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New SD Codefree Meter

Xyzzy I will be sure NEVER to compare two meters (when I get one)... I'd be JUST like you. I get the insane white coat hypertension too and I'm certain that stress contributed to me getting diabetes. I record how much walking I do and when I forgot to wear my pedometer one day I went MENTAL and blamed my boyfriend. :lol:

I really like all your posts, because you're very articulate and open. Thanks for inspiring me.
 
borofergie said:
xyzzy said:
Out of all the numbers bandied about I think HbA1c is one of the least useful. It will just tell me an average BG level over the last few weeks. It won't tell me that eating 75g of pasta spikes my BG's up to double figures after 2 hours even though after 4 hours I will be sub 6 and fine. So for 23/24ths of the day my average will be fine and therefore my average will be largely unaffected by the dangerous spike. Putting that all together if I did the same thing day in day out I could be spiking dangerously high each day but end up with a very low HbA1c.
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I don't get this xyzzy...

If you were spiking every day your average would be higher and so would your HbA1c.

The way I see it, every time you spike your HbA1c edges very slightly upwards. Your HbA1c is then a (weighted) measure of all your spikes over a the past few weeks. (There is obviously a contribution from your fasting BG too, which is like the baseline from where the spikes are measured).

I love HbA1c. If diabetes is a game, then HbA1c is the score.
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It's 12.30 at night and you want me to do maths!

Look at it like this. There are 24 hours in a day. Lets assume that apart from your main meal your BG is 6 for want of a better number). You eat something bad and spike to 10 after say 1 hour then you're back down to 6 by the next hour. Slightly unrealistic but lets go with it cos its late.

Lets assume you test every hour (ouch!)

So the total of all readings would be 23 x 6 + 1 x 10 = 148
So the average is 148/ 24 or approx 6.17

If you had no spikes you would measure 6 for each of the 24 hours thus the average is also 6.

Now assume you eat the same thing day in day out over the 90-120 day HbA1c period.

Each day your average BG is 6.17 because it contained the one dangerous spike as opposed to 6 if you were entirely level.

So your average BG REMAINS THE SAME EACH DAY thus when your blood is taken for the HbA1c it has an average BG content of 6.17 if you were spiking or an average of 6 if you were not.

Thus for 6.17 you end up with an HbA1c of 5.5% (if you do the BG to HbA1c conversion) and an HbA1c of 5.4% for 6 if you didn't spike.

So that's just a difference of 0.1% and you have an excellent HbA1c of 5.5% yet you still spiked dangerously to 10 on each of the previous 90 - 120 days. That's why taking real BG readings is so important rather than simply relying on an hBA1c%
 
Glados said:
Xyzzy I will be sure NEVER to compare two meters (when I get one)... I'd be JUST like you. I get the insane white coat hypertension too and I'm certain that stress contributed to me getting diabetes. I record how much walking I do and when I forgot to wear my pedometer one day I went MENTAL and blamed my boyfriend. :lol:

I really like all your posts, because you're very articulate and open. Thanks for inspiring me.
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Now I'm blushing :oops: as well as doing maths!

Keep blaming the boyfriend you know it makes sense :lol:
 
borofergie said:
I don't get this xyzzy...
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borofergie I just did maths at some god awful hour for you and you've gone to bed :***:
 
[
xyzzy said:
Out of all the numbers bandied about I think HbA1c is one of the least useful. .

.
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Of course it is! That is why the NHS thik we should rely on it without any oher testing and why our treatment is based upon
it! :lol: n
 
Ok borofergie it worries me that someone as obviously up on this as you doesn't get the HbA1c thing. So here's a story for your delectation (and anyone else) who wants to see why HbA1c is not all that good as a safety predictor. This way uses no maths at all.

You need to enter imagination land to do this and in my imagination it gets pretty gruesome so you have been warned!

Think of your blood, now zoom in to where you can see individual blood cells swimming about. If you're like me you end up with a mental image of lots of little red blobs moving around.

Now lets impose a personality on each blob. Make each blob a little spiky devil monster with big teeth and evil glowing eyes.

Now each monster can be in two states. Asleep or awake.

When they are asleep all is well, when they wake up then depending on how woken up they are they will progressively become angrier and angrier and psychotically and berserkly go around your body attacking the blood cells in the backs of your eyes cos they want to blind you or attack your feet to try and make them drop off or attack things called your beta cells which make their arch nemesis the insulin fairies.

First important thing to notice.

The insulin fairies are just that little fairies but they carry big hammers that they use to whack the evil awake blood cells with to put them back to sleep.

Second important thing to notice.

The blood cell devils are woken up by glucose which is coming from what you eat. The glucose ISN'T in liquid form so it can't be absorbed by all the devils just bathing in it. Its found in little sugar cubes so each blood devil has to be able to grab one to wake itself up. If it can grab two, or three or more GREAT it becomes more awake and more evil but it has to be able to grab at least one to wake up.

Third important thing to notice.

If I restrict what I eat I can control how many blood cell devils will wake up because if I'm good there won't be enough sugar cubes for all the cell monsters so only SOME will be able to wake up.

Fourth thing you notice.

Like most other living things the evil demonic blood cells have a life span. Each one lives for exactly 90 days and whenever any individual one shifts its mortal coil because of old age its instantly replaced by a new ASLEEP one so the total number of monsters stays the same each day and importantly if nothing is done to wake them up the proportion of AWAKE devils will fall each day because the new ones are always born ASLEEP.

Fifth thing you notice

Once they've been woken up the little b*****s stay awake. They can never be put make to sleep UNLESS an insulin fairy hits them with a hammer or they die when their 90 days is up.

So starting to bring it all together.

Imagine two weird people. They both only eat at one time each day. One just eats cheese which contains only a tiny number of sugar cubes, the other eats curry sauce and chips which contains loads.

Both have the same number of insulin fairies.

In both people just before they eat they number of awake blood devils is roughly the same.

In the person who eats cheese in the hour just after they eat the number of blood cell monsters awake and doing damage keeps roughly the same. The number does not spike.

In the other person its different in the hour afterwards LOTS of monsters are woken up career around his body ripping this and that eyeball blood vessel to shreds, hacking away at his feet and especially like tracking down and horribly mutilating, torturing and then finally gorging on the beta cells that make the insulin fairies as they are their favourite thing to eat.

Everyday during that hour the insulin fairies mount a valiant defence and hammer as many of the little blighter's they can find but ON AVERAGE each day just a few and ONLY A FEW blood devils escape and keep awake. They manage to stay awake until they day when their time is up and they die.

So because blood devils that reach 90 days and die are always replaced by ones that are ASLEEP and because the person eats the same curry sauce and chips each day THE AVERAGE number of AWAKE blood devils is the same on each of the 90 days. There are a FEW more AWAKE in our curry guzzling friend but not very many more than his cheese eating partner.

BUT THERE IS A DIFFERENCE ISN'T THERE. Our cheese eating friend never gets attacked for the one hour each day and his eyeball blood vessels and feet and beta cells remain intact.

Now both people go to their doctors who take the sample of blood monsters that gets sent to the lab. The lab results come back.

The GP says to the Cheese eater. Well done Mr Cheese you have over the last 90 days on AVERAGE very little blood monster activity your score is 5.4%, keep it up you fine fellow.

The GP says to the Curry sauce eater and chips eater. Well done Mr Sauce you have over the last 90 days on AVERAGE very little blood monster activity your score is 5.5%, keep it up you fine fellow.

Here endith the imagination of xyzzy.

Hope that clears it up for you :thumbup:
 
Just to bring this discussion back to the SD meter for a mo, after a few more tests it seems that the SD is consistently reading between 0.3-0.5mmols below my Aviva. If the Avivas tend to test slightly higher than most other meters, as Dr Bernstein has found, then I could continue using the SD and just err on the side of caution and add 0.3mmols to all my readings. The alternative is, test less often with my Aviva and only buy 1 box of strips a month instead of two. I've been diagnosed for 6 months now, so I have a pretty good idea of what I can and can't eat anyway, but as with xyxxy, I do tend to worry about what my bg is doing even if I have a general idea of where it should be. :?

To be honest, I think the SD Codefree is perfect for anyone who's been denied strips by their GP, and it may well be more accurate than my Aviva, but I think I feel more comfortable with the possible slight overestimate I get from the Aviva. But as my partner pointed out to me, all of these meters are only accurate to within +/- 20%, so what I should really concentrate on is the number before the point, ie. if I'm in the 4's, 5's, 6's, maybe the low or high 4's,5's,6's is the most I can take from these readings. I tend to get bogged down by small increases and decreases, which are essentially meaningless, it's the broader trends that are much more important and realistically all we can hope to identify with such basic testing monitors that are available to us for home use.

To be honest, all this has made be think I should be less reliant on my meter now, other than to see if a new food or activity causes a significant change to my bg, which maybe isn't such a bad thing. How on earth to insulin users manage when they need to inject exact amounts of insulin when using these readings as a guide?? :shock:

As far as HbA1c readings are concerned, I think they only reflect an average, which is of course very useful, but at the same time it doesn't truly identify spikes of a short duration which may not happen frequently enough to increase HbA1c into the danger zone, but even short and infequent spikes can cause microvascular damage.

Sorry if this post is a bit muddled, it's stillearly in the morning for me, I am a student after all! :D
 
:lol: :lol: :lol:

I think you were at the cheese before bed last night if that's what you're dreaming about, that's going to give me nightmares for weeks :clap:

Totally agree with what you're saying though, as I said in my post, even short spikes, that won't make a massive diiference to a HbA1c reading, will still cause microvascular damage.
 
Hi Borofergie and Xyzzy!
It's interesting this, because I did all these sums myself in the months after diagnosis. I wanted to see the effect of spikes on HbA1C. By my sums, you're both right. (how's that for diplomacy!). The effect of the spike on BG averages is a bit more than you suggest Xyzzy, well in my case anyway. If you went to any high spike, it takes longer to come back down to base. Also, a high spike normally means the BG went up quickly as well, and our poor depleted Pancreii? will atuggle and take a while to bring it back down. So you may be looking at a 3 hour curve from start of rise to back to base. If you peak at 10, the area under the curve may be, for example, representative of an overall average of 8 during the period of 3 hours. Nonetheless, that still doesn't have a massive effect on HbA1c,; 6 would go to about 6.25 on BG average in the 24 hours.
Few things though.
The guideline figures we aim for are after 2 hours. 8.5 nice, most of us aiming lower. But whatever we measure at 2 hours, we were almost certainly significantly higher 1 hour earlier. For me, it can be anything from 15% to 40%. So even if I'm 6 after 2 hours, I could have been 8.5 after 1. So 10 is not a massively higher "spike" If you took 10 as a 2 hour spike, then at 1 hour it would be even hiogher and the effect on HbA1c gets more significant.
Point is, if you test every meal, at 1 hour and 2 and 3, and fasting and before bed, then you could calculate your HbA1c ANYWAY (almost), and the individual BGs would tell you more in my view. But as most of us don't, certainly after a while anyway, the HbA1C is in my view a better acid test than the few BGs most of us take a while after diagnosis.
SO, See!, your both right.
Just one more thing though:
The problem we have with complications comes from the adherence long term of glucose platelets, which HbA1C measures. These affect our ability to heal, fight infection, our circulation etc. BG (as we measure with our meter) isn't a great measure of this because we can all have different Glycation rates. So higher BGs in one person might leave them with LESS adhesion (HbA1C) than me on lower BGs. Our glycation rate even changes from summer to winter (which is why we get worse HbA1Cs sometimes in Winter).
SO....we really need both! If we had to choose, Constant BG monitoring would I think be better, but without it, and considering I don't want to stab all day, HbA1C is better.
My vew....
 
Thanks xyzzy. I really enjoyed that. Very Roald Dahl! Will be of great use o hose of us less scientifically minded bu still anious to inform ourselves about our condition
Could also be useful in raining some HCP's :lol:

HBA1C is all wehave at he moment . I would like to believe that new measurements are in the pipeline but as The BMI , invented in 19th cenury Belgium and now dismissed by dietitians and others is still in use for wan of anything better I don't hold ou too much hope.

The HBA1C obviously has its uses but does ot allow for highs lows as as we all know these are very important.

For many of us the problems wih he HBA1c arise from the otal reliance of the HCPs we see and their approach o the HBA1c.
As with everything else , ithe resuls are just used o tick boxes. If they ick the righ boes then ther cannot possibly be a proble,
if not then there can be no valid explanation , and the focus must be on reducing the mumbers - never mind how this affects the patien.

I know this because I have suffered personally from beiing treated solely on the basis of both high and low results .

Had I ot been able to demonstrate that I suffered "spikes" and had I not been able to see someone who undersood this I would not now have fasting levels in the 4s , and 5s at most other times. Even with the evidence before her of a hugedrop in my HBA1C my "DSN" will not accept that the spikes and the weight -incresing medication given to me because of them were the cause of my high results.

Maybe I should print out "xYZZY's Tale" and drop a copy on my next visit for training purposes! Or maybe wait to see if its amended in any way after discussion with some of our other scientists.

Well done xyzzy :clap:
 
Grazer

I get where you are coming from that its not just one hour but trying to explain that mathematically is difficult so I went for the simple explanation.

To me it depends more on what and how you are eating that spikes. I agree if on average every meal you eat spikes you "moderately" then that will be reflected in the HbA1c because by the time one spike has gone you've started the next one. So in this case I agree HbA1c is an effective and good measure of how "good" you are and is valid.

However in the way I eat (and anyone else who does similar) my way of looking at things is better imo. If only one (your main meal) has the potential to spike because you choose low carb options for the rest of the day then for the majority of the 24hrs you will be low and a potentially dangerous main meal spike can get by an HbA1c because of the way mathematical averaging plays out.

The mechanism of how biologically things work is relevant but isn't necessarily the deciding factor.

The HbA1c system was made using regression analysis modelling a mathematical tool. From memory they took a few thousand mixed type, sex, age people and got them to measure 7 times a day. There was an original study that came out with an initial model and a later one that is what we now currently use. Using those sets of real BG data they created a line of best fit that fits the data after fiddling around with the weightings so that later readings have more weight than older ones. When you present your blood then based on its average your hBA1c is read of from the model. So your HbA1c is your average BS level compared essentially against other peoples average BS levels. So in my mind HbA1c is fine if you are an average person but I would suggest you, me and borofergie and many many others on this site are not the average person.

If you go back to my numbers example if you double the number of hours you are high then you get 6 * 22 + 20 = 152 which only takes the average to 6.3 or an HbA1c of 5.6, treble the time (i.e 3 hours a day you are at 10) then you still only get to 5.7. The majority of people out there would be overjoyed with 5.7% yet if their eating pattern means they weight their major carb intake at one time of the day they could still be getting damage from spikes and hence its important to test.

It's the importance of testing that I was trying to put across (if you trawl back up the trail) not that HbA1c is not a good thing.
 
Hey Guys!

Interesting debate! I have a few things to add (although I haven't read through every post in detail, so I might have missed something - so forgive me if I'm talking rubbish!)

1. HbA1c is not an average - we just call it that for convenience really. It is actually the measure of how much glucose has attached to our red blood cells over the preceding 3 (ish) months. This might or might not equate to an average.

2. HbA1c does not really measure spikes. As an LADA sufferer, I can promise you that my after food spikes can be really significant, but my HbA1c is generally in the high 5s. Despite point 1 (above), it sort of averages out.

3. HbA1c is a measure of general control of diabetes. We know that people with good HbA1cs are statistically less likely to develop complications and we know that good BG control leads to good HbA1cs. Now, whether there is a statistical difference between getting a good HbA1c but having a wide standard deviation from mean and getting a good HbA1c but having a narrow standard deviation from mean is not clear. If we assume there is no difference, then the HbA1c is a perfectly good measure of BG control. If there is a difference, then it is not so good.

4. If we obsess and stress over the result of every slight variation in our BG measures on different meters or stress over a .5 difference in a very good level, we are actually justifying the NHS response that allowing Type 2s to home test causes them stress and serves no purpose.

My advice is: relax! Use your meters wisely to identify trends and food that causes spikes. Use your HbA1cs to demonstrate your diabetes control.

Smidge
 
Not really stressing just pointing out why you should test your BG's. If you really spike high each day it COULD do damage without it being picked up in your HbA1c imo, read the other thread for more info.
Not trying to pick a fight - honest :D

smidge said:
1. HbA1c is not an average - we just call it that for convenience really. It is actually the measure of how much glucose has attached to our red blood cells over the preceding 3 (ish) months. This might or might not equate to an average.
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It's an average. Look at it this way. This is a bit extreme I know but it makes the point. They slurp out your blood and each of the millions of red blood cells will have a glucose value attached.

Sample one from a person who kinda averages their carb intake over the day then each of the cells will have (roughly the same) level.

Sample two from someone who ULC's all day then does a massive carb fest for their main meal then the majority of the cells will have a low value but some (the ones that will do you harm) will have a very high value. But when you AVERAGE the BG levels across the millions of cells the two samples may have the same AVERAGE glucose level.

So when your average BG is comapred to the HbA1c regression model of other peoples averages both will end up with the same HbA1c even though the person supplying the second sample had a massive spike each day.

smidge said:
2. HbA1c does not really measure spikes. As an LADA sufferer, I can promise you that my after food spikes can be really significant, but my HbA1c is generally in the high 5s. Despite point 1 (above), it sort of averages out.
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Sorry but you should try and minimize your spikes if they are occurring regularly. My understanding is if you spike higher than 7.8 regularly you begin to put yourself at risk. I'm sure someone will correct that if wrong.

smidge said:
3. HbA1c is a measure of general control of diabetes. We know that people with good HbA1cs are statistically less likely to develop complications and we know that good BG control leads to good HbA1cs. Now, whether there is a statistical difference between getting a good HbA1c but having a wide standard deviation from mean and getting a good HbA1c but having a narrow standard deviation from mean is not clear. If we assume there is no difference, then the HbA1c is a perfectly good measure of BG control. If there is a difference, then it is not so good.
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As a measure of general or AVERAGE good or badness I don't disagree at all. All I'm pointing out is that if you weight your carb intake to one time or one meal then if you spike dangerously high at that point it may not be picked up by your HbA1c because of the plain mathematical reasons I've written about how averages work. Look at the "smiley" example on the other thread.

smidge said:
4. If we obsess and stress over the result of every slight variation in our BG measures on different meters or stress over a .5 difference in a very good level, we are actually justifying the NHS response that allowing Type 2s to home test causes them stress and serves no purpose.
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Was stressing over doing two meters not the levels themselves. have got rid of one meter so back to only one. Now I'm not stressing at all and back to testing BG's which is important as that what I find keeps me on the straight and narrow.

Thanks for taking an interest :thumbup:
 
Hey xyzzy!

Agree with some of what you say. Clearly we all need to minimise spikes (although that's not at all easy with LADA). I agree spikes are damaging. However, what I haven't seen any evidence of is whether the HbA1c i.e the amount of glucose attached to the red blood cells, is, in itself, the thing that indicates the risk of complications or whether there is a direct correlation between spikes and complications regardless of the level of glucose attached to the red blood cells. Now, on the whole, the higher your average BG the higher your HbA1c will be, but average BG is not the only factor in an HbA1c as we know. So, I guess I'm asking is the amount of glucose attached the red blood cells the important factor in itself, or is how they got there equally important? I don't believe we currently have an answer to that and for me, that is the crux of the issue as to whether the HbA1c is a reasonable measure of diabetes control. Not sure I've explained that very well, but I know what I mean!

I'll take a look at the other thread later.

Smidge
 
Hey Smidge

The answer is nobody knows according to Phoenix. If you look on the "Insulin Fairies" thread in Type 2 Diabetics he left some useful links.

I'm not claiming to have found any new dangers far from it. All I wanted to do was to show that because of how maths and averages work really high spikes could be recorded each day and not get picked up in a later HbA1c.

Even though its a nobody knows answer at the moment I would recommend people err on the side of caution i.e. don't read what I've written and go GREAT I can get an HbA1c of 5.5% and still spike to 14 on one meal per day if I low carb for the rest of the day.

The answer is you probably could get a low HbA1c and have the big spike every day so if I'm trying to put out an "education" message in all of this it's to take the spike rules everyone knows about and reads all over the place and treat them seriously and to do that you should test BG's two hours after your main meal.

:wave:
 
recieved codefree meter kit today with 100 extra strips. all looks fine and good to go. what a price! as a type 2 i receive strips on script but only 50 per repeat prescription for metformin. Did request 100 before though only 50 prescribed.
I have printed a chart to record extensive daily records on carb intake and results etc over a two week period morning to night.
Using a low carb diet and metformin my levels are pretty good with hb1ac below 7 however i believe it is time for a radical personal review/monitoring-session. I drink wine 4 or 5 nights per week and go out approx 6 times per month for drinks/food/dance/chat. I intend to reduce my wine intake considerably and i know it will impact on my weekly BG levels. I would even guess my wine consumption is a big factor in my levels staying within range which may mean my 2 x 500mg metformin, one am one pm, may no longer be suffient for the task.

As 100 strips now only cost £10 rather than £30.30 i can now go on a blood drilling frenzie.
 
It's about time someone started selling reasonably priced strips. Hopefully the likes of Roche and Bayer will now start to lose their grip on the well-milked udders of the diabetes cash cow. :clap:
 
al_leister said:
As 100 strips now only cost £10 rather than £30.30 i can now go on a blood drilling frenzie.
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:lol: Just take care al_leister just remember the NHS reckon sticking yourself too much can lead to anxiety and depression. I do take that advice quite seriously now after the "doing my head in" stuff that happened when I tried the CodeFree out against my other meter. Wouldn't stop me testing in the slightest but just be aware of the possibility and recognise if you're getting in anyway obsessive.
 
I'm sure for those who are longer diagnosed and perhaps gadget geeks the little codefree would be a bit basic, but for me it's ideal and I love it. It's small enough in it's case to just pop into my handbag, and so easy to use. I wanted to be free to test as much as my fingers would allow without breaking the bank, I can with this. It's been so important for me to feel I have some control over my condition and that I am not being controlled by it.

I have no idea how accurate it is, but it shows me peaks (salad cream today) and I need to know these things, that's why I bought it. I have no desire to upload to the web or anything else, I want to test my BG, record my results, learn what I can and can't eat and stop myself getting any diabetes related complications. The codefree does that all for me.

I have read all the previous posts, and have to admit they make my 'ead hurt. While it make for fascinating and educational reading, I am sure for the vast majority of us (especially newly diagnosed 'us') these figures and 'posh' meters mean little (no disrespect to any previous poster by the way, just my own observation). It may well be as time goes on I will want a meter with more features, but for now, I am more than happy with my wee friend, it has given me control and peace of mind.
 
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