 8.0, depending on time of day, food eaten and when, and any exercise etc which , so from what I can see is I am fairly normal, as in not diabetic.
    My conundrum; if I graze, my blood sugar, as measured by my GP, which measures the blood sugar average over the previous 3 monthsish in HbA1c, will consistently be high, thus indicating I am pre-diabetic or diabetic. However, when I only eat 2 meals a day, and within 4 hours of each other, my blood sugar is low most of the day ( 5.0 /mmol/L for 18 to 20 hours), rising to about 7.5 after a meal (for 2 to 3 hours), and therefor from what I can understand, I am not diabetic or pre-diabetic.
    Could someone please explain, in simple lay terms, what the truth is and whether I am diabetic, pre-diabetic or neither?
    Regards
    David
     
  2. chalup

    chalup Type 2 · Well-Known Member

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    I am not a doctor and don't presume to diagnose you. Anything over 7.8 is considered to be a level that can cause damage. This is as measured with your meter not Hba1c. If your doctor is telling you that you are pre-diabetic can you really afford to disregard this? It is easy to slip into full diabetes without knowing. No one wants to hear that there is something wrong. I wish you the best of health always.
     
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  3. GrantGam

    GrantGam Type 1 · Well-Known Member

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    If your HbA1c indicates that you have pre-diabetes, then you are pre-diabetic with regards to your current lifestyle.

    To put things really simply. If you were to eat and drink nothing but refined carbohydrates and sugary drinks, all day - every day. Then you will find that you will remain pre-diabetic or possibly become diabetic.

    But, like you said when you cut your meals down to 2 per day and cut out the snacking, your bloods perform better. Diet has a big role to play and you can ask other people on the forum about this.

    It doesn't mean that you're not allowed to snack or eat more than two meals per day though! Frankly, you can eat as much as you like (to a certain degree) - providing it's the right stuff. Try to avoid things like refined carbohydrates, sugary snacks, drinks, sweet, etc. Instead substitute these for low GI foods, high fibre foods, any green veg, brown rice, brown pasta. In terms of carbohydrates, try and set a limit on these as consuming large amounts of carbohydrates will leave you finding it harder to control your BGL. Also, stay away from things which are described as "diabetic" foods, they're just a marketing gimic.

    The control of your HbA1c doesn't have to be purely dietary related though, you may find that increasing your activity levels and exercise will have a positive impact also.

    To summarise, you currently have control over your blood glucose without insulin or any other medication. So you can keep things in check with positive adjustments to your lifestyle. I'm by no means saying you live recklessly! But you have already seen for yourself that your blood glucose levels can drop with changes made by you.

    Hope this makes some sense?:)

    Grant
     
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  4. 4ratbags

    4ratbags Type 2 · Well-Known Member

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    The Hb test is your average BS over 3 months so the test accounts for high and low days.
     
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  5. bulkbiker

    bulkbiker Type 2 · Master

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    Could your HbA1c result have been 49 and not 4.9? If so then you are just Diabetic. Check out this page.
    http://www.diabetes.co.uk/what-is-hba1c.html
    This would then explain what your meter readings are showing.
    If you change what and when you eat you could probably lower your HbA1c but you should first check the exact result from your Doctor.
    I will also tag @daisy1 for the intro to the Low Carb lifestyle that a lot of us use to control our blood sugar levels very successfully.
    All the best
    Regards
    Mark
     
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  6. Pinkorchid

    Pinkorchid Type 2 · Well-Known Member

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    4.9 if that is what your blood test level was is not prediabetic it is normal
     
  7. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    I think he must mean 49, not 4.9. I agree with @bulkbiker This would make him diabetic as it is over 47.

    @DavidE54 You also need to remember that our finger prick tests are just snapshots. Unless you test every 15 minutes 24/7 you can't really compare the averages to an HbA1c. However, your daily finger pricks do show normal levels at the time of the test, which indicates you have reasonable control.
     
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  8. daisy1

    daisy1 Type 2 · Legend
    Retired Moderator

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    @DavidE54

    Hello David and welcome to the forum :) Lots of interesting replies above from members. To add to this, here is the information we give to new members and I hope you will find it useful. See the link to the Low Carb Program too. Ask as many questions as you want and someone will help.


    BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

    Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

    A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 150,000 people who are demonstrating this.

    On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

    The role of carbohydrate

    Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

    If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

    The bad news

    Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

    The good news

    People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

    Controlling your carbs

    The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
    There are two approaches to controlling your carbs:

    • Reduce your carbohydrate intake
    • Choose ‘better’ carbohydrates

    Reduce your carbohydrates

    A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

    The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

    Choosing better carbohydrates

    Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
    http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

    The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

    Read more on carbohydrates and diabetes

    LOW CARB PROGRAM:
    http://www.diabetes.co.uk/low carb program


    Eating what works for you

    Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

    To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

    The blood sugar ranges recommended by NICE are as follows:

    Blood glucose ranges for type 2 diabetes
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 8.5 mmol/l
    Blood glucose ranges for type 1 diabetes (adults)
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 9 mmol/l
    Blood glucose ranges for type 1 diabetes (children)
    • Before meals: 4 to 8 mmol/l
    • 2 hours after meals: under 10 mmol/l
    However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

    Access to blood glucose test strips

    The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

    • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
    • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

    Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

    You may also be interested to read questions to ask at a diabetic clinic

    Note: This post has been edited from Sue/Ken's post to include up to date information.
     
  9. sud5nala

    sud5nala · Well-Known Member

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    I, too, wonder if the numbers were typed wrong.

    I think people are more likely to rate as pre-D and D with the A1c than with the other two tests, which would be an unfair discrepancy. That said, if the test result really was 4.9%, that is extremely far below pre-D, while if the result was in fact 49, then officially that is clearly diabetic.

    In the units of %, official prediabetes is in the range of 5.70 to 6.49%. 11 IFCC units equal 1.0 of the % units. In IFCC units, official PRE-diabetes is approx. 39-47.

    My personal results: Two years ago, when I tested myself with an enormous quantity of juice, glucose rose to from 4.7 to 10.1 mmol/l, and the 4.7 was regained in 3 hours. Last year, after an exercise program, the change was still from 4.7 to 10.1, but recovery took only 2 hours. It should never take more than 2 hours, and 1 hour is much preferable.

    You also reported results from the glucometer. The highest value has been "8.0", apparently in units of mmol/l. This is a tad high. Perfect control would be that glucose doesn't rise at all when we eat, but in fact, the vast majority of people go high.

    To get the answer you seek, you would need to take a standard glucose tolerance test. The standardized meal test is offered rarely. The usual challenge test, OGTT, consists of drinking 75 g of glucose which has been added to water, and recording the blood glucose at 2 hours. This is a bigger challenge that any natural meal would furnish.

    In the OGTT, prediabetes is defined as a 2h OGTT of between, approx., 7.8 mmol/l and 11.1. Your glucometer results after eating cannot serve to predict whether you would pass the unnaturally strong glucose challenge. That said, most people enjoying low fasting glucose who would take the OGTT would peak at 6.7 and 7.8. For a person to exceed 7.8 while eating naturally calls for some changes in exercise or eating, like your two meal a day schedule.
     
  10. DavidE54

    DavidE54 Prediabetes · Member

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    Hi
    Have just checked my records and my last blood test was actually 47. There seem to be so many different measure I forget which is which.
    A big thank you for the factual and detailed replies. I'll take my time in digesting it all.
    Regards
    David
     
  11. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    Well there you go, you are pre-diabetic - but only just under the 48 cut off. You now know where you are starting from. Good luck. :)
     
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