Testing blood glucose

Scott-C said:

One of the key points to understand, which I think applies to everyone whether T1, T2, pre-diabetic or muggle is not so much the carbs but the rate at which carbs are absorbed into the blood stream. Bit of cake, whoosh, straight into your blood, spike. Brown rice with it's fibre mixed with the fat and protein from the fish breaks down slowly, no spike.

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The problem with this, for diet only (and Metformin) T2's and pre-diabetics is that the brown rice, although taking a lot longer to break down fully, still breaks down. The glucose still gets produced. The spikes may be lower, and that is fine, but the levels stay up above normal base levels a lot longer. I agree that plenty of fat will bind and keep levels lower, but still longer above base. The good thing about this is the deviation above the median is a lot less, and this is very good and to be aimed for, but the base levels may well be higher as by the time of the next meal (or snack) the pre-meal level will be higher as they haven't yet returned to base.. If that makes sense!

Bluetit1802 said:

The problem with this, for diet only (and Metformin) T2's and pre-diabetics is that the brown rice, although taking a lot longer to break down fully, still breaks down. The glucose still gets produced. The spikes may be lower, and that is fine, but the levels stay up above normal base levels a lot longer. I agree that plenty of fat will bind and keep levels lower, but still longer above base. The good thing about this is the deviation above the median is a lot less, and this is very good and to be aimed for, but the base levels may well be higher as by the time of the next meal (or snack) the pre-meal level will be higher as they haven't yet returned to base.. If that makes sense!

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Hmm, fair point, shouldn't have expressed it in the context of an 80g meal, but I still think that the point about considering the absorption rate/GI holds true for any size of meal and any type of person.

From a T1 point of view, it's something I'll think about when deciding how far in advance to pre-bolus.

I've been paying a lot of attention to variability since getting the libre. I've been following the various Westminster and Holyrood petitions for getting cgm on the NHS, and the government responses seem to be NICE guidance is that hba1c is fine so no need. I've not yet been bored enough to check out the studies which led NICE to that view, but it seems to me at first glance that they're kind of missing the point. Hba1c is an average so you could have two people with the same a1c, but one is tightly controlled and the other has lots if lows and highs but it still averages out at superficially good. Cgm, though, whether through AGP or daily graphs shows swings in a way which a1c just doesn't. Pretty much everything I've read suggests that swings/variability is damaging, so how governments can say that a1c is good enough without the depth of information an AGP provides is frankly beyond me.

@Scott-C I totally agree. I use the Libre myself and there is nothing like seeing my levels like small wavy lines close to the median. Much better than the big bump after my Sunday dinner sometimes.

This is one reason why the HbA1c is not a reliable marker for good control. It is useful for diagnosis, but that's about all, in my opinion.

It's great you have been caught early and have the opportunity to get to grips with it all and it is fab that you are testing your blood glucose levels.

As you can see from my signature I have been up and down over the 6 years but reducing carbs really helped with the blood glucose and weight loss.

Tagging @daisy1 for some new member info for you. This really helped me and there is lots of support and information on the forum.

Bluetit1802 said:

@Scott-C I totally agree. I use the Libre myself and there is nothing like seeing my levels like small wavy lines close to the median. Much better than the big bump after my Sunday dinner sometimes.

This is one reason why the HbA1c is not a reliable marker for good control. It is useful for diagnosis, but that's about all, in my opinion.

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These are interesting times. I remember using colour changing strips before meters came in. I can't recall whether there was the same political fuss about the cost of them as is going on now about meters/cgm. Any old timers out there who remembers?

I've got a lot of respect for doctors but they can be a conservative bunch. I don't think they really know that much about AGPs at the moment. Even if they do, I don't think the usual 10 to 15 minutes we normally get for a consultation allows more than a cursory glance at the 24/7 analysis we all do as a matter if course. I'm comfortable ignoring most suggestions my doctor makes to me, on the basis that senior consultants have told me that with a self treated condition he might have the letters after his name but he is a "book" diabetic and knows f..k all about the cold, harsh realities of it.

I was thinking about starting a thread on experiences of taking AGP graphs along to check ups.

As an example, I took my 3 month AGP and dailies along to my last hospital check up.

The 25th to 75th percentile are all sitting happily between 4.7 and 7.8 all the time, the post-noon 10th to 90th percentile are pretty tight too, but midnight to noon are out of range more than I'd like.

Daily graphs show that this is more than likely because as a Scottish middle aged male, I am required by law/custom/peer pressure (and to be frank, just enjoying it!) to go out for a few beers at the weekends and I'll either over or under bolus for that, so I'll need to start paying more attention to that.

So, I explain this analysis to the doc. Her response? Lower your basal. ***? I've got reassuringly straight lines overnight during the week, and, indeed, even at the weekend when I've not messed up bolus, so it's obviously a bolus weekend situation, not basal, so why on earth is she telling me to lower my basal? She sees god knows how many Ts each day. Can I expect her to pay attention to people turning up with 30 pages of dailies? Is the NHS just hard wired into avoiding hypos at all cost even though higher levels aren't good?

Coincidentally, had a GP check up too shortly after that. After the usual, "no, I don't want a flu jab, because I've never had flu." routine, I ran the AGP graph past her. Response was it's great to get this amount of information. But she gave it a glance. Barely looked at it.

Actually, reading that back, I'm revising my initial view that I respect doctors. They're idiots. I was feeling ill going through my finals, all the usual T1 stuff, tired, weight loss, drinking, peeing, thought I'd stick it out and go see a doctor at the end. Dad came to pick me up, took me straight to hospital, diagnosed as, "exam stress and thrush in the mouth", dad gave me a sly look about the latter implying where's your mouth been, was sent home. Was taken back to hospital next morning DKA, unconscious, came round after a day after parents being told it's 50/50. One of the lab technicians by coincidence is a family friend, told us later that the consultant in charge of the junior medic who'd sent me home yelled him out to the point he needed some medical attention himself. It was along the lines of, "the most obvious case of diabetes ever and you sent him home, you useless little f...er!". Still, it all ended well, I got out alive, after some careful attention from an Italian nurse which is pretty much everything a 21 year old could ask for, and the consultant was quite pleased because he'd seen me doing some Kussmaul breathing instead of just reading about it in books.

marlene11040 said:

I have absolutely no idea what you're talking about!

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Oops, sorry, I've rarely any idea what I'm talking about either, I just waffle on!

There was two main points.

First, some foods like cake, potatoes, bread, rice, biscuits, break down quickly into glucose and end up in your bloodstream, raising your blood sugar very quickly to too high a level, which is generally a bad thing because too much glucose in your bloodstream puts a lot of pressure on small blood vessels, which is why T1s and T2s can end up going blind, having limbs amputated, having their kidneys fail. Sorry if that sounds harsh, but that's the reality of it. The idea of losing my sight was the main reason why I've paid a hell of a lot of attention to managing my levels well. What my earlier post was saying is that carbs aren't really as bad as some people make out but there are some carbs which are better than others. Brown bread, brown rice, brown pasta, oatmeal, barley have more fibre in them so when they break down into glucose, it's a slow trickle instead if a rush which tends to be more manageable than the white versions. The problem you've got is that while some are happy with a certain level of carbs, others regard them as the spawn of the devil, so you'll just have to make up your own mind whether it's ok to have an omellete with or without toast.

Second point was about blood testing. There's a lot of politics going on at the moment about whether a thing called cgm should be on the NHS or not. Blood testing shows your sugars at that point in time. Cgm measures levels continuously so you can see where it's been and where it's going. ****, phone's now down to 5% percent so will have to waffling!

@marlene11040

Hello Marlene and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as 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 well over 147,000 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.

Scott-C said:

It's quite common for T1s to need a bit more insulin in the morning compared to later in the day for the same amount of carbs. A lot of people also find that their sugars rise quite a lot just by getting up and moving around.

You're pre-diabetuc, not T1, but biology is biology, so I suspect that similar factors apply. There'll probably be a few pre-diabetes people along to clear it up.

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marlene11040 said:

Is there any benefit to doing the blood test an hour after a meal and then again 2 hours after? I've read somewhere (can't recall where) that in the initial stages of determining which foods spike blood sugar this can be a useful measurement. I thought I might do this for, say, the first week and keep a comprehensive list of foods that might be contraindicated for me or perhaps look into reducing the quantity of those foods rather than eliminating them altogether? I don't want to over-complicate things but I do want to be clear about what foods, if any, I should be avoiding altogether.

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Hi, I'm also recently been diagnosed with Prediabetes. I, like everyone else, wanted to revers/cure the prediabetes fast and stopped eating most white carbs. Anything with white flour, white rice, potatoes, pasta. And no sugar. What's left? I have Oats with extra oatbran for breakfast, (doesn't work for everyone). I have yummy salads for lunch with Quinoa, vegies, chicken breast, eggs, cheese or whatever is in the fridge. Lots of cooked vegies for dinner, meat and no potato!! Sometimes, lentils, beans aso When I started testing before meals and 2 hrs after, I found out what I could eat, when I ate too much or too late or early in the evening. In the beginning I had a wholemeal cracker with peanut butter just before I went to bed to prevent my BG to go up. Some people get high Fasting BG in the morning if they don't have an evening snack. Some don't. Test, test , test. Best advice I ever got. After 4 months I've lost almost 10 kilos, I've added fats to my low carb diet now, have no idea how to count carbs or calories, so I go with the numbers and try and keep BG under 7.6 at all times. My morning BG is now from 5.6 to 6.1 most mornings. I can live with that for now. If anything I would have started intermittent fasting earlier, as some research shows it can reverse the prediabetes. I also wants to get started on HIIT High intensity interval training in the evening as it seems to help getting numbers down as well. Hope this helps..

marlene11040 said:

Ok I've been doing this now for 4 days and a pattern is beginning to emerge:
I start the day with a fasting BG of between 5.5/5.8
Depending on what I eat during the day, the highest it has been is 8.7 (carb heavy meal)
My last meal of the day is usually around 6.30/7pm; I do my last check at 9-9.30 and it's been between 4.7/4.9 consistently, no matter what the fluctuations are during the day.
So what, if anything, should I glean from this?
Any thoughts much appreciated. Thanks.

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Those numbers look good to me. Is the 8.7 after 2 hours? If so a little high. Plus you are looking for foods that only cause a rise of 2 after 2hours.