Question about managing blood sugar levels

Food
1

I am trying to figure out the best way to evaluate how my sugars are doing. I am testing 2 hours after eating to learn how my body responds to different foods at different times of days. I’m learning lots, but I also am getting more confused. For background - I have pre-diabetes but no obvious risk factors (39 years old, healthy weight, active, eat healthy, good cholesterol, low blood pressure). I had gestational diabetes three times and have been testing with a1c in the pre-diabetes range for 3 to 4 years.

Here is my biggest question - should I always avoid eating for two hours after eating a meal? I generally eat a small meal and then eat or drink a small item an hour or so later. However, I have noticed that this really messes up my 2 hour readings. Is it a reasonable management technique to wait until your sugar drops to a certain level (say below 100) before eating more so as to keep the spikes lower? This would be a major change in my eating patterns, but one that I could do if it worked. I was hypoglycemic growing up so I got in the habit of never letting my blood sugar drop very much and trying to maintain a relatively constant level all day. That is clearly no longer a problem for me! Does anyone have some suggestions about this? Is it a good idea to go for longer stretches without eating when high blood sugar is the problem? Thanks!

2

Hi, Why do you eat 1 hour after your meal? Are you hungry then? If not and if your bg isn't dropping I wouldn't do that if it is messing up your readings and spiking you. Try to wait till the two hour mark. Also, if you're bolusing for that after meal snack you are going to end up stacking insulin. I was told not to bolus for another meal until 3 hours after the meal bolus when the insulin is out of your system. Unless you're doing a double bolus for something that spikes you. I do go much longer now between meals than I used to and like you I used to eat small frequent meals due to low bg and reflux and other issues.. I still have tiny little snacks now to manage things like a couple of nuts, water, tea, sometimes a slice of cheese, these usually don't spike me too much.

3

Doesn't that 2-hours after testing just drive ya nuts!?
I tried for a couple of months and gave it up. Like you, I might eat something later, but often-times I'd just forget to do it. Instead I diligently tracked carb.intake and before meal glucose level, every meal, every day!
I've got a "long song-and-dance" on my web-site (http://www.weloop.com/HATS.html) that I won't repeat here.

After several years of me not paying much attention, my doc put me on insulin and I had to step-up to reality. Insulin usage at each meal required me to calculate dosage based on the meal's carb.content and to adjust for a high glucose test. That, plus testing before bed, gave me a pretty good picture of what was going on.
I then reviewed my glucose & eating by meal, by day of the week, and by time of day so I could see the patterns. I found I had to make some changes to reduce carb.intake, toast at breakfast, sugar-free snacks between meals, and most painfully weekly-pizza. I did find that there is only 1-gram of carbs in a long-shot of bourbon, so I drink it on-the-rocks and doubly enjoy it because it fells a little like rebellion.

I am no longer using any insulin, have my glucose well under control, and allow myself to cheat occasionally, a small piece of cake at a grand-child's birthday, and even pizza now-and-again.

I've found that my glucose level can be highly volatile. If I forget to test and eat a couple of bites, then test, the test will be high so I make a comment in my records, I am usually able to explain the cause. I read somewhere that there may be as much as 20% variance in test-meter results so I've decided this is not a game of precision but rather one of consistency and regularity.

I have no idea whether my experiences are common, for me the answer is WATCH THE CARBS. My wife gives me a hard time, she's not diabetic and watches calories and fat-content, when I tell her "I don't care about that, just tell me the carbs".
With 4 glucose tests virtually every day I find that my numbers align very well with those my doc gets, my last 3 A1c results are 5.7, 6.1l, 5.9 which gave estimated.Avg.Glucose of 117, 128, 123, and aligned very well with the average glucose levels my records gave.

I'm a stubborn guy and don't want to be dictated to by my diabetes, as my grandson says "He's not the boss of me!". Once I decided to be the BOSS, and accepted the associated responsibilities, I was meticulous, probably a bit irritating, but I found the means to be in charge. I still test 3-4 times every day and watch the numbers to be sure I'm not "sliding off of the wagon". Yes, I've made some changes in my routine, but I now know enough about how my system works that "I'm the boss of him!".

4

Since you are 'pre-diabetes', and not currently taking medications or insulin, I'd suggest you look into understanding first and second phase insulin release for the non-diabetic.
This link might be helpful.
http://www.medscape.org/viewarticle/483307_2

When you first eat, there is a first phase rapid release of insulin that was stored up, then a more gradual release for second phase insulin. When you eat too soon after your meal, your body does not have time to build up the reserve for first phase for that additional food.

You may need to experiment with your proportion of carbs/proteins/fats at your first and second 'meal'. Your pre-diabetes may be caused by you having insufficient phase 1, or more sluggish phase 2, but I don't think it's easy to tell.

The 2 hour BG check is often used with diabetics taking medications, to see if the dosage and timing is correct, and make adjustments if necessary. In your case, you may need to instead change your meal content and timings to match your insulin production.

5

Thank you so much for the thoughts. That article was incredibly interesting and relevant. "Further evidence that abnormal first-phase insulin secretion is an early event in the deterioration of beta-cell function is seen in women with a history of gestational diabetes but with normal postpregnancy glucose tolerance. These women, who are at very high risk for the future development of diabetes, exhibit a diminished first-phase insulin response to both oral and intravenous glucose, while other markers of beta-cell function appear normal." applies to me pretty exactly! At least now I have something that makes sense. I do think it makes sense to wait to eat and the suggestion to test before eating rather than after also seems logical. I'm still in the exploratory stages so at times I'm overwhelmed by what I should do. This site is full of wonderfully helpful and knowledgeable people!

6

CQJ - Congratulations on your perceptive awareness of your health. Many people in your situation would choose the easier path of denying reality, especially since it's not causing any acute problems. Gaining an awareness of your metabolic weakness before it progresses too far gives you a very good chance to alter the trajectory of your health over many years. Your are sitting at the exact place that many diabetics wistfully think about when they conclude, "If I only knew then what I know now."

Your story reminds me of Franziska Spritzler, the Low Carb Dietitian. She, too, has pre-diabetes and noticed, through her own curiosity and using a blood glucose meter early to inform herself about the consequences of her meals. She did not have gestational diabetes like you but you may be able to benefit from her experience. Here's her story about how she took control of her health by making a conscious and deliberate better choice. Good luck to you.

7

Thanks! That website is very informative and the author does seem to have the same approach as I do. I'll be looking more into her information. Thanks for the link! The hard part I have is remembering to take it all seriously even though the consequences for not doing so are years the future if ever. I know I have a problem (I periodically make my husband test his sugars and I've never seen him over 110, never mind the 150's I'm occasionally seeing) and my doctor is always telling me she doesn't like my A1c numbers given my age and weight. So, I work on keeping my mind focused. The meter is good because my numbers are clearly not right, even if they aren't bad.

8

I agree with everyone that if there's no need to eat and you don't want to spike (and don't have the T1 solution of piling more insulin "logs" on the fire...), it might be better to forgo the snack or find something pretty low carb, eggs, meat, spinach, etc. Pork rinds are about the lowest carb/ highest junk food item I can think of but I always figure there's got to be a down side to them.

Another article that I have found interesting and informative about the different items going on in T2 (which it explains is a combination of different factors...) is "From the Triumvirate to the Ominous Octet". I don't know if there's anything exactly that can be done proactively w/o a diagnosis to get going on meds but I've read blurbs in Diabetes Forecast and probably online as well (Sorry I don't have a link up my sleeve...) that it's better to avoid hyperglycemia entirely w/ T2 type of issues by whatever means are necessary.

I recall 'Lilmama, another member, and also Bad Moon T2 and quite a few other T2 folks report exercising frequently, sometimes after each meal to avoid spiking. If you can fit a walk into your schedule, it might be another way to buzz your BG down without needing an rx, plus endophins, exposure to greenspace, cardiovascular health and the other benefits of exercising although I sort of think that 3x/ day is a lot to go.

9

Carbohydrates raise blood sugar, yours and mine. So select foods that will help you keep your blood sugar levels down. If your blood is spiking to extremely high numbers, then assume that eliminating more carbs will help it to stay lower. Some foods, like pasta, will continue to raise your blood sugar for as many as 5 hours after eating, so maybe you are still getting readings from your regular meal, and not the snack afterwards.

We know that the average blood sugar level in non-diabetics is 83, so strive to keep your blood sugar at that level. Eat protein, green leafy veggies, eggs, you know the routine, and good luck to you with keeping things on an even keel.

Congratulations to you for striving to manage and control your blood sugar to fend off full blown diabetes. It is confusing, and the scientific and medical researchers are coming up with new data about Type 2 Diabetes and Pre-Diabetes all the time. There has been so much new information in the last 10 years that changes the way we treat these two conditions that it is hard to keep abreast of it all.

You didn't tell us if you are taking any medication to control blood sugar, or just managing it through diet and exercise. I assume you aren't on meds, just using diet. If so, the answer is low carb and daily exercise of any sort. Just don't stop testing until you've got the formula down pat. Once your blood sugar stays relatively level, you can measure less and less.

Keep up the good work.

10

My fav junk food is guacamole and pork rinds. Very high in cals but you don't eat much at once since it is so fatty.

11

You sound like me. I saw an endocrinologist who is treating me as a type 2 even though my a1c is 5.7. I am fairly thin. 5’2" and 110 lbs. but he asked me to try to lose 5 more lbs. I am exercising 4-5 times a week. He put me on metformin to preserve my beta cells and a lower carb diet. I test myself at 1 hr. my bs goal is less than 140 at that point. Hopefully it’s under 120. Which I’ve been able to get to since starting the metformin last week. Good luck.

12

Thanks for the advice and encouragement. For those that have mentioned it - I am not on medication. My fasting numbers are under 100 (sometimes even under 90) and most of my post-meal numbers are under 140 at 1 hour and under 120 at 2 hours (although not if I'm not careful). My a1c has ranged from 5.7 to 6.1. I really wanted to get it below 5.7 before I turned 40, but that will not happen. I think I am finally on the right track (by checking my sugars) and I hope to continue to improve. At this point I am going to try the low carb diet (or move in that direction) and continue checking to see how much I need to restrict my carbs. I will also try waiting long enough that I have reached a 'fasting' level before eating again (that means I need to try and eat more during meals!). I know stress plays a large role in all this and I try hard not to let it overwhelm me (though lately I've been losing that battle!). Anyways, I really appreciate the support and suggestions, so please keep them coming!

13

I'm similar to you except that I never had pregnancies. I'm not on meds.

The biggest help to me was to go on a low-carb diet. At first I had to be strict (30-60 a day), and it took 6 months for things to settle, but I'm never hungry, and my numbers are fine as long as I don't cheat.

When I cheat, numbers can go over 200. Yesterday I had a large cheat of cake and too much ice cream (I do okay with the occasional 1/4 cup, but this time I went overboard), and after 3 hours, I was still in the high 130s. Usually I keep testing to see how long it takes, but yesterday, I just said, "I won't do that again" and gave up. This morning I was fine.

If I walk every day and avoid high-impact sweets like cake, frosting, cookies, I can eat 80-100 grams a day. We're all so different, though.

14

Mar2a - Wow! You really do sound just like me! I have been doing reasonably well on a 60-80 carb a day diet with occasional days as high as 100 grams. It seems to work overall, but if I eat something too sweet intense I can also go over 200. I've been doing this since January 1. I think it is working really well. I do still have trouble with snacking, but I'm learning what to eat at meals (more fat, for example) to help me go longer between eating. My goal is to stay off meds as long as possible.