Testing results

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Beancounter298

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My question is about what happens going forward. I was diagnosed type 2 just over a month ago with level of 98 and on metaformin.
My test results now seem more "normal", I test before and after my main meal and carbs are between 70 and 90g per dsy. Is this due to the medication or the low carbs or both?
Should I just continue like this until my next HBca test in a couple of months?
My diabetes nurse wants me to have a pancreas ultrasound scan "just to rule anything out" but this is making me very anxious
 
Hi @Beancounter298. I would work from the notion that getting good control of blood glucose is a marathon not a sprint and just continue with both medication and low carb until your next HbA1c. If your testing is showing results somewhere around "normal" levels just stick with what you are doing, be in a good place after your next HbA1c, and work from there..

I took up the offer of an ultrasonic pancreatic scan - same process as pregnant ladies have - and thanked my DN for suggesting it. It was quick, efficient and instantly ruled out anything sinister. Probability of finding anything is very low but my opinion is that if there are any problems the earlier they are found and dealt with, the better.
 
Beancounter298 said:
My question is about what happens going forward. I was diagnosed type 2 just over a month ago with level of 98 and on metaformin.
My test results now seem more "normal", I test before and after my main meal and carbs are between 70 and 90g per dsy. Is this due to the medication or the low carbs or both?
Should I just continue like this until my next HBca test in a couple of months?
My diabetes nurse wants me to have a pancreas ultrasound scan "just to rule anything out" but this is making me very anxious
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I'll echo what @Docb says. I'm still testing on waking and post-meal so that I can spot any shift in my BG levels over time, rather than waiting with fingers crossed for my next HbA1c, and I'm still following a low carb diet, and it's almost 5 years since my diagnosis. My GP also thought a pancreas scan was worthwhile so I had one and it found no issues, which was reassuring.
 
Thank you both, that's helpful
I am not sure I understand why blood sugar is higher in the morning first thing thsn after evening meal, yesterday mine was 6.4 before dinner and 8.5 2 hours later but this morning it's up to 9.4
 
I don't try and pretend to understand what is going on with blood glucose levels. All I know is that carbohydrate intake and how my pancreas reacts to the glucose produced from it is an important factor and it is the one thing I can do something about. There are other things going on which affect blood glucose which as far as I can see just happen.

I try and look at the big picture and treat oddities (like how come my morning reading can wander quite a lot even though it is 12 hours since I ate anything) as interesting curiosities which I will never get to the bottom of because I don't know enough about it. There are lots of opinions about these things, some of which might well be sensible, but quite which apply to me will always remain a mystery.
 
Beancounter298 said:
Thank you both, that's helpful
I am not sure I understand why blood sugar is higher in the morning first thing thsn after evening meal, yesterday mine was 6.4 before dinner and 8.5 2 hours later but this morning it's up to 9.4
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Dawn Phenomenon.
The liver produces glucose in the early hours and in T2 diabetics insulin resistance and lack of insulin secretion combine to lead to rising levels. (The liver continues to pump it out, even though levels are already high.)

This is a good summary of the current state of the research in 2013, although I don't think anything new has been discovered since:

www.ncbi.nlm.nih.gov

Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes

www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

It happens in non-diabetics, but the metabolism deals with it by a modest rise of insulin and the liver stops making glucose.

It can take a while to come down, as from what I have read T2D affects insulin secretion based on the time of day, and can be made worse by a breakfast high in carbs (Extended dawn phenomenon).

According to the above, the only way to prevent it is a shot of long lasting insulin in the evening.
 
Beancounter298 said:
Thank you both, that's helpful
I am not sure I understand why blood sugar is higher in the morning first thing thsn after evening meal, yesterday mine was 6.4 before dinner and 8.5 2 hours later but this morning it's up to 9.4
Click to expand...
I've never understood it either and have long giving up trying to. I got a 5.2 this morning after a 6.1 post-meal yesterday evening, yet the day before I got a fasting 5.6 after a post-meal 4.8 the previous evening, so a complete reversal from one day to the next. I log all my results in a spreadsheet and as long as I'm not seeing them trending upwards I don't fret about the actual numbers.
 
Agree with you @Martin.A - its the trends that are the thing to look for. I'm currently tracking my waking bg quite closely because it has been steadily creeping up over the last few months and you can only see that by looking at a lot of data. You cannot see it by looking at individual results.

@Beancounter298 - the message seems to be you have to be a bit nerdy with the numbers to begin to make sense of be BG results and even then conclusions are a bit iffy. If you do not want to be nerdy don't worry. If your test results generally look "normal" then be pleased, keep on doing what you are doing and wait for your next HbA1c is my suggestion.
 
Martin.A said:
I've never understood it either and have long giving up trying to. I got a 5.2 this morning after a 6.1 post-meal yesterday evening, yet the day before I got a fasting 5.6 after a post-meal 4.8 the previous evening, so a complete reversal from one day to the next. I log all my results in a spreadsheet and as long as I'm not seeing them trending upwards I don't fret about the actual numbers.
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Yep.

The 'normal' value is a range, somewhere between 4 and the low sixes for fasting. Averages are far more important as this will pick up trends.

I've seen people without diabetes worried when they see a 5.9 on their meter in the mornings.
Morning levels are fairly notorious for being a bit unpredictable due to the various physiological things going on during this period. Plus the meters aren't that accurate and diet can cause changes in insulin response/handling as well.

I find fasting readings in the afternoon are far more consistent.
 
I find exercise in the evening helps to reduce my overnight and waking readings and reduce the glucose output from my liver in the mornng (Dawn Phenomenon/Foot on the Floor syndrome).
I also always test when I wake up and before I get out of bed each morning because my levels can rise by several mmols in the 30 mins after I swing my legs out of bed and stand up. I have the advantage of insulin to deal with this and I now jab 2 units as soon as I wake up to manage it but before I started doing this I could be 6mmols higher than my waking reading by an hour later.
For some people, eating something low carb like a few nuts or a small chunk of cheese as soon as you wake up can stop the liver churning out glucose, so that might be something else to try..... although obviously not if you have a nut allergy!
 
I've read a lot of research papers in to DP in T2D and not a single one of them has said eating a low carb snack can prevent it. Even most of the medication for T2 has very little effect (With some of them being unsuitable due to the way they work as they could cause hypos, i.e. things like gliclazide).

The cause in T2 is due to gluconeogenesis and glycolysis occurring because there's a lack of insulin to switch it off and/or the message is being ignored due to insulin resistance in the liver/muscles/fat and/or there's a large amount of free fatty acids that fuel the gluconeogenesis process...
 
Martin.A said:
I've never understood it either and have long giving up trying to. I got a 5.2 this morning after a 6.1 post-meal yesterday evening, yet the day before I got a fasting 5.6 after a post-meal 4.8 the previous evening, so a complete reversal from one day to the next. I log all my results in a spreadsheet and as long as I'm not seeing them trending upwards I don't fret about the actual numbers.
Click to expand...
Thanks, I am keeping a spreadsheet too (the accountant in me coming out!)
 
Beancounter298 said:
Thanks, I am keeping a spreadsheet too (the accountant in me coming out!)
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In my case it's the Data Analyst in me coming out, having spent some years working in that field.
 
Beancounter298 said:
Thanks, I am keeping a spreadsheet too (the accountant in me coming out!)
Click to expand...
In my case it is the research scientist. I'm different to you guys in that I work on a low probability of the spreadsheet giving me something useful.
 
My experience was in some respects similar Beancounter.
September 2022 I went to my GP with a first occurrence of psoriatic arthritis (exquisitely painful swollen hands mostly) and saw a rheumatologist in January 2023 who initiated a battery of tests which turned up an HBa1c around 96 to my amazement, in addition to some seriously elevated enzymes. He called in the diabetologist who happened to be in clinic next door and he confirmed type 2 diabetes.
A scan showed significant fatty liver and pancreas which meant most treatments for the arthritis were contra-indicated. Metformin was prescribed along with advice to restrict carbs and try to lose a bit of weight to attempt to reduce the fatty deposits, though my BMI was well within normal range.
Fortunately my liver function tests returned to normal after a few weeks, a further scan by a hepatologist showed the fatty deposits had gone and my HBA1c was 45% on metformin and dapagliflozin with a seriously card restricted diet.
I have regular blood tests because I now take methotrexate and adalimumab for the arthritis and I'm pleased to report all is now within the normal range.
Do give it time, don't chase individual readings and use HBA1c as your measure of progress. I think just being aware of the effects of what we eat is a major contributor to control of blood glucose. I have no idea what caused the initial problem after 40 years of suffering from psoriasis without any additional complications. I do have two younger brothers who are type 1 (out of 5 of us) but I rather assumed as I hadn't developed that in my teens like they did I had escaped it.
Wishing you all the best and counselling patience. Hope this is reassuring.
 
Very reassuring, thanks. The diagnosis came out of the blue (in an abrupt phone call from a GP) so I'm still trying to get my head round things
 
Your over night and before you go to Bed can always be different. I have had Type 1 Diabetes 54 Years now and never had similar readings.
Also you cannot trust the Specialists or Nurses as they only look 2 weeks back? You cannot judge control of Either Type 1 or Type 2 Diabetes as my Father had Type 2, but they only looked back 2 weeks. This is no use they must look at least 2 months or more to see how long your readings to far out to control Diabetes. This was done when I had Diabetes and Mum had Dot Charts and the Specialist looked back months to balance my Diabetes. He also had Diabetes and new all about it. I saw him time he retired after about 6 to 7 years.
He looked after by Diabetes and balanced me so well I only had to see him every 6 months. I have told the Doctors and Nurses to look back more than 2 weeks results to control patients, and I say this after 54 years with Diabetes. Hope some of this helps people. and remember to remind Doctors and Nurses that look after you ask them how far that reading results.
 
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