Pre diabetes & Thin

[Trevenwith]

I was astounded to have an HbA1c of 42, thus putting me into the range of pre-diabetes. However, my BMI was only 19, so having worked at reducing my carbs I have lost weight which brought down my BMI to 17. My HbA1c returned to normal (37) but what to do now? I do not want to lose more weight (it was making me feel unwell also), and I cannot find any information for pre-diabetes for thin people.

 

[DCUKMod]

I was astounded to have an HbA1c of 42, thus putting me into the range of pre-diabetes. However, my BMI was only 19, so having worked at reducing my carbs I have lost weight which brought down my BMI to 17. My HbA1c returned to normal (37) but what to do now? I do not want to lose more weight (it was making me feel unwell also), and I cannot find any information for pre-diabetes for thin people.

Gosh, you have got ultra slim! Do you get hungry at all?

In order to stop the weight loss, I would suggest you try a couple of things, however, it would also be useful to know how quickly you are losing weight. Is is a slow creep down or are you losing quickly?

When I got to be trim (OK, I'd been diagnosed with T2), whilst following a low carb diet, the first thing I did was just have slightly larger portions than usual. That wasn't enough for me to stop losing.

Next I upped my protein intake a bit, until I didn't want the portions to be as big as they were becoming. Next, I tried a few extra nuts, then finally, I upped my fats, and managed to stabilise. I've maintained since then, which is now almost 3.5 years.

Many folks just go straight for upping the fats, but that wasn't my choice.

Whatever you do, don't change any more than one thing at a time, or you could end up not knowing what works and what doesn't work.

 

[Juicetin]

More healthy fats, nuts, seeds, avocados etc plus things like butter and cheese in moderation. Bigger portions too. BMI of 17 is very low.

 

[Salvia]

Hi @Trevenwith, and welcome. DCUKMod has outlined a good approach for you to plan how you might want to go about increasing your weight. For me I found that dairy was the key; too much and no weight loss because of the high calorie content. Assuming you are ok with dairy you could try increasing your use of cream, full fat milk, eggs, cheese, etc. Snacks of nuts like walnuts, almonds, cashew, are also fairly calorific. Perhaps keep your exercise levels up as well, though, to stop weight simply turning to flab around the middle.

Good luck, and please just ask if there are any other questions. There is usually someone around who can help. In the meantime I'll tag @daisy1 who has some really useful info for new members.

 

[daisy1]

@Trevenwith

Hello Trevenwith and welcome to the Forum Here is the Basic Information we give to new members and I hope it will be useful for you. Ask as many questions as you need to and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 250,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.

Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.

 

[AloeSvea]

Yes @Trevenwith - healthy fat will give you a calorie punch, but won't affect your blood glucose. Win, win.

Eating nuts? (Especially if you are dairy intolerant, which is not uncommon after all.) My thin partner Mr Svea would waste away if it wasn't for peanuts. (Naturally thin, along with all his family of origin members.)

My daughter is thin/slender like you, but is watching her carb intake for diabetes prevention, because of me. I ply her with cheese, and cream, and cake made from nut flours (which certainly pack a calorie punch). (If she wasn't a vegetarian, I would ply her with pork fat slices!) (Good quality pork of course.) We put lots of olive oil on salads, which is a good source of healthy fat. I am very grateful for camembert and brie. All low-carb high-healthy-fat food.

 

[ringi]

First question is what "race" are you, as Type2 seems to develop differently in people from the far east.

 

[Glink]

We are the minority but we are here. It is frustrating to read all this advice that was meant for the majority of prediabetics and not know what applies to you or not, I know.

Are you still losing weight, or did you just lose to a certain point and then stop? If the latter, is this a point that has ever been your "normal" or do you feel underweight for you?

Have you read about LADA/type 1.5? You may be at risk for that rather than type 2.

YMMV, but for me exercise (building heavy muscle) and eating protein help bulk me up a bit and when I don't exercise I get skinnier.

You may be able to eat a little more carb than you have been without ill effects, too--not sure how dramatic your dietary changes have been.

 

[azure]

@Glink has just mentioned it, but is there any possibility you could be slow-onset Type 1 @Trevenwith ?

 

[Glink]

Also wondering--was your prediabetic reading based on a single test? If so, it may be possible that it was wrong, or an anomaly (e.g., high because you were fighting an infection or some other stressor).

 

[Trevenwith]

Thank you all for your helpful comments. I have lost the weight steadily over 5/6 months. Since a review with GP have reintroduced some carbs and increased healthy fats, and am feeling better.. Due to have HbA1c done again in October. Diet has definitely improved in relation to veg/pulses - so will wait and see. I am white/British and there is no family history of diabetes.

 

[Alexandra100]

I was astounded to have an HbA1c of 42, thus putting me into the range of pre-diabetes. However, my BMI was only 19, so having worked at reducing my carbs I have lost weight which brought down my BMI to 17. My HbA1c returned to normal (37) but what to do now? I do not want to lose more weight (it was making me feel unwell also), and I cannot find any information for pre-diabetes for thin people.

Hello everyone, I'm SO glad to read this post, as I have a similar problem to Trevenwith and I have been struggling to find any advice for people who DON'T need to lose weight! At age 75 I am actually pre-pre-diabetic with an HbA1c of 41, up from 40 a year ago. As this is going in the wrong direction, I want to turn things around now, rather than waiting for a possible 42 in 2018. I was extremely shocked to get this reading as there is no history of diabetes in my family and I exercise hard and regularly, running, walking and resistance training. I already eat a healthy diet, except that it has been heavy on fruit and dark chocolate. For years my weight has been gradually falling without dieting and my BMI is now 16.5, so I really don't think I should lose any more weight. I can't eat lots of cream and cheese as I also have slightly high cholesterol - 5.5 total, 2.1LDL, 2.6HDL. I have been used to consuming small fast acting sugary snacks during and after exercise and I am concerned that this may be causing big swings in my blood glucose, but if I just stop it I may be causing hypos. I am wondering about buying a glucose monitor to see exactly what happens around meals, exercise and various foods. Any advice would be extremely welcome.

 

[ringi]

There is a chaptor in The Art and Science of Low Carbohydrate Living about this, you have to learn to accept that "fat is my freind". Maybe also some resistance training as is used for body building but with ligher weights.

 

[Alexandra100]

Thanks, Ringi, but I am already doing resistance training 2-3 times a week. It is depressing to read about people turning their diabetes around by adopting healthy exercise, when I am already doing that. As for "fat is my friend", I am currently eating more peanut butter, and oily fish daily, but I can't face sardines more than once a day! As I am also dealing with raised cholesterol I am reticent about eating saturated fats. Whether to eat saturated fat seems to me still pretty controversial. The British Heart Foundation has not yet abandoned their advice to avoid it. Has anyone ever suggested that one can lower one's LDL by reducing carbs?

 

[Jo123]

I was prediabetic but now normal, just had an hba1c of 35. I had the problem of losing weight so I increased my 'healthy' fats like nuts, extra Virgin olive oil and limited amounts of saturated fats, but my fat intake of saturated and unsaturated is above the recommended level. I now maintain my weight easily.
Interestingly I have just had an angiogram (due to chest pain and the enzyme specific to heart muscle damage raised) and my arteries are absolutely perfect!!

 

[ringi]

Google for "cholesterol low carb donwunder" and watch some of the talks. The worce type of LDL can be controled very well with low carb, but a lot of the standard tests pretends that all LDL is the same.

(I have got my LDL down from "too high for the to measure" into the normal change within 8 week with low carb.)

 

[Alexandra100]

Thanks Jo and Ringi, very interesting, it's a relief to find there are some ways forward.

 

[Kailee56]

Hello everyone, I'm SO glad to read this post, as I have a similar problem to Trevenwith and I have been struggling to find any advice for people who DON'T need to lose weight! At age 75 I am actually pre-pre-diabetic with an HbA1c of 41, up from 40 a year ago. As this is going in the wrong direction, I want to turn things around now, rather than waiting for a possible 42 in 2018. I was extremely shocked to get this reading as there is no history of diabetes in my family and I exercise hard and regularly, running, walking and resistance training. I already eat a healthy diet, except that it has been heavy on fruit and dark chocolate. For years my weight has been gradually falling without dieting and my BMI is now 16.5, so I really don't think I should lose any more weight. I can't eat lots of cream and cheese as I also have slightly high cholesterol - 5.5 total, 2.1LDL, 2.6HDL. I have been used to consuming small fast acting sugary snacks during and after exercise and I am concerned that this may be causing big swings in my blood glucose, but if I just stop it I may be causing hypos. I am wondering about buying a glucose monitor to see exactly what happens around meals, exercise and various foods. Any advice would be extremely welcome.

Alexandra100, I am 60 and the 3rd generation to be a "thin" diabetic 2. I realized this when my thin sister was diagnosed and, since I already followed my ketones, decided to get some glucose strips. When I first started tracking, I found that if I had a high carb meal it took 3 days, including a 24 hr fast, for my glucose to get below 100 in the USA or 5.6 in the rest of the world. I have been shocked at what increases my glucose. I definitely find benefit to following my glucose levels. If for no other reason than having evidence that many items advertised for diabetics totally spike my glucose level. I have also found that vigorous exercise, like brisk walking in hot weather, will spike my glucose level quite high while working with weights or putting up hurricane shutters only spikes it a little

FYI: My BMI is 19-20, I have a pre-diabetic HgbA1c and high serum glucose, after almost 2 years of low carb with 1 cheat meal/week, combined with the lowest "normal" insulin level and high insulin sensitivity, according to the lab. I guess that puts me in the 1.5 category. Since your weight was already decreasing, you might want to ask your physician about testing your insulin response, not just your blood glucose. Since 1.5 can present as a thin type 2, but with low insulin levels as opposed to high insulin resistance, it is a thought.

 

[Trevenwith]

Hello Everyone, I am back. Having reintroduced some carbs, feeling better and weight stable - BMI still around 17. HbA1c has slipped upward though - now 40. I have taken it upon myself to test my before and after meal blood sugars. Has anyone else found that PEANUT BUTTER has a disastrous affect?!! I buy it from health food shop - it is delicious - and is made in the shop without any additives. My understanding was that peanut butter had a low GI load!

 

[Guzzler]

Hello Everyone, I am back. Having reintroduced some carbs, feeling better and weight stable - BMI still around 17. HbA1c has slipped upward though - now 40. I have taken it upon myself to test my before and after meal blood sugars. Has anyone else found that PEANUT BUTTER has a disastrous affect?!! I buy it from health food shop - it is delicious - and is made in the shop without any additives. My understanding was that peanut butter had a low GI load!

Peanut butter has that exact effect on me. However, I started to have the occasional teaspoon after a meal to help with satiety and it didn't spike me. A peanut butter sandwich however is a thing of the past.
Glad you're feeling better.