Confused

[Duane Charles]

Yesterday (25th) I thought my BG readings were strange because of what I’d eaten. This morning my pre-FOTF was 12.9. I had a croissant with some turkey and cucumber for breakfast, 2 hours later my BG had gone up to 14.3 which I guess isn’t too bad a rise. At about 1 I had a piece of christmas pud cheesecake (well it is Christmas after all) 2 hours after that I’m down to 9.0. I’m struggling to work out what is happening on a “normal” day let alone during a holiday. I understand that different things affect everyone differently and I don’t think this is me overthinking things.

 

[Leadinglights]

Yesterday (25th) I thought my BG readings were strange because of what I’d eaten. This morning my pre-FOTF was 12.9. I had a croissant with some turkey and cucumber for breakfast, 2 hours later my BG had gone up to 14.3 which I guess isn’t too bad a rise. At about 1 I had a piece of christmas pud cheesecake (well it is Christmas after all) 2 hours after that I’m down to 9.0. I’m struggling to work out what is happening on a “normal” day let alone during a holiday. I understand that different things affect everyone differently and I don’t think this is me overthinking things.

But what was it at 1pm before you had your pud cheese cake, paired reading are much more informative as to what might be going on.

 

[Duane Charles]

But what was it at 1pm before you had your pud cheese cake, paired reading are much more informative as to what might be going on.

I’ve not had anything since the cheesecake and I’m now at 10.4 and about to have something to eat, I’ll check again in a couple of hours.

 

[Proud to be erratic]

One of the complicating things about our bodies is that our natural resistance to insulin (your own or my injected insulin) changes at different times of the day and also changes depending on how low or high one's BG is. Most of us get an increase in resistance when our BG is higher - but that's not a definitive rule.

So if you woke with a BG at 6 your body might naturally cope with extra carbs from breakfast from your own insulin release, whereas it might not cope if your BG was 12 - because of the possible natural increase of insulin resistance. Later in the day your natural resistance might lessen and starting closer to 12 your natural insulin might cope a little better. Or it might not.

So getting an understanding of how you should expect your BG to respond needs regular routines (logged); and clear comparative records (particularly fps just before a meal and consistently at the 2 hr point). Then with a series of results it becomes a little easier to draw a conclusion AND the confusion is lessened. None of this is easy. If it were easy these sort of questions would not occur.

If a series of results from similar routines simply does not produce an identifiable trend then it becomes easier to explain in terms of your pancreas not producing insulin in any sort of consistent way - probably (certainly possibly) arising from your earlier panc'y damage. At the very least if your various "exploratory" measures doesn't get you to consistent BGs somewhere around the 5-7 zone then there seems to my non-medical mind a strong necessity to get you onto a full MDI routine and bring some stability to your BG 24 hrs a day. An overnight change to MDI won't bring an instant stability; it will need time (months probably) to find the right doses in relation to meals being eaten.

Again, none of this is easy - but is doable and your endeavours and questions in the last month leave me feeling that YOU can do this. The first step is wanting to take care of yourself and you've made that start.

 

[Duane Charles]

But what was it at 1pm before you had your pud cheese cake, paired reading are much more informative as to what might

One of the complicating things about our bodies is that our natural resistance to insulin (your own or my injected insulin) changes at different times of the day and also changes depending on how low or high one's BG is. Most of us get an increase in resistance when our BG is higher - but that's not a definitive rule.

So if you woke with a BG at 6 your body might naturally cope with extra carbs from breakfast from your own insulin release, whereas it might not cope if your BG was 12 - because of the possible natural increase of insulin resistance. Later in the day your natural resistance might lessen and starting closer to 12 your natural insulin might cope a little better. Or it might not.

So getting an understanding of how you should expect your BG to respond needs regular routines (logged); and clear comparative records (particularly fps just before a meal and consistently at the 2 hr point). Then with a series of results it becomes a little easier to draw a conclusion AND the confusion is lessened. None of this is easy. If it were easy these sort of questions would not occur.

If a series of results from similar routines simply does not produce an identifiable trend then it becomes easier to explain in terms of your pancreas not producing insulin in any sort of consistent way - probably (certainly possibly) arising from your earlier panc'y damage. At the very least if your various "exploratory" measures doesn't get you to consistent BGs somewhere around the 5-7 zone then there seems to my non-medical mind a strong necessity to get you onto a full MDI routine and bring some stability to your BG 24 hrs a day. An overnight change to MDI won't bring an instant stability; it will need time (months probably) to find the right doses in relation to meals being eaten.

Again, none of this is easy - but is doable and your endeavours and questions in the last month leave me feeling that YOU can do this. The first step is wanting to take care of yourself and you've made that start.

A couple of questions that has come to my mind in reading your response, yes I’m modifying my diet and trying to increase fluid intake however, would this suggest that whatever I’m doing isn’t enough and should I still be looking at 3c?

 

[Leadinglights]

I wonder if you are off work then by following a more conventional meal pattern would help you find out what happens to your before and after meal readings. Everybody natural insulin production will vary throughout the day following circadian rhythms and if your meals are out of step with that it maybe why your levels are all over the place.

 

[Duane Charles]

I wonder if you are off work then by following a more conventional meal pattern would help you find out what happens to your before and after meal readings. Everybody natural insulin production will vary throughout the day following circadian rhythms and if your meals are out of step with that it maybe why your levels are all over the place.

I have just taken another reading, which is 2 hours after eating a ham/turkey/cucumber sandwich (wholemeal seeded bread) and some raspberries washed down with 300ml water, it was 10.3

 

[Duane Charles]

I’ve checked my meter and have the following readings:

• 7 day average 11.1
• 14 day average 11.7
• 21 day average 12.3
• 28 day average 12.2

I don’t know if this is a trend or not, but today is exactly 4 weeks since I started the regular readings.

 

[Leadinglights]

I have just taken another reading, which is 2 hours after eating a ham/turkey/cucumber sandwich (wholemeal seeded bread) and some raspberries washed down with 300ml water, it was 10.3

So pretty well the same so that looks promising.

 

[Proud to be erratic]

Yes it does look promising that you've maintained that sort of level with a slight improvement over 7 days than 28 days. I'd feel happier for you if you could get that down into the 8s or better - simply because the secondary risks from high BG are further reduced. There might also be that additional spin off that with even lower BG your natural insulin resistance is also lower and then your body should get the benefit of that. Anyway, well done and this is far from a gloomy outcome.

Now you have something tangible to discuss on the 28th. I'm afraid that without looking back through your individual posts I can't remember where you are in the prescribed doses of Metformin and Alogliptin - but if I am remembering correctly you are on increased doses but not yet at maximum doses. It could be that after the 28th you will be encouraged to increase the oral meds and see if they will give you the breakthrough from c.11-12 to below 8s?

Just out of complete curiosity, does the recent change in your eating patterns or what seems from this distance the gentle improvement in your BGs have any consequence for your Pacemaker and your brachycardia & arrhythmia?

 

[Duane Charles]

Just out of complete curiosity, does the recent change in your eating patterns or what seems from this distance the gentle improvement in your BGs have any consequence for your Pacemaker and your brachycardia & arrhythmia?

The pacemaker controls the bradycardia and arrhythmia. Prior to having the pacemaker my heart had stopped 30 times in 3 weeks and it wasn’t unusual to have a resting heart rate in the lower 30’s, this was a night time thing.

I have been on the Alogliptin for just over 2 years, the Metformin only prescribed back in November. I was started on 1 x 500mg the first week and increased to 2 x 500mg. When I started the 2 tablets a day I took them both during breakfast. Just before Christmas (21st) I was increased to 4 x 500mg which again I have taken every morning.

My next appointment with a DN isn’t until 19th Jan when I’m due to have my HBA1C checked.

 

[Duane Charles]

I also want to apologise for all the questions I’m asking.

 

[Proud to be erratic]

I also want to apologise for all the questions I’m asking.

NO APOLOGIES are needed. Questions are good and even if they are either not answered or bring too many different answers they are still good - because they provide a way of formally documenting something that might otherwise be floating around in a random manner.

Thanks for your earlier answer - I'm mildly annoyed with myself for just misremembering and not bothering to look back for myself. I'm out all day and flying home tomorrow, so will be in low profile for a couple of days.

 

[Duane Charles]

I wonder if you are off work then by following a more conventional meal pattern would help you find out what happens to your before and after meal readings. Everybody natural insulin production will vary throughout the day following circadian rhythms and if your meals are out of step with that it maybe why your levels are all over the place.

I have been off a couple of days, so that may have helped.

 

[Duane Charles]

This morning my pre-FOTF was 14.1 ketones checked too. I had breakfast that consisted of a bowl of porridge and mug of black coffee. On taking my after meal BG (2 hours later) of 10.4

I know I’m not consistent with what I have for breakfast because I’m trying different things to see what is good and what isn’t. Some days when I’ve had porridge it has pushed me up and others like today brought me down. I just hope I can get the swing of this soon.

 

[Sally71]

Diabetes likes routine - probably not worth worrying too much over the Christmas period when you are out of routine and eating things that you probably wouldn’t normally. Once you’re back to normal in January then hopefully you might start to see some patterns. Well done on all the effort, and don’t worry about asking questions, we were all new and confused once!

 

[Sharron1]

This morning my pre-FOTF was 14.1 ketones checked too. I had breakfast that consisted of a bowl of porridge and mug of black coffee. On taking my after meal BG (2 hours later) of 10.4

I know I’m not consistent with what I have for breakfast because I’m trying different things to see what is good and what isn’t. Some days when I’ve had porridge it has pushed me up and others like today brought me down. I just hope I can get the swing of this soon.

If this might help.. I also have porridge for breakfast daily but a small amount, it fills me up and doesn't spike my blood glucose. I have a sachet of porridge approx 16 carbs. Trial and error, the best way forward. Good luck.

 

[Duane Charles]

If this might help.. I also have porridge for breakfast daily but a small amount, it fills me up and doesn't spike my blood glucose. I have a sachet of porridge approx 16 carbs. Trial and error, the best way forward. Good luck.

The porridge I have is about 18 carbs, so not far from what you have. Some days my BG goes up and others down. As you say everything is trial and learning and thank you.

 

[Duane Charles]

Diabetes likes routine - probably not worth worrying too much over the Christmas period when you are out of routine and eating things that you probably wouldn’t normally. Once you’re back to normal in January then hopefully you might start to see some patterns. Well done on all the effort, and don’t worry about asking questions, we were all new and confused once!

I agree that this time of year probably isn’t the best time for routines, that said I’ve just kept on taking readings and I’m already returning to my routine today.

 

[Duane Charles]

Thanks for your earlier answer - I'm mildly annoyed with myself for just misremembering and not bothering to look back for myself. I'm out all day and flying home tomorrow, so will be in low profile for a couple of days.

Safe travels and thank you for your insights