A New Awakening

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Robert42

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Type 2
Greetings every one. I have been a Type II Diabetic for over 20 years and I thought I had it all under control until my last HBA1c came back at 10.3% which is 89. I stand corrected, I got this from my medical records. So time to do something, I bought a CGM as I am sure my glucometer was missing something, particularly in the night. I do have some questions, but I will put this into the appropriate forum
Nice to meet you all.
 
Hi and welcome.

Sorry to hear you have had a bit of a jolt with a sudden high HbA1c result.

CGM are really great but they do have limitations which are important to understand (I will post a link to them below), but yes there is a lot that finger pricks miss because BG levels can do all sorts in between tests.

forum.diabetes.org.uk

CGM limitations and precautions

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk forum.diabetes.org.uk
 
Also meant to ask if you would like to tell us how you manage your diabetes? ie. Diet and exercise or medication as well and if so which medication(s)?
 
Robert42 said:
Manage with diet, Gliclazide and Lantus. Not very complient.
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Ok, so quite strong medications then. What sort of doses do you take and can you explain what you mean by "not very compliant"? ie. do you not take your medication regularly or at the appropriate times or do you mean that you have not changed your diet and exercise much to help manage your diabetes? If the latter, then you would need to be cautious about any changes you make to diet and exercise now when you are on those medications because it could cause you to have hypos. So any changes would need to be small and steady and may need some medication reduction if levels start to reduce.

Most people do not realise how powerful lifestyle changes can be. More powerful than most diabetes medication but if you don't make lifestyle changes, then Type 2 diabetes will usually be progressive and require increasingly larger doses or stronger medications to manage it. If you make lifestyle changes and particularly dietary changes, then you can in many cases, prevent progression and sometimes push it back into remission. ie achieve normal HbA1c results with no medication. There are cases of people changing their diet and gradually coming off insulin and other oral meds altogether and just managing it through diet and exercise and weight loss and feel a whole lot better for it. ie. they become healthier rather than just taking medication to manage their diabetes.
 
I should add that my post is not in any way intended as a criticism. Unfortunately NHS dietary advice is not ideal and 20 years ago it was probably even less so. Plus changing your lifestyle is tough and at times of stress we often turn to comfort food to help us cope. I was a sugar addict and carb monster pre diagnosis and I knew that my diet was not healthy but sadly it took my diagnosis to provide the kick up the backside I needed to change..... perhaps your high HbA1c has had the same effect on you which has spurred you to buy a CGM and join this forum..... which has been instrumental in me turning my diet and diabetes management around and I am incredibly grateful to the forum and it's wonderful members for helping me find my way and keeping me motivated.
 
When I was diagnosed, I was living in Australia. Back then, Glycaemic Index (GI) was a big then and most supermarket product had the GI on it. Don't know what happened about it. I have not heard about the GI diet, and they did not seem to know anything about it at NHS.
I am compliant with medication. It is the exercise, but I get breathless because I am old.
I see my nurse a week Tuesday and I certainly will not be fiddling with doses.
 
I think if you just exercise as best you can. I personally feel it is diet which accounts for most of the problems but everyone is different. I know someone who is Type 2 diabetic and she cannot manage without eating potatoes. There is probably no point in telling her not to eat them as she wouldn't comply. I did ask her if she could manage without them and she said no.
 
Hi Robert - never too late to learn and/or change summat if it needs changing. We do all get stiff when we get older, its a natural process - BUT - there is now a thing generally termed 'social prescribing' so the NHS (God bless it, for all its failings) can sometimes actually arrange/prescribe folk to exercise programs in partnership with local gyms - a mixture of physio and physical exercise wholly dependent on each persons physical capabilities so can be very gentle seated exercise, up to using some of the new fangled machines the gyms have. Is that something you could imagine yourself trying? If so - ASK!!!

My parents and their peers were prone to quoting that 'God helps them that help themselves' when I was young - so why not try and find out if there is anything you could have a go at where you live?

And by the way - you really can ask anything that you might feel you're lacking info about. There absolutely are NO silly questions about health - but it's not always guaranteed you won't occasionally get a silly answer!!
 
Low Gi is well known here in the UK too, but what you may not be aware of is that everyone responds to foods differently, due to the variability of our digestive tract metabolism and gut biome. The GI index is an average of how 100 people responded to particular foods I believe. There is no guarantee that you will be one of the people near the average or one of the outliers. This means that whilst a particular food may be low GI for some people, it may not be for others. Porridge is a classical example of this and particularly relevant with regards to diabetes as many Health Care Professionals (HCPs) recommend porridge as an ideal breakfast for diabetics and yet with the aid of modern technology like CGM some of us find that the glucose released from it is not slow release at all and hits our blood stream like rocket fuel! It was the last carb rich food I gave up on as I couldn't find a way to make it work for me, even with insulin without spiking my levels pretty badly. I now have creamy natural Greek style yoghurt for breakfast with a few berries and mixed seeds and a tiny sprinkle of nutty granola and a good dusting of cinnamon and that works really well for me and I enjoy it. Occasionally I have a 2 omelette usually with mushrooms and onion and peppers and cheese with a side salad and coleslaw and that will keep me going all day until my evening meal, so I don't need to bother with lunch.
 
I do realise that changes in diet has to be slow. Eating between meals is something I haver to give up. BSLs falls off in the wee hours, that is why I went to Libre 2. It has shown what I wanted. I have eaten dinner at 8PM instead of 6PM, I will keep to that change.
Thank you all.
 
Are you sure your levels are falling whilst you sleep and it isn't just compression lows where you lie on your sensor and it gives a false low reading? If your HbA1c is high at 89 and you are having genuine lows during the night then you must be pretty high most of the day, none of which is good. HbA1c levels are usually better (edit - should probably say lower rather than better) if you are having lows at night because they average out the highs during the day to give you a better result numerically, but not good for your body. If you have an HbA1c of 89 and are having genuine hypos at night then your levels must be horribly high during the day.

Can you post a graph from your Libre showing a typical 24 hours?
 
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Currently, 13.7 typical. After midnight, it falls reaches 3AM in the 3. I got up very woozy and needed some carbs, this means going downstairs - not safe, but I have to.
Sensor is placed on the back of the arm according to Abbot. Even if you lie on that side, which I don't have the sensor is clear. I see some people with the sensor on the top front or side, not recommended.
 
Robert42 said:
Currently, 13.7 typical. After midnight, it falls reaches 3AM in the 3. I got up very woozy and needed some carbs, this means going downstairs - not safe, but I have to.
Sensor is placed on the back of the arm according to Abbot. Even if you lie on that side, which I don't have the sensor is clear. I see some people with the sensor on the top front or side, not recommended.
Click to expand...
Are you checking the low with a finger prick to check. It would be wise to keep something to have by your bed rather than have to to downstairs. Jelly babies or 150ml can of full sugar coke if your reading is genuinely that low, then check again after 15mins to see if it is coming up to a better level but not too high.
Are you also checking the 13 as the Libre is not a accurate at high and low levels.
 
You should always have hypo treatments and testing kit by your bed when you are on insulin. The last thing you need is to be negotiating the stairs when you a half asleep and hypo. It is an unnecessary risk.
When do you take your Lantus? I wonder if you are having hypos through the night, if changing the time you take it will reduce that risk. Lantus builds to a peak of activity about 5hours after you take it and then slowly tails off over the next 15 hours. Ideally you want the peak of activity to coincide with when your liver is releasing the most glucose which for most people, is in the morning when you get up. But our liver usually releases the least amount of insulin in the depths of the night between 1am and 3am, but everyone is different and there are some people who need more insulin through the night than during the day. Learning how your body works and then matching your insulin's profile to it to get the best fit..... or changing to an insulin with a slightly different profile that will complement your body better, is key to having good diabetes management. I think you may also benefit from a fast acting meal time insulin if your levels are going high during the day as a result of the food you eat. Has your nurse ever suggested that?
 
Welcome to the forum @Robert42

Glad to hear you’ve decided to turn your diabetes around following your raised HbA1c result.

I was another for whom taking Lantus last thing at night (as recommended by my nurse) caused night time hypos. It was something it too me a long time to discover, but thankfully simply moving my injection to breakfast time went a long way towards solving the problem entirely.

Might be worth discussing your night time hypos at your appointment? Lantus’s ‘flat’ profile isn’t as flat as advertised, unfortunately. The documentation even shows the 5 hr mini-peak in activity.
 
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