Newbie Confused by all the numbers

[Stuart60]

Well I am now well and truly confused by the numbers and where I should be looking.
5 weeks ago I was involved in a major RTC and was airlifted to a major trauma unit and as part of my monitoring they have been taking regular blood sugar readings, far more often than I would do at home.
At home I have always worked on the figures found on this site of being in the range of 4-7 mmols before eating and upto 8.5 upto 2 hours after eating.
On the day of the accident my morning reading before setting off on a long journey was 4.7 which I thought was fine based on the above I then had cereal and a cup of tea and set off to my first customer some 3.5 hours away, about an hour into the journey the dashcam footage from a vehicle following would seem I drifted on a fast single carriageway road across the road into the oncoming traffic and thus a head on crash ensued, the police who viewed this said the crash was due to me having a medical incident. I have absolutely no recollection of this or indeed the actual impact and only woke when paramedics arrived.
After me hitting some issues here following surgery with passing to much urine at night and by a lot I mean 8 times in 6 hours a doctor on the rounds suggested that this was linked to my diabetes as my readings would swing quite a lot and had during the time had been as low as 4.4 and as high as 17.5, these particulars were one offs during the time however a pattern of an evening was that around an hour after evening meal it would be over 10 and usually around 12 mark so this would suggest to high and the doctor arranged for the diabetes specialist nurse to come see me.
She gave me a leaflet which stated that the DVLA advised you should not drive if you blood sugar is below 5mmols which seems somewhat at odds and certainly in the 10 years or so I have been diagnosed as Type 2 diabetic nobody ever told me this.
When I explained that she had been called because of the range of my sugar readings and in particular the persistence for readings over 10 and the Doctor felt this was linked to my constant need to pass urine of a night she said that this was not the case and my figure ranges were as she put it Normal which flies against what is stated on this website and many more such as the BHF site.
Who is actually right here, should my blood sugars range so much even if I accept the high of 17.5 and 15.1 were one offs as she put it she feels that even going from a reading of 5.4 up to 12.1 in 2 hours is perfectly normal, what is the members thoughts on this

 

[Leadinglights]

Welcome to the forum
I can see you must have been in total shock about your accident, and probably still are, you had a lucky escape.
When your body is in shock then all sorts of things can happen to blood glucose levels as the body goes into survival mode.
There are rules about Driving but those usually apply to people on medication which has the potential to cause low blood glucose. So one question is are you on any medication for your diabetes?
The symptoms of frequent loo visits is certainly an indication of high blood glucose but I'm afraid that hospital food is not the best for managing blood glucose so I can see that your post meal level could well be high but readings over 10 after 2 hours is not in the range you want to be, but less than 8.5 is.
How do you normally manage your condition, what dietary approach are you following. You are right that the aim is 4-7mmol/l fasting and pre meal and as said 8-8.5 2 hours post meal. Of course if you test sooner that that it will be higher.

I hope you are recovering from your accident but I can tell things are still a muddle for you so take time to recover.
To late for today but ringing the DUK helpline on Monday may clarify things for you.

 

[Stuart60]

Welcome to the forum
I can see you must have been in total shock about your accident, and probably still are, you had a lucky escape.
When your body is in shock then all sorts of things can happen to blood glucose levels as the body goes into survival mode.
There are rules about Driving but those usually apply to people on medication which has the potential to cause low blood glucose. So one question is are you on any medication for your diabetes?
The symptoms of frequent loo visits is certainly an indication of high blood glucose but I'm afraid that hospital food is not the best for managing blood glucose so I can see that your post meal level could well be high but readings over 10 after 2 hours is not in the range you want to be, but less than 8.5 is.
How do you normally manage your condition, what dietary approach are you following. You are right that the aim is 4-7mmol/l fasting and pre meal and as said 8-8.5 2 hours post meal. Of course if you test sooner that that it will be higher.

I hope you are recovering from your accident but I can tell things are still a muddle for you so take time to recover.
To late for today but ringing the DUK helpline on Monday may clarify things for you.

Yes have been on a range of medications and recently my GP doubled my Metformin dose, I also take Alfulosin and linagliptin to try and control it,
Due to covid my surgery was very reluctant to see patient so only saw a GP once in 3 years rest of time changes were following phone consultations
I do wonder if the driving rule is not to drive when below 5 but the aim is 4-7 mmol/l would mean not driving when in the bottom of the target range.
The hospital here is set to the timings to ensure that 2 hours have elapsed before testing again.
Thanks for best wishes on the recovery the actual physical injuries are doing well considering the severity and the various surgeons on follow ups are impressed with the speed of recovery thus far. I appreciate the shattered femur is going to be a long slow recovery before it can take full weight bearing but will get there in the fullness of time.

 

[Leadinglights]

Yes have been on a range of medications and recently my GP doubled my Metformin dose, I also take Alfulosin and linagliptin to try and control it,
Due to covid my surgery was very reluctant to see patient so only saw a GP once in 3 years rest of time changes were following phone consultations
I do wonder if the driving rule is not to drive when below 5 but the aim is 4-7 mmol/l would mean not driving when in the bottom of the target range.
The hospital here is set to the timings to ensure that 2 hours have elapsed before testing again.
Thanks for best wishes on the recovery the actual physical injuries are doing well considering the severity and the various surgeons on follow ups are impressed with the speed of recovery thus far. I appreciate the shattered femur is going to be a long slow recovery before it can take full weight bearing but will get there in the fullness of time.

This link https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving? about driving may clarify things, the linagliptin is a medication that encourages the pancreas to produce more insulin so is classed as a medication which could cause hypos. I wonder if you could just have fallen asleep rather than having low blood glucose but you will probably never know.
Injuries like that can take time to heal and the immobility does not help managing blood glucose or losing weight. I was quite surprised I managed not to put on weight after my knee injury sitting all day with a leg brace for 3 months.

 

[Stuart60]

This link https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving? about driving may clarify things, the linagliptin is a medication that encourages the pancreas to produce more insulin so is classed as a medication which could cause hypos. I wonder if you could just have fallen asleep rather than having low blood glucose but you will probably never know.
Injuries like that can take time to heal and the immobility does not help managing blood glucose or losing weight. I was quite surprised I managed not to put on weight after my knee injury sitting all day with a leg brace for 3 months.

Interestingly sitting around immobile all this time has had the effect of me losing Yes LOSING 2stone 3lb in just 5 weeks
Was never made aware of the Linagliptin issue, certainly only been on it a month or so hence fairly new to me I was never advised of issues with the using Linagliptin.
I felt I had had a good night sleep the night before having been in bed since just after 9 and not waking till after 7 the next morning but as you may never know for sure but would seem odd as I have held long distance driving jobs for 27 years (Cars and small vans, not HGV) and never had an issue like this before

 

[Leadinglights]

Interestingly sitting around immobile all this time has had the effect of me losing Yes LOSING 2stone 3lb in just 5 weeks
Was never made aware of the Linagliptin issue, certainly only been on it a month or so hence fairly new to me I was never advised of issues with the using Linagliptin.
I felt I had had a good night sleep the night before having been in bed since just after 9 and not waking till after 7 the next morning but as you may never know for sure but would seem odd as I have held long distance driving jobs for 27 years (Cars and small vans, not HGV) and never had an issue like this before

What is your blood glucose levels like now, that weight loss in just 5 weeks sends up red flags for the possibility you may be Type 1 or LADA particularly if you had been struggling with blood glucose levels with all the medications you are on.
How long ago did you have the accident.

 

[Stuart60]

What is your blood glucose levels like now, that weight loss in just 5 weeks sends up red flags for the possibility you may be Type 1 or LADA particularly if you had been struggling with blood glucose levels with all the medications you are on.
How long ago did you have the accident.

Accident was 5 weeks ago yesterday I was weighted 2 days back.
I had been calling my Gp surgery over last 2 months because my glucose levels seemed unstable but due to covid restrictions they were still applying most consultations were via the phone, the first time they did a HBC1c and said this seemed normal but as figures were still jumping around I kept calling and first off the added lingliptin then after that they doubled the metformin dose. quite surprisingly this week the diabetic nurse here just stopped my Metformin altogether so not had for 3 days, reading up suggests stopping suddenly especially on such a high dose is not a good idea

 

[rebrascora]

Hi and welcome form me.

So sorry to hear that you had such a nasty accident. I hope all parties involved are recovering. It must be a horrible shock.

As regards driving regulations, the saying that you have to be 5 to drive is not strictly true..... If you are between 4 and 5 you can still drive provided that you eat some carbs. From what you say, you ate a breakfast of cereal after the 4.7 reading, so you complied with the legal requirements even if you didn't know them.

I am not going to comment about your medication because I am not familiar with it and it's mode of action, but my gut (non medical) feeling is that you didn't have a low glucose event if this happened after your breakfast..... how long after eating did the accident occur? It is possible that your levels went high and made you sleepy, especially after eating cereal as it is high carb and if your medication has been increased recently as a result of increasing BG levels or HbA1c, then that might be a more likely scenario. Do you know what your last HbA1c was that sparked the doctor to increase your medication?

The high readings in hospital afterwards are to be expected. Your body is under significant stress from the trauma, so high levels in someone with diabetes would be normal.

You say that the 10 after a meal was only an hour after. That is a reasonable reading for a diabetic and particularly in hospital, eating hospital food. What you need to understand is that the 2 hour reading is not capturing the peak of the spike from food but a point after the peak which shows how promptly your body is dealing with that peak. At 1 hour, it would not be unreasonable to be at 10 or 12 (17 is a bit high but after a serious accident totally understandable) but ideally at 2 hours you would like to be below 8.5..... but after such a serious accident where the body is still recovering and healing and perhaps being disrupted by further surgery, that is probably still quite optimistic.

It also occurs to be that you have not been given good dietary advice to help you manage your diabetes if you are eating breakfast cereal and needing your diabetes medication increased. Has anyone ever explained to you that diabetes isn't just about sugar but all carbohydrates and breakfast cereals are generally about 60% carbs, so not an ideal choice for a Type 2 diabetic looking to manage their BG through diet and oral meds. Not blaming you because I know NHS dietary advice for diabetes management is not ideal, but just wanted to make comment on that as something to consider for your furture management and possibly starting to reduce meds instead of increase them. Dietary changes are a more powerful factor in managing Type 2 diabetes than most oral medication.

Anyway, those are my initial thoughts on your situation.

Wishing you a full and speedy recovery.

 

[rebrascora]

Don't think there is any problem stopping the Metformin suddenly. I am pretty sure I went from 4 a day to none 6 months after starting insulin without any issues. The problem with Metformin is generally starting straight on a large dose as it upsets the digestive system, so needs to be graded up to the full dose slowly.

Are you underweight now? I wonder if that is why the Diabetic nurse.... who I am guessing is a DSN covering the wards and will be far more knowledgeable than the ward doctors or GP. Metformin is designed to overcome insulin resistance in people who are overweight or carrying visceral fat around their organs. If you have had sudden and dramatic weight loss then Metformin is likely not helpful anymore. Are your BG readings still going up to mid teens? The weight loss needs to be considered and investigated and if you are regularly getting very high BG levels then that might indicate that your insulin production has been damaged and you should be monitored for ketones. It is worth asking the nurse if they are checking for ketones which is a biproduct of your body "eating" it's own stores (fat and muscle) for energy because it can't obtain them from the food you are eating. This might be because you are not producing enough insulin or because you are not producing enough digestive enzymes..... bowl movements are usually affected by the latter as the food comes out only partially digested which can make it greasy and particularly unpleasant smelling and sometimes uncontrollable. Not wanting to pry, but just make you aware of things to look out for.

 

[Stuart60]

Don't think there is any problem stopping the Metformin suddenly. I am pretty sure I went from 4 a day to none 6 months after starting insulin without any issues. The problem with Metformin is generally starting straight on a large dose as it upsets the digestive system, so needs to be graded up to the full dose slowly.

Are you underweight now? I wonder if that is why the Diabetic nurse.... who I am guessing is a DSN covering the wards and will be far more knowledgeable than the ward doctors or GP. Metformin is designed to overcome insulin resistance in people who are overweight or carrying visceral fat around their organs. If you have had sudden and dramatic weight loss then Metformin is likely not helpful anymore. Are your BG readings still going up to mid teens? The weight loss needs to be considered and investigated and if you are regularly getting very high BG levels then that might indicate that your insulin production has been damaged and you should be monitored for ketones. It is worth asking the nurse if they are checking for ketones which is a biproduct of your body "eating" it's own stores (fat and muscle) for energy because it can't obtain them from the food you are eating. This might be because you are not producing enough insulin or because you are not producing enough digestive enzymes..... bowl movements are usually affected by the latter as the food comes out only partially digested which can make it greasy and particularly unpleasant smelling and sometimes uncontrollable. Not wanting to pry, but just make you aware of things to look out for.

Hi Barbara
On the day of the accident I had 4.7 reading, ate my breakfast straight after and then started driving about an hour into my journey is when the incident occurred.
The only time they tested Ketones was when I had the 17.5 reading and said they were happy with that reading.
I was on coming in here about average weight for my height but now am classed as underweight with the 2stone 3lb loss
When I say the readings of an evening are over 10 in the main they are around 12 or 13 as was the case this evening when I am 12.7 this is just over 2 hours after the evening meal and the on duty nurse did question what I may have eaten since the evening meal which was nothing,
Early on in this journey just after the major 5 hour surgery I did have issues with my bowels for around a week but that was first week and have for the last 4 weeks had normal bowel movements and actually for the first 3 to 4 weeks my bladder operation was normal but this last 8 days have been a nightmare, not only do a go a lot through the night but when I do it stings, this however is not the case during the daytime when I may go once or twice without any stinging but hit after 9pm it starts till around 3 to 5am
It is the different information being given by different health professionals and I am finding from my searches on the internet on sites such as Diabetes UK and the BHF who both give the 4 to 7 mmols range as the norm.

 

[Stuart60]

Hi and welcome form me.

So sorry to hear that you had such a nasty accident. I hope all parties involved are recovering. It must be a horrible shock.

As regards driving regulations, the saying that you have to be 5 to drive is not strictly true..... If you are between 4 and 5 you can still drive provided that you eat some carbs. From what you say, you ate a breakfast of cereal after the 4.7 reading, so you complied with the legal requirements even if you didn't know them.

I am not going to comment about your medication because I am not familiar with it and it's mode of action, but my gut (non medical) feeling is that you didn't have a low glucose event if this happened after your breakfast..... how long after eating did the accident occur? It is possible that your levels went high and made you sleepy, especially after eating cereal as it is high carb and if your medication has been increased recently as a result of increasing BG levels or HbA1c, then that might be a more likely scenario. Do you know what your last HbA1c was that sparked the doctor to increase your medication?

The high readings in hospital afterwards are to be expected. Your body is under significant stress from the trauma, so high levels in someone with diabetes would be normal.

You say that the 10 after a meal was only an hour after. That is a reasonable reading for a diabetic and particularly in hospital, eating hospital food. What you need to understand is that the 2 hour reading is not capturing the peak of the spike from food but a point after the peak which shows how promptly your body is dealing with that peak. At 1 hour, it would not be unreasonable to be at 10 or 12 (17 is a bit high but after a serious accident totally understandable) but ideally at 2 hours you would like to be below 8.5..... but after such a serious accident where the body is still recovering and healing and perhaps being disrupted by further surgery, that is probably still quite optimistic.

It also occurs to be that you have not been given good dietary advice to help you manage your diabetes if you are eating breakfast cereal and needing your diabetes medication increased. Has anyone ever explained to you that diabetes isn't just about sugar but all carbohydrates and breakfast cereals are generally about 60% carbs, so not an ideal choice for a Type 2 diabetic looking to manage their BG through diet and oral meds. Not blaming you because I know NHS dietary advice for diabetes management is not ideal, but just wanted to make comment on that as something to consider for your furture management and possibly starting to reduce meds instead of increase them. Dietary changes are a more powerful factor in managing Type 2 diabetes than most oral medication.

Anyway, those are my initial thoughts on your situation.

Wishing you a full and speedy recovery.

As for the driving the leaflet given me was a leaflet produced by DVLA which suggests if it is lower than 5 you should eat some high carb food then test between 30 minutes to an hour to see if it has reached 5 mmols before driving
They test here over 2 hours after both the lunch and evening meal, they also test first thing in the morning before breakfast and again just before lunch and before evening meal are eaten.
When the Doctor who suggested my issues with the bladder were sugar level related after evening meal did say he was referring me because he believed I may need to go on insulin control and in the last discussion with my GP she did say if the Linagliptin didn't work she would refer me with consideration for going on insulin control but the accident put paid to that idea.
I have since being diagnosed as type 2 made quite a change to my diet with the help of my partner and my stepson who is a head chef so knows his food stuff but as this wasn't working I was started with the Metformin 1 tablet twice a day then came Alfulosin before the double hit of doubling to 2 metformin twice a day and the linagliptin which I did think was a big change in one hit but GP who issued this change said it was normal as per the BNF
So hopefully you appreciate how this is all very confusing to me when much seems to contradict what is published on websites such as Diabetes UK and BHF sites

 

[Leadinglights]

The time scale of adding extra medications seem a bit odd in that it has not really given a chance for the first one to work especially if you had also made some dietary changes. What were those by the way.
How long before the accident were you diagnosed and had you already started to lose any weight prior to the accident.
I am assuming you are still in hospital, how are you getting on with food choices as I found it very difficult to find low carb foods on the menu, even the yoghurts were high carbs.

 

[Leadinglights]

Just thinking if you are still in hospital it might be difficult to phone the DUK helpline but you could use the e-mail contact which is below the telephone number.
You might find it beneficial to discuss your situation with them.

 

[rebrascora]

Unless the DVLA advice has changed since I read it ..... if you are below 4 then you eat fast acting carbs and are grounded until 45 mins after your levels have come up above 4, but between 4 and 5 you can eat carbs and drive straight away provided that you haven't been below 4 in that preceding 45 mins.... or at least that is how I interpret it..... although I accept that the DVLA wording on diabetes and driving and hypo awareness is quite ambiguous in places. 🙄 The caveat would be if you feel hypo even above 4, then you should not drive until you feel recovered..... Unless this is specific advice regarding the particular medication you are on. I use insulin. I stand to be corrected by other forum members.....

Yes, I can see how you are confused and I appreciate that whilst your stepson is a chef and may know food very well, he may well not fully understand diabetes and since the NHS don't always give helpful advice on a suitable diet for Type 2 diabetics, even the NHS dieticians who promote the Eatwell plate, then you can't really expect a chef to know what is right. In fact the correct diet for any diabetic is quite individual and best established via pre and post meal testing rather than following any particular guidance. We all digest foods differently because we have different metabolisms and gut bacteria which break down the food.

As regards your increased urination being due to diabetes, I would have thought it is a simple matter to test your urine for glucose to see if it is being removed that way and also test it for ketones. In a hospital environment I would imagine this would be very simple to incorporate into the daily tests.
The Alfulosin medication you mentioned for prostate issues (it is not a diabetes medication as far as I can see) could be what is causing the increased urination if your BG levels are not desperately high to trigger your kidneys to remove glucose into your urine and therefore stimulate increased urination. .

I really hope that they manage to get this issue fully investigated and find a treatment plan which helps you. Insulin may be the answer for you and if so, it will hopefully make you feel better and enable your weight to stabilize or increase if you are underweight. It is however a tricky balancing act and can be a bit daunting at first but if you take time to understand it and how to balance it with the food you eat, then it just become part of your new life. It means you need to give more thought and planning to many aspects of each day because it affects meals and exercise and sleep and illness and stress and alcohol, but you get used to it and the needles are tiny and modern methods of monitoring BG levels are improving all the time to help us.

 

[Leadinglights]

If you are on medication for prostate issues that could explain your frequent urination particularly at night.
My other half got to the point when he could be up 7 times in the night until he had TURP surgery, which he had to have done twice.

 

[Stuart60]

The time scale of adding extra medications seem a bit odd in that it has not really given a chance for the first one to work especially if you had also made some dietary changes. What were those by the way.
How long before the accident were you diagnosed and had you already started to lose any weight prior to the accident.
I am assuming you are still in hospital, how are you getting on with food choices as I found it very difficult to find low carb foods on the menu, even the yoghurts were high carbs.

I was somewhat worried by the timescale on the changes but they assured me they had checked it all out with their contacts in the Diabetes specialist nurses within the Health Authority
i was diagnosed about 10 years before the accident but only lost weight in here, I weighed myself weekly and had been stable for around the last few years
The hospital food is ok, not massive portions but on the choice menu foods suitable for diabetics are marked on the sheets and I try to stick with these

 

[Stuart60]

Unless the DVLA advice has changed since I read it ..... if you are below 4 then you eat fast acting carbs and are grounded until 45 mins after your levels have come up above 4, but between 4 and 5 you can eat carbs and drive straight away provided that you haven't been below 4 in that preceding 45 mins.... or at least that is how I interpret it..... although I accept that the DVLA wording on diabetes and driving and hypo awareness is quite ambiguous in places. 🙄 The caveat would be if you feel hypo even above 4, then you should not drive until you feel recovered..... Unless this is specific advice regarding the particular medication you are on. I use insulin. I stand to be corrected by other forum members.....

Yes, I can see how you are confused and I appreciate that whilst your stepson is a chef and may know food very well, he may well not fully understand diabetes and since the NHS don't always give helpful advice on a suitable diet for Type 2 diabetics, even the NHS dieticians who promote the Eatwell plate, then you can't really expect a chef to know what is right. In fact the correct diet for any diabetic is quite individual and best established via pre and post meal testing rather than following any particular guidance. We all digest foods differently because we have different metabolisms and gut bacteria which break down the food.

As regards your increased urination being due to diabetes, I would have thought it is a simple matter to test your urine for glucose to see if it is being removed that way and also test it for ketones. In a hospital environment I would imagine this would be very simple to incorporate into the daily tests.
The Alfulosin medication you mentioned for prostate issues (it is not a diabetes medication as far as I can see) could be what is causing the increased urination if your BG levels are not desperately high to trigger your kidneys to remove glucose into your urine and therefore stimulate increased urination. .

I really hope that they manage to get this issue fully investigated and find a treatment plan which helps you. Insulin may be the answer for you and if so, it will hopefully make you feel better and enable your weight to stabilize or increase if you are underweight. It is however a tricky balancing act and can be a bit daunting at first but if you take time to understand it and how to balance it with the food you eat, then it just become part of your new life. It means you need to give more thought and planning to many aspects of each day because it affects meals and exercise and sleep and illness and stress and alcohol, but you get used to it and the needles are tiny and modern methods of monitoring BG levels are improving all the time to help us.

My Stepson before doing his chef training did a food technology qualification and had to study diets for those with medical issues including diabetes but if you say it is all very individual then makes it more difficult though when I was first diagnosed I was asked for 6 weeks to keep a testing diary where I took readings before eating, immediately after and then again after 2 hours to take to the diabetes team.
As for the Alfulosin I had been taking this for around 6 months before the accident so would seem odd this frequent urination only came on around 3 weeks after being in here.
The idea of being on insulin was one of the things my GP was working toward but had been told to add the Linagliptin into the mix along with the upped dose of Metformin to see if this avoided me having to go to see the diabetes team to get considered for insulin and also the doctor here who made the referral to the diabetes specialists nurse also said that it may be necessary for me to go on insulin.
Just to give a fuller picture, I have never in my 60 years smoked anything and I rarely drink the last alcoholic drink was at New Year and even that was only one pint of bitter and one dram to see in the new year.
I am also hoping that we go down the insulin route as I really want to get a grip on this spiking for many obvious reasons

 

[Stuart60]

If you are on medication for prostate issues that could explain your frequent urination particularly at night.
My other half got to the point when he could be up 7 times in the night until he had TURP surgery, which he had to have done twice.

As I said to someone else the Alfulosin I had been on for around 6 months so would seem odd it starts 3 weeks after being here in hospital.
Some 13 years ago I did have urology surgery due to similar urination issues and have asked here to be seen by a urologist but they just comment on the notes saying they think everything is Normal!!

 

[Leadinglights]

I was somewhat worried by the timescale on the changes but they assured me they had checked it all out with their contacts in the Diabetes specialist nurses within the Health Authority
i was diagnosed about 10 years before the accident but only lost weight in here, I weighed myself weekly and had been stable for around the last few years
The hospital food is ok, not massive portions but on the choice menu foods suitable for diabetics are marked on the sheets and I try to stick with these

I found nothing on the hospital menu other than omelette and salad that was suitable for a low carb diet so you must be lucky where you are. Oh and a chocolate eclair which I found too sweet.

 

[helli]

I found nothing on the hospital menu other than omelette and salad that was suitable for a low carb diet so you must be lucky where you are. Oh and a chocolate eclair which I found too sweet.

Is it possible that what a hospital describes as "suitable for diabetics" is not low carb but more "traditional" - whatever that may be?