Low carb diet but HbA1C results worse

[Biltea]

Hi there

This is my first post. I was diagnosed as pre-Type 2 diabetic in December 2016, with an HbA1C score of 42. I went on a reduced-carb diet in May this year and had another HbA1C test last month. The result was 43, a (marginal) worsening. When I mentioned to my GP that I had hoped the result would have shown a little improvement, she said 'not necessarily', to keep up the diet and have another test in six months time. Was she correct in saying 'not necessarily'?

I am 72, male, BMI well within the guide-lines and have lost 7 lbs in past six months. My diet consists of having two Weetabix for breakfast instead of four, cutting out bread, potatoes and pasta altogether, reducing fruit consumption, apart from berries, and eating even more veg (lots of spinach, cabbage, green beans, broccoli, etc) I also eat a lot of eggs (say 10/week), more cheese than before, white fish and oily fish. Biscuits and cakes are out completely. I don't smoke and have a glass of red wine four or five times a week. I walk briskly for two miles or so each day (with my dog). I reckon I must be down to say 150 grams of carbs/day, perhaps half of my previous consumption.

I would be grateful for any comments on my GP's reaction, and any other useful advice anyone can think of. As a 'ps' I have just ordered Michael Moseley's book.

Thanks - Biltea

 

[Boo1979]

It would probably be useful to buy a home glucose testing machine so that you can guage the impact different foods and different carb levels have on your sugars.
The Tee 2 meter can be ordered free from spirit health care as can tubs of 50 test strips at £7.75 a pot.
There is also the code free meter which has a small cost but slightly cheaper strips
If you decide to get a meter then testing your sugar level immediately before you eat a meal and again 2hrs later will tell you how much impact that food has on your sugars

 

[miahara]

Hi @Biltea ! Well, your HbA1c results put you in the pre-diabetic range rather than diabetic and I (as a completely unqualified medic) would guess that the difference between your two results is insignificant.
You done very well as far as weight loss goes so that is certainly going in the right direction.
The only thing I'd suggest is cutting out the weetabix as it is very high carb at 72.7gm/100gm. I know I can't eat them without elevating my blood glucose.
Here's a link regarding HbA1c just in case you've not alread seen the chart.
http://www.diabetes.co.uk/what-is-hba1c.html

 

[Guzzler]

As the HbA1c is an average taken over a three (or six) month period then I would say that there has been no change. There are margins of a couple of points. Sorry but Weetabix is not low carb, a fry up would be a better choice but leave out the bread/hash browns etc. Look at it this way, if you had not lowered your carb intake (well done on that) your A1c might have risen a lot more. So, keep doing what you are doing 'cos you're doing well.

 

[Grateful]

I agree with the previous posts. You are doing rather well already.

However if you are interested in lowering your A1c you could perhaps aim for a lower level of carbs. You current 150g/day is in the "moderate carb" range, you could try going rather lower and seeing what happens when the next A1c test is done. You don't necessarily have to stick with the lower level ad infinitum but doing a controlled test with a lower-carb level would give you a good idea what can be achieved; and also give you a baseline for action should your A1c worsen in future.

 

[Bluetit1802]

The 7lb weight loss is great, but your HbA1c has remained stable, so something isn't quite right.

I agree with the others on 2 points.

Firstly, if you buy a glucose meter you can see at a glance what a particular meal has done to your levels - and you are likely to have a shock with the weetabix (I assume you have milk with them - that is also full of sugar). Testing before and after you eat is a good way of working out which foods your body reacts to, and helps you calculate a suitable portion size for the carbs.

Secondly, 150g carbs appears to be too many for you at the moment. It may be worth while changing your breakfasts, but a meter will guide you with this.

 

[Biltea]

Hi

Thanks for all the helpful replies. I will reduce the Weetabix further, I know it is not low-carb. However, I did not think milk was too bad: 4.9gm/100 is hardly high? (semi-skimmed).
I will buy a testing machine and strips and look at the results carefully.
I will try to reduce my daily carb intake to say 100-130 gms/day and see what happens in next blood test.
No-one actually answered the question I posed, ie - should I have seen a reduction from 42 in the HbA1C test, following five months of reduced carb intake from 300 gms to 150 gms/day? I would be interested in your views on this point.

Thanks again for the useful comments.

 

[Brunneria]

Hi and welcome @Biltea

I think the answer to your question is almost impossible to answer - because your body is absolutely unique, and will be reacting in slightly different ways compared with anyone else. Perhaps the easiest way of looking at it is that we each have a personal carb tolerance, based on our individual bodies, diet, exercise and fitness levels, other illnesses, etc. Unfortunately, that personal carb tolerance is not only unique, it is also variable.

As an example, my own father (in his 80s) has been sliding into type 2 diabetes for about 20 years (we think) based on his snoozing after meals, and similar lack of concentration. He has recently adjusted his diet, rather like you have, and while his HbA1c is still firmly in pre-diabetes, it looks like he has improved from before, and potentially halted the decline.

That is a really positive thing, even though his results look fairly static.

There is a lot of 'age onset' type 2 around, and it is becoming more and more prevalent. Presumably, the older we get, the less our bodies are able to cope with stresses that we used to take in our stride. So whereas someone may have coped very well indeed with 300g carbs a few years ago, they may only be able to cope with 130g or even 80g now.

Well done on what changes you are making. If you do decide to get a test meter and strips, you may find that you can narrow down exactly what is elevating your blood glucose quite easily.

 

[Grateful]

No-one actually answered the question I posed, ie - should I have seen a reduction from 42 in the HbA1C test, following five months of reduced carb intake from 300 gms to 150 gms/day? I would be interested in your views on this point.

@Brunneria is right, the question is almost impossible to answer. I can think of several possible explanations for why your A1c did not budge and even then, it's possible that none of them is correct (or that the answer is a mixture of factors):

• Your carb-lowering efforts had a good effect in lowering your blood glucose, but simultaneously, you progressed toward diabetes rather than just pre-diabetes (@Guzzler mentioned this possibility: "if you had not lowered your carb intake ... your A1c might have risen a lot more"). If this was the case, your timing in lowering carbs was excellent. Further efforts in lowering carbs (below 150g) may see an actual lowering in A1c.
• Or, nothing changed in your body (you did not progress toward diabetes) but you are someone who will not see an actual lowering of their A1c without going rather "lower" than just the "moderate carb" diet of 150g that you are currently on. This was my theory in an earlier post, but there is no guarantee that it is correct. To find out, you would have to try it out. (This is essentially what I did after diagnosis: I went very low-carb at 30g/day, and for the first couple of months I also sharply reduced the calorie intake. But I was full-flown diabetic, while you only have pre-diabetes; you should be able to be a bit more "relaxed" about it, if that fits in with your personality.)
• Or, you may be eating/drinking things that you did not list in your post and that contain unexpected carbs. By definition any provided list of foods eaten in a six-month period can only be a summary; perhaps there were other foods that contain what I call "hidden carbs" (foods that one does not normally think of as "carb-laden" but in fact, are). Forum members such as @Bluetit1802 who are suggesting you use a meter have a good point here. I don't use one myself, but that does make the whole process of figuring things out more time-consuming because it relies on those relatively infrequent A1c tests.
• Or, something else is at play: it could be stress, lack of sleep, overwork, lack of exercise, the list is long! We are not doctors so all of this is guesswork anyway. ("Informed" guesswork but still guesswork nonetheless.)

You have made a great start. Keep plugging away, you are on the right track!

 

[AdamJames]

and any other useful advice anyone can think of. As a 'ps' I have just ordered Michael Moseley's book.

I can think of 2 bits of advice, purely from my own experience.

Firstly, don't rely on any recipes in the Blood Sugar Diet / Recipe Book. Many of them may be fine (some of them are lovely!), but you can only trust your meter, as others have said. One of the recipes in there has 48g of carbs in it - porridge with milk and apple. The oats are justified in the book because of this idea that they are "slow release" and the apples because they have lots of fibre and are therefore also "slow release". Don't believe it. It's true for some people, not for others. Certainly not for me. Trust only your meter.

The other is if you really like your cereal in the morning with milk, one solution I found incredible was to get various bags of nuts - almonds, hazelnuts, walnuts - even some coconut flakes, some seeds and *just enough* raisins to give it a sweet kick, literally 2 or 3 chopped. Once you get used to low carbs you'll probably find the milk is sweet enough and you don't need the raisins. For me - and again, trust only your own meter - this had no effect on my 2hr postprandial reading. Also, the amount of milk you need to add to the mix to make it satisfying is tiny compared to weetabix or oats, so again, there's less carbs. The texture can be adjusted by how finely you chop the nuts. I found it was practically the same as muesli even without the oats. The portion size will need to be small because of the calories, but I found it plenty filling once I'd got used to a low calorie diet.

 

[Boo1979]

The other is if you really like your cereal in the morning with milk, one solution I found incredible was to get various bags of nuts - almonds, hazelnuts, walnuts - even some coconut flakes, some seeds and *just enough* raisins to give it a sweet kick, literally 2 or 3 chopped. Once you get used to low carbs you'll probably find the milk is sweet enough and you don't need the raisins. For me - and again, trust only your own meter - this had no effect on my 2hr postprandial reading. Also, the amount of milk you need to add to the mix to make it satisfying is tiny compared to weetabix or oats, so again, there's less carbs. The texture can be adjusted by how finely you chop the nuts. I found it was practically the same as muesli even without the oats. The portion size will need to be small because of the calories, but I found it plenty filling once I'd got used to a low calorie diet.

Or, if like me youre too busy (ahem in my case lazy) to do all the faffing about, just pop down to Aldi and buy this
https://www.reddit.com/r/ketouk/comments/74vky6/paleo_muesli_from_aldi_only_15g_nc_per_100g/
http://www.myfitnesspal.com/food/calories/aldi-foodie-market-nutty-paleo-muesli-563528618
I find a 45g serving with almond milk has b all effect on my sugars wheres half that amount of ‘normal’ muesli would send them over the edge

 

[AdamJames]

Or, if like me youre too busy (ahem in my case lazy) to do all the faffing about, just pop down to Aldi and buy this https://www.reddit.com/r/ketouk/comments/74vky6/paleo_muesli_from_aldi_only_15g_nc_per_100g/

Aha! That's where I got the idea from! Unfortunately my Aldi doesn't do it any more.

My homemade "version" is lower carb anyway. Plus with one of the Aldi ones - I can't remember which - they had some very small seeds or something in them which I found kept getting stuck between my teeth. They are very, very, very nice, though!

 

[AdamJames]

I should add that, while I second the recommendation for the Aldi paleo muesli, that's a good example of needing to use your meter.

One of them never had an effect on my 2 hr readings, one always did. I think it was the one with freeze dried berries in. Not sure it was the berries, because there is other stuff in there like fig paste if I remember correctly.

 

[Boo1979]

I should add that, while I second the recommendation for the Aldi paleo muesli, that's a good example of needing to use your meter.

One of them never had an effect on my 2 hr readings, one always did. I think it was the one with freeze dried berries in. Not sure it was the berries, because there is other stuff in there like fig paste if I remember correctly.

I expected the one with the freeze dried berries in to have a bigger effect than the nutty variety but with a 45g serving my pre and post prandial sugars flatline or show a slight decrease with both - as you say and with evry new food, eat to your meter is essential as we will all respond differently to the same foods

 

[Biltea]

Hi

Thanks again for all the advice, which I will follow up, including the paleo muesli. I'm now counting carbs more regularly and am down to 80-100 gms per day. I may have another question or two once I get my new meter up and running.

 

[ironny]

I have picked up on this thread from 2017 almost 5 and a half years later, as there are similarities with my situation, plus so much more evidence exists on diet and nutrition. I am a 72 year old woman who was diagnosed with pre-diabetes in December 2020, with a HbA1c of 4.1, and attended an on-line course. In September 2021 my test results were 42.1, in January 2022 45.4 and after more attention to my diet it came down to 43 in January this year. I was then determined to try and take myself out of the pre=diabetic range and discovered the Low Carb Program, which I have followed strictly for three months, keeping to 100 carbs or under. I am underweight rather than overweight with normal visceral fat, low BMI and body fat percentage and exercise regularly. However, I have had high blood pressure for 10 years and am on 5mg amlodipine daily. After 3 months, on low carb my HbA1c tests have come back at HIGHER than before I started low carb at 44.4 and 6.2 which has devastated me, especially as I took a fasted spot test three days previously and the reading was normal at 5.4. The recent high test was taken fasted at the same time of day. I feel my options are to buy a BGM, but I have tracked my food for years and have a good idea of macros; to go lower in carbs to 50 or under; or to follow a wholly low fat and plant based diet with eventually increasing wholefood carbs as suggested by the Mastering Diabetes advocates. All advice gratefully received. I am at a loss to know what to do.

 

[Resurgam]

I have picked up on this thread from 2017 almost 5 and a half years later, as there are similarities with my situation, plus so much more evidence exists on diet and nutrition. I am a 72 year old woman who was diagnosed with pre-diabetes in December 2020, with a HbA1c of 4.1, and attended an on-line course. In September 2021 my test results were 42.1, in January 2022 45.4 and after more attention to my diet it came down to 43 in January this year. I was then determined to try and take myself out of the pre=diabetic range and discovered the Low Carb Program, which I have followed strictly for three months, keeping to 100 carbs or under. I am underweight rather than overweight with normal visceral fat, low BMI and body fat percentage and exercise regularly. However, I have had high blood pressure for 10 years and am on 5mg amlodipine daily. After 3 months, on low carb my HbA1c tests have come back at HIGHER than before I started low carb at 44.4 and 6.2 which has devastated me, especially as I took a fasted spot test three days previously and the reading was normal at 5.4. The recent high test was taken fasted at the same time of day. I feel my options are to buy a BGM, but I have tracked my food for years and have a good idea of macros; to go lower in carbs to 50 or under; or to follow a wholly low fat and plant based diet with eventually increasing wholefood carbs as suggested by the Mastering Diabetes advocates. All advice gratefully received. I am at a loss to know what to do.

As you are not a typical, ordinary case of pre-type 2 just by being underweight, I would have thought that you'd have been checked for other variants.
If you can find a way to eat a plant based diet and keep your blood glucose levels down at normal levels I'd be quite surprised, even allowing 100gm of carbs

 

[Robbity]

I'm now over 80 and I've been eating a low carb/ketogenic type diet (aiming for below 50g a day) or over 9 years after being diagnose with T2. Since then I've reduced my glucose levels to pre-diabetic (under 47) and kept them roughly at the lower end of that range for most of that time. I allow for slight variations in diet, health issues, stress and (permitted) meter variances as causes for slight ups and downs. So I feel you're doing OK, and you really need not be concerned over such a minor increase - we're actually human beings not some sort of robotic laboratory statistic.

 

[Oldvatr]

This is a very old thread, so the OP has probably lost interest. But to share my research and trying to answer the OP question, it is a documented 'fact' that HbA1c rises as we age, and at 72, this is possibly what the OP was experiencing.

PS The advice regarding Weetabix abstention is spot on.

 

[ironny]

Thanks people for taking the time to reply and share. I am still trying to figure out what to do next. However, I have just been sent a gift voucher for afternoon tea by my daughter, so think I need to buy a glucose monitor before I go!