Newbie post - unexplained prediabetes. - Diabetes Research...

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Newbie post - unexplained prediabetes.

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For over two years I have had prediabetic HbA1c test results, creeping upwards from 43mmol/mol in a routine test in May 2018 to 47 at the last test (just before lockdown in March). 48 will indicate diabetes. After the first test result I bought a blood glucose monitor and, whilst, thoroughly researching the subject, immediately put myself on a very low carb diet resulting in a reduction from an already good BMI of 19.5 to 18.3. I have never been overweight, eaten healthily (and in addition I followed the 5:2 diet for 4 years prior to the first test) and always fit and active through both cardiac and resistance exercise. I have a sympathetic GP who, having consulted our local endocrinologist, offered a CT scan of the pancreas in December which showed no problems. I would really like to know what the cause is of the prediabetes, since it is clearly atypical, and would like to have a fasting insulin test to work out whether the problem is insulin resistance or glucose intolerance but the endo says there are no appropriate tests he can do without further symptoms and the GP has her hands tied with nothing further she can suggest. I received an invitation from my surgery to join the NHS diabetes prevention programme but declined explaining that I was already doing everything the programme could suggest. With lockdown and all the NHS restrictions in place, I don't feel I can ask for a further blood test at the moment and it seems unlikely that I will see the same GP again. Nor do I feel there is actually any interest from the medics to do anything other than to 'watch and wait', presumably for diabetes or something more specific to finally kick in so they know what they're dealing with. I've read endless studies and papers about age related beta cell reduction (I'm 70) and how beta cells can be regenerated and have tried various tweaks to my diet and exercise programme but the only thing I've found that shows a significant but temporary improvement in my finger prick tests is exercising half an hour or so after a meal which blunts the postprandial spike. Nevertheless, my fasting BG (which should be under 5.5 to be normal) is almost always in the 6s, sometimes the 5s but never the 4s. Very, very occasionally (about 6 times in 2 years) I have been astonished to have a reading during the day in the 4s which I could never justify on the basis of anything I had done.

Do I just have to accept that there is nothing further I can do and wait for what seems an inevitable decline into diabetes, which I really want to avoid?

14 Replies
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I was diagnosed type 2 and immediately put on gliclazide. I have PMR so take steroids long term which makes your sugars spike. 6 months after my hba1c went to 39 so I was taken off the gliclazide and now control it with diet and exercise. I am not sure how you eat but I have cut my carbs down and this is helping to keep my hba1c down with the last 2 over the last year being 35 now. I walk at least 10,000 steps a day and the low carb high fat diet helps a lot.

Good luck

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Hidden in reply to Koalajane

Thanks very much for your reply. I am already on a very low carb diet and take a lot of exercise but it hasn't changed my blood test results for the better which is why it is so frustrating!

Activity2004
Activity2004Administrator

Hi and welcome to the group, Hidden. :-) Thank you for introducing yourself to everyone. Please feel free to continue posting and commenting, asking questions, take a look at the Topics/Events/Pinned Posts/Polls sections for some ideas/suggestions. Also, continue to meet the group members. We will be happy to try and answer all your questions to the best of our abilities.

Has your doctor given you any medication? Insulin? Said anything about changing your diet?

What do you usually have for your breakfast/lunch/dinner/snacks?

Sometimes, when people are stressed out, the blood sugars can go higher/lower than normal.

Hidden
Hidden in reply to Activity2004

Hi, and thanks for your interest. I am not on any medication as I am not yet categorised as diabetic. The GP has not advised on diet but knows I am on a very low carb diet with no starchy or sugary foods at all (no bread, rice. pasta or potatoes, except small amounts of sweet potato) and omitting the higher carb root veg and fruits. I stick to either animal or veg protein, especially nuts, with vegetables, and eat eggs and other dairy. If I want to sweeten anything e.g. rhubarb, I use xylitol and if I bake, I use recipes with almond flour and xylitol. I have tried reducing meat and dairy foods to try a more plant-based diet for a period of time but seen no difference from a low carb diet that includes those foods. I don't have many snacks but when I do I have nuts or a 12.5g piece of 85% chocolate which, according to the wrapper is about 2.3g carb. I'm aware of the issues around stress and blood sugar but haven't had a cortisol test and don't think it is the cause of this now fairly long-term state . All the research I have done leads me to believe it is caused by a reduction in beta cell production but there seems little that will ameliorate that.

Activity2004
Activity2004Administrator in reply to Hidden

How have you been feeling lately? Sometimes, if a person has a cold or flu/infection, the blood sugars go up and down, too. If you weren't feeling well or had an infection when you had the A1c done, then that may explain the higher result at the time of the test.

Hidden
Hidden in reply to Activity2004

I've felt fine all the way through with no ill health at all. If I hadn't had the tests every three months for the past two years showing blood glucose levels gradually rising, I would never have known there was anything amiss.

Activity2004
Activity2004Administrator in reply to Hidden

Have you tried a new lab?

Hidden
Hidden in reply to Activity2004

I don't have that option in the UK under the NHS system unless I choose to be referred to (and pay) a private consultant and I'm not convinced that it would necessarily be advantageous at the moment.

Activity2004
Activity2004Administrator in reply to Hidden

Okay. See what the new number is after you get the next blood drawing done and if it doesn't match with what you have been doing, you may want to see if the doctor's office can do the test themselves.

Hidden
Hidden in reply to Activity2004

My own daily figures can't really give an indication as to what the HbA1c will be over 3 months and I have full faith in the test results that I am getting. The fact is that my condition is atypical and there doesn't seem to be a way of getting to the bottom of the reason for it without, perhaps, going privately and spending a lot of money trying to find out. I'm hoping to come across someone who has had a similar experience but so far have drawn a blank. Many thanks for all your efforts to help though.

"Do I just have to accept that there is nothing further I can do and wait for what seems an inevitable decline into diabetes, which I really want to avoid?" No, is the short answer.

It depends how meticulously you govern both protein and carbohydrate. The important aspects are that you reduce the demand for insulin, and don't put more glucose back into your body than you take out of your glycogen.

What most people find hard is that not only was the advice they've been given wrong, but it's often completely opposite to what our body is designed to eat. Namely, for this to be a lifestyle change, get most of your energy from natural fat, 3:2 monounsaturated to saturated.

Definitely don't eat little and often, don't remove the fat from meat/protein, and don't choose lower-fat dairy because all of those increase the demand for insulin.

Assume you are insulin-resistant, because that underpins type 2, and most of the developed world is.

God bless you!

One question that comes to mind is why would your blood glucose spike after eating if it were truly very low carb, unless you're having too much protein? How much protein and carbohydrate do you actually eat?

Hidden
Hidden in reply to StillConcerned

Well, precisely, something I would like to know too. And why my fasting BG level was 6.7mmol/mol at 8.30 this morning more than 12 hours after eating yet 5.8 yesterday in the same circumstances. It is completely unpredictable day by day and meal by meal. By 'spike' I mean the highest BG point after a meal which for me is about 40-60 mins and can be between 9.0 and 11. I can bring it down from there by 2-3 mmol/mol by exercising for about 10 mins at that point (not always very convenient). I usually manage to get down to the recommended level of under 7.8 two hours after a meal, even without exercising, though I recently had a 2 hr reading of 8.3 after having a breakfast of just one boiled egg and a coffee with whole milk. I generally only count macros occasionally now, having done so obsessively for over a year but am on a LCHF diet (<50g carb) and confident I'm not overdosing on protein. Anyway, I did a count yesterday and it came to 45g carbs, 80g protein, 110g fat which equates to 1493kcal of which 12% carbs, 21% protein and 67% fat. Sometimes the carbs are lower and the fat higher but protein mostly about the same.

My husband has the same meals as me plus some carbs i.e. rice, pasta or potatoes, and if we compare BG levels afterwards always has a much lower reading than me. I am convinced that this is not a diet issue. After all, why, two years ago when I was eating a 'normal' diet with the usual carbs, though not excessively, was my HBA1c level lower than it is now after all this carb reduction yet I am now on the brink of tipping into a diagnosis of diabetes? Everything I read about prediabetes is about weight reduction but I have moved from 120lb to 114 lb and can't afford to lose any more. I do have a mild thyroid insufficiency medicated with a low dose of thyroxine and the GP says there can be a connection between different metabolic conditions.

I have read study after study and can only conclude that my unpredictable readings are the result of an intermittent malfunction in the insulin-producing beta cells causing the insulin to work in fits and starts. There are scientific studies addressing this but little on how it can be mitigated. It's all very frustrating. Thank you, though, for reading this and for your support.

StillConcerned
StillConcerned in reply to Hidden

I can answer the bit about why your HbA1c was normal two years ago. it's because high amounts of insulin were keeping it there, which is just as bad, if not worse than high blood glucose.

Similarly, you've done well by measuring the peak of your blood glucose rather than the convention. Now you need to employ a bit of nouse. Normal fasting blood glucose levels are where your body functions best. Going higher demands more insulin, which is what causes your blood glucose to fall again.

Is it possible that you're underestimating how much carbohydrate you're having? Not counting the small amounts in veg or seeds for instance? Are you counting what's in your drinks for example? diabetes.org.uk/resources-s... Carbs are in most things of course, and even small amounts add up. Although eating should be fun, if you think of the mechanics, the function of carbohydrate is to prevent glycogen becoming exhausted. If your glycogen isn't becoming depleted, causing you to 'hit the wall' then you have enough on board; you don't need anymore, especially if it's causing your blood glucose to go high.

No, that's not a massive amount of protein, but it is 60% more than the reference intake (RI).

As for weight reduction, well that follows conventional thinking again. It's quite possible to be producing too much insulin, leading to insulin-resistance and harmful VLDL on the inside without it showing as subcutaneous fat on the outside.

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