BG ... what is the right target?

[mbudzi]

I'm new to this and trying to interpret something sensible from the generic answers I have been given by diabetic team - your help/experience in setting a target for BG would be appreciated.

On diagnosis 4 months ago I was told that I should try to keep my BG between 4 and 7 which I went hell for leather to do. At my last review the diabetic team said that my HbA1C of 6% was a bit low and I should relax my eating a little because of the hypos I was getting (about 2 a week). This seems at odds with what I had read with people trying to get HbA1C to between 5 and 6.

Subsequently the diabetic nurse has told me that BG up to 10 is fine and not to use any rapid acting insulin unless I get up to 13 (I just use small doses of intermediate acting insulin usually).

My interpretation of this nonsense is that I should
1) reduce my insulin, not relax my eating
2) still chase an HbA1C of 6 or lower
Am I being foolish on this?

I know BG depends on what is eaten, but can someone give me a rough guideline on what BG should be when I wake up, before I eat, after I eat. Also, should I test 1 or 2 hours after eating - I have read both - is 2 hours supposed to be back to the pre-food level?

Help ... I'm not sure I've got this testing malarkey quite sussed yet.

 

[daisy1]

I wonder if this information might answer your questions even though I think that you are not newly diagnosed:

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.

 

[ishjohno]

Hi

I think from reading your questions that you would be great for a DAFNE course. You seem to have a good understanding of the basic BG knowledge, your HbA1c of 6% is maybe a little low, my last HbA1c was 6.2% and I was advised that it was too low.
Do you have good hypo awareness?

Your profile says your are on Humulin, you probably need to ask your diabetic team how soon you can test your BG after eating as this insulin acts a little bit differently from the ones I know about.
Your quoted "BG between 4 and 7" is correct you have obviously achieved this BUT the 2 hypos a week is what your diabetic team is worried about. Do you drive? Do you test your BG before you drive?

Ask if your area has a DAFNE course, I believe that you would be a good candidate for it.