Newbie needing advice and support!

[Garlo]

Hi folks,

I was diagnosed as pre-diabetic (42 mmol/L) in April 2023, and reaffirmed in November 2023 (48 mmol/L).

Being right on the "cusp" in November, accelerated and deepened my lifestyle changes. This included: cutting calories and upping exercise. Lost about 8-9 pounds on lead up to Xmas, put 4lbs on after Xmas (had a bit of an "Xmas blow out"), then, on Jan 2nd...I started my Freestyle Libre 2 GMS.

WOW! Now I'm really frightened. Actually frightened. And need some words of wisdom (which I'm also seeking from NHS - but it takes a bit more time) around the results from the monitor. EVERY carb, I seem to spike (with exception of Ryebread...in which I spike slightly less.

I should add, I'm hardly eating any quantity of carbs.

I'm often within range (around 5.2-6 mmol/L) when I start eating, and more often than not, over the course of 45 mins or so - I spike to around 10-10,6 mmol/L. and then come down (often whilst out speed walking) to the point where my glucose level goes below 3.9 mmol/L and I need a snack bar or apple. Is this normalish pattern of behaviour for Type 2 D or prediabetic?

Time in range (3.9 to 8 mmol/L) is 90%.


I've observed 3 lows in a week (one at night and 2 after lunchtime walk). Both times I've snacked. and BS goes back within range.


Am I being sensible/cautious? Or overtly overconcerned/ paranoid? I'm absolutely worried myself sick...which has probably actually made things worse! Doh!

Any help in interpreting stats from the GMS would be lovely. The internet is a minefield!!!!

 

[Inka]

If you’re not on meds @Garlo 3.9 is a normal blood sugar. You shouldn’t worry about that. How many carbs are you eating in your meal when you spike from 5/6 to 10 approx?

 

[Martin.A]

Everybody's BG spikes after eating, even non-diabetics. The issue is how quickly it comes back down again. That's why our post-prandial tests are done 2 hours after starting a meal.

 

[trophywench]

If I slapped a Libre sensor on my husband's arm (he doesn't have diabetes) I'd probably get very similar results to yours. As Martin.A has already said, look immediately prior to eating, then approx 2 hrs after that time having eaten the food meanwhile. The aim (for Type 2 diabetes, generally) is for the 2nd result to be no more than approx 3.0 above the first one.
All the values are approximate ones since every single person's body is different, in the same way that our eyes, hair and skin tone are.

 

[Leadinglights]

The Libre will give you a lot more information than you would get from finger pricking and sometimes too much info means you over react to what you see.
The aim is to be 4-7mmol/l before meals and no more than 8-8.5 mmol/l 2 hours after your meal, to some extent what happens in between doesn't really matter too much and it looks as if that is causing you to worry.
Many do find a low carb approach successful but that is no NO carbs but with the aid of the Libre or finger pricking you can b determine what your personal tolerated limit per meal is.
Have a look at this link for some ideas for modifying your diet. https://lowcarbfreshwell.com/
There is absolutely no need to panic and take things day by day and introduce changes as it is better to bring glucose levels down gradually to avoid issues with your eyes and nerves.

 

[Garlo]

If you’re not on meds @Garlo 3.9 is a normal blood sugar. You shouldn’t worry about that. How many carbs are you eating in your meal when you spike from 5/6 to 10 approx?

Hi Inka! Thanks for your response! I had one slice of Bio Rye Bread (71kcals)...as, thus far, it's the only carb I don't spike on so quickly. The rest was: x6 tomatoes and slices of cucumber. Big bunch of rocket. Skinless cooked chicken breast. Tbsp of fresh sauerkraut. one slice of Lederhammer lite cheese. smallest (teaspoon-worth) of v mature cheddar cheese.

Due to work, I leave it 10 mins (20 if I can) before going out for a 45-60 mins walk. Each walk - I drop from around 8.5-9 mmol/L9ish) after around 10-20 mins after finishing eating. To around 3.4 - 3.8 mmol/L (ish). I can actually feel when BS is getting lower. When it drops, around 45 mins after eating, to around 4.2-4.7 I have either an apple or Nakd snack bar to mitigate going below 3.9 Mmol/L.

 

[Garlo]

Everybody's BG spikes after eating, even non-diabetics. The issue is how quickly it comes back down again. That's why our post-prandial tests are done 2 hours after starting a meal.

Hi Martin!

Many thanks for this!!!! I think, singularly - this has been one of the most helpful comments I've come across! Thank you so much for this reassurance. I speak with my doctor later today, so hopefully it'll be the same message too!

I've spent around a week (outside of family/work commitments) going to deep dark places in the soul through endless Google and YouTube searches. Doh

I just wasn't sure how much increase and decrease of the mmol/L was non-diabetic/prediabetic/diabetic..and where I stood!

Thank you MArtin. I appreciate your response 🙂

 

[Leadinglights]

Hi Inka! Thanks for your response! I had one slice of Bio Rye Bread (71kcals)...as, thus far, it's the only carb I don't spike on so quickly. The rest was: x6 tomatoes and slices of cucumber. Big bunch of rocket. Skinless cooked chicken breast. Tbsp of fresh sauerkraut. one slice of Lederhammer lite cheese. smallest (teaspoon-worth) of v mature cheddar cheese.

Due to work, I leave it 10 mins (20 if I can) before going out for a 45-60 mins walk. Each walk - I drop from around 8.5-9 mmol/L9ish) after around 10-20 mins after finishing eating. To around 3.4 - 3.8 mmol/L (ish). I can actually feel when BS is getting lower. When it drops, around 45 mins after eating, to around 4.2-4.7 I have either an apple or Nakd snack bar to mitigate going below 3.9 Mmol/L.

Calories are really irrelevant and it is the carbohydrate content you want to be looking at.

 

[Inka]

Hi Inka! Thanks for your response! I had one slice of Bio Rye Bread (71kcals)...as, thus far, it's the only carb I don't spike on so quickly. The rest was: x6 tomatoes and slices of cucumber. Big bunch of rocket. Skinless cooked chicken breast. Tbsp of fresh sauerkraut. one slice of Lederhammer lite cheese. smallest (teaspoon-worth) of v mature cheddar cheese.

Due to work, I leave it 10 mins (20 if I can) before going out for a 45-60 mins walk. Each walk - I drop from around 8.5-9 mmol/L9ish) after around 10-20 mins after finishing eating. To around 3.4 - 3.8 mmol/L (ish). I can actually feel when BS is getting lower. When it drops, around 45 mins after eating, to around 4.2-4.7 I have either an apple or Nakd snack bar to mitigate going below 3.9 Mmol/L.

If you’re not on glucose-lowering drugs, then your own body will sort out your 3.4 and 3.8. That 3.9 on the Libre is really for people on insulin because we need a buffer zone to protect us from hypos.

Do you mean Biona Rye bread? Spikes after food are normal. Your blood sugar should come back down below 7.8 by two hours after your meal.

 

[Garlo]

If I slapped a Libre sensor on my husband's arm (he doesn't have diabetes) I'd probably get very similar results to yours. As Martin.A has already said, look immediately prior to eating, then approx 2 hrs after that time having eaten the food meanwhile. The aim (for Type 2 diabetes, generally) is for the 2nd result to be no more than approx 3.0 above the first one.
All the values are approximate ones since every single person's body is different, in the same way that our eyes, hair and skin tone are.

Thank you trophywench!

Massively reassuring! Thank you thank you thank you! I think I've been slightly blinded by too many sites, too much information and too much interpretation of some of that information, and knew I needed to communicate with people who have prediabetes/diabetes to more fully understand my results. After 2 hours, my readings are sometimes actually loyer than my starting baseline point.

 

[Garlo]

The Libre will give you a lot more information than you would get from finger pricking and sometimes too much info means you over react to what you see.
The aim is to be 4-7mmol/l before meals and no more than 8-8.5 mmol/l 2 hours after your meal, to some extent what happens in between doesn't really matter too much and it looks as if that is causing you to worry.
Many do find a low carb approach successful but that is no NO carbs but with the aid of the Libre or finger pricking you can b determine what your personal tolerated limit per meal is.
Have a look at this link for some ideas for modifying your diet. https://lowcarbfreshwell.com/
There is absolutely no need to panic and take things day by day and introduce changes as it is better to bring glucose levels down gradually to avoid issues with your eyes and nerves.

Hi Leadinglights,

I think you, Martin A and others, have pretty much summed things up reassuringly well. Thank you! Overreacting to something completely new is, I guess, quite normal (for me 🙂 ). So my baseline aim (4-7 mmol/L) is in target (before eating) in over 95% of meals I guess (I'd need to double check).

I'm using the NHS "lose weight" App to help control my calorific intake (in which I'm being successful). I've yet to learn about the carb contents...all I've gathered is breads (except Rye bread)/pastas (of all sorts), white rice and most veg that "grows underground" (except carrots?) are to be reduced or omitted.

I had seen a book by a university (Trent or Newcastle) where they explain how to calculate carb values. It was called "carbs and calcs" or something. Frustratingly, I didn't book mark the page and can't locate the webpage and video.Tthanks for the link btw! I shall have a delve now. 🙂

 

[rebrascora]

Libre also often reads lower than Blood Glucose (BG) at low levels and can read higher at high levels ie it can exaggerate the highs and lows, so chances are those low readings may not have been that low but in any case, your liver will release glucose to bring you back up so there should be no need to eat anything unless you were on medication like insulin or Gliclazide which can drop you too low, sometimes quicker than your liver can bring you back up. Your pancreas and liver balance your BG levels with insulin and glucose. Your night time low may well have been what we call a compression low, where you lie on the arm with the sensor and that compresses the tissue under the sensor causing a false low reading. It will usually bounce back to it's original level when you roll off it again and release the pressure although it takes probably about half an hour to regain it's previous level. It is however normal for levels to drop very slightly into "the red" in the depths of sleep and this will look more like a very slack washing line where your levels drift downwards and then back up towards waking up time. So a compression low would generally look like a sharp dip and rebound on the graph and a genuine deep sleep low would be a slow steady decline and rise. Neither indicate that anything is amiss.

Really sad that you have been in such a panic about the results you have been getting and wish you had come to the forum sooner to seek advice. Most GPs and nurses will not be familiar with CGM devices like Libre because it is not something that they routinely deal with so don't be to reliant on any info they give you about it and indeed they may well be dismissive because in come respects these devices can cause people undue anxiety and they get the backwash from it, which is why many GPs and nurses actively discourage people from testing at all, which is a shame because testing can be really helpful in the right circumstances, but you need to understand what you are looking at and the limitations of the kit you are using.

 

[Garlo]

If you’re not on glucose-lowering drugs, then your own body will sort out your 3.4 and 3.8. That 3.9 on the Libre is really for people on insulin because we need a buffer zone to protect us from hypos.

Do you mean Biona Rye bread? Spikes after food are normal. Your blood sugar should come back down below 7.8 by two hours after your meal.

No - not on any drugs yet Inka. I think I will now switch off the .9 mmol/L alarm on Libre. For now. I do feel "low blood sugary" (if that makes sense) as I approach 4.2mmol/L (ish).

Yes, sorry, I did mean Biona Rye Bread. Seems to really work for me.

I was astonished at the speed and height of how I reacted to my (small) bowl of porridge oats with tsp of goji berries and cacao nibs!!! For months and month, I had religiously eaten this for breakfast about 5-6 days a week - and it seemed to give the highest spike (about 12.2-12.4 mmol/L) of everything I've had! yet it's low GI? Good grief I feel I have so much more to learn...

 

[rebrascora]

Many of us find that porridge is like rocket fuel and one of the benefits of testing is that it shows you how your particular body responds. The GI index is an average response from a quite limited sample of people to various foods, but in reality this will vary, sometimes quite significantly from one person to another due to our individual gut biome and metabolism and is why we advocate for self testing here on the forum. There is no way to know if porridge will live up to it's low GI reputation for you as an individual or not without testing. Sadly NHS advice is to recommend porridge as a highly suitable breakfast for Type 2 diabetics when in reality, for many it may be a very poor choice, but without testing they would never know. So at least that is one good thing to come from your Libre experience.

 

[Garlo]

Libre also often reads lower than Blood Glucose (BG) at low levels and can read higher at high levels ie it can exaggerate the highs and lows, so chances are those low readings may not have been that low but in any case, your liver will release glucose to bring you back up so there should be no need to eat anything unless you were on medication like insulin or Gliclazide which can drop you too low, sometimes quicker than your liver can bring you back up. Your pancreas and liver balance your BG levels with insulin and glucose. Your night time low may well have been what we call a compression low, where you lie on the arm with the sensor and that compresses the tissue under the sensor causing a false low reading. It will usually bounce back to it's original level when you roll off it again and release the pressure although it takes probably about half an hour to regain it's previous level. It is however normal for levels to drop very slightly into "the red" in the depths of sleep and this will look more like a very slack washing line where your levels drift downwards and then back up towards waking up time. So a compression low would generally look like a sharp dip and rebound on the graph and a genuine deep sleep low would be a slow steady decline and rise. Neither indicate that anything is amiss.

Really sad that you have been in such a panic about the results you have been getting and wish you had come to the forum sooner to seek advice. Most GPs and nurses will not be familiar with CGM devices like Libre because it is not something that they routinely deal with so don't be to reliant on any info they give you about it and indeed they may well be dismissive because in come respects these devices can cause people undue anxiety and they get the backwash from it, which is why many GPs and nurses actively discourage people from testing at all, which is a shame because testing can be really helpful in the right circumstances, but you need to understand what you are looking at and the limitations of the kit you are using.

Thanks rebrascora ! (great anagram btw!)

I have literally just come off the phone to a GP. She said that the starting point (baseline) pre-eating levels seems fine (from a pre-diabetic point of view), that the spikes are normal physiological responses to ingesting food (of all types), and that the spikes may seem scary, but shouldn't be considered as worrisome. She suggested I keep using the monitor as a guide to help understand which carbs work well for me and which don't (as we're all individuals that react differently to different foods etc). She also said that the v. low (2am) readings I've experienced aren't to be concerned by, and the post walk/ during walk "lows" (and they're fairly energetic walks)...may well be attributed to the calorific deficit I'm putting myself through...or I'm exercising too quickly or not quickly enough after eating, and this is how my body reacts. Interesting about the "arm lying on the sensor" may falsify readings!! As I recall sleeping on that side hen I woke!

For the "lows" (.9 mmol/L, but not lower than 3.4 mmol/L) I can often feel "low blood sugary" (if that's a term!) around 4.5 mmol/L on a downward trend, so will have the snack bar or apple...which helps mitigate that "low blood sugary" feeling.

It's interesting that there's a small amount of error margin in Libre monitors. The GP did say they were "pretty accurate"..but that does not equate to "100% accuracy".

I now feel, since the very start of 2024 - slightly more relaxed than I did thanks to all responses on this forum (and to the helpful GP too). I also realise that my "thirstiness" is likely to have been driven by fear and anxiety rather than "slightly elevated BG readings" on a monitor that can sometimes be slightly less accurate than we'd like (or appreciate 🙂).

Thanks for your response! Really helpful...and I feel I can now breathe normally again. My 7yo son said to me after school today "You OK daddy? You seem happier." Lol!

 

[Drummer]

No - not on any drugs yet Inka. I think I will now switch off the .9 mmol/L alarm on Libre. For now. I do feel "low blood sugary" (if that makes sense) as I approach 4.2mmol/L (ish).

Yes, sorry, I did mean Biona Rye Bread. Seems to really work for me.

I was astonished at the speed and height of how I reacted to my (small) bowl of porridge oats with tsp of goji berries and cacao nibs!!! For months and month, I had religiously eaten this for breakfast about 5-6 days a week - and it seemed to give the highest spike (about 12.2-12.4 mmol/L) of everything I've had! yet it's low GI? Good grief I feel I have so much more to learn...

Sorry @Garlo but oats are a grain, and all grain is high carb.
I have been told that I can eat oats (and other carbs) and be just fine - well - no, I'm not - and am never going to be - and it is not me being delusional, or anyone else trying to deal with type 2 diabetes either. Labelling a food low GI or GL is just nonsense when it doesn't do anything but cause a spike every single time.
To get normal results I eat under 40 gm of carbs a day, but I had a long long history of being unable to cope with carbs, but was always being advised to eat carbs as they are healthy.
Hopefully you have been diagnosed far earlier than I was, so by cutting down carbs you'll return to a more normal metabolism and get normal HbA1c numbers.

 

[Inka]

It depends on the individual @Garlo as to how they react to certain foods. It also depends on the kind of oats you have. The best are the jumbo oats - the thick ones that take, say, 6 or so minutes to cook. It also depends on what you accompany your oats with - and, importantly, the portion size. Many people eat more cereal than the recommended portion. A set of digital scales can help you make sure you’re having the right size portion.

For carb information, just look on the packet or box. You can also use the supermarket websites as most of them have the Nutritional Info for foods.

 

[rebrascora]

Delighted to hear you have an enlightened GP. Sadly many are not.

Regarding accuracy or error range, those f us who are insulin dependent are told to accept our finger prick BG meter result as being more reliable than CGM and BG meters generally have a 15% error margin, so CGM will be slightly higher than that. We try not to use the term accuracy because there is no way to establish the absolute value of BG at any given time. Most of us who are insulin dependent compare our BG meter result to our Libre results at various times for various reasons. Generally Libre reads lower than BG for me by about 1mmol, particularly at low levels. On the rare occasions that I get into the teens Libre reads very slightly higher but some people find that it exaggerates by more than 1mmol in double figures. Other people find that it can be 2mmols or more out. It seems to agree with some people's body chemistry better than others. I absolutely love Libre and it is consistent for me within those parameters I have described with my body but the number of times it has alarmed and given me a reading in the high 3s and I have been mid to high 4s with a finger prick makes me a little skeptical of some of it's low readings. Sometimes you can feel "low/hypo"" when your levels are dropping fast particularly from a higher level, but it isn't actually too low. In those circumstances 1 jelly baby (5g carbs) is usually enough to steady it. If you are eating a nut bar or an apple you are likely having 3x as many carbs as you actually need. 5g carbs is generally considered capable of raising your BG levels by 1.5mmols. An apple or nut bar is going to be about 15g carbs, maybe more, so then your body has to release more insulin to deal with that extra glucose. I appreciate that fruit is healthier than eating jelly babies, but since you are not needing very fast release carbs like those of us wo are insulin dependent, maybe consider just one dried apricot or prune as that equates to about 5g carbs. A dried fig or date is a bit sweeter at about 8g carbs.

 

[helli]

@Garlo have you been informed of the limitations of CGMs like Libre?
If not, you may be getting concerned unnecessarily.
For example, how soon after applying the Libre, did it report highs and lows? The reason I ask is that soe of us experience "insertion trauma" - the sensor incorrectly reports for the first 24 to 48 hours after insertion due to the "trauma" of having an unfamiliar alien object in our arm.
And how likely is it that you were lying on your sensor at night when you experienced the low? This could be a "compression low" caused by pressure being applied to the sensor causing it to report a false low.
Before scaring yourself more, I recommend have a read of this thread about the limitations of CGMs.

 

[trophywench]

ROFLMAO 'Daddy' - you know what else? Approx 2am ish to 3am ish - ie a few hours after normal bedtime for most of the civilised world - is when human beings generally usually have their lowest blood glucose of each 24 hours. (sorry to add this, but it is true - also used to be known in A&E circles as 'the suicide hour')