Is this good control or not?

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Geekesse

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At risk of diabetes
I was diagnosed with pre-diabetes last year based on raised HbA1c (46) and high fasting blood sugar (7.9). I did everything the doc advised - lost 4st so that my BMI is now 23.5, made permanent changes to my diet to reduce carbs to around 80 per day, last HbA1c was 41. I have maintained the weight loss and low carb diet.

I do a finger-prick test before and after my main meal each day. The results seem to suggest that I’m still not really handling most carbs. Recent readings include
1. meal with carbs in: single Greek flatbread, tzatziki, tomatoes, total carbs 42. Before meal: 5.3 After meal 8.3 - bit high
2. meal with carbs in: brown rice, mixed berries, ice cream, total carbs 43. Before meal: 4.5 After meal 6.1 - all ok
3. meal with carbs in: flour-dusted fish, raspberries, ice-cream, total carbs 61. Before meal: 5.1 After meal: 8.2 not good
4. meal with carbs in: brown spaghetti, whole orange, total carbs 42. Before meal: 4.3 After meal: 8.9 - not good
(I do have many main meals with fewer carbs - omelettes, cheese or cold meat salads, mushroom curry, cauliflower rice etc which do not induce spikes)

It seems to me that this indicates a problem which is well-controlled by a low carb diet, not a reversal of the condition. If I eat a normal meal with unmeasured carbs - not particularly carb-heavy, just an ordinary meal like steak, peas and chips - or anything with bread or pasta, or any type of biscuit, cake or sweets, my blood sugar spikes and is slow to go down. I can’t have a sandwich, potato or breakfast granola. And just once in a while, I would sell my soul for a takeaway pizza.

My fasting reading is still around 7, so even though I get it down by lunchtime through physical activity (I do a lot of walking at work), it feels as if I always have to think about how much exercise I get and what I eat. Should I ask for further testing, perhaps a GTT?
 
yoe may be misunderstamding the way things wotk.. When we eat carba the blood glucose goes uo, The body respund to this by producinf insulin. This should bring the BG down in about 2 hours, It is normal foe BG to go up after a neal, the test is did it come down again after 2 hours.

But you can eat anything that does not leave your BG much higher after 2 hours than it was befor the meal
 
Hi @Geekesse

Hopefully you'll get some replies from type 2s soon, who will be able to give you better advice than I can, but a couple of things spring to my mind reading your post

Firstly the target for type 2s to be 2 hours after meals is 8.5 - so only one of the examples you give is actually above range, the 8.9 - the others are fine, and 8.9 is only just out of range - perfectly healthy non-diabetics will get readings of 9 or 10 from time to time so it's really not that high.

Secondly it's not just how high your blood sugar goes after food, it's also how much it rises from where it starts - again, the 8.9 is the only one which is a bit more of a rise than is ideal as you were 4.3 before that meal. I suspect the orange, which is full of fast-acting carbs which will send your blood sugar up quickly, so not ideal for a low-ish-carb diet. You'd probably be better off with the pizza, or at least a slice of it (as an occasional treat), as the cheese will slow down the carbs in that!

And, as Leon says, if you're testing immediately after the meal rather than waiting 2 hours before testing, you're probably doing much better than you think you're doing!
 
I think the key question is how long after eating are you doing the test?
 
Well done on your weight loss @Geekesse 🙂 Those readings look ok - how long after your meal did you test? Blood glucose is supposed to go up and down within a normal range. People without diabetes go up to the 8s after food sometimes and occasionally up to the 10s.

It could be that you still have some insulin resistance, but if you continue with your diet and plan, that might improve, just as you’ve seen improvement now.
 
rebrascora said:
I think the key question is how long after eating are you doing the test
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Inka said:
Well done on your weight loss @Geekesse 🙂 Those readings look ok - how long after your meal did you test? Blood glucose is supposed to go up and down within a normal range. People without diabetes go up to the 8s after food sometimes and occasionally up to the 10s.

It could be that you still have some insulin resistance, but if you continue with your diet and plan, that might improve, just as you’ve seen improvement now
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I’m sorry, I wasn’t clear - I test two hours after the start of a meal. It’s the possibility of insulin resistance that bothers me long term. At present, it feels as if I’m having to continue eating as if I am a type 2 diabetic controlling the condition with diet and exercise. Don’t get me wrong, I don’t have any urge at all to return to the way I was eating before - the changes to my diet really are permanent - but I’d like to occasionally eat ‘normally’ without worrying what the number on the machine is going to be afterwards. If I do have insulin resistance, I’d like to know so I can process the knowledge and learn to accept that I’ve said farewell to sandwiches, chips and cake forever.
 
I’ve tested my non-diabetic friends’ blood sugars at 2hrs and seen 8s before @Geekesse Also, not all your post-meal results are 8s so you’re heading the right way. Little thing can help too, eg keeping active after a meal, say with a walk or even doing chores that keep you moving. It sounds trivial but it can really help.
 
I managed to reduce my HbA1C from 50mmol/mol by a low carb to 39mmol/mol but feel that it is only by maintaining the low carb (approx 70g per day) that I am keeping it there. I tend to not have more 25g carbs per meal at least not often as that tends to make the meal increase a bit more than desirable.
Some people tolerate some carbs better than others so I tend not to have rice or normal pasta.
 
Those readings look OK. What do you get if you try 3 hours later?
If I have a lot of carbs (40g+) then I see 8s after an hour, maybe in the sixes two hours later and then a drop back to 4s/5s at the 3 hours. If I have even more carbs, the peak of around 8 seems to stick around a bit longer, but always comes down. Sometimes very rapidly.

The high fasting (Is that morning?) might be an indication of some insulin resistance, maybe liver insulin resistance.
I generally stick to < 40g of carbs a day and my hba1c has been in the 30s for almost two years now (From a high of 83)

A lot of websites make claims that after 2 hours it should be back to 'normal', but different mixes or food have different effects.
 
Hmm, I haven’t tried testing after three hours - will do so. Thank you for the suggestion.
 
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