Confused

[debbieinoz]

Hello
I have been reading the forum for some time, but I wonder if you may be able to advise me. I was diagnosed just over one year ago. My levels are quite low I think compared to some, but for me they are significant and mycardiologist is really getting heavy about me reducing BG, cholesterol and triglycerides. My GP on the other hand isn't really doing anything. I am also slightly dismayed to discover that he believes my HB1ac reading of 6.2 is expressed in mmol rather than percentage so he thinks it's fine. I take Metformin 500mg x 1. Despite me reducing my carb intake to under 25g per day for months, for me, my readings are not in control. I was getting readings in the 5s and even 4s but for the last month I normally get something in the high 6s or low 7s first thing in the morning which continue to rise until I have a lateish breakfast. After a couple of hours they drop into the low 6s, but for two days I've not chnaged my eating habits, I'm not ill... but yesterday my fasting number was 9.3 and today it was 7.9. As I'm typing it's still 7.1. On Sunday it was 4.9 and that's how it's been going - it's just not in control, for me. Nothing has changed, I'm not sick, so I wonder if anyone can suggest anything please? Thank you in advance.

 

[debbieinoz]

Metformin 500mg x 1 a day is not doing a lot in lowering your BS. You have to control your sugar levels with a balanced diet.
Loosing weight, eating the right things is your option.

Hi, thank you for answering, I appreciate it. Annoyingly, I don't have much weight to lose. I eat really well I think - I've had no dairy, no wheat, no sugar or sugar alcohols whatsoever, no bread, pasta - in fact zero processed carbohydrates at all. Not even one single bad choice (aka cheat!), in almost three months. I don't eat fruit at all, ever, can't even have lemon juice as it sends my numbers up instantly. I've not eaten a single thing that I haven't prepared and cooked myself. For quite a while my carbs have been down to under 25 per day - that's all from green leafy veg and salads - occasionally a single slice of tomato but never potatoes, no starchy vegetables. So this is the problem I face - I don't know what else I can give up. I'm very active, I'm 66 and on the go all the time dashing around. I'm thinking Metformin maybe isn't doing anything for me, but my doctor is of the opinion that provided I keep my fasting glucose under 8 (and he's delighted with my A1C being 6.2%) then I'm doing really well and he isn't worried that the cardiologist is nagging me to get all my numbers down. Everything was fine until a few weeks ago when I notice my numbers are suddenly all over the place. It's quite a worry.

 

[mfactor]

So it sounds like you are doing all that can be done diet/weight wise , maybe a bit of structured exercise may help, as you need to get your heart rate up for it to help swimming/walking/gym etc ...........

If you do that and its still the same, I see it as you have two choices.........

1) Carry on as is as your readings are still pretty good with just the odd blip.........

2) Up your medication...........



Personally if it were me I would go down the exercise route first, you do say you are active but doing something a bit more taxing could be the answer....

I would go with option 1) until such time as you need to go option 2)



But as said you cant really do much more , your diet is spot on and you are not overweight ...........well done ,

 

[debbieinoz]

You are lucky being able to have so many carbs - I yearn for rice! I can't as my numbers go crazy, likewise all root vegetables and fruit. Just daren't touch them. Luckily I do like green vegetables. Yes, my BS is always up in the mornings, but used to mostly be mid or high 5s. Over the last few weeks they have jumped up to 6s and low 7s, and now to the 9s. I just don't understand it. I thought my HbA1c was pretty ok but the cardiologist says I MUST get it down to 5.5 next time. I just can't find any reason why this is happening hence posting here to see what others might think. I don't want to have to take more Metformin but I can't help wondering if I'm going to have to. If anyone has any bright ideas, I'd be very grateful!

 

[debbieinoz]

So it sounds like you are doing all that can be done diet/weight wise , maybe a bit of structured exercise may help, as you need to get your heart rate up for it to help swimming/walking/gym etc ...........

Hi mfactor - thank you for answering. I was beginning to wonder if I need to up my medication. Don't want to, but... because I am disabled (my joints dislocate all the time) I can't swim or do any other sustained exercise, so keeping on the go and moving on my feet is my only option, hey ho! But thank you for the congrats, I appreciate it!

 

[Hiitsme]

Welcome to the forum
Although you have been diagnosed some time I will tag @daisy1 for her information. It would seem that you are following the advice on this forum but might be worth reading through.
I've not been diagnosed quite as long as you but am same age as you.
I worked on diet, weight loss and exercise.
My BMI was just under 25 at diagnosis but with the change of diet it is now just over 20 so now at lower end of normal. My aim is to keep it there. Also exercise which I did very little before. Now I try to walk 4 or 5 miles each day and I'm sure that helped as well. What I did may not work for you but thought I would share. I have now put more carbs back into my diet but keep a close eye on my blood sugars.

 

[Alzebra]

Maybe your recent jump is due to a minor ailment, a cold or something?? I think a lot of your frustration is coming from the mixed signals between your GP and cardiologist, maybe you could get in touch with the cardiologist's secretary and briefly ouline your concerns to her? Consultants' secretaries are generally very helpful people and she might be able to draft a letter to your GP for the cardiologist to sign, highlighting the need for a reduction in your HbA1c?

Other than that, keep testing and logging your results and if the upward trend continues then you will have evidence to present to the GP. Do you have a diabetes nurse?

 

[Lamont D]

Hi,
Your morning fasting is slightly higher because you may have a reading of what is known as dawn phenomenon. Which means that your liver is preparing you for the day ahead.
This may have started because of losing enough visceral fat (you don't have to be obese!!) to give your liver a chance to work better and your insulin resistance is better.
If you are uncomfortable with more carbs then perseverance in what you are doing, and record everything and see if there is a trend.
Your figures are good and you are still on track to be nearly normal.
A bit of stress can up your bloods up!
Sort it out with your consultant, if you are really concerned.

Hope that helps!

 

[Clivethedrive]

You are lucky being able to have so many carbs - I yearn for rice! I can't as my numbers go crazy, likewise all root vegetables and fruit. Just daren't touch them. Luckily I do like green vegetables. Yes, my BS is always up in the mornings, but used to mostly be mid or high 5s. Over the last few weeks they have jumped up to 6s and low 7s, and now to the 9s. I just don't understand it. I thought my HbA1c was pretty ok but the cardiologist says I MUST get it down to 5.5 next time. I just can't find any reason why this is happening hence posting here to see what others might think. I don't want to have to take more Metformin but I can't help wondering if I'm going to have to. If anyone has any bright ideas, I'd be very grateful!

Hello debbieinoz,essentially you are on the right path, one trick that i have learn't is to use an exercise that kick starts you fat burning processes into overdrive!
7 x 3 minutes intense exercise with 3 minutes break in between each exercise. This set of exercises has been proven to continue burning fat and glucose for the next 24 hrs.clive

 

[daisy1]

@debbieinoz

Hello Debbie As you have been reading the forum for a while, you may well have already seen this. Here is the information we give to new members and I hope you will find it helpful.

BASIC INFORMATION FOR NEW MEMBERS

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

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.

 

[Chook]

Your raised fasting reading really sounds similar to what I am experiencing at the moment. I believe that it's Dawn Phenomenon (also known as Liver Dump) as mentioned above by Nosher8355.

I don't know the answer to it. I have tried splitting my metformin so I take some before bed but that didn't work. I have noticed that my dawn phenomenon reading is much higher if I go to bed with a reading in the low 4s. So tonight I'm going to have a 5g carb snack before going to bed to see if that helps.

There are many threads on this website about it and loads of web pages about it if you Google it.

 

[Catlady19]

You are lucky being able to have so many carbs - I yearn for rice! I can't as my numbers go crazy, likewise all root vegetables and fruit. Just daren't touch them. Luckily I do like green vegetables. Yes, my BS is always up in the mornings, but used to mostly be mid or high 5s. Over the last few weeks they have jumped up to 6s and low 7s, and now to the 9s. I just don't understand it. I thought my HbA1c was pretty ok but the cardiologist says I MUST get it down to 5.5 next time. I just can't find any reason why this is happening hence posting here to see what others might think. I don't want to have to take more Metformin but I can't help wondering if I'm going to have to. If anyone has any bright ideas, I'd be very grateful!

But I think your doctor is correct, 6.2 is a good HbA1c reading. It does make you wonder how much the CARDIOLOGIST understands diabetes, no wonder you are feeling so confused and distressed. From what you have explained of your good diet and problems with exercise I think you may have to get more medication. However, this may lead to you going too low!

Your morning highs do sound like Dawn Phenomenon but don't forget that any slight illness, stress, lack of sleep, etc, etc can raise your readings. I think @Alzebra is right, you may have to contact the cardiologist again.

Hope you get it sorted

 

[mfactor]

Hi mfactor - thank you for answering. I was beginning to wonder if I need to up my medication. Don't want to, but... because I am disabled (my joints dislocate all the time) I can't swim or do any other sustained exercise, so keeping on the go and moving on my feet is my only option, hey ho! But thank you for the congrats, I appreciate it!

No probs , shame you cant do exercise, I would suggest low impact stuff but swimming is fairly low impact
so if you cant do that I would guess everything is out..........

Personally , , your figures are ok , your average is good and your spikes are still only single figures................I would just carry on as you are and monitor, if you start averaging higher then maybe up the metformin , as you are on a low dose as it is...........

jase

 

[mrspuddleduck]

Just a thought @debbieinoz, (triggered by you mentioning the cardiologist) are you on any other medication? Some meds raise blood sugar. Sue xx

 

[Clivethedrive]

Hello debbieinoz,essentially you are on the right path, one trick that i have learn't is to use an exercise that kick starts you fat burning processes into overdrive!
7 x 3 minutes intense exercise with 3 minutes break in between each exercise. This set of exercises has been proven to continue burning fat and glucose for the next 24 hrs.clive

Pardon me, did not see your previous post re your limited movement