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What to do

Of course, many people say I'm not normal, but if I wanted to never be below 4, I would be eating full-time, including through the night.

In my view, and from reading I have done, there are no issues being under 4, provided there are no symptoms. Under the very low 2s should be investigate, whether or not the individual feels tickety-boo. That low, and I have been there, I feel fine, except for very hungry. that's usually justified, as it would usually be pretty much just before eating, or where eating has been unavoidably delayed. I also get a bit grumpy, but then I'M HUNGRY!

As an non-medicated individual with a very good HbA1c, I have no intention of eating my scores up, unless there is solid data to compel it.

In my view, each individual has a running healthy range, and mine just so happens to be relatively low for someone with a past diagnosis of diabetes. I consider my body has recovered itself well, to be back no a robust functional place.
 
@davidtobi

Hello David and welcome to the forum :) I am glad to see you have had so much advice from members. Here is some more - this is the information we give to new members and I hope you will find it useful. Ask more questions when you want and someone will be able to help.

BASIC INFORMATION FOR NEW MEMBERS

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

http://www.diabetes.co.uk/low carb program


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.
 
AndBreathe said:
Of course, many people say I'm not normal, but if I wanted to never be below 4, I would be eating full-time, including through the night.

In my view, and from reading I have done, there are no issues being under 4, provided there are no symptoms. Under the very low 2s should be investigate, whether or not the individual feels tickety-boo. That low, and I have been there, I feel fine, except for very hungry. that's usually justified, as it would usually be pretty much just before eating, or where eating has been unavoidably delayed. I also get a bit grumpy, but then I'M HUNGRY!

As an non-medicated individual with a very good HbA1c, I have no intention of eating my scores up, unless there is solid data to compel it.

In my view, each individual has a running healthy range, and mine just so happens to be relatively low for someone with a past diagnosis of diabetes. I consider my body has recovered itself well, to be back no a robust functional place.
Click to expand...
I think it very much depends on what medication one is on. The OP is T2 on Metformin and diet, so the risk of hypo is quite low. i am T2 also, but on a bgl lowering drug, so I need to be wary of sub 4 readings. I do get them, and sometimes I can accept it since my medication has a limited time of action where I could go lower still. But sometimes I take a few carbs to keep me off the bottom rung, which for me starts at 3.6.

My buddy is T1 and last night he had a severe hypo at 3.4, which needed medical assistance with IV drip. His bgl at lowest was 2.4, and he was totally comatose and non responsive, with convulsions.

He also almost succeeded in setting fire to his house, and I had to douse the flames before I could attend to him. There was a crowd of people outside his front door complaining about his fire alarm, and then when the ambulance turned up with blue light flashing, two of the neighbours requested that they park elsewhere or they call the police. Three paramedics struggled to revive him, but they could not use their glucogen kit since he had not been prescribed it, and it was Sunday, and no duty doctor was availble. They ended up taking a needle off a hypodermic, and filling it with Lucozade and squirting it between clenched teeth.

So I am happy you can run safely on sub 4 levels, but I would not recommend it myself. That level of 4 as recommended by DVLA as a safe lower limit is there for a reason, since it covers most meter inaccuracies and plasma/whole blood variations
 
As I said, there are one or two that do seem to function with abnormally low BG, but others don't fare so well.
 
Oldvatr said:
I would agree with you if our bgl meters were accurate so we could rely on them, But you have to allow for +/- 0.8 mmol/L error on any reading below 4mmol/L, so the quoted reading of 3.4 could actually be 2.6 and the meter would be considered correct. It is worse if the meter is an SD Codefree or an Accuchek since these are calibrated to measure 12 % higher than other meters, (3.4 then could be 2.3)
Click to expand...

Does this refer to the difference between the basis being whole blood and the basis being plasma? Clinical measurement of glucose concentration is done with reference to plasma. While informally people speak of 'BG', blood glucose, the intravenous measurement of the fasting level is 'FPG', fasting plasma glucose. Are those two meters the only ones calibrated against plasma?
 
sud5nala said:
Does this refer to the difference between the basis being whole blood and the basis being plasma? Clinical measurement of glucose concentration is done with reference to plasma. While informally people speak of 'BG', blood glucose, the intravenous measurement of the fasting level is 'FPG', fasting plasma glucose. Are those two meters the only ones calibrated against plasma?
Click to expand...

Some are and some aren't. In both the Codefree and the Accuchek Mobile it is detailed in the technical specifications in the booklet that comes with the meter.
 
Bluetit1802 said:
Some are and some aren't. In both the Codefree and the Accuchek Mobile it is detailed in the technical specifications in the booklet that comes with the meter.
Click to expand...

Maybe whole blood meters are more important in Britain. You mentioned in an old post that DVLA uses whole blood numbers. Dealing with legal consequences, yes it's crucial to be on the same page as the government.
I may soon be monitoring my BG. I had thought whole blood meters were passe.

From the Joslin Diabetes Center (USA). "By having the meter record results as plama glucose, you and your healthcare team can more easily compare your lab tests with your blood glucose meter results. . . . today most newer meters provide blood glucose (sugar) readings as plasma glucose readings. . . . plasma numbers read about 10 - 12% higher than the older whole blood numbers. So if your fasting and pre-meal blood glucose target is 90 - 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads whole blood."
http://www.joslin.org/info/plasma_glucose_meters_and_whole_blood_meters.html
This Webpage is undated, but the text could possibly be many years old.
 
sud5nala said:
Does this refer to the difference between the basis being whole blood and the basis being plasma? Clinical measurement of glucose concentration is done with reference to plasma. While informally people speak of 'BG', blood glucose, the intravenous measurement of the fasting level is 'FPG', fasting plasma glucose. Are those two meters the only ones calibrated against plasma?
Click to expand...
So far they are the only ones using Plasma Calibration. I believe ALL Accuchek meters bought after 2011, and the SD Codefree. I have posted this info many times on different threads, and so far no one has identified any other bgl meters. Certainly my Abbott meters are all whole blood. The whole blood used to be called interstitial fluid which is what the finger prick tests measure. The problem may arise when doing alternate site testing which is capilliary blood, so closer to plasma.

Things get even more complicated, since the term plasma is used with different meaning in terms of blood transfusions.
 
sud5nala said:
Maybe whole blood meters are more important in Britain. You mentioned in an old post that DVLA uses whole blood numbers. Dealing with legal consequences, yes it's crucial to be on the same page as the government.
I may soon be monitoring my BG. I had thought whole blood meters were passe.

From the Joslin Diabetes Center (USA). "By having the meter record results as plama glucose, you and your healthcare team can more easily compare your lab tests with your blood glucose meter results. . . . today most newer meters provide blood glucose (sugar) readings as plasma glucose readings. . . . plasma numbers read about 10 - 12% higher than the older whole blood numbers. So if your fasting and pre-meal blood glucose target is 90 - 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads whole blood."
http://www.joslin.org/info/plasma_glucose_meters_and_whole_blood_meters.html
This Webpage is undated, but the text could possibly be many years old.
Click to expand...
Here in the UK. the labs use plasma because most of the testing they do is on venous samples. It is almost impossible for a patient outside hospital to get to see a lab result on what you term FBGL, I made a special request so i could check my calibration of my personal meter, but they refused to tell me what it was in my venous sample. Our GP system here uses HbA1c as primary diagnostic tool, or they use a portable bgl meter just like we do. So Joslin advice seems to be irrelevant here in UK. They re certainly incorrect in their assertion that most meters are now plasma.

Edit to Add: Apparently the MyLife unio is also now plasma calibrated. NZ has mandated their meters should be plasma, and appaently the Pharmaco range should comply. Also the Medica Pacifica meters as distributed in NZ. Now we know. Anyone else found one?
 
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Oldvatr said:
So far they are the only ones using Plasma Calibration. I believe ALL Accuchek meters bought after 2011, and the SD Codefree. I have posted this info many times on different threads, and so far no one has identified any other bgl meters. Certainly my Abbott meters are all whole blood. The whole blood used to be called interstitial fluid which is what the finger prick tests measure. The problem may arise when doing alternate site testing which is capilliary blood, so closer to plasma.

Things get even more complicated, since the term plasma is used with different meaning in terms of blood transfusions.
Click to expand...

Why not start a thread asking people to check whether their meters internally change the whole blood reading to a plasma reading? If they still have their original meter booklet it should show in the technical specifications, or at the very least on the company website.
 
Oldvatr said:
Here in the UK. the labs use plasma because most of the testing they do is on venous samples. It is almost impossible for a patient outside hospital to get to see a lab result on what you term FBGL, I made a special request so i could check my calibration of my personal meter, but they refused to tell me what it was in my venous sample. Our GP system here uses HbA1c as primary diagnostic tool, or they use a portable bgl meter just like we do. So Joslin advice seems to be irrelevant here in UK. They re certainly incorrect in their assertion that most meters are now plasma.

Edit to Add: Apparently the MyLife unio is also now plasma calibrated. NZ has mandated their meters should be plasma, and appaently the Pharmaco range should comply. Also the Medica Pacifica meters as distributed in NZ. Now we know. Anyone else found one?
Click to expand...

Here's a converter between whole blood measurements and plasma measurements. How would you assess it? http://www.diabetes.co.uk/whole-blood-readings-to-plasma-converter.html

Could you clarify the remark about values not being obtainable for a certain blood property? (BTW, the acronym I used was 'FPG'.) When people post their fasting BG on these forums, do you mean their figure is whole blood based, and that HCP's will not derive a plasma based figure?

Do you think whole blood based has certain advantages over plasma based?
 
Bluetit1802 said:
Some are and some aren't. In both the Codefree and the Accuchek Mobile it is detailed in the technical specifications in the booklet that comes with the meter.
Click to expand...
I've recently got a code free meter and it has recorded much higher readings than my old meter which is an Accu chek mobile, e.g. this morning 8.9 vs 6.2 and y'day 10.0 vs 6.9 these are consistent with other readings. I realise that there is a margin for error, but I find these differences more significant than that. It doesn't matter about pre and post prandial readings, as you're looking at the difference between the readings, but I'm thinking of funding the Accu chek for fasting readings.

Any thoughts?
 
I think there is good evidence that in the long term, all hypos are bad news, regardless of whether they are symptomatic or asymptomatic. Every time you go below 3.9, you are risking a small amount of brain damage, even if you feel fine. 9I do have a paper on it somewhere, but can't find it to upload.....sorry). When I started intermittent fasting, I was getting down to 4.1 sometimes, but no symptoms. So have taken myself off Gliclazide as just didn't want to risk going under 4. Now average BG a bit higher, but I'm OK with that. I'd rather be between 5 and 7 most of the time, than be between 4 and 6 and risk small hypos.
 
Jasperville said:
I think there is good evidence that in the long term, all hypos are bad news, regardless of whether they are symptomatic or asymptomatic. Every time you go below 3.9, you are risking a small amount of brain damage, even if you feel fine. 9I do have a paper on it somewhere, but can't find it to upload.....sorry). When I started intermittent fasting, I was getting down to 4.1 sometimes, but no symptoms. So have taken myself off Gliclazide as just didn't want to risk going under 4. Now average BG a bit higher, but I'm OK with that. I'd rather be between 5 and 7 most of the time, than be between 4 and 6 and risk small hypos.
Click to expand...

I would be very interested in seeing that link, if you find it. :)
I wonder if the study takes into account the differences in cognitive function when 'fat adapted' or keto?
 
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PosyPip said:
I've recently got a code free meter and it has recorded much higher readings than my old meter which is an Accu chek mobile, e.g. this morning 8.9 vs 6.2 and y'day 10.0 vs 6.9 these are consistent with other readings. I realise that there is a margin for error, but I find these differences more significant than that. It doesn't matter about pre and post prandial readings, as you're looking at the difference between the readings, but I'm thinking of funding the Accu chek for fasting readings.

Any thoughts?
Click to expand...

I have both the codefree and the accuchek mobile. In comparison tests I find them very similar. I recently did 20 comparison checks, some fasting and pre-meal, some post meal. Over those 20 tests both meters averaged 6.1. It is quite possible the tub of codefree strips you have is a duff one for some reason, or maybe because the method of testing is different between the 2 you haven't quite got used to the codefree strips.. If you get a large discrepancy again, or a number that you consider to be way out, it is always worth testing another twice to confirm.

Whatever you decide to do, it is wise to stick to one meter for your personal records and not to swap about from one to the other. It is consistency and trends you are looking for, not low numbers (unless you are on insulin or gliclazide or similar)
 
Thanks @Bluetit1802 . I think I've got used to the method of testing on the code free, but I will continue to double test to calculate average scores. Then, I'll try another set of strips if it's still out.

My problem is if the code free has significantly higher numbers such as 10 it would cause me real concern, when fbs should be under 7.0. I've had few over 7.0 and that was when I was ill, such as now.
 
PosyPip said:
Thanks @Bluetit1802 . I think I've got used to the method of testing on the code free, but I will continue to double test to calculate average scores. Then, I'll try another set of strips if it's still out.

My problem is if the code free has significantly higher numbers such as 10 it would cause me real concern, when fbs should be under 7.0. I've had few over 7.0 and that was when I was ill, such as now.
Click to expand...
I am not putting this here to blow mein own trumpet, but it contains a graph that demonstrated how my SD Codefree and my NEO / XCEED meters tracked each other quite consistently over time. I was able to detect and reject 2 paks of NEO strips that were duff (omitted from my results, so not shown in graph). I use my NEO for hypo management but the SD gives me confidence, especially when both trend together. Where the graph starts to diverge or converge, then this is usually due to a strip change.
 
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