Blood glucose results - good or bad?

[Felinia]

I've been following a low carb plan for 12 weeks now, and I think my BG readings are still far too high. I'd like to know why my readings on rising are so high, after fasting for 15 hours, and also why the before readings drop before lunch but rise before dinner. This is my general pattern. I'm not on diabetes medication yet and suspect I need it, so before my review next week, I'd welcome feedback from more experienced people than me.

Today
Breakfast: Reading before 8.8, One large poached egg, one medium grilled tomato, 3 small grilled mushrooms. Two cups of tea with dash of milk, prescribed Fybogel and Benecol drink with my other medications. Reading 2 hours later 8.3.

Lunch: Reading before 6.9, 75gm prawns, one large boiled egg, mixed salad of lettuce, cabbage, peppers, shredded carrot, shredded raw beetroot, tbsp sweetcorn, tbsp fat free dressing. One cup of tea with dash of milk. Reading 2 hours later 6.3.

Dinner: Reading before 7.3, Two Slimming World chicken sausages, 130gm carrot/swede mash, tbsp green beans, three cauliflower florets, three broccoli florets, one tsp low salt chicken gravy granules made up. Reading 2 hours later 7.5.

I did have a snack in the evening after last reading, two more cups of tea, and several glasses of water during the day. The total carb count was 76gm.

Thanks.

 

[trophywench]

What's your BG just before bed, and are the fasting tests taken before you actually step out of bed in the morning? What's your BG at 3am ish?

 

[Eddy Edson]

FWIW, it seems to me that yr main issue is that waking/fasting levels are a bit high, and that forms a high base for the rest of the day.

Although it gets lost in the low-carb buzz, for T2D's this is classically more to do with impaired regulation of gluconeogenesis than carbs. Gluconeogenesis is the production of glucose mainly by the liver from amino acids, lipids etc, not from carbs. It kicks in when BG levels go low, shuts down when they're OK. The liver knows when to turn it on/off via complicated-looking pathways but one of the factors is the amount of insulin in the system. With hepatic (liver) insulin resistance from T2D, this signalling is broken and the liver keeps chugging away when it shouldn't.

The main benefit of Metformin for T2D is to improve hepatic insulin senstivity, restore the signalling and reduce undesirable gluconeogensis. Another way to improve things is to lose enough weight to clear some fat from the liver, because that fat is a major cause of hepatic insulin resistance.

So: Carbs are not the be all & end all; cutting down on carbs usually wouldn't be expected by itself to get fasting BG down to "normal" levels. For that, Metformin or other T2D meds might help, as might losing some weight. As always, it's all very individual.

This has some reasonably accessible & well-credentialed discussion: https://www.ebmconsult.com/articles/metformin-hypoglycemia-mechanism-diabetes

 

[Felinia]

What's your BG just before bed, and are the fasting tests taken before you actually step out of bed in the morning? What's your BG at 3am ish?

The first reading is taken about an hour after I get up, but before anything, even water, goes into my system. I don't test immediately before bed or during the night. I am Type 2 and did not realise this was necessary. The form I downloaded from DUK only mentioned the 6 times I recorded.

 

[grovesy]

Do a forum search of Dawn Phenomenon.

 

[Felinia]

FWIW, it seems to me that yr main issue is that waking/fasting levels are a bit high, and that forms a high base for the rest of the day.

Although it gets lost in the low-carb buzz, for T2D's this is classically more to do with impaired regulation of gluconeogenesis than carbs. Gluconeogenesis is the production of glucose mainly by the liver from amino acids, lipids etc, not from carbs. It kicks in when BG levels go low, shuts down when they're OK. The liver knows when to turn it on/off via complicated-looking pathways but one of the factors is the amount of insulin in the system. With hepatic (liver) insulin resistance from T2D, this signalling is broken and the liver keeps chugging away when it shouldn't.

The main benefit of Metformin for T2D is to improve hepatic insulin senstivity, restore the signalling and reduce undesirable gluconeogensis. Another way to improve things is to lose enough weight to clear some fat from the liver, because that fat is a major cause of hepatic insulin resistance.

So: Carbs are not the be all & end all; cutting down on carbs usually wouldn't be expected by itself to get fasting BG down to "normal" levels. For that, Metformin or other T2D meds might help, as might losing some weight. As always, it's all very individual.

This has some reasonably accessible & well-credentialed discussion: https://www.ebmconsult.com/articles/metformin-hypoglycemia-mechanism-diabetes

Many thanks for this. You have confirmed what I was beginning to suspect, particularly as one dietitian made the throw-away comment that I could be insulin resistant. I should get confirmation next week and at least will be going to the appointment better prepared. My next door neighbour is also Type 2, he is on Glycizade and Metformin and has advised I ask for slow release Metformin. I have other digestive track issues I don't want to mess up.
I have managed to lose 16 pounds since diagnosis (still a lot more to lose), and do 4 Aquafit one hour sessions a week, as well as following the low carb plan, so think I am doing what I can to help myself. I am pleased to see I am not getting big spikes after eating, but as you say, the base line is too high, which is what I thought.

 

[Felinia]

Do a forum search of Dawn Phenomenon.

Thanks - will do. I have now and it certainly seems to describe me. I had been fasting 15 hours, from about 6pm to 9am as my diabetic nurse said it would not matter. I think I'm now going to try a small handful of chopped nuts before bed at night and see how that affects me - one of the suggestions made.

 

[Docb]

FWIW, it seems to me that yr main issue is that waking/fasting levels are a bit high, and that forms a high base for the rest of the day.

Although it gets lost in the low-carb buzz, for T2D's this is classically more to do with impaired regulation of gluconeogenesis than carbs. Gluconeogenesis is the production of glucose mainly by the liver from amino acids, lipids etc, not from carbs. It kicks in when BG levels go low, shuts down when they're OK. The liver knows when to turn it on/off via complicated-looking pathways but one of the factors is the amount of insulin in the system. With hepatic (liver) insulin resistance from T2D, this signalling is broken and the liver keeps chugging away when it shouldn't.

The main benefit of Metformin for T2D is to improve hepatic insulin senstivity, restore the signalling and reduce undesirable gluconeogensis. Another way to improve things is to lose enough weight to clear some fat from the liver, because that fat is a major cause of hepatic insulin resistance.

So: Carbs are not the be all & end all; cutting down on carbs usually wouldn't be expected by itself to get fasting BG down to "normal" levels. For that, Metformin or other T2D meds might help, as might losing some weight. As always, it's all very individual.

This has some reasonably accessible & well-credentialed discussion: https://www.ebmconsult.com/articles/metformin-hypoglycemia-mechanism-diabetes

Makes sense Eddy, and curiously helps my thinking about my version of diabetes because it encourages me to eliminate problems with glucogenisis from my experience.

What I have found, and as you say it is all individual, is that gliclazide has a clear effect on my waking levels. I stopped taking it for a while and bg levels all round jumped up by best part of 2 points, with waking levels creeping up to high 6's from low 5's. Started the gliclazide again, and they came back down again. I have not experimented with metformin doses - I am on minimum dose and any more has given me problems with side effects. Also, when on higher doses of gliclazide I never went hypo, to me suggesting that glucogenisis was working OK and stopping my levels going dangerously low.

I interpret this as my diabetes problem being more associated with insulin production and not insulin resistance since the gliclazide is said to promote insulin production. It is also, from my amateurish viewpoint, to be consistent with a few other things. I am not overweight - as you say a primary pointer to hepatic (liver) insulin resistance. I have found carb intake is important and I seem to be able to overload my system with glucose very easily simply by eating something "carby". Finally, and I don't know if this makes physiological sense, I run out of energy very quickly and I interpret this as whatever glucose I have in the system is not doing its job particularly well due to a lack of insulin to process it.

That said, I am sure your basic comments are applicable to many, if not most, type 2's.

 

[trophywench]

Grovesey and I have never met physically - but our brains are certainly friendly! LOL

 

[grovesy]

Agree.

Thanks - will do. I have now and it certainly seems to describe me. I had been fasting 15 hours, from about 6pm to 9am as my diabetic nurse said it would not matter. I think I'm now going to try a small handful of chopped nuts before bed at night and see how that affects me - one of the suggestions made.

I have found for me the suggestions have not worked. Though all you can do is try them and see.

 

[Drummer]

I noticed that eating early and late gave me much better numbers.
At first, when I'd been taking Metformin I used to do my errands in the morning, come back and eat my first meal, then eat again later, but my numbers were much higher in the mornings and kept on rising. Eating breakfast became a safe option again, and when I tried that my BG level stopped going up.