Newbie

[Bogart99]

Hi
Been reading a lot but am still unsure. Been told pre diabetic by nurse at surgery. She quoted blood sugar values that do not seem commonly used ie mmol/mol whatever that is.
Everyone else seems to use mg/dL or mmol/L . I did ask why do they just quote a number. Apparently 42 to 48 is pre dianbetic but 49 up throws you in to the type 2 ring.
So being intrigued I thought I would get myself one of these pin prick /slide testers. Found though they quote in the mg/dL mmol/L system. Tried to find a conversion chart, still searching. There seem so many any suggestions as to a good one?
Also was told HbA1c is a measure over last 3 months still unsure how that works. Told blood cells die off after 3 months but still not sure how it can be an accurate average measure.
Sorry if these questions seem a bit dumb.

 

[JoKalsbeek]

Hi
Been reading a lot but am still unsure. Been told pre diabetic by nurse at surgery. She quoted blood sugar values that do not seem commonly used ie mmol/mol whatever that is.
Everyone else seems to use mg/dL or mmol/L . I did ask why do they just quote a number. Apparently 42 to 48 is pre dianbetic but 49 up throws you in to the type 2 ring.
So being intrigued I thought I would get myself one of these pin prick /slide testers. Found though they quote in the mg/dL mmol/L system. Tried to find a conversion chart, still searching. There seem so many any suggestions as to a good one?
Also was told HbA1c is a measure over last 3 months still unsure how that works. Told blood cells die off after 3 months but still not sure how it can be an accurate average measure.
Sorry if these questions seem a bit dumb.

Don't think there is such a thing as a dumb question... It's a quest for knowledge, more like. And it's not the first time these have been posed, so... Welcome to our little corner of the web, and hopefully we can help some.

So, there's two different types of tests. The finger prick, which tells you what your bloods are doing right at that moment. And the HbA1c, which is a fairly accurate measurement of a three month average, weighing more heavily on the most recent weeks. Sadly, those two tests are measured in varying units across the world, which can get very confusing, as you've discovered. So, the finger prick is in mmol/l, and at least the bulk of the UK/European members here will understand those, as well as a HbA1c done in mmol/mol. No need to convert anything, we can read those numbers just fine as they are.

This chart might help some as well.

Some blood glucose testers can also provide a guesstimate of a HbA1c, but that'd mean a LOT of testing, because one or two pricks a day are just not enough data, when blood sugars fluctuate wildly throughout, and for a lot of reasons.

No idea if that helps at all... Do say so if it doesn't, as others here can probably put it a lot more clearly than I can. And if there's other questions, throw them out there and we'll see what we can do.

Again, welcome... And just for the record, you're going to be fine. This is something that can be controlled in whatever way suits you, and you're already asking questions, which is a very, very good sign.

Jo

 

[Bogart99]

Thank you for your prompt reply. That chart is just the sort of thing I tried to find but failed. Thinking of getting a finger prick job from Amazon see what it shows

Dave

 

[Bogart99]

Oh and meant to add on the hBA1c what happened to 47 it goes to 48 after 46?

Dave

 

[JoKalsbeek]

Oh and meant to add on the hBA1c what happened to 47 it goes to 48 after 46?

Dave

Sometimes the chart skips a number, because the other way to measure HbA1c's doesn't do two decimals behind the point, but they do actually exist. That's why a HbA1c in mmol/mol is a little more exact. As for a tester, check the cost of the strips before you order. That's where the running costs lie. I think @Rachox can help you find a meter that would suit, so I'm tagging her into this conversation.

And don't just test randomly, it's a waste of strips and will tell you nothing of use. Test before a meal and 2 hours afterwards, that'll tell you whether your body could cope what you put into it. (Aim for a rise of no more and preferably less than 2.0 mmol/l between the two). Some test in the morning, but the last number to come down is the morning one, as it is more a matter of what your liver dumps into your system, than what you've eaten (or fasted), and that takes a while to reduce. So if you want to check what your fasted numbers are in the am, test them once a month or so.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some with the T2/Prediabetic basics.
Hope it helps!
Jo

 

[Bogart99]

Hi
Many thanks for the info.
Will keep you informed.

Dave

 

[Rachox]

Hi @Bogart99 , thanks for the tag @JoKalsbeek , here’s some info with links for UK meters, and to be clear I have no commercial connections with any of the companies mentioned.



HOME HEALTH have the Gluco Navii, which is a fairly new model and seems to be getting good reviews.

https://homehealth-uk.com/all-produ...ose-meter-test-strips-choose-mmol-l-or-mg-dl/



Links to the strips for future orders:

https://homehealth-uk.com/all-products/glucose-navii-blood-glucose-test-strips-50-strip-pack/



Then they sell the older SD Code Free, details to be found here!

https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/





SPIRIT HEALTHCARE have a meter called the Tee2 + which is quite popular:

https://shop.spirit-health.co.uk/co...e2-blood-glucose-meter?variant=19264017268793



The strips are to be found here:

https://shop.spirit-health.co.uk/co...py-of-tee2-test-strips?variant=19264017367097



If there is a choice of units of measurement then ‘mmol/L’ are the standard units in the UK, ‘mg/dl’ in the US, other countries may vary.



Don’t forget to check the box if you have diabetes so you can buy VAT free. (for all meters and strips)

 

[KennyA]

Hi
Been reading a lot but am still unsure. Been told pre diabetic by nurse at surgery. She quoted blood sugar values that do not seem commonly used ie mmol/mol whatever that is.
Everyone else seems to use mg/dL or mmol/L . I did ask why do they just quote a number. Apparently 42 to 48 is pre dianbetic but 49 up throws you in to the type 2 ring.
So being intrigued I thought I would get myself one of these pin prick /slide testers. Found though they quote in the mg/dL mmol/L system. Tried to find a conversion chart, still searching. There seem so many any suggestions as to a good one?
Also was told HbA1c is a measure over last 3 months still unsure how that works. Told blood cells die off after 3 months but still not sure how it can be an accurate average measure.
Sorry if these questions seem a bit dumb.

What you've been told above is correct. The HbA1c doesn't measure your blood glucose, and it's not an average. It counts the numbers of red blood cells at the point of test that have at some point had a glucose molecule attached to them. The majority of the non-diabetic population has a BG level of around 38 mmol/mol HbA1c, and almost everyone (non-diabetic) has a HbA1c somewhere between 36 and 42 (graph attached).

The fingerprick test measures your blood glucose at the point of testing. The constant glucose monitor, which stays fixed to you and gives a constant readout, measures glucose in interstitial fluid rather than blood.

This all means that it's a bit difficult making predictions from one test to the other. But the newer IFCC HbA1c in mmol/mol is the one used in the UK and most of the world, it's just that the USA hasn't moved on from the older system (so the internet gets even more confusing) and many docs in the UK still use the older percentage etc measurements they're familiar with.

As RBCs live around three months, the HbA1c can give a picture of how your blood glucose has been over about the last three months, skewed heavily towards the most recent month. It isn't perfect and some other conditions (such as pregnancy or anaemia) can affect the result. Some people's RBCs live longer than the norm, and that affects it too. But it's good enough for most of us most of the time.

The 48 level was chosen round about 2008 as the level at which a patient would automatically be diagnosed as diabetic (Type 2) even without symptoms. The idea was that it would be a backstop, and 48 was chosen because diabetic retinopathy is rare at lower levels but increases in incidence once past that level. Unfortunately many of us have experience of being refused a diagnosis, even with a number of clear diabetic symptoms, because our blood sugars "weren't high enough".


Best of luck. Keep asking questions.

Info from Bilous and Donnelly's Handbook of Diabetes

 

[Bogart99]

Hi
Thanks for the reply. Until the nurse told me I was prediabetic, think she quoted 42 I had no idea about all this stuff. Even now I am confused by all the different measuring systems but I have a least the chart downloaded from JoKalsbeeks message to do some cross referencing.

 

[Bogart99]

Right an update I have bought the Gluco Navii and have got a Freestyle Libra2 on free trial.
Not used either yet, not yet read instructions. What I did notice was that the Navii comes ithe only 10
lancets and strips. I duly ordered 100 more strips assuming incorrectly that they would come with 100
lancets, wrong so need to order a few more of those. I found odd kit only comes with 10. I see there are two sizes 28g and 30g ones is their any preference?

 

[Bogart99]

Now more questions I thought best to list separately so any replies only need address one question.
It is all about food namely carbs. Nearly everywhere says avoid carbs. Okay so I started looking avidly at food labels. So what I do not understand is one is told to avoid say pasta. Now looking in the kitchen cupboard we have various pastas. The carbs range roughly around 32/33g per 100g but state of which sugars 0.5g to 1.3g. So am I missing the point here and do the 32/33 g get converted into 32/33g of sugar? If not 0.5g to 1.3g does not look too bad to me.
Again I read avoid normal flour and use almond or coconut flour. I am finding their carb content not much less than normal wholemeal flour.
Confused you bet I am.

 

[TheSecretCarbAddict]

Now more questions I thought best to list separately so any replies only need address one question.
It is all about food namely carbs. Nearly everywhere says avoid carbs. Okay so I started looking avidly at food labels. So what I do not understand is one is told to avoid say pasta. Now looking in the kitchen cupboard we have various pastas. The carbs range roughly around 32/33g per 100g but state of which sugars 0.5g to 1.3g. So am I missing the point here and do the 32/33 g get converted into 32/33g of sugar? If not 0.5g to 1.3g does not look too bad to me.
Again I read avoid normal flour and use almond or coconut flour. I am finding their carb content not much less than normal wholemeal flour.
Confused you bet I am.

There are different types of carbohydrates. I like to think about these in following categories: simple carbohydrates, complex carbohydrates, fibre, and sugar alcohols. Our body digest most of these into blood glucose which is then used to fuel our bodies. The type of carbohydrate will determine how quickly and how much of it will be turned into blood glucose. Sugars are simple carbohydrates and will be converted into blood glucose very quickly and spike your blood glucose pretty immediately, complex carbohydrates (usually the part that is not called out as sugar on labels) will take longer to digest but will still be converted into blood glucose. Fibre is usually called out separately as, while it is a carbohydrate, it does not get digested and turned into blood glucose and sugar alcohols (most artificial sweeteners fall into this category e.g., xylitol, erythrol, etc.) will have some or no impact on your blood glucose (my rule of thumb is to count these as 50% of advertised carbs unless I'm using erythrol which is not counted). So, when you look at your food labels what matters is not just sugar, but total carb count (except fibre).

Our bodies are quite individual in terms of how they respond to different items of food, and this is where testing comes in. You monitor impact of different meals either via CGM or via glucometer by testing just before meal and around 2h after to see your body's response to what you have eaten. If your blood glucose levels spike and stay up the type or amount of food is not right for you if you want to manage your blood glucose via diet.

For many of us who are either in remission or want to minimise the medication taken the reality is that the amount of carbs our body will tolerate is quite low (20-30 grams a day or even less for some).

 

[TheSecretCarbAddict]

Just to add to the above. You might have heard about Glycemic Index (GI) and/or Glycemic Load (GL). These are indexes that describe expected impact of carbohydrates on your blood glucose. GI looks at the impact of a standardised portion of carbs while GL allows you to calculate impact of the specific amounts of specific food you are consuming. It might be useful to look and compare these metrics for different foods (you can find info online + there are different mobile apps available). The downside is that a) this information is only available for ingredients rather than whole meals and b) this is a generalisation only and your body might react to different foods differently.

Once you start getting into nitty gritty you might find that what you eat with your carbs (how much and what type of protein/fat) and how you eat your meals can also have an impact on your blood glucose.

 

[Bogart99]

Yes I can see the indivual effect as we are not all the same. So reading from what you said I assume then that the carb fig od which sugars figure is not the end of the matter and the rest of the carbs go to sugar at some point in time. If so your idea of 30g of carbs a day makes sense as seen and read that one should limits ones sugar intake to no more than 35g a day, ie one can of coke.

 

[TheSecretCarbAddict]

Yes I can see the indivual effect as we are not all the same. So reading from what you said I assume then that the carb fig od which sugars figure is not the end of the matter and the rest of the carbs go to sugar at some point in time. If so your idea of 30g of carbs a day makes sense as seen and read that one should limits ones sugar intake to no more than 35g a day, ie one can of coke.

Yes, it is the net carbs that matter the most (total carbs less fibre and you might choose to discount sugar alcohols) as they will be all converted into blood glucose. My intake of carbs comes mostly from green leafy vegetables, avocados, nuts, berries, etc. I've cut out all grain products, starchy vegetables (potatoes, carrots, etc.), sugary fruit (bananas, mangoes, or pineapples), lots of dairy and plant alternative products with high carb content. Foods with up to 5g carbs per 100g are on my safe list, up to 10g per 100g on my use sparingly list, and above 10g per 100g on my avoid list.

But it gets even more complicated. Protein and fat in our food also can be converted into blood glucose albeit slower and through different mechanisms than carbs. These mechanisms are less impactful than managing carbs so won't go into these at this time, but something to explore if needed once you have worked out the carb side of things.

 

[Bogart99]

PLus there is so much incorrect, or conflicting info out there. For example this is supposedly from West Sussex health trust. I would say there is quite a bit wrong with this.

 

[Bogart99]

Sorry no idea why is listed twice. I am not overly confident in my GP practice either. For example getting blood pressure taken.
Many moons ago went for BP test and told was high, 'but that is to be expected most people's BP is high when they come to the surgery'.
So my reaction why why do it and put the shivers up people. I bought the same machine as the surgery use. One fact it makes plain in the
usage instructions is to rest for at least 5 minutes before taking a reading, no talking no moving. Has that ever happened at my surgery? No!
Checking at home I am fine. Well not in the 120/80 group, not far off mind. But as one gets older ones BP rises so how this magic 120/80 is meant
to cover everyone now is ludicrous.

 

[TheSecretCarbAddict]

The approach I take to my health is that a) I own it, b) I stay curious and question everything (including healthcare professionals and also my own perceptions) and c) use the wealth of information available these days + tools to measure feedback from our bodies to see what works for me and stick to it.

Going low-carb has not only meant I'm off most of my diabetes medications, but I have also improved my weight, BP, cholesterol... why would I go back to 'official' advice when it never worked for me? That is not to say it is right or wrong in general, but that it is wrong for me and how my body functions.

 

[KennyA]

PLus there is so much incorrect, or conflicting info out there. For example this is supposedly from West Sussex health trust. I would say there is quite a bit wrong with this.

View attachment 67995View attachment 67995

What you've got here is essentially the "Eatwell Plate" dietary advice that's still officially handed out to everyone by the NHS. It's got nothing to do with preventing or managing diabetes and was supposed to be a diet that would reduce heart disease.

Unofficially, large parts of the NHS are moving away from this sort of thing as (in my view) it's contributed greatly to the rise in diabetes and obesity, which brings a large number of other problems along. My "welcome to diabetes" course in 2020 had a nurse promoting the Eatwell approach, and a dietitian who was 100% for low carb.

Personally, I abandoned taking dietary advice from the NHS (and 99% of the media) four years ago. I have friends who cannot understand why, given I'm eating lots of "all the wrong things" I have shed ~six stone and am in diabetic remission.

 

[Bogart99]

So your the perfect example to use common sense relating to oneself. I do watch some of the youtube videos and one following another states the exact opposite of the previous one! I do think though that the American Diabetic Association has it all wrong, grossly wrong. Not sure if they have a hidden agenda somewhere.