Newly confused

IanBlue said:

Hi,

37 and newly diagnosed Type 2.

I had been trying to lose weight and was s doing well. The sudden increase in weight loss and frequent toilet runs in the night were my big clues!

On diagnosis my H1 bloods were 117 and fast meter readings in the high 20's.

4 weeks ago I was put on Zircon (1 per day) and two metformin a day.

I changed my diet overnight with an emphasis on lower carbs (to mixed results).

My question surrounds my first diabetic nurse meeting and a follow up with a GP this week.

At the nurse meeting another blood test was done and H1 had come down a bit to 110.

My daily testing is recording levels below 6 at all times. I've been asked to check twice a day at differing times.

In the last 7 days my average is 5.9 and today both readings are below 5.

In total this year I have lost nearly 4 stone and have continued this month with 10 lbs.

So....

What should I be asking of the doctor?
Should I be looking at reducing medication?
What was the point of a second H1 test within 2 weeks (I understand it's an indicator of the previous three months)?
With only 2 readings over 7 in two weeks (both after a couple of beers) are my readings good enough to consider diet only approach (this was not offered by GP for obvious reasons)?

I'm baffled by a lot of things, and I wish I had read the section on questions for the nurse before I went.

Anyway... Hi ... I'm Ian.

Click to expand...

Hi Ian and welcome

I suggest waiting for 3 months after the last HbA1c test and seeing what that result is before discussing meds with your doctor/nurse. Well done on your good results!

@daisy1 will be along shortly with your welcome pack.

Hi and welcome,

It isn't unusual to have 2 close together on initial diagnosis as the doctor may have wanted to confirm the first one. I had 2 ten days apart when I was diagnosed.

Your HbA1c tests were both high. I wouldn't consider coming off all meds until your next test, probably in 3 months time and see where you are then, and certainly not without discussing it with your doctor. If you are only testing a couple of times a day, your own averages are fairly meaningless as regards your average blood glucose. They will only give you a snapshot of what you were at the time you tested. They won't tell you what you were an hour earlier or later for example. However, your readings do seem to be very good indeed, and it may be worth asking if you can reduce your meds as opposed to coming off them completely.

Well done on the weight loss, too

@IanBlue

Hello Ian and welcome to the forum Here is the information we give to new members and I hope you will find it useful. Ask all the questions you want and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

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 over 150,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

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

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 bloodglucose 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.

Something wrong with all that. Those testing numbers are not too bad. Sure they could do with some improvement but they don't reflect your Hb at all. 117 and fasting of high 20s, yes ... but under 7s?. No. I would go back for another test. They don't make sense. I reckon you're probably way under 110. Diet and weight loss can help VERY quickly Ian. Not for everyone but they did with me.

It does Ian but it's weighted somewhat heavily to the last month. Someone will shoot me down if I'm wrong but the two figures do not compute. Reckon you have had one massive turnaround

I'm in the 5s with a mmol/mol of under 40. I'm no expert but I'd go back.

Why don't you spend a day or two testing before and after every meal? Personally, I find my peak rises after a meal are at about 90 minutes after my first bite. If this still results in your excellent levels, then ask for another test a couple of months after your last one.

On the day you saw a 7 after a couple of beers, how long after you drank them did you test? Beer is generally known as "liquid bread". It normally shows a sharp rise not long after drinking, then a low whilst the liver is dealing with the alcohol. These lows can be very low in some people. I am just a little concerned you aren't catching your peaks when you test.

IanBlue said:

Is it because the HbA1c shows a three month average rather than "real time" reading?

That's what the nurse told me but that doesn't compute in my none medial brain. How can your blood show anything other than the current state of affairs?

Click to expand...

I'm probably not going to explain this as well as others can, but HbA1c measures changes to the actual red blood cells from the glucose molecules binding to them over a couple of months. A BG level is just a snapshot measurement of the level of glucose in the blood. Hope that helps.

There are certain blood conditions that make the A1c test inaccurate. I'll include a couple of links that may help. You could try asking for a fructosamine test instead.

http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker/
http://care.diabetesjournals.org/content/30/10/2756.full
https://labtestsonline.org/understanding/analytes/fructosamine/tab/test/

I'm surprised your HCPs aren't aware of these issues with the test, though I guess by now I shouldn't be.