What metric to watch?

CHF and diabetic here:
1. I have been using Freestyle Libre for past 2 years; it has made a big difference in my approach to diet and food intake. I guess any CGM is better than noting to make progress with your A1C and blood sugar control, in general.
2. For me, first priority would be to focus on Avg. Blood Glucose and Fasting BG. Once they are in better control, you should see a difference for Avg. Blood Glucose and Highest Point. A1C of 13 is way too high. Try to get to 7 - 8 as soon as possible. Then, make every effort to get under 7; 6 - 5.80 will be preferable but will take time and effort to achieve it.
3. Fruits - Not all of them are equal; check which ones have less impact on your Blood Sugar numbers. Always good to include them in your diet. You did not mention vegetables but I assume you are aware that for diabetics, it is essential to strike a balance between veggies, fruits and proteins. Talking about proteins, check your heart health seriously, even if you do not have any issues so far. By taking good care of it now, you will avoid bigger problems in the future.

Your A1C of 13 is very high. Are you taking metformin or anything?

Try following the Glycemic Index of Foods (web search) and try and stay with low or middle range foods.

Good luck!

@freyarmr

I have been eating mostly just protein and vegetables. If I eat 100% that way then my blood sugar stays pretty stable. But if I add fruit or legumes, it’s another story. Today I had a plum with my lunch and my blood sugar went up 45 points and didn’t go all the way back to where it had been before it was time for dinner. It was still under 180, so it won’t impact my time in range score, so I don’t know how much to worry about that.

I do know that 13 is really bad. One of the top endocrinologists in my city let me jump her year long waiting list because I had the highest score! I always wanted to win something for having the highest score and now I did! Anyway, when I went she said they if they projected an A1C based on my most recent 14 days of Stelo data I would have a 7.2 so I am figuring it out. But I still have a lot of questions.

As for meds I have a prescription for Ozempic but it took a while to get approval and then a while because the pharmacy was out of it. I am out of town so I will start when I get back.

Hi; I managed my 28-yr t2 the first 24 years with small portions/well-balanced diet and a lot of exercise (mostly brisk walking after/between meals). A1cs around 6, after being diagnosed age 55 with 350 blood glucose.
So I'd say: eat small, healthy portions and exercise, exercise, exercise. I used my fasting numbers to adjust my exercise and the fuel.

A really good book to get, actually a couple of good books, are those written by Dr. Bernstein , Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. That is one of his books. He is a diabetic and does know his stuff in my opinion. His books are really good reads for someone wanting to lower their blood sugar,

@anonymom3 Since GLP-1 slows metabolism and decreases insulin resistance it will reduce the magnitude of the spikes that you now see eating a plum. The GLP-1 needs to be titrated so it will take 1-3 months to get to an effective dose without major side effects. The .25mg dose just gets you use to the medication. Will need to go to .5mg (and maybe up to 1mg) to get glycemic control. A1c is most important and if it is really 7.2 the GLP-1 should take it down to below 6 once you get to the proper dose. It will also lower fasting glucose.

A second med may be required if your actual A1c is closer to 13 vs <8. Did your doctor mention SGLT2s? These act immediately (no titration) by allowing glucose to pass through the kidneys into urine. Most are expensive but Farxiga (Dapagliflozin) just went generic and is now available for less than $50 for 90 days.

Hi! Let me see if I have this straight, because it sounds like your story is much like mine. Pretty much out of the blue you were in for a checkup and blood panel and they said, "Hey your A1C is crazy!" But they sent you home, got you the Stelo continuous glucose monitor (CGM), and now it projects your A1C at 7.2! That's remarkable.

(in my case with a similar A1C they told me to rush over to the ER, admitted me for a weekend of observation and insulin, and to make a long story short, over 90 days and various med I got my A1C down under 6, and now I just maintain with diet, exercise, and metformin)

They didn't even get you some metformin to start immediately? That would probably get your readings down well under 7.0. And, did they mention exercise? Do you get any exercise? A nice one-mile walk, a couple of times a day, can work wonders. I mean even a full point off your A1C.

So yes, there's a learning curve as you learn to count carbs, and get your eating habit slowly adjusted. It's really not complicated - just eat modest portions, avoid the worst stuff as often as you can, and you'll be fine.

If there's one number to watch I'd say it's the average glucose.

Are you really also using a fingerstick when you have a CGM?

I’m sorry your A1C of 13 “won you a prize” of getting to the front of the line to see endocrinologist! 😲😳

My endocrinologist recommends watching the metric of Target Range. I have Dexcom G7 and my In Range Target is 70-180.

Second metric to watch is the spikes. Sounds like your Stelo has alerted you to which foods cause dramatic increases in your blood sugar level. Yes, fruits are good, but I agree with a previous respondent who stated that “not all fruits are equal”.

Yes it is anxiety causing to spend a lot of time looking at all these metrics AND being aware of everything you put in your mouth AND how much time to put into exercising. I don’t wish diabetes on anyone! It can be a full time job!

That being said, it sounds like you’re on the right path to bringing your A1C down. Keep eating those veggies and protein, but limit portion size per meal 👍. I encourage you to google why it’s best for diabetics to eat smaller meals several times a day versus large meals 3 times a day.

My highest A1C was 14. My lowest has been 6.5. I’ve been diabetic for 21 years and used a CGM for the past 7 years. It was only when I got the CGM that I finally felt more control of this mysterious disease. Because of the CGM I know what foods AND amounts of food spike my blood sugar.

For example: bananas are my highest spike and even half of a banana is too high. An apple spikes high, but half of an apple is within target range (below 180).

That’s my experience. Your body may respond differently. I encourage you to watch how certain fruits and other foods spike your blood sugar and then adjust the amounts to half a serving and gauge if that food spikes.

My endocrinologist recommended pairing fruit with a protein. For example: have a few peach slices with cottage cheese. You can Google why this is a good recommendation.

Another tool in my personal tool belt is the Carb Manager app on my phone. It’s free, but you can also pay for upgrades to premium versions. It asks you questions: height, weight, activity level, maintain or lose weight, or build muscle, etc.

After this questionnaire it will give you your daily goal macros = carbs, fat, protein and calories.
Mine are 67 grams carbs + 60 grams fat + 135 grams protein + 1348 calories. I’ve lost 25 pounds in 4 months using this app along with riding my outdoor recumbent bike.

Full disclosure - the daily protein goal of 135 grams is very difficult for me to reach, but I feel it’s worth striving for. I won’t go into detail of exactly what foods I’ve found to keep me under 67 carbs per day, unless someone is truly interested in trying the Carb Manager app.

You also mentioned you would be starting Ozempic soon. Please let us know your experience with this drug. I was on Ozempic for the past 7 years and recently my new endocrinologist switched me to Mounjaro. I won’t go into the reasons why, unless someone out there is interested.

Bottom line: you can do this! It will take time, but don’t give up! There are those of us who have been diabetic for many years and we are cheering for you and would love to see you succeed!

@carbcounter

It’s interesting because it seems like our beginnings were the same, but the response of the medical professionals were different. I had the blood test at urgent care and they called me back the next day and said “your A1C is 13.6 you should go see an endocrinologist.” No sense of it being an emergency. I googled and google convinced me it kinda was, so I looked around and found an endocrinologist, who was a couple hours away but had an appointment the next day. She tested me and it was 13 in her office, and she said “you have diabetes, you should eat better and exercise and come back in 3 months for another A1C.” I asked about medication and she said I could if I really wanted to, I mentioned that I was concerned about my weight too and she picked Ozempic. But none of it seemed urgent.

But Google said it was urgent, so I read a bunch of things and started exercising and got the Stelo. I also found an online dietician who was a great cheerleader but didn’t have a clue about diabetes.

But that didn’t seem right so I went looking for a local endocrinologist who saw me this week, and a dietician who is a CDCES who saw me this week too.

I have been exercising a lot. I have a job where I walk a lot, and I have been walking on my days off. My average since diagnosis has been about 9K. I have been trying to work out twice a day. I have been the treadmill on an incline, the elliptical, swimming, and doing tai chi and stength videos. Interestingly, my numbers are better if I exercise before I eat, instead of after, which is good because that’s easier for my schedule.

Anyway, because it’s only been a month they haven’t rerun the A1C but the endo said that my current stats would be 7.1 or 7.2 if they stayed there for 3 months.

@carbcounter

Should I not be doing finger sticks when I have the cgm? My first endo told me “get a meter and test once a day in the morning”, and so I have been doing that.

My finger sticks have been weird, I have had 3 or 4 times recently where the first number was really far from the cgm, (once lower twice higher) and I immediately retested and it was much closer. I don’t know what that’s about.