Newly Diagnosed Type 2 testing question

Status
Not open for further replies.
C

cornylady

Member
Relationship to Diabetes
Type 2
I was diagnosed 4 weeks ago with a HbA1c of 56 (55 on a repeat test). I have seen the diabetic nurse and tbh although she was very nice the whole appointment was less than helpful. The nurse never even discussed testing/levels/ etc or really made any helpful/useful suggestions. No advice on what to do just signposting me to other services for "education", eye checks etc. After a couple of weeks of trying to get my head around things myself I decided that to understand what was happening I would invest in a Freestyle Libre2 as a short term measure with a view to then reverting to finger pricking when I was more confident about what I can eat. I have now had a CGM since Sunday eve so this is my 4th full day. I have reduced my carb intake and currently varying between 70g and 130g per day as I'm figuring out what I can eat. So my questions are:
  1. If my levels spike after eating but are back within the 2/3 increase 2 hours after eating is this OK or a problem? (I wouldn't know about the higher reading if I didn't have a CGM?)
  2. Do you measure 2 hours after starting eating or finishing eating - sometimes I'm quite slow
  3. I have noticed that some days (not every day) I have a spike in the morning as I wake up. I understand why this happens but then why not every day? Does it matter? What can I do to improve it (if anything).
  4. Is time in range a good indicator? Is the range correct? I didn't change the settings and used the default which was 3.9-10.0.
  5. What if you consume things slowly? Does that make a difference? Does it just avoid a spike but put you generally up?
  6. Nurse basically said that even if my numbers are looking good that could be because I am overproducing insulin to make it look like that so I will still wear out my pancreas early and therefore recommends that I start on medication as that increases your sensitivity to insulin. I didn't as I wanted to try the diet approach first but don't understand how if this is the case, that type 2's are not automatically put on meds straight away.
Feel like I'm falling down a rabbit hole of numbers which is a bit triggering for me but I don't see how I can work out what works for me without this as I am asymptomatic and don't feel any different. Also trying to lose weight which is also an issue for me.

Any help or guidance would be very appreciated.
 
cornylady said:
I was diagnosed 4 weeks ago with a HbA1c of 56 (55 on a repeat test). I have seen the diabetic nurse and tbh although she was very nice the whole appointment was less than helpful. The nurse never even discussed testing/levels/ etc or really made any helpful/useful suggestions. No advice on what to do just signposting me to other services for "education", eye checks etc. After a couple of weeks of trying to get my head around things myself I decided that to understand what was happening I would invest in a Freestyle Libre2 as a short term measure with a view to then reverting to finger pricking when I was more confident about what I can eat. I have now had a CGM since Sunday eve so this is my 4th full day. I have reduced my carb intake and currently varying between 70g and 130g per day as I'm figuring out what I can eat. So my questions are:
  1. If my levels spike after eating but are back within the 2/3 increase 2 hours after eating is this OK or a problem? (I wouldn't know about the higher reading if I didn't have a CGM?)
  2. Do you measure 2 hours after starting eating or finishing eating - sometimes I'm quite slow
  3. I have noticed that some days (not every day) I have a spike in the morning as I wake up. I understand why this happens but then why not every day? Does it matter? What can I do to improve it (if anything).
  4. Is time in range a good indicator? Is the range correct? I didn't change the settings and used the default which was 3.9-10.0.
  5. What if you consume things slowly? Does that make a difference? Does it just avoid a spike but put you generally up?
  6. Nurse basically said that even if my numbers are looking good that could be because I am overproducing insulin to make it look like that so I will still wear out my pancreas early and therefore recommends that I start on medication as that increases your sensitivity to insulin. I didn't as I wanted to try the diet approach first but don't understand how if this is the case, that type 2's are not automatically put on meds straight away.
Feel like I'm falling down a rabbit hole of numbers which is a bit triggering for me but I don't see how I can work out what works for me without this as I am asymptomatic and don't feel any different. Also trying to lose weight which is also an issue for me.

Any help or guidance would be very appreciated.
Click to expand...
Hi cornylady ... I'm on the same road and have had great help from here with very similar questions. I put out a similar call for advice a few weeks ago. Lots of questions but I'll address the carbs one. I'm eating low carb and lowish calories to lose weight and stop T2 spikes and avoid meds for now. There are lots of resources online. I got going by reducing my carb intake gradually to no grains and no food with carbs and high GI. So out goes bananas Jam bread rice etc. In comes non root veg, eggs, chicken, Olive Oil and butter and red meat (moderation).

I have had diabetic symptoms - eyes, feet and fatigue. It's not fun so I'm with you, as are all on this forum, to address it.
One question regarding food and weight... can you exercise safely ? I am finding, for me, avoiding meds is likely to involve daily gentle exercise.

Franthepotter
 
Hello! By the looks of it in my opinion you have calmly got your head round things in a reasoned and professional way. I am no expert, others on here are far more clued up than me but in my opinion.....
Your Hb result is not horrific by any standard and diet modification should see you in good stead. The carb intake you have selected for yourself is a good start, and mirrors mine roughly.
1. Everybody spikes after eating in the first hour, I used to limit it if I could to about 8 ish. I now don't bother to check as I know my way around food now, but its useful when starting out to see what effects you and how badly.
2. I just follow the two hour rule now. I used to try and keep the two hour reading to 6.5 or so but now go for the 7.8 which is the range some non diabetics can experience two hours after food. The measurement time I take is from first mouthful. You have a cgm so you will get a whole range of readings! If you have a "pudding" then you will likely be testing only an hour after if your a slow eater, I make mental adjustments for this. If you have eaten a lot of protein the numbers may take longer to drift down as the body takes longer to process this along with fats.
3. Morning spikes I ignore now as there is little I can do about it, my liver is in charge and I have no control over it! Mostly I am 4.5 -5 in mornings but can be higher if I delay testing and have eaten a big meal previous evening or snacked before going to bed. If you are high getting up, moving around and having breakfast should sort it out. I believe most are very sensitive to carbs in the morning, less so at lunch and even less at dinner, I am able to have quite a carby meal at dinner including a beer.
4. Time in range, the more the better obviously but I don't use this factor.
5. Not sure but there is evidence of different effects in combining foods and smothering carbs. I.e. if I eat half an apple I spike, if I have it with cheese I don't. Some dieticians advise eating the lower carb things on your plate first, followed by the higher carb mouthfuls.
6. Nurse is wrong in my opinion, you are correct, low carb will greatly reduce stress on pancreas.

Exercise is a good fire extinguisher, if you have overdone it walk up and down stairs a few times or go for a short walk your cgm will make interesting reading!

Hope that helps!
 
Dave_Z1a said:
Hello! By the looks of it in my opinion you have calmly got your head round things in a reasoned and professional way. I am no expert, others on here are far more clued up than me but in my opinion.....
Your Hb result is not horrific by any standard and diet modification should see you in good stead. The carb intake you have selected for yourself is a good start, and mirrors mine roughly.
1. Everybody spikes after eating in the first hour, I used to limit it if I could to about 8 ish. I now don't bother to check as I know my way around food now, but its useful when starting out to see what effects you and how badly.
2. I just follow the two hour rule now. I used to try and keep the two hour reading to 6.5 or so but now go for the 7.8 which is the range some non diabetics can experience two hours after food. The measurement time I take is from first mouthful. You have a cgm so you will get a whole range of readings! If you have a "pudding" then you will likely be testing only an hour after if your a slow eater, I make mental adjustments for this. If you have eaten a lot of protein the numbers may take longer to drift down as the body takes longer to process this along with fats.
3. Morning spikes I ignore now as there is little I can do about it, my liver is in charge and I have no control over it! Mostly I am 4.5 -5 in mornings but can be higher if I delay testing and have eaten a big meal previous evening or snacked before going to bed. If you are high getting up, moving around and having breakfast should sort it out. I believe most are very sensitive to carbs in the morning, less so at lunch and even less at dinner, I am able to have quite a carby meal at dinner including a beer.
4. Time in range, the more the better obviously but I don't use this factor.
5. Not sure but there is evidence of different effects in combining foods and smothering carbs. I.e. if I eat half an apple I spike, if I have it with cheese I don't. Some dieticians advise eating the lower carb things on your plate first, followed by the higher carb mouthfuls.
6. Nurse is wrong in my opinion, you are correct, low carb will greatly reduce stress on pancreas.

Exercise is a good fire extinguisher, if you have overdone it walk up and down stairs a few times or go for a short walk your cgm will make interesting reading!

Hope that helps!
Click to expand...
Hi corny - like Dave I have needed at times to move after a meal. I often need to walk up the road at a brisk pace - I'm still learning what my body can take. I don't stress, just head out before doing the washing up
 
Franthepotter said:
Hi cornylady ... I'm on the same road and have had great help from here with very similar questions. I put out a similar call for advice a few weeks ago. Lots of questions but I'll address the carbs one. I'm eating low carb and lowish calories to lose weight and stop T2 spikes and avoid meds for now. There are lots of resources online. I got going by reducing my carb intake gradually to no grains and no food with carbs and high GI. So out goes bananas Jam bread rice etc. In comes non root veg, eggs, chicken, Olive Oil and butter and red meat (moderation).

I have had diabetic symptoms - eyes, feet and fatigue. It's not fun so I'm with you, as are all on this forum, to address it.
One question regarding food and weight... can you exercise safely ? I am finding, for me, avoiding meds is likely to involve daily gentle exercise.

Franthepotter
Click to expand...
Thanks for the reply. I appreciate all the support here. Unfortunately I am disabled with severe arthritis in both knees so have very limited mobility so exercise is problematic.
 
cornylady said:
Thanks for the reply. I appreciate all the support here. Unfortunately I am disabled with severe arthritis in both knees so have very limited mobility so exercise is problematic.
Click to expand...
Diet is going to be the most important thing but there are some seated exercised on the NHS web site which you cold try.
You seem to have put some work into finding out about a way forward. I have never used the Libre and based my food decisions on finger prick testing before eating and after 2 hours from to start of the meal (mostly). I sometimes think the Libre can give too much information and cause people to over react. Looking at trends rather than individual readings will be a good guide, If finger pricking then 4-7mmol/l before meals and no more than 8-8.5mmol/l 2 hours post meal is where people aim at. Morning reading can be the last to come down and for some they never do to as low as before meal readings, that pesky liver releases glucose as soon as you get up to give you energy for the day in the absence of food, not a lot that people who are Type 2 can do about it.
For some menu ideas have a look at this link for a low carb approach. https://lowcarbfreshwell.com/
Low carb is not no carb, it is suggested no more than 130g carbs per day is a good starting point but some do advocate much lower but that is only something you can decide based on blood glucose readings.
 
Leadinglights said:
Diet is going to be the most important thing but there are some seated exercised on the NHS web site which you cold try.
You seem to have put some work into finding out about a way forward. I have never used the Libre and based my food decisions on finger prick testing before eating and after 2 hours from to start of the meal (mostly). I sometimes think the Libre can give too much information and cause people to over react. Looking at trends rather than individual readings will be a good guide, If finger pricking then 4-7mmol/l before meals and no more than 8-8.5mmol/l 2 hours post meal is where people aim at. Morning reading can be the last to come down and for some they never do to as low as before meal readings, that pesky liver releases glucose as soon as you get up to give you energy for the day in the absence of food, not a lot that people who are Type 2 can do about it.
For some menu ideas have a look at this link for a low carb approach. https://lowcarbfreshwell.com/
Low carb is not no carb, it is suggested no more than 130g carbs per day is a good starting point but some do advocate much lower but that is only something you can decide based on blood glucose readings.
Click to expand...
Yup food is more important than exercise. My dad always says 'the best thing about exercise is that I can't snack whilst I am doing it'. Willpower and habits I think are important. I read in a Michael Moseley book that he got his wife to lock up all the carbs in a cupboard with a real lock! I find eating and not loitering in the kitchen helpful. But with plenty of good fat and protein and fibre in veg you should feel full anyway.
 
Franthepotter said:
Yup food is more important than exercise. My dad always says 'the best thing about exercise is that I can't snack whilst I am doing it'. Willpower and habits I think are important. I read in a Michael Moseley book that he got his wife to lock up all the carbs in a cupboard with a real lock! I find eating and not loitering in the kitchen helpful. But with plenty of good fat and protein and fibre in veg you should feel full anyway.
Click to expand...
One thing I did was to serve the food onto the plates in the kitchen rather than taking in a serving dish to the table, takes away the temptation of just having another spoonful. I do take the salad to the table however.
 
Leadinglights said:
One thing I did was to serve the food onto the plates in the kitchen rather than taking in a serving dish to the table, takes away the temptation of just having another spoonful. I do take the salad to the table however.
Click to expand...
I've just raided the fridge. Not good! I should get a door to the kitchen or a child gate !!!
 
Leadinglights said:
One thing I did was to serve the food onto the plates in the kitchen rather than taking in a serving dish to the table, takes away the temptation of just having another spoonful. I do take the salad to the table however.
Click to expand...
Doesn't work for me, just get up, walk to kitchen, and help myself to more! :rofl:
 
@cornylady You are fairly low in the HbA1c range, so avoiding, reducing or replacing high carb foods should be effective in lowering you to normal numbers. The two hours after starting to eat measurement seems to indicate just how well the meal suited you and how well you are coping with that level of carbs, as we find that people react differently to different foods - except me, I just react to everything.
I kept to no more than 50 gm of carbs at first, and by the time I went to the last of the 'education' sessions I was no longer diabetic. That was 7 years ago now and I feel so much better, have lost weight and am more mobile. Last night i was trying to demonstrate a morris jig.
 
Drummer said:
@cornylady You are fairly low in the HbA1c range, so avoiding, reducing or replacing high carb foods should be effective in lowering you to normal numbers. The two hours after starting to eat measurement seems to indicate just how well the meal suited you and how well you are coping with that level of carbs, as we find that people react differently to different foods - except me, I just react to everything.
I kept to no more than 50 gm of carbs at first, and by the time I went to the last of the 'education' sessions I was no longer diabetic. That was 7 years ago now and I feel so much better, have lost weight and am more mobile. Last night i was trying to demonstrate a morris jig.
Click to expand...
Hi Drummer is it OK if I ask you some questions here about the same subject. So when you kept to 50g carbs was that all carbs and did you count them? I'm guessing there is no grains etc. What I mean is how did you in practice log your carbs?
 
Franthepotter said:
how did you in practice log your carbs?
Click to expand...
I don’t see any need to log your carbs, no one’s coming round to check your diary to see how many carbs you ate. You might like some general notes if that helps you to keep track of which foods work ok for you.
 
Franthepotter said:
Hi Drummer is it OK if I ask you some questions here about the same subject. So when you kept to 50g carbs was that all carbs and did you count them? I'm guessing there is no grains etc. What I mean is how did you in practice log your carbs?
Click to expand...
Absolutely fine - though diagnosis was over 7 years ago now and the tablets prescribed at that time absolutely blitzed my memory.
I had done Atkins in previous decades, and so decided on 50gm a day as that was the level I had found when things were going well. As soon as I was told I was a very bad diabetic I went back to the protocols laid out for Atkins. I counted all carbs.
I ate meat, fish, eggs, cheese, full fat dairy without weighing or restricting the amount.
I found a little booklet and wrote out a list, in a fairly random manner of suitable foods and their carb count. I put an electronic weighing scale and a glass bowl ready for use - the glass bowl is to lift up the plate high enough to see what the display showed and to reach the buttons on the scale. I used a sliderule to calculate the amount of carbs - multiplying the weight of any carb containing food by the carb content. I wrote the numbers on a Victorian school slate to keep track through the day as it is so easy to forget as the hours pass.
My limit for carb content is 10%.
I had a blood glucose meter as my mother in law was diabetic and we had found numerous meters and test strips at her house.
For the first few days I ate only meat and drank water - I'd really been pushed beyond my limits to eat carbs and I was pretty angry. When the consequences of taking Metformin hit I was fairly incandescent.
 
cornylady said:
Feel like I'm falling down a rabbit hole of numbers which is a bit triggering for me but I don't see how I can work out what works for me without this as I am asymptomatic and don't feel any different.
Click to expand...

Sorry to hear you’re getting a bit triggered by the numbers. It’s not uncommon, particularly with sensors. Remember that these numbers are just information, not a reflection of your how much effort you are putting in. They are just clues to help you build a picture.

They can be so useful, but also a bit overwhelming at times. So be kind to yourself, and remember that you are improving your health as you learn and respond to the flow of information. Don’t aim for ‘perfection’, and don’t be hard on yourself if numbers go awry from time to time - there are many factors that influence glucose levels that are not directly under our control.

The initial rise (before the 2hr mark) can be caused by an impaired first phase insulin release. In some people with T2, the initial buret of insulin as you start to eat doesn’t fire, so there’s an early rise. By the 2hr mark the second phase will be chugging, so levels will be coming down. I think that’s the reasoning behind the 2hr target.
 
Drummer said:
Absolutely fine - though diagnosis was over 7 years ago now and the tablets prescribed at that time absolutely blitzed my memory.
I had done Atkins in previous decades, and so decided on 50gm a day as that was the level I had found when things were going well. As soon as I was told I was a very bad diabetic I went back to the protocols laid out for Atkins. I counted all carbs.
I ate meat, fish, eggs, cheese, full fat dairy without weighing or restricting the amount.
I found a little booklet and wrote out a list, in a fairly random manner of suitable foods and their carb count. I put an electronic weighing scale and a glass bowl ready for use - the glass bowl is to lift up the plate high enough to see what the display showed and to reach the buttons on the scale. I used a sliderule to calculate the amount of carbs - multiplying the weight of any carb containing food by the carb content. I wrote the numbers on a Victorian school slate to keep track through the day as it is so easy to forget as the hours pass.
My limit for carb content is 10%.
I had a blood glucose meter as my mother in law was diabetic and we had found numerous meters and test strips at her house.
For the first few days I ate only meat and drank water - I'd really been pushed beyond my limits to eat carbs and I was pretty angry. When the consequences of taking Metformin hit I was fairly incandescent.
Click to expand...
Thanks Drummer, I'm doing the same but keeping it going is really really hard. Thanks for the positive words it means a lot. Its a bit of a lonely place here with T2. ! I finished my cgm so now I'm going to get a cheap meter and I'm beginning to be able to feel when the sugar goes high. I was at a pub yesterday and a doctor friend said living without grains is probably OK.
 
Status
Not open for further replies.
Back
Top