Diagnosed as pre-diabetic

[sansevieria]

Hello, I have recently been told that I have impaired glucose tolerance. I had a HbA1C test in October, and again in December, both showing a result of 48 mmol. I have had an oral glucose test as well, but wasn't told the result. I haven't really been given any advice since then, as no one seems to think it's much of a problem? I was sent to a diabetes nurse who said I didn't need to do anything, and to a dietitian who is very concerned that I'm underweight - my BMI is 18. She attempted to prescribe me a weight-gaining drink that had 30g of sugar in it per serving(!!) despite knowing my HbA1C result, and told me to eat more cakes and biscuits. This is terrible advice, right?

My doctor refused to prescribe the drink and is looking at finding an alternative. I have been gradually losing weight over the past year and a half or so, I used to be 55kg and now I'm 47kg. Whatever weight I manage to gain I seem to instantly lose again (I got to 51kg in December, was proud of my progress and made an active effort to gain even more and then lost it all again somehow ).

I've looked around the forums here about carb-reducing, but I don't really eat very many anyway (about 70 grams per day), all from "good" carbs like brown rice and bread, and only in small amounts as I don't have a large appetite. A lot of the dietary information I've come across appears to be aimed at overweight people, so I'm not sure how applicable it is to me, especially with cutting foods out.

Is it a matter of taking it all into my own hands and buying a glucose meter, finding out which foods work for me and which don't? Or is it nothing to be concerned about as my doctors seem to think? (...I probably wouldn't be here if I agreed with them lol). The only thing my doctor ever suggests is to have another blood test, I think I've been having them every month but there's never any change.

(and maybe a silly question) is pre-diabetes always indicative of type 2? like it can't develop into type 1 (or be misdiagnosed)? I looked at the pages here but the "signs and symptoms" bit of both seem very similar? I'm in my early 20s, never been overweight, never really liked "junk food" and no one in my family has diabetes so I'm a little bit confused as to how this happened so type 1 makes more sense to me in that respect?

 

[DeejayR]

Hello. Are you in the UK? You need a proper support team. Can you change your doctor? An HbA1c of 48 is threshold Type 2, like me.
I lost too much weight on the official medium-carbs-low-fat diet. Now I eat low-carb-full-fat my weight is stable at what I want. So I would say yes, get a meter and take control.
Your last question will be competently answered by someone else.

 

[Bluetit1802]

Hello and welcome.

Has your doctor done other tests to see why you are losing weight? Thyroid for example?

You say you have a small appetite and don't eat much, so maybe that is your problem. Eating lower carb is excellent for blood sugar control, but you also need extra fat and protein to make up for the lost calories. Are you eating enough dairy foods like butter, cheese and full fat yogurts for example, and enough protein from eggs, meat and fish?

Getting a meter is a good idea. Without one you have no idea which foods are causing your raised levels, and with an HbA1c of 48 you are teetering on the very brink of diabetes, so you do need to do something to stop it in its tracks. It is perfectly possible to get the levels right down to normal. Many have done it on this forum with HbA1cs a lot higher than yours.

May I suggest you ask for a print out of your blood tests, including the oral glucose test. Then you may have a better idea of where you are.

 

[sansevieria]

Thank you for the replies

Hello. Are you in the UK? You need a proper support team. Can you change your doctor? An HbA1c of 48 is threshold Type 2, like me.
I lost too much weight on the official medium-carbs-low-fat diet. Now I eat low-carb-full-fat my weight is stable at what I want. So I would say yes, get a meter and take control.
Your last question will be competently answered by someone else.

I am in the UK, yeah. I did recently change doctor, but he's very much focused on who I've seen prior to him/what the problems I'm having are etc (I end up repeating myself every time I see him) and then it's all oh we've now run out of time see you next week sort of thing.

Hello and welcome.

Has your doctor done other tests to see why you are losing weight? Thyroid for example?

You say you have a small appetite and don't eat much, so maybe that is your problem. Eating lower carb is excellent for blood sugar control, but you also need extra fat and protein to make up for the lost calories. Are you eating enough dairy foods like butter, cheese and full fat yogurts for example, and enough protein from eggs, meat and fish?

Getting a meter is a good idea. Without one you have no idea which foods are causing your raised levels, and with an HbA1c of 48 you are teetering on the very brink of diabetes, so you do need to do something to stop it in its tracks. It is perfectly possible to get the levels right down to normal. Many have done it on this forum with HbA1cs a lot higher than yours.

May I suggest you ask for a print out of your blood tests, including the oral glucose test. Then you may have a better idea of where you are.

I've had blood tests checking for hyperthyroidism and coeliac disease to see if that's what causing the weight loss, but it was a long time ago, maybe about this time last year. They came back normal though. I have some minor-ish bowel issues and got seen by a gastroenterologist and an IBS nurse specialist, but the consensus was just some kinda of mild functional bowel problem, maybe IBS. I tend to err more to the side of constipation than anything (sorry if that's tmi lol), so I don't think it's happened through diarrhea.

I wasn't intentionally eating lower carb, that's just how I am normally. I haven't really changed much about my diet yet, as I don't want to end up losing more weight. All I've done is change from cold cereal to porridge, and use a different brand of bread. I can't eat dairy and I'm vegetarian, though I do eat fake meats and dairy alternatives, and I have increased the amount I eat in general but it's difficult as I'm not very hungry and quite nauseous most of the time. I've attached a chart of what I roughly eat in the spoiler - is eating lower carb the "easiest"/best way to reduce blood sugar?

Spoiler

 

[Bluetit1802]

The first thing that jumps out at me from your food is the low calorie consumption. I was on 1200 calories a day when I was trying to lose weight, which I did very successfully on 1200 calories. I now need about 1700 to 1800 just to maintain, and I am fairly sedentary ( housework plus 2 walks a day of 20 mins each) Your carbs are your highest numbers at the moment, so you perhaps need to increase the protein and fats. Eggs? Olive oil? More seeds? More nuts? More avocado? This is only my personal opinion, but I really think you are far too low on calories for weight gain. I also wonder why you are tracking the sugar levels on MFP. Sugars are carbs, so are included in the carb allowance. What about changing it to fibre? Just a thought.

 

[Bluetit1802]

Sorry, I should have added that yes, lower carbs aren't just the best way to reduce blood sugars, they are probably the only way

 

[sansevieria]

My weight to me feels like a concern mostly because I eat notably more than I did a few months ago but am losing weight more quickly than I used to. I guess I don't know how I can comfortably increase intake, and by such a large amount as well, when I don't have the appetite (or the digestive system) for it. I think I can get myself to 1500 calories with food, and I should get a weight-gaining drink thing prescription on Friday, so hopefully that will make a difference. Does being underweight negatively effect glucose levels? I know I need to gain weight for my health generally, but I feel like I'm trying to solve a symptom rather than the underlying problem.

(and I've only just started using MFP, I didn't know I could change which things to track, it's more helpful this way thank you )

 

[Bluetit1802]

I wish you luck with your endeavours. It must be very hard for you. I would definitely try to get those calories up, and maybe the weight gain drink will help. I hope so. I have no idea if being underweight affects glucose levels. Maybe you could ask that elsewhere on the forum. Obviously being overweight doesn't help because it causes insulin resistance.

 

[Daibell]

Hi. From what you say I would hazard a guess that you may be an early stage Late onset Type 1 (LADA). Assuming there are no other medical possibilities that you have already mentioned, then serious weight loss when you are not really starving yourself is a strong pointer to LADA. This can happen when the body's insulin production had dropped to the extent that it can't use carbs fully. The result is weight loss and a rise in blood sugar. As your blood sugar is still not too bad then there could be other causes, but I went down the same route and many GPs don't recognise LADA thru inexperience. There are two tests if you can persuade the GP to do them i.e. GAD and c-peptide. I would do as others have said and continue the low-carbing and have enough fats and proteins. If you do have low insulin demonstrated by the c-peptide test, then Glicazide is one of the commonly prescribed tablets; I had to suggest this to my diabetes GP and he agreed and prescribed them! Be aware that there can be other medical conditions causing weight loss so keep an open mind.

 

[sansevieria]

wow, I feel a bit silly not knowing there were more than two types! I used to be borderline anaemic, and I think I was that way for a very long time before finding out - my iron stores are normal and always have been, but my ferritin level is lower than average, and oral iron tablets haven't had much of an effect. I do also have a connective tissue disorder (diagnosed with Joint Hypermobility Syndrome, but that might not be all), but I don't think it can cause weight loss (unless it effects intestinal tissue and causes diarrhea which mine doesn't seem to).

I'll bring it up with my doctor on Friday, because it's not been mentioned at all to me. Thank you! Even if it doesn't end up explaining what's going on at least it feels like I'm moving forwards a little

 

[AnnieC]

Hi and Welcome
I have been prediabetic for the last three years or so I have never been overweight in my life but when I cut out all sugar foods my weight dropped by over a stone .I eat smaller portions of bread and potatoes than I used to but still eat most vegetables and fruit I have Burgen Linseed and Soya bread.. quite a few here have that it is better than wholemeal... I have never been a big bread eater so probably only have about 4/6 slices a week which is usually toast some days with breakfast .I don't eat rice or pasta because I don't like them I am not a vegetarian like you but not a big meat eater either I mostly have chicken so vegetables make up the biggest part of my meals along with salad stuff Some here have a fried breakfast but I can't stomach that in the morning but I do have eggs scrambled or omlette with cheese I can't go lower on the carbs that I have as I just loose more weight if I do. I do eat quite a lot of mixed nuts to keep my weight up