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Weirdo BG readings - are they really the norm?

I

increasingly cynical

Well-Known Member
Messages
91
Hi All,

Looking through a number of 'threads' in the forum, I notice that lots of people express concern about 'weird' readings (BG readings that don't seem to match with their food, insulin or exercise for example). How common is this? Can anyone who has had 'weirdo' readings comment?

I have a great example of this, although for me odd readings seem to be the norm (BG meter is calibrated and absolutely fine..) one recent example: Wake up at 7am with a BG of 13.2 (I don't get the morning effect - my morning readings are always the lowest) ... had a slice of wholemeal bread toast with butter...nothing else... 3 hours later BG of 27.6.... 3 hours later again (no food in between, but also no exercise) BG=11.4... a second recent 'wierdo' example.. an afternoon reading of 11.4 following no food for 3 hours, went for an hour's walk with the dogs (still no food), BG reading up to 15.5.

I suspect, reading the threads this may not be uncommon - any comments/suggestiosn as to cause?
I am not on meds currently, but also fail to see how meds would be controllable given constant manic readings ...

:|

Regards.
 
Hi increasinglycynical,
Although my readings do not swing to the degree you mention, I do seem to have 'unexplained' readings. This was why I tried to go right back to basics and check my dosages prescribed were correct for me. This week my readings have been much more 'even' and that is because I think I actually need twice the ratio of insulin I was put on......most of the time. I say most of the time because randomly I still, at times, have 'odd' readings that I just cannot explain.
Finally sussing out I need a higher fast-acting insulin to carb. ratio has made a huge difference to me mentally, too, as it was driving me round the bend not knowing what I was doing wrong.
I have also come to the conclusion that I am the sort of awkward person that is just going to have 'odd' readings that are unfathomable. If I can now maintain more even levels for a high percentage of the time, I think I'll just have to live with the odd weird one.
 
Hi Chocoholic & Slinger,

Thanks very much for your replies. Would you have any comments about my feelings regarding approaches to "diabetes" as set out below, based on your experiences? thanks!

Despite having v. high BG readings on 'diagnosis' over 12 months ago (16 mmol/l fasting) I am not currently on any medication. Although I thought this was poor treatment to start with, reading through the forum postings I do begin to wonder. Virtually everyone on the forum seems to be on meds or insulin (many on a range of these, with a variety of associated risks) and most also restricting their diet in quite extreme ways and yet most talk about a 'diagnosis' initially at actually quite low adverse levels (e.g just over the arbitrary '7') and,, frankly, as far as I can gather, it doesn't seem as if the meds have done more than a bit of exercise, change in diet, or a glass of wine with meals could have achieved with lesser physiological risk of the extreme problem of hypoglycaemia.

At very high and unpredictable levels of BG it is unclear what a diagnosis should be and what treatment is capable of, as far as I can tell and at the low levels at initial diagnosis cited by most of the forum, avoiding meds would have seemed to be preferable in terms of long-term outcomes... have I lost the plot here? (nb. the manufacturers of lantus recently confirmed that a mean change in BG of 1.7 mmol/ltr with their product is about all that can be expected... they provide data that shows that the mean change achieved by having a couple of glasses of red wine with a meal is 2.5...???!)

:|
 
Hi increasingly cynical

Wonky readings do happen though from what I gather it seems more common in type 1 who are completely dependent on insulin and have to put in what we dont have. it does happen however though I suppose your concept of wonky is relative. Exercise, weather etc all impact but its usually transient

In respect of yourself, I think you need to go back to your GP.
Whilst you could take the route of many and look at low carb/diet but with a bg on diagnosis of 16 which hasnt really improved at all, you need to do something.
It may be diet works for you but IMHO it might be that meds of some sort are required. I know if preferable type 2s do like to tackle with diet but that doesnt mean if you need/take meds then you have 'failed'. Type aside, bg of 27 is too high. In fact I was admitted to hospital on dx on the basis of that reading.

You also say that your fasting sugars are your lowest and you dont get morning phenonemon. Maybe not, but if 13 is your baseline bg, then there is no way you are going to see good numbers over the day. You say this is your lowest but (dont hate me) this is not low. If i get over 7 I am puzzled and on the verge of tears if I cant fathom it. Dont know if you have Dawn Phen. but you cant continue running these numbers and ensure good long term health.

I agree with your own assessment that on diagnosis you treatment was poor.Does you doc take a regular hba1c? Is this showing high average? I appreciate your point of view re meds not working but you wont know until you try. Your wonky readings may be because pancreas is acting erratically and sometimes helping, sometimes not. HAs your type been classified? If you have managed a year without crisis then its unlikely you are type 1, but what about LADA? Or maybe just classic type 2 and insulin resistant? Do you feel well, are you getting symptoms with the high readings?

Go kick your docs ****, and let us know how you get on

L

PS Re the wine - by all means. Your pancreas might thank you but your liver wont because you would need to skelp a fair bit of red wine to stop bg of 27!
 
Increasingly cynical,
It's interesting. On diagnosis(the first, wrong diagnosis of Type 2) I was 15 on a fasting test and put straight onto Gliclazide. I have read that others have been allowed to try diet and exercise first. My DN said my reading was too high not to go straight onto meds. Also I had just a trace of ketones in my water.
I would have done anything not to go on insulin but after a year was told I had to. I was not overweight, was following what I considered a healthy diet (though it certainly contained more carbs. than I eat now) and had joined a walking group. I felt I'd failed but the DN said it was not a case of failing, it was just bad luck.
Since my re-diagnosis of Type 1 (LADA), I have struggled to sort out the changeover from a mixed insulin to basal/bolus BUT and here is the big BUT, now I have worked out my ratio of NovoRapid was wrong and that it should be double what was suggested to me, I am feeling a lot happier. Avoiding meds. would be great,yes but sometimes we just have to accept our body needs more meds. than we'd like.
Having said that, I believe I can still have relatively little insulin by cutting the carbs. that little bit more. I'd say I'm on a medium levels of carbs. at the moment but now I know where I stand, I intend working harder on cutting the carbs. a bit more. Just to have levelled out readings has been hugely encouraging this last week or so.
My advice, go back to your docs. or change docs. if necessary. Your readings are too high.If a diet and exercise change don't work for you, you might have to go onto meds. I was the sort of person who would never even take a painkiller or headache pill, in the past. I've had to accept medication for life. If, long-term, that medication is going to make me healthier, then so be it.
I hope you get the help at your surgery you are entitled to. If not, stamp your feet and make a fuss until you do. I can give private lessons in foot-stamping and my fees are very reasonable.
 
Insulin does work far more effectively you suggest
Just read the Banting Nobel lecture From the first they demonstrated that insulin saved lives inboth children and adults. Diet is mentioned as OK for 'mild' diabetes in the over 50s, otherwise the pronosis for everyone was poor. Luckily we've come a long way since then and for those that diet doesn't work and who have some insulin production there are other medicines. Some people may need one type, some more than one type and some may require insulin . If diet doesn't work because there is too much resistance or too little insulin surely it makes sense to give these medicines a chance.
http://nobelprize.org/nobel_prizes/medicine/laureates/1923/banting-lecture.htmls e

When I was diagnosed like lilibet I was hospitalised, my fasting BG was 21mmol, I was very ill and losing weight.
Insulin brought down those high levels within 3 days.
My first logbook (10 days after that fasting test) shows a highest post prandial reading of 10mmol, my average fasting glucose for that first week at home was 6.5, six months later the first page of the next log book shows an average fasting of 5.3mmol and a highest reading of 7mmol. My highest Hb A1c in the four years since then has been 5.6%.
Without insulin I would probably not be writing this, I wouldn't be alive. Incidenlty, I do not restrict my diet in 'extreme ways', though I probably exercise more than most.

Your readings are erratic, but I feel (from a lay point of view ) they point to an insufficiency of insulin but you may also have some resistance : the higher levels you have, the more resistant you are likey to be. You go to bed with a high reading and wake up with the same one, you are therefore able to tick over producing just enough insulin for your glucose needs during the night but not enough to reduce the high level. That high level i will be causing damage to other systems. Hb A1c is highly correlated to many peoples' overnight blood glucose levels, after all it accounts for up to half of the time.
You are obviously not producing enough insulin to cope with the carbs in your meal, though your production or insulin sensitivity may vary from day to day. It also seems that when you exercisie and your muscles need some more glucose, the liver is producing it but there isn't enough insulin available to utilise it. As people have already pointed out, you may have LADA.
I think you have said that you are losing weight, remember that it is not just fat that you are losing, it is muscle and the heart is a muscle.
Thank goodness we have medication, without it many of us would have died of starvation or quickly developed life threatening complications. Please, do not adopt an approach of doing nothing. If necessary look upon it as an experiment but go and discuss the alternative medicines with your doctor though realising that it may in the end be advisable to accept his suggestion of insulin.
 
At the levels you are reading you will be suffering from "glucose toxicity" where the high BG itself will be tending to keep your BG high.

In the States more proactive initial treatment is commoner, the plan being to throw as much medication (at your levels quite possibly insulin) at the problem initially to bang you rapidly down into a normal range, after which the meds can be reduced or discontinued as the diet and reduced insulin resistance will have much more effect.

Doing it the stoic British way takes a lot longer and leaves you running dangerously high numbers for far too long.

One reason for your numbers jumping around a lot is probably insulin resistance causing your liver to dump glucose more or less at random instead of when required. It's also possible you have gastroparesis and your food is moving down your gut slowly and in big jerks, leading to glucose production out of step with your actual eating.

Either way I'd go back to your doctor.
 
Dear All,

thank you so much for your helpful and detailed replies. You are all so knowledgeable and so willing to help! This is in stark contrast to what I have been able to glean from the medical service to date. I still don't understand the difference between what the manufacturer's state is the level of effectiveness of their insulin products and the much greater effect that people on the forum have experienced... it may take me a while to absorb all your suggestions but I will certainly look at the information link setc. and take on board your comments and experiences... thanks again for the help and encouragement ... I have an appointment booked with the latest consultant they have passed the buck to this week - I'll let you know if they actually get around to providing any treatment... or even any ideas...! Mayeb its a 'postcode lottery' thing...

 
Just another point, increasingly cynical......when you mention Lantus, I'm not sure if you know this does not work in the same way as a fast-acting insulin like Novorapid. Lantus is used as a background insulin. As I understand it, a normal person will have small amounts of insulin released throughout the day, apart from the insulin that is released in larger amounts, when starting to eat.
Something like Lantus is used to replicate the background insulin a non-diabetic will have naturally. This keeps your insulin level 'ticking-over' as it were, mimicking a non-diabetic's insulin release. Now the fast-acting insulins, such as NovoRapid work in a completely different way. Thus, when injected, they will start to act very quickly (again mimicking what happens naturally in a non-diabetic) but these insulins have a tail off of several hours (as opposed to an expected tail off of 20-24 hours for something like Lantus).
I do apologise if that is as clear as mud or you already knew that but as you are a non-insulin user I wanted to try and clarify the difference for you. This is why when you read about the 1.7mm movement from Lantus usage, although correct, a faster acting insulin will have a much greater, faster effect on BG levels.Hope that helps.
 
Hi Chocoholic,

Ah - that's interesting. I did realise that Lantus was a '24 hour' release, but i didn't realise that that made it different in terms of the extent to which it could take BG down. I approached Lantus because my GP said that if she decided (eventually!) to give me insulin it would be Lantus as everything else is (quote) "old fashioned and inconvient" ... I suppose I assumed that the products were therefore all pretty similar in effect ... how odd then that given my very high BGs she would suggest a product that seems to have a pretty trivial effect... hmmm, I will raise this when I see the consultant later this week .

Thanks again!

:!:
 
Most use both a slow acting like lantus or levimir in conjuction with a fast acting like novorapid, humalog or apidra which they use to cover the mealtime carbs. Your doc is l perhaps ooking towards the more modern MDI regime rather than the twice daily mixed insulin regimes. You should be very grateful for this.
 
Hi Phoenix,

Thanks for your response, but what is an 'MDI' regime and what level of impact does it have (to what extent does it lower BGs?)

Thanks!

:?:
 
Hi increasingly cynical
Whatever is going on with you is less important than the danger of continued high BGs. You need to get those numbers DOWN. a non diabetic runs at about 5, with very few peaks.
It's up to you and your careteam to decide on how you will achieve healthy levels, but you have a number of choices.
get to the Doctor and get it sorted out. your numbers are dangerous.
 
Hi Hanadr,

I am with you on that (need for treatment), but where is the proof? Do you have any links to research citations which show either 1) that high BGs (rather than obesity) are the direct link with 'diabetic' complications or 2) that insulin or oral treatments avoid these complications (rather than taking down BGs but not necessarily avoiding the complications)

I think, in respect of accessing treatments I have the following 'problems' :

1) I am very slim
2)I am vegetarian and eat very little / eat 'healthily'
3) My BGs are always high but veer widely and show very little correlation with food intake
4) At about the same time my BGs went nuts, my blood pressure (previously always low as I exercise a lot) also went nuts , systolic is primarily OK or high-ish, but diastolic can zing between a low of 52 and a high of 148 in a few hours...had a 'holter monitor' recently and it scared the consultant so much he just pushed me off to yet another consultant...

From the point that the above were identified, more than a year ago, but both problems increasing, my GP went into evident despair and said she didn't have a clue what was going on , as it (BG and BP) was very 'acute' and I was previously very fit and didn't match any of her (preconceived) criteria .... Since then I have spent a year being passed from one consultant specialist to another (3 months in between each referral...) Nobody wants to 'treat' me as they don't have a clue what is going on, so they pass me on to another speciality....

the only 'treatment' I have been offered in respect of the BGs is gliclazide - by the GP diabetic nurse - and each of the consultants I have seen have told me not to take that as it could be counter-productive re the pancreas.... yet so far no-one has done any of the tests recommended on this site to see what version of 'diabetes' I might have....!

I need to be able to argue with the professionals on the basis of the research evidence, but - re my queries above - is there actually any?

Would really appreciate further comments and, in particular evidence, as I am going to see the next consultant on thursday and I am really panicked now that I will just be sent to see someone else because I haven't actually collapsed in front of anyone yet (although I feel lousy) !! Controlling BGs by diet and exercise has no chance of working, I can eat nothingf or 24 hours or more and still have BGs above 15, or I can stuff myself with pasta and go down to 13. I can sit around like a slug and decrease BGs or go for long walks or to the gym and increase by a few BG points... all the same with BP also... getting a bit desperate here...

Many thanks for listening to my rant and trying to help!!

:|
 
Hi Trinkwasser,

Thanks for the paper citations, I'll look these up. Having been passed around 5 consultants over 18 months or so, for no very obvious reason (other than that they couldn't understand the profile I was presenting them with) I have finally landed (I think) with a consultant who both seems human and appears to know what he is doing! He started swearing when he realised I had been sent 'round the houses for so long with such high BG readings and promptly oragnised some blood tests including GAD, as he (like people on the forum) feels that the profile looks like 'LADA'. He is in favour of low carb diets and definately willing to work with rather than against his patients, so its looking much more promising now that I will get some treatment and medical support to get the BGs down, I was getting close to complete despair I must say!

Many thanks for your help and support and that of everyone else following this thread.

 
There is a strong correlation between HbA1c and complications. the numbers are in the Bernstein book.
I am a mere retired science teacher, but what you describe sound more like a T1 type of diabetes LADA possibly.
Gliclazide wouldn't work for long, if at all. All T1s and their variants need Insulin.
It's VERY neglectful of your medical team to leave you in this state.
Please if you feel unwell, report yourself to A&E and tell them you are diabetic. For T1 types, things can go wrong and get dangerous, very quickly
 
Hi Hanadr,

Thank you for your concern. What is it that goes 'quickly wrong' in LADA / Type 1? i.e what should I keep an eye on. The most recent consultant I have seen, who I think is good, said at least one member of his team is on 24 hours and if I felt any significant 'symptoms' i should contact them straight away... rather dozily I realise now that I'm not sure I would recognise a 'serious symtpom' if I saw one.. ... ! My BGs are always between 15 - 20 + and my blood pressure varies from perfectly normal, to too low, to absurdly high... what other 'symptoms' should I take as 'serious'?

thanks for any advice!

:?
 
The immediate danger is that if you have T1 you could get DKA.(Diabetic Keto-Acidosis) The onset of this can be extremely rapid and life-threatening, so make sure that you know the symptoms (typically abdominal pain, vomiting, dry mouth and skin, extreme thirst, an increased heart rate and shortness of breath). If you have even the slightest suspicion that you are coming down with this then don't mess about waiting to see your GP. Go straight to the nearest hospital. Call an ambulance if necessary.
 
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