Hello I’d love some straightforward guidance

[LindaSA]

Hello and thank you to everyone who posts here with sound guidance and experience to help newbies like me.

I’d love some guidance as even though I was diagnosed as a Type 2 diabetic some years ago, I have to be honest and say I’ve never really understood the numbers used in testing and results given.

Please bear with me in this post as I explain my situation and ask my question. Thanks so much if you can put me straight!

My understanding is that my blood sugar results are usually supplied as a result of a fasting blood plasma test as opposed to a Hbac1. Seven years ago when I was diagnosed, three days after being widowed in my early 40s, my blood sugar test result was 18.5. Within 3 months I got that down to normal levels (low 6s or under but it’s a blur) through healthier eating, losing around two stone (but still being obese) and some exercise.

Two years ago I suffered two more very close bereavements within a month of each other, one of which was at a young age, and my eating again went haywire. It continued that way on and off until March this year when another blood test showed my blood sugar was 12. I decided to do something about it again and started to follow the Blood Sugar Diet and began to exercise well and regularly 12 weeks later my blood sugar levels were 6.4 and I was told ‘prediabetic’

I’ve continued to lose weight and am due a ‘diabetic review’ in the coming weeks. I’ve lost a total of 65lbs and come down into a healthy weight range for my height. All the time I’ve continued to take metformin twice a day, with two 500mg tablets each time. I had in mind to contact my diabetic nurse to discuss reducing these this week.

This morning on waking, after last eating at 2pm yesterday, I was dizzy, headachey and sick, and threw up, with an upset tummy. I’ve been avoiding ‘obvious’ carbohydrates as part of my eating healthier/losing weight way of eating and have adopted more of an ‘intermittent fasting’ approach for the last couple of weeks where I don’t snack overnight, nothing drastic.

I got in my car to drive to an event I was due at this morning but was too dizzy. I was concerned my blood sugar may be too low or I was affected by a lack of salt or something and rang NHS 111 after eating some toast, just for advice.They sent a paramedic who tested my blood sugar, the reading about an hour after having 3 slices of white toast with butter was 8.8. They said this was normal.

But I’m totally baffled by the numbers and looking at the information online, including through Diabetes UK I still don’t get it. It’s like I have a mental block.

So my question is basically - is a reading of 8.8 an hour after eating 3 slices of white bread a cause for concern? Does this sound normal? Diabetic? prediabetic?

I know I could be measuring my own blood sugar levels at home and maybe this is the answer, but someone somewhere along the line advised me not to do this. I’m hoping to have more positive news from my diabetic nurse as I continue improving my health.

Thank you for reading and thanks if you can help.

 

[Eddy Edson]

So my question is basically - is a reading of 8.8 an hour after eating 3 slices of white bread a cause for concern? Does this sound normal? Diabetic? prediabetic?

Plenty of non-diabetics can peak at 9+ after eating. Grains in particular can cause relatively high after-eating BG levels for many folks, diabetic or non-diabetic. So your 8.8 wouldn't by itself in isolation cause a doc to say you're diabetic or pre-diabetic, I think.

 

[LindaSA]

Plenty of non-diabetics can peak at 9+ after eating. Grains in particular can cause relatively high after-eating BG levels for many folks, diabetic or non-diabetic. So your 8.8 wouldn't by itself in isolation cause a doc to say you're diabetic or pre-diabetic, I think.

Thank you that’s really helpful. And good to know.

 

[rebrascora]

Hi and welcome.

I am so sorry to hear of your losses and totally understandable to seek comfort in food at those times and indeed it is unreasonable to expect to maintain very strict control of your diet for prolonged periods without a little bit of falling off the wagon here and there.

It sounds like you have done fantastically well in losing all that weight and gaining control of your BG, when you have had an impetus to do so.

My guess would be that your blood glucose was a bit low from fasting when you felt light headed/dizzy that morning and the 3 slices of bread would easily take you up to 8.8.... (it would take me nearer 18.8!) ....as an aside, white bread is not really a healthy option for a diabetic and 3 slices is a huge amount to have at one go, especially breakfast time when insulin resistance is often higher, so that may be something you want to look at going forward. Having a Blood Glucose Meter is something that many health care professionals discourage, I believe due to a worry that people will become obsessive about checking but if you are funding it yourself you will find the financial cost of buying strips self limiting unless you are particularly wealthy and it is hugely beneficial to be able to test yourself especially when you feel unwell like that and therefore know how to treat it. If for example your BG had gone very high that morning and was making you dizzy and unwell, having 3 slices of bread could have made you significantly worse. They are inexpensive to buy at about £15 for a meter which usually comes with a finger pricker and 10 test strips and 10 lancets. After that they cost anywhere from £8-£20 for a pot of 50 test strips depending upon which make of meter you buy.... test strips are not interchangeable, so buying a meter which has the cheapest test strips is the most economical way to do it.... for that reason the SD Codefree glucose meter is usually recommended.
The fact that you are still on Metformin suggests that you may not be fully in remission with your diabetes so you are likely to get higher than normal readings from time to time, especially if you eat starchy foods like bread in any quantity. There is a lot of confusion over readings because there are not just different readings ie finger prick, HbA1c but also the units of those readings, so it is important to know not only what a reading is but what it is being measured in. I believe HbA1c can be expressed in 3 different ways one of which is as a percentage which can be a very similar number to the BG reading, so without knowing what the reading you are given represents, it is very difficult to interpret it.
There is a graph which shows the various readings for HbA1c and corresponding BG averages which might help clarify it. Hopefully someone else will post a link to it.

 

[LindaSA]

Hi and welcome.

I am so sorry to hear of your losses and totally understandable to seek comfort in food at those times and indeed it is unreasonable to expect to maintain very strict control of your diet for prolonged periods without a little bit of falling off the wagon here and there.

It sounds like you have done fantastically well in losing all that weight and gaining control of your BG, when you have had an impetus to do so.

My guess would be that your blood glucose was a bit low from fasting when you felt light headed/dizzy that morning and the 3 slices of bread would easily take you up to 8.8.... (it would take me nearer 18.8!) ....as an aside, white bread is not really a healthy option for a diabetic and 3 slices is a huge amount to have at one go, especially breakfast time when insulin resistance is often higher, so that may be something you want to look at going forward. Having a Blood Glucose Meter is something that many health care professionals discourage, I believe due to a worry that people will become obsessive about checking but if you are funding it yourself you will find the financial cost of buying strips self limiting unless you are particularly wealthy and it is hugely beneficial to be able to test yourself especially when you feel unwell like that and therefore know how to treat it. If for example your BG had gone very high that morning and was making you dizzy and unwell, having 3 slices of bread could have made you significantly worse. They are inexpensive to buy at about £15 for a meter which usually comes with a finger pricker and 10 test strips and 10 lancets. After that they cost anywhere from £8-£20 for a pot of 50 test strips depending upon which make of meter you buy.... test strips are not interchangeable, so buying a meter which has the cheapest test strips is the most economical way to do it.... for that reason the SD Codefree glucose meter is usually recommended.
The fact that you are still on Metformin suggests that you may not be fully in remission with your diabetes so you are likely to get higher than normal readings from time to time, especially if you eat starchy foods like bread in any quantity. There is a lot of confusion over readings because there are not just different readings ie finger prick, HbA1c but also the units of those readings, so it is important to know not only what a reading is but what it is being measured in. I believe HbA1c can be expressed in 3 different ways one of which is as a percentage which can be a very similar number to the BG reading, so without knowing what the reading you are given represents, it is very difficult to interpret it.
There is a graph which shows the various readings for HbA1c and corresponding BG averages which might help clarify it. Hopefully someone else will post a link to it.

Thank you Barbara for your detailed and thoughtful reply. I really appreciate it and am very grateful. I can see you’re talking complete sense! I’ve been working so hard so in hindsight why I touched that bread is a mystery - but I did kid myself that because it was toasted straight from frozen that was somehow better! When it comes to the figures and how they’re expressed I think I really need to talk to my nurse about this. I only seem to take in ‘it’s getting better’ - so this leads to confusion. Thank you again.

 

[SueEK]

Hi Linda and welcome. I do agree with Barbara regarding getting a meter. Once you have had it a couple of months and tested just before and two hours after eating you will really know which foods you can and cannot tolerate, it is then much easier to sort out what sort of meals you can have and therefore the need for testing becomes much less. We are all so different in what we can tolerate that it is very difficult to advise what you should and shouldn’t have. I also agree that it needs to be made clear to you what your readings are measured in or it is confusing for you, it would be to me too.
As regards your Metformin I would advise caution. In my case I was on 2000mg a day and levels were reduced from 90 to 43, I thought great, however my levels have started to creep back up despite being on the same food regime as before and after a conversation with the diabetes care team the other day I have now been put back on 1000mg a day which I am disappointed but accepting of.
I would suggest you write all your questions down to take with you to your review as it is very difficult to remember when in your review as they do tend to lead the conversation. Please let us know how you get on and of course ask any more questions that you may have. Sue x

 

[LindaSA]

Hi Linda and welcome. I do agree with Barbara regarding getting a meter. Once you have had it a couple of months and tested just before and two hours after eating you will really know which foods you can and cannot tolerate, it is then much easier to sort out what sort of meals you can have and therefore the need for testing becomes much less. We are all so different in what we can tolerate that it is very difficult to advise what you should and shouldn’t have. I also agree that it needs to be made clear to you what your readings are measured in or it is confusing for you, it would be to me too.
As regards your Metformin I would advise caution. In my case I was on 2000mg a day and levels were reduced from 90 to 43, I thought great, however my levels have started to creep back up despite being on the same food regime as before and after a conversation with the diabetes care team the other day I have now been put back on 1000mg a day which I am disappointed but accepting of.
I would suggest you write all your questions down to take with you to your review as it is very difficult to remember when in your review as they do tend to lead the conversation. Please let us know how you get on and of course ask any more questions that you may have. Sue x

Thank you Sue and that’s a really good point about writing down my questions. I think the number one thing I need to understand is how the figures I’m given work. Having lost four and a half stone in five months with much reduced carbsI’m really very hopeful of getting to remission. I’m going to book an appointment for the coming weeks and continue to eat healthily with white bread definitely off the menu! I’m going to ask about reducing metformin at my next appointment. Whether this is possible or not I have to be very positive about the improvements I’ve made. I’ve been in remission before and gone way up before, due to grief and stress. I really would like to think I’m now on the way to doing it for good x

 

[SueEK]

You’ve down extremely well with your weight reduction and it’s bound to show in your figures and you’ve had an awful lot to contend with. Sounds like you know basically what foods to have and not to have though I am still learning as I think with all of us our diabetes seems to change as the months go by just to keep us on our toes and it most certainly does 😉😉😉

 

[LindaSA]

You’ve down extremely well with your weight reduction and it’s bound to show in your figures and you’ve had an awful lot to contend with. Sounds like you know basically what foods to have and not to have though I am still learning as I think with all of us our diabetes seems to change as the months go by just to keep us on our toes and it most certainly does 😉😉😉

Thank you - I was in denial for years sadly. Thanks for being so thoughtful and helpful.

 

[SueEK]

Thank you - I was in denial for years sadly. Thanks for being so thoughtful and helpful.

No point looking back Linda, just look forward, you are definitely on the right road now and Im sure you can also contribute to other peoples problems on here as we all need help and support at certain times. Please feel free to keep asking questions though and I look forward to seeing your posts xx

 

[TheClockworkDodo]

Here is the meter Barbara was talking about, if you want to get one - https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/
You need to say you are diabetic and then you won't have to pay VAT.
And you need to choose mmol/L as that's the measure we use in the UK.

Testing your own blood sugar before and then a couple of hours after meals is really helpful as it will show you which foods are a problem for you and which you can eat without them spiking your blood sugar at all.

And here's a chart which shows all the confusing numbers:

The numbers at the bottom are the numbers you'll get with a finger-prick test - the ones in mmol/L.
(The ones at the top are different ways of measuring the HbA1c, if you have one of those done.)
As you can see, you want to stay in the green area if you can.

As a type 2, the numbers you're aiming for are around:
4-7 mmol/L before meals
5-9 mmol/L after meals

 

[LindaSA]

No point looking back Linda, just look forward, you are definitely on the right road now and Im sure you can also contribute to other peoples problems on here as we all need help and support at certain times. Please feel free to keep asking questions though and I look forward to seeing your posts xx

Thank you that’s very kind of you.

 

[LindaSA]

Here is the meter Barbara was talking about, if you want to get one - https://homehealth-uk.com/all-products/codefree-blood-glucose-monitoring-system-mmoll-or-mgdl/
You need to say you are diabetic and then you won't have to pay VAT.
And you need to choose mmol/L as that's the measure we use in the UK.

Testing your own blood sugar before and then a couple of hours after meals is really helpful as it will show you which foods are a problem for you and which you can eat without them spiking your blood sugar at all.

And here's a chart which shows all the confusing numbers:

The numbers at the bottom are the numbers you'll get with a finger-prick test - the ones in mmol/L.
(The ones at the top are different ways of measuring the HbA1c, if you have one of those done.)
As you can see, you want to stay in the green area if you can.

As a type 2, the numbers you're aiming for are around:
4-7 mmol/L before meals
5-9 mmol/L after meals

Thank you Juliet for taking the time and trouble to post this. I have stared blankly at this chart far too often. My ignorance is shocking really. Thank you for explaining.

Can I ask specifically on a fasting blood plasma test, are the results of that expressed as the percentage at the top of the curve?

Thanks for your help. I find it ridiculous that I’ve not had this conversation with my nurse/doctor, I must have done at some point.

 

[grovesy]

No they are differnt tests.

 

[Eddy Edson]

Thank you Juliet for taking the time and trouble to post this. I have stared blankly at this chart far too often. My ignorance is shocking really. Thank you for explaining.

Can I ask specifically on a fasting blood plasma test, are the results of that expressed as the percentage at the top of the curve?

Thanks for your help. I find it ridiculous that I’ve not had this conversation with my nurse/doctor, I must have done at some point.

No, the percentage is a different scale for HbA1c - used in the US etc etc. You can just ignore it.

The blue numbers above the percentages are the HbA1c scale used in the UK. The numbers down the bottom correspond to average BG. The idea is that a particular HbA1c reading will correspond to a particular avg BG over the last 2-3 months. So for example an HbA1c of 53 mmol/mol corresponds to average BG over the last 2-3 months of 8.6.

The correspondence is generally pretty good but it's not an exact thing, and it may be off by varying amounts for different people at different times.

There's not enough information in a single finger prick to tell you what your HbA1c or average BG levels are - hence the reason for the HbA1c test.

I do think this stuff could be explained better when you first get diagnosed, but on the other hand I guess it's usually a case of information overload at that point.

 

[Drummer]

Unfortunately a lot of emphasis is put on weightloss and fasting levels, but remission is having normal glucose levels.
I can't help with your main question about your levels after bread - I would never eat normal bread or be taking Metformin (it made me very ill) but you seem to be rather mystified about diabetes in general.

For most type twos, the Hba1c test is the key to their response to being diabetic. If it is above normal levels they know that overall their intake of carbs is too high, medication can help, but for the lucky ones, like me, I just need a meter and to check that what I am eating day to day is not causing spikes. The meter I got measures the glucose levels in millimoles per litre (mmol/l) which is the standard in the UK - the levels I see are almost always under 10mmol/l, mostly under 7 and occasionally under 6. I test after meals - 2 hours from starting to eat. If you look at the figures under the arc in the chart, that puts me firmly in the green zone.

 

[LindaSA]

No they are differnt tests.

Thank you.

 

[LindaSA]

No, the percentage is a different scale for HbA1c - used in the US etc etc. You can just ignore it.

The blue numbers above the percentages are the HbA1c scale used in the UK. The numbers down the bottom correspond to average BG. The idea is that a particular HbA1c reading will correspond to a particular avg BG over the last 2-3 months. So for example an HbA1c of 53 mmol/mol corresponds to average BG over the last 2-3 months of 8.6.

The correspondence is generally pretty good but it's not an exact thing, and it may be off by varying amounts for different people at different times.

There's not enough information in a single finger prick to tell you what your HbA1c or average BG levels are - hence the reason for the HbA1c test.

I do think this stuff could be explained better when you first get diagnosed, but on the other hand I guess it's usually a case of information overload at that point.

Thank you. Really grateful for the explanation. I think when I was first diagnosed I had so much else going on I never got to grips with it. I did get back to normal blood sugar levels and came off medication until renewed grief hit me too hard and emotional eating took over again.

 

[LindaSA]

Unfortunately a lot of emphasis is put on weightloss and fasting levels, but remission is having normal glucose levels.
I can't help with your main question about your levels after bread - I would never eat normal bread or be taking Metformin (it made me very ill) but you seem to be rather mystified about diabetes in general.

For most type twos, the Hba1c test is the key to their response to being diabetic. If it is above normal levels they know that overall their intake of carbs is too high, medication can help, but for the lucky ones, like me, I just need a meter and to check that what I am eating day to day is not causing spikes. The meter I got measures the glucose levels in millimoles per litre (mmol/l) which is the standard in the UK - the levels I see are almost always under 10mmol/l, mostly under 7 and occasionally under 6. I test after meals - 2 hours from starting to eat. If you look at the figures under the arc in the chart, that puts me firmly in the green zone.

Thank you for replying so thoughtfully. I think one of the things I’m most baffled/confused by is that in my appointments over the years with my diabetic nurse, tests have largely been fasting blood tests and these are what have been used to keep me informed of how I’ve been getting on. I totally get the importance of reducing blood sugar levels through a variety of means but I’ve never fully grasped the significance of hbac1 tests as my experience has been they’ve not been used in my case. I understand how important the average over 3 months is but I’m asked to fast for my blood tests and you don’t fast for the Hbac1 as I understand it. Sorry if I’m going round in circles. I’m focusing on how much I’ve improved from 18.5 to 6.4.

 

[SueEK]

If you have got down to 6.4 from where you were you are doing extremely well and I can only encourage you to carry on as you are. There are lots of tweaks we can all do at times but we still have to live an enjoyable life and so it can take a while to work out what is best for us, our lifestyle and most importantly our health. Everybody’s diabetes story is as different as their lives and so although we can and should take advice from each other, ultimately the changes we make must be what fits best for us. It is confusing to begin with and can be for some considerable time but just remember that you are doing very well and we are all here to help xx