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Moderate hba1c but bit high bg

G

gj256

Member
Messages
5
Type of diabetes
Type 2
Greetings!!!

I am recently diagnosed Type 2 diabetic. I was diagnosed in Jan this year with shockingly high hba1c of 122 mmol/mol. GP put me on metformin and then gliclazide. My bg were still on higher side. I was controlling my diet, cutting down all sugar and reducing carb intakes. So after 4 months of oral medication, GP put me on insulin. During these months, missed to get another hba1c test. After 2 months being on insulin, I got hba1c test again in July end and it came as 50 mmol/mol. That was a pleasant surprise and a relief.

Now GP is continuing me on insulin. Though hba1c reading is very good but my bg are still on bit higher side. They are between 7 to 9 in morning before meal.

Also, I still have feet pain, tingling sensations all the time.

My bmi is normal and I keep an active lifestyle, walking and running.

My concern is insulin needed with this hba1c level or I can live on oral medication? GP thinks that insulin is working for me.

Another concern is why bg readings are still so high when hba1c reading is so controlled.

Any advises?

Many thanks
 
Sounds like you are getting neuropathy in your feet. Try Alpha Lipoic Acid for this. Maybe vitamin B12 as well as metformin can reduce B12 which can lead to neuropathy.

You should try to eat a low carb diet and as your blood sugars reduce, you can reduce your medication. A fasting blood sugar if 7 to 9 is high. You should be aiming for between 4 and 7. Cut out breakfast cereals, bread, potatoes, rice and pasta. Also avoid fruit juice and fruit such as bananas and grapes.
 

4? Not when on insulin. One could drop/still be dropping, further..? (Regardless of liver dump in morning.)

Hi @gj256 ,

Welcome to the forum!
What insulin regime are you on.? Type of insulin/s...
Tagging in @daisy1
 
You need a blood glucose meter to find which foods spike your blood sugar. Many type 2 sufferers find that they can control blood sugars by eating a LCHF diet. That is low carbs, with higher fat to compensate for less carbohydrates. You need to be careful with gliclazide and insulin that you don’t get hypos once you eat low carb.
 


Good advice above. Read the information @daisy1 will provide.
Get a meter - test yourself before and 2.5 hours after eating - record times, readings and food eaten.
In very little time, with this approach, you will soon notice which foods are pushing your blood sugar up (and I would bet my backside that it is food that is high in carbohydrate).
Identify food you eat that is high in carbohydrate and eliminate it from your diet or at least reduce it substantially.
This will allow you to take control.

ps. while I am confident that too many carbs will be keeping your blood sugar up, in the very unlikely event of me being wrong - I will probably renege on that bet...as I have need of my backside (mainly to sit on).

Good luck.
 
@gj256

Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask more questions and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

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.
 
If you do cut carbs keep an eye on your insulin dose, it may need to be reduced. Do you carb count at present?
 
Passing by and noting that people are advising a T2 on insulin to get a meter and test.

I may be wrong but I think it highly unlikely that an insulin user would not be testing.

Or is there a regime where you take a set amount of basal insulin and don't top up to cover meals?
Just the thought makes me slightly nervous.
 
I agree with all the advice given above
I was diagnosed in March and in shock for at least a month
My diabetes nurse was very helpful, and told me to count carbs and informed me of these forum sites for diabetics
I've been following the low carb programme, now in week 3
I got myself a BG monitor, and use it 3/4 times daily
Diagnosed 140! Then June 79, so her advice was working, but I needed more help!!
My BP is high (Forgotten readings, will ask her today for past and present BP) and using both Amlodipine (x1) and Metformin ( Slow release x2 )
My self readings on BG levels were 16, and gradually now in 7's and sometimes even the odd 6!
I hope eventually to not to have to take either of these meds, by controlling thru diet
Good luck to all, who like me are just starting to get to grips with diabetes
 
I. too, am a bit concerned about some of the above replies to a person taking insulin when we have as yet no idea which insulin regime he is on. He clearly has a meter as he knows what his morning BGs are.

@gj256

If you tell us which insulin you are taking, and when, it will help us to help you. It will also help if you tell us what sort of levels you see before and after eating.

You ask why you are seeing high BG levels when your HbA1c is moderate.
The HbA1c is a sort of average over the previous 2 to 3 months. Your BG finger prick test is just a snap shot of what you are at the time of the test. You have no idea what you are the rest of the time, but would have a better idea if you test more frequently.
 

Snipped down to just address one issue.

Your HbA1c is an average throughout the day and across three months (last month being the most significant).

What you appear to be describing is "Dawn Phenomenon" where your BG drops far enough over night for your liver to dump some of the glycogen store to prevent you from going hypo. This can result in a BG on waking which is higher than your BG for the rest of the day and most of the night (until the liver dump).

This is quite common and likely to keep happening until you have full BG control (and perhaps even then).

T1s and T2s on insulin often battle this and the apparent lack of logic behind it when two days doing the same thing give different results.

Diabetic neuropathy (if this is what you have) can take quite a while to reverse after you have got your BG steady so should perhaps be regarded as a long term work in progress. At least it should not progress further if your BG control is good and solid.

You were only diagnosed in January so please don't expect instant results; slow and steady is the way to expect changes. Then you can be pleasantly surprised if it goes faster.

I think your doctor is being very sensible. You have gone from being well out of control to establishing what looks like pretty good control in about 6 months. I imagine your Doc would be happy to look at tapering off the medication if you maintain the control for another 3-6 months. Meanwhile you are doing something that is working and it is very good for you that it is.

Edited to expand on Dawn Phenomenon.
 
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The advantage of insulin compared to gliclazide is that you should have been trained in how to monitor your BG and adjust your insulin. You are likely to get better long term health outcomes if you can reduce your insulin while still keeping your BG under control.

Therefore try to slowly reduce the carbs you eat while checking your BG often and reducing the insulin dose when needed.

If (and only if) you are committed to cutting carbs and/or intermittent fasting Dr Jason Fung says that BG should be allowed to go as high as 10 mmol by reducing insulin just before you start. Low BG (below 4) when using insulin or gliclazide is a medical emergency and must be dealt with by eating a few carbs.

Remember it can take a few days for all the insulin or gliclazide to get removed from your body, so even after you have stopped taking insulin, you can’t allow your BG to get below 4 mmol for a few days. If ever there was a good case for a CGM, this is it!

gliclazide is no better the insulin for your body, however, talk to your doctor about SGLT2 inhibitors as they would allow you to take less insulin, so helping you lose weight.

It would be wonderful to think that people had access to doctors who will support them with low carb and/or intermittent fasting, but in the real world this is not the case, hence too many people have to chose to disregard medical advice or accept the complications of Type2.
 
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well it all depends on your willingness to radically change what kind of foods you eat if you start counting the numbers of grams you eat in total daily and go lower than 100 grams or even lower you might be able to do without insulin.
but as long as you use insulin you need to keep levels of around 5 mmol and a bit higher but under 8mmol after eating..while still on insulin it can be dangerous to get too low and one must always remember that one can get even lower and one can end up unconscious or even die from too low blood glucose
 

Hello from Mallorca

I note you put forth cut off level guidelines from Nice which I have no doubt are as quoted, however, my million dollar question to everyone out there, especially those who are frantically daily 1,2,3,6,7, or even more times a day who testing
really questioned "ARE THE CUT OFF LEVELS 100%% I raise this to attention, as the Nice as quoted within, state one
set of cut offs, other diabetes Associations in UK quote other, in New Zealand for Example, their Cut off for A1C is 50mmol/mol 6.7% to allow diagnosis of Diabetes with classic symptoms, without symptoms 2 tests required, prior to diagnosis, UK and Spain are 6.5%.

Surely, based on the vast variations of what are supposed to be cut off levels that one uses as a guide is quite concerning, you may have a result that your under a false impression is either good or bad.

All cut offs Which by the way are acknowledged by ADA and The Who, are arbitrary levels decided upon lessened by so called expert committee with no 100% clinical or medical support evidence regards the final cut off levels worldwide, that is frightening, and what is more frightening, even the ADA and their Endos cannot agree on what should be cut off for A1C regards Pre Diabetes. If the experts cannot agree, and cut offs Finger Real Blood Testing that vary worldwide, i.e.it depends where you are time of diagnosis for example.

I do not trust the arbitrary figures in place by the Diabetes World, as they are only random, at whim choice, the lower the numbers the more people are prescribed drugs and other. I feel it is an appalling situation overallwithin the medical and Diabetes World, generally, they should be ashamed to allow such variations, of cut off numbers, some say
on, some say up to and including, some say over, for goodness sake, we will all go or are going a little crazy, there should be
one cut off that the world follows a strict guideline for A1C and Finger Testing numbers, that number is backed by clinical and medical evidence as to why that is the cut off threshold figure.

Until that takes place, I don't check my fingers, only perhaps 1 every three months, and A1C yearly, why, to give example.
Here in Spain I fall under Diabetic as my A1C is 6.5%, yet if I hope on the plane back home to New Zealand I fall under their pragmatic sensible Diabetes system viewing, as Pre Diabetes, with recommendations, change lifestyle, eating, and exercise.

When I test every 3 months, guess what, my numbers are consistent, and more or less one number higher or lower as 3 months previous, last test fasting mode, 86mg/dl 2 hour after eat 89mg/dl Random anytime after eat 91mg/dl

Yes, the system/s and diabetes world have cut offs, but the DOUBT QUESTION remains sadly, are they correct, just because they state a number, that does not mean its correct, we are ultimately the ones to look after our bodies, and do some research,
don't always believe or follow recommended guidelines, listen to your body and use common sense is one of the best
recommendations at the end of the day.
 

@pollensa - Your post would likely receive more appropriate replies, if it were a thread of it's own. Would you like me to move it and create a new thread?
 
Thanks a lot guys, you are awesome. Thanks for all the advises.
I think I did not provide enough information. So this is my current regime:
1. Past couple of months, I have been taking fasting BG readings in morning only before I take insulin
2. I am currently on Humulin I kwikPen and take 22 units single dose in the morning
3. I am not keeping count of carbs. Just reducing carbs, and keeping it to minimum. For ex reduced amount of rice, bread etc compared to what I ate before diagnosis.
4. Any advises on how to keep count of carbs? How much carbs a slice of bread or a roti would have? And how much carb is low carb?
5. From today, I am planning to start taking dinner time BG as well, before and after. So that I can understand whether its dawn phenomenon suggested by LittleGreyCat. Because it seems to be true in my case. Some day I expect my fasting BG to be low considering my previous day diet but they are high and some day I expect high but they are low. So just some random BGs I get in morning.
6. I have cut down all the sugar and not taking any sugar at all. Tea, coffee all are without sugar now. No banana and other sugary fruits as well.

After reading through all your comments, I am feeling that carbs are the culprit and still not low enough to bring down the BG. Let me do this dinner time reading for a week and see what it says.

I think I have covered all the points raised by you guys. I will check all messages once I get home in evening and respond if I have missed anything.

Many thanks
 
You ask how many carbs in something like a slice of bread. On any foods that come in a packet, wrapper, package, whatever, such as bread there will be a nutrition label somewhere. This details what is in that food per 100g. One of the items is total carbohydrate. On many foods it also lists the amount of things per slice, or per portion. Most ordinary and wholemeal breads are around 17 to 20g carbs per slice. Have a look in your cupboards and see if you can see these labels.
 

Hi. I wasn't sure if you had a meter (which appears to to have irritated some people...though not yourself... as did giving you advice on cutting carbs despite not knowing what your were doing specifically regarding insulin ). I was basically advising that meters are very important little weapons for any of us to have...but I can see now you do have one. You do appear to be using it less than I would say was informative. the pre and post meal readings are where the answers lie regarding carbs. I guess I am guilty of offering advice based on my own experience (which clearly doesn't cover all possibilities). Anyway, I am still saying cut the carbs but adding that you should keep an eye of levels as you are using insulin and test often to ensure you don't go too low. That's been stressed by other above though. I am not urging you to suddenly get rid of all carbs as the impact may certainly be a concern. I can only say from my own experience that the kinds of foods which are high in carbs and tend to cause spikes in blood sugar for me (and many many others) are bread, spuds, cereals, pasta and rice (among others). I completely avoided these for months to get in control of my blood sugar and seldom touch them now. The best way for you is to try reducing things and keeping check on your levels so you are comfortable with You ask how much carb is low carb - generally, I consider anything around 10g carb or less per 100g as low carb. You just need to get used to checking labels (or looking online for details of particular food and think about the size of the portion so you know how many carbs you are consuming. Again, be sure to stay careful to avoid hypos. Good luck.
 
Hi,
Thanks for your reply. You say you seldom touch bread, cereal, pasta, rice etc then may I ask what do you usually eat? What's your diet and what food gives you enough energy to last your day?
I have been thinking of cutting down all these high carb food completely but have been thinking what to eat to get enough energy. Please share. Thanks.
 

Carbs turn to glucose, which is used for energy. There is another nutrient that doesn't turn to glucose but can be used for all the energy requirements you have. That nutrient is fat. Our bodies will run off fat in the absence of glucose. As you decrease your carbs you can increase fat consumption. You don't need to go overboard, you just need to stop avoiding it. Healthy fats are good for you - olive oil, avocado, dairy, nuts, fish (especially oily fish such as salmon) etc. You could eat bacon and egg with mushrooms and a tomato for breakfast without feeling guilty, or strawberries and cream some days. Vegetables that grow above the ground are fine, as is meat.

Do keep in mind that the fewer carbs you eat the less insulin you will need, so adjustments need to be made to avoid hypos. You can discuss this with your doctor/nurse.
 
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