Why

[Relax657]

I got diagnosed in Jan type 2 level 52 so stopped heavy drinking no spuds no white bread no white rice watched the carbs lost over 4 stone now here is the rub! Blood tested this week and still 52.
Can anybody enlighten me?
Regards

 

[Drummer]

@Relax657 Lower HbA1c is usually due to lower blood glucose levels - which is why so many of us use a blood glucose tester to check our meals are suitable.
To get to normal numbers of HbA1c I need to stay down under 40 gm of carbs a day - maybe I could do 50 at a pinch, but as I get older I want a margin of safety.
The modern diet is so carb heavy, we are told so often how healthy carbs are - at least I was, so it is easy to go over the amount you can cope with.
Perhaps a check on just how much sugar and starch you are eating each day might throw some light on the matter, and possibly you could be something more exotic and interesting than a plain ordinary type 2. I suspect that there are several different conditions which get labelled type 2 but require different solutions, or are eventually reassessed as not type 2 after all.

 

[Martin.A]

I got diagnosed in Jan type 2 level 52 so stopped heavy drinking no spuds no white bread no white rice watched the carbs lost over 4 stone now here is the rub! Blood tested this week and still 52.
Can anybody enlighten me?
Regards

Those are good things to drop from your diet and that's a terrific weight loss, but it's difficult to comment without knowing what your diet now consists of. For example, you specifically mention white bread and white rice, so does that mean you've stopped eating bread and rice altogether or have you switched to wholemeal versions?

 

[Relax657]

No rice at all sourdough very rarely no spuds and down from 30/40 pints a week to 3 to 4 and bottle of brandy to zero

 

[Martin.A]

No rice at all sourdough very rarely no spuds and down from 30/40 pints a week to 3 to 4 and bottle of brandy to zero

So what would a typical day's meals look like - breakfast, lunch , tea, snacks?

 

[rebrascora]

Hi and welcome.

Well done on the changes you have made as those will benefit your general health but can totally understand why you would be a bit gutted not to see a reduction in your HbA1c result.

Presumably you are still eating bread and pasta and rice but brown/wholemeal versions of them? Unfortunately those "healthier" versions still contain a lot of carbs, so it is important to also reduce portion size and frequency of eating. I pretty well gave up on bread as I could see from testing it put my levels into orbit. I also haven't had pasta since diagnosis 6.5 years ago but I really don't miss that. I very occasionally have a spoon of my partner's rice if we share a Chinese takeaway but that is only about twice a year and to be honest I don't really miss it. There are alternatives like cauliflower rice or konjac rice which are lower carb but I don't feel I need rice in my menu either.
I do share a single portion of fish and chips with my partner about once a month and that is enough of a treat if they are good fish and chips but if they are poor I feel like I have been robbed!!

What are you typically having for breakfast, lunch and evening meal so that we can perhaps identify foods which may be causing a problem and suggest possible lower carb substitutions for them.

4 stone is a really massive weight loss so many congratulations on that. Di the weight come off easier than you expected.... just some types of diabetes can promote weight loss. Do you have much/any more weight to lose? If so, would you consider the Pathway to Remission Program which is a year long program starting with 12 weeks of very low calorie soups and shakes meal replacements, to help you lose weight quickly and then support with reintroducing real food. This has also been very successful for some people.

You don't mention exercise/activity? Walking is a great way to lower BG levels if you are able and so is gardening. It doesn't have to be anything too sporty or physical although if you can build a bit of muscle that can help.

Have you always been a heavy drinker? No judgement intended as I was pretty much a sugar addict pre-diagnosis. It is perhaps possible that has caused damage to your pancreas and it is now unable to produce as much insulin as it needs to to keep your Blood Glucose (BG) levels well balanced. Has your doctor checked your liver function? Perhaps a scan of your pancreas might be worth asking about if you suspect this may be part of the issue. Damage to the pancreas can also cause weight loss.

Anyway, those are just a few thoughts on your situation, but I can totally sympathise with your disappointment and frustration at not seeing a reduction since Jan. Maybe some BG testing might help you identify particular foods which are inflating your levels too much. Many people here liken diabetes management without testing to driving without a functional speedometer. You don't know if you are keeping to the speed limits or not until you get a ticket through the post or a disappointing HbA1c result!

All that said, 52 is not a desperately high result and is not putting you ate significant risk.... Some of us started in 3 figures including myself, but obviously if you can lower it a bit more that would be ideal.

 

[Relax657]

Lots of veg some meat Greek yogurt nuts low carb roots celeriac sweet etc fish cheese nothing sweet thou ( I never did )
A couple of pints after work on Friday

 

[Relax657]

On the walking and exercise front I’m a bit of a disaster looking for another place to happen Knees including replacement busted elbows both been broken and neck all at different times but all come back to haunt but daily between 4000 and 15000 steps!

 

[JITR]

Why? A good question!

Losing weight and keeping it down do wonders for your wonders for your health in the long run. Do you need to lose more?

About 15 years ago Prof Roy Taylor and his team at Newcastle University established that some people can put T2D into remission by losing up to 15 kg or even 20 kg plus. However some did not respond to weight loss because their pancreas did not recover it's capacity to secrete insulin, or for some other reason.

HbA1c is only an indicator of blood glucose levels and a pretty loose one at that across the population. Was your T2D confirmed by other symptoms or by a sugar test?

In summary I would say have a good look at your diet as already suggested and discuss your situation with your GP.

 

[MarkStAlbans]

What I find helpful to remember with these things is that (coming from engineering and science) is that with any physical system real world operation and theory are often significantly different and that its possible to do everything right and effect no change due to an unknown factor.

I started at 110 and was down to 38 (cgm predicted) in a week but this was just luck of the draw and may go up with a blood test.

Keep applying your good habits and your progress will continue. As Ive said in other posts T2 managment seems to me to be more art than science

 

[Lucyr]

I started at 110 and was down to 38 (cgm predicted) in a week but this was just luck of the draw and may go up with a blood test.

Hba1c is a roughly 3 month average. The libre estimate GMI based on one week is not an accurate reflection of your hba1c. You cannot get an a1c from 110 to 38 in one week.

 

[MarkStAlbans]

Hba1c is a roughly 3 month average. The libre estimate GMI based on one week is not an accurate reflection of your hba1c. You cannot get an a1c from 110 to 38 in one week.

Its still the same after 30 days, just stating the facts from the technology.

 

[Relax657]

Why? A good question!

Losing weight and keeping it down do wonders for your wonders for your health in the long run. Do you need to lose more?

About 15 years ago Prof Roy Taylor and his team at Newcastle University established that some people can put T2D into remission by losing up to 15 kg or even 20 kg plus. However some did not respond to weight loss because their pancreas did not recover it's capacity to secrete insulin, or for some other reason.

HbA1c is only an indicator of blood glucose levels and a pretty loose one at that across the population. Was your T2D confirmed by other symptoms or by a sugar test?

In summary I would say have a good look at your diet as already suggested and discuss your situation with your GP.

Thanks for reply! I was blood tested while checking my T levels on thyroid.
It was checked again on Monday as the 6 monthly

 

[Relax657]

What I find helpful to remember with these things is that (coming from engineering and science) is that with any physical system real world operation and theory are often significantly different and that its possible to do everything right and effect no change due to an unknown factor.

I started at 110 and was down to 38 (cgm predicted) in a week but this was just luck of the draw and may go up with a blood test.

Keep applying your good habits and your progress will continue. As Ive said in other posts T2 managment seems to me to be more art than science

Thanks

 

[Relax657]

Libre 3 monitors I think is next step and weight down by another couple of stone won’t go amiss

 

[PhoebeC]

@Relax657 it stayed the same and didn't go up, that is still a win actually. As others have said there are so many other factors in better control.

Well done on the changes you have made so far. Sometimes things take time to have an impact, which feels so rubbish but these results are information, now its about what you can do next. Brush yourself off and get back on it.

 

[Martin.A]

Its still the same after 30 days, just stating the facts from the technology.

@Lucyr is right, though - you need to have 3 month's CGM data (or 3 months of finger prick results) for any meaningful estimate of HbA1c, and even then there's a margin of error.

 

[Docb]

What I find helpful to remember with these things is that (coming from engineering and science) is that with any physical system real world operation and theory are often significantly different and that its possible to do everything right and effect no change due to an unknown factor.

I started at 110 and was down to 38 (cgm predicted) in a week but this was just luck of the draw and may go up with a blood test.

Keep applying your good habits and your progress will continue. As Ive said in other posts T2 managment seems to me to be more art than science

You also need to remember that what we mean by technology is a box containing one or more microprocessors that takes the output from a sensor and provides some sort of display of that output. What is on the display very much depends on the software in the microprocessor and often implies a far greater precision than is actually possible.

For example, if you really want to get a good estimate of your blood glucose at any given time by finger pricking, then you should take 10 or so tests in rapid succession, compute a mean and then express your result as x+/-y where x is your blood glucose and y the confidence interval at whatever statistical probability you want to use. I did this and found 95% confidence intervals of around +/- 1 unit. The finger pricker cannot provide a blood glucose level to the precision implied by giving readings to 0.1 mmol/l

It gets even more interesting when you come to CGM. They don't measure blood glucose. They measure glucose in interstitial fluid and then by some hidden jiggerypokery in a microprocessor use that to imply a blood glucose and then use that data to compute a HbA1c. The number you get depends on the jiggerypokery. Whoever did the jiggery pokery did a pretty good job but nowhere do you see an error quoted.

The two pieces of kit are amazing and the fact that they get sufficiently close to blood glucose behaviour to allow those with T1 to adjust insulin doses to control blood glucose has been one of the great advances in T1 management. I just suggest a little caution when it comes to interpretation of the numbers they provide. They are estimates subject to error and generally you have no idea what those errors are.

My thought is that it is not a good idea to loose sight of the bigger picture by looking at details, especially when you have no idea of the errors in the data being used.

@Relax657. Congratulations on the weight loss and I wish you well in your quest to loose a couple more stones. Might not have moved your HbA1c much but it will have reduced considerably the burden on your cardiovascular system and joints. Got to be a good thing for the future. I would not be too worried about the fact that your HbA1c has not reduced - the important thing is that it has not gone up. I would be happy to wait to see what my next HbA1c gives and work from there.

Also my understanding is that HbA1c tends to increase with age and when, like me you get into elderly gentleman (or gentle-lady) territory, you are entitled to be a little more "relaxed" about numbers in the 50's than you would be if you were 20 years younger.

 

[MarkStAlbans]

@Lucyr is right, though - you need to have 3 month's CGM data (or 3 months of finger prick results) for any meaningful estimate of HbA1c, and even then there's a margin of e

In any measurement system there is a margin of error thats the nature of physical measurement systems and the statistical models on which they rely, I was reporting my experience.only, not recommending any course of action. 🙂

 

[MarkStAlbans]

You also need to remember that what we mean by technology is a box containing one or more microprocessors that takes the output from a sensor and provides some sort of display of that output. What is on the display very much depends on the software in the microprocessor and often implies a far greater precision than is actually possible.

For example, if you really want to get a good estimate of your blood glucose at any given time by finger pricking, then you should take 10 or so tests in rapid succession, compute a mean and then express your result as x+/-y where x is your blood glucose and y the confidence interval at whatever statistical probability you want to use. I did this and found 95% confidence intervals of +/- 1 unit. The finger pricker cannot provide a blood glucose level to the precision implied by giving readings to 0.1 mmol/l

It get even more interesting when you come to CGM. They don't measure blood glucose. They measure glucose in interstitial fluid and then by some hidden jiggerypokery in a microprocessor use that to imply a blood glucose and then use that data to compute a HbA1c. The number you get depends on the jiggerypokery. Whoever did the jiggery pokery did a pretty good job but nowhere do you see an error quoted.

The two pieces of kit are amazing and the fact that they get sufficiently close to blood glucose behaviour to allow those with T1 to adjust insulin doses to control blood glucose has been one of the great advances in T1 management. I just suggest a little caution when it comes to interpretation of the numbers they provide. They are estimates subject to error
and generally you have no idea what those errors are.

My thought is that it is not a good idea to loose sight of the bigger picture by looking at details, especially when you have no idea of the errors in the data being used.

@Relax657. Congratulations on the weight loss and I wish you well in your quest to loose a couple more stones. Might not have moved your HbA1c much but it will have reduced considerably the burden on your cardiovascular system and joints. Got to be a good thing for the future. I would not be too worried about the fact that your HbA1c has not reduced - the important thing is that it has not gone up. I would be happy to wait to see what my next HbA1c gives and work from there.

Also my understanding is that HbA1c tends to increase with age and when, like me you get into elderly gentleman (or gentle-lady) territory, it is wise to be a little more "relaxed" about numbers in the 50's than you would be if you were 20 years younger.

Indeed 🙂