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You seem to be getting confused by the HbA1C test which is a 3 month average of blood glucose level so whether it is fasting or not makes no difference and the spot testing which gives a moment in time blood glucose level and that is related to the food /meals you eat.
Testing before a meal and after 2 hours will tell you if that meal was tolerated, you should be aiming at no more than 2-3mmol/l increase and hopefully lower than 8.5mmol/l though initially you may not quite see that. This is a better strategy than random tests.
Steroids are well known for raising blood glucose levels, but I think the main problem is the very high carb foods that she is having, cream crackers, grapes, apples after fish and chips and ice cream, toast all in one day.
The only thing low carb is the cheese.
I’m sure there will be a simple explanation but why would her BG drop from 13.5 to 12.3 two hours after the high carbs of cream crackers, grapes and apple...if anything I would have thought at best it would have remained the same, at worst higher...
You would think that regular checks would be done on everybody and if detected, treated, surely that would be more cost effective (sorry for sounding mercenary) and would possibly reduce the numbers going on to more serious problems and causing further financial burden...
The problem is that many people who are diagnosed with diabetes don't really engage with it. They assume that if they take the tablets it will all be OK but the main part of the treatment is dietary changes. Either calorie restriction to effect weight loss or carbohydrate reduction to reduce Blood Glucose (BG) levels. The tablets help but have very limited impact on their own. If your wife doesn't modify her diet then her levels will continue to be high and she will likely need stronger and stronger medication as well as risking the insidious complications of sight loss and damage to the blood vessels and nerves in her feet. Once these things happen it is often too late to reverse things.
Diagnosing more people through screening would be only a small part of the issue. Getting people to change how/what they eat and/or lose weight is much more difficult.
You seem to be in denial that your wife has diabetes because she doesn't have any symptoms, but the symptom is her high BG levels that you are seeing on the meter after eating carbohydrate rich foods. If you wait too long she may have much more serious symptoms like damage to her sight or neuropathy.
You mention a fasting reading and a reading after a meal. Both of those results 67 and 76 appear to be HbA1c readings and it doesn't make a ha'peth of difference if it is done as a fasting blood test or after food, because it equates to a 3 month average of her BG levels, so one extra meal is neither here nor there. They may have done other tests on that blood sample like cholesterol and that may be why it was done fasting. If those 2 results are in the correct order ie 67 and then 76 it appears that things are deteriorating and therefore dietary changes are all the more important.
If you don't understand what carbohydrates are, they are sugars and starchy foods. There are sugars in all sorts of healthy foods as well as the more obvious cakes, biscuits, sweets and yes, ice cream (next time perhaps treat her to a manicure or something none edible or something low carb like a tub of olives if she likes them). So fruit contains sugars (fructose) and milk contains sugars (lactose). All grains and grain products and anything ,made from them is high in starchy carbs, so bread, pastry, pasta, rice, whole grains, couscous, batter and breakfast cereals and yes crackers too as well as starchy root veg/tubers like potatoes and parsnips and of course all potato products like chips, mash, baked potatoes, boiled potatoes, crisps etc. Not saying that your wife shouldn't eat any of these things anymore but restricting them is important to help bring those BG numbers down and making wise choices and not having 3 carb rich meals in one day.
If you want suggestions for lower carb meals we can help you with that, but the first step is to recognize which foods contain a lot of carbs and then start to reduce portion sizes or restrict those. There are plenty of other low carb tasty things to eat once you start to look at food labels and understand what you are trying to do.
h
You seem to be getting confused by the HbA1C test which is a 3 month average of blood glucose level so whether it is fasting or not makes no difference and the spot testing which gives a moment in time blood glucose level and that is related to the food /meals you eat.
Testing before a meal and after 2 hours will tell you if that meal was tolerated, you should be aiming at no more than 2-3mmol/l increase and hopefully lower than 8.5mmol/l though initially you may not quite see that. This is a better strategy than random tests.
...I’m really confused now, the day she went into hospital it was in an ambulance from the GP surgery, the nurse had already taken a blood sample from my wife due to her condition, we never heard anymore about that or the result of that blood test. My wife spent ten days on a high dependency unit with pneumonia during which she had blood taken intravenously and finger prick blood taken regularly, nothing was said to her regarding the results of these blood tests. My wife was discharged on the Friday, ten days after admission. The following Tuesday after discharge at 9 am she attended the GP surgery at their request for what as described as a ‘routine‘ hospital discharge blood test where blood was drawn intravenously, this was a ‘fasted‘ blood test. She was then contacted the following day, Wednesday and asked to go back into the surgery two days later on the Friday afternoon after a meal for a second blood test, and was told she would get the results the following week. It was a week the following Tuesday, so well over a week when she was contacted by the surgery nurse who told her her results were 67 and 76 and that she was diabetic, that the GP had prescribed metformin to be collected from the pharmacy. An appointment was made for my wife to visit the diabetic nurse at the surgery the following Friday. Due to an ‘issue’ with the surgery we were in the throws of registering with another and the original surgery cancelled my wife’s appointment with the nurse! It has taken three weeks to get registered with another surgery and the wife has an appointment in two weeks time with a diabetic nurse which bynthen she will have been on metformin for three weeks without any input from anyone in the medical fraternity...I then purchased the BG monitor a couple of days ago to keep an eye on her BG until we get to see the nurse. I do understand that the Hba1c test is for the previous three months and the BG monitor is for a there and then real time BG reading and I am steadily learning about the effect carbs etc have on BG levels, but what nobody has explained is why, for instance, fasted BG monitor readings would drop one mml/l over two days and why after having a high mml/l reading pre meal this evening, she would have a lower reading two hours after what has been described as a high carb evening meal? Sorry for the long winded reply but...
I’m sure there will be a simple explanation but why would her BG drop from 13.5 to 12.3 two hours after the high carbs of cream crackers, grapes and apple...if anything I would have thought at best it would have remained the same, at worst higher...
The exercise from earlier in the day may be kicking in (all that walking and climbing the steps) and that can take levels down quite significantly. Also the cheese may have slowed the release of the carbs from the crackers and grapes, so her levels might spike again later or all that exercise may counteract it. Our BG levels fluctuate quite dramatically throughout the day normally and there are something like 42 factors which influence them. Food and exercise are the 2 main players though.
Carbs usually have an impact on levels within 2 hours but fatty foods like cheese or foods high in fibre like lentils and beans can slow the digestion down and mean that our levels spike 3 or 4 hours later. Exercise can have an impact on reducing BG levels for up to 48 hours afterwards, so it is not always obvious what is causing what. The key thing is that your wife's levels are too high and that is putting her at risk of complications if it continues.
The problem is that many people who are diagnosed with diabetes don't really engage with it. They assume that if they take the tablets it will all be OK but the main part of the treatment is dietary changes. Either calorie restriction to effect weight loss or carbohydrate reduction to reduce Blood Glucose (BG) levels. The tablets help but have very limited impact on their own. If your wife doesn't modify her diet then her levels will continue to be high and she will likely need stronger and stronger medication as well as risking the insidious complications of sight loss and damage to the blood vessels and nerves in her feet. Once these things happen it is often too late to reverse things.
Diagnosing more people through screening would be only a small part of the issue. Getting people to change how/what they eat and/or lose weight is much more difficult.
You seem to be in denial that your wife has diabetes because she doesn't have any symptoms, but the symptom is her high BG levels that you are seeing on the meter after eating carbohydrate rich foods. If you wait too long she may have much more serious symptoms like damage to her sight or neuropathy.
You mention a fasting reading and a reading after a meal. Both of those results 67 and 76 appear to be HbA1c readings and it doesn't make a ha'peth of difference if it is done as a fasting blood test or after food, because it equates to a 3 month average of her BG levels, so one extra meal is neither here nor there. They may have done other tests on that blood sample like cholesterol and that may be why it was done fasting. If those 2 results are in the correct order ie 67 and then 76 it appears that things are deteriorating and therefore dietary changes are all the more important.
If you don't understand what carbohydrates are, they are sugars and starchy foods. There are sugars in all sorts of healthy foods as well as the more obvious cakes, biscuits, sweets and yes, ice cream (next time perhaps treat her to a manicure or something none edible or something low carb like a tub of olives if she likes them). So fruit contains sugars (fructose) and milk contains sugars (lactose). All grains and grain products and anything ,made from them is high in starchy carbs, so bread, pastry, pasta, rice, whole grains, couscous, batter and breakfast cereals and yes crackers too as well as starchy root veg/tubers like potatoes and parsnips and of course all potato products like chips, mash, baked potatoes, boiled potatoes, crisps etc. Not saying that your wife shouldn't eat any of these things anymore but restricting them is important to help bring those BG numbers down and making wise choices and not having 3 carb rich meals in one day.
If you want suggestions for lower carb meals we can help you with that, but the first step is to recognize which foods contain a lot of carbs and then start to reduce portion sizes or restrict those. There are plenty of other low carb tasty things to eat once you start to look at food labels and understand what you are trying to do.
...we were told the two blood tests taken at the GP surgery, one fasted the other after a meal two days laterWAS the Hba1c test results, so wether or not it makes a hapeth of difference isn’t the point, this is what she was asked to do and this is what we were told. If your saying, quite correctly I believe, that the Hba1c test is to give a three month ‘average’ picture then why did she have to give two samples, one fasted and two days later one after a meal?
The fasted one is to give a baseline when there are no carbs/sugar to raise the level. The one after a meal is to see the reaction to food. I have not been type 2 for long, but have had annual blood tests for years, a lot of them fasted - now I have been told I don't need the fasted ones as they know my baseline. Often a fasted test is also used to check cholesterol level, as was in my previous annual tests.
The fasted one is to give a baseline when there are no carbs/sugar to raise the level. The one after a meal is to see the reaction to food. I have not been type 2 for long, but have had annual blood tests for years, a lot of them fasted - now I have been told I don't need the fasted ones as they know my baseline.
I believe there is a protocol where you need two HbA1c results of 48 or more to be diagnosed diabetic, so that may be why the second test was done. It may be that it was requested as a fasting test to also do cholesterol because there are guidelines for medicating diabetics with cholesterol levels above 4 Technically the cholesterol test no longer needs to be a fasting test either but many clinic staff are not aware of that. Also many doctors don't know a lot about diabetes and might just as assume that the HbA1c needs to be fasting but it really makes no difference. There is sadly a lot of misinformation and misunderstanding and outdated practices within the NHS about diabetes in particular. This is why this forum is so wonderful, because we share information and experiences and up to date thinking and technology so that we become more knowledgeable and most importantly we share strategies that work in reducing BG levels and HbA1c results.
Well at just after 5 pm her BG was 13.5, she had five cream crackers with spread and slices of cheese an apple and a slack handful of grapes, just checked her BG and it’s 12.3...
Cream crackers and apples are high in carbs, and grapes are literally sugar bombs. I am very much concerned that the information on carbs is just not registering with both of you. We would really like to help.
You may benefit for getting the book or app Carbs and Cals which I regard as my bible to find what foods are better options and in planning low carb meals.
…what nobody has explained is why, for instance, fasted BG monitor readings would drop one mml/l over two days and why after having a high mml/l reading pre meal this evening, she would have a lower reading two hours after what has been described as a high carb evening meal? Sorry for the long winded reply but...
The home glucose meters have a 15% margin of error, so the 13 and 12 are basically in a very similar area. The fasting tests will vary slightly and, again, the meter might say 8.1 when it’s 7.5 or whatever.
Your wife by definition has diabetes (because of the two HbA1Cs and shown by her high numbers). Her body could not cope with the amount of carbs in the fish and chips. She can use her meter to see what foods work for her. To do this, she’ll need to be aware of the amount of carbs she’s eating and reduce them. If she can add up the carbs and stick to a maximum per meal, that would be good, or she can simply do it by eye eg replace half her normal potato portion with green veg and see how that goes.
You say she has no symptoms but that’s not uncommon. There are around one million people walking around with Type 2 who don’t know it yet. Your wife is lucky that her diabetes was spotted.
No regular screening for diabetes - no there isn't unless that person already has PCOS, or had gestational diabetes or something. There again - when did you last have a PSA blood test to see if your prostate gland is still performing at 100% ? The only sign of anything questionable my husband had was the fact he could no longer 'pee up the wall as high as he used to' and being as he was in his mid 60s by then, we both wrongly assumed it was just his age ..... Nope - aggressive prostate cancer.
Cream crackers and apples are high in carbs, and grapes are literally sugar bombs. I am very much concerned that the information on carbs is just not registering with both of you. We would really like to he
Morning @Billy boy. Just been back to your first post and wonder if you feel that you (and your wife) are any further forward after the wide ranging discussion it provoked?
You asked a couple of questions I think.
First was whether your wife's HbA1c readings leading to a diagnosis of T2 would be seen in somebody not showing symptoms of T2. I think the answer to that is yes. Read around the forum and you will find a lot of anecdotal evidence that that is the case. The diagnosis comes as a complete surprise for many. She could have been running elevated blood glucose levels for a while and not be aware of it.
Second was whether the elevated HbA1c could be due to her illness. By the way, it sounds as if it was pretty nasty and I hope she is recovering well. Again, if you read around the forum, you will find a lot of anecdotal evidence to suggest that severe illness and its aggressive treatment can result in elevated blood glucose levels. Because of the nature of the HbA1c test, this will only show up in that test if the levels were particularly high, they were there for a reasonable period and the timing of the test. So the answer to your question is that the elevated HbA1c might been due to the illness, but the chances are that it was not. It is possible to speculate, but you will only find out for sure when your wife is clear of the illness and another HbA1c test is done.
Either way up, it makes good sense to treat the results as a warning flag and start looking at the lifestyle tweaks that should bring it back down to sub diabetes levels. No need to panic but could be time to put the thinking cap on.
...we were told the two blood tests taken at the GP surgery, one fasted the other after a meal two days laterWAS the Hba1c test results, so wether or not it makes a hapeth of difference isn’t the point, this is what she was asked to do and this is what we were told. If your saying, quite correctly I believe, that the Hba1c test is to give a three month ‘average’ picture then why did she have to give two samples, one fasted and two days later one after a meal?
