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It happened to me, I think.

D

Davidmaxwaterman

Newbie
Messages
4
Type of diabetes
Type 2
Treatment type
Diet only
A couple of years ago I had a colonoscopy/endoscopy op, and blood tests (HbA1c) associated with that caused the doctor to suggest I might have prediabetes. I obtained the blood glucose test equipment and started testing daily, but it was always pretty much in a normal range...though, I do now wonder what exactly that range is, since different web sites suggest different numbers - AMA* and this one are the ones that come to mind. Anyway, since it always seemed normal, I stopped measuring it. To be honest, I've kind of forgotten what the measurements were then...

Anyway, I had a check-up again a couple of weeks ago and it included another HbA1c test, which again caused the doctor to be concerned, and he suggested I now did actually have diabetes. However, in the prior month or so to the test, I did have a notably poor diet, so I wondered if it was just a reflection of that. I've since seen a specialist and she put me on some medication (Glucophage) to help, and instructed me to cut out all added sugar, increase my daily exercise, and monitor my blood glucose again; and to return in a month to discuss a plan. She also added some medication I'm on for hypertension (in addition to some I'm already on), though I'm not sure that's directly related.

Since I saw that doctor, I've been monitoring the blood glucose as soon as I've gotten up in the morning, which I think is called a 'fasting' measurement. It's usually been 5.X mmol/L or so, with one at 4.9 mmol/L and another at 6.0 mmol/L. The app I use (MedM) suggests they're all normal.

However, yesterday, I decided to take some blood glucose readings ~2hr after my lunch. Yesterday, it was 5.6 mmol/L, so kind of normal. But today, was 9.6 mmol/L. Yesterday, my lunch was cauliflower and mushrooms (fried), baked potato and poached egg. Today, it was a bought salad - prawns and avocado were the main ingredients, with lots of greens, and brown rice. I also had a couple of spoon fulls of blueberries (defrosted from frozen), and a coffee (latte with full fat milk)....and I had a timer on my watch set for 2 hours at the beginning of the meal. So, I could imagine the blueberries and coffee might account for the increased reading, along with the not-quite-2hours before taking the measurement.

My wife said it has to be 2 hours from the end of the meal, and no fruit with the meal (ie as pudding), until I take a reading; but I looked it up and the advice is different on different web sites. AMA* says 1-2 hours from the beginning of the meal, and this site says 2 hours from the end. I presume it doesn't matter all that much, but better to be consistent...and also better to do what the wife says(!) just to keep the stress levels (and blood pressure down). It is disconcerting that the advice is different in each place I look :/

Also, it seems like 9.6 mmol/L might be high, but the MedM app suggests it is still in 'normal' range, and it seems to be using the AMA's numbers. Annoyingly, they seem to use different units too, so I need to convert my 9.6mmol/L to mg/dL...but converting seemed to confirm it was considered normal, albeit at the high end. This site, however, says I should be aiming for under 8.5mmol/L for "At least 90 minutes after meals (post prandial)"...so I am higher than that; though the diagnosis is "11.1 mmol/l"....I don't think I've ever been that high (maybe I can find the test results).

I don't really know what I'm trying to say, actually...or exactly why I'm here. I guess I don't get much support or empathy from my wife so that's why I'm here. She does give me instructions and is quite strict with it, so that's surely a good thing.

There is a web page somewhere (lost it now) which says how much of a shock it can be to get such a diagnosis and even to measure a high blood glucose reading; also, depressing. Maybe that is me.

Any thoughts or advice?

Max.

[EDIT: I meant ADA, not AMA]
 
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Hi @Davidmaxwaterman - I feel your pain - there is so much to take in and so much information, much of it contrary...

And, it's hugely difficult to pin down what normal is, because we are all totally unique in this regard, and the body is hugely complex.

Couple of simple things though - measuring blood glucose as a snapshot makes things very difficult to get to grips with what is actually going on in those critical couple of hours after eating - do you have any thoughts about using a continuous monitor? There are often free trial periods, or some will self fund, or you could try persuading your GP to prescribe, but even using on for it's two week lifespan will tell you a lot.

Second - the raise in blood glucose is almost all down to your body reacting to the sugars and starches in the food. (actually, it's much more than that, but for now, this is fine). Starches break down quickly to sugars (why a piece of potato on your tongue can taste sweet) and then that goes straight to your liver.

For this reason, many on this forum (and I'm one) have had success lowering blood glucose by simply recognising the sugary and starchy foods and paring them back as much as possible (what is possible will vary). Ie, from what you said, I personally would struggle with a baked potato or rice of any type or quantity.

The numbers you quote really are pretty close to normal though - with small changes you should see large improvements ..
Hope that helps.
 
Hi and welcome. The test that's usually used for diagnostic purposes is the HbA1c test. It uses mmol/mol as units (the older unit was a percentage figure) and the "normal" range is clustered around 38mmol/mol - have a look at the attached graph which shows HbA1c results for a non-diabetic population.


You'll see that almost everyone falls into a range of 34 to 42. A few years ago there was international agreement to automatically diagnose Type 2 diabetes at a level of above 48 mmol/mol: nothing to stop a diagnosis being made sooner, but in the UK practically all diagnosis is now done only on the test. So if your HbA1c is confirmed as >48 you will get a diagnosis of Type 2 diabetes. Do you know what your last HbA1c was?

Your fingerprick (mmol/litre) readings are therefore not all that relevant as far as diagnosis goes. They're a snapshot of how you dealt with the food recently eaten, and also perhaps stress, illness, exercise, ambient temperature and a host of other things that can cause your liver to add glucose to your system. The UK arrangements do allow for diagnosis of T2 at 11.1mmol/l in someone with typical symptoms of diabetes (Bilous and Donnelly, Handbook of Diabetes). You don't say whether you have any symptoms - maybe not? In any case I don't know of anyone who has been diagnosed in that way.

Whether it's two hours from starting or two hours from finishing doesn't (IMO) matter all that much as long as you're consistent. Apply common sense - you establish a baseline and then test again for the effect. It will be different if your meal lasts ten minutes or two hours. What you're looking for is to work out how well your system handles the food you're putting in. If you haven't finished putting food in, at the point of the second test, you may get a skewed response. Peak BG will probably be somewhere around 40-45 minutes after eating - but you're not looking for that.

My preference is to test two hours from the initial test. However if the meal is one of those that goes on, I'll maybe do an extra test or tests.

The good news is that it's relatively simple to reduce your starch and sugar intake and take the stress off your system. It worked really quickly for me. If you have a read of the "Success Stories" section of the forum you'll see what can be done. Some willpower is a great help. The otjher thing is that this forum exists to help and support people, and ther's no limit to the number of questions you can ask.

best of luck
 

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Thanks for this advice. I wasn't aware of starches, so I'll keep that in mind...especially rice, which is something I have often (though tend to prefer brown rice).

Thanks for the encouragement and empathy...I think that's what I'm missing most.
 

My most recent* HbA1c result was 52, iinm...and the doctor gave me value of 42 as 'normal' and 48 as 'diabetes'. However, as I said, I did have a "bad" month or so prior to that, so I would have expected higher values than normal...if that is all it is. However, I doubt it is.
* actually, I have had a more recent one, and that is what my current doctor is working from, but I don't have that value to hand.

I'm not sure I have any symptoms or not. Everything seems normal, but perhaps I have become used to the symptoms.

I've not done this "initial" test, unless that is what the test I do when I wake up, first thing in the morning. Today, it was higher on the test I did in the morning than the test 2 hours after the meal, which my wife and I both thought was odd. The only thing I can think of is that it was because I took a brisk walk after my lunch, and before the test. The morning (fasting) value was (iirc) 5.6 and the 2hr after lunch was 4.9. My lunch was steak and broccoli, so no sugary or starchy things, and I would expect for a low test. My breakfast, which was after the 1st test, and 5 hours before lunch, was porridge oats with full fat milk, and a couple of handful of mixed nuts in there.

Thanks for the guidance. It really puts my mind at ease.
 
Hi @Davidmaxwaterman,

You're encountering a steep learning curve and a lot of conflicting information. First thing I thought was the same thing @Chris24Main came up with: A continuous glucose monitor would give you a couple of answers. On here we often talk about testing before a meal (which was what was meant as an "initial" test), and two hours after the first bite. If your rise is no more than 2.0 mmol/l between those two, your body could process what you put in it. That said though, it does NOT catch how high your numbers went, it just tells you whether your body could deal, and bring numbers back down to a decent number in an acceptable amount of time. A spike comes somewhere in those two hours, but exactly when? That depends on how much fats and fibres were included in the meal, whether the carbs you had were liquid or no... Some hit the system faster than others, so your spike could be after 5 minutes, or after an hour. With a CGM you could track what your blood glucose numbers get up to at any given moment, and that might answer some questions for you. I never had a CGM, but I did make something called a "curve", a few times when I was first diagnosed, doing finger pricks every 30 minutes. It was eye-opening, even if not as exact and minute-to-minute as a CGM would have been. Any grains, so wheat for brekkie or rice for dinner, would up your numbers. Also, in the morning you're likely to be higher, as you've already discovered. This higher fasting number is called Dawn Phenomenon. It's not directly due to what you've eaten, but the liver releases glucose into your bloodstream in the morning, to give you energy to start the day. Forgive the little idiot, it thinks it's helping. For me, this morning, I was a whopping 7.0 mmol/l, and I can link that directly to a sleepless, rather stressful night, a rather painful IBS flare after food poisoning, and my trying to get rid of non-alcoholic fatty liver disease. Nothing to do with what I ate yesterday, because my post prandial numbers were lower and actually, non-diabetic throughout. Partially thanks to low carbing, partially due to walking 11k. Food affects our blood sugars, but so does interrupted sleep, nightmares, stress, irregular work hours/shifts, other medications like statins or steroids, pain, a vaccination or virus. It helps to know the many, many things that can affect blood sugars.

Also, your diet might've been bad for a month or so there, but in someone who doesn't have diabetes, that wouldn't impact their HbA1c to a point where it reads as diabetic: their bodies can deal with what'd put in there. If my husband and I ate the same meals, his HbA1c would still be beautiful, while mine would be sky high and I'd be very ill, with all the potatoes and bread he puts away on a daily basis.

Quite a few diabetics don't experience symptoms, or don't realise they're symptomatic. Maybe you noticed that wounds heal slowly or get infected easily, maybe you're tired a lot, thirsty, weeing often (waking up in the night once or twice), the occasional yeast infection/itch, being tired or feeling weak every now and again. Stuff one could easily chaulk up to being over 40 or 50, you know? Maybe you fall asleep after dinner? Stuff like that could indicate high blood sugars.

High blood pressure and diabetes both fall under the Metabolic Syndrome umbrella. Other things you might also experience are obesity, high cholesterol and non-alcoholic fatty liver disease. Or not. I had all of them except for high blood pressure, mine's always been low until some recent spikes cropped up during (peri?)menopause. So you might have one or two issues, or all of them. It's quite normal, and usually when blood glucose comes down, the other issues'll improve as well, if that's any consolation.

What else... Oh, yes, the diagnosis itself... You do realise that a life-changing diagnosis is both traumatic and gets a response of mourning? So if you're feeling shocked, scared, angry, sad, any of that, it's entirely normal. You work through it for a bit, and when you see numbers improving as you test, and you maybe start feeling better.... It ebbs off some. You get a bit more of a feeling of being in control of your body and your life, which you probably currently feel like you do not have at all. You have a say in how all this goes. You maybe change your diet, you decide whether or not to take medication for it, you learn what works for YOU specifically... Because you're right, there's a lot of conflicting information out there, and part of that is because we're all different. What is true for one, might not be true for another. So do test your heart out and find what is the sweet spot for you. Or, not so sweet, considering the subject.

All in all, you don't have to do any of this alone, the forum's right here and there's a large amount of very knowledgable folks who can help out with questions you may have.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html this might help a bit in the interim.

Sorry about the information dump, but you do sound like you need answers, or something to work with, at least. Ignore entirely if it's too much!
Good luck,
Jo
 
Davidmaxwaterman said:
Thanks for this advice. I wasn't aware of starches, so I'll keep that in mind...especially rice, which is something I have often (though tend to prefer brown rice).

Thanks for the encouragement and empathy...I think that's what I'm missing most.
Click to expand...
You may find this initial period somewhat turbulent - some of what you learn will be contrary to everything you believed in for most of your life (at least it was for me) - so your reaction (I'll put it another way, MY reaction) may be all over the place.

Too much sugar in an apple!! how can that be...

Skimmed milk is just milk with relatively more sugar? -

Ten different ingredients on this list are actually sugar!!

and so on... the more you pay attention, the more you realise that all sorts of things need to be viewed differently.

On the other hand - it's not all bad...
Steak and broccoli. - excellent. One of my greatest pleasures through last year was learning to properly cook steak - I would previously trim off all the fat to the point that it wasn't worth cooking what was left.. but understanding that if sugar and starch is the real issue, then fat isn't; just gradually allows a different way of cooking - so now I can grill up a steak in minutes - it's the ultimate fast food - and every one, I'm enjoying more..

Then - for breakfast - you may find this a step too far today, but I'm enjoying eggs and bacon for breakfast every day.

Cheeses, paté, salamis, creams - butter ... all sorts of things I would have found difficult to cook with, the minute you free yourself from the fear of fat, all these things jump back on to the menu.

And as @JoKalsbeek says - you're on a path now - in retrospect, personally I don't think I`ve ever had a "symptom" that I could ascribe to diabetes (other than effects from treatment, but that's a whole other story) - it's all about the long term, and with knowledge (and lets face it, a bit of an unexpected shake-up) you can really make a difference to that longer term health.
 
I'm going to try to not duplicate what others have already said, if possible.

You can't really understand the result of the +2 hrs test unless you have a baseline - the pre-meal test - to compare it with. Establish baseline, apply stimulus, evaluate response. For example - a +2 hrs result of 7.5 means what? That depends on the pre-meal - and you might draw different conclusions from a pre-meal of 4.5 compared to one of 7.5.

I guess you'll have completely missed finding out how well you can handle porridge. It's a heavy carb item and accordingly (unfortunately) off my list. You might find you can handle it. Or not.

Your early morning readings (assuming no food for a while) are probably nothing to do with a walk and all down to to your liver. Livers are not that readily controllable, have their own ideas about what your BG should be, and are slow learners. Many of us find that livers will make and dump glucose into your bloodstream to give us a boost in the morning. This comes from stores, and not directly from food. The liver will consider that where your BG has been recently is where it should be in future, so will do its best to keep it there.

It took my liver about six or eight months to fully accept that it could and should cope with my new low BG. About the same time I gave up regularly testing in the mornings because I was only monitoring my stubborn liver, and not anything I had control over. These days I do a week of morning tests once a year just for curiosity. They will invariably be the highest I see all day.

And - I'd really recommend keeping a food & readings diary. Record what you ate and when, and anything else relevant (like illness or exercise or stress) and put the readings in as well. After a few weeks you should start to see some patterns and recurring themes, and decide what if anything you might do about them.

It does get clearer, honest.
 
Wow, such great advice, thanks!

Thinking about symptoms, sleep has been the major one. For several years I've had trouble not sleeping at night, and instead finding it a lovely experience sleeping in the morning...which is difficult to break out of if you work(ed) from home, and there's little else to do in the morning.

Also, I have long had issues with (what I think is) low glucose, in the afternoon...making me tired and shaky, to the point of me having to have something with sugar in it, like some sweets or soft drink.

I'm not obese, but I am overweight, and losing weight has been a part of my plan to attack the problem...the doctor said I have to lose 10% at least in my first month, and I've done that already, but I still have probably 10kg to get to 'normal', iinm.

Wow, good to be informed that porridge is carbohydrate. I had been assuming it wasn't anything to worry about, and had actually been avoiding things like poached egg on toast. I guess the toast isn't so good (as per the porridge), but maybe I can get some other things to go with it, or just have eggs...interesting that butter isn't an issue. I guess some of these things might actually be good to reduce in order to lose weight, and not specifically for blood sugar. Once my weight is down maybe it'll I can have some of the fatty things more.
[Edit: I find lots of references saying porridge is good, so I'm not sure about this...still, I don't mind a poached egg at all, so win-win]

Hrm. Lots to consider.

What a great forum! (Though, it keeps deleting my newlines when I try to delete a character, which is a little annoying - is that a known issue?)
 
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Poor quality sleep is indeed something you'll find a lot of folks here complaining about. After my BG went out of whack I started gaining weight, and that led straight to apnoea, which made matters worse.

I would guess that you are not actually having low blood glucose in the afternoons. If you tested, though, you'd see what sort of figure you got.

What you're having may be a relatively low blood glucose - you'll sometimes see it referred to as a "false hypo". It's in no way dangerous but because your BG is slowly decreasing from (say) 10ish to (say) 7ish your system (mainly the pesky liver) recognises the fall, but treats it as a fall from normal levels to truly low levels. By feeding yourself sugar, you confirm to your liver that it was right, and that those higher levels are "normal" and where they should be maintained.

If your experience is anything like mine and a good number of other people on here, normalised blood glucose happens well before any weight loss. Low carb did both for me - normal BGs in 3-4 months, and weight loss over the following 3-4 years. I definitely didn't lose 10% of body weight in a month.

Butter is fat, and dietary fat doesn't affect BG at all. Dietary fat is also not digested and stored as body fat. Carbohydrates however are digested to glucose and glucose is stored as body fat. I have eaten what would be described as high amounts (as much as I wanted) of fats and proteins over the last five years and have lost about 90lbs, because I've eaten next to no carb - and I have never allowed myself to be hungry.

Bread and anything flour-based including pasta, potatoes, oatmeal, beer, cereals, rice, most fruit, anything sugary - all high in starches or sugars, all carbohydrates. All will be digested to glucose and have an immediate impact on your blood glucose and the capability of your insulin response system to deal with the extra glucose load. You might find it useful to have a look at the diet doctor website that has a lot of data on carb content. It's here: https://www.dietdoctor.com/low-carb There are others.

One of the problems is that the official "healthy eating" advice still tells everyone to base all meals around carbohydrates, and I think the "recommended" level is around 300g/day. That's where you'll see people saying that "porridge is good".

I wish it was. I used to eat like that - didn't eat any "nasty sugary stuff" although I lived off pasta and drank gallons of orange juice - and wound up with T2. I spometimes advise people to try to forget everything they think they know about healthy eating - or at least, what we've been told by government and the media and food manufacturers is "healthy eating" since about 1980, namely "hi carb, lo-fat" - and go back to the previous advice, which was to lose weight, cut out starches and sugars.

If we tell everyone to eat starches and sugars, and they follow the advice, it's not surprising that we have seen such a rise in both T2 diabetes and bodyfat percentages in the last forty years.
 
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