Terminology

[geekesse]

I was diagnosed with pre-diabetes last year. I did all the right things, lost a lot of weight, and dragged my HbA1c down to just within the normal range. Doc is pleased, says I’ve ‘reversed’ diabetes so I no longer have a problem.

It seems to me that there’s some woolly thinking going on, though. What is the difference between a ‘diabetic well controlled by diet’, ‘not diabetic’, ‘not diabetic but insulin resistant’ etc? The HbA1c seems like a clumsy tool, since it’s not measuring how well the body handles carbs in general, but just how well an individual has balanced their intake of carbs with insulin production/effectiveness. So a non diabetic who puts away rice, pasta and potatoes but metabolises them effectively can get the same HbA1c as a diabetic who cuts carbs ruthlessly to balance lack of insulin or insulin resistance.

I can only maintain good levels of control if I eat a very carb-restricted diet. If I eat, for example, even moderate amounts of pizza, rice, pasta - all quite normal foods with carbs - my blood sugar shoots up two hours after a meal, and is really slow to come down. That tells me I’m not ‘non-diabetic’, just jolly careful about what I eat.

Am I just overthinking, or do I have a point?

 

[Antje77]

Am I just overthinking, or do I have a point?

You completely have a point.
Non diabetic numbers doesn't equal cured.

It does mean very well controlled though, and it also means that chances of diabetic complications in the future are way reduced. Well done, and keep it up!

 

[Zhnyaka]

Healthy people can eat as many carbohydrates as they want and their pancreas will cope with this with a small amount of insulin and in a fairly good time.

If a person develops insulin resistance, it's not diabetes yet, it's just that he needs more insulin produced by the pancreas to digest carbohydrates.

Diabetes begins when the pancreas stops coping with the amount of carbohydrates that a person eats. That is, in order to absorb the necessary amount of carbohydrates, you need more insulin than the pancreas can produce.

In the case of diet-controlled diabetes, a person reduces the amount of carbohydrates so that his pancreas can cope with it and in fact his BG will be the same as in healthy people. Since insulin is the cause of insulin resistance, in this case the pancreas will produce less insulin than before and resistance may decrease.

But it may be that insulin will still not be enough to keep BG normal, in which case medications are prescribed. Some of them can reduce insulin resistance, some can make the pancreas produce more insulin than before. If this is not enough, insulin is prescribed.

Glucose in your body is taken not only from the carbohydrates that you eat. This is the main fuel of the body and without it your brain simply will not work so your body will get glucose in any case, but without insulin it will not be absorbed.

If you're wondering what type one diabetes is, then in this case the human immune system goes crazy and kills the pancreatic cells that produce insulin. Whether a person has insulin resistance or not does not matter (basically ihe has not)

 

[geekesse]

Healthy people can eat as many carbohydrates as they want and their pancreas will cope with this with a small amount of insulin and in a fairly good time.

If a person develops insulin resistance, it's not diabetes yet, it's just that he needs more insulin produced by the pancreas to digest carbohydrates.

Diabetes begins when the pancreas stops coping with the amount of carbohydrates that a person eats. That is, in order to absorb the necessary amount of carbohydrates, you need more insulin than the pancreas can produce.

In the case of diet-controlled diabetes, a person reduces the amount of carbohydrates so that his pancreas can cope with it and in fact his BG will be the same as in healthy people. Since insulin is the cause of insulin resistance, in this case the pancreas will produce less insulin than before and resistance may decrease.

But it may be that insulin will still not be enough to keep BG normal, in which case medications are prescribed. Some of them can reduce insulin resistance, some can make the pancreas produce more insulin than before. If this is not enough, insulin is prescribed.

Glucose in your body is taken not only from the carbohydrates that you eat. This is the main fuel of the body and without it your brain simply will not work, since the body will get glucose in any case, but without insulin it will not be absorbed.

If you're wondering what type one diabetes is, then in this case the human immune system goes crazy and kills the pancreatic cells that produce insulin. Whether a person has insulin resistance or not does not matter (basically it does not exist)

Yep! I already knew all that. I was married to a T1 and my mum had LADA.

 

[lovinglife]

Great explanation @Zhnyaka

 

[KennyA]

I was diagnosed with pre-diabetes last year. I did all the right things, lost a lot of weight, and dragged my HbA1c down to just within the normal range. Doc is pleased, says I’ve ‘reversed’ diabetes so I no longer have a problem.

It seems to me that there’s some woolly thinking going on, though. What is the difference between a ‘diabetic well controlled by diet’, ‘not diabetic’, ‘not diabetic but insulin resistant’ etc? The HbA1c seems like a clumsy tool, since it’s not measuring how well the body handles carbs in general, but just how well an individual has balanced their intake of carbs with insulin production/effectiveness. So a non diabetic who puts away rice, pasta and potatoes but metabolises them effectively can get the same HbA1c as a diabetic who cuts carbs ruthlessly to balance lack of insulin or insulin resistance.

I can only maintain good levels of control if I eat a very carb-restricted diet. If I eat, for example, even moderate amounts of pizza, rice, pasta - all quite normal foods with carbs - my blood sugar shoots up two hours after a meal, and is really slow to come down. That tells me I’m not ‘non-diabetic’, just jolly careful about what I eat.

Am I just overthinking, or do I have a point?

You do, and I agree with your point. Almost every "non-diabetic" person will have a BG somewhere between 38 and 42 mmol/mol (see the attached graph). My personal view is that if your BG is higher than 42 you need to be taking action long before it reaches the >48 diagnostic backstop. I had a good number of unpleasant diabetic symptoms while my BG was in the low and mid 40s, but was firmly told I wasn't diabetic, becase my blood glucose wasn't high enough.

As you say, it doesn't follow that having an A1c in the 38-42 range means you're non-diabetic. Mine has been 38 or below for three years now. I am still diabetic. I control it by diet, which boils down to not eating carb, but I am sure that if I went back to eating carbohydrate as I used to my long-term BG would start to rise again, because my insulin system does not and would not cope .

My practice classes me as "well-controlled in remission", because I've had no >48 HbA1c result in the previous 12 months and taken no glucose lowering medication in that time. You'll see many other looser definitions of "remission" being used.

 

[In Response]

I have Type 1 but my HBA1C puts me as pre-diabetic and the comment next to my results say I am "at risk of diabetes"

I think the issue is the attempt to put a label on something.
I don't care whether the label says I am pre-diabetic, Type 1 or anything else. What I care about is that I get the treatment I need which is insulin.

 

[Antje77]

I have Type 1 but my HBA1C puts me as pre-diabetic and the comment next to my results say I am "at risk of diabetes"

Don't you love those automated messages!

 

[Lamont D]

You do sometimes have to be aware that these labels, actually are just a way of explanation that doesn't actually give a true diagnosis.
What I mean is that, even though, I could be described as non diabetic, doesn't mean I am not prone to glucose/insulin imbalance as does a T2.
It depends on how tolerant you are to certain foods and or how you body copes with too much glucose/insulin and your hormonal responses with day to day life. Other hormones and your gut are so important to how you got here.
Being T2, could be so different to other T2s!
A healthy lifestyle is definitely not a healthy diet for a certain number of us!
So called Healthy food are not healthy for me!
I have normal fasting levels, I have normal hba1c, healthy normal foods would make me very ill.
Put a label to describe this? Other than being hypoglycaemic!

Best wishes.