Confused

[Roy Batty]

I recently had a blood test in the UK at my GP for Hba1c and cholesterol at my request. I was surprised when the results came back and showed my Hba1c to be 47. Surprised because 4 weeks previously in the US another test came back at 41. I had the second test because I wanted to see if after a third month of TRE it caused a drop in my Hba1c.

I'm a 66 year old white male with no health conditions or allergies and I'm not on any medication.

My BP is 120/75 and RHR is low 60s BPM.

I don't smoke.

I weigh 100 Kgs and my height is 1.86 m, in strict BMI terms and I would be classed as overweight and borderline obese.

I had a Dexa scan and my body fat % is 19.5, I have very high bone density and a very good LMI (92nd percentile).

I was contacted by a NHS Diabetes clinic and was disappointed in the approach, they were more concerned about advising me to exercise and diet and didn't ask at all about my lifestyle.

I eat very little carbs, no pasta or rice for weeks on end, rye bread occasionally, perhaps one biscuit or a scone once a week. Some potatoes, rarely chips. No pizzas.

I exercise a lot, 5 or 6 times a week. I have my own indoor rower and row 5 Kms on exercise days, I also have my own weights and do resistance exercises. I walk daily and always take stairs on London underground and walk up escalators.

I'm at a loss to explain the variation in the results of the 2 Hba1c tests and if the latter higher result is correct what to do about it. I can't realistically cut my carb intake much more, unless I go hard core keto. Exercising more is not really an option either, how hard would I need to exercise if what I'm already doing isn't enough?

I don't feel ill in the slightest, I have plenty of energy, I never need a nap and I sleep well, 8 hours a night.

Am I missing something?

Thanks for any replies.

 

[Resurgam]

Hello @Roy Batty and welcome to the forum.
I found that I just needed to go back to my Atkins level of carbohydrate, under 50gm a day to get my Hba1c from 91 down to normal numbers, but for many that seems a very small amount. I wonder if - having been told that carbs are part of a healthy diet, you are still eating more than you can cope with.
There is always the chance of something more interesting than ordinary type 2, but that s what most HCPs assume at diagnosis when older.

 

[Lakeslover]

Hi,

It would be useful to let us know what you do eat. Is it possible there are hidden carbs there? What do you have for breakfast?

Maybe keep a food diary for a week and see how many grams of carbs a day you are having? Ideally get a meter and test your blood sugar before a meal and two hours after for a while to see how much it is rising. That would show you if any particular meal is causing a problem.

 

[ianf0ster]

Hi @Roy Batty and welcome to the forum.
2 points:
HbA1C tests have a certain amount of error and the difference between a 41 and thus defined as non-diabetic in the UK (but still pre-diabetic in the USA) and 47 (still rather than diabetic in both all countries), isn't that large when the accuracy is taken into account. pre-diabetic.

For the average person, it has been proven and is well accepted in up to date medical circles that exercise is little to no help with losing weight. The truth is that it is what you eat (to suppress hunger) that matters most. Indeed the more you exercise the more hungry you feel. So unless it i muscle building exercise (muscles can absorb glucose). They studied a group of people over 30 days and the ones who exercised the most lost 0 lbs on average!
So the old saying 'You can't out-run a poor diet' still holds true.

 

[Roy Batty]

Hi,

It would be useful to let us know what you do eat. Is it possible there are hidden carbs there? What do you have for breakfast?

Maybe keep a food diary for a week and see how many grams of carbs a day you are having? Ideally get a meter and test your blood sugar before a meal and two hours after for a while to see how much it is rising. That would show you if any particular meal is causing a problem.

Thank you for your reply.

I don't have breakfast, I eat my first meal at 1 p.m. Today I had a salad Nicoise that I made myself with 3 baby new potatoes cut in half. For my main meal I had cold chicken with vegetable kebabs that I made, courgettes, mushrooms, peppers, tomatoes and shallots.

Can I use a simple finger prick test before and after meals?

 

[Roy Batty]

Hi @Roy Batty and welcome to the forum.
2 points:
HbA1C tests have a certain amount of error and the difference between a 41 and thus defined as non-diabetic in the UK (but still pre-diabetic in the USA) and 47 (still rather than diabetic in both all countries), isn't that large when the accuracy is taken into account. pre-diabetic.

For the average person, it has been proven and is well accepted in up to date medical circles that exercise is little to no help with losing weight. The truth is that it is what you eat (to suppress hunger) that matters most. Indeed the more you exercise the more hungry you feel. So unless it i muscle building exercise (muscles can absorb glucose). They studied a group of people over 30 days and the ones who exercised the most lost 0 lbs on average!
So the old saying 'You can't out-run a poor diet' still holds true.

I don't exercise to lose weight, I exercise to maintain my health and fitness. I have a high LMI. Thanks for your reply.

 

[Roy Batty]

If it's okay I'll ask another question. If I do have pre-diabetes will I have any other signs or symptoms aside from my Hba1c level? I feel in great health and I'm very fit.

 

[ianf0ster]

If it's okay I'll ask another question. If I do have pre-diabetes will I have any other signs or symptoms aside from my Hba1c level? I feel in great health and I'm very fit.

Most people when diagnosed with Type 2 diabetes (not just pre-diabetes) they discover that they have probably had it for years if not decades. The symptoms can be so subtle or even show no sign even while high insulin and high glucose is possibly causing damage to blood vessels. This is a particular problem for TOFI's since they have no real outward sign at all since they are hardly overweight if at all.
But of course at the opposite and of the weight scale, there are many obese people who don't have diabetes - it's a complex disease.

When I first reduced my Blood Glucose levels down into the pre-diabetic levels, I thought I was safe from complications, but further reading suggested that it's a sliding scale of risk and so I was still at risk and probably still am at a very small risk even though now below the UK pre-diabetic levels!

 

[coby]

Thank you for your reply.

I don't have breakfast, I eat my first meal at 1 p.m. Today I had a salad Nicoise that I made myself with 3 baby new potatoes cut in half. For my main meal I had cold chicken with vegetable kebabs that I made, courgettes, mushrooms, peppers, tomatoes and shallots.

Can I use a simple finger prick test before and after meals?

In case nobody else has already said, YES you can do finger prick test. Right before first bite of your meal and then two hours afterwards. The rise should be no more than two. So if beforehand it is say 6, then two hours later it should be no more that 8 x I would be suspicious of the potatoes!

 

[MissMuffett]

Yes definitely can do a finger prick BG test at home. You‘ll probably have to buy a metre and test strips yourself though unless you GP practice is proactive, it’s always worth asking for one.

 

[CatsFive]

Hi @Roy Batty and welcome to the forum.
2 points:
HbA1C tests have a certain amount of error and the difference between a 41 and thus defined as non-diabetic in the UK (but still pre-diabetic in the USA) and 47 (still rather than diabetic in both all countries), isn't that large when the accuracy is taken into account. pre-diabetic.

For the average person, it has been proven and is well accepted in up to date medical circles that exercise is little to no help with losing weight. The truth is that it is what you eat (to suppress hunger) that matters most. Indeed the more you exercise the more hungry you feel. So unless it i muscle building exercise (muscles can absorb glucose). They studied a group of people over 30 days and the ones who exercised the most lost 0 lbs on average!
So the old saying 'You can't out-run a poor diet' still holds true.

But how did they measure the body fat? Exercise can build muscle, if one builds muscle & sheds fat total body weight can stay the same.

 

[Roy Batty]

But how did they measure the body fat? Exercise can build muscle, if one builds muscle & sheds fat total body weight can stay the same.

I paid for a full body DEXA scan, much more accurate than calipers or other means of measurement.

 

[CatsFive]

I paid for a full body DEXA scan, much more accurate than calipers or other means of measurement.

I meant for the study @ianf0ster mentioned

 

[ianf0ster]

I meant for the study @ianf0ster mentioned

I didn't note the reference. But it was on one of the morning shows on BBC1 TV that Dr Zand van Tullekan did round 2 months ago. This wasn't news to me because I'd heard it and noticed it in practice from overweight people complaining that no matter how hard they exercised they didn't lose weight.
The study ran for 30 days and measured starting weight, ending weight and the amount of exercise done. The TV show didn't going into details of body composition and whether at the start they all had similar body composition and did similar exercise per day. So as is usual with these studies the design may not have been perfect, though it was said to just be a confirmation of previous studies.

I feel that it confirms the old saying that 'You can't out run a poor diet' . Or to put it another way the more you exercise the hungrier you get and in the medium to long term human willpower will give out, so for the majority a weight loss way of eating (= Low Carb) which doesn't make you hungry wins out over starvation or a drastic increase in exercise.

edited for missing first letter of doctor's name

 

[KennyA]

If it's okay I'll ask another question. If I do have pre-diabetes will I have any other signs or symptoms aside from my Hba1c level? I feel in great health and I'm very fit.

It's possible. I had a large number of diabetic symptoms for around ten years prior to diagnosis when my A1c was in the mid 40s. I was told firmly I didn't have diabetes - reason, my blood sugar wasn't high enough. If you don't have symptoms that's great, you really don't want them.

The 48 diagnostic was intended to be a fallback - if diabetes hadn't already been diagnosed, and you were symptom-free, you'd eventually be diagnosed in the absence of anything else if/when your BG hit 48.

48 was chosen around 2008 (iirc) because diabetic maculopathy is rare in people with lower BGs - rare, but not unknown. And all the international medical organisations accepted that.

Unfortunately most of the NHS interprets this to mean that you won't be diagnosed unless your BG is at 48.

Pre-diabetes is to my mind a kind of made-up no mans land for anyone out of normal range but not yet at 48, beacsue no-one seems to be able to diagnose diabetes anymore without the test. In my opinion, if you have symptoms, you have the disease, and you (and the healthcare system) should be doing something about it.

One of the things you can do is testing before and +2 hrs after meals to see what blood glucose impact that food has.

 

[MrsA2]

If it's okay I'll ask another question. If I do have pre-diabetes will I have any other signs or symptoms aside from my Hba1c level? I feel in great health and I'm very fit.

I had no symptoms that I'd noticed before diagnosis. Yet after going low carb I really noticed how often i had been weeing, weight gain also put down to being a woman of a certain age.
Turns out when accessing my medical records that I was prediabetic back in 2006 but no one told me or monitored it until I was diagnosed in 2020. I only went for the test then becuase a close relative developing t2 and my age suddenly put me in a high risk group.
I have no idea what damage I might have been doing in those missing 14 years and didn't recognise any symptoms as being anything wrong

 

[Roy Batty]

I didn't note the reference. But it was on one of the morning shows on BBC1 TV that Dr and van Tullekan did round 2 months ago. This wasn't news to me because I'd heard it and noticed it in practice from overweight people complaining that no matter how hard they exercised they didn't lose weight.
The study ran for 30 days and measured starting weight, ending weight and the amount of exercise done. The TV show didn't going into details of body composition and whether at the start they all had similar body composition and did similar exercise per day. So as is usual with these studies the design may not have been perfect, though it was said to just be a confirmation of previous studies.

I feel that it confirms the old saying that 'You can't out run a poor diet' . Or to put it another way the more you exercise the hungrier you get and in the medium to long term human willpower will give out, so for the majority a weight loss way of eating (= Low Carb) which doesn't make you hungry wins out over starvation or a drastic increase in exercise.

If you don't lose weight through exercise but your body composition changes i.e. more muscle and less fat, especially around the major organs then surely that will have the same effect as losing weight on insulin sensitivity?

 

[ianf0ster]

If you don't lose weight through exercise but your body composition changes i.e. more muscle and less fat, especially around the major organs then surely that will have the same effect as losing weight on insulin sensitivity?

Yes, but most people tend to do cardio exercise rather than muscle building exercise. So loss of weight (when desired) is usually a good thing. I was more of a TOFI (Thin Outside Fat Inside) so both weight and waist measurement were the easy things to measure, if I had not been able to afford a BG Meter.

As it was I could afford the meter and enough test strips (the main expense) to do pretty thorough testing of my meals until I knew exactly how to keep my BG spikes below 2mmol and my max BG 2hrs after eating below 8 mmol. Once I could do that consistently I knew I was on track for remission.

 

[Outlier]

I had no symptoms that I'd noticed before diagnosis. Yet after going low carb I really noticed how often i had been weeing, weight gain also put down to being a woman of a certain age.

This for me too. Looking back, I can see all sorts of tiny pointers that I was heading for T2, but that's from information given here.

 

[Roy Batty]

Yes, but most people tend to do cardio exercise rather than muscle building exercise. So loss of weight (when desired) is usually a good thing. I was more of a TOFI (Thin Outside Fat Inside) so both weight and waist measurement were the easy things to measure, if I had not been able to afford a BG Meter.

As it was I could afford the meter and enough test strips (the main expense) to do pretty thorough testing of my meals until I knew exactly how to keep my BG spikes below 2mmol and my max BG 2hrs after eating below 8 mmol. Once I could do that consistently I knew I was on track for remission.

That's interesting as my understanding is that greater muscle mass increases skeletal muscle glucose uptake and improves insulin sensitivity. Why then is there so much emphasis on cardio exercise to reduce weight when resistance based exercises to boost muscle mass may be equally, or more effective?