On the fence

[runcs]

Hi I'm not sure I'm technically diabetic but I have questions as I think I might be nearer the line than I would like!!

I'm 32 with a history of recurrent miscarriages and 5ish kilo babies (LARGE)
Insulin resistance is a possible cause of the miscarriages
I have had a normal hba1c (I haven't a number as it was some years ago) and I had a negative ogtt when I was pregnant with my first baby, so in theory am not diabetic, but following doing a lot of reading, it seems that these things being can test normal but mask some insulin resistance/room for improvement

But I'm wearing a cgm for the next 6 weeks as I'm not convinced my insulin response is as normal as it could be.

I know 'normal' would be under 7.8 post prandial for an ogtt (100%glucose) but I'm unsure how that relates to normal eating (fats/fibre making a slower rise and fall relative to 100%glucose drink for an ogtt). If I'm being strict, measuring straight from finishing a carby meal im noticing it takes 2hrs 15 to 2hrs 30 for me to dip back under 7.8, but the levels are not actually peaking until 1hr 45ish after ths meal.

Eg today I had a big chili jacket potato, BG peaked at 9.2 1hr 45 after the meal then was under 7.8 by 2hr 15.

I'm wondering if the late peaking is due to the food or a slow/poor response to insulin at 45mins to an hour so the are climbing for longer than they should be.

I do get a little peak when I get up in the morning but as soon as I sit down it drops, I read this is normal?

The only other thing I'm noticing is that when I'm pottering on the day, they are 5.5-6.5 even when I'm 2-3hrs plus after a meal, but if I sit down and do nothing, they drop to 4.5-5.5.

The overall highest number I have had so far is 9.8 after 2 bits of banana bread and it was down within 2 hrs.
Im not wanting diagnosed, just perspective on how normal all this is my instincts (I'm medical but not a Dr) are slight insulin resistance/room for improvement for glucose tolerance but I'm considering that it may be normal and I'm over thinking it.

 

[Leadinglights]

Welcome to the forum
The only definitive test for Diabetes is the HbA1C when a result of below 42mmol/mol would be normal, 42-47mmol/mol 'at risk' or prediabetes and anything over that would be a diabetes diagnosis. It OGTT is very rarely used for diagnosis now that the HbA1C is available.
What you are getting in terms of your readings from your Libre look pretty normal.
If people are finger prick testing then they are aiming at 4-7mmol/l fasting and before meals and no more than 8-8.5mmol/l 2 hours post meal or an increase from the meal after 2 hours of no more than 2-3mmol/l.
Obviously different types of carbs are metabolised at different rates and will differ between people depending on their gut microflora and also if the meal contains fats.
If you are concerned then ask for an HbA1C, then you won't be on the fence.

 

[Inka]

Welcome @runcs 🙂 I agree that you’re probably overthinking it. By definition, if your HbA1C is normal then you’re not diabetic. Blood glucose meters have a 15% margin of error and aren’t for diagnostic purposes. Your post-meal readings are very similar to non-diabetic friends’ of mine. I’ve tested lots of them and yes, sometimes they don’t go back below 7.8 until a bit after 2hrs. This seems to depend on the size of the meal. People without diabetes can occasionally go up to the 10s.

If your last HbA1C was a while ago, do ask for another. If you’re overweight and/or inactive, improving those things will help whether you’re diabetic or not.

 

[runcs]

Thanks. I'm not able to have another hba1c for a couple of months as mostly most recent miscarriage required a big blood transfusion, so a lot of the rbcs aren't mine!! Have been keeping watching the numbers since my first post and I'm still suspicious. I think while not diabetic it's somewhere morning that direction than normal. A jacket potato took me into the 9's with a 3+ hour wait to get back under 7.8.

The norms I can find for a truly normal person's insulin response are BG very rarely higher than 6.9, peak is at 45mins and it drops under 5.6 within 1-2 hours. I'm nowhere near that

The significance of the potential insulin resistance is that even with normal ISH blood glucose numbers, if high levels of insulin are being used in order to achieve this, the chronically high levels of circulating insulin as damaging to egg DNA as well as the developing placenta. As well as the health implications as well I guess. I read a fasted insulin test can be more appropriate than the glucose monitoring, I'll have to keep reading!

 

[helli]

Hi @runcs
Do you have a finger prick meter?
One of the great things about Libre is that you don't need to calibrate it. One of the annoying things about the Libre is that you cannot calibrate it against your body.
Some people find that the Libre reads consistently high and others find it reads consistently low and some people find the higher values are consistently higher whilst the lower values are consistently lower.
Given, as @Inka mentioned, it is not unusual for people without diabetes to spike over 10, your numbers are not overly high but, if you want to get a better view, I would recommend checking a few of the higher readings which concern you against finger pricks if possible.
Relying entirely on the Libre means you may be unnecessarily worrying yourself.

The other thing to consider is what you would do if you did find out you had diabetes and could you do any of it now? For example, do you have any weight to lose? Would you consider changing your diet to reduce the amount of carbs you eat? If you would be willing to do this, why wait for a diagnosis when both these suggestions could help your health regardless of diabetes.

 

[harbottle]

I see many websites (Mainly US based) that state all these figures for levels over time but I'm not sure what food they used to get these figures. (A lot of pages state levels don't go over 7.8, but since the advent of CGMs it's been seen that this isn't true.)

I see a huge variation of how food affects BG. For example, lentils don't cause much of rise until two hours after eating them.

A burger an bun peaks at two hours (usually around 8) and is back to the 5/6s in 3 hours. I once had a meal with 70g of carbs alongside meat and cheese, and it didn't even start to go up until an hour and half!

Glucose clearance isn't speedy, and the speed/way food is digested isn't the same for everyone. The composition also makes a difference.

 

[runcs]

Hi I do, I did notice that the smoothing algorithm on the libre seems to disappear the highest of highs unless I watch it 100%of the time. I'll take some finger reads at to cross check. Do I rely on the BG reader for absolute numbers more than the libre?

Ill be making changes to try to improve the numbers anyway I think, so I guess a diagnosis only really matters if I need Metformin?!

 

[Inka]

Yes, the finger prick tests are the ones to go by @runcs

 

[Leadinglights]

Hi I do, I did notice that the smoothing algorithm on the libre seems to disappear the highest of highs unless I watch it 100%of the time. I'll take some finger reads at to cross check. Do I rely on the BG reader for absolute numbers more than the libre?

Ill be making changes to try to improve the numbers anyway I think, so I guess a diagnosis only really matters if I need Metformin?!

If you make some dietary changes which it sound as if you have room to do then it would likely be at a level once you are able to have the Hba1C test not to need metformin as that would only be needed if your HbA1C was well over 55mmol/mol. Some GPs will reach for the prescription pad a bit too hastily in my opinion, though I can see their logic if they feel that people won't engage with dietary changes.

 

[helli]

I did notice that the smoothing algorithm on the libre seems to disappear the highest of highs unless I watch it 100%of the time

I am not sure it is the smoothing algorithm that does this.
CGMs do not measure blood, they measure interstitial fluid. Changes in blood sugars are reflected in interstitial fluid about 15 minutes later. Libre takes this delay into consideration by predicting the current value through extrapolation of the current trend. If the direction of the trend changes in the last 15 minutes, the prediction will be wrong. So, when reaching the peak of a spike, Libre will correct its prediction.
What this means is that you never reached the high that Libre predicted.

 

[mitchsi]

@runcs if you are worried about insulin sensitivity (interesting theory and sorry for your losses) I found exercising every other day at least ( I run for 30 to 60mins, karate 1 or 2 times a week) meant good insulin sensitivity. Having stopped exercise and good diet for two weeks or so (Xmas break!) my insulin resistance has gone crazy. Now I’m back into healthy eating I now need a lot more insulin compared to before until I can train again (put my back out).
Not sure if you exercise regularly or with enough intensity but if not you might observe a difference with the libre2 after ? Amount of time regularly exercising. that peak might not be so high or so long after eating if you become more sensitive.

 

[Proud to be erratic]

Hello @runcs,

I'm a 73 Yr old male so I'm potentially out of my depth here! But, I truly can sympathise with your losses.

My instinct was also that you could be over-thinking matters, however since you are on this 6 week trial with Libre, there are a things you could exploit from it.

Firstly, since Libre is a 14 day wear it then discard and wear another - you don't have to be wearing one for 6 continuous weeks. You can time your trials to fit in with anything else going on in your life.

Secondly Libre allows you to log anything you need to record in the Notes and by registering on LibreView through the web as well as having the LibreLink app on your phone you can see the fuller picture, alongside your notes for whatever duration permutation you select (ie 1 , 3, 14 , 28 etc) days.

Thirdly, @mitchsi is absolutely right in pointing out that most of us notice a significant improvement in our insulin's performance once modest (aerobic) activity is concurrent. That's my clumsy way of saying that usually insulin resistance decreases with and after activity. You could set aside a few days with a sensor to explore that relationship - since we are all different and get different responses. The relevant thing here is there is little point in mixing dietary changes with activity variations - you'll be most unlikely to identify which action (food or activity) is causing BG changes.

With repeatable and consistent eating arrangements a day or two on establishing just those arrangements you should see a probable pattern, then bring activity into the mix and see how that helps (or not) both at the time ofvactivity and shortly after but also up to 48 hours after. For example you could spend a full 14 days looking at activity: perhaps 2 days establishing your baseline, then varying perhaps a 3rd single busy/ active day with days 4 and 5 to see what response occurs, then days 6 and 7 busy / active, day 8 observe recovery and finally days 9, 10, 11 busy/ active leaving day 12 observe recovery finally day 13 into a degree of anaerobic (truly strenuous) activity and see the difference for the end of day 13 and through 14. All of this should give you a better perception of how your BG responds to being active vs being relatively sedentary. [Few of us are truly sedentary for even half an hour, never mind a full day, unless bed-bound!]

 

[Sarahp]

Hi I'm not sure I'm technically diabetic but I have questions as I think I might be nearer the line than I would like!!

I'm 32 with a history of recurrent miscarriages and 5ish kilo babies (LARGE)
Insulin resistance is a possible cause of the miscarriages
I have had a normal hba1c (I haven't a number as it was some years ago) and I had a negative ogtt when I was pregnant with my first baby, so in theory am not diabetic, but following doing a lot of reading, it seems that these things being can test normal but mask some insulin resistance/room for improvement

But I'm wearing a cgm for the next 6 weeks as I'm not convinced my insulin response is as normal as it could be.

I know 'normal' would be under 7.8 post prandial for an ogtt (100%glucose) but I'm unsure how that relates to normal eating (fats/fibre making a slower rise and fall relative to 100%glucose drink for an ogtt). If I'm being strict, measuring straight from finishing a carby meal im noticing it takes 2hrs 15 to 2hrs 30 for me to dip back under 7.8, but the levels are not actually peaking until 1hr 45ish after ths meal.

Eg today I had a big chili jacket potato, BG peaked at 9.2 1hr 45 after the meal then was under 7.8 by 2hr 15.

I'm wondering if the late peaking is due to the food or a slow/poor response to insulin at 45mins to an hour so the are climbing for longer than they should be.

I do get a little peak when I get up in the morning but as soon as I sit down it drops, I read this is normal?

The only other thing I'm noticing is that when I'm pottering on the day, they are 5.5-6.5 even when I'm 2-3hrs plus after a meal, but if I sit down and do nothing, they drop to 4.5-5.5.

The overall highest number I have had so far is 9.8 after 2 bits of banana bread and it was down within 2 hrs.
Im not wanting diagnosed, just perspective on how normal all this is my instincts (I'm medical but not a Dr) are slight insulin resistance/room for improvement for glucose tolerance but I'm considering that it may be normal and I'm over thinking it.

Just wondering if you also have PCOS like me? I had multiple losses due to insulin resistance , verity have quite a good support network for those with pCOS, thinking of you.

 

[runcs]

I see many websites (Mainly US based) that state all these figures for levels over time but I'm not sure what food they used to get these figures. (A lot of pages state levels don't go over 7.8, but since the advent of CGMs it's been seen that this isn't true.)

I see a huge variation of how food affects BG. For example, lentils don't cause much of rise until two hours after eating them.

A burger an bun peaks at two hours (usually around 8) and is back to the 5/6s in 3 hours. I once had a meal with 70g of carbs alongside meat and cheese, and it didn't even start to go up until an hour and half!

Glucose clearance isn't speedy, and the speed/way food is digested isn't the same for everyone. The composition also makes a difference.

Thank you, this is the pattern I'm noticing, but those deal numbers make very little sense unless your primary insulin response and secondary insulin response should both kick in by 45 mins regardless of wheat you have eaten. Apparently a truly normal person should, but as you say we don't really know as there is no reason to spy on them? I haven't tried anything with just pure glucose yet, but I might as I think the response time might be within that, because I can actually digest/absorb it that fast. Th pattern I'm seeing is basically that the numbers aren't back down under 5.8 until I'm done digesting my meal, which from sensation is softer hours and hours later!

If you make some dietary changes which it sound as if you have room to do then it would likely be at a level once you are able to have the Hba1C test not to need metformin as that would only be needed if your HbA1C was well over 55mmol/mol. Some GPs will reach for the prescription pad a bit too hastily in my opinion, though I can see their logic if they feel that people won't engage with dietary changes.

Thanks, it's only really in the context of the miscarriages that I'm looking at it, I have zero symptoms, could be thinner but not fat, but do have extra round my tummy but very much still have a waist. I used to be very active but I haven't exercised as much or as productiveley since I had kids, and less weight training/less muscle mass. The miscarriages raised the question but when I had a big think about it, I noticed I was getting keloid type scars after insect bites, other just little things what could well be due to inflammation, and also the giant babies point to some insulin resistance I generally eat unusually well, so would not experts hba1c to be that raised as I don't really eat in a way that would manifest a consistent issue. I actually only really eat 'junk' when I'm at work (part time). But seeing my climbdown times.from normalmfoods it seems I could handle it better. From what I'm reading it's improvable/ reversible depending on the why.

I'm also inferring from other comments that the hba1c% means more than the actual day to day numbers, so if your hba1c means your diabetic/prediabetic, your day to day numbers matter, but if you hba1c% is normal, those same numbers are not concerning (within reason)

 

[runcs]

Hi I do, I did notice that the smoothing algorithm on the libre seems to disappear the highest of highs unless I watch it 100%of the time. I'll take some finger reads at to cross check. Do I rely on the BG reader for absolute numbers more than the libre?

Ill be making changes to try to improve the numbers anyway I think, so I guess a diagnosis only really matters if I need Metformin?!

I am not sure it is the smoothing algorithm that does this.
CGMs do not measure blood, they measure interstitial fluid. Changes in blood sugars are reflected in interstitial fluid about 15 minutes later. Libre takes this delay into consideration by predicting the current value through extrapolation of the current trend. If the direction of the trend changes in the last 15 minutes, the prediction will be wrong. So, when reaching the peak of a spike, Libre will correct its prediction.
What this means is that you never reached the high that Libre predicted.

Thanks that's very helpful, I'll cross reference as the disappearing highs had me concerned and a bit confused.

@runcs if you are worried about insulin sensitivity (interesting theory and sorry for your losses) I found exercising every other day at least ( I run for 30 to 60mins, karate 1 or 2 times a week) meant good insulin sensitivity. Having stopped exercise and good diet for two weeks or so (Xmas break!) my insulin resistance has gone crazy. Now I’m back into healthy eating I now need a lot more insulin compared to before until I can train again (put my back out).
Not sure if you exercise regularly or with enough intensity but if not you might observe a difference with the libre2 after ? Amount of time regularly exercising. that peak might not be so high or so long after eating if you become more sensitive.

I exercise (march around like a mum) all the time but am going to add back in more formal exercise as I used to do a lot more before I was a mum, pregnant and feeling ick and then grieving a bit! Apparently the insulin can be a big issue for DNA fragmetation so miscarriage offs are much higher.

Hello @runcs,

I'm a 73 Yr old male so I'm potentially out of my depth here! But, I truly can sympathise with your losses.

My instinct was also that you could be over-thinking matters, however since you are on this 6 week trial with Libre, there are a things you could exploit from it.

Firstly, since Libre is a 14 day wear it then discard and wear another - you don't have to be wearing one for 6 continuous weeks. You can time your trials to fit in with anything else going on in your life.

Secondly Libre allows you to log anything you need to record in the Notes and by registering on LibreView through the web as well as having the LibreLink app on your phone you can see the fuller picture, alongside your notes for whatever duration permutation you select (ie 1 , 3, 14 , 28 etc) days.

Thirdly, @mitchsi is absolutely right in pointing out that most of us notice a significant improvement in our insulin's performance once modest (aerobic) activity is concurrent. That's my clumsy way of saying that usually insulin resistance decreases with and after activity. You could set aside a few days with a sensor to explore that relationship - since we are all different and get different responses. The relevant thing here is there is little point in mixing dietary changes with activity variations - you'll be most unlikely to identify which action (food or activity) is causing BG changes.

With repeatable and consistent eating arrangements a day or two on establishing just those arrangements you should see a probable pattern, then bring activity into the mix and see how that helps (or not) both at the time ofvactivity and shortly after but also up to 48 hours after. For example you could spend a full 14 days looking at activity: perhaps 2 days establishing your baseline, then varying perhaps a 3rd single busy/ active day with days 4 and 5 to see what response occurs, then days 6 and 7 busy / active, day 8 observe recovery and finally days 9, 10, 11 busy/ active leaving day 12 observe recovery finally day 13 into a degree of anaerobic (truly strenuous) activity and see the difference for the end of day 13 and through 14. All of this should give you a better perception of how your BG responds to being active vs being relatively sedentary. [Few of us are truly sedentary for even half an hour, never mind a full day, unless bed-bound!]

Thank

Just wondering if you also have PCOS like me? I had multiple losses due to insulin resistance , verity have quite a good support network for those with pCOS, thinking of you.

So Ive never had symptoms or been tested, but have obviously had millions of ultrasounds along this pregnancy road so the theory is probably not as someone would have noticed by now. Honestly when I started seeing these numbers I actually felt a bit hopeful, like maybe it's been this all along, because all this time there been no cause for the losses detected. I'll eat and exercise like a monk and see if that gets us this third baby!!
s, I think I'll dabble but it is hard to unpick when lots of variables are changing day to day. Thanks for the tip for the online version, the app is a bit naff!

 

[runcs]

Also just a huge thanks Everyone for taking the time to reply, this level of consideration and nuance is exactly why I posted here rather than ask the GP, who just wouldn't have the time or insight to help me understand all this better!

 

[Sarahp]

Thanks that's very helpful, I'll cross reference as the disappearing highs had me concerned and a bit confused.

I exercise (march around like a mum) all the time but am going to add back in more formal exercise as I used to do a lot more before I was a mum, pregnant and feeling ick and then grieving a bit! Apparently the insulin can be a big issue for DNA fragmetation so miscarriage offs are much higher.

Thank

So Ive never had symptoms or been tested, but have obviously had millions of ultrasounds along this pregnancy road so the theory is probably not as someone would have noticed by now. Honestly when I started seeing these numbers I actually felt a bit hopeful, like maybe it's been this all along, because all this time there been no cause for the losses detected. I'll eat and exercise like a monk and see if that gets us this third baby!!
s, I think I'll dabble but it is hard to unpick when lots of variables are changing day to day. Thanks for the tip for the online version, the app is a bit naff!

Thinking of you, you can have pcos and not have cysts, they can come and go especially with diet/lifestyle/weight changes. I would say if you have other symptoms as listed on verity then maybe ask for a review as part of your investigations as insulin resistance is has a known link to pcos and losses and metformin and other meds can help prevent the losses, happy to chat if I can help and sending a hug x