Visit to Diabetes Centre

Type 2
1

Hello and Happy New Year to everyone!

I just got back from my first visit to the Diabetes Center and wanted to share the numbers I was given to see what people think about them.

A1C - Should be 7.0 or less
BG Before Meals - Between 72 - 126
BG 2 hours after Meals - between 90 - 180

I also asked about testing 1 hour after meals, to see the spikes, but they indicated I should test 2 hours after meals. The educators didn’t feel testing 1 hour after a meal was necessary as most non-diabetics will spike after eating most meals anyway.

They also have normal ranges for non diabetics: Normal range of 108 or less, 72 - 108 before meals and between 90 - 144, 2 hours after a meal.

Overall I was happy with what the educators discussed (I also got a free meter and test strips :)) but they did say my recent weight loss should be monitored closely. One of the dietitians did indicate that I could be LADA as some of you have suggested here. But, she also indicated that there probably isn’t any need being tested as my numbers will show when it is time to start taking insulin. When I go back to my new Dr on the 14th to get my results (I had almost every test done :)) I will request this test so I can at least stop wondering.

Overall my weight has leveled out at 143lbs for the last 3 weeks and I am trying very hard to gain some weight back but I’m finding it hard to eat the recommended 2300 calories/day. I eat my breakfast and lunch and realize I still have 1500 cal to go :frowning:

Anyway, sorry for the rambling…

Thanks again for any advice or input!

Paul

2

Hi Paul,

Happy new year! Glad you’re maintaining weight, but frustrating not to be able to gain the weight you’d like,

Great you’re going to insist on the tests to determine if you’re LADA or Type 2. Foolish for the dietician to have said that you’ll know when & if you need insulin. Proper treatment is based on knowledge & facts. It won’t do you much good if a doctor puts you on oral meds believing you’re T2 (if your numbers start to climb) when insulin is needed.

The ranges they gave you are standard ADA guidelines, which are high. The closer to normal you can maintain BG, the better. You want to aim for significantly under 180 after meals. BG over 140 causes damage. Non-diabetics don’t go as high as 144 after meals.

3

Hey Paul, thanks for the post. Happy New year too… Here is a link you may find interesting…
www.phlaunt.com/diabetes/16422495.php

Here is what normal blood sugars look like on a study they did with a CGM with corresponding chart. Personally I am shooting to get my A1C in the 5’s, thats my goal. You may want to check out her site. Bottom line for me is the farther you get away from a normal A1C the greater the chance for heart problems and I am concerned about that.

I know many believe that you should not be spiking above 140 two hours after a meal. I try to watch that closely as well.

Hey good to hear from ya. I hope everything works out for you on your next appointment. Hopefully they can nail this LADA down for you. Talk to ya

4

I shoot for 140 after 1 hour, and 120 after 2 hours, or lower… People who say that usually dont have to live with Diabetes, or deal with the complications… Here’s some food for thought. http://www.phlaunt.com/diabetes/14045621.php

5

Happy New Year , Paul and supporter Wife ,

Are you willing to share some of your latest finger poke results or a general statement about your BG’s with us ? Are they within the norm or does it look like you should be taking insulin ???

I like to recommend, that you google Canadian Diabetes Association 2008 Clinical Guidelines …lots of reading …215 pages and please remember Guidelines are just that : Guidelines .
On page 15 it states : Treatment decisions must be individualized . It is important to remind the Health Care Professionals about the need to incorporate patient values and preferences into the decision making ( I read here : advocate for yourself ) .
You will find Targets on page 45 and A1C < 6.5 maybe considered …to be balanced against the hypo risk .
You mentioned BG before meal …I wonder if the word Fasting was used , ie not having had anything for 8 hours , as during the night ? I read same numbers as you noted 4 mmol/L( x 18 ) -.7mmol/L ( x 18 )
2 Hour post meal : between 5 mmol/L ( x18 ) and 8 ( x 18 ) , when " possible " .
I am a bit baffled too by the comment the Dietitan made: " But, she also indicated that there probably isn’t any need being tested as my numbers will show when it is time to start taking insulin " esp. when it was mentioned to keep a watch on your weight . Hope your Doc has a different view …and tell Doc you are familiar with the CDA 2008 guide lines and prefer to do better .
Is wife able to come along again to the app’t on Jan 14 ??

6

Hi nel,

Yes, I can share numbers with you but I am totally baffled and getting frustrated at different numbers. For example I had a home made bean salad and low carb yogurt (5 carbs) for lunch today. I was 6.1 before the meal and tested using the new meter (OneTouch Ultra Mini) 1 hour after. It was 9.3/167. The old meter (Bayer Contour) read 7.5/135. This sort of stuff is getting to me. It makes me wonder if that meal was ok? How would I know if I only had the old meter. if the new meter is accurate and my reading was 9.3 then I wonder how I am ever going to gain weight if I’m so afraid of eating carbs. I must note that 2 hours after the meal my numbers were 6.5/117 by both meters.

Generally my fasting numbers at 7am are usually 4.2 - 5.2 (75 - 93). I have never really been much higher than that. So I think these are right on target and not a concern (unless they start to rise). What I am concerned about is my spike after meals which is keeping me from eating a balanced diet and thus not able to gain any weight back. One time when I had a substantially large amount of pasta (this was at the beginning of my diagnosis) my 1 hour post BG was 14/252 but came back down to 6/108 2 hours after. I think this is what shocked me and probably scared me into cutting back a lot, or most of my carb intake. I think I may have over reacted.

Maybe if I was taking insulin I would be able to tolerate more carbs at meals and gain some weight back.

I may call the diabetes centre back tomorrow and ask for a 1 on 1 meeting because today’s session was a group thing and I couldn’t really ask personal questions too much. I want to know if I should be taking insulin before meals.

Thanks again for any feedback. I really appreciate all of the support and information I have received here. I know this may sound silly but I often feel alone with this because I have yet to talk with a professional that understands what is going on with me.

Paul

7

Thanks Pauly,

I get my first A1C results back on the 14th so I will share those numbers with you. Until then I am just trying to keep my post meal numbers below 140 and gain weight (not an easy task!).

Cheers, Paul

8

Thanks Gerri,

I think I will call the center back tomorrow and ask for a personal meeting with someone there. I need to figure this all out and have the LADA test done so I can get on with the rest of my life. Once I have been tested at least I can go forward and work at it no matter what the result. Right now I just feel like I’m going nowhere.

Thanks, Paul

9

I really would suggest ditching the Ultra Mini, for any of the other very reliable meters people have used, or recommended in here. I know, I know… every meter can vary 15-20 points from a lab test, and that’s a normal variation. But my ultra mini was giving me outrageous variations from whatever I had at the lab. Even my Bayer Breeze2 only had about 10-15 pt difference from the lab, while the Mini always had about 30-40 pt difference. It kept frustrating me, as I was adjusting carbs according to that… and I was going high, not knowing so. As far as meeting 1 on 1, it’s always a good idea… Just make sure to do a little research before you go, so you can know what you’re getting yourself into, a little more… and it’s not just THEIR decision, but your own, as well. :slight_smile: Knowledge is power. The Blood Sugar 101 site will help you get a head start.

10

Paul,

It’s frustrating, sorry. Not knowing is aggravating!

The tests you want are a GAD antibody panel & C-peptide. Hope you can speak with a doctor there.

11

To gain weight while still keeping oneself under 140 mg/dl, go to four meals a day. Increase protein, even if it’s Morningstar sausages, ham sandwich, Muenster cheeses. At your weight, 2 grams carbs raises you 10 mg/dl. So 20 grams raises you 100 mg/dl. That’s if you don’t have much resistance.
I second everyone’s advice on here. Best wishes!

12

Hi Leo,

I checked online and I’m supposed to be consuming 2300 calories and that’s being non active. I walk 75 mins/day which I wont give up so in order to gain weight I must consume more than 2300/day… That’s easier said than done!

I’ve been logging my daily calorie intake and I find it hard just to maintain this 2300, thus not gaining anything…

I am a little concerned that eating all this meat/eggs/cheese is too much bad fat/cholesterol?

Thanks, Paul

13

Hey Paul,

Many discussions here & tons of on-line info about how carbs, not fats, contribute to bad lipid profiles. You want to be sure to get a balance of fats from other sources as well–nuts, avocadoes, flax seeds, cold water fish (not farm raised).

14

Paul,

I have to tell you, your blood sugar response just does not seem that bad. I know that you are concerned about your numbers at 1 hr, but frankly your numbers at 2 hours seem fine. For lunch you had a “bean” salad. Is that like a kidney bean salad? That alone could be like 30-50g carbs /cup. You clearly are not responding like a non-diabetic when you eat carbs, and while your phase 1 response still sucks (that is why you have high numbers at 1 hr), your phase 2 response is still strong and bringing you back to good numbers. You are still learning all the ropes about low carb and stuff and you need to just go easy on yourself. You will get this in order.

I’ve found the diabetes center folks to be very helpful, but they will advocate ADA like loose blood sugar control. I’d suggest you not debate them on these issues, it is wasted time, that is what they have to teach. What they can help you with is better carb counting and better management techniques, they are good with that sort of stuff.

You’ve only been at this three months, given the numbers you have related, you are unlikely to be referred for insulin. It is certainly appropriate to talk to them about insulin and how and when you can transition to it.

Oh, and eat some more food. You need to learn to eat even when you are not hungry. Get yourself a 5 lb bag of almonds and measure out 1 cup every day. You need to eat that cup as snacks during the day. Carry that cup of nuts around all day in a plastic bag and finish it by the end of the day. That’s an extra 800 calories a day.

I know this seems harsh, but you are still dealing with this and learning to accept it. You may think that you will just figure out what is wrong with you and it is just going to get fixed. But in the end, we mostly never really know exactly what happened to us, why we got diabetes, or even necessarily what “kind” of diabetes we have. What we do learn is to manage our condition and make the most of our lives. And in the end, that is all that really matters.

Oh and don’t forget the nuts.

15

You need to get over the whole protein/fats are bad thing. There are many of us who can provide you with background reading on the subject, but frankly, if you cut out the carbs and avoid the protein and fats, well then you are left with nothing. Nothing is clearly bad for you.

ps. What happened to the whey protein shakes?

16

Hi bsc,

Thanks, I really appreciate your “get a hold of yourself” approach to my concerns. I have to agree that I do get worked up about all of this and should just take thinks a little easier. I am drinking a pint glass of chocolate whey protein every day. I mix it with 8oz of cold water, 4 ice cubes, 2 tbs of heavy cream and 1/2 cup of strawberries. I have to tell you I love it! It is something I look forward too each day. The clerk at the health food store suggested I take it with fish oil supplements so I take 2 of those each day with it.

believe it or not I am eating… I had a medium size steak, some french fries and vegetables for dinner this evening and 1-1/2 after (I did my 75min walk right after) I was 117. As I have mentioned my evening numbers are typically better than my a.m. numbers with breakfast being the worst…

I like the idea of a cup of almonds in a bag and eating throughout the day. I didn’t realize that would be 800 calories.

I know I will eventually get this under control… I just have to relax a bit…

Thanks, Paul

17

I know that you want it all to be better fast, but it is not to be. It took me probably six months to get my postprandial numbers on track after diagnosis. And then I was unable to get my morning fasting anywhere near target for months after that, and only after I adopted the low carb techniques of Bernstein. You just need to remind yourself that you are doing fine and that you will be ok. You are taking care of things and everything is on track. If you do have a more serious form of diabetes like LADA you will see it coming and you will handle it, it will be ok. There are lots of people who ignore their situation and let diabetes creep up on them and go uncontrolled, I am sure that won’t happen to you.

ps. One more secret weapon. Cottage cheese, I eat it almost every night. 1cup 25g protein, 5 g carbs and probably another 200 calories.

18

Hi Paul: I am glad that you are getting tested for LADA/Type 1. There are actually three antibodies to be tested for (GAD, ICA, IA2). C-peptide is useful but not definitive. Regarding what the dietician said about starting insulin, the DCCT conclusively demonstrated the benefits of intensive insulin treatment, especially amongst adult-onset Type 1s who had some residual insulin production. LADA researchers in Japan have conclusively demonstrated that better preservation of beta cell function occurs with exogenous insulin compared to sulfonylureas, and that sulfonylureas hasten beta cell destruction. In other words, doctors may inappropriately use Type 2 therapies in new-onset LADA/Type 1 diabetes, but all scientific studies indicate that the correct therapy is intensive insulin therapy. Best of luck to you.

19

Paul , I am living with diabetes for 27 years and some moments in my life are the pits ,because I get hang up about my BG numbers NOW …I tell ME to " get off it " and the next moment I feel on top ot the world …talking to myself helps …hope this works for you too , including being pro-active as you seem to be …And remember the supportive Spouse you have !!
Hang in there CANUCK !!!

20

Hi Paul,

Really glad to see you are moving ahead, and plowing through the discouraging parts of all of this. You got a lot of information from here, and I doubt I could add anything other than I would agree completely with you NOT debating numbers with those who live and die with ADA standards.

I suppose a lot depends on the "feel"you get from whomever you are talking to, but most will just toe the company line. If it seems like you could ask, set them up by asking at what level of BG, does damage being to occur to your organs, and your system. Far as I have learned, its 140, so you paint them into a corner if the accept that, since they allow you to 180 an hour after you eat. They are saying its okay to damage your organs, and I think I have a problem with that. Better to keep the precise numbers out of it I suppose :slight_smile:

I use a One Touch Ultra Mini. Twice at the lab, I have tested along with the lab meter and been all but dead on. If you are not confident in your meter, find one you are, but that will require testing at the lab to give you the peace of mind you need. For now, quit using two different meters. There is no point in chasing your tail. Use it for trends. A meter that is off by 15 pts (btw, thanks for posting both types of numbers ) will still show you that “this food raises my BG 30 points” and that is what you need to know.

Your fasting numbers are really good. Nice going there. That should really keep your A1c in line. I think over 6.0 is getting into the grey area and you can get to 6.0 or less because that is 126 average, and if your fasting numbers are happily under 100, and you don’t allow your one hour spikes to go past 140, it seems like your system is quite capable of getting you down to 100 or less after two hours. That would be a great average for your A1c.

That’s enough from me :slight_smile: You have been given a lot of good advice. Don’t want to screw it up :slight_smile: Peanut butter is another way to get calories into you. I am good for several spoonfuls a day. I just wish peanut butter tasted like chocolate instead! I also munch on unsalted nuts and walnuts throughout the day.

OBTW, without being rude, and hoping the word will not offend you or anyone, screw the cholesterol urban legends. If you are low carb, you are doing what you have to do. Bacon and eggs and sausages are good for you. Eat em with the same moderation you use for all other things, be in good shape, have great BG levels, and watch your LDS, HDLS, lipids, etc all fall right in line. The actual cholesterol number doesn’t mean much. Its all the other subsets of it, that matter. Make sure you get all of that information when you do a blood workup.

I am happy for you. It sounds like you are gonna make it work no matter what, and that is the only way to attack this stinking disease

Oh, and ramble all you want. I know I do :slight_smile:

John