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Finally spoken to Dr, finally got HBA1c, what do I do next?! :S

Karajane

Member
Relationship to Diabetes
Type 2
Hi all,

Im not sure if you remember me, but I posted about being diagnosed and feeling like it was my fault. Thankfully, you guys were amazing and Im doing a bit better mentally.

3 weeks after the letter just popped on the doormat, I have finally spoken to a Dr and found out my HBA1c is 51-53, they've done a few blood tests apparently. I wasn't aware as I regularly have bloods done anyway. So thats where I'm starting from which is not bad from what I know but I don't know very much. Ive been told a nurse will come to see me when she gets round to it. Ive been doing some testing before and after meals, my worst spike has been 13.4 measured 2.5hrs after pasta bake - i've not had that since. The other day I started the day at 10.8 before breakfast so you can imagine how that day went.

Where should my regular morning levels be? And how high do they have to be to warrant medication? I spoke to my nurse re diet today and we both agreed (because I have swallowing problems) that I am extremely limited to what I can do, and Im likely to be as good as we can get me and Im likely to need meds. Would I be needing meds yet at this stage? What are your thoughts?

I'd like to hear your thoughts before I listen totally to the nurse as I've learned via my other condition that they don't always have the best advise. Although I know here is just opinions and support not medical advice etc. Just wondered your thoughts,

Thanks so much, Kara xxx
 

Karajane

Member
Relationship to Diabetes
Type 2
Some mornings before breakfast my BM has been 10.8. Its nearly always over 8. Thanks, hopefully I can find them.
 

everydayupsanddowns

Administrator
Staff member
Relationship to Diabetes
Type 1
Hello again @Karajane

On the plus side, your A1c is at the low risk end of the spectrum.

Perhaps consider making some small reductions in the carb content of your meal to reduce the impact on the BG levels from meals - you can check what’s happening by measuring BG immediately before a meal and then again an hour or two after eating. Ideally your level should rise by less than 3mmol/L at 2 hours (so if you start at 6, no higher than 9).

Lots of experienced folks here to give you support and share what they find helps them.
 

Robin

Well-Known Member
Relationship to Diabetes
Type 1
It's also worth remembering that cooked pasta has almost double the carb content of uncooked pasta, so I only have 40 or 50 grams as a portion.
What? It can’t gain carbs in the cooking process, surely?
 

Kaylz

Well-Known Member
Relationship to Diabetes
Type 1
Pasta needn't necessarily be a problem. I have it regularly, but I buy wholegrain spelt pasta which is recommended as an alternative in some things I've read. It's also worth remembering that cooked pasta has almost double the carb content of uncooked pasta, so I only have 40 or 50 grams as a portion.

Martin
Sorry?
 

Robin

Well-Known Member
Relationship to Diabetes
Type 1
The nutritional info on the pack suggests that as cooked pasta wieghs almost double what it was uncooked. I might be interpreting it incorrectly but assumed that's why half portions are recommended?
Happy to be wrong, though.

Martin
A given amount of raw pasta, when cooked, doubles in weight because it has absorbed water during the cooking process.
Small portions are usually advised because a large amount of unrefined carbs can send your blood sugars spiking before your injected insulin kicks in, (or in the case of someone with Type 2, before their own insulin response gets going)
 

SB2015

Forum Host
Relationship to Diabetes
Type 1
The information on the packs of pasta can be very confusing!!
They often give the carbohydrate information for the pasta after it has been cooked, but who wants to weigh their food when it Is is cooked? I suppose you could do it but it is a bit late then as you already have the plateful. Pasta does increase in weight when cooked.

For one that we use it is:
38g of uncooked pasta, weighs 75g once cooked, and gives me 25g of carbs
The information is there but takes a bit of working out.

So if you work out how many carbs you want to eat, see what weight of cooked pasta will give you that, and then halve that weight to work out how much dried pasta to use it would be a reasonable approximation for some brands. phew!!

Having said all that, my Libre shows me what a nightmare pasta is for controlling my BG, so I just don’t eat it. I now use Black bean or Edamame pasta. It is about a quarter of the carbs content and at least I still get a good carrier for my bollognaise.
 

everydayupsanddowns

Administrator
Staff member
Relationship to Diabetes
Type 1
Yes It’s a nightmare trying to unpick pasta packaging. I’m always a bit dubious of the ‘when cooked’ numbers as surely it depends on how ‘al dente’ the pasta is when you eat it - as that will vary the amount of water absorbed, and therefore the weight.

In my experience pasta is uniform enough across all the different shops to allow you to use ‘uncooked’ information from one supermarket to calculate for another which only supplies ‘cooked’ information on its packaging.

I wonder if @Anitram is thinking of that trick where cooked and cooled pasta which is then reheated makes a change in some of the starches so that some of it no longer gets digested? That’s the only ‘carb reduction’ thing I’ve ever heard about related to pasta cooking (aside from the different numbers for cooked/uncooked because of the weight change).
 

Karajane

Member
Relationship to Diabetes
Type 2
Well, I've seen the Diabetic nurse finally, after taking readings all week and 2.5hrs after a low sugar low carb meal getting readings like 14.8 etc, she flipped through my little booklet and went through my food diary and said she thought as a bed bound patient with swallowing difficulties too, and having a low carb, low calorie diet already - she and the diabetic dietician agreed there were not enough significant changes I could make that would make much difference to my sugars, but I would need a small dose of medication to try and bring it down.

And she told me not to worry about my diet as much as I am actually under eating often. So I felt relieved after that, partially not relieved as I wanted to avoid meds, not also relieved as I really didn't know what else I could have done under the circumstances. So glad that they saw that, as it was really getting me down.

One day I had only consumed 15.1g of sugar in total in 24hrs (including all carb sugars) yet my blood glucose was 10.3, that really got me down, and they agreed that the readings and what I'd eaten didn't seem to match up or relate, there was no pattern and it was quite erratic. I don't know what that means, but at least we've gotten somewhere finally.
 

Karajane

Member
Relationship to Diabetes
Type 2
Talking pasta though, I've found a brand called Ugo Thrive who do a pasta that is gluten, wheat and egg free, and that has half the carbs to normal pasta, and only traces of sugars. My Mum is Celiac, so its good for me to be eating that as she can have some if she comes around one day. xxx
 

SueEK

Well-Known Member
Relationship to Diabetes
Type 2
Hi Karajan, I wouldn’t worry about the medication. I am on full dose Metformin and other than suffering from nausea in the mornings (which has now gone as I now take it lunch time and evening time) I have had no side effects at all. My bg’s have come down from 90 to 51, obviously helped by the medication. You can only do what you are physically and medically capable of and sounds like your nurse is on the case. I wish you well and keep in touch with how you are doing x
 

Drummer

Well-Known Member
Relationship to Diabetes
Type 2
I think that being hard on yourself might be a bit of a habit - it is still early days for you and - really, everything is going to go more slowly - except if you get the Metformin consequences - which would be no fun at all if you can't run to the toilet with all the urgency that can induce.
Remember that it is the total carbohydrate, starches as well as sugars which is significant.
Your progress seems good to me - in a couple of weeks your levels are down - from almost 15 to nearly 10 is statistically significant, even if it is not happening regularly now it could soon be the normal thing you see, because it does seem to be cumulative.
These days I could probably eat a couple of 'normal' meals and still see normal numbers, because my ability to cope has improved over the years - I wouldn't because I really find what I can eat is the better option.
Do try to eat enough though, I'd not take the nurses assurances that under eating is OK - Human metabolism alters when there isn't enough food around - it is how people got through hard times and we inherited the ability to survive the famine, it is the feast of carbs that is the problem these days.
 

Karajane

Member
Relationship to Diabetes
Type 2
Thank you both. I know they're not putting me on metformin as its too big for me to swallow, but they're trying something else but I can't remember the name - I get it later. When I said the nurse told me not to worry about my diet because I was underrating, I phrased that wrong, she meant what you said, that I was trying to hard and I should go easy on myself and not worry as much about it, as it was causing me to under eat. I am low on carbs as well as the sugars.

I've not come down from 15 to 10 though, its just totally erratic, Ive done three weeks of bg testing in morning and before bed and before meals and 2.5hrs after meals and there is no correlation between meals and sugars or times and spikes. One morning (8.30ish) my sugars were 13.4 and I'd not eaten since 7pm the last night and sugars before bed were 8.2. So still high, but I'd had nothing to spike me to 13.4!

The nurses looked at it all next to my food diary and said the sugar readings didn't seem to be corresponding with what you'd expect from what I am eating, they said it might be that Im not responding to insulin? Don't understand what that means really. But anyway, first step happens today when I get my tablets and start on one a day to add to my copious medication list. I really hope its small enough to swallow, as their versions of small and mine for swallowing are often two different things! Hopefully should be ok, and get my levels down via this medication. Thanks you guys <3 xxx
 

MikeTurin

Well-Known Member
Relationship to Diabetes
Type 2
Pasta al dente has a lower glycaemic index confronted with overcooked pasta, besides overcooked pasta has less gluten and other nutrients.
So, for overcooked pasta the carb content is proportionally higher in percentage. Anyway because basically the cooking process wil make the pasta absorb the water that has no calories, it' obvious that the same weight of raw and cooked pasta have less calories in the latter case.

@Karajane I've also found a pasta made with chickpeas https://www.mdspa.it/marchi-scheda/179-Sedanini-di-farina-di-ceci that is interesting, has less carbs confronted with regular pasta and actually tastes good.
 

mikeyB

Well-Known Member
Relationship to Diabetes
Type 1
Napolina do gluten free chickpea pasta, around £2 a pack from Sainsbury’s, cheaper in Tesco.
 

SueEK

Well-Known Member
Relationship to Diabetes
Type 2
Sadly I have given up pasta completely and virtually all rice, wish I had so much control over my desire for white bread
 

TheClockworkDodo

Well-Known Member
Relationship to Diabetes
Type 1
Thank you both. I know they're not putting me on metformin as its too big for me to swallow, but they're trying something else but I can't remember the name - I get it later. When I said the nurse told me not to worry about my diet because I was underrating, I phrased that wrong, she meant what you said, that I was trying to hard and I should go easy on myself and not worry as much about it, as it was causing me to under eat. I am low on carbs as well as the sugars.

I've not come down from 15 to 10 though, its just totally erratic, Ive done three weeks of bg testing in morning and before bed and before meals and 2.5hrs after meals and there is no correlation between meals and sugars or times and spikes. One morning (8.30ish) my sugars were 13.4 and I'd not eaten since 7pm the last night and sugars before bed were 8.2. So still high, but I'd had nothing to spike me to 13.4!

The nurses looked at it all next to my food diary and said the sugar readings didn't seem to be corresponding with what you'd expect from what I am eating, they said it might be that Im not responding to insulin? Don't understand what that means really. But anyway, first step happens today when I get my tablets and start on one a day to add to my copious medication list. I really hope its small enough to swallow, as their versions of small and mine for swallowing are often two different things! Hopefully should be ok, and get my levels down via this medication. Thanks you guys <3 xxx

My blood sugar readings are quite erratic too, I think that's par for the course with ME, because you get delayed reactions to everything, so my blood sugar in the evening will often reflect my whole day rather than just reflecting my evening meal, and sometimes this will carry over to the next day too. None of the diabetes professionals I've seen know much about ME, so I've had to work a lot of things out for myself in terms of how my ME and my diabetes interact.

I'm glad they're not giving you Metformin, I don't think it's a good idea for pwme, because it can cause digestive problems. I'm guessing they'll put you on Gliclazide - if you can't swallow that or it doesn't work for you they might need to give you insulin, but please don't worry about that (because using insulin is really easy and you can eat more or less what you like on it!).
 

Karajane

Member
Relationship to Diabetes
Type 2
My blood sugar readings are quite erratic too, I think that's par for the course with ME, because you get delayed reactions to everything, so my blood sugar in the evening will often reflect my whole day rather than just reflecting my evening meal, and sometimes this will carry over to the next day too. None of the diabetes professionals I've seen know much about ME, so I've had to work a lot of things out for myself in terms of how my ME and my diabetes interact.

I'm glad they're not giving you Metformin, I don't think it's a good idea for pwme, because it can cause digestive problems. I'm guessing they'll put you on Gliclazide - if you can't swallow that or it doesn't work for you they might need to give you insulin, but please don't worry about that (because using insulin is really easy and you can eat more or less what you like on it!).

Thanks Juliet, yes, we MEEPS have to work a lot out for ourselves don't we lol! My nurse did ask though if ME affected the metabolic or endocrine systems and I said yes they can do, and in me, Im very Severe, and every system is affected now. So it makes sense as a progression of my endocrine dysfunction. My autonomic function is so bad I now need oxygen, despite having a clear chest and no sign of heart disease (other than POTS) and I've stopped absorbing meds and vitamins from food. So its going to be trial and error with meds as I do absorb it, but I often have to have more prescribed than I actually will absorb in order to get the effect of the meds I need etc.

For s first try they're putting me on Alogliptin as I can swallow small tablets and the dose is 12.5mg at first just to see how we go. I'm hoping it works and we don't experience any of the side effects.

Hope you are as well as possible Juliet, Kara xxx
 
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