Diabetic Review

[AndBreathe]

The nurse did mention Gliclazide but said as I was on a low carb diet I couldn't have it. I did notice two or three weeks before my test my levels were higher than normal. I had a few hospital tests coming up and a few social events so I put my higher results down to that. I asked the nurse if this could have affected the results but she said the A1c was over 3 months so it wouldn't have affected the results. I am thinking of ordering a home A1c test but not sure how accurate they are but I might do that and test in 3 months, Thanks for you help.

The HbA1c test does give a view over the last 2-3 months, but the levels are heavily influenced by the last 2-4 weeks.

Over time our blood cells die and we cleverly make brand new ones, but they don't die and be replaced to a timetable. We're all different.

If you had a lot going on in the most recent weeks before your test, that COULD have influenced the result, but of course, we have no way of proving it.

Bearing in mind the increase is around 10%, and all tests 50 could be 49 or 51, by rounding up or down, I would urge you to monitor your food, bloods and any symptoms, but try not to worry about it too much over the shorter term. Next test may tell you more.

The foregoing is not medical advice, but what I would try to do in your shoes.

Fingers crossed for you.

 

[timbo_dolman]

Hi @mazza 2

I feel for you and have had to been even more strict with carbs myself. For me it has been stress related . I did only go up to 48 but now being very strict it is coming down again but so hard to stick to. I had got down to 30:s but with my husband's terminal illness and death HbA1c just went up even keeping to same diet. I also wonder if it increases with age.

Definitely stress is a factor , I was keeping very fit and lost weight, but my HbA1c was still quite high and that was no doubt due to family stress. My GP also agreed and it was just a blip.

 

[Mrs T 123]

Hi Everyone,
Just wanted your opinions on my latest diabetic review with my DN. Basically, I've been low carb since diagnosis in 2018. I've never managed to get into non-diabetic numbers but have maintained pre-diabetic numbers. Last year my A1c was 45 but this year it's increased to 50 without any changes in my diet or exercise. I am slightly under-weight and am pretty strict with my diet. My DN seems to think that considering my weight and diet that I need to take Linagliptin as my pancreas function is getting worse. She told me that people who are not overweight tend to go on insulin sooner than those who are not and it's just my body letting me down. I have told her that I will think about taking Linagliptin but I would like another A1c test in 6 months first and decide what to do once I have the results. She was o.k with this but gave me the impression that it would just keep progressing. Does anyone have any ideas what I can do to try and lower my A1c or do you think she is correct? I know our bodies are all different but it's quite disappointing after being so committed to this new lifestyle change for so many years. Thanks all.

I would be surprised too as your numbers imo are good ... but remember with this beast it is not just what we eat ... there are a lot of other factors that can increase our levels too such as stress, lack of sleep, the weather or anything really ...

 

[MattInUSA]

Personally I had my HbA1c at 106 and I was maxed out on Metformin, Actos and Gliclazide. My doctor told me my pancreas was bust and I had to go onto insulin therapy for life. I refused, and joined this site. My HbA1c results since have all been either non diabetic or prediabetic but none above 48.

Congrats! Was weight loss involved or was it purely diet and the small dose of gliclazide? Also, how long was your A1C high?

 

[Oldvatr]

Congrats! Was weight loss involved or was it purely diet and the small dose of gliclazide? Also, how long was your A1C high?

My HbA1c levels prior to my born again moment were diabetic (>50) for around 15 to 20 years (since diagnosis) and when I woke up to the Progressive Nature of the beast ( aka GP referral for insulin therapy at the local hospital) then I started self monitoring, and immediately started LCHF diet. Yes I did lose weight but the transition according to the graphs I drew of my bgl readings was almost linear from day 1 so the weight loss followed the sugar levels, not the other way round. On the way down I did reduce my meds and did not get any serious hypo events, but the joy of (a) seeing my first sub 3.9 mmol/l reading and (b) having to replace my 38" tight fitting jeans for a pair of 32" (currently now 30" waistband) was like rebirth of the old me. I went from nearly 18 stones down to currenty 10 stones, and I remain steadfastly at 10 stones for the last 8 years since taking back control.

I remain LCHF but do not do keto although I did for a while become fat adapted just to try it. I decided to keep a small holding dose of Gliclazide because it gives me more freedom in my food choices which frees up my mind for other things. the Glic also gives my GP the tickbox item that he needs to prescribe me as a T2D on orals with test strips for my meter. it works well as the testing daily keeps me incentivised, and logging my results gies me warning of any carb creep or meds change effects.

I did discover two instances of fraudulent test strips supplied by my pharmacy, and I did discover several things about my medication where it affected glucose levels in ways not shown in the patient data. (i.e Sukkarto is NOT the same as Metformin SR, and was useless for me as it was not dissolving or being absorbed.)

 

[Mimidou]

Definitely stress is a factor , I was keeping very fit and lost weight, but my HbA1c was still quite high and that was no doubt due to family stress. My GP also agreed and it was just a blip.

Loads of underlying medical conditions, such as diabetes, blood pressure etc are stress related.
The more stress we are, the higher it goes up, which is dangerous and can even be fatal.
I'd say stress is a slow killer.
Choose to do yoga, meditation or even going for walks as it can relaxe you and with the right diet, medication or insulin for some, hopefully everyone should stay healthy and happy.

 

[Mrs HJG]

Hi @mazza 2 I would definitely ask to be referred for anti-body testing as you could well be LADA as others have suggested. Rather than paying for further tests maybe pay for a Libre to try for a fortnight, if you can't get the free trial. This will fill in all the blanks between your finger-prick tests and be really informative about what your BG is really doing 24/7.

If the nurse has second-sight to know results of tests you haven't had, she should be in a circus, or give us next week's lottery numbers - I would go over her head back to your GP and say you need to be referred for further testing as 'your research' is pointing you in the LADA direction, and if proven right, you will be entitled to Libre on prescription, and to come under a knowledgeable consultant and specialist team, not just a nurse who read a book about diabetes in the 80s! (oh maybe that was just my surgery DN!). If you turn out to be antibody-negative, then at least you'll know for sure.

If you have been ill, on any other medication and/or particularly stressed these can increase you BG, my sister went from an HbA1c over 100 back to non-diabetic range in 3 months after covid, antibiotics and steroids cleared through her system, your next HbA1c, (if finger-pricking doesn't show a continual increase), will support or refute the recent test.

Good luck getting some more answers.

 

[MattInUSA]

If the nurse has second-sight to know results of tests you haven't had, she should be in a circus, or give us next week's lottery number

Lol!

If you have been ill, on any other medication and/or particularly stressed these can increase you BG, my sister went from an HbA1c over 100 back to non-diabetic range in 3 months after covid, antibiotics and steroids cleared through her system, your next HbA1c, (if finger-pricking doesn't show a continual increase), will support or refute the recent test.

This is a good point. My father went to the ER and was found to have incredibly high glucose. They medicated the heck out of him for diabetes (he was on nothing prior), not even concerned that he seemed to have an infection. My mom and I spent the next six months reducing his medication as he was bottoming out every day. We ended up with only a low dose of Actos, and he's maintaining pre-diabetic numbers despite being very overweight and eating like ****. Whatever drove up his glucose was obviously temporary, most likely driven by the infection that he wasn't even treated for.

I went from nearly 18 stones down to currenty 10 stones, and I remain steadfastly at 10 stones for the last 8 years since taking back control.

That's amazing! I do think weight loss, even if it comes via lowering blood sugar, can clear the pancreas and liver of some fat, which may be why you are tolerating higher carb meals so well. Or maybe you had some beta cell regeneration once you got things under control. Regardless, your outcome is fantastic and long term. I think it's the kind of ending every diabetic strives for.

 

[mazza 2]

Thank you to everyone that has responded to me, Your advice and opinions have been really helpful. I will read through them all again and decide my best course of action. I am testing regularly and so far my levels are o.k. I am using the tee 2 so I'm hoping it's fairly accurate. I was using the accu-chek which was completely out of whack with the A1c result. I had used it for 5 years so maybe it wasn't working properly, I will look into getting a libre as advised just to see what my levels are doing in between finger pricks and get a better over view of my levels. Thanks again, you've been great as always x

 

[diabetic.pt]

Hi Everyone,
Just wanted your opinions on my latest diabetic review with my DN. Basically, I've been low carb since diagnosis in 2018. I've never managed to get into non-diabetic numbers but have maintained pre-diabetic numbers. Last year my A1c was 45 but this year it's increased to 50 without any changes in my diet or exercise. I am slightly under-weight and am pretty strict with my diet. My DN seems to think that considering my weight and diet that I need to take Linagliptin as my pancreas function is getting worse. She told me that people who are not overweight tend to go on insulin sooner than those who are not and it's just my body letting me down. I have told her that I will think about taking Linagliptin but I would like another A1c test in 6 months first and decide what to do once I have the results. She was o.k with this but gave me the impression that it would just keep progressing. Does anyone have any ideas what I can do to try and lower my A1c or do you think she is correct? I know our bodies are all different but it's quite disappointing after being so committed to this new lifestyle change for so many years. Thanks all.

Have you had you antibodies checked? Could be LADA, which often gets mistaken for T2. If so, you need insulin, not pills.

 

[Oldvatr]

Have you had you antibodies checked? Could be LADA, which often gets mistaken for T2. If so, you need insulin, not pills.

A transition from 45 to 50 is only just over the border into diabetes, so is not necesssarily an indication of impending pancreas failure. It is unlikely that a GAD test would show sufficient antibodiy activities at that stage anyway. The problem may still be increased insulin resistance, or some other subtle change within either the diet or lifestyle to produce such a minor change. I would say IMO that it is not a call to arms or insulin at this stage.

 

[ianf0ster]

Thank you to everyone that has responded to me, Your advice and opinions have been really helpful. I will read through them all again and decide my best course of action. I am testing regularly and so far my levels are o.k. I am using the tee 2 so I'm hoping it's fairly accurate. I was using the accu-chek which was completely out of whack with the A1c result. I had used it for 5 years so maybe it wasn't working properly, I will look into getting a libre as advised just to see what my levels are doing in between finger pricks and get a better over view of my levels. Thanks again, you've been great as always x

I have no personal experience, but have been told that CGM's are usually a little less accurate than a finger-prick BG Monitor. But they are very useful for seeing trends and what is happening overnight and between meals.

Edited to correct typo.

 

[Glucobabu]

Morning numbers range from 5.8 to 6.7. So today fasting number: 6.7 on waking pre breakfast 7.3 2 hours later: 7.5. Pre lunch 6.5 2 hours later 6.3
Pre dinner 6.2 and 2 hours later 7. Before bed 6.4. Thanks

Looking at your BG levels and your diet I feel you are dealing with your diabetes in a very competent manner and you should be proud of it, though I am also baffled about your HbA1c results.

 

[Oldvatr]

Thank you to everyone that has responded to me, Your advice and opinions have been really helpful. I will read through them all again and decide my best course of action. I am testing regularly and so far my levels are o.k. I am using the tee 2 so I'm hoping it's fairly accurate. I was using the accu-chek which was completely out of whack with the A1c result. I had used it for 5 years so maybe it wasn't working properly, I will look into getting a libre as advised just to see what my levels are doing in between finger pricks and get a better over view of my levels. Thanks again, you've been great as always x

In days gone by, glucometers were calibrated for what was termed Whole Blood. then it changed and all modern meters are calibrated to what is termed Plasma levels. the difference is between 10 and 15 % lower for whole blood compared to meter readings today. The diabetic guideline advice levels did not change.

Here is a technical treatise on glucometer accuracy - it is a bit out of date, but discusses confounders that can affect bgl readings at home.

Variability of capillary blood glucose monitoring measured on home glucose monitoring devices

Self monitoring of blood glucose helps achieve glycemic goals. Glucometers must be accurate. Many variables affect blood glucose levels. Factors are analytical variables (intrinsic to glucometer and glucose strips) and pre analytical related to patients. ...

www.ncbi.nlm.nih.gov

 

[Oldvatr]

I have no personal experience, but have been told that CCG's are usually a little less accurate than a finger-prick BG Monitor. But they are very useful for seeing trends and what is happening overnight and between meals.

Is your CCG my CGM?

 

[mazza 2]

Looking at your BG levels and your diet I feel you are dealing with your diabetes in a very competent manner and you should be proud of it, though I am also baffled about your HbA1c results.

Exactly Glucobabu, that's why the DN assumes my pancreas is failing. I don't know if she is correct but I think a test in 3 months would be sensible before I make any decisions about taking more medication. Hopefully, it will go down, fingers crossed. Thanks

 

[AnnRob]

Thank you to everyone that has responded to me, Your advice and opinions have been really helpful. I will read through them all again and decide my best course of action. I am testing regularly and so far my levels are o.k. I am using the tee 2 so I'm hoping it's fairly accurate. I was using the accu-chek which was completely out of whack with the A1c result. I had used it for 5 years so maybe it wasn't working properly, I will look into getting a libre as advised just to see what my levels are doing in between finger pricks and get a better over view of my levels. Thanks again, you've been great as always x

I’ve just read this thread with interest being a T2 following a low carb diet. I’m stubbornly in the pre-d range and I was curious to know why. I got a Libre on their free trial which I found helped. If you prepare for the two week trial you can get the best out of the device. Try to find a fortnight which is “normal” for you before you attach it. Make sure you take the readings at all the appropriate times during the day and even at night if you can.
You haven’t mentioned what you drink during the day. I drink a lot of coffee. The Libre showed me that the milk I was consuming from the coffees was keeping my BG, fairly level, but too high. Coffee with cream wasn’t much better. Black coffee is fine and is not much of an adjustment to adapt to.
I then decided if the food was fairly under control I must need more exercise. I chose running (if you knew me you would know that is faintly ridiculous). I started with a park run on a Saturday morning. Now some 9 months later I still can’t run the whole 5k but it’s a work in progress. I found once a week was not enough so I found a local, friendly running group who meet on Wednesday’s. The combination of this “difficult” exercise had a beneficial effect on my Libre graphs (I now buy them and use just occasionally, especially when life is not “normal”. I know it’s £50 a time but health is important.
If you do give these two ideas a try it would be good to get your feedback.