The A1c Test Gives More Weight to What Your Average Glucose Levels

Three weeks ago and my A1C came back at 7.0 and I was placed on Lantus. I had only been on insulin for two weeks when I had additional lab work at my internal specialist's office. Unbeknownst to me, in addition to a liver function test and fasting lipid test, he also ran an HbA1C which came back at 6.2. I've been watching my numbers closely and can not see where they would have dropped enough that in two weeks my A1C would have gone from 7.0 to 6.2. Why the rapid decrease in such a short amount of time?

I know the A1c test gives more weight to what your average glucose levels have been in the closer-in-to- the-test- date weeks. IOW, when you went on insulin and things started to normalize, those couple of recent weeks swung the result into a surprisingly low number. The only other thing I can think of is that even the most dedicated tester only tests 8 or 10 times a day, probably not at all during the night, for instance. So it's impossible to get a true average from your home meter, not in the way you can with the A1c test. Other than that, I'm clueless, but maybe others will have some other ideas. Whatever, I'm glad to hear you're doing better.

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Glucagon kit [was Re: Sugar Lows-OJ vs. Glucose Tablets]

>A glucagon kit is a syringe pre-loaded with a fluid that gets mixed into a vial of powder, and then injected. It is typically only used in emergencies, and only when a person with diabetes is unconscious or otherwise unable to treat a low blood sugar by eating or drinking. For someone who has passed out because of a low blood sugar, a glucagon kit is the only alternative to an ambulance. A glucagon kit is a prescription item, and they do have expiration dates. Most of us living with diabetes would do well to make sure we have at least one, and to make sure it has not expired.<

If all you take is metformin, you probably won't ever go so low as to find yourself unconscious and immersed in an emergency. But if you take hypoglycemics and/or insulin, yes, a Glucagon kit is a darned good idea. This is a prescription item (my local pharmacy always has to order me one, so I imagine most folks don't know about it or think they need it), and the expiration date is usually only about a year out, so that needs to be watched. Remember, though, that it's no good having it around if those who sleep with you and spend time with you (coworkers included) don't know you have the kit, where it's kept, or how and when to use it, so you'd have to study up on it yourself and then clue in everyone else.

Your doc will probably pooh-pooh at you and tell you you don't need it, but if you have more than a couple lows a month, especially during the night, IMO it'd be a good idea. It is ONLY used in the case of unconsciousness- - if you can still swallow, it's better to go the OJ, milk, soda route. I hear Glucagon makes you throw up, but of course, better throwing up than dead....

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Glucose Tablets for lows

>Still doesn't seem like enough to combat double-digit reactions.<

One of the problems of treating lows is the "danger" of over-treating them. There you are, sweating, shaking, messed up vision, befuddled thinking, and your body is screaming at you to 'eat something, eat something now, damn it!' It's very easy to sit down and shove 500 calories into your mouth without literally a thought. Sure, that cures the low, but there you are a few minutes later at 200+, and then what?
Using 15 grams of glucose tablets (the ones I buy are 4 gm each, so I'd need to use 4 at a time), chewed up well and washed down with a few ounces of water, will get you out of trouble and stop any kind of free-fall your glucose level might be doing. Then you retest at 15 minutes and repeat if needed. At that point, 99% of the time, you'll be up over 100 again. And isn't that what we want? I sure don't want to roll from 50 to 200 in less than a half hour, because that's going to make me feel even more awful for many hours to come.

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Higher morning BS than evening?

>I recently had a Diabetes Nutrition class in which the question was asked, "Is your FBG higher or lower in the morning?" Everyone but me said, "Lower." I said, "Higher."The Dr. told me that mine is higher because I have a Liver Problem and it is normal for the FBG to be lower.<

I don't know that it could be called a liver problem or abnormal... at least, I've never seen anything that led me to believe dawn phenomenon (that's what this higher-than- expected fasting glucose number is called) results from any kind of liver malfunction. It simply is what it is. One of the functions of the normal, healthy liver is to take some circulating glucose, convert it into glycogen, and store it for when it's needed. Then when the liver senses that you don't have enough glucose moving around to support your body's demands at the moment (it takes a certain amount of glucose to maintain brain and muscle function), it can take some of that glycogen, reconvert it back to glucose, and move it back into the bloodstream. This can happen at any hour of the day or night.

When you don't eat for 10 or 12 hours, many times the liver is just being oh-so-helpful and giving you a little food, that's all. In a non-diabetic, the pancreas would compensate and excrete enough insulin to "cover" that extra excreted glucose, but our pancreases don't get their memos, so in us, up goes our blood glucose level, and tah-dah! Dawn phenomenon. But as I say, it's not a liver problem, not as far as I know. But why this happens in some and not in others is for greater minds than mine to say. But I would definitely put it under that all-purpose YMMV (your mileage may vary) category we like to use around here.

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How do you feel if you having really high blood sugar levels?

Unfortunately for me, I feel great when I am having really high blood sugar levels, such as 225, etc. I wish I did feel bad, but I don't. I actually start getting that shaky feeling in my stomach when I start getting a little under 120. And by the time I am at 100, I am shaky. It's crazy....but I guess we are all different.

This is actually pretty typical and one of the things that makes uncontrolled (undiagnosed or just ignored) diabetes so dangerous-- let's face it, if it hurt, we'd work a lot harder at getting things controlled, wouldn't we. But the pysical symptom-changes involved getting up to those 200+ levels are often so gradual, we just get used to the way it feels, and we don't question it. I was diagnosed twice (long story), and the second time, my diagnosis A1c was 14.7, which equates to about a 430 *average* blood sugar... my god! But I was working full time, taking care of a big house and two teenagers and the husband, and I thought I was doing okay. Sure, I was a little dry-mouthed, thirsty and stuff, but... I already knew I had diabetes and that I'd gained a bunch of weight; I figured I was getting less and less controlled, but I was managing, so... when I finally faced the music and got back into treatment (shocked to find just how far out of control I was), it was more out of guilt (I knew better than continue to do that to myself) than because I felt physically bad.

Diabetes is *dangerous*. Type 2 normally comes on gradually, in stages, and it doesn't usually scream for treatment until it's waaaaaay over the top. Meanwhile, we've gotten used to that sleepy, thirsty, duh-brained feeling, the depression and lackluster way of being, and think it's just us being us. Then when we get into treatment, our body goes into a "WTF is this" kind of reaction for a while, responding with shakiness and protesting that "we *liked* being half asleep, why are you waking us up?" So that we're duped into thinking we were better off before, and getting into control feels awful, so why bother. Truth is, the shakiness of better control goes away pretty quickly if we just keep on keeping on, working at normalizing our blood sugar levels. None of us should be accepting 150-200+ daily averages as our "normal"; nothing could be farther from the truth, and this is dangerous.

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Glucose levels in American

>I have seen several posts with glucose levels in the 100s and up.My glucose meter mesaures in 10s.for me in the morning I should have lower then 7 and after dinner lower then 10 can someone please explaine the difference.Thanks.<

I assume you are not American. In the rest of the world, the meters express results in metric form or something, and ours don't. With a calculator, the numbers are easy to convert:
Take the American number and divide by 18 to get the rest of the world's equivalent.
Take the rest of the world's number and multiply by 18 to get the American equivalent.

American numbers are rounded up or down to the nearest whole number: 108.6 is rounded up to 109; 108.4 is rounded down to 108. The rest of the world's use decimals to the tenths place only, so 5.44 is 5.4, and 5.67 is 5.7.

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Standards Might Rise on Monitors for Diabetics1

This article's focus is the common use by hospitals of glucose monitors meant only for home use-- an indefensible cost-cutting measure, I assume, since home monitors were never meant for such high-volume, accuracy-is- all applications. The article also says that accuracy is most important for insulin-dependent diabetics who are trying to keep their blood sugar levels at normal or even slightly less than normal levels. For them, an accurate meter is invaluable, even life-preserving.

IMO, for the diet and exercise controlled among us, as well as those whose only med is metformin, that 20% margin of error in home testing is not a big issue-- let's face it, the diff between 115 and 92 is not a big deal if someone's not on hypoglycemic meds. For the non-med-takers, the purpose of their testing is to make sure they're staying within a good range of levels and not seeing glucose averages going on an upward trend, for whatever reason(s). What I found surprising were the statistics the article cited about the high incidence of diabetic shock experienced by those who take insulin. It said that insulin takers slip into unconsciousness on an average of one time a year (what?), and that 40% of all insulin takers will suffer seizures or coma at least once in their lifetimes! Wow. Obviously no one should be taking insulin without lots and lots of daily testing, with as accurate a meter as money can buy...read more

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Adrenaline and bs (actually bg)

I wanted to share w/you my experience w/adrenaline and exercise as a type-1 diabetic who was diagnosed @ age 7. As Ted says, adrenaline continues to pump (sometimes hours) throughout the body after exercises. Studies have proven that when a game is played, the team who wins continues high adrenaline levels well after the game, comparatively to the team that looses, who's adrenaline levels peak and end quickly (although still present). Here's an example of my own struggles w/adrenaline and controlling my BS levels. Just on Wednesday evening I was meeting some friends at the park to play basketball. I was high (220 mg/dl) before playing, however I did not give any insulin to correct high BS. An hour and a half later I got home and tested again, my BS was at 330! This was after an hour and a half of rigorous exercise. I gave 5 units of Novolog as a basil had a bowl of soup and tested again before bed. I was down to 211, but still these numbers are much higher than I am used to. So I went to bed around 10:30 PM at 211, but, even at this number I ate a fudge pop (12 cho) and an 8 oz glass of orange juice (24 cho). (I know, I know, orange juice at above 200???) I woke up at 6:45 AM the next morning and my BS was at 66 mg/dl! These were the delayed affects of my exercise, affecting my BS well after the actual exercise.

As a type-1 diabetic who lived through puberty and the raging hormones middle schoolers have I have become well versed in adjusting on the fly. There are some commandments in diabetes-management that we all know (don't eat when high, don't inject when low) but sometimes (especially as a type-1 insulin-dependent) we need to shift or bend the rules to fit our lifestyle. Obviously the 12 year old male has a greater range of hormones pumping through him than the 65 year old male. Regardless of age there are certain adjustments that must be made and the longer you live with the illness (you and your son for that matter) the more you both become aware of which adjustments work and which do not. As was mentioned before, have a bag of tricks some with fast-acting carbs for a low (lifesavers or starbursts) and some long-acting (chocolate or other peanut-butter based snacks for more protein to slow the absorption of the sugar) that the body will take longer to break-down. Just be on top of it, on trips like these don't be afraid to test up to 10-12 times per day, more often than you would normally at home on a "regular" schedule. The last time I was at Disney Land I was 17. I carried around my trusty fannie pack and the embarrassment I felt as a teen with a fannie pack is long-gone. However, the positive experience that I could do Disney World on my own as a self-responsible diabetic is with me to this day. I hope you have a fantastic trip. All the best,

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Liver enzymes were 100 over what they should have been

>Been lurking here. Just diagnosed end of June. Have just been reading and trying to learn. Thank you to everyone here for all of the information you provide. I did post once and thank you for those responses. I've just really been overwhelmed by all of this and trying to figure it all out.<

I'm glad you're here, Dee. We certainly can't guide you in the right direction for all aspects of your care, but sometimes it helps just to know that others are in the same boat, struggling with the same issues,and that if there was light at the end of the tunnel for them, there will be for you, too.

>1st time I ever had blood work in over 14 years was end of May. Liver enzymes were 100 over what they should have been (they told me to fast 10 hrs which I did but I drank til 2am).<

14 years is a long time to go with no blood test screenings, especially as someone gets older, and especially if there's any family history of diabetes, and especially if there's drinking going on. I assume you're talking about drinking alcohol. Alcohol is metabolized by the body as a drug, not as a food, and it can mess up a diabetic's blood sugar levels big time, not to mention damage done on the cellular level throughout the body.

>A1c was 8.6. Now on 1000 mg metformin a day. Levels are up & down & all over the place.<

Good diabetes care thrives on regularity and predictability. Eat at about the same time every day, in roughly the same quantities, and don't binge, even mini-binge. Become a tea-totaler if you can. I have no idea if you're one of them, but some newly diagnosed type 2s do struggle at times with hypo(low)glycemia, especially in response to eating refined sugar-- half a bad of M&Ms, and suddenly it's 45 on the meter, and how in heck did I get here? Whereas maybe next week a half a bag of M&Ms might end up being 245 on the meter. In a case like this, the pancreas is simply wonky; it doesn't get its memos, and seems to have forgotten what it's supposed to do when the person eats high sugar stuff. So do your best to eat whole foods, as unrefined as possible, and forego the sugar and high fructose corn syrup. Also add exercise, roughly in the same amount and at the same time every day; that'll really help. Even a 10 minute walk in the AM and another in the PM will really make a difference. There is a learning curve as you said, Dee, definitely. But you'll reach your goals if you just stay the course.

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Variation of blood suger test

>I am testing my BS (fasting)daily... today it was 118 mg on my left hand middle finger,then i checked the middle finger of my right hand it was 107 mg!!! anybody knows why? is it normal? could the strips or the meter are not working normal? temperature ? 30 C,or 80 F may cause expiration of the strips?<

For home glucose test daily monitoring purposes, 118 and 107 are statistically the same. If the strips are not beyond their expiration date and haven't been exposed to excess heat (direct sunlight or exposure to a heat source in your home or shut up inside a hot car), don't worry about this; nothing's wrong.

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I have a question about diabetes1

My question is, if I continue to do everything right, my blood sugar and A1C should stay good right? I mean they won't go high again unless I start eating things I shouldn't and putting weight back on right? Has anyone here been weened off all medication and are doing good on their own?

Theresa, you have done an amazing job! Congratulations! Will your blood sugar stay where it is? Nobody knows. Diabetes is considered a progressive disease and that's why people work so hard to control it -- to control it now and to slow down the progression. Many things can temporarily affect your blood sugar -- illness, medications, stress, and so on, so don't let a rise upset you. If it fails to come back down, then perhaps a call to the doctor is in order. Bill's blood sugar consistently stays between 90 and 120 -- great numbers. However, sometimes, it's up -- as high as 160, and seemingly for no reason. Of course, there is a reason, it's just not something he can pinpoint. Right now he's battling poison ivy (or something similar). He's on steroids, antibiotics, and benadryl. His numbers aren't soaring, but they are higher than normal. He's also grouchy! I've read about people using meds to stabalize and then using just diet and exercise to control their diabetes. I can see how diet and exercise can control the numbers, but I don't see how it can help resistance issues, but I'm sure there's a great deal I just don't understand. If someone knows, I'd like to hear more. My guess is that without the meds, you will have to work even harder to keep good numbers, but that's a personal choice, and not something I would discourage, just something to keep in mind. And I think age probably matters too. Bill's 59 and was diagnosed last year. At this stage of the game, I don't think he has any interest in trying to battle the disease without drugs. He is ever mindful of the food he eats and tries to exercise most days. Without the meds, he'd be working so much harder, and well... quality of life matters too.

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My BG is Being Strange1

Before I went in for my Cataract Surgery and tested this morning I was at 109. When they got thru with my Surgery and Tested I was over 200. I just tested again and am at like 214. I also just took my Byetta and Humalog and going to eat something light. When they did the first eye 6 weeks ago I was like 160 and then like 175, so maybe this time it is the Stress? But I am home and things went OK. I am going to be home all day and probably sleep some depending on how I feel.

I think having surgery itself causes stress on all the organs and makes bg change sporadically. When I had my gallbladder removed over a year ago, my bg went from 88 when I got up to 195 immediately after surgery and then to 224 an hour later. The nurse told me this was to be expected. By the next morning, mine was back to normal again. Hope this helps you. Glad things went okay for you.

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My BG is Being Strange

Mine is flipped out as well today and I am not wven sure why, it has zoomed up to 345. I have done nothing, I had my normal breakfast, this morning, went and exercised, came home to a cup of coffee, with sugar free creamer and viola I get a reading of 345, I have not seen that number in weeks. Good thing I have a doctor's appointment later I guess.

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Moderation in all things?

I'm not a doctor, nor do I play one on TV, but in my humble opinion, allowing yourself to enjoy your vacation and staying under 150 during that time shouldn't be a concern. Those are still fairly low numbers for many. I used to regularly stay under 140 but as things have progressed, I now run between 110-180 but my A1C is still under 6.5 so my doctor doesn't seem too concerned about the slight elevation in BG readings. Even having cake & ice cream yesterday only raised me to 209 and I was back under 120 when I did my fasting test this AM. Now if I was constantly 180 or higher, I would probably be concerned.

This brings up a question I have been wondering about. I was on vacation this past week, and did not watch my diet as well as I should have. OK let's be honest, I really didn't watch it much at all. I checked my bg levels about 3 times per day and it never was sky-high, but stayed under 150 every time I checked it. Does going "off the wagon" for a week do damage or if you get back on the diabetes plan when you return do you minimize any damage you may have done?

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Caffeine May Interfere With Glucose Control

In the study, published in the August issue of Diabetes Care, researchers looked at the effects of caffeine on glucose and insulin levels in 14 people with type 2 diabetes who regularly drank coffee. None of the participants required insulin therapy as part of their diabetes treatment. The participants were observed on two different mornings after an overnight fast and abstinence from caffeine.

On the observation days, the participants took their prescribed diabetes medications and provided a blood sample 30 minutes later. While still fasting they were then given two 125-milligram capsules of caffeine or a placebo. A cup of coffee contains from 80 milligrams to 175 milligrams of caffeine. A second set of blood tests were then analyzed an hour after the taking the pills. Participants were then fed a liquid meal containing 75 grams of carbohydrates and another 125-milligram caffeine capsule or placebo. Additional blood samples were taken an hour and two hours following the meal.

The study showed that caffeine had little effect on glucose and insulin levels during the fasting period, but it caused significant surges after eating a meal. People who received the 375-milligram dose of caffeine experienced a 21% larger increase in glucose levels and a 48% larger increase in insulin levels compared with those who took the placebo during the two hours following their meals. "It seems that caffeine, by further impairing the metabolism of meals, is something diabetics ought to consider avoiding. Some people already watch their diet and exercise regularly," says Lane. "Avoiding caffeine might be another way to better manage their disease. In fact, it's possible that staying away from caffeine could provide bigger benefits altogether." The researchers say that blood sugars after meals correspond more closely to overall blood glucose control and may more accurately predict heart disease risk.

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Caffeine May Hamper Blood Sugar Control

Caffeine may cause problems with blood sugar control after meals for people with type 2 diabetes, according to a new study. Although more research is needed to confirm these results, researchers say their findings show that people with diabetes who have problems with glucose and insulin control should consider cutting back on caffeine in their diets.

The study showed that after a large dose of caffeine, blood glucose and insulin levels surge in response after meals in people with type 2 diabetes. These patients can have high insulin levels because they inefficiently use the hormone to lower blood glucose.

"In a healthy person, glucose is metabolized within an hour or so after eating. Diabetics, however, do not metabolize glucose as efficiently," says researcher James D. Lane, PhD, associate research professor in the department of psychiatry and behavioral sciences at Duke University, in a news release. "It appears that diabetics who consume caffeine are likely having a harder time regulating their insulin and glucose levels than those who don't take caffeine." "The goal of clinical treatment for diabetes is to keep the person's blood glucose down".

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Does anyone drink Crystal Light and does it make your blood sugar levels go up?

My blood sugar level is close to 120 every morning and it use to be in the 80's. I am wondering if the Crystal LIght is causing that because I just starting drinking that about 2 weeks ago and I wake up with my insides shaking and having to go to the bathroom more and have an incredible thirst most of the time.

I assume you're not drinking two gallons of the stuff every day, just a couple of glasses, right? I don't know if CL has aspartame or Splenda as its sweetner, but either one shouldn't drive your blood sugar up 40 points. Thirst and peeing too much are two classic symptoms of high blood glucose levels.If your fasting blood sugar is 120, it's very possible you're up around 200 after meals (are you testing to see? you should be), so that might explain that. Not sure about the shakiness, but some folks do get shaky from either highs or lows.

Something's changed, for sure, and whether or not it's CL that's responsible for that change or not (I doubt it), you need to find out what's going on. If I were you, I'd discontinue the CL for a week or two, step up the testing (and keep a careful written log of the results so you can see in black and white what's going on), and consult with your doc if you don't see things come back into line.

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Suggestions on Snacks when Glucose Tabs Work Very Well

The glucose tabs work very well and I always carry those when I leave the house and have them all over the house. Check the numbers on the vial/box...to see how many carbs in each tablet. You can then take the number needed to get to the safer bg: if each tab is 4 gms...then 3 tabs will raise bg by 12 points. If starting at 68 you should go to 80. Check at 15 min. If not gluc tabs I have juice on hand: any kind..check the number of carbs per serving: eg: juice mb 16 carbs/8 oz. If you drink 4 oz it might be enough to raise bg to a safer number: 68+8=76 and buy time to get a good meal. Then eat a meal promptly. I find this works well for me, those times. In a *real* emergency put sugar in water and drink that! Live first and then worry about bgs!

The idea is to quickly prevent going lower and lower. Cookies and peanut butter, crackers etc...take too long to get through stomach. If you have time you can eat those...ie: a little low and need time to make a meal. You want to have a plan in place ahead of time so that it can quickly be put into action without much thinking. Mental process deteriorates as the bg drops and it's much more difficult to think clearly. Lows are not pleasant and are not good for the bod so good thing to treat quickly.

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Blood Sugar "Morning-After Pill"? - Nothing mysterious

Nothing mysterious. 120 is just an arbitrary value selected for a maximum. You could use 100, but that is about as low as I like to go due to heart concerns (But I was 84 this morning and that is just fine). My endo uses 120 in his version of the "add" formula for pre-meal adjustment to background BG. My reason for asking about PP numbers is that since I am new to insulin, I just did not have a feel for what could be expected of insulin in the way of PP compliance.

Really, 120 should be your max target. Excursions higher after meals may not be avoidable, but 120 is sort of considered the magic number. I'm not sure that I understand this, Syd. You've mentioned in several messages regarding your insulin use that 120 is your 'target bg' that you correct DOWN to -- are you saying that you not only correct 'down' to 120, but also don't want to go any HIGHER than 120? I'm wondering if that plays into what you were asking the other day about how high you would expect to see a person be elevated PP? Because there is NO way that insulin is able to stop ANY rise in BG from occurring, even if the insulin to carb ratio is set correctly. Personally my correction target is 100, and if I'm higher than 100 I correct down to 100 and add that into my pre-meal dose. If you're starting a meal either AT 120, or higher than 120 and adding insulin to that meal dose to bring your BG DOWN to 120, you're already playing with variables that will result in your being higher than 120 1 and 2 hours post-meal.

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Went up to 152 after dinner: Need help with BG levels

To give a list of best carbs to eat is a problem because it is so individual, especially for Type 2s. But the list of "safe" veggies that Vicki (Whimsy) gives in her newbie letter is pretty universal. You do have to test for yourself. As to cookbooks, I can suggest any one of the low carb cook books by Dana Carpender, which have some awesome recipes. Searching online for "low carb recipes" yields lots of sites, too. However, personally, I avoid making anything with ingredients I cannot readily find at my grocery store.

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