I was recently summoned by my surgery to have a Haemoglobin A1c level blood test for type 2 diabetes, which apparently I had 3 years ago, but do not recollect at all.
The result was that it was 42 mmol/mol (whatever that means?) an increase from 41 in 2018. The standard range for non-diabetic is 20.0 - 41.0, so 42.0 puts me in the Prediabetes range and is cause for concern!
I discussed this result with a Rheumatology nurse, who didn't seem concerned at all, as apparently test results can vary depending on other factors such as time of day blood test was taken etc. I also understand that the result can be affected by the ingestion of Vitamin C. I have taken Vitamin C tablets daily for the last year, but not sure if this is relevant? I have also had anemia all my life, which I understand can also be a consideration?
When the practice nurse called me to discuss the results, it was no doubt to discuss my poor diet, lack of exercise and intended weight loss programme, none of which apply to me in any shape or form! There is no family history of diabetes either! So it looks like I am heading for type-2 diabetes probably caused by long term Prednisolone (6 years) and MTX (3 + years) which is just another negative to have to deal with during this long and arduous journey that seems to have no light at the end of the tunnel, not even a flicker! Really disappointing to say the least!!
I would really appreciate your thoughts on this subject and particularly any fellow PMR and or GCA sufferers who have experienced this problem and, more importantly, if there is anything positive that I can cling on to.
Best wishes Liz
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LizMitchell
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"apparently test results can vary depending on other factors such as time of day blood test was taken etc."
I'm afraid not - she should have listened to what the test was: Hba1c is a reflection of the average blood sugar levels over the previous 3 months, it is not a one-off picture. That applies to a plain random blood glucose level.
Several members of the forum have managed to get their Hba1c levels down again by cutting carbs. When you take pred it alters how your body processes carbs and triggers the liver to release random spikes of glucose from the stores in the liver and muscles. These trigger production of insulin and that crashes the BS level which is what causes the cravings for carbs and general hunger when on pred. Even if that doesn't apply to you, you can improve the Hba1c levels by reducing the carbs contribution that you CAN control - dietary ones. Your diet may be very good and healthy by most standards but if you eat a lot of carbs relatively speaking, even if they are in the form of wholegrains and fruit then that is contributing to the Hba1c level. Yours is barely into pre-diabetic, it is a warning not a sentence. You don't have/are not heading for Type 2 diabetes, you have steroid-induced hyperglycaemia, different thing, different cause.
So basically - cut the carbs you can and keep them for special treats.
42 is just on the edge of pre diabetes, 48 is reckoned to be diabetic. The pre diabetic idea is quite recent to catch people before they become diabetic and teach them how to reduce the number. Have they offered pre diabetic courses and regular testing?
My diet is very low carb, rarely have bread or potatoes these days! I will have to take extra special care, but my diet is generally good, I am well within my weight range and on the "low end" for BMI, plus I walk 2 to 4 miles every day, which is why I was not expecting to be diabetic!
I have not been offered any assistance or information from my surgery, so I will ask them next time I am there.
My brother in law is pre diabetic and he eats very healthily, mainly because my sister is a Food Historian and insists he does. I had my last Ha12bc blood test in May and as you know it checks your food intake over the last three months or so. I panicked as I had indulged in a few Easter eggs!
That is really aimed at people who are obese, you say you aren't, and have insulin resistance - which shouldn't be the case in steroid-induced diabetes.
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I too was diagnosed with pre-diabetes when I was on high dose pred, I’d never had this problem before, I was eating slightly more than usual but not massively, I’d put on about 5kg but was still in the low weight for my height. When I started to reduce pred my pre- diabetes vanished, I did cut back on carbs and my favourite drink (baileys). Now I couldn’t face drinking a baileys, it’s funny when you give something up, after a while you no longer want it.
Don’t worry too much I’m sure it will rectify itself soon.
My HbA1c was 43 when I was diagnosed with PMR. My GP explained that it had risen as a result of the inflammation. It went down to 37 over 18 months, in spite of the initial higher doses of pred. It went up to 43 when I had a flare of PMR and 42 when GCA-LVV was diagnosed, but back into the 30s in between. Now I'm on Tocilizumab and 5mg pred, the recent HbA1c is 36.
My diet has remained constant at low/moderate carbs all the time.
In my case it seems that inflammation does cause my blood sugar to rise. I confess I've not looked into it further.
Interesting. Now I'm remembering from working days that if a patient with diabetes had an infection, we weren't too worried if their blood sugar was up a bit - as long as it came down again!
I reversed mine using the keto diet but I’m overweight and need to lose a few stone! There may be a pinned post on this subject or it may just be about diets...worth checking out I think!
Hi Pixix I have looked at the Keto diet and, apart from the large amount of fat content and timings of food intake, my diet is very similar in that I consume very little, if any, carbs!
I did some research on anti-inflammatory diets in 2017 and came across the Amy Myers diet (US) which is basically the food we ate before processed foods were available. The diet claims that it will enable you to reverse your auto-immune condition. I did it for 2 months, it was very restrictive, but I have incorporated it into my daily diet ever since and my weight has been easy to maintain with the odd treat. I will have to be more attentive to what I eat going forward and hope that .you pre-diabetic level goes back down to normal.
After a month on the keto diet my levels went down and I no longer have any problems. I had three further blood tests and all were normal. They seemed sure that mine was steroid induced and as I reduced the steroids the problem resolved (in conjunction with diet). It sounds as if yours is purely steroid induced as your diet is so good. That has to be good news, I hope! Good luck!
I test my blood sugars regularly. They start off in the morning at 4.8 but even without lunch they go to 7 or 8 about 4 hours after taking my pred dose and stay there for about 4 hours. By the time I have my evening meal they are back to low 5s/high 4s.This shows that it is the prednisolone that ups the sugars.
I am on 4.5mg of pred at the moment. My last hba1c was 38 and I do not take any medication for my type 2 which has been in remission for more than 3 years.
This is really interesting and thank you for sharing. It is invaluable to me to have this wonderful forum to share my health concerns with people who really understand the issues x
I got the same news as you on my birthday in March, I was a bit concerned as there is no history of diabetes in my family. I am nearly 6 yrs into PMR and am now down to 5.5mg Pred. The Diabetes nurse rang me and suggested I follow a low-carb diet, which I have been trying to do, lots of salads, wholemeal bread, rice and pasta, (small portions)and have managed to lose 7lbs in 3 months. I am having another blood test in August so hopefully my level will have dropped below 42. Don't want to add Diabetes to my list of ailments so am trying hard to avoid sugar and processed foods. I recommend "The 8 week blood sugar diet recipe book" by Dr Clare Bailey. Good luck with it, at least it is good weather for salads.
Hi Marcia We are on the same page then, as I am 6 years into PMR, although also have GCA, and doing the DSNS method of tapering Prednisolone I am currently tapering to 4mg, the.lowest I have ever been! My rheumotologIst added Methotrexate in 2017, so guess that has helped, although still too many flares along the way.
As you say, PMR and/or GCA are challenging enough without unwelcome "add ons". I live in hope that it will burn itself out one day, although honestly expected that would happen within 5 years, so who knows... it does its own thing and we just have to live with it.
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