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Friday, October 27, 2006

Test, Review, Adjust

When I was first diagnosed, the doc told me to "lose 8% of my body weight" (117Kg, 257lbs at that time) and test my blood glucose before breakfast and before the evening meal. My HbA1c was 8.2%. 8% of 117Kg was 9.4Kg or a little over 20lbs.

So, I did that after designing my own way of doing it using my Weight Loss Cooking and Eating Plan and decided to just keep going after I passed the 8%. In the initial plan I tried to follow the diet guidelines on the pamphlets from Diabetes Australia (DA) - which are much the same as those from the American Diabetes Association (ADA) but I also included tricks and tips from many past diets. The final version is now significantly different.

My A1c only dropped to 7.5% despite losing the weight, so during that period I decided to attend a dietician’s presentation at the local support group meeting. Later, in another post I’ll chat more about dieticians, DA and the ADA. To put it briefly – the high-carbohydrate low-fat guidelines were a disaster for me.

There are interminable arguments these days about "low-fat" versus "low-carb". To be honest - I'm not interested in those definitions. What I was looking for is the "low-BG spike, excellent nutrition" menu that suited Alan. As to the "low-BG spike, excellent nutrition" menu that will suit you - you'll have to test to find your own. Here's how I did that.

I found misc.health.diabetes on usenet and eventually I was directed to Jennifer’s famous Test, Test, Test advice. I’ve also provided a link on the side-bar. Jennifer is not a doctor either – just another type 2 diabetic. But that advice works. And it’s free.

I started following her advice and the results, in a very short time, were quite dramatic. My fasting blood glucose and A1c started going down, my after-eating (post-prandial) numbers dropped rapidly, the occasions when I suffered "lows" with the shakes and nausea a couple of hours after meals disappeared, and my weight loss re-commenced after being stalled for a few weeks.

Take the time, right now, to read it and print it out. Then come on back.

One of the reasons it works so well is that it allows us to discover what works for us as individuals – and what doesn’t. Over time I modified that advice to suit myself. Eventually I had tested often enough at one-hour and two-hours after meals to know the peak blood glucose (BG) spike timing. Once I knew that, I found I only needed to test at the peak unless the number was too high and needed a further check an hour later.

I tested a lot in those first few weeks, but the high volume of testing reduced quickly as I learned and results became predictable. If the thought of a lot of testing worries you, see how to test without pain in my post on Painless Pricks

These days I still test more than most diabetics – but nothing like those early fact-finding days. Then, as I cut or reduced the "danger foods" I reviewed the resulting menu regularly to see if I was missing anything important; over time I added, and tested, lots of new things – especially vegetables and fish – as a result. More on that in a later post.

I added some supplements, but very few. I only add a supplement if I cannot find a way to meet the need from my menu. Thus, I added Psyllium husk for fibre and calcium to compensate for a drop in dairy consumption.

To summarise, it’s as simple as this:

Start with whatever you eat now.

Eat, then test after eating at your spike time and if BG’s are too high then review what you ate and change the menu next time. Then do that again, and again, and again until what you eat doesn’t spike you. You will get some surprises, particularly at breakfast time. The so-called "heart-healthy" Breakfasts are NOT for most type 2's. Similarly, you will find variations through the day - the same thing will have different effects at breakfast, lunch, dinner and supper. But I can't say how they will affect others - only how it affected me - which is why we all need to test ourselves.

As you gradually improve your blood glucose levels, review the resulting way of eating to ensure adequate nutrition, fibre etc are included and adjust accordingly.

Then test again.

Test, review, adjust, always towards better and better blood glucose levels.

And no - you won't have to test so intensively for the rest of your life. As time goes on and you build your knowledge you won't need to test as often because many of your results will become predictable as your numbers improve. You will be building your own personal Glycemic Load database. As that happens you can reduce the intensive testing to "maintenance" levels. I still do two or three fasting tests and several one-hour post-prandial tests randomly each week. Just to be sure that things aren't changing. I may do a few more if I am adding a new dish to the menu or trying a new restaurant. But I no longer need to test after every meal or snack.

Finally – add at least 30 minutes of exercise to your day – but that’s another post.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter


jolindaTX said...

Alan, Thanks. I have just found out I have diabetes. My A1C was 10.
I have been reading your blog. It has helped me a lot. I did not realize that cereal and 2% milk was not helpful. I will be changing my breakfast, thanks to you.

Anonymous said...

Interesting post, amazing ideas. Keep writing!

Shana H. Neely said...

Thank you, Alan! I appreciate your note and advice as I try to help my Dad stay healthy!
Shana :-)

Mary said...

Mary from the ADA board here. Very good information. Thank you.

Mary said...

Thanks Alan. Mary for ADA board

Lisa said...

I was just diagnosed last week, I too have an A1C level of 10.1. I appreciate your post, I'm starting now today to do what you said and see what works. Went to Dr. and was told to start meds immediately, but to not return for 3 mo., think I'll turn to specialist.

Lisa said...

I was just diagnosed last week, I too have an A1C level of 10.1. I appreciate your post, I'm starting now today to do what you said and see what works. Went to Dr. and was told to start meds immediately, but to not return for 3 mo., think I'll turn to specialist.

My Left Foot said...

Thank you for your information and helpful attitude for people like me who are lost in this new world of diabetic confusion. Although the doctor has told me I am not a diabetic, he said I am pre-diabetic and need to get it under control now.

Wow...I was scared that my A1c began at 5.9, then to 6.0 and now is 5.8 and some people here are at 10.1 and you were an 11!

I have only been on the Metformin for 5 days now. Not sure if this is helping me yet due to the fact that I read it takes a month or more to fully take effect.

Thanks again

Alan said...

G'day Lefty :)

Nice to meet you. Just for accuracy my A1c was 8.2% at diagnosis.

The metformin may take some time. Your dietary changes are more likely to be effective at this early stage.

Cheers, Alan

Teresa B. said...

Almost everyone in my family is diabetic except me, but I was diagnosed as "prediabetic". My Mom's doctor says you are either diabetic or you aren't. He says there is no "pre".
I'm is confused!
MY doctor hasn't told me anything about changing my diet to testing. What now?

Anonymous said...

I'm now not sure where you are getting your info, but good topic. I needs to spend a while studying more or understanding more. Thanks for magnificent info I used to be searching for this information for my mission.
My weblog :: www.diabeteswarrior.net

Anonymous said...

Sir, your blog is exactly what I needed to find. I have been tearing my hair out over trying to figure out what the "good foods" are, sorting through the conflicting advice, and wishing for clear, simple instructions (I'm an engineer, too).

'Test, test, test' is something I can do. Sounds like I need to get myself a meter!

Anonymous said...

This makes so much sense to me. Eat, test, and then adjust what I eat based upon the test results. I am glad I came here to find some help and information.

Anonymous said...

Thank you.I have been doing exactly the same thing for the past 10 or 15 years.i have been successful and do not check my BG regularly.My meals are perhaps a little bland but I do fine.

Daniel Hodge said...

I've been type II for about 15 years & generally done ok with a1c between 6.3 to 6.6 but recently it rocketed to 7.1 and I literally lost control of my bg. Went on essentially a carb starvation which brought my numbers down and seemed to reset my system. I discovered that I didn't need nearly as many carbs as experts recommend and finally cut out all conventional starches like cereal, bread, pasta and rice. Pretty much protein, vegetables & legumes. It's only been two weeks but my numbers are always good & I stopped using Metformin entirely. Bottom line is I wish I'd known about this 15 years ago.

Jan said...

Thanks for the info. Will be reading regularly and catching up with what I've missed. I thought I wasn't diabetic. Total denial. My highest reading was 8.8 after some canned corned beef so I'm thinking I'm an idiot! 5.2 is my best reading but that's when I'm 'being good' on Atkins. Ditto x

Barbara said...

Allan, I have been on and off your blog for years now, and have a couple of questions -- I'm still technically Pre-diabetic, but I think I need more aggressive care, and am going to ask my doctor to start me on Metformin. What can I expect? Does it really take months for results? are the side effects really terrible?

Alan said...

Barbara, why do you believe you need more aggressive care? Is it A1c, FBG, post-prandials or complications?

I can't say what to expect because we are all a bit different. I had no problems but I was already under good control and limiting carbs. A minority have severe gastro effects, some have them to a lesser degree and over half have no problems at all. If you add the med I suggest you discuss ramping up with your doctor, beginning with a low dose (1x500mg) and adding 500mg weekly if you do not have problems until you reach the effective dose precribed by the doctor.

Similarly I cannot say how long it may take to see improvements in blood glucose levels.

Barbara said...

Hi Alan,
My fasting glucose has been too high each morning -- about 120, and I can't seem to get it lower. During the day, after eating it's around 140 to 160. Last check my A1C was 5.8, but that was 6 months ago. I'm trying to lose a few pounds before the doctor again.
I'm thinking that since Metformin is a safe drug, why not start? there was a Harvard study a few years ago that suggested every pre diabetic start on it, since virtually everyone will eventually proceed to full blown diabetes. That study always stayed with me.
I really appreciate your slow going with dosage. I'll write that down when I see my doctor next.
As to my other question regarding how to get that high glucose down, so there's no silver bullet? If I see a 180 an hour after a meal, there's no remedy is there, short of insulin?

Alan said...

Barbara, slowly rising fasting numbers are the same reason I started on metformin after three years just on diet and exercise. Your 140-160 post-prandial numbers are a bit high for my liking despite your good A1c. I suggest a review of the carb portions in the meals leading to those numbers.

Barbara said...

Thanks Alan -- I DO need to control portions a bit better, and I've gained some weight. Really depressing.

Anonymous said...

Yes the side effects were bad enough for me to just STOP taking it! Bad bloating GAS pain diarrhea. CONSTANT FEELING UNCOMFORTABLE. I NO LONGER EAT more than 20 carbs per day and my BG readings are never over 140 1 and 2 hours after meals. I personally feel pharmaceutical companies give doctors kick backs for prescribing their drugs and that's WHY doctors don't tell you the bad side effects nor do they tell you it can be controlled with what you eat and exercise. Metformin also causes vitamin b12 deficiencies

Barbara said...

Alan, you no doubt know this, but I was reading American Scientific this month and saw their main article about surgery for Diabetes. It is now assumed that the small intestine has more to do with insulin resistance than previously thought. Those who have bypass surgery are almost completely cured of type 2 diabetes without controlling diet or losing any weight yet -- often as soon as two weeks after the surgery and they remain free of the disease for years. For those of us who don't qualify for major surgery, there are now new procedures that involve a sleeve in the intestines to close off the duodenum -- this apparently is all that's needed to influence the GI tract downstream and most of the mechanisms of glucose control. This sleeve already exists and has been approved for use in Europe and South America. There are other noninvasive procedures coming down the road soon too. Analysts figure it can save us millions of dollars in treatment. I don't think big Pharma likes it at all, but I'm going to keep watch on this. It's the best news I've heard in a long time. Tell me what you know about the subject.

Alan said...

Barbara, I do not know enough about the topic to comment properly, apart from noting I am very wary of surgery as a 'cure' and very aware of the risks involved. Personally, I will continue to do what I do. I may become more interested when those other noninvasive procedures reach their destination on the road they are coming down.

Barbara said...

Yes, of course. We'll all be watching for those more noninvasive procedures. What's so interesting, however, is the new information regarding what actually causes diabetes.

Anonymous said...

Hi Alan, I wanted to gain some perspective from someone that has done a lot of research.

Over the last 5-7 years I have kept an eye on my fasting glucose and A1C levels for no other reason than being a bit of a hypochondriac. The numbers don't seems to have an upward tendency, but have always fluctuated between 90-96 fasting and 5.2 - 5.6. I have a great diet (with tons of vegetables) and exercise a lot (I am currently 133 pounds and 5'9).

I keep thinking I need to modify my diet further, but everyone tells me I'm over-reacting. By modify further I mean exchanging some fruits with vegetables, because I LOVE fruits. I also need to increase my sleep and its quality (hard to do with children) and relax more. I seem to be edgy or anxious most of the time.

What would you say is a proper range for someone in their mid thirties, a solid diet, and an active lifestyle. I would think 80 - 90 and 4.8 - 5.2, but then again everyone is different.

So confused...

Quintessa said...

I was at 11.9 in August 2017. Don't remember what it was when diagnosed in 2001...

Anonymous said...

Hi Alan,

Thank you so much for the wealth of information on your blog. I have a family history of diabetes, last year my A1C was 5.2 this year it shot up to 5.7 with a fasting BG of 104. I am 33 year old, with a BMI of 23 (so normal weight), but I am not very active and my food mainly consisted of carbs and eating out (so very bad nutrition).

I have started with your advice (I already bought a meter) and will be changing my diet to minimize spikes. I have few questions for you if you don't mind:

1- My fasting BG is now hovering around 101 but I'm not sure how to bring it lower. Any advice?

2- I saw the target values you have for yourself, but is there optimal numbers I can target? Having a maximum is good, but having an ideal will allow me to tweak my diet a bit better.

3- I can in theory have many (8+, every 2 hours) small meals throughout the day and maintain a low BG level. If I do that, insulin would be always be produced in my system. Alternatively, I can have 3 or 4 larger meals, setup in a way that doesn't raise my BG too much. In this case I would be giving my pancreas a break and not producing insulin all day long. (I'm theorizing here!) Which one is a better approach?

4- How do you define a spike? if I eat a breakfast that spikes BG to 140, I'm sure if I eat half of that same breakfast, the spike will be much less, no? So is a spike related to the size of the meal? This question is really related to the previous question.

5- Would a diet that continuously reduces the spikes and BG level lead to an improvement of the disease (i.e. fasting BG < 90, A1C < 5.7)? or once I achieve my ideal diet/exercise plan the numbers I would get would be the best I can hope for going forward since the disease is progressive? I'm asking since I am still 33 yo and having diabetes at this young age is really terrifying me.

Alan said...

Kam, I would be very happy with a fasting BG of 101. My optimal numbers are as close to non-diabetic as is reasonably possible without stress. I aim to be under 8(~140) at all times, preferably a little lower for most peaks and avoid going lower than 4(~70). Regarding meals I tend to graze (see http://loraldiabetes.blogspot.com/2008/06/grazing.html) but that suits my lifestyle; the best method is whatever works for you. I define a spike as a swift rise to anything higher than my target of 8(~140). It is not the size of the meal but the size of the carb portions in that meal which affect post-meal blood glucose. Finally, the same carb portions might lead to quite different results for breakfast, lunch and dinner.

Kam said...

Thank you Alan for your response. Another question if you don’t mind. When I calculated the net carbs intake at the end on my day I realized that it’s almost always around 50 to 60g. Then I realized that this is Keto range. I personally wouldn’t want to enter kerosis as not enough studies have been done on its healthiness. Do you have thoughts on the matter?

Alan said...

Kam, I have no problem with using keto in the short term and it certainly works well for many type 2 diabetics. My concern with keto is that I need a way of eating I can follow comfortably for the rest of my life - or at least until the cure is discovered - and I cannot see myself following keto forever.