Pre-diabetes - surprised initial reaction

[PeterB2023]

Yesterday I was asked to come back to my GPs surgery following my annual check up and blood tests, she explained that I did not have diabetes however my blood test showed I had reached the mark of 42 on the HBa and that meant she wanted to raise my awareness. I was really surprised as I am a keen cyclist ( usually average 100 miles a week), my wife is great cook (has other talents!) and prepares 90% of our meals from scratch. We usually eat 4 veggie meals a week, 2 fish and 1 with meat usually chicken. My weight is 12st 3lb down from 12st 9lb average last year height is 5ft 10.

My father developed Type 2 diabetes at about 85 when he was in a care home and lived for another 7 years and died of natural causes. My 2 siblings have never mentioned diabetes.

So I am at a loss as to why I am showing signs of developing diabetes - is there something else I should be looking at?

 

[KennyA]

Hi Peter, and welcome to the forums. Your HbA1c is actually at the top end of "normal". Normal is a reading of 38-42, meaning that almost all non-diabetic people fall inside that range. Attached graph shows this. There is a little bit of variance in the test, maybe by one or two points, so you could be lower or higher. If your previous readings have all been (say) 38, then it's more likely perhaps to be a real rise.

One of the rules on this forum is that we can't attempt to diagnose or give medical advice, so I won't be doing that. However a lot of us here have similar experiences of being unable to tolerate a lot of carbohydrates in food: unfortunately for us the official "healthy eating advice" for the last thirty years or so has been to base meals on carbohydrate. I used to do that. After a long delay I was eventually diagnosed as having T2 and by reducing carbohydrates in diet I was able to quickly reduce my blood glucose level, get rid of almost all the symptoms, and lose weight.

It may be that you currently eat a lot of carbs - in root veg, bread, pasta, rice etc in what are usually termed "healthy " foods. Unfortunately if you are in fact becoming insulin resistant (which is T2 essentially) then carbohydrate will not be processed properly by your system and the glucose will remain in your bloodstream. Why some people develop this problem and others don't is "not fully understood" as they say.

Other things as well as food can affect BG levels - for example stress, illness, activity, ambient temperature etc. You might be able to identify something that might have had an impact.

In your shoes I would ask for another test in six months. The HbA1c works off a rough average of the last three months (because that's how long red blood cells live) and you might find that the next test results in a 38 or 39. On the other hand, if it's gone up, many of us have returned to normal BGs very quickly through a low carb lifestyle.

 

[PeterB2023]

Hi Peter, and welcome to the forums. Your HbA1c is actually at the top end of "normal". Normal is a reading of 38-42, meaning that almost all non-diabetic people fall inside that range. Attached graph shows this. There is a little bit of variance in the test, maybe by one or two points, so you could be lower or higher. If your previous readings have all been (say) 38, then it's more likely perhaps to be a real rise.

One of the rules on this forum is that we can't attempt to diagnose or give medical advice, so I won't be doing that. However a lot of us here have similar experiences of being unable to tolerate a lot of carbohydrates in food: unfortunately for us the official "healthy eating advice" for the last thirty years or so has been to base meals on carbohydrate. I used to do that. After a long delay I was eventually diagnosed as having T2 and by reducing carbohydrates in diet I was able to quickly reduce my blood glucose level, get rid of almost all the symptoms, and lose weight.

It may be that you currently eat a lot of carbs - in root veg, bread, pasta, rice etc in what are usually termed "healthy " foods. Unfortunately if you are in fact becoming insulin resistant (which is T2 essentially) then carbohydrate will not be processed properly by your system and the glucose will remain in your bloodstream. Why some people develop this problem and others don't is "not fully understood" as they say.

Other things as well as food can affect BG levels - for example stress, illness, activity, ambient temperature etc. You might be able to identify something that might have had an impact.

In your shoes I would ask for another test in six months. The HbA1c works off a rough average of the last three months (because that's how long red blood cells live) and you might find that the next test results in a 38 or 39. On the other hand, if it's gone up, many of us have returned to normal BGs very quickly through a low carb lifestyle.

Thanks for the reply, sorry didn't mean to imply I was looking for medical advice - fully understand that is not allowed. I am surprised that the "healthy" food I eat regularly such as root veg, pasta and rice could be the issue. I will take a look at this more carefully and possibly make some adjustments to my eating habits. Once again thanks for the help!

 

[KennyA]

Thanks for the reply, sorry didn't mean to imply I was looking for medical advice - fully understand that is not allowed. I am surprised that the "healthy" food I eat regularly such as root veg, pasta and rice could be the issue. I will take a look at this more carefully and possibly make some adjustments to my eating habits. Once again thanks for the help!

You didn't imply it. It's just something I put in this and similar posts to make it clear it's my own experience I'm talking about. Like you, I ate a "healthy" diet with lots of the high-carb items approved by the media and the official advice, took plenty of exercise, and wound up diabetic. It happens.

 

[MrsA2]

@PeterB2023 There is definitely a genetic or epigenetic link to a tendency to getting T2. I don't think anyone has actually proved it yet as other factors come into play as well.
All I know is I was deemed low risk until I aged and a sister got diagnosed. Those 2 factors (which I could do nothing about) sent me to the GP, thinking it won't be me, but yes it was. No symptoms, no history, a lifetime of healthy eating fruits, cereals, pasta...
Now after 3 years of learning I think ablood test showing prediabetes in 2006 should have been given much more importance (I don't remember ever being told about it but it's on my medical record) as in the intervening 17 years I could have developed all sorts of the complications and tipped over in full blown T2 at any point.
So, regardless of how your diabetes was obtained, I'd urge you to accept it and take action now, and for ever more, to prevent it getting worse. A few dietary changes are easy to do to keep the medications and doctors at bay

 

[Melgar]

I was told I was pre-diabetic at the end of 2019. I am now diabetic. I was a competitive long distance runner and very active for much of the preceding decades. No diabetes in my family (including my aunts and uncles) other than my brother who is T1. I always ate healthy meals, never touched soft drinks, chips, crisps and fast food, breads or pastries. Not overweight, in fact a few years ago I had terrible trouble keeping weight on. And yet here I am T2. To be honest I felt hard done by and angry. I could have understood it if I ate pizzas and McDonalds and junk but nope I was almost freakin angelic with my food. Well that came back to bite me. The other thing that I totally despise is social media banging on about how T2 is preventable. You will just have to try and ignore that aspect. I need to breath lol I feel worked up even typing it. lolol

 

[ajbod]

The classic giveaway is that you had a "healthy" diet before. Most of us here have learnt that what is considered healthy is completely wrong for insulin resistant people. If you follow the medical advice regarding diet, you will almost certainly develop type 2 diabetes, reduce your carbs should see you improve your HbA1c.
You've now also learnt that the normal thinking of being diabetic because you're fat, is not strictly true.

 

[TriciaWs]

I loved rice, tropical fruit and toast sometimes, plus milk chocolate. But I gave that all up on my diagnosis.
I do occasionally have a slice from a small loaf if it is lower carb but not often.
I have cauliflower rice, a small serving of berries and a small amount of dark chocolate instead of my previous favourites.
I have protein in cheese, eggs, chicken and fish, avoid or only have small amounts of pulses, and eat large amounts of green veg.

 

[Resurgam]

Yesterday I was asked to come back to my GPs surgery following my annual check up and blood tests, she explained that I did not have diabetes however my blood test showed I had reached the mark of 42 on the HBa and that meant she wanted to raise my awareness. I was really surprised as I am a keen cyclist ( usually average 100 miles a week), my wife is great cook (has other talents!) and prepares 90% of our meals from scratch. We usually eat 4 veggie meals a week, 2 fish and 1 with meat usually chicken. My weight is 12st 3lb down from 12st 9lb average last year height is 5ft 10.

My father developed Type 2 diabetes at about 85 when he was in a care home and lived for another 7 years and died of natural causes. My 2 siblings have never mentioned diabetes.

So I am at a loss as to why I am showing signs of developing diabetes - is there something else I should be looking at?

Unfortunately all the propaganda about what is a healthy diet for a Human is just that - with much of the advice about such things as fruit and vegetables, units of alcohol, saturated fats and so on simply something seemingly made up when advice was requested from 'experts'.
It was devised without any research on the actual levels or the consequences of following the advice given.
Years later someone goes to find the originator of the standard advice and is told that they were asked to voice an opinion and gave the advice at short notice in response to a general question. Some have been rather apologetic about it.

 

[hillie5*]

Hello folks, I was diagnosed pre-diabetic in August last year with HbA1c @42 and got it down to 37 in 3 months by doing a very low carb diet. And lost a stone in the process taking my BMI down to 23.6 from 25. The only advice I was given about how to maintain a normal blood sugar range going forward (it will be a whole year before another HbA1c test) was to only allow an occasional treat. What guidelines do other folk follow to maintain a good level? Do you roughly tot up CHO amount eaten in a day? Do you just avoid processed foods and obvious sugars? Are you incredibly strict with carbs but liberal with non-starchy veg. My preferred occasional treat is dried fruit eg apricots which I used to eat by the bucket-load! So far just one mince pie and 5mm chocolate log.........

 

[KennyA]

Hello folks, I was diagnosed pre-diabetic in August last year with HbA1c @42 and got it down to 37 in 3 months by doing a very low carb diet. And lost a stone in the process taking my BMI down to 23.6 from 25. The only advice I was given about how to maintain a normal blood sugar range going forward (it will be a whole year before another HbA1c test) was to only allow an occasional treat. What guidelines do other folk follow to maintain a good level? Do you roughly tot up CHO amount eaten in a day? Do you just avoid processed foods and obvious sugars? Are you incredibly strict with carbs but liberal with non-starchy veg. My preferred occasional treat is dried fruit eg apricots which I used to eat by the bucket-load! So far just one mince pie and 5mm chocolate log.........

Hi and welcome to the forums. Personally I will have an occasional meal (maybe every three months or so) that is not what I'd usually have. It is (probably) still technically low-carb, but not as low as usual. I invariably see a rise in fingerprick BGs in the next couple of days and it knocks me out of ketosis. So it is very occasionally.

 

[hillie5*]

Hi and welcome to the forums. Personally I will have an occasional meal (maybe every three months or so) that is not what I'd usually have. It is (probably) still technically low-carb, but not as low as usual. I invariably see a rise in fingerprick BGs in the next couple of days and it knocks me out of ketosis. So it is very occasionally.

Thank you. No one has advised me to do finger pricks or otherwise monitor blood sugars so I feel very in the dark on a day to day basis about how I am going on, which is anxiety-provoking - I feel I need a CHO chart which includes GI scores and clear advice eg take 100-150g CHO per day (or whatever it should be) and then I would know what I am aiming at. I can't find anything online - maybe someone out there has? Do dieticians give this sort of advice out or would I have to be diagnosed with type 2 or 1 diabetes to get access to a dietician?

 

[jjraak]

Thank you. No one has advised me to do finger pricks or otherwise monitor blood sugars so I feel very in the dark on a day to day basis about how I am going on, which is anxiety-provoking - I feel I need a CHO chart which includes GI scores and clear advice eg take 100-150g CHO per day (or whatever it should be) and then I would know what I am aiming at. I can't find anything online - maybe someone out there has? Do dieticians give this sort of advice out or would I have to be diagnosed with type 2 or 1 diabetes to get access to a dietician?

As someone with type 2 I never see any dietician...so good luck there .

And I ignore the GI & just count carbs.

I aim for 30 a meal.
2 meals a day takes me to 60.

Others go lower
Others go higher


As for carb amounts...
It's personal.

Get a meter and test each meal you eat..once before eating and then after 2 hours.

A rise of over 2 mmols, means you need to look at what you ate

Perhaps eliminate one of the carbs or perhaps have a smaller portioned plate

It is in the beginning very much a detective story

Separating the innocent from the guilty

None will wear black hats, saying "baddie"

That's where the ' forensics ' comes in.. < wink >

Happy hunting

Ooh, & diet doctor website offers a lot of useful information re carbs recipes foods etc.

 

[Melgar]

Thank you. No one has advised me to do finger pricks or otherwise monitor blood sugars so I feel very in the dark on a day to day basis about how I am going on, which is anxiety-provoking - I feel I need a CHO chart which includes GI scores and clear advice eg take 100-150g CHO per day (or whatever it should be) and then I would know what I am aiming at. I can't find anything online - maybe someone out there has? Do dieticians give this sort of advice out or would I have to be diagnosed with type 2 or 1 diabetes to get access to a dietician?

I had the same advice when I was told I was prediabetic back in late 2019, which was "watch what you eat. " The prediabetic blood glucose levels showed up after a random blood panel for something completely different. I was shocked. I was also told that I will very likely be diabetic in 10 years, but it happened 2.

 

[KennyA]

Thank you. No one has advised me to do finger pricks or otherwise monitor blood sugars so I feel very in the dark on a day to day basis about how I am going on, which is anxiety-provoking - I feel I need a CHO chart which includes GI scores and clear advice eg take 100-150g CHO per day (or whatever it should be) and then I would know what I am aiming at. I can't find anything online - maybe someone out there has? Do dieticians give this sort of advice out or would I have to be diagnosed with type 2 or 1 diabetes to get access to a dietician?

Well, your starting A1c of 42 is still technically still in normal range. You also don't report any diabetic symptoms. However there's a bit of error in all tests and your BG could well have actually been a little higher or lower. "Normal" is usually defined as an A1c of 38 to 42, mainly because most non-diabetic people have A1cs in that range. I've attached a graph showing this, from a Dutch study.

Your reduction to me shows that whatever you did worked and maybe you should just keep on with that.

There is a lot of info on various websites showing carb content of food - I found dietdoctor.com very helpful. One of the wrinkles with this is that the carbs in foods are different and have different impacts on individuals. Example: I am not too bad with legumes but cannot tolerate potatoes or pastry. Both cause my BG to rise - legumes a little and slowly, pastry/potatoes a lot and very quickly. GI isn't apparently a factor for me.

If you were diabetic I would certainly advise using a blood glucose monitor. You are not, it seems, diabetic. Whether you use one or not is up to you, and as you're only looking for a small reduction in BG maybe the expense isn't worth it. The cost usually doesn't lie in the device but in the testing strips.

In your shoes I would want to honestly assess how many carbs I had generally been eating. Most so-called "healthy" diet advice produced by the NHS and echoed in the media is to eat lots of carbs - cereal, fruit/fruit juice, bread, pasta, rice, potatoes, that sort of thing. All very carb heavy, and I used to eat a lot of all of them. You might try generally cutting back on some, and seeing what happens.


I haven't spoken to a dietitian since my "training" just after diagnosis. The guy was NHS and excellent. His best advice was that "carbs are inessential and we can happily live without them".

 

[sw600]

OP should read the 'thin fit' thread, but essentially, I am in a similar boat, HBA1C 43. I am VERY interested to know more about the exercise/adrenaline response. I got a couple of freestyle libre sensors and wore them over the whole of December, including a trip to see the family in Mallorca and Denia (great for cycling). The biggest spikes in that time were seen not from eating but from exercise. I mean some fairly hard exercise, so 30-45 mins at threshold heart rate climbing in the mountains would spike glucose to 13, whereas eating a large bowl of cereal was <10. I do wonder whether my prediabetic results are down to this; in this case (in one respect at least) is exercise unhealthy? Or is that high sugar 'OK' because it's exercise? HBA1C might not tell the whole story in this case.

Doing this exercise however creates a great halo effect for the next day, if you do that every day it really controls spikes from food.

 

[sw600]

As someone with type 2 I never see any dietician...so good luck there .

And I ignore the GI & just count carbs.

I aim for 30 a meal.
2 meals a day takes me to 60.

Others go lower
Others go higher


As for carb amounts...
It's personal.

Get a meter and test each meal you eat..once before eating and then after 2 hours.

A rise of over 2 mmols, means you need to look at what you ate

Perhaps eliminate one of the carbs or perhaps have a smaller portioned plate

It is in the beginning very much a detective story

Separating the innocent from the guilty

None will wear black hats, saying "baddie"

That's where the ' forensics ' comes in.. < wink >

Happy hunting

Ooh, & diet doctor website offers a lot of useful information re carbs recipes foods etc.

Data is key here as you say. Does anyone have any examples of a normal person's glucose response from a CGM sensor, what the curve should look like after a typical meal? I want to see what 'good' looks like.

 

[Oldvatr]

Thank you. No one has advised me to do finger pricks or otherwise monitor blood sugars so I feel very in the dark on a day to day basis about how I am going on, which is anxiety-provoking - I feel I need a CHO chart which includes GI scores and clear advice eg take 100-150g CHO per day (or whatever it should be) and then I would know what I am aiming at. I can't find anything online - maybe someone out there has? Do dieticians give this sort of advice out or would I have to be diagnosed with type 2 or 1 diabetes to get access to a dietician?

Many of us use the dietdoctor website for low carb info or this forum Low Carb section.. If you use Dr Google, then try "carbs in xxx" or "XXX nutrition". There are phone apps that you can use too. The main criteria to use is carbs per 100g or carbs % Anything above 5% needs curtailing either in portion size or avoid.

I would advise getting a bgl meter and keeping a food log as an essential tool for any diabetic. ~The meters are cheap - its the test strips that are the main expense. You will probably need to fund it yourself.

As a general rule, CHO up to around 30g a day is regarded as a ketosis type diet, and up to 150 a day is Low Carb. At the HbA1c and weight you are at, you do not need ketosis diet. Mainly cut down on starchy foods, processed foods. Eat above ground veg, less root veg.

There are other diet style you could consider, but ones like Newcastle Diet are only suitable for high BMI people. I use a low carb variant of the Mediterranean diet, but I also use a small amount of medication so I can tolerate higher carb intake. We are all different, and what suits me will differ from what you use. The food log would help you find your pathway.

 

[jjraak]

OP should read the 'thin fit' thread, but essentially, I am in a similar boat, HBA1C 43. I am VERY interested to know more about the exercise/adrenaline response. I got a couple of freestyle libre sensors and wore them over the whole of December, including a trip to see the family in Mallorca and Denia (great for cycling). The biggest spikes in that time were seen not from eating but from exercise. I mean some fairly hard exercise, so 30-45 mins at threshold heart rate climbing in the mountains would spike glucose to 13, whereas eating a large bowl of cereal was <10. I do wonder whether my prediabetic results are down to this; in this case (in one respect at least) is exercise unhealthy? Or is that high sugar 'OK' because it's exercise? HBA1C might not tell the whole story in this case.

Doing this exercise however creates a great halo effect for the next day, if you do that every day it really controls spikes from food.

Well to try and answer two questions

The idea of 'Spiking' as I understand it, IS something diabetic AND non diabetic people do

THAT is normal.

The issue seems to be the longevity of the spike

Below my signature is Jenny
ruhls diabetes 101.

Jenny Ruhl T2D patients always get worse.?.mmh

Blood Sugar Levels and Organ Damage

The blood sugar levels linked to neuropathy, retinopathy, kidney disease, CVD and other diabetic complications in peer reviewed research.

www.bloodsugar101.com

I liken the body to a pot.
A fuel tank, if you like

Over time for those who build up resistance to carbs (type 2). The pot doesn't drain out as well at the bottom like it does for non diabetics .

At some point it begins to spill over as it's overfill drips then pours into our bodies.

Our poor body tries it best to mop it away and tidy up, by stashing it into places it shouldn't really be

(Mainly as fats wrapped around every organ and as the visceral fat around our bellies in particular )

And there is an argument that diabetes MAKES people fat.
V
FAT turns people diabetic .

At some point that stuffing away of fats causes issues and if left untreated begins the progressive nature of the illness of type 2

The solution for type 2's is
Follow doctors advise and slow but don't stop the decline

Follow a low carb diet and POSSIBLY slow the decline enough not to as big an issue as it could be .

I imagine well managed the decline might not even be an issue as other age related illnesses get us .

So exercise spiking ..normal.
Spiking after food ...normal.

But for type 2's it's the duration of the spikes that causes us damage .

Issue for type 2 is HOW to reduce the pot of glucose inside us
And how to slow or stop it refilling each time we eat .

I think of it as one step forward using up glucose versus 2 steps back if we add more carbs then our meters say we can handle .

The idea of the 2 mmols or less increase is where type 2's try to mimic a non type 2's glucose response .

A long winded reply, but I hope of some use seeing the difference between type 2 & non type 2.

Good luck finding your answers.

 

[Oldvatr]

The spikes due to exercise are not unexpected. Our muscle cells not only burn glucose for energy, they also store glucose as a local storage. In the absecnce of adrenlin, but in the presence of insulin they store glucose. Turn off the insulin and they use internal stored glycogen (glucose,) Turn on the adrenalin through stress or intense exercise, demand then the cells take glucose straight from the blood. Turn off the adrenalin then there will be a period where you are not really using or storing glucose, so the levels rise because it takes a while for the liver to turn off the supply. Then you will go back into storage mode and the levels drop again. It is described by the Krebs or Citric cycle with a nod to the Randle cycle if burning fat through ketosis.