Another Newbie (Type 2)

[Wolfman Bob]

With apologies, but this is a post I made this morning on a small Renal Forum I belong to. Since then I found this site and forum, so hope you will not mind if I post a copy here...

Hi there

Diagnosed with Diabetes just before Christmas. Transplanted 2 years 9 months ago and kidney doing ok, but concerned about this new development.

Been given all the dietary advice, and glucometer, and testing regularly.

Although only early days, I am concerned with my results. I appreciate that the human body is not a predictable machine, but I was hoping for some logical relationship between what I eat and my BM results.

Having read various views on the net when to test, I thought I would try one day (yesterday) testing two hours after each meal, and once 5 hours after my main meal (lunch).

The morning went well (about 6.6 2 hours after breakfast) as did the afternoon (8.6 two hours after lunch) - but when I did my next test just before supper (5 hours after lunch) it was 15!

Just wondered whether diabetes with kidney complcations and drug regime (Myfortic, prograf and pred) was a bit more complicated when trying to settle down into a dietary routine with sensible sugar levels, or whether I should rethink my testing times to give a more accurate reflection of what is actually going on?

I am on Gliclazide (40mg, 2 times a day), and my GP recommended tests twice a day (2-3 hours after breakfast and just before evening meal to give near fasting result). I have been doing this, but by and large the results follow a similar pattern - AM good, PM bad.

I do not want to trouble my GP at this early stage (unless my results continue to spike regularly), and my first Clinic is 2 months away, so really I was wondering if anybody could recommend a Diabetes site that has useful (and reliable!) advice, and perhaps a forum so that I can get a feel for the best way to get this under control from others who have been through similar experiences.

I always try and be pro-active in my own health-care, so although I am perhaps being impatient, I am looking for a way forward quickly to reduce the amount of damage that high blood sugar levels are causing me.

Sorry to ramble on for so long, but any thoughts would be appreciated. Thanks.

Best Regards

Update - reading 3 hours after breakfast this morning (and not a sensible one!) - 6.6!

Before retiring on health grounds I was a software analyst/diagnostician - so these results are really confusing me! :?

 

[Grazer]

Hi Wolfman and welcome! Daisy will be along soon with her advice sheet for new members, so I won't duplicate all that.
In terms of testing, you'll need to test more than the doc says in the early days. We all react differently to different foods, eaten at different times,and with the drugs you're on you'll be different to most potentially! You need to ignore what anyone here says if it conflicts with things you need to do for your renal issue, but as far as diabetes is concerned, your blood sugars (BGs) will be all over the place until you settle into a steady, and probably reduced carbohydrate, diet. You need to test before you eat, and then 2 hours after, to see the difference. Ideally, 2 hours after eating, you should be at 7.8 or lower. However, if your BG was raised BEFORE eating you may not achieve that, which is why you should test before as well. 6'ish before eating is kinda ok. So it's the before and after difference we're looking at. In the early days, I tested loads with different foods cooked in different ways until I found out how it all affected me. Now I only test when I try something different, or now and again to ensure things aren't changing. You'll also find that the same food (or amount of carbs) eaten at different times will affect you differently. I can eat a lot of carbs for breakfast, with big bowls of cereal, with low BGs 2 hours later. Others can't tolerate that and have eggs or ham/cheese or some other non-carb food at breakfast. Then again, those people can often tolerate lots of carbs ((preferrably low GI (Glycemic Index) ones)) in the evening and I can't.
Your Gliclazide will help with all this BG stuff, but adjusting to fewer low GI carbs will help it work better - although that's not necessarily what your "health professional" will tell you!
You'll get loads of good info and advice on here, so stick around!
Good luck

 

[daisy1]

Hi Wolfman and welcome to the forum I don't think Grazer has left me much to say as he has given you good advice in his post. As he mentioned, here is some information we give to new members which I hope will help you. Ask as many questions as you like as there is always someone here to 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 well over 30,000 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 ... rains.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

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 blood glucose 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.

 

[Wolfman Bob]

Many thanks for your responses, Grazer and Daisy - always good to know that a forum is well-subscribed and active.

Sadly this is my second attempt at a second post - my previous one seemed to disappear into the ether when I pressed Submit - so who knows - it could maybe appear anywhere! (note to self - always make copy to clip-board before pressing buttons!).

Rather than type it all again (in case it does re-appear) the main points I suppose were my confusion that my BM result 2 hours after a meal was 8.6, but 15.0 3 hours later! (maybe morning Gliclazide effect wearing off inbetween), and when doing more testing in the early days whether online sources (e.g. Amazon, Ebay etc. ) for strips was ok, or is there some possible doubt about quality/freshness from some sources.

Once again, many thanks for your responses, and apologies if I post too often with too many questions!

Best Regards

 

[Grazer]

I don't use on-line strips, but a number of people on this forum do and apparently they don't have problems. You can have a "one-off" odd reading sometimes; could be a duff strip, or you didn't wash your hands properly (sugary residue on the skin from anything would give a false reading) I tested less than a minute after a por reading once and went from 11 to 7.2 in that minute! Bad test. You normally get a solution to test your batch of strips and it's worth doing. Other thing to remember is that BGs can carry on rising for hours. 2 hours is the stage at which your BG should be back down from a peak to an ok number, but that's not always the case. Some foods can act more slowly for longer. Nonetheless, the 15 sounds a bit odd. If you did a massively hard amount of exercise without eating, your BG could have gone low and then had a liver dump, but sounds high even for that. Keep an eye on thingds and see if it happens again. And make notes! Easy to forget what happened and when.
By the way, you're obviously paying for strips. Wouldn't your doctor give you a prescription? They often won't for a T2 on diet only or metformin, but with gliclazide there's a good case for it to avoid hypos. NICE guidelines say testing can be used as part of "structured education" Suggest you go back and give your GP a hard time and explain you want to see how different foods affect you so you know what to avoid. Tell him you'll reduce testing when you know what is good and bad FOR YOU - we're all different. quite a few people have succeeded in getting strips for testing on prescription even when they are not on meds like Glic that can cause hypos, so be pushy!

 

[Wolfman Bob]

It was in my original (lost) second post, but I am fortunate enough to get strips on prescription (at least at present). My GP was very on the ball about Hypos, so no concerns there.

The reason I asked about online sources was that prescription strips are finite, being unable to order more until 28 days have elapsed, so I thought if I paid for some extra for initial tests and bench-marking then I would not feel guilty about taking too much from the system, and also I would not run out!

With regard to the apparently anomalous later reading of 15 - it seemed fairly consistent with testing on previous days, with morning readings being good, and near-fasting readings at about 6p.m. being bad!

Admittedly the majority of my testing to date has been done without strict regard to my diet (for the first couple of weeks my GP said have your normal diet - presumably to judge the effect of the medication - or maybe he was just being kind as it was just before Christmas!). However, having now seen my DSN, my diet is much closer to standard guidelines.

Therefore I could only come up with two theories for the anomaly/ies - either the drug-effect wearing off after 9-10 hours, or my conversion of carb to glucose is especially slow, regardless of the GI value (perhaps some complication due to renal situation and anti-rejection drugs?).

As you can probably tell, I am somewhat floundering at the moment - but hopefully with further and more rigorous, structured testing I will get a better idea of what is actually going on, and how best to meet my bodies needs and targets.

Thank you once again for your help and advice

Best Regards

 

[Grazer]

However, having now seen my DSN, my diet is much closer to standard guidelines.

Just be aware, if your DSN is switched on that's great, but if you get the "eat plenty of starchy carbs " line; well, up to you, but most of us wouldn't go near it! Daisy's post is the line to follow in my opinion.
Bon Chance!

 

[Wolfman Bob]

Indeed. Even my brief researching on the net has shown that in general, carbs are not flavour of the month!

Not sure about my DSN - seems pleasant and competent enough - but I suspect has a very high caseload so may well give advice "by the book", one size fitting all.

Armed with my meter, and helpful advice from reliable quarters, I am sure I will be able to arrive at what suits me best.

Good news today though - 2 hours post main meal 7.8, 5 hours post main meal 6.6.

At last - some logic! Prepared though for wayward and anomolous readings, but hopefully most of them will reflect how good (or not so good!) I am being with my diet.

Feel much happier now, and slightly more in control

Thanks and Best Regards...

p.s. Green tea has been recommended to me - checked on this forum and there seem to be some views - but I think I would like to try it if it is definitely not harmful, and might have some benefit.

 

[Grazer]

p.s. Green tea has been recommended to me - checked on this forum and there seem to be some views - but I think I would like to try it if it is definitely not harmful, and might have some benefit.

No harm, but minimum benefit I believe compared to the difference you can make with diet and exercise changes

 

[Wolfman Bob]

Hi again

Not gone away, just testing and trial and error with diet. Looking far more promising than earlier, so I suppose I must be doing something right!

Not had a result in double figures since I last posted (worst was 9.0 - but after a 'pub lunch of Fish and (a few) Chips , and a pint of beer!).

Two overnight fasting tests - 4.9 and 5.5 - so hopefully I am more or less on track.

My problem is that my GP said that BM results after 2 hour tests are ok if less than 10. I get the impression most people on this forum would shudder if they were even close to that high!

I have looked through this forum trying to get a feel for what a good figure would be, but understandably there seems to be a bit of a variation of view (although obviously the general opinion is the lower the better).

I am really looking for a practical figure/target, bearing in mind I have other health issues (kidney TX, high BP), that I can aim for without being too miserable on my diet. I accept that the less rigorous you are, the more risk you run, but I am looking for a reasonable balance whereby I can have "naughties" from time to time withpout feeling too guilty that I am shortening my life (or the quality thereof) too much.

Just for a little added context, I and (most of) my family have/had PKD (herediatery kidney disease) - my Father died at 46, my Brother at 51, my Sister at 50 - I am 57 - so I can not quite shake the slight sense of being on "borrowed" time.

Not being downbeat or complaining (I am sure many here have endured far worse situations), but just pragmatic.

So, would appreciate any views on a maintainable level or target that may expose one to a slightly higher risk than ideal, but that is sustainable for the longer term with reasonable discipline.

Apologies if the question is viewed as a little "heretical", but a good forum hopefully should encompass a broad spectrum of views, goals and life-styles.

Thank you and Best Regards

Wolfman Bob

p.s. I am trying Green Tea with lemon - not quite acquired the taste for it yet but I will persevere

 

[Grazer]

Not heretical at all. NICE guidelines are below 8.5 at the 2 hour stage which is one target for you. Another perhaps "sensible" but not too demanding level is below 7.8, which is the max level a non diabetic could get to. Good luck!

 

[Daibell]

HI. The NICE Guidelines will give you some idea of targets and medication options. See:

http://guidance.nice.org.uk/CG66

Yes, 10 is too high as a target. I try to keep my BS below 10 but I'm struggling to meet a reliable Hba1C so sometimes go near to 10. Some would say anything below 8.5 2 hours after a meal is acceptable, but the nearer to 6.5 the better. It may be that the range of tablets you can have is more limited than normal due to your kidney history, although on the other hand high blood sugar doesn't do a kidney much good. I would have thought with your kidney history your GP should refer you to a diabetes clinic where they will have more experience of the range of options available?

 

[Angeleyes]

Not heretical at all. NICE guidelines are below 8.5 at the 2 hour stage which is one target for you. Another perhaps "sensible" but not too demanding level is below 7.8, which is the max level a non diabetic could get to. Good luck!

Hello Grazer.
A little puzzled by the comment that 7.8 is the 'maximum' level that a non diabetic can get to? Where does that information come from?

Surely it would all depend on the food consumed and I am also sure a non diabetic can achieve much higher levels that that! The fact is an ND can get their levels lower afterwards much more quicly and easily. Perhaps that is what you really meant?

 

[Grazer]

Although a ND can get higher than 7.8 short term, 2 hours after eating a ND should be back below 7.8, regardless of what they ate. This figure is published by the International Diabetes Federation and is used by most countries. Diabetes.co.uk (this website) publishes this figure as well.

 

[phoenix]

Off original topic... sorry
Normal levels in non diabetics
Up until recently a lot of our ideas about normal glucose levels have been speculative. Testing at intervals doesn't reveal a true picture. In the last few years they have been able to study the glucose profilesof people wearing continuous glucose monitors in real life situations. These have helped to confirm that the glucose levels of people without diabetes are kept for the most part within very small ranges with the occasional slightly higher or lower level. I haven't found any that suggest that levels above 20mmol/l are in any way normal.. I'd be interested to see tsome evidence of this. As Grazer says such a level in an OGTT or just 2 two random readings above 11mol/l would be diagnostic of diabetes. ( in addition orange juice has a lower GI than glucose )
.
One study of non diabetics ( 74 children and adults), all non diabetic on a glucose tolerance test and wearing continuous monitors for up to 7 days, demonstrated that for the vast majority of the time they had levels within the 71mmol/l-120mml/l range. (3.9mmol/l-6.6mmol/)
http://care.diabetesjournals.org/conten ... l.pdf+html
There were a couple individuals in all but the oldest age group that reached a level of 180mg/dl (10mmol/l) : that was for extremely brief periods. None is reported to have reached levels approaching 20mmol/l (360mg/dl) which is double this level .
full stats in online appendix
http://care.diabetesjournals.org/conten ... pendix.pdf

Another study where again the subjects (80) wore continuous monitors and were non diabetic (normal HbA1cs and fasting levels but no glucose tolerance test) showed that most people went over 7.8mmol/l but not for long periods (median 26 min a day). In this study there were some subjects (7/80) who reached levels above 11mmol/l and 1 subject went to 16.7mmol/l. The subjects that reached these higher levels were older, had higher HbA1cs , higher fasting levels and higher BMIs.

It maybe that these people reaching higher levels were showing normal glucose variability but it may also be that the failure to use an OGTT to select subjects meant people with some glucose intolerance were included in the study. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892065/

 

[Grazer]

Thanks Phoenix. :thumbup: Interestingly, the post I was answering was a query from a newbie about what levels to aim for 2 Hours post prandial, NOT immediately after eating, hence the 8.5 and 7.8. Your post has confirmed this nicely