New to prediabetes (with cardiac issues)

[ciao]

Good evening and thank you ! i write from Italy for my husband who is 67 yo (he had a stroke in 2016 plus 5 coronary stents, he takes statins and other pills). He has always been thin , so he developed tha habit to eat a lot or carbs . Last blood test : HbA1c - DCCT 5.7 % HbA1c - IFCC 39 mmol/mol. We bought a glocometer and since a couple of weeks he is eating low carb , mainly fish, lean meat and vegetables and the number are very encouraging ; ie this morning fasting measurementwas 4,8 and 2 hrs after meal was 5,6 (fish , green vegetables and a bit of brown bread). If he eats pasta or when i cooked meatballs with legume and vegetable it was about 7.8 ... He already lost 5/6 lbrs in 2 weeks and i think he almost halved the calories intake .... not sure if this is good new however ... he is going to see a doctor in a couple of weeks but meanwhile he wants to do his best. My questions are : what shoud be our goal as postprandial measurement, given the fact that he is already slim and probably low carb diet is not the best for cardiac issues ? Does it make any sense to be very strict for a couple of months in order to 'reset the system' and add some carbs later on ? I realize that we need to see a doctor , i would like him to see a nutritionist but he's very busy at the moment and i do trust this forum... Thank you in advance!!

 

[Antje77]

Hi @ciao and husband, welcome to the forum.

Last blood test : HbA1c - DCCT 5.7 % HbA1c - IFCC 39 mmol/mol.

I'm a bit puzzled by this. 39 mmol/mol is below the prediabetic threshold, which lies at 42 in most countries.

If he's already thin, why did he halve his calorie intake? This sounds pretty dangerous.
Apparently his usual way of eating kept him at his normal weight, being thin, eating only half of his usual food sounds like he'll be starving!

Does it make any sense to be very strict for a couple of months in order to 'reset the system' and add some carbs later on ? I realize that we need to see a doctor

None of the numbers you mention are out of range for a healthy person, and especially not at 67 years old.
I don't understand the change of diet or wanting to see a doctor.
Why do you feel he has an issue with his blood glucose?

 

[JoKalsbeek]

Good evening and thank you ! i write from Italy for my husband who is 67 yo (he had a stroke in 2016 plus 5 coronary stents, he takes statins and other pills). He has always been thin , so he developed tha habit to eat a lot or carbs . Last blood test : HbA1c - DCCT 5.7 % HbA1c - IFCC 39 mmol/mol. We bought a glocometer and since a couple of weeks he is eating low carb , mainly fish, lean meat and vegetables and the number are very encouraging ; ie this morning fasting measurementwas 4,8 and 2 hrs after meal was 5,6 (fish , green vegetables and a bit of brown bread). If he eats pasta or when i cooked meatballs with legume and vegetable it was about 7.8 ... He already lost 5/6 lbrs in 2 weeks and i think he almost halved the calories intake .... not sure if this is good new however ... he is going to see a doctor in a couple of weeks but meanwhile he wants to do his best. My questions are : what shoud be our goal as postprandial measurement, given the fact that he is already slim and probably low carb diet is not the best for cardiac issues ? Does it make any sense to be very strict for a couple of months in order to 'reset the system' and add some carbs later on ? I realize that we need to see a doctor , i would like him to see a nutritionist but he's very busy at the moment and i do trust this forum... Thank you in advance!!

I'm with @Antje77 here... He doesn't sound particularly pre-diabetic with those numbers, and his HbA1c is perfectly fine, especially for someone on statins... Dropping caloric intake seems a little drastic when he's already skinny, and there doesn't seem to be an immediate need to start any kind of diet, really. See a doc if you feel you should, but at this point, I doubt they'd do much, if anything, as all looks fine from this end...?

 

[ciao]

Hi @ciao and husband, welcome to the forum.

I'm a bit puzzled by this. 39 mmol/mol is below the prediabetic threshold, which lies at 42 in most countries.

If he's already thin, why did he halve his calorie intake? This sounds pretty dangerous.
Apparently his usual way of eating kept him at his normal weight, being thin, eating only half of his usual food sounds like he'll be starving!


None of the numbers you mention are out of range for a healthy person, and especially not at 67 years old.
I don't understand the change of diet or wanting to see a doctor.
Why do you feel he has an issue with his blood glucose?

Thank you for your answer Antje77! The point is that his numbers are getting higher every lab test he does and we became alarmed by these last ones. I read it on a post in this forum that his numbers are at the low end of pre diabetic stage in US. So he is slowly but surely going in the wrong direction. Diabetes (and I guess prediabete also) is going to complicate cardiac issues a lot … this is the reason why we decided to took action. Unfortunately his habits were wrong : no breakfast, many coffee with sugar, 2 big meals with A LOT of high glicemic index food, evening meal very late in the evening, cookies before sleeping, no physical activity… So I am very frustrated and knowing he has a ‘scientific mind ‘ (and a scientific Phd) I bought him a glucometer and this simple fact changed his attitude … but he exaggerated , we both exaggerated… we wanted to reverse the trend …. But after a couple of weeks we realized this is not the right way… I’d like him to see a nutritionist … his health situation is tricky… I still think we can reverse the trend if we take the right , REASONABLE, steps … but you see, many of us has a black or white mentality (or psychological reaction) and the middle way seems to be the most difficult….

 

[ciao]

I'm with @Antje77 here... He doesn't sound particularly pre-diabetic with those numbers, and his HbA1c is perfectly fine, especially for someone on statins... Dropping caloric intake seems a little drastic when he's already skinny, and there doesn't seem to be an immediate need to start any kind of diet, really. See a doc if you feel you should, but at this point, I doubt they'd do much, if anything, as all looks fine from this end...?

Thank you for your answer Jokalsbeek! writing in English takes a lot time and effort to me, so please forgive me if I paste the answer I gave to Antje77. We appreciate your support ‘The point is that his numbers are getting higher every lab test he does and we became alarmed by these last ones. I read it on a post in this forum that his numbers are at the low end of pre diabetic stage in US. So he is slowly but surely going in the wrong direction. Diabetes (and I guess prediabete also) is going to complicate cardiac issues a lot … this is the reason why we decided to took action. Unfortunately his habits were wrong : no breakfast, many coffee with sugar, 2 big meals with A LOT of high glicemic index food, evening meal very late in the evening, cookies before sleeping, no physical activity… So I am very frustrated and knowing he has a ‘scientific mind ‘ (and a scientific Phd) I bought him a glucometer and this simple fact changed his attitude … but he exaggerated , we both exaggerated… we wanted to reverse the trend …. But after a couple of weeks we realized this is not the right way… I’d like him to see a nutritionist … his health situation is tricky… I still think we can reverse the trend if we take the right , REASONABLE, steps … but you see, many of us has a black or white mentality (or psychological reaction) and the middle way seems to be the most difficult….’

 

[JoKalsbeek]

Thank you for your answer Jokalsbeek! writing in English takes a lot time and effort to me, so please forgive me if I paste the answer I gave to Antje77. We appreciate your support ‘The point is that his numbers are getting higher every lab test he does and we became alarmed by these last ones. I read it on a post in this forum that his numbers are at the low end of pre diabetic stage in US. So he is slowly but surely going in the wrong direction. Diabetes (and I guess prediabete also) is going to complicate cardiac issues a lot … this is the reason why we decided to took action. Unfortunately his habits were wrong : no breakfast, many coffee with sugar, 2 big meals with A LOT of high glicemic index food, evening meal very late in the evening, cookies before sleeping, no physical activity… So I am very frustrated and knowing he has a ‘scientific mind ‘ (and a scientific Phd) I bought him a glucometer and this simple fact changed his attitude … but he exaggerated , we both exaggerated… we wanted to reverse the trend …. But after a couple of weeks we realized this is not the right way… I’d like him to see a nutritionist … his health situation is tricky… I still think we can reverse the trend if we take the right , REASONABLE, steps … but you see, many of us has a black or white mentality (or psychological reaction) and the middle way seems to be the most difficult….’

No problem copy-pasting.

There is a chance your husband's blood sugars are slowly creeping up because of the statins. They can elevate blood sugars, as can steroids and the like. Now, he does need his medication, having a history with cardiac events, so yeah.... I see where that might feel like a problem. At this point in time though, he's fine. And you don't want to know how many people here have gotten their diabetes under control practicing low carb and one meal a day. (I always skip breakfast, so stick with two meals mostly, these days). So him skipping breakfast is fine. Just make sure he's eating healthy the other two meals. Good fats (like fish, avocado and the like), protein, maybe a little less carbs than before to even out the possible effects of the statins and whatever else he may be on, but... Don't cut calories. If he's already skinny, there is absolutely no need to, and he doesn't end up feeling better if he's malnourished. And let go of glycemic indexes. They're of more use to diabetics who need to know whether they have to split a dose of insulin, they're not relevant at all at this stage. So yeah. Up the fish, meat and such, maybe cut the carbs a little... Keep an eye on things. But for the moment, he's all good.

 

[Antje77]

The point is that his numbers are getting higher every lab test he does and we became alarmed by these last ones. I read it on a post in this forum that his numbers are at the low end of pre diabetic stage in US. So he is slowly but surely going in the wrong direction.

At 67 years old, his hba1c is actually below average in non diabetics.
It's completely normal to have it a bit higher as you get older!

If he had an hba1c of 39 while eating large quantities of high carb foods, he really doesn't have any blood sugar issues.

Long story: https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0338-7

 

[ciao]

No problem copy-pasting.

There is a chance your husband's blood sugars are slowly creeping up because of the statins. They can elevate blood sugars, as can steroids and the like. Now, he does need his medication, having a history with cardiac events, so yeah.... I see where that might feel like a problem. At this point in time though, he's fine. And you don't want to know how many people here have gotten their diabetes under control practicing low carb and one meal a day. (I always skip breakfast, so stick with two meals mostly, these days). So him skipping breakfast is fine. Just make sure he's eating healthy the other two meals. Good fats (like fish, avocado and the like), protein, maybe a little less carbs than before to even out the possible effects of the statins and whatever else he may be on, but... Don't cut calories. If he's already skinny, there is absolutely no need to, and he doesn't end up feeling better if he's malnourished. And let go of glycemic indexes. They're of more use to diabetics who need to know whether they have to split a dose of insulin, they're not relevant at all at this stage. So yeah. Up the fish, meat and such, maybe cut the carbs a little... Keep an eye on things. But for the moment, he's all good.

Thank you very much Jokalsbeek for the helpful and thorough answer; although I am late in answering (I apologize for that), I can tell you we immediately began to increase calories as we read your posts . We are aiming to mediterranean diet now; husband became fond of the glucometer and in my opinion it can still play a role in helping him to eat more correctly, increasing the awarness on what to eat ; for example at Restaurant he used to have mostly pasta and lot of white bread .. , now he chooses more proteins and vegetables and he cut with sugary food ...so overall it should be healthier but thanks to your much appreciated help , we are more aware now that he need to keep up with calories with an eye to the wheightscale …

 

[ciao]

Thank you very much Antje for the very helpful and thorough answer; although I am late in answering (I apologize for that), I can tell you we immediately began to increase calories as we read your posts . We are aiming to mediterranean diet now; husband became fond of the glucometer and in my opinion it can still play a role in helping him to eat more correctly, increasing the awarness on what to eat ; for example at Restaurant he used to have mostly pasta and lot of white bread .. , now he chooses more proteins and vegetables and he cut with sugary food ...so overall it should be healthier but thanks to your much appreciated help , we are more aware now that he need to keep up with calories with an eye to the wheightscale …