How To: “Eat to Meter”

This section contains the core information on which your future health depends. It covers the essential points about monitoring your blood sugars whether you are an insulin user or not.

The more normal your blood sugars are through the day and night and during and after meals the better able you are to prevent or delay complications.

“Eat to meter” is a shortened way to say that you eat whatever you like, whenever you like AS LONG AS YOUR BLOOD SUGARS STAY WITHIN THE NORMAL RANGE.

This is perfectly easy if you don’t have metabolic syndrome or diabetes but causes considerable difficulty for people with glucose metabolism problems.

Many diabetologists genuinely believe that diabetics cannot realistically acheive normal blood sugars. They hope that the best they can do is to monitor your inevitable decline in health that high blood sugars produce long term and sort out the worst of your complications with drugs, lasers and surgery.

There is no doubt that achieving normal blood sugars most of the time requires a lot of personal education, self experimentation, time and effort. Whether this is worth it or not is a decision that is only your own. It is after all your eyes, kidneys, feet and heart that are at risk.

Unfortunately the NHS and many other international health care systems do not currently provide an available, affordable and appropriate educational package to help you achieve normal blood sugars.  Helping you get the degree of control you want is the purpose of this site. It is essential that you become an expert in your own type of diabetes and its management. This site has lots of ideas, book and internet based resources to help you. Joining a diabetes forum like the “Bernies” can be a good way to get specific answers to your questions, get emotional support and encouragement and even make friends.

Before you start to change your diet or other management it is essential that you consult a doctor or diabetic specialist nurse so that any changes can be done in a planned, step wise and consistent way that will not have an adverse effect on your overall health. People on oral hypoglycaemic drugs and particularly insulin are likely to see a dramatic reduction in their dosage requirements and any change of diet will require close supervision and blood sugar monitoring so that dangerous and potentially fatal low blood sugars do not occur.

Normal fasting and between meal blood sugars for a fit young adult are 4.7. Blood sugars should not usually go below 4.0 even if a fit young person has not been eating or has been exercising vigorously.  A healthy young person can expect to have a hbaic of less than 5.0 although the laboratory range takes the older and not so fit or slim population into consideration and often gives an upper limit of 6.0.

Pancreatic beta cells start to die off at blood sugar levels of only 6.1 and irreversible damage to nerve cells starts at sugar levels of 7.8.  The blood sugar levels we therefore recommend that you aim for are therefore:

Fasting or before a meal assuming 3 spaced meals a day:

Ideal:  4.7
Type Ones  5.0
or at least below 6.1

One hour after your meal has been finished  a maximum blood sugar of 7.8

Two hours after your meal has been finished a maximum blood sugar of 6.5

In order to achieve these most people will have to go on a pretty strict low carb diet. As well as this you will need to understand about how other physiological events and exercise affect your blood sugars.   Remember that you are making long term decisions about your health every time you eat. Very tight control may not be for everyone. Have a look at the next section which is applicable to type ones as well to decide what you are aiming for.

This section is summarised from Gary Schiener’s excellent book for insulin users, “Think Like a Pancreas.” and “Pumping Insulin” by John Walsh and Ruth Roberts.

Extremely tight control
Ideal for pregnant women or women who are planning a pregnancy. This reduces maternal and baby complications to almost non diabetic levels. In the USA some centres put these women on insulin pumps 9 months prior to a planned conception to help acheive this. Their blood sugar targets are much lower than in the UK. The use of continuous blood glucose monitoring devices are used to detect night time lows and warn of pump failure. A diet with no more than 40% calories from carbohydrate (which is still quite high) is given and high glycaemic foods are banned.

Hbaic target 4.8%
Premeals and bedtime 3.6-5.2
one hour after starting to eat 7.2
2am-6am 3.6-5.2

If these targets are not met the high or low blood sugars can cause damage to the mother and baby. A pregnancy may be lost. These targets are aimed to mimic what goes on in a non diabetic pregnancy and the closer to target the less risk their is of damage.  If permanent damage from high blood sugars can manifest itself and be crudely countable in the form of miscarriages, foetal deformity and birth complications after 9 months, what do you think goes on in your body over say ten years or more?

Unfortunately the  will and infrastructure is not geared in the UK to offer this sort of support to pregnant women yet and in the USA it remains very expensive.

The plus point is that if you are willing to reduce your dietary carbohydrate sufficiently it is certainly possible to meet these targets and with less hypoglycaemia risk whether you are a type one or type two, male or female, pregnant or not, youthful or not so youthful.

Tight Control
For older children. They are going to have diabetes for a long time.
For those in honeymoon. This phase can be prolonged with tight control.
Experienced insulin pumpers. You have the technology to achieve this.
Low carbers. You will find it easier than most to achieve this.

hbaic is 5-6%
premeal target range 3.3-7.8
one hour post meal range less than 8.9
specific premeal target 5.6

The majority of the Bernies achieve this level of control according to a recent poll. Of course some are at normal “non diabetic” blood sugar levels and others are much higher but working their way down gradually.

Typical Control
Ideal for drivers who wish to avoid hypoglycaemia.
Most adults.
New insulin pump users.
Whenever you are switching to a new insulin or delivery method.

hbaic range 6-7%
premeal target range 3.9-8.9
one hour post meal target less than 10
specific premeal target 6.7

These blood levels would have most diabetologists and endocrinologists cartwheeling down their hospital corridors with glee. These levels are great to get to when you have been struggling so hard with a high carb/low fat diet on insulin or perhaps are quite insulin resistant.  Please be aware however that you will be delaying rather than preventing complications at these levels.  I don’t want to take the wind out of anyone’s sails but when you have been low carbing for a while it does get progressively easier to hit these targets. If this is you do you think you could go a little lower?

Looser control
Ideal for babies and toddlers and young children whose food intake and activity is unpredictable. Youngsters also tend to me more mentally affected by recurrent or severe hypoglycaemia.

Adolescents may have great trouble keeping their levels other than this because of the great hormonal changes that are occurring. Control will become easier in your twenties so just do the best you can do.

Older diabetics and particularly those who live alone. Because diabetic complications develop slowly over several to many years you may be able to be more relaxed.

hbaic range 7-8%
premeal target 4.4-10
post one hour target 11
specific premeal target 7.8

To get good control you need to have the appropriate tools and help from your medical support team.  You will need to test your blood sugars quite frequently and you will need to know something about carbohydrate counting.

Good records help a lot because you can see patterns in your control. Frequent high or low blood sugars at certain times of the day indicate that a change may be needed.

It is always best to sort out any low blood sugar problems first before you try to sort out the highs.  Sort out baseline blood sugars before dealing with meal issues. Sort out problems that occur early in the day before tackling the problems that are going on later.  More detailed advice on how to do this for insulin users is given in the type one section.

Keeping your diabetes in control is what enables you to enjoy your life and fulfil your other obligations. People who are consistent with their diet, avoiding unnecessary or frequent snacks tend to achieve much better blood sugar control.

Because you and your and the doctor will be making decisions based on your blood sugar levels you can improve accuracy by:

1. Washing and drying your hands.

2. Apply a sufficient amount of blood to the test strip (apply a sufficient amount of blood to the test strip at the first go–don’t “milk” the blood spot as this gives artificially high blood sugar readings).

3. Code your meter accurately.

4. Keep your meter with you or perhaps have one on your person and one in the house or car.

5. Have a regular checking system so you don’t run out of batteries, strips or lancets.

6. Record your findings at the time or before you go to bed for the night.

7. Remember your record book when you visit the medical team.

8. Do averages of several readings at the same times of the day to look for patterns in control. Between 3 to 14 days works well for many people depending on how stable your diabetes is and how many changes around exercise, meals and medications you are making.

9. Patterns may vary with shift work, work or weekends, monthy cycles, weather conditions and seasons.

10. Consider computer based logs that can produce graphs and charts to make this more visual and interesting.

Quite long Quiz:
1. Who is responsible for your diabetes management?
a I am responsible for my own diabetes management.
b The Consultant Diabetologist or Endocrinologist is responsible.
c The Diabetes Nurse.
d My family.

2. Three of these body parts are affected by long term high blood sugars. Which one is not?
a Heart.
b Eyes.
c Cartilage.
d Feet.

3. Damage to nerves starts at a blood sugar over which level? (The first number given is the UK, Canada and Australia measurements in mmol/l and the US figure follows. The US figure is the UK figure x 18)
a 4/72
b 8/144
c 12/216
d 16/88

4. What foods cause a rapidly high blood sugar level?
a Starch such as bread and potatoes.
b Meat such as fish and burgers.
c Vegetables such as cauliflower and broccoli.
d Fat such as butter and cheese.

5. Your hbaic test is …
a A test of whether you are anemic or not.
b A test of your blood sugar over the last week.
c A test of your blood sugar over the last 2-3 months.
d A test of your blood sugar over the last year.

6. A normal blood sugar after fasting and between meals is…
a 15/270
b 10/180
c 4.7/85
d 2.5/45

7. A normal blood sugar two hours after meals is…
a 20/360
b 10/180
c 8/144
d 6/108

8. Your blood sugar is starting to be too low when it is..
a 1.9/35
b 2.9/52
c 3.9/70
d 4.9/88

9. A normal hbaic for a healthy non diabetic person is..
a 7.5%
b 6.5%
c 5.5%
d 4.5%

Have you got it?
1. For most people taking this course the answer will be ME. If you are a child or have special needs eg visual problems you may need to rely more on your family.

2. Cartilage is not affected by high blood sugars but other tissues certainly are.

3. Levels of 8/144 or over are toxic to neurones. This is a frightening ly low level but did you know that pancreatic beta cells are affected adversely by levels of just 6.1/110 or over?

4. Starchy foods release sugar quickly. Mashed potatoes for instance release glucose faster than the table sugar some people put in their coffee. Not you of course!

5. The hbaic test reflects the past 2-3 months blood sugars with a stronger emphasis in the last two weeks. High blood sugar spikes affect it more than low blood sugar dips.

6. 4.7/85 is normal for healthy young people. This is why it is advisable for diabetics to aim for 4.7/85. Insulin users need to aim slightly higher at 5.0/90 to give a margin of error in order to avoid hypoglycaemia.

7. D 6/108 and this can be lower for fit young folk. Many diabetic organisations give much higher targets ranging between 7.8/140 and 10/180. Gary Scheiner has found that 9 out of 10 USA kids had higher blood sugars than this when tested one hour after finishing their meals. These target levels may be considered as good as you can get for those on high carbohydrate diets but are not a reflection of what goes on in non diabetic healthy people. Normal blood sugars for diabetics is the aim of Dr Bernstein’s programme.

8. 3.9/70 is getting too low. Below this you could be starting to be impaired for such things as driving. Most drivers wouldn’t realise they were impaired even at much lower sugar levels than this!

9. A normal hbaic for a healthy young non diabetic person is 4.5%

Reference Info:

Where to go Next?
The next section is quite intensive too. If you need to take a break now. When you are ready please move onto the How To: Count Carbohydrates section.