UKH

Blood sugar levels vary hour by hour. So if I go to my GP surgery for a blood test, how can the results be sensibly interpreted? I can remember some years back going for a cholesterol test where I was told to attend first thing in the morning having eaten nothing since previous evening meal. Why doesn’t the same thing apply for blood sugar?

In reply to Rog Wilko:

I've thought the same thing.

I wore a Freestyle Libre monitor (they cost £50) for 2 weeks which gives you 1 minute interval measurements. I wanted to understand how to I react to various foods as I often get pretty bad crashes after a meal.

From my data, I would spike 10 minutes after a meal, and it would be back tonormal less than an hour later. 

So what the GP is checking is your baseline blood sugar level. For me (might be different for you) as long as I haven't eaten within  an hour, it should be my baseline.

In reply to Rog Wilko:

If they're looking for Type 2 diabetes (as they most likely are if this is one of those "health MoT" things) they're probably just looking for it being dangerously high.  A healthy person's doesn't vary that much as the insulin response is quick and effective.

In reply to Rog Wilko:

A fair few years ago now I was asked to do a fasting blood test, so wasn't allowed to eat/drink for 12hrs before. 

In reply to Rog Wilko:

There are a few tests that look at the levels of blood sugar over the preceding weeks - for instance measuring the glycosolation of erythrocytes (red blood cells) - most often used in people and fructosamine (most often used in cats and dogs). As well as this they will look at accompanying markers such as fats in the blood, liver enzymes and the actual blood glucose. They may add a urine analysis, we would for animals. I am surprised there was no food/sweet drink stipulations before your test though. 

More generally, the ZOE study/scheme has shown how blood glucose changes with different foods and circumstances in different ways in different people and given some population data - you could look for information about that. Continuous blood monitoring for diabetes mellitus is becoming normal and has revolutionised treatment success when used well. 

In reply to Jenny C:

Not drinking for 12 hours just seems wrong!

In reply to SouthernSteve:

Alcohol rapidly lowers your blood glucose levels so it's a must I'm afraid.

In reply to montyjohn:

Water doesn't and that is what I took Jenny to mean.  

In reply to montyjohn:

I was informed I was prediabetic a couple of years ago. Should I hit the bottle as a precaution?

In reply to SouthernSteve:

It wasn't fun! Not least because I couldn't get a morning appointment, so was nill by mouth all day.

In reply to Rog Wilko:

No, the main test is not for glucose it is for HbA1c levels 

(https://en.m.wikipedia.org/wiki/Glycated_hemoglobin) This can show if you have had elevated or unmanaged blood glucose it the past even if blood glucose itself is normal at the time you have the test.

"...HbA1c is measured primarily to determine the three-month average blood sugar level and can be used as a diagnostic test for diabetes mellitus and as an assessment test for glycemic control in people with diabetes.[5] The test is limited to a three-month average because the average lifespan of a red blood cell is four months or 120 days..."

Maybe the docs know what they're doing

In reply to Lankyman:

Don't get carried away with a bottle. Just a cheeky shot after every meal should sort you out.

In reply to Neil Williams:

The feedback I received was that I was near the bottom of the “pre-diabetic” range. I think they quoted 42 or 43 (units unknown to me!). Then I got the spiel about watch your consumption of all starchy carbs as well as sugary things. I’m quite willing to make some small adjustments in diet, but that seemed quite OTT. Where does your energy come from without any carbs? What’s left to eat?  I already eat loads of green veg, fruit, nuts, pulses etc.

 I didn’t feel I was getting personalised advice, and surely if I’m bottom of pre diabetic do I really need to completely transform my already healthy diet? I could admittedly cut down a bit on cake and fruit juice, but maybe that’s all I need to do.

In reply to Rog Wilko:

It might also pay to eat your grub in 3 meals, separated by a few hours, if you're a "grazer", as snacking through the day can play about with your blood sugar level, even if the total calories consumed is the same over the day

In reply to Rog Wilko:

You've had an HbA1c level done (units are mmol/mol) which is essentially a measure of your average blood glucose over the preceding few months rather than a single blood glucose measurement. 

Energy comes from all 3 of carbs, fat and protein - it's perfectly possible to live on very low carb diets as people doing keto show. 

Diabetes UK has a summary of prediabetes that may be useful.

https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2/pr...

In reply to Rog Wilko:

It sounds like you've been given far more 'personalised' advice than I got a couple of years ago. I was given a series of weekly zoom sessions where very general advice was dished out by someone reading from notes. Without being too judgemental, a lot of the other attendees looked like they were more at risk than me. I stuck it for a few months then decided to clock off as nothing was particularly aimed at someone who's not overweight or has an inactive lifestyle. I imagine the company that got the gig managed to tick some boxes and fulfilled its remit from the NHS. I haven't changed anything in my diet or lifestyle which, like yours Rog, is a bit different to the general population.

In reply to montyjohn:

Wasn't there some study that showed before a meal was more effective? A bit like the traditional apéritif sort of thinking rather than digestif

In reply to CantClimbTom:

Best to do both then (just to be safe). In fact, since eating seems to be bad for you probably best to cut the meal part out altogether.

In reply to Rog Wilko:

As well as measuring our HbA1c levels, as somebody up above has pointed out, they will also likely be measuring your fasted glucose level. If your fasted glucose level is between 5.5-6.9mmol/l then you are on the verge of becoming T2 diabetic i.e. "pre-diabetic". Essentially alarm bells should be ringing at this point as, although it is now regarded as possible to reverse T2 in a small number of people, it is much more likely / easier to reverse the effects before you get there - that is, in the pre-diabetic stages.  

In reply to Lankyman:

noted

In reply to Andy Hardy:

Thanks, but I don’t snack.

In reply to mik82:

 

Thanks, that’s encouraging.

  
Is that a good idea? Advice I came upon this morning re ideal diet was talking about starchy carbs being an important part of a balanced diet. Can’t seem to find the reference just now. Other people seem to think a wide variety of food is important, rather than cutting out whole areas. 

Thanks for your input.

In reply to mik82:

 

That’s very encouraging. I don’t want to act on doubtful data. I know how unreliable such data can be e.g. BP. 

 

And should I want to do that, if it’s not necessary?

Thanks for your reply.

In reply to Rog Wilko:

https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eight-tips...

Is this all out of date now, then? If I sound a little sceptical it’s because I’m old enough to remember being advised never to exceed three eggs per week.

In reply to GraB:

What is the cause of this 'pre-diabetes'?

I've heard it discussed, but could find nothing about it on the NHS website.

In reply to Rog Wilko:

Sorry about the (more or less) duplicated post above . The second one was actually the first one to be posted, but it went off somewhere and only appeared after a period of time, by which time I thought it had never got posted.

In reply to Rog Wilko:

As others have already answered, bld glucose isn’t used much anymore to diagnose diabetes. 
The HBA1C test is usually better as it gives you a 3 month average and doesn’t need to be in fasting. There are some circumstances where it is less reliable: pregnancy, sickle cell disease and some others. Then you might use fasted bld glucose or the more complicated glucose tolerance test.

For HBA1C, there are a few different units for expressing the result which give either single or double digit results: for the latter 40 or less is normal and 50 or higher is diabetes (with 2 seperate results and no confounding factors as above), which leaves 41-49 as neither one nor other, often called pre-diabetes. An important result as gives the best chance to make lifestyle changes and reverse it.

There are still levels of non-fasting bld glucose that could suggest diabetes, but normally this then needs confirmation by another test. 

In reply to captain paranoia:

Type 2 diabetes tends to be caused by 'insulin resistance', which I think is essentially a lazy pancreas, possibly caused by long term overuse.

A number of studies have shown that you can reverse T2 diabetes through following either a keto or a plant based diet for some weeks (~8 I think?). Then you can go back to a typical balanced diet.

I've found that both the NHS and diabetes UK are very behind the times with their recommendations. As a type 1 diabetic, I have found that being veggie/vegan has been very helpful in lowering my average blood sugars (latest hba1c at 42 mmol/mol). Diabetes specialists and nurses have always treated me with scepticism when I talk about my dietary experiences - so aren't necessarily the best people to follow advice from.

In reply to Rog Wilko:

I eat lots of meat, cream, cheese, yogurt and eggs.  I don't drink alcohol, eat fruit or carbs.  I have been doing this for 5 years and feel good. 

Today, a late breakfast was 500g of Greek yogurt with cream, some cheese and pickled onion at lunch & two large bowls of stew this evening.

In reply to Rog Wilko:

No, not really out of date. But it's also not really relevant to you as you have been advised to reduce your sugar/carb intake due to issues with your insulin sensitivity. A balanced diet is fine for someone with no disease/pathology, but may not be appropriate if you do have something wrong, or beginning to go wrong.

A person with coeliac disease shouldn't eat a balanced diet as they can't process gluten very well. Although the mechanism is different, a diabetic should be more considerate of their sugar intake, and as such probably shouldn't eat a balanced diet in the manner described in your link.

Ultimately you don't have to make any changes if you don't want to, but you're likely just increasing the risk of future complications. If you're OK with that, crack on.

In reply to The Norris:

I am told I can have a retest in 3 months time. I’ve decided to make a few small changes to see if this tips the balance:

cut out my small glass of breakfast fruit juice, the grapes I liked to have on my cereal bowl ( see below), halve my toast and marmalde allowance to about two bites, omit the couple of biscuits I usually have two nights a week at the bridge club, reduce fruit cake to small slice twice a week. Will this make the difference I wonder?
I know breakfast cereals are not recommended but this is my standard breakfast: two level dessert spoons of Grape Nuts, 1 dessert spoon of wheat germ, a splash of unsweetened soya “milk”, a teaspoon of flaxseed oil, two heaped desert spoons of chopped mixed toasted nuts, 200ml of homemade kefir (made with Channel Island milk) squished up with half a pear or about a third of a banana, and a sprinkling of puffed wheat and a few blueberries (no grapes any more). There is no added sugar in either cereal. Apart from a couple of bites of toast and marmalade this is my breakfast. Oh, and coffee no sugar, but a splash of oatmilk. I think this is a nutritious start to me day, apart from being very enjoyable, so I’m very reluctant to change any of it.

In reply to Rog Wilko:

Clearly... you've not drinking the kool aid, from Dave Macleod's nutrition podcasts 🤣🤣