It's school tomorrow so this sudden splurt of blogging is going to stop and a whole load more homework is bound to be rolling in. Oddly enough having a diabetic dad can actually effect my homework. Ish. The other day I was doing some I.T. homework (not for very long admittedly), when I realised I had been working on the file still attached to the email. Oops. So when I discovered this and saved it onto my account the work I had just been doing disappeared. I called Dad to come and help me, but he was all over the place with his levels and consequently very grumpy. This meant when he was trying (and failing) to find my missing homework, he got a bit frustrated. He started hammering at the keyboard and snapping at me. It was quite scary actually. I sort of wanted to get Mum but I was kind of scared Dad would smash my laptop up. Eventually he gave up and I ended up redoing that bit of the homework. Never mind.
THE CONFESSION
I don't actually understand what diabetes is. Dad tries to explain it, but ends up using confusing words like glucose etc. I always nod and pretend I understand when really what I'm thinking is 'I have absolutely no idea what you're talking about'. Why can't he just say 'I don't have the right stuff in my blood and this stuff substitues it' or something. Adults, honestly.
I am now on a mission to discover what on earth diabetes is.
B
Sunday, 27 February 2011
Thursday, 24 February 2011
'HbA1c phenomenon' and feeling grumpy
I have an annual review coming up in April. I know this because I called the hospital a while ago to check I was still on their list (I recently transferred back, having been seen at my GPs for a few years).
I also know it because my blood glucose levels have been running stupidly high recently. This seems to happen to me a lot. As soon as I know I'm in the 3 months running up to the test (HbA1c gives an indication of average BG levels over the last 3 months) it all goes to pot. I've come to think of this as 'HbA1c Phenomenon'.
I've been working hard at getting my diabetes under control for around a year now. When I look at monthly average figures during much of that time they are around 6.9 - 7.1 mmol/L. There's a ready reckoner which suggests your HbA1c if you give it an average BG level for 3 months or so, provided the tests include a decent spread of pre- and post-meal results (which mine now are). There are a fair few of these conversion formulae, but the one I use is:
HbA1c = (BG average+2.52)/1.583
Weekly averages recently have been in the mid 8's. I haven't been doing this badly for about 8 months. I was so hoping for a good A1c. Almost as an 'official' affirmation of the work I've been putting in. Secretly I think I was hoping I'd make it into the elusive 5% club (sub-40 in new mmol/mol numbers), but now I think I'll be lucky to match my last one of 7.1%. If I was still pottering along without paying much attention I'd be happy enough with that (as indeed I was), but when you are working much harder at something it's nice to see some sort of results, and a little frustrating to think that you would have seen those results a month or two ago when you didn't have the test scheduled!
In my heart I know that the HbA1c is a pretty poor indicator of control. I've cheated low numbers before by having enough hypos to cancel out all the highs. But it's the badge which defines you as far as the medical profession is concerned. However inaccurate it is, it's still considered the 'gold standard' indicator. I wanted not only to have better control (which I do) but to have a pleasingly low A1c to match.
So I am trying (and largely failing) not to get too grumpy about this. To breathe deeply, take one test at a time and be happy with how far I've come in the last 12 months.
You never know... the test is weighted to the most recent 4 weeks or so. I might still have a chance to knock a bit off if I can keep my head during March.
I also know it because my blood glucose levels have been running stupidly high recently. This seems to happen to me a lot. As soon as I know I'm in the 3 months running up to the test (HbA1c gives an indication of average BG levels over the last 3 months) it all goes to pot. I've come to think of this as 'HbA1c Phenomenon'.
I've been working hard at getting my diabetes under control for around a year now. When I look at monthly average figures during much of that time they are around 6.9 - 7.1 mmol/L. There's a ready reckoner which suggests your HbA1c if you give it an average BG level for 3 months or so, provided the tests include a decent spread of pre- and post-meal results (which mine now are). There are a fair few of these conversion formulae, but the one I use is:
HbA1c = (BG average+2.52)/1.583
Weekly averages recently have been in the mid 8's. I haven't been doing this badly for about 8 months. I was so hoping for a good A1c. Almost as an 'official' affirmation of the work I've been putting in. Secretly I think I was hoping I'd make it into the elusive 5% club (sub-40 in new mmol/mol numbers), but now I think I'll be lucky to match my last one of 7.1%. If I was still pottering along without paying much attention I'd be happy enough with that (as indeed I was), but when you are working much harder at something it's nice to see some sort of results, and a little frustrating to think that you would have seen those results a month or two ago when you didn't have the test scheduled!
In my heart I know that the HbA1c is a pretty poor indicator of control. I've cheated low numbers before by having enough hypos to cancel out all the highs. But it's the badge which defines you as far as the medical profession is concerned. However inaccurate it is, it's still considered the 'gold standard' indicator. I wanted not only to have better control (which I do) but to have a pleasingly low A1c to match.
So I am trying (and largely failing) not to get too grumpy about this. To breathe deeply, take one test at a time and be happy with how far I've come in the last 12 months.
You never know... the test is weighted to the most recent 4 weeks or so. I might still have a chance to knock a bit off if I can keep my head during March.
Wednesday, 18 March 2009
Vegetables that help control blood sugar in Type 2 diabetes.
I have found that some vegetables are very helpful to me in my effort to control blood sugar after meals. Conversely, there are some that are very harmful.
The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.
Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.
All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.
The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.
The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.
Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.
All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.
The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.
Tuesday, 17 March 2009
What to do when one strays from the strict plan for controlling blood sugars.
When controlling blood sugar with diet and exercise, willpower plays a strong part. And the willpower has to be applied not just on one day or for a specific period of time. It has to become permanent. One is not on a "diet" plan when trying to manage Type 2 diabetes without medication. One is on a "lifelong" course.
For me, use of willpower to do my daily exercise is much more manageable than applying willpower to resist eating desserts or food items that are not allowed.
I can do my workouts anywhere anytime. Whether I am traveling on business or enjoying a vacation in a tropical paradise, I will find time and create the opportunity to get in some walking time, tread milling and lifting weights. It does not appear like it is a chore to me. So I have that base covered.
Ever since I have had my glucose readings and my A1C in the normal range I have felt good. But over time, I have become a little more relaxed in my restrictions related to sweet dishes and how much of a particular dessert I consume at one time.
This can be dangerous. Fortunately, I have been through these types of situations enough times that now I have a pretty set way of dealing with the deviation. In other words, i have a system for getting back to good control when I have fallen off the wagon.
Luckily, this happens generally for no more than 1 or 2 meals. And that also around the holiday time. Here's my process for course correction.
First, after every meal in which I know I have eaten more carbs or higher glycemic index food, I always check my blood sugar multiple times until the "clearing" takes place. If the peak is high, like 147 for example, I get concerned. So first step is to get a wee bit scared. And the fear comes from looking at a high reading. And that happens from an established habit of checking blood sugar frequently. I am quite data-driven so that also helps.
Second step is a follow-on from the first one. Fear from the high reading puts me in a fighting mood. Combat status to quell the rising glucose blood sugar number and get back to normal as quickly as possible. I take action the next day right from breakfast. I watch what I eat and do my exercise attentively. And I test. Blood sugar returns to my usual levels. Leads to relief and satisfaction. Good feelings to have.
For me, use of willpower to do my daily exercise is much more manageable than applying willpower to resist eating desserts or food items that are not allowed.
I can do my workouts anywhere anytime. Whether I am traveling on business or enjoying a vacation in a tropical paradise, I will find time and create the opportunity to get in some walking time, tread milling and lifting weights. It does not appear like it is a chore to me. So I have that base covered.
Ever since I have had my glucose readings and my A1C in the normal range I have felt good. But over time, I have become a little more relaxed in my restrictions related to sweet dishes and how much of a particular dessert I consume at one time.
This can be dangerous. Fortunately, I have been through these types of situations enough times that now I have a pretty set way of dealing with the deviation. In other words, i have a system for getting back to good control when I have fallen off the wagon.
Luckily, this happens generally for no more than 1 or 2 meals. And that also around the holiday time. Here's my process for course correction.
First, after every meal in which I know I have eaten more carbs or higher glycemic index food, I always check my blood sugar multiple times until the "clearing" takes place. If the peak is high, like 147 for example, I get concerned. So first step is to get a wee bit scared. And the fear comes from looking at a high reading. And that happens from an established habit of checking blood sugar frequently. I am quite data-driven so that also helps.
Second step is a follow-on from the first one. Fear from the high reading puts me in a fighting mood. Combat status to quell the rising glucose blood sugar number and get back to normal as quickly as possible. I take action the next day right from breakfast. I watch what I eat and do my exercise attentively. And I test. Blood sugar returns to my usual levels. Leads to relief and satisfaction. Good feelings to have.
Monday, 16 March 2009
Blood sugar after exercise ............reply to reader's comment.
Adnan's second question was about blood sugar after exercise. Some people say that their blood sugar rises immediately after exercise. And then there are others who claim that their glucose level actually drops after exercise.
In my own case, I have experienced both. Let me explain.
When I go for a walk for 30 minutes - the brisk, arm moving, spring in the step kind of walk - and come back and check my blood sugar, it invariably is in the 90s. I have not tested the effect of shorter walks because in my opinion, those walks do not provide much exercise.
After a vigorous 30 minute treadmill workout, my blood sugar tends to also be in the 90s. And then it may slip back to the high 80s.
The only time I have seen an increase is after lifting weights. There is definitely something about a workout involving muscle action that stresses specific muscles to the point of no return. Meaning I just could not do one more rep if my life depended on it. Which is how muscle building exercises tend to be....they work you to exhaustion. The glucose meter definitely shows an increase after such a workout for me. But not by much and not for long. Maybe in the low 100s and then within half an hour, it comes back to the 80-90 mark.
I am sure everyone sees a glucose response to exercise that is unique unto themselves.
In my own case, I have experienced both. Let me explain.
When I go for a walk for 30 minutes - the brisk, arm moving, spring in the step kind of walk - and come back and check my blood sugar, it invariably is in the 90s. I have not tested the effect of shorter walks because in my opinion, those walks do not provide much exercise.
After a vigorous 30 minute treadmill workout, my blood sugar tends to also be in the 90s. And then it may slip back to the high 80s.
The only time I have seen an increase is after lifting weights. There is definitely something about a workout involving muscle action that stresses specific muscles to the point of no return. Meaning I just could not do one more rep if my life depended on it. Which is how muscle building exercises tend to be....they work you to exhaustion. The glucose meter definitely shows an increase after such a workout for me. But not by much and not for long. Maybe in the low 100s and then within half an hour, it comes back to the 80-90 mark.
I am sure everyone sees a glucose response to exercise that is unique unto themselves.
Sunday, 15 March 2009
Blood sugar upon awakening ......reply to reader's comment
Adnan from Phoenix raised a great question.
About testing blood sugar first thing in the morning. And the answer is yes, absolutely. No matter where I am, I make it a point to do so. In fact, I can't recall even one single day since diagnosis when I might have missed testing my fasting blood glucose.
I have done it both ways. I test the blood sugar after waking up and then after I get ready just before breakfast. Most days the time lapse between these two readings is about an hour. Both readings are fasting sugar numbers. I have not found any significant pattern between the two readings. In other words, the second reading is not consistently higher or lower than the first reading. Actually, most of the time, they are pretty close, within plus or minus 10 mg/dl.
Sometimes I double-check my readings with a second meter. This morning my blood glucose was 74 taken at 10 AM. It was a late night last night. I was watching a movie, Linewatch on Bluray disc. Good movie.
In Adnan's case, a reading consistently between 102 and 110 is interesting in that there is so little variability from day to day. Each reading can vary by at leas 5 per cent on the basis of differences in strips and because of the inherent tolerance in the accuracy of the meter itself.
There is also this thing called the "dawn phenomenon" which increases the fasting glucose number in some people to 30-40 mg/dl more than the bedtime reading in spite of the fact that these people may not have had anything to eat after going to bed. Apparently it is caused by an overactive liver that dumps a lot of glucose into the bloodstream in the morning to prepare body for the day's activities.
And then there is the matter of late night snack. I always have something at about 10 30 PM. The snack definitely contributes to the fasting reading but here again, the effect differs widely. Some can control the snack related increase by having a protein-based snack whereas in other people, it doesn't matter what kind of snack they have - it always raises the reading.
So far I have been lucky in not having a noticeable "dawn effect" and being able to snack without causing a big increase in my morning blood glucose. I am keeping my fingers crossed.
About testing blood sugar first thing in the morning. And the answer is yes, absolutely. No matter where I am, I make it a point to do so. In fact, I can't recall even one single day since diagnosis when I might have missed testing my fasting blood glucose.
I have done it both ways. I test the blood sugar after waking up and then after I get ready just before breakfast. Most days the time lapse between these two readings is about an hour. Both readings are fasting sugar numbers. I have not found any significant pattern between the two readings. In other words, the second reading is not consistently higher or lower than the first reading. Actually, most of the time, they are pretty close, within plus or minus 10 mg/dl.
Sometimes I double-check my readings with a second meter. This morning my blood glucose was 74 taken at 10 AM. It was a late night last night. I was watching a movie, Linewatch on Bluray disc. Good movie.
In Adnan's case, a reading consistently between 102 and 110 is interesting in that there is so little variability from day to day. Each reading can vary by at leas 5 per cent on the basis of differences in strips and because of the inherent tolerance in the accuracy of the meter itself.
There is also this thing called the "dawn phenomenon" which increases the fasting glucose number in some people to 30-40 mg/dl more than the bedtime reading in spite of the fact that these people may not have had anything to eat after going to bed. Apparently it is caused by an overactive liver that dumps a lot of glucose into the bloodstream in the morning to prepare body for the day's activities.
And then there is the matter of late night snack. I always have something at about 10 30 PM. The snack definitely contributes to the fasting reading but here again, the effect differs widely. Some can control the snack related increase by having a protein-based snack whereas in other people, it doesn't matter what kind of snack they have - it always raises the reading.
So far I have been lucky in not having a noticeable "dawn effect" and being able to snack without causing a big increase in my morning blood glucose. I am keeping my fingers crossed.
Saturday, 14 March 2009
The second part of optimal post-meal blood sugar.
Controlling the peak of post-meal blood sugar is the first part of my goal. And that is to keep the peak below 140 mg/dl. Just like in the case of non-diabetics. Big question then is: how does one determine the peak?
Here is how I figured out the peak. Medical literature states that post-meal blood sugar in Type 2 diabetics peak somewhere in between the first and second hour after the meal. So that is a good starting point. Over many meals I collected sugar readings at the 1 hour, 1.5 hours, 2 hours and 2.5 hours after the first bite. Another key point is to count the time from the first bite not when the meal is finished.
Based on those many post-meal measurements, I found that in my case 1.5 hours after the first bite is when the peak occurs. For me, this is quite consistent. So whenever I have a meal whose carb content I am unsure of, I will test the post-meal blood sugar at 1, 1,5 and 2 hour points to determine the peak. Generally, a single reading at the 90 minute mark gives me an excellent measure of my peak. And this is the number I try to keep below 140. This is the first part.
The second part has to do with when the blood sugar returns to the pre-meal level. This is the hard part. Non-diabetics go back to their pre-meal levels within 2 hours of their first bite. For a Type 2 controlling with diet and exercise, this 2-hour goal can be quite challenging. There is even debate about the 2 hour normalizing observation. Some diabetes doctors I have spoken with consider a 3 to 3.5 hour clearing time.
Also the 2-hour clearing goal is difficult for Type 2s because of the delayed insulin response from the pancreas. Which is why we have this condition in the first place.
Normally, the pancreas releases insulin in response to food in two phases. Phase 1 insulin response is based on how much insulin the pancreas already has stored and Phase 2 response has to do with what it needs to make to handle the food load it faces.
For me, I have set my goal as follows: I must reach my pre-meal blood sugar within 3 hours or sooner. And that number has been consistently below 95 with my present diet and exercise routines.
Here is how I figured out the peak. Medical literature states that post-meal blood sugar in Type 2 diabetics peak somewhere in between the first and second hour after the meal. So that is a good starting point. Over many meals I collected sugar readings at the 1 hour, 1.5 hours, 2 hours and 2.5 hours after the first bite. Another key point is to count the time from the first bite not when the meal is finished.
Based on those many post-meal measurements, I found that in my case 1.5 hours after the first bite is when the peak occurs. For me, this is quite consistent. So whenever I have a meal whose carb content I am unsure of, I will test the post-meal blood sugar at 1, 1,5 and 2 hour points to determine the peak. Generally, a single reading at the 90 minute mark gives me an excellent measure of my peak. And this is the number I try to keep below 140. This is the first part.
The second part has to do with when the blood sugar returns to the pre-meal level. This is the hard part. Non-diabetics go back to their pre-meal levels within 2 hours of their first bite. For a Type 2 controlling with diet and exercise, this 2-hour goal can be quite challenging. There is even debate about the 2 hour normalizing observation. Some diabetes doctors I have spoken with consider a 3 to 3.5 hour clearing time.
Also the 2-hour clearing goal is difficult for Type 2s because of the delayed insulin response from the pancreas. Which is why we have this condition in the first place.
Normally, the pancreas releases insulin in response to food in two phases. Phase 1 insulin response is based on how much insulin the pancreas already has stored and Phase 2 response has to do with what it needs to make to handle the food load it faces.
For me, I have set my goal as follows: I must reach my pre-meal blood sugar within 3 hours or sooner. And that number has been consistently below 95 with my present diet and exercise routines.
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