Diagnosed 2m, confused by low BS results.

[Kingmob]

Been lurking for last few months, this site has been an amazing resource that has really helped me understand and make positive changes. Have an follow-up with practice nurse on Wednesday, self-testing suggests changes I've made are helping with control but worried that I've misinterpreted results and setting myself up for disappointment.

I was diagnosed T2 at end of July after a re-occurrence of a leg infection from 4-5 years ago, hba1c at diagnosis was 108. Doctor put me on 2*500mg metformin and ramipril for high blood pressure, passed me off to practice nurse who has been helpful but advised against self-testing and even self-monitoring of BP. Been testing 3-5 times a day and concerned I'm misinterpreting my results, since the start of September results have averaged 5.2 daily with high and lows for individual readings between 4.5 and 6. Test after fasting and before lunch/dinner and around 90-120 minutes later. Compared both a codefree and accuchek nano to ensure meter wasn't issue. Is such an improvement feasible? What should I expect hba1c to be, my understanding is blood cells last for 12 or more weeks so will recent results be noticeable?

Some background. I cut out alcohol 4-5 months ago, been walking 6-7 miles a day and been working on making changes to lifestyle since start of year to help with weight loss. Unsure of starting weight, was 390lb early-august, 350lb now. Eating about 1700 cals a day, cut carbs to less than 100g but haven't tried LCHF yet. Was told BP was extremely high but with exception of check at time of diagnosis has been around 130/80. Mentally and physically I feel a lot better than I did 3 months ago.

Doctor generally uninvolved, keeps requesting blood/BP tests for monitoring but not providing feedback. Given blood 4-5 times since diagnosis, ring to check results and told "Ok". Attended DESMOND course two weeks ago and they had diagnosis results, asked about subsequent tests, they tried but couldn't get anything since diagnosis. Practice nurse has been helpful but sticks to NHS recommendations. Found desmond course to be a mixed bag, diet advice seemed suspect and surprised when asked if anyone self-tested then instructors seemed unhappy when two people said yes and spent some time telling other attendees why this was a bad idea.

 

[Bluetit1802]

Hi and welcome,

It sounds to me like you are doing extremely well indeed. You know what your current levels are, no matter what your HbA1c says, and your own readings are brilliant. Everyone has different lifespans for red blood cells. The standard used in the HbA1c is 120 days, but not everyone falls in that bracket. Some have cells that are replaced earlier than that, and others have very long lived ones. No real way of telling where you are. Fingers crossed the HbA1c will be very favourable to you.

If you are seeing levels between 4.6 and 6.0 at various times of the day, before and after eating, there is no reason to believe you are misinterpreting them. We can expect an odd rogue reading here and there, but if your trend has been stable or dropping, all is well.

One piece of advice - at every single blood test, ask for a print out of the results. You need to know. You could ring the surgery and ask for them all, from each test done since diagnosis. It isn't just the blood glucose ones that are important. The cholesterol, lipids, liver & kidney functions and full blood counts are equally important for us. You will be having regular tests, probably forever, so having them all in black and white enables you to compare them, see improvements, and watch for deterioration. I NEVER believe doctors or nurses when they say "OK" or "fine". What does this mean? Nothing at all. What they consider fine may not be. It maybe within the normal range, but teetering on the edge of not being. It may be deteriorating. Will they notice? No, not until your results become abnormal, and then it is too late. If you are in England you could also ask if your surgery puts tests results on-line as they are supposed to do, and how to register for this.

Good luck with your nurse, and let us know how you go on.

 

[Alison Campbell]

Hi @Kingmob welcome to the forum, no one will be able to predict you HBA1C because the blood cells replenish at different rates. Mine are always a lot lower than I expect.

It sounds as if you have made some amazing life changes since diagnosis and I would be really suprised if you don't get some good news from your new tests.

This is a long game so we often have to adapt and tweak things dependent on the results. Less than 100g of carbs is definately LC to me.

Does you GP practice give online access to test results. Mine does once I signed up with a photo ID shown for proof and I often see my results online within hours/days of tests and usually weeks before appointments to discuss the results are available. This reduces the stress associated with waiting about 100% for me.

 

[Bluetit1802]

I should have added that my HbA1c results are ALWAYS significantly higher than my other measuring methods (finger pricks and Libre sensor readings) I have given up worrying about it because I have to conclude my red cells are long lived, so my blood is full of old cells and not many new (clean) ones!

 

[AM1874]

Hi @Kingmob .. and welcome
I guess that you are pretty familiar by now with much of the info on the forum .. and you have already taken a number of positive steps. You also seem to have received the sort of "advice" from your doc that, sadly, many folk here experience. It can all seem uphill to start with but, in my experience, it gets easier .. very quickly. So ask your questions and be assured that you will receive the answers that you need.

The key point to take on board now is that managing and controlling your diabetes through exercise, diet and testing your blood glucose seems to be the best way forward for many people. For me, committing to an LCHF (Low Carb High Fat) lifestyle and testing 3-5 times a day seems to be working and you'll find that there is a wealth of info, relevant advice and positive support about LCHF on the forum ..

You have probably seen the info from @daisy1 but, just in case, I have tagged her for you and I suggest that you read up on the info that she will soon be sending to you. I would recommend that you consider LCHF and I think that you will find the discussion on the Low Carb Diet forum helpful .. together with the following Diet Doctor websites, which will give you all the info that you need on what and what not to eat ...
Low Carb Intro and Information and Low Carbs in 60 Seconds

I'm not sure why you are concerned about your blood sugar readings .. they seem fine to me. I'm also testing 4 or 5 times a day, before meals and two hours afterwards .. this enables me to monitor trends over time and to check which (if any) foods give me "spikes" .. and my numbers are pretty similar to yours. To keep things on track, I record everything manually on a simple set of spreadsheets, namely:
# a food-carb list of everything that I eat in a day (carb values listed for range of foods)
# a BP monitoring log
# a daily exercise chart with calories burnt for: golf, kms walked, kms on exercise bike

It seems as though you already have a test meter but, if not, or you are considering a change, the following websites might help:
https://homehealth-uk.com/product-category/blood-glucose/
for the SD Codefree meter, which costs £12.98 or:
http://spirit-healthcare.co.uk/product/tee2-blood-glucose-meter/
who distribute the TEE 2 meter, which is free.
I have both which I alternate for comparative purposes and I have never found any significant difference between them.

Make sure that you tick the appropriate box on the on-line order form and you won't pay VAT on your meter or strips.
For the SD Codefree, the strips are £7.69 for a pack of 50 and there are discount codes available for bulk purchases:
5 packs x 50 use code: 264086 .. cost is £29.49
10 packs x 50 use code: 975833 .. cost is £58.98
For the TEE 2, the strips are £7.75 for a pack of 50 .. but there are no discount codes currently available

Back to the "advice" that you have received .. I have developed a useful little mantra that I employ whenever I am getting the same sort of stuff from my HCPs ..
# Listen
# Nod
# Smile and say thankyou
# Ignore

Hope this helps

 

[Guzzler]

Well done on lowering your bg and the weight loss. Giving up the booze will, on its own, have made a big difference as will the rise in excercise. Sometimes the NHS advice seems counter intuitive, that is because it is thirty years behind the times and subject to the costs involved. You already know what has made a difference and how that has improved your well being so keep trusting your intuition, you're doing well.

 

[bulkbiker]

Doctor generally uninvolved, keeps requesting blood/BP tests for monitoring but not providing feedback. Given blood 4-5 times since diagnosis, ring to check results and told "Ok". Attended DESMOND course two weeks ago and they had diagnosis results, asked about subsequent tests, they tried but couldn't get anything since diagnosis. Practice nurse has been helpful but sticks to NHS recommendations. Found desmond course to be a mixed bag, diet advice seemed suspect and surprised when asked if anyone self-tested then instructors seemed unhappy when two people said yes and spent some time telling other attendees why this was a bad idea.

If you are in England you can try to register for the online test results then you will be able to see for yourself what your actual readings have been and we can help you out. As @Bluetit1802 says you need those numbers really.. but if you are seeing 4-7 on your finger prick tests then yes your HbA1c should be a lot lower than when you were diagnosed and you're doing really well even without medical help. I'm afraid that a lot of us have had to do the same.

 

[Kingmob]

Thanks everyone for the replies, feel more confident now.

I plan to ask for copies of test results when I go to see the practice nurse on Wednesday, have some concerns that the various groups in the practice don't seem to be communicating and no-one seems aware of all of the tests done recently. I'll inquire about online access but even getting online access to prescriptions (or changing contact number) has been a huge pain. Currently I have access for prescriptions but can't see or request anything.

Been reading up on LCHF and what I have been doing is in that direction although been replacing carbs with a mix of fat and protein. Focusing on gradual changes to ensure I can stick with it. Being consistent with things such as logging on MFP and pre-preparing meals have been key for me.

 

[Alison Campbell]

As you can see we love questions so feel free to ask as many as you like. Also please let us know how you get on with your results.

 

[daisy1]

@Kingmob

Hello Kingmob and welcome to the Forum Here, in case you haven't already read this, is the Basic Information we give to new members and I hope you will find it useful. Ask more questions when you need to and someone will help.



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 250,000 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

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.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

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.

Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.

 

[SimonCrox]

Brilliant news about the improved lifestyle and consequent improvement in glucose levels.
If people measure theri blood pressure properly (upper arm device apporved by British Hypertension SOciety), then the results are really useful, particularly compared to a single BP reading in a rushed clinic. There is good evidence that if folk are involved with their BP treatment, that the outcomes are better.
I cannot understand why the nurse said not to bother testing your BP
Cutting out the alcohol will decrease your BP; each kilo of weight lost drops BP about 1mm systolic
Best wishes

 

[Kingmob]

I've been monitoring BP with an Omron meter since diagnosis, never seen it over 140/90 generally it's around 130/80. Hoping to see it drop lower as I continue to lose weight and improve my general fitness. My pre-diagnosis doctor (retired now) mentioned my high BP every visit and then seemed surprised when he checked and it wasn't. I've monitored for a few months every time that happened and never saw results overs 140/90.

Found it useful to speak to the nurse but glad to have the information available here. Advice closely aligned to what I've read other people here say are the NHS guidelines with anxiety/accuracy/understanding results given as reasons not to test. Desmond described as being a fantastic resource, was good to meet other people in same situation and understand it needs to be accessible to all but surprised that focus was on cutting fat and light on information about control.