Pre-diabetes - surprised initial reaction

[AloeSvea]

Hi @PeterB2023. I noticed @jjraak referenced the magnificent Jenny Ruhl up there. If you want to do a deep dive into the true complex world of diabetes there is another article of hers on her website that you could read (kind of - if you dare! It can be a lot to take on, imho). I've just finished referencing it in one of my threads so easy to copy and paste again here:

'The Real causes of type 2 diabetes' by Jenny Ruhl:

The Real Causes of Type 2 Diabetes

What peer reviewed medical research has found about the genes, pollutants, drugs and other factors that cause Type 2

www.bloodsugar101.com

 

[Melgar]

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.

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.

I have a question, if as you say "FAT turns people diabetic " then every person who is obese or very over weight would eventually become diabetic and that's not the case. My own mother was obese (A result of a stroke in her 40's and being confined to a wheelchair as she had Rheumatoid arthritis) And, she had the world's worst diet. She had very high blood pressure and high cholesterol. She lived to a few months short of her 80th birthday. She was not diabetic or even prediabetic. So there has to be something else at play. Insulin resistance?, but what happens to people who are active and fit why do they get T2. Exercise is supposed to open up the cells so they can be more receptive. It seems to me that it is very complicated. Maybe in a few years time they will have more to say on the matter, who knows. Not wanting to challenge you but these are questions I often ask myself and I have no answers.

 

[MrsA2]

Not wanting to challenge you but these are questions I often ask myself and I have no answers.

The article posted above answers thos questions

 

[jjraak]

I have a question, if as you say "FAT turns people diabetic "

You need to re-read what was said.

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

It's rather an old fallacy prompted by many.

I'm sure most T2' s who have extra weight have heard that from family, friends & likely HCP's.

Are some people fatter without being type 2 diabetic.?..sure.

Are all type 2's fat .. definitely not.

So while I haven't read all of the excellent link from @AloeSvea .

I think there is enough evidence to make one question if type 2 itself could be what makes people fatter.

Many just attribute it to
Being older
A little less active

All points that maybe contribute,
But the underlying metabolic challenges is, I believe why those type 2's who are 'larger' ( as was I), are made so , by the illness, rather than by overeating.

Otherwise as you say , everyone 'larger' must be type 2.....and they are not

So it seems likely something else is at play.

The result, that reducing weight, helps those DX as type 2, return to better metabolic health is touted as 'proof' of concept.

Whereas I believe it's helping them reduce the damage done BY the diabetes itself, ( the weight gain it imposes) that clears the path back to better health.

 

[Oldvatr]

There is a characteristic of T2D that is identifiable - Metabolic Syndrome. It is not FAT as in overweight , it is rolypoly fat round the midriff, which is where the main adipose tissue resides. I am TOFI, but I developed a wheat belly. My limbs and neck remained lean, But I was 18 stone, whereas I am now 10 stone;. Same legs. My midriff has shrunk from size 38 being tight to size 30 and needing braces (suspenders in US) coz otherwise my jeans would be round my ankles, which is not a pretty sight.

 

[Outlier]

Fantastic link, AloeSvea. Thank you.

 

[ChiswickRich]

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?

Peter - I had the same experience 3 months ago, cyclist, home cooked healthy meals and HbA1C of 42, although I was carrying a little more timber than yourself. Tweaked the carbs (not Keto), intermittent Fasting, bought a finger prick meter and numbers are improving.

 

[Melgar]

You need to re-read what was said.


It's rather an old fallacy prompted by many.

I'm sure most T2' s who have extra weight have heard that from family, friends & likely HCP's.

Are some people fatter without being type 2 diabetic.?..sure.

Are all type 2's fat .. definitely not.

So while I haven't read all of the excellent link from @AloeSvea .

I think there is enough evidence to make one question if type 2 itself could be what makes people fatter.

Many just attribute it to
Being older
A little less active

All points that maybe contribute,
But the underlying metabolic challenges is, I believe why those type 2's who are 'larger' ( as was I), are made so , by the illness, rather than by overeating.

Otherwise as you say , everyone 'larger' must be type 2.....and they are not

So it seems likely something else is at play.

The result, that reducing weight, helps those DX as type 2, return to better metabolic health is touted as 'proof' of concept.

Whereas I believe it's helping them reduce the damage done BY the diabetes itself, ( the weight gain it imposes) that clears the path back to better health.

Thanks for your reply. I'm sorry I misread your comment. You hear it all the time , don't you - T2 is caused by an inactive and over eating lifestyle. I'm normal weight and very active with T2. I've been an athlete and thin all my life. Go figure. So I'm searching for answers. I just bought Jenny Ruhl's recommended 'Blood Sugar 101' book.

 

[jjraak]

Thanks for your reply. I'm sorry I misread your comment. You hear it all the time , don't you - T2 is caused by an inactive and over eating lifestyle. I'm normal weight and very active with T2. I've been an athlete and thin all my life. Go figure. So I'm searching for answers. I just bought Jenny Ruhl's recommended 'Blood Sugar 101' book.

Agree fully...

It's a perception many have , that needs to change.

I got laid up last year, unable to mobilise or feed myself for a few months ...so I put on a few pounds.

If I used the perception of type 2, It's because I'm lazy & totally ignoring the underlying factors.


I came to find blood sugar 101 a good bit after I found the forum, so only read the blogs and what I could find online.

But by then Dr Jason fungs book "The Diabetes Code" was the first book I bought to read up on diabetes.

I like how he lays out some quite technical details in a easy to understand way.

Check the reviews.

Not sure it should be issued to all T2D's...but definitely should be pointed out as one to read, imho.

 

[Melgar]

Agree fully...

It's a perception many have , that needs to change.

I got laid up last year, unable to mobilise or feed myself for a few months ...so I put on a few pounds.

If I used the perception of type 2, It's because I'm lazy & totally ignoring the underlying factors.


I came to find blood sugar 101 a good bit after I found the forum, so only read the blogs and what I could find online.

But by then Dr Jason fungs book "The Diabetes Code" was the first book I bought to read up on diabetes.

I like how he lays out some quite technical details in a easy to understand way.

Check the reviews.

Not sure it should be issued to all T2D's...but definitely should be pointed out as one to read, imho.

Thanks @jjraak I will have a look at Dr Jason Fung's book too. I've checked out the Diabetes 101 website in the past, I loved it. Now I am reading her book. I'm so glad you posted that book reference.

 

[AloeSvea]

I also like the 'personal fat threshold' theory, a la Prof Taylor, and taken on by many, including the marvellous Dr Fung. It explains a lot, and is easily tested in N=1 experiments.

This links up with the... my recent difficult reading (you know - as in having to think), was referenced by the magnificent Ruhl...as in ancestral differences in expression of carbohydrate metabolic genes. I'm kind of on the hop today - off for some Saturday midday fun, but I will come back and reference it for other's ease, but it is in the article I posted of Ruhl's above.

I know that over the holiday period I was discussing tolerance to dairy (which absolutely has ancestral differences involved), and I was joking with my daughter's motherinlaw that as she was so dairy tolerant she would have had a lot of milkmaid's in her ancestry (as I do, which I benefited from in my tolerance to dairy), (and my daughter - absolutely!). She had never heard of this notion, which is strangely common I find. (Especially strange for a post-colonial society like this one - Aotearoa/New Zealand, which has the whole range of ancestral differences when it comes to metabolic health, and ill-health.)

Anyway, I have to beat it, but I will throw in one of my favourite metabolic differences quote - and that is Dr Robert Lustig - he is fantastic with stats, and one of his I like is that 80% of fat/overweight/whatever folks will have some kind of metabolic dysfunction (the full range - CVD and diabetes to mild metabolic syndrome for example), but 20% will remain metabolically healthy. I quote this to an old galpal of mine, who is clearly in the 20% range, and I give her lots of postitive reinforcement for it - and tell her to just sit back and enjoy it! (We are old enough now for the fact she is one of the 20% is very clear .) Oh to be carrying body fat and be metabolically well! Ah! But yes, it happens. Lucky dogs.

 

[sw600]

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




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.

Thanks for the link. I read through Jenny's website, I was initially concerned because usually when you see a 'what doctors aren't telling you' then it's some quack pseudoscience, moreso when they start banging on about toxins. However it seems that this person is able to read scientific studies and draw sensible conclusions from them, from the limited number of references I followed up, so I'm assuming it's trustworthy.

I found some bits very interesting, and indeed there is a page on what 'normal' looks like. However I still couldn't find much on what athletes might expect. I did some more random googling though and discovered this:

<I can't post links it seems, but search on the US National Library of Medicine site for PMC5094325>

This is right in my sweet-spot, investigating sub-elite athletes (emphasis on SUB in my case). My numbers (vo2 max, resting HR etc) are not much higher than those. Anyhow:

4/10 athletes studied spent more than 70% of the total monitoring time above 6.0 mmol/L even with the 2-hour period after meals is excluded. Fasting BG was also in the ADA defined prediabetes range for 3/10 athletes. Only 1 participant spent substantial time below 4.0 mmol/L which was largely due to significantly lower energy intake compared to recommendations. [my emphasis]

Contrary to expectations high BG appears to be more of a concern for athletes then low BG even in those with the highest energy expenditure and consuming below the recommended carbohydrate intake. This study warrants further investigation on the recommended diets and the BG of athletes to better determine the causes and impact of this hyperglycemia on overall athlete health.

That's interesting. Matches my experience. It's only a small study though so I will have to see if there is something a bit more statistically significant somewhere.

 

[Oldvatr]

Thanks for the link. I read through Jenny's website, I was initially concerned because usually when you see a 'what doctors aren't telling you' then it's some quack pseudoscience, moreso when they start banging on about toxins. However it seems that this person is able to read scientific studies and draw sensible conclusions from them, from the limited number of references I followed up, so I'm assuming it's trustworthy.

I found some bits very interesting, and indeed there is a page on what 'normal' looks like. However I still couldn't find much on what athletes might expect. I did some more random googling though and discovered this:

<I can't post links it seems, but search on the US National Library of Medicine site for PMC5094325>

This is right in my sweet-spot, investigating sub-elite athletes (emphasis on SUB in my case). My numbers (vo2 max, resting HR etc) are not much higher than those. Anyhow:



That's interesting. Matches my experience. It's only a small study though so I will have to see if there is something a bit more statistically significant somewhere.

This may be of interest to athletes

Impact Of Ketogenic Diet On Athletes: Current Insights

The impact of a ketogenic diet (KD) (<50 g/d carbohydrate, >75% fat) on athletic performance has sparked much interest and self-experimentation in the past 3–4 years. Evidence shows 3–4-week adaptations to a KD in endurance-trained ...

www.ncbi.nlm.nih.gov

And for a laugh

You Won't Believe What Sport Stars & Celebs Eat LCHF & Ketogenic Diets

A lot of misinformed people will tell you otherwise but these famous Low Carbers prove that LCHF and Ketogenic Diets are Performance Enhancing

www.myketokitchen.com

(not sure about the veracity of this latter article)

 

[sickasapig]

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".

yes that great advice , i have been using my wifes old glucose monitor from when she had gestational diabetes from her last pregnancy, (yes i am an old dad lol ) you can get a libra 2 , 2 week monitor for free at the moment to better understand what foods spike you for free on the website

 

[Steveee]

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?

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?

Hi, the thread seems to have drifted off your original question of ‘why I am showing signs of developing diabetes….?’ TBH it’s a difficult question to answer just based on a single test result.and really down to an endocrinologist to investigate. From what you say you’re doing all the right things but for some it’s just bad luck! Some people are diagnosed as type 2 when adults but are actually a subtype of type 1 caused by an autoimmune condition aka LADA, or have a condition called MODY caused by a gene mutation. Both can be tested for if your HbA1c drifts into a level you have a diabetes diagnosis. It’s imortant to get the diagnosis right. If they are the diagnosis, both are treatable but in different ways.
It is important to get your HbA1c checked regularly, as long term higher than normal bg levels can cause complications we all want to avoid.
Just to give you assurance, diabetes (if controlled) isn’t a life limiting condition. I’ve been diabetic (Type 1) for over 50 years and have managed my HbA1c down to 46 mmol/L avoiding any associated health conditions.

 

[Melgar]

I wonder how many athletes test their blood sugars, or how many Dr's request an HbA1c for anyone under 50 who is an athlete. When I was running I didn't even think about my blood sugars. Maybe that was my bad. I focussed on carbs in general of course. Carbs in the context of slow release and sustained energy. I never questioned or even considered whether my blood sugars were too high or too low. I tested my heart rate, my resting heart rate, and how quickly my heart rate returned to homeostasis. I monitored my BP, but never my blood sugar. Maybe International athletes get their BG's monitored. So my point is do we damage are BG systems by carb loading?

 

[Oldvatr]

I wonder how many athletes test their blood sugars, or how many Dr's request an HbA1c for anyone under 50 who is an athlete. When I was running I didn't even think about my blood sugars. Maybe that was my bad. I focussed on carbs in general of course. Carbs in the context of slow release and sustained energy. I never questioned or even considered whether my blood sugars were too high or too low. I tested my heart rate, my resting heart rate, and how quickly my heart rate returned to homeostasis. I monitored my BP, but never my blood sugar. Maybe International athletes get their BG's monitored. So my point is do we damage are BG systems by carb loading?

it is not proven that carb loading is to blame. We do know from personal experience that a low carb diet is a means of controlling blood sugars. There is some evidence that some athletes use low carb diets, and / or ketogenic diets with success.

Someone with pre diabetes is at increased risk of developing full blown diabetes, and should consider taking risk management actions to avoid that. Reducing carb intake may be suitable. But it is not mandated. Its a relatively easy choice though.

 

[Oldvatr]

Like @AloeSvea I too found Jenny Ruhl to be an informed source of information. I have her book on the shelf near me as I type.

 

[saky]

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

Am borderline. I too run half marathons but i was eating lots of carbs and junk. I was overweight but lost weight eventually. I severely restrict my carbs and try to eat more veggies, fibre , protein, fat etc. Still in borderline range. Social media does say it can be reversed but it can't be for most diabetics. It progresses for most diabetics.

 

[ajbod]

If you eat a "healthy diet", and follow the recommended medical advice. Then yes most diabetics will get progressively worse.