Frustrated by advice

The HbA1c is, as you say, a sort of average of the previous 2 to 3 months, weighted towards the last few weeks of that period. Clearly, an average does not show the spikes nor does it show the troughs. Regular spikes can be dangerous and lead to diabetic complications over time, in addition to running high all the time. I think (not sure) that constant spiking to the high 7's and above is considered unacceptable. The odd spikes here and there are less worrying. Even non-diabetics spike after eating carbs (usually at 60 to 90 minutes) but because they have a fully working pancreas, their insulin brings them down to acceptable levels by about 2 hours. Diabetics aren't so lucky, it takes them longer to come down, and the longer it takes, the more dangerous those spikes become. Does that help?

Totto said:

GAD I think it is an antibody to something pancreatic. There are also the islet something antibodies, both can be tested for in pursuit of autoimmune diabetes.
C-peptide is something that pro-insulin leaves behind and is measurable so sometimes used to evaluate insulin production in order to see if you are type two or type one,

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Yes, a GAD test checks for 'GAD' antibodies that kill off islet cells; there are other less common antibodies as well. Also, viruses, pancreatitis and so on can cause islet cell death. The GAD test becomes less reliable after several years of diabetes but the c-peptide test becomes more reliable and reflects the amount of insulin in the blood. If it's high it implies T2 thru insulin resistance. If low it implies a failing pancreas. I'm generalising but these tests are better than the GP's 'guess' if you are doubtful.

You can test as often or as little as you feel he needs. Testing before and after meals will tell you what that meal has done to his levels. Once he has tested exactly the same foods a few times and is satisfied with the results, he can stop testing that particular food. Fasting and bedtime tests will show how he is doing generally and are worth doing for the duration.

Pre-evening meal is usually when we see our lowest readings of the day because our insulin resistance improves as the day progresses, due mainly to being active during the day as opposed to being asleep overnight!

xirles said:

Thanks, that's helpful. Sorry, another question: As he is now following a low carb (50g max) diet, is it necessary to test pre and post each meal? I ask this because when he was poorly controlled and went on metformin the GP here wanted readings morning (when he first got up) and 7pm each evening (probably because in Spain that is before evening meal, I guess).

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The point with testing for most T2 is to find out what can eaten safely. Once you know that you don't really need to test that much.

I know the advice is to test before and two hours after a meal. If you want to be really thorough you, or in your case he, can test hourly or even every half hour until back to baseline when testing something new. Some things seem to linger in the system for quite some time while others give you a proper spike and then wears off quickly. I remember when I tried glass noodles and both one and two hours said 6.something but at four hours I was 7.3. Porridge on the other hand gives me 10-11 at one hour but is down to 6-8 at two hours, lower if I have been working physically.

Hi,

You asked why the spikes are bad.
Have a look at the bloodglucose101 link in my signature.
That whole website is a fantastic sources of info. It's aimed at type 2s and gives excellent detail, drawn from studies, on what and why healthy BG is important.

Yes do get B12 checked again. I think it is a good idea to supplement with B12 and it is more or less impossible to overdose so very safe. I use methylcobalamin as it is said to be easiest for the body to use.

Vitamin D is also a good vitamin this time of year. Lack of vitamin D is very common and can make you very tired and achy. Ask if he get it tested and throw in a thyroid test when you are at it if the GP agrees.

Statins has a lot of unpleasant side effects so it could be them too.