Confused by testing, what exactly am i looking for?

Hello there,

I know this is an incredibly long post. I apologise.

I live in France. Blood tests about 10 years ago marked me as 'insulin resistant' and i was diagnosed T2 about 6 years ago. Had a bad experience with Metformin and was prescribed Gliclazide 2 x 30mg, per day, which i have never taken.... I must admit, there is a language problem, because although i speak relatively good French, I cant always be sure the endocrinologist has understood me, or that i have 100% understood her, which makes it difficult to ask questions. SO, i did the worst possible thing and googled it....

So i read that Gliclazide INCREASES the amount of insulin my body produces, but i think that i have insulin, my body is just not using it efficiently.

I was concerned that the drug would cause weight GAIN OR that it would lower my blood sugar too much and i would be MORE fatigued or would suffer more acute diarrhea and more headaches..
.
The dietician told me that if i were to lose 20 kilos, the problem would most likely go away, so last year, we discussed the possibility of controlling it by diet and exercise. So, although she STILL advised that i should be taking in 1/3 of my daily calories in starchy carbs and should cut down on fat, this did not work for me so I now follow a LCHF diet (in conjunction with intermittent fasting) with a modicum of success. I started on 20g of carbs per day and am now up to about 60g, if i go any higher than that, i stop losing weight, sometimes i even gain. Over the past 7 months I have lost 10 kilos and my HBA1C is now at 6.5%, down from 7.2%. I don't get test strips on prescription so i only test now and again.

I have my annual check up with the diabetes doc. next month and she has asked me to keep a diary in the run up to the visit, with tests up to 6 times per day. Morning Fasting, 2 hours after breakfast, Before lunch, 2 hours after lunch etc.

I am looking at the diary now and the guides and am more confused than ever. What is 'Dawn phenomenon'? No one has explained this or what i should do to counteract it.

Should i be eating breakfast? Since i started the intermittent fasting, i don't eat before mid day or after 8pm. However, my exercise class starts at 8 and its an hour's drive away, so i try and have something before the class, is this ok? It does not seem right to me to fast for 12 hours before doing formal exercise. I tested this morning at 6.45 (8.2mmol) and then had a banana just before starting the class at 8, then i tested after one hour of exercise at 9 and the result was 11.6. at 10am it was 10.7 Are these results normal? My fasting counts for the last 7 days are average. 7.7mmol. I go to this class twice a week and walk every day, and usually manage 9 - 10k steps each day.

I have had some 'experimental' meals, and i can see from the food diary and the testing that there are the things that send my results up. Porridge is too ghastly without full fat milk and a bit of sugar so that's a no no, so I tried weetabix or corn flakes and they are as bad as eachother, without the sugar.! 2 hours after a bowl of cornflakes my count went from 8.4 to 17.7. Fruit is not much better. My first meal of the day, brunch, usually has eggs, tomatoes and mushrooms and the one slice of wholegrain bread i am allowed.

So, can anyone explain, in idiot-proof language, what sort of levels i should be looking at, and how does the exercise thing fit in? And how often SHOULD i test? I am going to ask for test strips on prescription but i am likely to be refused. What sort of questions should i be asking, particularly regarding the medication?

ringi said:

First, remove all sugar from your diet, this includes sugar in fruit as well as added sugar. Then reduce most carbs.

Your levels 2hr after starting to eat a meal should be no more than 2 over what they were before the meal. You only care about the INCREASE in the BG due to the meal, not what the absolute levels are. That way you can take life "one meal at a time".

@daisy1 will post the standard information on carbs for you if she had not already done so.

I stopped eating ALL bread, cereals, porridge etc and replaced them with lots of meat, fish and above ground veg (mostly green) along with a little olive oil or butter on the veg. This got my diabetes under control within a few weeks.

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Thank you for your speedy reply. I started out LC eating less than 20g carb per day, i had cut out all cereals, sugar, cake biscuits etc and went cold turkey on bread, pasta, rice, potatoes, root veg etc. and eating lots more protein. After about 3 months, i started to introduce carbs gradually, and am now around 60g per day. But i still find that i have to cut out almost all fruit. Why do the 'health experts' still insist that i eat more fruit, and include pasta and potatoes and porridge, muesli etc in my diet when i know that these will send my BS high? When i show the diabetes nurse the diary, i get a sort of gallic shrug, suggesting that if i dont follow their advice, then its all my own fault!

Bluetit1802 said:

What your doctor has asked you to do in the run up to your appointment is wise and sensible. Testing before and 2 hours after eating is done to help you find the foods that your body can cope with. We all have different tolerance levels, so you need to find yours. Your food diary needs to include all ingredients of the meal and portion sizes of the carbs. Test before then 2 hours after first bite. If you do anything within that 2 hours, write that down. Record your levels alongside and concentrate on getting any rise from before to after as low as you can. You can do this by reducing portion sizes or eliminating things. Patterns will emerge and you will soon learn which foods and in what amounts your body copes with, and which it doesn't. You have already learned that Cornflakes and fruit are best left off your menu.

As for the dawn phenomenon, until your insulin resistance improves a lot there isn't a great deal you can do about it. Some people use a small amount of protein or fat without any carbs at all (such as a piece of cheese or a coffee with cream) as soon as they get up to try and stop it, others just ride it out. Carbs will not help and will hinder.

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Thanks.

Te be fair, when i started all the extra testing, i got curious about what it was that was sending my blood sugar levels up and began to experiment with foods i had removed from my diet, ie the bread, the cornflakes, or the banana. I did not expect to see such wild fluctuations.

I started Low Carb on a max of 20g carbs per day, after 3 months i increased it a little and after another 3 months, increased again etc. I have found that at around 60g carbs per day is about the maximum i can tolerate. Almost all fruit sends the count up more than 2 but the 'health experts' are telling me to eat more fruit, more potatoes and more porridge!

Resurgam said:

I find that my BG levels are steadier if I eat early and late, with most carbs in the evening, but some in the morning - none is not good at all, nor is half a day's worth at each meal.
You can test to see what timetable is best for you, and how you react to longer or shorter fasting - early or late carbs etc.
Once you settle on a way to eat then the testing can be reduced down as you should only see improvements as long as you stick to the foods you know you can eat.
I have not eaten sugary or very starchy foods for over a year and have been in the normal ranges for over half that time now.

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The Atkins diet seemed to be the only one which worked for me as a weight loss tool and coincidentally, it appears to be the healthy option for T2 diabetes . I have adapted it to suit me and i have had a steady weight loss for the last 9 months, about a kilo per month. I now combine the Low Carb with the 16 hour intermittent fast and as an eating pattern, it seems to suit me. From what i have read, it is not essential that i have breakfast before i exercise, so that will stop. Even though the dietician will give me a shrug and tell me i have myself to blame and that I must eat more fruit, more cereal, more complex carbs and not skip breakfast etc etc. Since starting this testing regime, i am much more aware of which foods i can tolerate and which i cant. .

ringi said:

Lots of people find that a 10-minute walk after a meal (and/or just before) has a benefit on BG levels much greater then they would expect from the little effort required.

Recent studies have shown that hard exercise has few benefits, but that not sitting down for more the 1hr at a time has great benefit. So standing up every hour (when not sleeping) and walking to the window to look outside has more benefit, then going to the gym for a 2hr hard workout one or two times a week.

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That i did not know, so lots of small walks then!

sally and james said:

@aseret Can I suggest that you have a good, long look at the Diet Doctor site, https://www.dietdoctor.com/low-carb to gain a really good understanding of what Low Carb really is. You mention various breakfast cereals, bread, bananas and other fruits, none of which should be part of a Low Carb diet for a T2 diabetic.
Wether you eat breakfast or not is up to you. There are some who say that sporting achievements are better during a fast.
The point of testing is to find out what foods you should/shouldn't be eating. Often people are only truly convinced that some, so called health food is in fact hastening their demise when they see the numbers on a screen. Test immediately before your meal and then two hours later. If the rise is more that 2mmol/L, that meal, or something in it, wasn't suitable. Once you understand what you can and can't eat, testing, in my view, is only necessary for very occasional reasurance.
The basic levels you should be looking for is something in the 4's and 5's before a meal and under 8, though preferably lower, after a meal. Dawn phenomena is a rise in blood sugars first thing in the morning to get you going. It is beyond your control, though as you begin to reduce overall sugar levels, it often becomes less pronounced.
Concentrate on avoiding carbs, personally I would recommend a maximum of 30gram per day coming from vegetables and other incidentals, no bread or weetabix etc.
Exercise, while a good thing, does not make a significant overall difference to blood sugars or weight. Remember, you can't out run a bad diet, it's what you put in your mouth that matters.
Sally

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From what i have now gleaned, breakfast is not the most important meal of the day after all! I will go back to intermittent fasting and LCHF and to about 30 - 40g carbs per day. I had cut out all bread, pasta Rice, potatoes, sugar and cereals and i think that is why my levels had improved.
The 'breakfasts' i mentioned in my first post were not really part of the LCHF diet, when i started all this extra testing, i began to 'introduce' stuff more out of curiosity to see what happened to my blood sugars. Especially as the dietician told me not to skip breakfast, eat more fruit, meuesli, cereals, and more complex carbs. None of which seems to be good for my levels. I started LC on max 20g carbs per day, after a few months i increased it gradually, about 60g seems to be the max i can tolerate and still keep the blood results stable.

walnut_face said:

@aseret, you don't say where in France you are. The diet in Lille is very different from that of say Toulouse!
As far as Blood sugar levels go https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html
If you can better those, without suffering hypos, go for it!
I often exercise (5km run and weights) before my first food of the day. I would say that a banana is not good for your blood sugars. As for your breakfast, I would suggest leave the bread out, have a 95% pork sausage instead (if your life choices allow)
From your own testing you have found out that cornflakes are not good. Testing is the best way of adjusting YOUR diet to YOUR (blood sugar) needs

HTH

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I am in rural south west france, certainly nearer Toulouse than Lille! The advice on here is much more helpful than that given by my 'health experts' but i suspect when they read my diary, they will shrug and tell me that its my own fault for not following their advice, not eating more complex carbs, eating too much fat and protein and skipping breakfast!

sally and james said:

@aseret Can I suggest that you have a good, long look at the Diet Doctor site, https://www.dietdoctor.com/low-carb to gain a really good understanding of what Low Carb really is. You mention various breakfast cereals, bread, bananas and other fruits, none of which should be part of a Low Carb diet for a T2 diabetic.
Wether you eat breakfast or not is up to you. There are some who say that sporting achievements are better during a fast.
The point of testing is to find out what foods you should/shouldn't be eating. Often people are only truly convinced that some, so called health food is in fact hastening their demise when they see the numbers on a screen. Test immediately before your meal and then two hours later. If the rise is more that 2mmol/L, that meal, or something in it, wasn't suitable. Once you understand what you can and can't eat, testing, in my view, is only necessary for very occasional reasurance.
The basic levels you should be looking for is something in the 4's and 5's before a meal and under 8, though preferably lower, after a meal. Dawn phenomena is a rise in blood sugars first thing in the morning to get you going. It is beyond your control, though as you begin to reduce overall sugar levels, it often becomes less pronounced.
Concentrate on avoiding carbs, personally I would recommend a maximum of 30gram per day coming from vegetables and other incidentals, no bread or weetabix etc.
Exercise, while a good thing, does not make a significant overall difference to blood sugars or weight. Remember, you can't out run a bad diet, it's what you put in your mouth that matters.
Sally

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I have a good understanding of Low Carb dieting, have read the diet doctor site you suggest and have followed it (basically adapted Atkins diet) for some time. My blood sugar level has dropped and stabilised and i have lost weight BUT it does not appear to be compatible with the information i am being given by the dietician, who is attached to my diabetic clinic. They keep telling me not to skip breakfast, to eat more fruit, more cereal, more complex carbs like cereals, whole bread, potatoes etc. I only started to introduce porridge and weetabix and bananas when i started this testing regime, more out of curiosity, and this is where my confusion stems from. The very foods they suggest i eat send my BS readings way above the acceptable increase 2 hours after eating. I have my annual check up in a couple of weeks. They will see my diary and tell me I am doing it 'all wrong'.

Resurgam said:

My absolute limit these days is 60 gm of carbs a day or I put on weight - which is about the limit many type twos report for similar results to mine for their BG levels - so many I begin to think that it is a 'normal' amount to eat for those with similar problems to my own.
I could do up to 80 gm with two short intervals of exercise - I used to go out mid morning and mid afternoon every day, either to cycle to the shops or to collect the children from school, or later on I got a trampoline in the garden, which is great fun easy exercise and gentle on the joints, making an excellent and comfortable surface for yoga or stretching as it distorts to support the weight over a larger area than even a foam mat on a hard flat surface.

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Yes, i have found that if i go above 60g carbs per day the weight loss stops and sometimes i even started to gain, my ideal level seems to be about 50g per day. I dont normally test frequently because i dont get the strips on prescription but i am going to ask at my next appointment.