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I've been hovering on the edge of prediabetes for almost 5 years and now it's finally happened.

Discussion in 'Prediabetes' started by gardengnome42, Oct 27, 2017.

  1. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Despite my best efforts I've tipped over into prediabetes and am feeling pretty upset about it. Five years ago when I was 70 a health check found I had hypertension and subsequently I found out the HbA1c was 41. As I had recently been diagnosed with osteoarthritis I determined to lose 3 stone, and although I take medication for the blood pressure, it is well controlled.

    I have an HbA1c test annually as part of the BP review and it has been 41, 39, 41, 40 and now suddenly it is 43. I don't know where that came from and have been told to make a 20 minute appointment to see the nurse next week. What I wonder is she likely to do/say other than some patronising talk on how to live my life according the the NHS. Do they give oral glucose tests these days or fasting glucose tests or does the HbA1c cover everything?

    I cook from scratch, use almost no salt, drink rarely and walk 3/4 hr daily with the dog, plus working every day in our large garden.. My BMI is 19 and I weigh 58 kilos; I could not realistically lose more weight. 2years ago my then dr said the A1c would rise [he was very sure] and when it reached close to 48 he would have Metformin for me. What did he know that I didn't I wondered, but determined it would not happen to me and yet it's getting there.

    I do not eat much bread, rice or pasta or potatoes but plenty of carbs in the way of fruit. I don't realistically see what more I can do, at least on a sustainable level. Where do I go to from here to avoid full blown T2?
     
  2. Resurgam

    Resurgam Type 2 · Well-Known Member

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    As you eat plenty of carbohydrates then I would expect that your inability to cope with them will result in your HBa1c rising year on year, as your doctor predicted, unless you can change how you are eating. If you can reduce the amount of carbs to what you can cope with then there is a good chance that your diabetes will not progress.
    My own experience has been that my Hba1c dropped like a stone when I cut down on the amount of high carbohydrate foods I ate, and I now stick to under 60gm of carbs per day in order to maintain normal results from blood glucose and Hba1c.
    I checked which foods I could eat without spiking my blood glucose using a testing meter, there are some which are quite inexpensive to use - it is the cost of strips which makes the difference.
    By increasing the amounts of protein and fats you eat, in order to compensate for fewer carbs you would not lose weight.
     
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  3. Prem51

    Prem51 Type 2 · Well-Known Member

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    The fruit you are eating will be raising your blood sugars. Apart from berries most fruit especially tropical fruit contain a lot of fructose sugars. Your HbA1c at 43 is not too far into the pre-diabetic range, and you should be able to lower it into non-diabetic figures fairly easily by cutting out the fruit.
     
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    #3 Prem51, Oct 27, 2017 at 6:47 PM
    Last edited: Oct 28, 2017
  4. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Thanks both of you for your reply. The fruit I mainly eat has come from the garden. Rhubarb, gooseberries, plums and blackcurrants - and raspberries too. There's just so much of it but the season is over now so perhaps the next test will reflect this. Most of the fruit I prepare for my husband who has it for breakfast daily, I stick with grapefruit though if I have to take a statin for high cholesterol that might have to go by the board. That also was tested and was high at 6.7 total.
     
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  5. Grateful

    Grateful Type 2 · Well-Known Member

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    That's a very narrow band. I have read some sources that list the margin of error for any one HbA1C test as plus or minus 0.5 percentage points on the old NGSP scale. Looking at your numbers, the lowest reading (39) is 5.7% and your latest (and highest) reading is (43) is 6.1%.

    I am not saying you should not be concerned, just that statistically speaking there may not be much significant difference between those readings (in particular, the jump from 40 to 43 could just be statistical "noise"). However I will admit that I don't know very much about this subject and hope that someone can pipe in with more information about the margin of error for HbA1C tests.

    It does look like you are doing a lot to manage your condition. Well done.
     
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  6. Pipp

    Pipp I reversed my Type 2 · Moderator
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    Hello @gardengnome42

    Sorry you are feeling upset by your recent HbA1c result. Though I would add that 43 is not too bad.

    Do you use a meter to test the effects of various foods on your blood glucose? That could be the best thing to start with. Then some minor tweaking of diet could be all you need.
     
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  7. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Thanks Grateful and Pipp for the reply. I think I was just really shocked to see the test result online with just a cursory 'abnormal - see the nurse' comment.

    I saw one of my neighbours today who happens to be a practice nurse in another surgery and deals with patients like me all the time - most of whom she said are 'Forty, fat and inactive' !! She said the diabetic nurse will look at me and realise that I don't fit the usual picture, with me being as she knows, fit, slim and active. She said not to worry 43 isn't so bad and if diabetes is going to get me then it will but life style advice won't make any difference in my case.

    She is not only a practice nurse but has diabetes running through her family, both T1 and T2 [mother, sister and niece] although neither she nor her husband and children have it so I guess she has loads of experience.
    Have to say I do still feel anxious at the thought of seeing the nurse 'For my diabetes' as the receptionist said when I made the 20 min appointment.
     
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  8. Bluetit1802

    Bluetit1802 Type 2 · Oracle

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    One of the problems is fatty liver and insulin resistance. Thin people can have this, you don't need to be fat. It is when fat accumulates in the liver, stopping it working in tandem with the pancreas and making us insulin resistant. This eventually leads to diabetes. One of the major causes of this is fructose. Fructose is contained in all fruits, but certain ones are worse than others. Raspberries are one of the best choices. (It is also contained in other foods - Google will help if you want to know which)

    https://www.dietdoctor.com/fructose-fatty-liver-sugar-toxin
     
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  9. Pipp

    Pipp I reversed my Type 2 · Moderator
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    Unfortunately many HCPs do have that stereo typical view of the reason people develop T2. This can lead to narrow minded attitudes, and blaming the patient. Don't fall into that mindset. As you point out you do not fit that description. Nor do many of us.
    You will most likely be told at the appointment that you have a progressive condition, that will lead to medication for life. Also that you do not need to test your blood glucose, and that you should eat healthy carbohydrates at each meal.
    Many of us have followed that advice and continued to see increasing blood glucose levels despite adhering to advice from HCPs. Many members here have found that by monitoring their own blood glucose responses to various foods they are able to work out for themselves which foods to avoid. By doing so they are able to disprove the theory that they have a progressive condition, and come off or avoid the need for diabetes meds.
     
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  10. Grateful

    Grateful Type 2 · Well-Known Member

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    Your friend sounds like a useful person to know! Personally, and with all the usual qualifications about "this may well not apply to you," I would be slightly careful about the notion that being fit, slim and active with a level of 43 "isn't so bad" and no need to make any adjustments at all.

    As I said in an earlier post, this is a pretty good number, but the A1C range you have seen in the past few years (between 5.7% and 6.1% in the "old" scale) does count as "pre-diabetic" here in the USA. My reading was 5.5% in 2009, then I did not have it tested again until 2017 (my fault, I was skipping the annual medicals because I thought I was invincible). I am thin, was quite physically active, and had been eating a supposedly healthy low-fat Mediterranean diet for decades. Here I am, eight years later, having been found firmly in the diabetic range (67, or 8.3%, at diagnosis early this year).

    If you are at all concerned about the progression, you might want to consider some simple lifestyle adjustments (notwithstanding what your friend said about this not making a difference). The thing that stands out in your first post is the fruit. Perhaps you could reduce this somewhat? The carb level in some fruits is very high. Also possibly re-equilibrate your diet somewhat, reducing the non-fruit carbs a bit as well. Edited to add: if you are adding sugar to anything (such as tea or coffee) try to get used to consuming it unsweetened.

    Hard to say, really. "Pre-diabetes" has always struck me as a tricky term. I see it more as a smooth spectrum, and right now you are in an ambiguous place in that spectrum. Bon courage, as they say in France!
     
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  11. Alexandra100

    Alexandra100 Other · Well-Known Member

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    Like you, I am slim and active and recently was very upset to find I had an A1c test of 41. I am determined not to let this develop into pre-diabetes, and like you was fortunate enough to find my way to this forum. I now know that a slim person who develops high blood glucose in later life may be Type 2 or alternatively may be a late onset Type 1 / LADA. (There is a section about this condition lower down.) Perhaps your neighbour was referring to this, as whereas eating a diet lower in carbohydrate can help to prevent T2 from worsening, it will not save a T1 from eventually needing insulin. HOWEVER both T2s and T1s can benefit enormously from a careful low carb diet at all stages. I strongly recommend that you have a look at Jenny Ruhl's website: http://www.phlaunt.com/diabetes/ and / or buy one of her books. This is the one I have read and it helped me a lot:
    https://www.amazon.co.uk/Your-Diabe...=sr_1_2?s=books&ie=UTF8&qid=1509203471&sr=1-2 This is a very complicated subject, but there are lots of things you can do to take control and minimise your problems. But beware - there are so many people out there who will give you terrible advice.
     
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  12. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Not sure that I do eat plenty of carbohydrate. It was certainly new to me that fruit was carbs but of course the sugar in it accounts for that, and presumably the fact that fruit contains natural sugar as opposed to white refined stuff makes no difference: it's still sugar. I certainly don't eat any rice or pasta and not many potatoes or bread, but I do eat some.
     
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  13. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Interestingly my friend the practice nurse said more or less exactly what you have said but this was in private. When in uniform and in the surgery they have to obey the rules and deliver the nonsensical NHS advice as you mention above, she mentioned in particular the Eatwell plate and all the carbohydrate they recommend.

    The 'progressive' bit is really scary though. However the comment about 'if it's going to get you then it will' is probably true. Son in law's father was diagnosed recently, he knew it was on its way and had been for a number of years but had been unable to halt it. It runs down his family yet he also is fit and thin. Despite his best efforts it arrived although he doesn't yet take any medication.

    I've ordered a meter [code free?] so intend finding out which are the best/worst foods for spiking.
     
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  14. Alexandra100

    Alexandra100 Other · Well-Known Member

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    Believe me, I do sympathise with your plight, as before my A1c I was more or less living on fruit, with milk and nuts. I thought I knew a lot about diet, but the last few weeks I have been disconsolately discovering the carb content of more and more foods that I had happily imagined to be "free". Did you know, there is 1 gramme of carb in an egg??? (My latest discovery.) Before that, I discovered the surprisingly high carb content of my beloved leeks and onions. Even garllic has about 1 gramme of carb per clove, but luckily one doesn't need very many of them. Really, I think only fish and meat, fats and oils are completely carb free. But don't panic, you may be able to get away with a moderate reduction of carbs. Given that a small apple has about 15 carbs, as does HALF a banana, you can see that eating less fruit very quickly achieves a big reduction. In addition, as has already been said, reducing the fruit sugar fructose will help your struggling liver.

    The fact that you start off fit, slim and active will stand you in very good stead. Walking for 10 minutes after meals, especially the evening one, often seems to help lower blood glucose levels. There is a section about exercise lower down where we discussed this more than once. Dr Bernstein is good on exercise against diabetes (and against ageing) and has made lots of short videos: http://www.diabetes-book.com/video-diabetes-exercise/
     
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  15. Alexandra100

    Alexandra100 Other · Well-Known Member

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    Excellent news about the meter. When I got mine it took me a week to get up the courage to use it, and then a tense session of ineffecttually pricked fingers and wasted strips before I got the hang of it. (I expect you'll do better, it's really very simple!) Now I find it extremely motivating.

    As for your son-in-law's father, you don't say if he is T1 or T2 or what he was doing to try to halt the progression. Some people are still following their doctor's counsel eg to avoid "white" foods, which is excellent advice, just useless for those going in the direction of diabetes. Even if it is your and my fate eventually to have to control our health with insulin and other medications, we can still make all the difference in the world to our length and quality of life by our lifestyle behaviours. Jenny Ruhl is over 70 and Dr Bernstein over 80, both have been living and living well with diabetes for decades.
     
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  16. Pipp

    Pipp I reversed my Type 2 · Moderator
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    Good move to have a meter.
    Test fasting first thing in morning, before eating, then at 1hour and 2 hours after eating. If you keep accurate records of readings and of what you have eaten you will soon build up a picture of what causes spikes in blood glucose.
     
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  17. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    I've read stuff from the phlaunt site before and had forgotten how good she was. Thank you for reminding me,

    Son in laws father is now 78 so no spring chicken. The men in his family all seem to develop T2 at some stage and none of them are fat. His younger brother died last year of diabetes complications - not sure what as I didn't know him and didn't like to ask but I know he rarely moved out of his armchair. The father in law is a different type all together and far more intelligent and careful. He is only just in the range as far as I know but I bet is the type who would believe what the NHS says without question. Why are so many men like that and WHY does the NHS insist on sticking with the high carb diet.

    I'm 75 myself and because I have high blood pressure and arthritis I was determined not to be compromised like my grandmother was back in the 1950's with similar problems. I only found out the HbA1c reading of 41 five years ago when I went online to get my medical notes and results of a health check. No one had mentioned it at all, all they were concerned with was filling me with blood pressure tablets. How long had it been hovering around that level I wonder. Interestingly my 86yr old husband has low blood pressure and his HbA1c last time it was done was in the mid 30's. Life isn't fair!
     
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  18. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Thanks, sounds like helpful advice. I await the meter with apprehension though!
     
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  19. Pipp

    Pipp I reversed my Type 2 · Moderator
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  20. gardengnome42

    gardengnome42 Prediabetes · Well-Known Member

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    Yes definitely. I researched possible side effects of the various meds beforehand, thankfully. Dr said he wanted me to go on to Amlodipine [a calcium channel blocker] which is a first line for the over 50's I believe and luckily I knew about the grapefruit so asked for another. Went initially on Ramipril [ACE] but that gave me the nasty cough so I take Losartan which works and is fine with grapefruit.
    Also when they lowered the threshold for statin intervention from 20% Qrisk to 10% I was offered one and refused it for the same reason. I asked the dr if she would take one given my [then] state of health and she said NO. She might say differently now though and I suppose the risk will have risen a little.
     
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