Newly diagnosed

[KennyA]

I’m not sure if i should open a new thread to ask a different question but if i am please to educate me. Also thanks all for the great help you have been so far..

Since learning that i am diabetic 5 months ago i have stuck to a breakfast of porridge and half a banana with almond milk (35g carb) my last HbAc1 was 46mmol/mol with this diet. I’ve heard a few say that they cant do porridge and I’ve not tested this one a lot. I tested this morn. I started with a fasting of 5.2mmol/l (which i think translates to uk measure of 96mg/dl) and 2 hrs later I’m at 8.2mmol/l (149mg/dl) this sounded high. I’ve normally been doing my second reading of the day before lunch which is usually at 5.6mmol/l, 4hrs after breakfast.

I remember reading a thread from a link that Jo posted, no more than a 2 point rise.
One side of my logic is saying I’ve got almost down to pre diabetic on a HbA1c with this diet and the other voice is saying is this effecting the rest of my day figures?

Do i have like a limit on what my insulin produces in the morning and the rest of the day runs from this bucket as such?

Am i putting excess problems on my pancreas/kidneys to produce or come down? With a reading of 8.2.

I’ve watched a video on diatribe (which i am not sure about because it’s American and can be different information) and it said that the rise is between 4-11mmol/l 2hrs after?
UK NICE website saying under 7.8

Which figures do i need to be aiming for.?

Sorry if the figure values that i measure in are all over the place. Still trying to configure to UK values.it feels like that metric and imperial balance going on in my head.

What are the figures i need to be aiming for 2hrs after a meal so my time in range is better or is this norm/ok as diabetes goes?

Is 3/4hrs too long out of range?
Thank you…

I think you're OK, it's all "newly diagnosed stuff". UK these days uses mmol/l for fingerprick tests, and mmol/mol for HbA1c. Some GPs still seem to use percentages, and the US appears to use both mg/dl and percentages, so it can be confusing.

Testing before and two hours after a meal is intended to give you the blood glucose impact of the meal. For those who are not T2 diabetics, the insulin response should ensure that the BGs have returned to baseline-ish by that time. Hence the " a rise of not more than 2mmol/l and not above 7.9" is recommended in the UK - so your body's insulin should (after two hours) have brought you back below 7.9 and within 2 of where you started. If it hasn't, that means that there were more carbs in the food than your system can cope with.


On that basis your breakfast didn't pass either test. You had a rise of more than 2, and you weren't back below 7.9 after two hours. I'm not surprised - porridge and bananas are full of carbs and sugar, and it isn't unusual to have that sort of response to at least 35g carbs. I'd have a similar result, probably - I haven't eaten either porridge or bananas for over three years. With your last A1c being 46 you have had some reduction to non-diabetic levels, you're obviously doing well elsewhere.

Note - everyone's blood glucose goes up and down all the time, in response to a large number of things. Problem for T2s is that we are insulin resistant so our BG potentially goes up higher and stays up longer than it would for non-diabetics. High blood sugars over time cause physical damage.

It's not usual to have a direct test of insulin in the UK - there is one, usually called the Oral Glucose Tolerance Test (OGTT) but I've not had one and it seems only a few have. However, it's possible/likely that our pancreas pumps out insulin at increasing levels to try to deal with elevated blood sugars. Producing insulin at higher and higher levels could overload the pancreas - you'll find discussions around "the beta cells being burned out" elsewhere on these forums. It does lead to some T2s being unable to produce enough insulin, and needing to inject.

You can't really "aim" for a particular figure because our bodies don't work that way. The liver has a habit of dumping glucose into the bloodstream when it think you might need it: so sometimes the first reading in the morning can be the highest you'll see all day. Illness, stress, exercise, ambient temperature and many other things have been reported as having an impact, in addition to what you eat and drink.

The overall goal is to lower your blood glucose (ideally to "normal" levels) so you don't have any damage - so if pushed I guess that's an A1c not higher than 42.

 

[Caz141]

I think you're OK, it's all "newly diagnosed stuff". UK these days uses mmol/l for fingerprick tests, and mmol/mol for HbA1c. Some GPs still seem to use percentages, and the US appears to use both mg/dl and percentages, so it can be confusing.

Testing before and two hours after a meal is intended to give you the blood glucose impact of the meal. For those who are not T2 diabetics, the insulin response should ensure that the BGs have returned to baseline-ish by that time. Hence the " a rise of not more than 2mmol/l and not above 7.9" is recommended in the UK - so your body's insulin should (after two hours) have brought you back below 7.9 and within 2 of where you started. If it hasn't, that means that there were more carbs in the food than your system can cope with.


On that basis your breakfast didn't pass either test. You had a rise of more than 2, and you weren't back below 7.9 after two hours. I'm not surprised - porridge and bananas are full of carbs and sugar, and it isn't unusual to have that sort of response to at least 35g carbs. I'd have a similar result, probably - I haven't eaten either porridge or bananas for over three years. With your last A1c being 46 you have had some reduction to non-diabetic levels, you're obviously doing well elsewhere.

Note - everyone's blood glucose goes up and down all the time, in response to a large number of things. Problem for T2s is that we are insulin resistant so our BG potentially goes up higher and stays up longer than it would for non-diabetics. High blood sugars over time cause physical damage.

It's not usual to have a direct test of insulin in the UK - there is one, usually called the Oral Glucose Tolerance Test (OGTT) but I've not had one and it seems only a few have. However, it's possible/likely that our pancreas pumps out insulin at increasing levels to try to deal with elevated blood sugars. Producing insulin at higher and higher levels could overload the pancreas - you'll find discussions around "the beta cells being burned out" elsewhere on these forums. It does lead to some T2s being unable to produce enough insulin, and needing to inject.

You can't really "aim" for a particular figure because our bodies don't work that way. The liver has a habit of dumping glucose into the bloodstream when it think you might need it: so sometimes the first reading in the morning can be the highest you'll see all day. Illness, stress, exercise, ambient temperature and many other things have been reported as having an impact, in addition to what you eat and drink.

The overall goal is to lower your blood glucose (ideally to "normal" levels) so you don't have any damage - so if pushed I guess that's an A1c not higher than 42.

Thank you for the reply Kenny. I think if today is anything to go by then i need to re look at my breakfast plans. Or repeat again tomorrow to just see if it is the same. Poss cut the banana. This is my highest meal of carbs through the day . I guess this would be an example where the HbA1c test doesn’t show the pit falls that the finger prick does.

 

[KennyA]

Thank you for the reply Kenny. I think if today is anything to go by then i need to re look at my breakfast plans. Or repeat again tomorrow to just see if it is the same. Poss cut the banana. This is my highest meal of carbs through the day . I guess this would be an example where the HbA1c test doesn’t show the pit falls that the finger prick does.

The HbA1c gives you a rough average of the last three months. The fingerprick is a "right now" snapshot. Adding up all the fingerpricks and averaging them will not necessarily predict your HbA1c, because you haven't tested what you haven't tested.

Having said that, if all your post meal readings are complying with the "not up more than 2 and not more than 7.9" I would be surprised if the A1c isn't somewhere better at next test.

 

[Caz141]

Just tried out the hi-low bread that someone suggested on here. I tested on one slice yesterday with readings of [email protected] and aft @5.1mmol/l (8g carb)which i thought was a good rise. I pushed my luck today with readings [email protected] and aft 6.5 (13g carb)My thoughts are on the high end but still below the 7 mark? The foods put with each meal were similar and normally don’t cause an issue, other than the extra bread…would this be a no no on 2 pieces or am i just splitting hairs and being too OCD?
Is there a reason that diabetic uk is 7mmol/l after a meal and the NHS figures are 8.5-9, 2 hrs aft meal?

 

[catinahat]

Is there a reason that diabetic uk is 7mmol/l after a meal and the NHS figures are 8.5-9, 2 hrs aft meal

If you have got the 7mmol after a meal from here https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing it is a different site to this one. You would need to ask Diabetes UK why they chose that figure. I think this site diabetes.Co.Uk recommends the Nice guidelines which are for T2, 4-7 pre meal and under 8.5 after, and for T1's 4-7 pre meal and 5-9 after.
I read somewhere that damage starts to occur at levels over 7.8mmol, so that is my personal upper limit

The foods put with each meal were similar and normally don’t cause an issue, other than the extra bread…would this be a no no on 2 pieces or am i just splitting hairs and being too OCD?

Your readings look fine to me, don't forget that the meters just give an idea of our sugar levels, your 4.4 could have actually been 5 something and your 6.5 afterwards could easily have been a 6 or even lower in reality. The meters are only accurate to 15% either way so it's just not worth getting too focused on the actual numbers.
That's why we give ourselves a 2mmol buffer, the equipment we have is just not accurate enough to work to decimal places.

 

[HSSS]

I started with a fasting of 5.2mmol/l (which i think translates to uk measure of 96mg/dl) and 2 hrs later I’m at 8.2mmol/l (149mg/dl) this sounded high.

The uk use mmol/l and the USA mg/dl for fingerpricks. Most people on this site use mmol/l. It might be best as it’s still confusing to stick to whatever your meter says (I’m not even sure at this point which that is lol) but include the units (or at the very least make clear it’s a fingerprick) otherwise it’s going to keep getting mixed up.

Another option is to divide mg by 18 to get mmol or multiple the other way around - only between blood glucose fingerpricks though as it doesn’t work for hba1c’s. I’d ignore charts that give equivalence between average blood glucose levels and hba1c as it confuses so many people early on and they try and use it for a single blood glucose reading which doesn’t work and isn’t really that useful as a result. So just use the top half of @KennyA image to compare the two types of hba1c and forget the bottom bit.

we aim for a rise of less than 2mmol at 2 hrs in order to mimic a normal non diabetic response which is generally back to pre meal at that time. You need that second reading to assess your response to the food. 4 hrs is too late unless you‘ve also been watching all along to see how long a long last high reading takes to return to normal.

So a rise of 3 is a bit too much. Not awful but not the best. It’s also an aim to be back under 7.8mmol at this time (once under control anyway) as that’s the point of diagnosis and it was set there because thats the point the risk of harm from high blood glucose ramps up at. So again slightly high.

But it’s early days and meters aren’t perfect. I’d not choose to have that porridge breakfast and if I was determined anyway I’d drop the addition of a banana for sure.

As to levels to aim at my goal is to aim for normal rather than prediabetes or “ok for a diabetic” levels (as I want a normal lack of complications not prediabetic or diabetic ones). Here are the levels https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html.

 

[HSSS]

It's not usual to have a direct test of insulin in the UK - there is one, usually called the Oral Glucose Tolerance Test (OGTT) but I've not had one and it seems only a few have.

That tests blood glucose not insulin. It used to be standard before hba1c was a thing and is still used when hb1ac might be inaccurate.

There is a fancier version (HOMR-IR I think) which adds insulin measurements too and give an insulin resistance result but that’s like rocking horse poo or quite expensive privately.

 

[Caz141]

If you have got the 7mmol after a meal from here https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/testing it is a different site to this one. You would need to ask Diabetes UK why they chose that figure. I think this site diabetes.Co.Uk recommends the Nice guidelines which are for T2, 4-7 pre meal and under 8.5 after, and for T1's 4-7 pre meal and 5-9 after.
I read somewhere that damage starts to occur at levels over 7.8mmol, so that is my personal upper limit

Your readings look fine to me, don't forget that the meters just give an idea of our sugar levels, your 4.4 could have actually been 5 something and your 6.5 afterwards could easily have been a 6 or even lower in reality. The meters are only accurate to 15% either way so it's just not worth getting too focused on the actual numbers.
That's why we give ourselves a 2mmol buffer, the equipment we have is just not accurate enough to work to decimal places.

Thank you for putting that into perspective for me.
I’m getting easier/relaxed on reading the figures but not quite got there yet.

 

[HSSS]

Is there a reason that diabetic uk is 7mmol/l after a meal and the NHS figures are 8.5-9, 2 hrs aft meal?

7.8 after a meal is diagnostic level of no longer normal response.
8.5 - 9 is the level they think will do, considering you are sick with a “progressive disease” and they don’t believe most people will/can do much better so want to set “achievable“ goals. Unambitious could be another word used. Self fulfilling another.

 

[Caz141]

That tests blood glucose not insulin. It used to be standard before hba1c was a thing and is still used when hb1ac might be inaccurate.

There is a fancier version (HOMR-IR I think) which adds insulin measurements too and give an insulin resistance result but that’s like rocking horse poo or quite expensive privately.

Thank you hsss . The measurements are confusing I keep thinking I’ve got it to realise I’ve not lol. I will keep in mind when quoting the finger prick measurement’s.

 

[Caz141]

Thank you hsss . The measurements are confusing I keep thinking I’ve got it to realise I’ve not lol. I will keep in mind when quoting the finger prick measurement’s.

Thanks for info on banana also, I’ve already removed this and lowered the potion size of the porridge. Much better reading. Another breakfast that came from the NHS which I’m starting to learn lots from, not! Have started to look on the forums here what are good breakfasts. Learning.

 

[MrsA2]

And remember as your body relearns to use food appropriately it may tell you to only need 1 slice of bread not 2, or even none! Carb numbers and bg are useful when learning and adjusting but fade into the background as your new way of eating becomes your new normal.

 

[Caz141]

Another question i have .
At present I’m testing 2 hrs after my first bite. Most meals are 1hr long as i have issues with my throat. So this means it only has a 1 hours break from the carb intake.

Would this make a difference on where i test?

Is an hour long enough to tell me what it is going to rise to or on the odd occasion fall…

I’ve reads a mixture of information on first bite or last bite testing? Another confused dot com!!!

 

[HSSS]

Another question i have .
At present I’m testing 2 hrs after my first bite. Most meals are 1hr long as i have issues with my throat. So this means it only has a 1 hours break from the carb intake.

Would this make a difference on where i test?

Is an hour long enough to tell me what it is going to rise to or on the odd occasion fall…

I’ve reads a mixture of information on first bite or last bite testing? Another confused dot com!!!

I’ve always done 1st bite. That’s what kicks off your insulin response. However so long as you are consistent it wouldn’t worry too much as the trends will still be there.

 

[catinahat]

Another question i have .
At present I’m testing 2 hrs after my first bite. Most meals are 1hr long as i have issues with my throat. So this means it only has a 1 hours break from the carb intake.

Would this make a difference on where i test?

Is an hour long enough to tell me what it is going to rise to or on the odd occasion fall…

I’ve reads a mixture of information on first bite or last bite testing? Another confused dot com!!!

The whole point of testing is for you to get information to help you manage your health. You need to come up with a method that suits you. You don't have to stick rigidly to what you read here or anywhere else.
Although the pre meal test is kinda set in stone, because you need to know what your base level is. The other tests are up to you, you could test every half hour until your level returned to base level if you wanted to. Your fingers would be like pin cushions but you would have a complete understanding of what that meal does to your blood sugar.
If you don't learn something from a set of tests, it's a waste of your time and strips, so if you're not sure that the 2hr test is giving you the full picture, test again 30min later, see if it's higher or lower than the 2hr one. If it's higher then you haven't caught the peak yet, maybe another test 30min later.
I know it sounds like a lot of faff doing so many tests, but within a few weeks you will have tested and have a pretty good understanding of most of your regular meals.
If you have tested a particular meal two or three times and found it to be OK there is no need to keep testing it, there is no point, you won't learn anything new.
The only testing I do now is a few random days in a month, I will test all my food just to make sure nothing has changed, and very occasionally I come across something I haven't had before so will test to see if I will ever have it again.

 

[Caz141]

Hi all
It’s me again.
Does anyone on here log there food on a app like my fitness pal or noom or similar?

I hear you all say healthy fats, eat more of but I’m now at the stage of what is a healthy portion of fats in a day.
Today i was at 118g of fat, 78g of that in unsaturated.
The rest between polyunsaturated fat and mono fat.
Generally this is where I’m registering each day.
Is that too much or is this a god can answer question?

I know that fat around the organs is one of the things that doesn’t help with diabetes. My carbs each day are still around the 50g mark.
My calories are still well below and i am starting to gain the weight slowly which is a good thing to reach a healthy weight as long as I’m not consuming too much fat in the process.

How do you all gage what is a healthy amount or is it just years of practice and reflection?

Then there is the cholesterol limit that seems to be over on my diet also? Which comes mostly from the eggs or almond bread in my diet.

Do i just go with these are the lesser of the 2 evils in comparison to where my diet was which was Totally overloaded on unhealthy fats and carbs.
A vast improvement.

Is this another one of those things i will just eventually know myself like I’m beginning to know on carbs but only because I’m doing the BG tests. How do i gage fats other than a blood test which doesn’t get done often enough through the doctors.

Really trying not to gain any more problems as much as i can. I’m feeling The ying yang effect…take something out but not sure if I’m putting the right in replace of. BG FP test figures are coming out quite level between 5-7

Thanks for being there and giving me different ideas and ways to look at things. It is greatly appreciated

 

[Lobsang Tsultim]

According to a couple of check-ups both my blood pressure and cholesterol levels came down to normal levels when I started controlling my carbs. I didn’t worry about getting my macro levels spot on according to some plan, I simply reduced my carbs to less than 30g a day and ate so I didn’t feel hungry. Sometimes, I’d skip a meal because I wasn’t hungry. Other times I’d have 3 meals and snacks in between because I was. Complicated tracking isn’t for me, I just try to control my carb intake and let my body regulate the rest.

 

[HSSS]

Keep it simple As lobsang says above. Keep the carbs low. Eat fats that occur naturally (nor the marg/veg/sunflower type oils that are heavily processed and have way too many omega 6’s). Eat til you are full. As you need to gain weight that’s all for now. Some people eat 80% or 90% fats. The app might have a setting for keto or low carb. Take a look.

 

[Outlier]

Easy way to see healthy fats is to stick with single source - so: butter, olive oil, fats that come attached to meat, oils that come from inside the fish, cream that sits on the top of milk or is taken directly from it with nothing added or removed.

 

[Caz141]

According to a couple of check-ups both my blood pressure and cholesterol levels came down to normal levels when I started controlling my carbs. I didn’t worry about getting my macro levels spot on according to some plan, I simply reduced my carbs to less than 30g a day and ate so I didn’t feel hungry. Sometimes, I’d skip a meal because I wasn’t hungry. Other times I’d have 3 meals and snacks in between because I was. Complicated tracking isn’t for me, I just try to control my carb intake and let my body regulate the rest.

Thank you for the help lobsang and i hope one day that once i get a grips on the right foods for me to eat i will look at the figures less and watch them fall into the back ground. It’s all a very different learning curve but learning.