Fit and Healthy but Prediabetic

[SimonCrox]

I am another example of this. In August, age 75, I got an A1c of 41, following on from 40 the year before and 37 before that. My GP would not have mentioned this to me, as I am still one point away from being officially pre-diabetic (in the UK). Luckily she wanted me to go on to statins to lower my LDL cholesterol, so sent me to the nurse, who dropped the bombshell. It was a very great surprise, as no-one in my family has had diabetes, though we all die of heart related problems. We are 100% English, with a smidgen of Scottish. I don't have any vascular disease, and with a BMI of 16.5 I don't have metabolic disease either, nor have I lost my spleen. I was eating the classic healthy diet and doing far more than average exercise. Given the fact that I have been gradually losing weight, I am wondering about LADA, but my GP doesn't want to do anything until I have achieved proper pre-diabetic status. I am testing my BG and weighing myself regularly, so if things start to accelerate I'll be back to the surgery at once.

I just wonder if at times conditions are blamed on abnormal glucose tolerance inapporpriately. Your glucose levels on the HBA1c are really not high enough to cause weight loss, and with a BMI of 16.5, you are underweight. I guess you have already chaecked that you do not have an overactive thyroid (which also raises glucose levels), or are not malabsorbing food or have some other reason to lose weight. At 75, you are not really old enough to start losing weight due to lack of appetite and loss of muscle mass. I would ask the GP about weight loss, unless you have already done this and got an adequate reply.

 

[Alexandra100]

I just wonder if at times conditions are blamed on abnormal glucose tolerance inapporpriately. Your glucose levels on the HBA1c are really not high enough to cause weight loss, and with a BMI of 16.5, you are underweight. I guess you have already chaecked that you do not have an overactive thyroid (which also raises glucose levels), or are not malabsorbing food or have some other reason to lose weight. At 75, you are not really old enough to start losing weight due to lack of appetite and loss of muscle mass. I would ask the GP about weight loss, unless you have already done this and got an adequate reply.

Thanks very much for taking an interest. I am registered with a large GP practice. When I first found out about my A1c test of 41 I was horrified and got a quick appointment with a GP I didn't know. He told me, in effect, not to fuss as one point more or less on my A1c had no significance. (A year before my A1c was 40, 2 years ago 37, so to my mind things are going absolutely in the wrong direction.) He said that most of his patients have A1cs nearer 41 than 21. (So that's all right then!) When I mentioned being under-weight he first said, no I wasn't and then advised me to address this by exercising less. (He had not asked how much exercise I do. It is actually not at all excessive.)

I have a complete bloods test several times a year which includes looking at my thyroid function, which always comes out normal. By contrast, my neutrophylls are always very low, which means my immune system is rubbish and I get infections easily, which coesn't help my weight. The GP I see regularly is referring me to a dietician.

My theory is that rather than my being insulin resistant, my capacity to produce insulin has been decreasing over the last few years - hence the gradual weight loss. But I don't know enough to back this up. I think it is possible I am suffering from LADA and if my BG rises I will go back to my GP with the evidence from my monitor. I used to think my weight loss was due to mal-absorption, but curiously since I have been limiting carbs my reflux symptoms have gone away.

I would have liked to be prescribed Metformin, in the hope that it would permit me to eat a few more carbs without raising my BG and so maybe gain or at least not lose weight. I am eating much more fat than ever before, but so far (it's early days) have not gained any weight.

 

[SimonCrox]

Thanks very much for taking an interest. I am registered with a large GP practice. When I first found out about my A1c test of 41 I was horrified and got a quick appointment with a GP I didn't know. He told me, in effect, not to fuss as one point more or less on my A1c had no significance. (A year before my A1c was 40, 2 years ago 37, so to my mind things are going absolutely in the wrong direction.) He said that most of his patients have A1cs nearer 41 than 21. (So that's all right then!) When I mentioned being under-weight he first said, no I wasn't and then advised me to address this by exercising less. (He had not asked how much exercise I do. It is actually not at all excessive.)

I have a complete bloods test several times a year which includes looking at my thyroid function, which always comes out normal. By contrast, my neutrophylls are always very low, which means my immune system is rubbish and I get infections easily, which coesn't help my weight. The GP I see regularly is referring me to a dietician.

My theory is that rather than my being insulin resistant, my capacity to produce insulin has been decreasing over the last few years - hence the gradual weight loss. But I don't know enough to back this up. I think it is possible I am suffering from LADA and if my BG rises I will go back to my GP with the evidence from my monitor. I used to think my weight loss was due to mal-absorption, but curiously since I have been limiting carbs my reflux symptoms have gone away.

I would have liked to be prescribed Metformin, in the hope that it would permit me to eat a few more carbs without raising my BG and so maybe gain or at least not lose weight. I am eating much more fat than ever before, but so far (it's early days) have not gained any weight.

We are here to help each other, if one can. Some folk do have an insulin deficient type 2 diabetes, and they are skinny, and it is common in folk from Japan and Korea. But you are keeping your HbA1c in the non-diabetic range (albeit not normal), so this really does not explain your weight loss. 1 kg of fat contains 7,000 KCal, so one has to do a lot of exercise to lose a bit of weight (although the exercise is highly beneficial to improve body composition and insulin sensitivity). If you are already underweight, metformin is likely to make you lose more weight, although it helps control the glucose in folk of all weights). Your GP seems to be keeping a good eye on your blood tests and if this has been going on for several years, oddly, this is good news. I would just wonder what your faecal elastase test is like for pancreatic malabsorption, and tissue transglutiminase blood test for coeliac disease is. The dietician referral to see if you are getting enough calories will be interesting and helpful. Yes - sometimes frequent infections bring the weight down
Best wishes

 

[jeanniefin]

Hello, I have just been diagnoses as prediabetic. I have had two HbA1c tests 3 months apart. The first came back as 47 and the second as 46 - so that seems pretty conclusive!

It came as a surprise as I am a very fit active person with a good diet and healthy lifestyle. A recent health check up gave me a body fat percentage of 14% and all other criteria were good. But I guess that is just the way it is!

So, I have started to cut out snacks such as cakes, biscuits, etc. and cut out 'bad' carbs but I find I am hungry most of the time and am worried that I will lose weight and my energy levels will drop.

I have been looking in to the low carb and ketogenic diets but I am not sure if and how this will affect my training - I do a lot of cycling and cross training.

Does anyone have any thoughts, suggestions or experience of this?

 

[jeanniefin]

Like others it was a shock to be told I was prediabetic while not overweight and taking more than average exercise - cycling and hill walking. Went low carb and substituted cooked sausages wrapped in bacon, hard boiled eggs, pieces of cheese, avocado and banana as snacks while exercising. I now enjoy a full cooked breakfast (no beans, potato or toast) before a full day's ride and lots of cream with some porridge or a small amount of fruit. Great treats after going low fat for years. My Hb1Ac is now below prediabetic and my cholesterol is lower than it's been for 5 years.
I also got a meter to finger prick test and got the reassurance that blood sugar levels stayed very steady while excercising and I've never had a crash or reason to be concerned even on a long ride or stiff hill walk.
Good luck.

 

[Alexandra100]

Like others it was a shock to be told I was prediabetic while not overweight and taking more than average exercise - cycling and hill walking. Went low carb and substituted cooked sausages wrapped in bacon, hard boiled eggs, pieces of cheese, avocado and banana as snacks while exercising. I now enjoy a full cooked breakfast (no beans, potato or toast) before a full day's ride and lots of cream with some porridge or a small amount of fruit. Great treats after going low fat for years. My Hb1Ac is now below prediabetic and my cholesterol is lower than it's been for 5 years.
I also got a meter to finger prick test and got the reassurance that blood sugar levels stayed very steady while excercising and I've never had a crash or reason to be concerned even on a long ride or stiff hill walk.
Good luck.

That's very encouraging, Jeannie. My next blood test is scheduled for January and I was wondering if my cholesterol would have risen as a result of my new Low(ish) Carb diet. I also struggle to think what to eat when out exercising. How do you manage the avocado - do you take a spoon with you? Very best wishes for your rides and hill walks.

 

[kokhongw]

It is odd that someone with a healthy lifestyle, diet and weight should get pre-diabetes; it is getting more common.

Sammi Inkinen
https://sg.finance.yahoo.com/news/fighting-diabetes-food-130043269.html

That would leave plenty of time for his main hobby: triathlons. A champion who obsessively tracks his biometrics, Inkinen was a fitness freak even by Silicon Valley standards. He had less than 8% body fat.

Not to mention Tim Naokes...

 

[Alexandra100]

Sammi Inkinen
https://sg.finance.yahoo.com/news/fighting-diabetes-food-130043269.html

Not to mention Tim Naokes...

Very interesting to read about Inkinen, but for $400 per month many on this forum would be willing and equally qualified to advise on the keto or even the Newcastle diet. I'd even have a shot at it myself!!!

 

[Alexandra100]

Like others it was a shock to be told I was prediabetic while not overweight and taking more than average exercise - cycling and hill walking. Went low carb and substituted cooked sausages wrapped in bacon, hard boiled eggs, pieces of cheese, avocado and banana as snacks while exercising. I now enjoy a full cooked breakfast (no beans, potato or toast) before a full day's ride and lots of cream with some porridge or a small amount of fruit. Great treats after going low fat for years. My Hb1Ac is now below prediabetic and my cholesterol is lower than it's been for 5 years.
I also got a meter to finger prick test and got the reassurance that blood sugar levels stayed very steady while excercising and I've never had a crash or reason to be concerned even on a long ride or stiff hill walk.
Good luck.

Hello again Jeannie, I've just been reading your past posts and I see that in July 2016 you were very discouraged by your HbA1c test, which hadn't improved despite your efforts to cut carbs. Great to read now that you are no longer pre-diabetic. Had you made any further changes to your diet? I see that, like me, you still like porridge for breakfast! I know everyone is different, but it would be very interesting to know what worked for you.

 

[kokhongw]

many on this forum would be willing and equally qualified to advise on the keto or even the Newcastle diet

Many of us are willing...but not so sure that we are qualified to advise...most of us here are just sharing our own journey, so that some may find some useful pointers for considerations...but don't qualify as medical advice.

The Virta program is backed by medical professionals who believe in the low carb ketogenic approach and would be able to deal with more complex medical conditions that may arise for those with multiple complications...I think $400/mth is reasonable for the results that they will deliver...

 

[Alexandra100]

Many of us are willing...but not so sure that we are qualified to advise...most of us here are just sharing our own journey, so that some may find some useful pointers for considerations...but don't qualify as medical advice.

The Virta program is backed by medical professionals who believe in the low carb ketogenic approach and would be able to deal with more complex medical conditions that may arise for those with multiple complications...I think $400/mth is reasonable for the results that they will deliver...

I think I trust advice LESS when it costs $400 per month. And especially as they are not over-enthusiastic about exercise.

 

[ParisChic]

Wow, seems like more and more thin & fit prediabetics here lately. I am also a biker and also a surprise diagnosis. I found that LCHF helped get my sugars under control (although I also take metformin now). I ended up going very low carb for the first year or two, and then adding some back in to help with exercise stamina, actually. I keep to under 100g/day, but I no longer do the 20g/day thing because I was just crashing with exhaustion after rides and losing weight t a disconcerting extent. Definitely get a metre and see how exercise affects your sugars also--I found this to be really different at different times of the day, but that strategic eating (not of carbs, just protein) helped mitigate it. Also weather during exercise affects me more now that before diabetes (heat, for example, makes the stress of a strenuous ride more and my sugars inevitably rise). It's a lot of trial and error! Also, if it hasn't already been raised, there's a chance you are early LADA, and it might be worth inquiring for a GAD antibody test or at least keeping an eye out for any sudden turns in your health.

Hi, what is LADA please?

 

[ajbod]

Latent Autoimmune Diabetes in Adults. Basically it's type 1, that comes on in adulthood, where the Pancreas gradually loses it's beta cells, and insulin production falls. It's often misdiagnosed as type 2 as insulin is still present at the start, referred to as the honeymoon period.