Just had my review and confused

The nurse is roughly quoting NICE guidelines which state:

Blood glucose ranges for type 2 diabetes
Before meals: 4 to 7 mmol/l
2 hours after meals: under 8.5 mmol/l

A lot of people on this forum would try and stick within a tighter range which would be no higher than 7.8 mmol/l at 2 hours post meal (and a number of people even tighter say 6.5 mmol/l)... 7.8 mmol/l has been shown to be the point at which beta cells (the insulin producing cells in the pancreas) die.

2 hours is considered the point to measure although you are correct that it may not be the highest point... the speed at which carbohydrate absorbs however is dependant on the type of carbohydrate and is also affected by the protein and fat in the meal that you are eating.. so in reality your highest spike could be anywhere from 45 mins post meal to 3 hours post meal...

So in summary... yes the odd spike to 9 mmol/l is not going to do any real harm (even non-diabetics can spike to this level in certain circumstances)... however generally the lower you can keep your 2 hour meal levels the better.

I agree with Pneu. The nurse is generally giving good guidance. Many people can stay below 9 at all times but others like me struggle. The range of diabetes 'severity' varies greatly so all you can do is measure, keep the carbs down and if you keep going outside the NICE guidelines ask for another review of your meds. For me sitagliptin has helped with spikes.

Personally if I was regularly going above 8.5 mmol/l at + 2 hours then I would look to reduce that. How you reduce that is up to you.. this may be more medication, less carbohydrate, additional exercise, etc... At the end of the day I would say the NICE guidelines are the minimum you should be aiming for.. There is a lot of information about... some of it contradictory but I would also recommend you read as much as you can and make an informed decision based on what you find out.

Pneu said:

Personally if I was regularly going above 8.5 mmol/l at + 2 hours then I would look to reduce that.

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If I've read the original post correctly, your DB nurse isn't saying that. I can (and infrequently do) spike higher than 9 at 1hr but come back to a reasonable reading at 2hrs.

I do, however, try to have foods that reduce that fluctuation to less than a couple of points, so a pre-meal reading of 5.7 would peak at around 7.7 at some point, but would be back at 5.7 after 2 hrs.

I think it's a positive thing that she's trying to get you off the Gliclazide and just on Metformin - she must have faith in your ability to change your diet.

Pneu said:

and a number of people even tighter say 6.5 mmol/l

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I'm one of the 6.5 people but that's my two hour limit. To do that level I've chosen to low carb most days and take Metformin. I like to try to be sub 7.8 after 1 hour but will except 8.5 especially if its something nice that I don't have that often. I think you have to draw the line somewhere as otherwise you could end up testing far to often and can end up worrying too much. Nowadays I will only test at 1 hour if I'm experimenting with a new food or trying to see if I can now eat more of something than I could a while back.

As Pneu says 7.8 is there for a reason as its the level that on average complications can start from. Pneu mentions beta cells but 7.8 is also the level that damage to eyes was shown to start from in the average person.

I like to look at 7.8 in another way as well. If its the level that on average things start to go wrong from then its the maximum level that someone should expect to get if they were an average non diabetic. If the average non diabetic exceeded that value they wouldn't be a non diabetic as they risk getting diabetic complications and would thus be classed diabetic.

So in my world view 7.8 is the level that 100% of average non diabetics can achieve at 2 hours.

I then chose 6.5 as my maximum 2 hours because that is the level that 19 out of 20 or 95% of average non diabetics achieve.

If it were possible for me I could choose 5.5 at two hours as that is the level that 3 out of 4 or 75% of average non diabetic achieve. I suspect until I lose a load more weight my insulin resistance will stop me getting very close to that 5.5 any time soon so its a very long term goal for me.