Boyfriend newly diagnosed, need help

Hi

I was diagnosed type 1 mid april and I would say that my eyes still are not totally back to normal. I was told by the doctor that they recommend that people don't get new prescription for at least 3 months because they can take a long time to settle down. I still haven't had my eye photo screening thingy - due on Wednesday, so I will check with them as to where mine will ever go back to where they were.

The key thing though is that the eyes won't settle until the BG readings are at a reasonable level. work on those and things should gradually get back to normal (so I have been lead to believe!)

Hope this helps.

There are several issues here. First of all, your boyfriend's eyes. Although one of the more serious complications of uncontrolled diabetes can be blindness - a minor condition that effects many newly diagnosed diabetics is a blurring of vision. These are completely different things, and the latter is very minor. It is caused by the fact that a high BG causes the eyes to dry out slightly and the eyeballs a. When you start to get the diabetes under control, the eyes change shape quickly and that causes blurring of vision. If he gets glasses at this time then, as you described, his eyes will likely have changed by the time he gets the glasses. I suggest waiting a few months - his eyes will eventually settle down, and then he can get glasses if he needs them (he may not).

The second thing is diet. The standard advice in medical textbooks is to eat a low fat, low sugar diet - with complex carbohydrates with every meal. This is what most GPs will tell you. However, there are other approaches to diabetes control, and if you read these forums you will quickly find that many people find a low carbohydrate approach much more effective. This means not worrying too much about fat, but cut out sugar completely and try to avoid obviously starchy foods (bread, potatoes, rice, pasta etc.). For a start I would suggest avoiding a big bowl of cereal for breakfast - that always does bad things to me. Try bacon and eggs instead!

Lastly there is the questiom of what to do with a meter. There is no point in testing if you don't make good use of the results. There are essentially three reasons for testing: monitoring your control; learning what you can and can't eat and preventing hypos. I shall assume that your boyfriend isn't at risk of hypos (most newly diagnosed T2s aren't, and if he is then I am sure his doctor would have briefed him on that).

To monitor how effectively the diabetes is under control the best way is to test first thing in the morning - before eating. This will give you a rough indication of how good the control was the day before. Any value over 10mmol/l is doing him damage and needs to be reduced ASAP. A value of 7-10 isn't too dire, but still needs to be improved. Really you are aiming to keep it under 7, and some diabetics with very tight control have a fasting BG of 4-5.

The other thing you can do with a meter is to learn how various foods (and combinations of foods) effects you. Everyone is different, so the only way you can learn what you can eat is to experiment. To do this take a reading just before a meal, and then take a reading every half hour while the BG is rising. When it starts to fall then take a reading every hour until it is close to where it started. Then plot this on a graph and compare different meals. You are aiming to minimize the area under the curve. With a bit of experimenting you will eventually learn what you can and can't eat.

Hi Boyfriend,

Firstly, you are quite right in thinking that low or high blood sugar levels require treatment in order to normalise / stabilise them.
Low blood sugar can be disabling, even life threatening, and therefore needs immediate treatment. This should, when possible, be by eating or drinking a source of glucose. Glucose tablets, which are widely available, are perhaps the best source since they act immediately and can be taken in small doses, sufficient to bring blood sugar levels back to normal without overshooting and ending up too high.
If your boyfriend is Type 2, however, as he must be if his only treatment is oral meds such as Metformin, then hypoglycemia is not a risk. If he takes an oral hyopglycemic such as Gliclizide however then low blood sugar levels are a possibility. Metformin makes insulin work more effectively while Gliclizide makes the pancreas produce more insulin.

High blood sugars are also harmful if left untreated, but when you are Type 2 on oral meds you don't have access to the injected insulin needed to bring blood glucose back to normal quickly. Symptoms typically include lethargy, thirst and the urge to pee. Your best long term strategy is to limit the foods most responsible for raising blood sugars in the first place, and exercise regularly to ensure the metabolism uses the blood glucose efficiently. Your boyfriend will find that if he limits or eliminates sugars and starches his blood glucose will improve straight away. A substantial breakfast of cereal and milk is honestly not a good way to achieve this, but if you eat then test 2 hours later you'll see what I mean.

All the best, and keep in touch,

fergus

Boyfriend said:

Thanks for that. Like i say everyone seems to give conflicting advice.

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I would say confusing rather than conflicting - there is a lot of complex stuff going on, and it can be very confusing when you are new to it.

Boyfriend said:

Last week i was on a first aid course and i asked the woman what were the signs of a low blood sugar, she said, anxiety, cold and clammy skin, shakiness etc, she said that he needed sugar straight away and once he has settled, he needed lots of carbohydrates....but from what i have noted on here carbohydrates seem to be a no-no......HELP?

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Here you are confusing two very different things - treatment for hypoglycaemia (i.e. low blood sugar) with diabetes control. In non-diabetic people there is a sophisticated system in place for regulating blood sugar levels. In diabetics this system break down, and the regulation has to be done "manually" - by some combination of exercise, diet, drugs and insulin. This is important, because if blood sugars go out of the normal range bad things happen. If they go too low you get a situation called "hypoglycaemia" (often called a "hypo"). This can be extremely dangerous, but fortunately is easy to treat. Your first-aider correctly described the early symptoms of a hypo - if it isn't corrected and blood sugars continue to fall the victim will go into a coma and will eventually die. Correcting it means eating! The best thing to eat is glucose in a liquid form because that is very rapidly absorbed (if at risk of hypos then it is probably sensible to carry something like a bottle of lucozade ). Not all diabetics are at risk of hypos - it is mostly a problem that affects Type 1s and Type 2s on insulin or some drugs. Diet-controlled Type 2s are extremely unlikely to get a hypo.

However, having a hypo is not the only risk of diabetes. A much more insidious risk is when blood sugars go too high. This is called "hyperglycaemia". This is a danger to all diabetics, but it doesn't tend to cause drastic symptoms unless it is really extreme. Usually the symptoms are quite mild (tiredness, thirst and frequent urination). However, it is a serious problem because high blood sugars slowly poison various biological systems - and this causes all of the dreaded side effects of diabetes. It can take many years for these to become apparent, but they can be extremely serious when they do. Also, if you wait until the side effects are obvious, permanent damage is quite likely to have occurred. Therefore, it is really important to control blood sugars and keep them in a safe range, and not let them go either too high or too low. There are several ways of doing this:

• Exercise - all diabetics should take at least 45 minutes of moderate exercise per day (i.e. do something strenuous enough to increase the heart rate and make you slightly out of breath).
• Diet - there are various schools of thought on the details of this, everyone is different and you need to find what works best for you. Many people seem to find that a low carbohydrate diet is most effective (except if you are going into a hypo - then you need carbohydrate fast!).
• Drugs - there are various ones available that will lower blood sugar. Your doctor will advise you. With Type 2 diabetes, most doctors prefer to try diet and exercise alone first but drugs are often necessary at some stage
• Insulin - if the drugs can't cut it then it is possible to control blood sugars completely by injecting carefully calculated doses of insulin. Type 1 diabetics loose the ability to make their own insulin, and so usually need to do this. Type 2 diabetics sometimes need it, but not usually for a while if it is diagnosed at an early stage

Boyfriend said:

And why has the optician prescribed his glasses for reading when his eyesight is so blurred....there doesnt seem to be any consistency.

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A good question. Did the optician know that he is a newly diagnosed diabetic? If this was known, then your boyfriend really should have been advised to wait until his eyes had settled down (and if that is the case, then you probably have cause for complaint to the optician). If the optician didn't know then he or she can't be blamed for just trying to fix the problem that was there on the day.

Boyfriend said:

Also what are the signs of high blood sugar and what should you do when this occurs?

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There aren't obvious immediate symptoms, as there are when they go too low - that is why most diabetics have glucose monitors and test their blood. The long term symptoms are the thirst and tiredness, but this takes days or week to develop. Also, again unlike blood sugars going too low, it isn't easy to fix it instantly. Taking some extra exercise might help bring them down a bit, but the real solution is the long term management strategy: exercise; diet; drugs if recommended by a doctor and finally insulin if a doctor considers that necessary.

I hope that this makes a bit more sense now. You are doing the most important thing to manage diabetes, and that is learning about the condition. Asking question on this forum is a good place to start, but at some stage it is probably also worth investing in some good books. When you feel ready to do that either look through these threads for advice, or post questions about which ones are worthwhile.

It is confusing, part of the reason is that we are all very different, what works for one will not work for another. There is some very good advice on the net Jennifers advice to the newly diagnosed. It offers some sensible practical ideas. Unfortunately it does rely on access to testing strips.
(just google it.


High Blood sugars. Many people don't actually feel anyting with high blood sugar, particularly if they have had high BS for a long period before diagnosis. (sometimes tiredness, lethargy, headaches, thirst).
To find out how high BS is you need to test.
If your boyfriend tests 2 hours after a meal and finds his BS to be above 8mmol, then he can use the information to adapt his mealtime choices. Unfortunately with metformin he can't use medication to lower a higher BS after a meal. For BS between 8mmol and 13.5mmol What he can do is take some exercise, a brisk walk can be very effective. (hopefully he won't be above this but he would need to take medical advice about exercising above this level)


Low blood sugars: On metformin he is unlikely to develop very low BS. (usually asociated with insulin and some other oral drugs). Hypoglycemia is technically anything under about 4mmol but is not dangerous until lower than this (2.2mmol). Your friend is correct about the symptoms (though they vary from person to person) However, since your boyfriend has not had normal BS for a while it is possible that he will feel those symptoms at a higher (non hypo) level. This is just because the body has become unused to normal levels. These false hypos will go. They are certainly not an emergency. Again the only way to tell for certain what the level is is to test.



Incidently your friends advice on the treatment for a hypo would tend to send the person high.
Standard treatment is 15gm fast acting sugar (3 teaspoons sugar, dextrose tablets, fruit juice) repeated if hypo still present after 15 minutes. If it is going to be more than an hour until the next meal then the person should take a small amount of slower acting carbs (couple of small biscuits, half a sandwich, not lots of carbs!)

These figures are very high, and you really need to get them down as soon as possible. Fasting BG (i.e. before eating in the morning) for a non-diabetic should be in the 4-6 range, and for a well controlled diabetic they shouldn't be far off that. The good news is that it should be easy to improve this, and that when they do improve the symptoms should improve dramatically.

It is quite likely that the medications need adjusting or completely changing, and he might need to be put on insulin (which is nothing to be afraid of - and would improve the situation very quickly). Send your boyfriend back to his doctor to discuss options. If you aren't confident with the doctor, then ask to be referred to a specialist. GPs have to deal with hundreds of different diseases, they can't be expert on all of them. Many GPs only know the basics of diabetes - which is a very complex condition - so you could well be better off with a specialist (and you have a right to demand one - don't feel shy about this - remember it is your right).

In the meantime, you could probably help a lot by making fairly major changes to diet. I know that most GPs will recommend a relatively high carbohydrate diet (because that is what the medical textbooks say) but most people find that a low carbohydrate diet is far more effective (and there is a lot of modern research backing this up). Try cutting out bread, cereal, potatoes, pasta and rice, and living off fruit and vegetables, salad, meat and fish. For me the meal that has less impact on blood sugar than anything else is steak with a green salad and red wine (a diabetic diet doesn't have to be all bad :wink: ). For breakfast instead of muesli and fruit (which is quite high carbohydrate) try bacon and eggs - it may not sound like traditional "health food" but it will help get his BG down.

Boyfriend said:

God this is a minefield.

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Please don't panic - you are doing exactly the right thing by learning about diabetes. There is a lot to learn, but it really is worth the effort. Diabetes is pretty much unique amongst serious diseases in that it is possible learn to manage it so well that it doesn't have to have any serious impact upon your life. This isn't an easy thing to do - you have to find a good medical team, and strike right balance between medication and lifestyle, but it is possible and it is something that is well worth striving for. Unfortunately, you may well find that not everyone in the medical profession knows as much about the latest thinking on diabetes as one might hope - and so for that reason each patient really does have to become his or her own expert.

Hi Boyfriend's girlfriend,
The sugar levels do seem to be coming down but 15.6 is still extermely high - more than double what it should be. Unfortunately a test 30 minutes after eating doesn't really help. The best times to test are immediately before meals and, if you do need to test after a meal, then 2 hours after. At 30 mins after eating your body is still busy converting the carbohydrate in the food into sugar, so a test at that point doesn't really tell you anything.

As the sugars are coming down, I would suggest that for a few days you just continue doing what you are doing and check the BG levels before each meal to ensure that the reading are continuing to reduce. If they don't reduce then you need to change what is being eaten by reducing the amount of carbohydrate.

Boyfriend said:

When are the best times to test your BG and also when would you expect them to be high or low i spose that is one big question that i need to understand......otherwise we are just testing willy nilly.

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Absolutely - you need to have a strategy for testing. A fasting test first thing in the morning will give you a very rough idea of how good overall control was the day before. Right now, that is probably the most important thing. Keep a record of these numbers, and hopefully you will quickly see them falling into single figures. If they don't, then your boyfriend will need to hassle his GP to get his medication sorted out.

The tests before and after meals are useful to see what effect those particular meals have. That will help you work out details of the diet. After eating BG shoots up (in both diabetics and non-diabetics) - that isn't a problem, the important thing is how quickly it comes down again. With diabetes management the trick is to find meals that don't send BG too high and that allow it to come back down again quickly (hence the usual advice to test 2 hours after eating). It is worth doing this to learn how various combinations of foods affect your boyfriend, because everyone is different. Advice like "avoid carbohydrates" is good general advice, but ultimately you have to work out how they affect him. In the long term when blood sugars are under control and you are fine tuning the diet, it might be a good idea to carry out experiments and plot the BG curve after various combinations of foods and exercise. However, that is not something to worry about at the moment - concentrate on getting those fasting figures down.

Boyfriend said:

Ok Thanks, i am beginning to understand this a little........So first thing in the morning after fasting how should the BG level be low or what?

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The ideal BG reading before breakfast (or pre-prandial as you will sometimes hear a doctor refer to it when they are trying to blind you with their superior knowledge) is below 7 and ideally between 5 and 6 mmol/l. But from the sound of it, your boyfriend has a long way to go before he reaches that level of control. But don't worry about it. You can't bring BG levels down that low in a hurry - it takes time and a lot of trial and error with diet to find out what things are good for his blood sugar levels and what things aren't. Bringing BG levels up from a hypo can be done quickly. Bringing them down to a controllable level takes time.

Boyfriend said:

and then what normally happens after eating does it go up and then level back down again after a couple of hours if you have eaten properly?

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After eating your BG will go up. How much it will go up by and how quickly will depend on how much carb and what type of carb has been eaten. All forms of sugar will raise BG within a couple of minutes. Other forms of carb will raise BG more slowly. The glycaemic index (or GI) of a food tells you how quickly or slowly it will convert to blood sugar - low GI foods convert to sugar slowly (45 mins or more), medium GI foods in 15 to 45 mins and high GI foods generally convert within 15 mins.

Generally the action of the body's insulin will reduce the blood sugar to a more normal range in about 2 hours - but it won't be fully reduced because some carb may still be being converted even after 2 hours. Generally by 3 hours the whole process is complete and BG is back to its normal resting level.

Boyfriend said:

Sorry i must sound like a real dimwit but my boyfriend is a little in denial at the moment so i am trying to guide him as much as i can without trying to be overbearing.x

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On the contrary - your boyfriend is a very lucky guy to have someone who cares for him as much as you obviously do. He is probably a bit confused by it all but you do need to try to get him out of denial. Problem is that its easy for him while you are doing all the worrying and research for him - he can just pretend it doesn't apply to him! Unfortunately its a familiar path that many of have trodden and years later come to regret it. Its a bit late when you have just had a foot amputated or gone blind to start thinking "I wonder if I should have listened to what they were telling me!".

Just 2 things to remember:
1. You can control diabetes - if you let it control you then it will always win.
2. Remember we are here for you so ask whatever you are not sure of. Being able to help each other is why we all participate in this forum.

Boyfriend said:

last night he tested at 10.6 before his meal and 12.3 just over two hours later. This morning he was 11.4, so it is still high but a great improvement on the day before.

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Looks like you are getting on top of this - keep an eye on it, but hopefully the BG will carry on coming down. Then your boyfriends symptoms should abate, and you can concentrate on fine-tuning the diet and developing a sustainable healthy lifestyle.

Boyfriend said:

hopefully we will begin to see a pattern.

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Absolutely, it is all about spotting patterns in the figures.

Boyfriend said:

well blow me but my result came out at 7.6(from what i have read on here that is quite high for a non-diabetic.....is that true?)

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If this was a fasting test, then that would be very high for a non-diabetic. However, the BG of "normal" people can go much higher than this after a meal - the problem with diabetes is the lack of an effective insulin response makes it much slower to come down again. A figure of 7.6 after eating a lot of chocolate sounds perfectly normal to me! If you are at all concerned, then try a fasting test. If your fasting BG is over 7 on more than one occasion, then you should go to see a doctor and get a "proper" test done. BTW although fingerprick tests are useful for monitoring BG control, they should never be used to diagnose diabetes - they are too inaccurate and there is too much that can go wrong. Diabetes is diagnosed in a lab, using blood samples drawn directly from a vein - and that needs to be done by a doctor or nurse.

Boyfriend said:

Are you saying then that it is better to test his BG 3hours after a meal rather than 2 to get a truer reading?

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It is not a question of getting a single "true" reading. BG is constantly changing over time, and the important thing is the patterns of that change. After a meal, BG will rise rapidly and then fall back to where you started. To some extent it matters how far it rises, but it is much more important how quickly it drops back. Typically, 1 hour after a meal the BG will be close to its peak and 2 hours after a meal it will be back somewhere close to where it started. However, the types of food, combinations of food and other factors such as exercise and medication can make a big difference. With some meals it can be back down in barely over an hour, others can take four or five hours. If you really want to see what is going on, then you need to take a series of measurements and plot the changes on a graph (the area underneath the curve on the graph is the best measure of the impact that a meal has had). However, you get through a lot of strips like that, and although that sort of experiment might be useful for fine tuning a diet, it isn't something that you should be doing right now. If you are doing a single measurement after a meal then 2 hours is probably the best time to do it - that will typically give you a rough idea of how large a glucose hit you have taken from the meal.