Friday, April 17, 2009

Test, Test, Test

The best advice I received from any source, professional or otherwise, since I was diagnosed with type 2 diabetes was written by a lady named Jennifer. I first met her in cyber-space posting on the alt.support.diabetes usenet group where she regularly greeted newly diagnosed people with the advice I repeat below. It appeared as Jennifer's Information for the Newly Diagnosed on the a.s.d. home page and has now been repeated on many other web-sites. Some years ago she graciously gave me permission to spread it far and wide. I have been doing that ever since by providing a link to that a.s.d page.

The web-master made some improvements to the site which I just noticed today so I will be revising the link wherever it appears in earlier blog posts. It occurred to me that this may happen again, so I have decided to repeat Jennifer's original advice here in full so that it will always be available for me to reference.

Jennifer's Information for the Newly Diagnosed

"Sounds like you're planning a move to take control of your diabetes... good for you.

There is so much to absorb... you don't have to rush into anything. Begin by using your best weapon in this war, your meter. You won't keel over today, you have time to experiment, test, learn, test and figure out just how your body and this disease are getting along. The most important thing you can do to learn about yourself and diabetes is test test test.

The single biggest question a diabetic has to answer is: What do I eat?

Unfortunately, the answer is pretty confusing. What confounds us all is the fact that different diabetics can get great results on wildly different food plans. Some of us here achieve great blood glucose control eating a high complex carbohydrate diet. Others find that anything over 75 - 100g of carbs a day is too much. Still others are somewhere in between.

At the beginning all of us felt frustrated. We wanted to be handed THE way to eat, to ensure our continued health. But we all learned that there is no one way. Each of us had to find our own path, using the experience of those that went before, but still having to discover for ourselves how OUR bodies and this disease were coexisting. Ask questions, but remember each of us discovered on our own what works best for us. You can use our experiences as jumping off points, but eventually you'll work up a successful plan that is yours alone.

What you are looking to discover is how different foods affect you. As I'm sure you've read, carbohydrates (sugars, wheat, rice... the things our Grandmas called "starches") raise blood sugars the most rapidly. Protein and fat do raise them, but not as high and much more slowly... so if you're a T2, generally the insulin your body still makes may take care of the rise.

You might want to try some experiments.

First: Eat whatever you've been currently eating... but write it all down.

Test yourself at the following times:

Upon waking (fasting)
1 hour after each meal
2 hours after each meal
At bedtime


That means 8 x each day. What you will discover by this is how long after a meal your highest reading comes... and how fast you return to "normal". Also, you may see that a meal that included bread, fruit or other carbs gives you a higher reading.

Then for the next few days, try to curb your carbs. Eliminate breads, cereals, rice, beans, any wheat products, potato, corn, fruit... get all your carbs from veggies. Test at the same schedule above.

If you try this for a few days, you may find some pretty good readings. It's worth a few days to discover. Eventually you can slowly add back carbs until you see them affecting your meter. The thing about this disease... though we share much in common and we need to follow certain guidelines... in the end, each of our bodies dictate our treatment and our success.

The closer we get to non-diabetic numbers, the greater chance we have of avoiding horrible complications. The key here is AIM... I know that everyone is at a different point in their disease... and it is progressive. But, if we aim for the best numbers and do our best, we give ourselves the best shot at heath we've got. That's all we can do.

Here's my opinion on what numbers to aim for, they are non-diabetic numbers.

Fasting............................Under 110
One hour after meals.......under 140
Two hours after meals.....under 120


or for those in the mmol parts of the world:

Fasting............................Under 6
One hour after meals......Under 8
Two hours after meals....Under 6.5


Recent studies have indicated that the most important numbers are your "after meal" numbers. They may be the most indicative of future complications, especially heart problems.

Listen to your doctor, but you are the leader of your diabetic care team. While his /her advice is learned, it is not absolute. You will end up knowing much more about your body and how it's handling diabetes than your doctor will. Your meter is your best weapon.

Just remember, we're not in a race or a competition with anyone but ourselves... Play around with your food plan... TEST TEST TEST. Learn what foods cause spikes, what foods cause cravings... Use your body as a science experiment.

You'll read about a lot of different ways people use to control their diabetes... Many are diametrically opposed. After awhile you'll learn that there is no one size fits all around here. Take some time to experiment and you'll soon discover the plan that works for you.

Best of luck!
Jennifer"

As an engineer, when I read that, it made sense immediately. So simple, yet so powerful. And it has certainly worked for me. Thanks again Jennifer.

Post-script. I've been musing on Jenny's comment below and decided to add this.

I used Jennifer's wonderful advice to gain control of my numbers fairly quickly. Once I understood it I did not mess about and I used a lot of test strips in those early days. I fairly rapidly achieved the goals she set and I realised that I could do better. At the time, despite their poor advice on carbs and goals the ADA recommended something that stuck in my mind "Keeping your blood sugar (glucose) as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes." That sounded logical to me so eventually I changed Jennifer's goals for myself to my present ones of:

Fasting............................Under 100
One hour after meals.......under 126
Two hours after meals.....under 100

or for those in the mmol parts of the world:
Fasting...........................Under 5.5
One hour after meals......Under 7.0
Two hours after meals....Under 5.5

Cheers, Alan
Everything in Moderation - Except Laughter.

14 comments:

Jenny said...

Alan,

Jennifer's advice is the single most powerful piece of information available for people with diabetes.

My one concern is that this version has an outdated definition for "normal" fasting blood sugar. Even the ultraconservative ADA now considers 100 mg/dl or 5.6 mmol/L to be the top of the normal range. So under 100 (5.6) is a much better target.

Based on the research, true fasting normal is in the mid-80s, (4.7 mmol/L) so the difference here is significant.

Alan said...

Hello Jenny

Lovely to hear from you. Of course, I agree with you. But rather than amend her writing, which I am loath to do, I think that leaving your comment here as an up-date is better.

I think the advice is still very relevant for a newly diagnosed person. However, as control is achieved targets should be re-adjusted. Once I achieved those goals I re-set mine, in mmol/l terms, to tighter targets of <7(126) at my post-prandial peak and <5.5(100) fasting. I know you aim much tighter yourself.

For newly diagnosed people I think Jennifer's targets are still good ones that are achievable reasonably quickly. I don't want people to feel the targets are too difficult to attain.

Once they achieve those, going that extra step will be much easier.

Cheers, Alan

Jenny said...

So, my husband has just been diagnosed with diabetes. He has been a terrible eater his whole life (all carbs, red meat, and cheese). On a positive note, he is an avid exerciser, and is not overweight. We have only tested BG to times, both mornings. Both times were 200-212! Yikes! He has cut just about all carbs out of his diet, but he wants his number to drop NOW. In your opinion, how long should it take to see the number drop even a little?

Alan said...

G'day Jenny. Obviously not the same Jenny as the first comment:-)

You wrote: "He has been a terrible eater his whole life (all carbs, red meat, and cheese)"

We see things differently. I have no problems with red meat and cheese in moderation, so I don't see that as terrible eating.

Then: "On a positive note, he is an avid exerciser, and is not overweight. We have only tested BG to times, both mornings. Both times were 200-212! Yikes!"

Great that he exercises and that he isn't overweight. As a separate issue, has he been tested to be sure he is type 2? Lots of T2s are normal weight at diagnosis, but it is wise to be sure of his type.

Testing only in the mornings before breakfast will achieve little more than scaring him and you. Start testing to find his peak after meals and use that time in the way Jennifer suggests, to review his menu.

"He has cut just about all carbs out of his diet, but he wants his number to drop NOW. In your opinion, how long should it take to see the number drop even a little?"

Every time I ask a person with numbers like his to list their daily menu when they claim to have cut out all carbs I find there are still significant carbs, usually at breakfast. For the next 24 hours, get him to record every morsel he eats and test as Jennifer suggests. See what patterns appear and adjust accordingly.

No-one can predict the speed of improvement, but if he is definitely a T2 he should see progress within a few days of following that technique. If not, he should be seeing the doc again. He may need a review of medications or of his type.

Anonymous said...

Wow,
This is all great information, I've been diagnosed with Pre diabetes almost 10 months ago. M ( 45) I started testing myself for the first few months and was so frustrated with the variations of BCL that I set the meter aside. I had no way of judging the impact of my diet, exercise to my BCL.
I have seen my BCL drop down to normal levels, and hope this method of checking 1 & 2 hours past the meal will point me in the right direction. I have concerns with my fasting level. It always runs 120-130 in thw AM, even when it may have been below 100 at bedtime. Why the heck is that? any thoughts???

Scott

Alan said...

Hello Scott.

"I have concerns with my fasting level. It always runs 120-130 in thw AM, even when it may have been below 100 at bedtime. Why the heck is that? any thoughts???"

Read this page, and the links on it to "Dawn Phenomenon". I hope it helps.

"I Ate Nothing! Why Are My BGs high?"
http://loraldiabetes.blogspot.com/2009/02/i-ate-nothing-why-are-my-bgs-high.html

Barbara said...

Alan I am a new type 2, scared to eat anything..lol and so glad to have found you!! Everything I eat seems wrong for me.
I have high b/p,high cholestrol, and on meds these as well as for thyroid. My thyroid is "acting" up, and med dosage is increased.
If I try a low fat, or low sodium diet,that seems to me to go against what I need to eat for type 2..??.. My BG Monitoring system was just handed to me with NO instruction, and I am a coward in using it..lol from childhood, there has been a memory of some BAD finger sticks for me..the teck kept sticking my finger repeatedly!! freaks me out!!
I know you are not a Dr, but you have experience in this, and that is what counts.. what can I eat?
I feel alone and drowning...any help will me MUCH needed and apreiciated. Thank you

Alan said...

Hello Barbara

I wrote a page which gives links that answer most of your questions called "Getting Started". You will find it on the sidebar on the left; click on that and you will find links to other pages.

Probably the first two to start you off are:
Painless Pricks
http://loraldiabetes.blogspot.com/2006/10/painless-pricks.html
and
What to Eat at First
http://loraldiabetes.blogspot.com/2008/05/what-to-eat-until-you-get-your-meter.html

Come back after you have read those if you have more questions.

Best wishes, Alan

wildman2 said...

Alan you have been an inspiration for me and thank you for this test test test I will try to give it a shot and see what I come up with.

Loopy said...

I am going to diagnosed as a Type 2 Diabetic very soon. this has been the one piece of advice that has really made my heart feel better. This and a Gastric Bypass :)

Susan said...

I hope I didn't miss this information somewhere else on this blog. I am currently taking only victoza, which for reasons I don't understand controls my blood sugar better than the metformin my doctor originally prescribed. If I employ this testing technique while on victoza will it still be an accurate indicator of what food my body does better with and which foods I should avoid? Or would the victoza skew the results?

Alan said...

My signature on the web is “Everything in Moderation - Except Laughter”.

It is especially important to use moderation if you change your dietary habits while taking diabetes medications. The test, test, test technique will work but your results will automatically reflect the medications you take.

For example, if you use insulin or an insulin-stimulating medication, sudden changes from too many carbohydrates to too few can lead to changing your blood glucose levels from too high to too low. That is very unwise and can be dangerous. For that reason if you are taking insulin or insulin-stimulating medications you should proceed cautiously after discussing this method with your doctor. Test after eating and if the result is high review the meal. Make a small change to the menu at the next meal of the same type. Repeat the process at that meal and continue with small changes, without risking hypos, until you see good numbers.

Similar caution should be used with any diabetes medication, although the others are less likely to lead to dangerous lows.

If you reach a stage where you feel your medication needs to be adjusted because of improvement in your blood glucose levels, discuss your medications with your doctor.

Anonymous said...

I am happy to find this blog. I was diagnosed with t2 in 2007 and struggled emotionally with the loss of favorite foods, but have had 5.9 HA1C for 4 years. I use the test, test, test concept on new foods and meals or when there are unusual circumstances. I was never given the check after 1 hour goals you mention, but I was given the 2 hour goal of 140. Still the eating adjustments I made worked. I exercise three times a day and everything is fine....except emotionally, I still get stressed over all the possible negative things that can happen and I miss enjoying food...eating out.

Terrence Flendersen said...

I am happy to find this blog. I was diagnosed with t2 in 2007 and struggled emotionally with the loss of favorite foods, but have had 5.9 HA1C for 4 years. I use the test, test, test concept on new foods and meals or when there are unusual circumstances. I was never given the check after 1 hour goals you mention, but I was given the 2 hour goal of 140. Still the eating adjustments I made worked. I exercise three times a day and everything is fine....except emotionally, I still get stressed over all the possible negative things that can happen and I miss enjoying food...eating out. diabetic supplies park ridge