A strange diagnosis

Hello,

I'm Dragan from Croatia. I'm slim (70kg/184cm) but not very active, mostly sitting and working at my computer but doing cardio about 2 times a week (sometimes every day when i have time). I eat normally and I usually have very plentiful late dinners, right before bedtime (sometimes at 11-12 PM). When I exercise, I do it on empty stomach in the morning.

As I was checking my blood about once a year for the past few years, I've noticed that my blood sugar number is getting higher and higher each year. Then it was measured 6 mmol/l last year so I went to see an endocrinologist in December 2017. He ordered some blood tests and here are the results (bloodwork done after fasting for 12 hours):

HbA1C: 5.4% (Normal: 4.0 - 6.2 %)

Lipids:
Cholesterol: 4.61 mmol/l (Preferable: 0-5)
HDL: 1.73 mmol/l (Preferable: > 1,5)
LDL: 2.67 mmol/l (Preferable: 0 - 2.5)
Triglycerides: 0.47 mmol/l (Preferable: <1.7)
Atherosclerosis index: 1.54 (Normal value: <3.0)
Risk factor: 2.66 (Normal value: <5.0)

Thyroid hormones:
FT4: 19.36 pmol/l (Normal: 12 - 22)
TSH: 1.55 μIU/ml (Normal: 0.4 - 4)


OGTT, 2 hours, 75g of glucose:

Time____________Glucose (mmol/l)________________Insulin (μIU/ml)
0'__________________ 6.01 ___________________________ 5.39
30'_________________10.90 ___________________________47.97
60'_________________11.25 ___________________________87.95
90'__________________7.06 ___________________________46.27
120'_________________5.91 ___________________________24.41

Please let me know if I should convert these to other units. In Croatia, we use these units.

I've made the charts for easier reading:






So, after seeing the results, my doctor ordered the anti GAD test which came out negative.

He told me that the results are not quite normal, but not diabetes either. That I'm right at the very edge (of prediabetes?).
He diagnosed me with something that would be "increased fasting glycemia" when I translate it to English as a layman.
he prescribed Glucophage (Metformin), told me to eat healthy, not to eat after 7pm and exercise more. I should get back to him with HbA1C and OGTT for control in one year.

Now, I didn't start with metformin right away, I wanted to inform myself and read about the condition to see if something could be done without tablets. But I'm only getting more and more confused because I'm very slim and all the advice is mostly for people who can afford to lose weight. Does the doctor suggest that I'm on my way of becoming a Type2? Do my OGTT insulin measurments and a negative anti-GAD definitely suggest that I'm not developing Type1?

Please share your thoughts. Should I buy a glucose meter and measure my levels throughout the day. If so, do you know of a guide as to when should I take measurements and how to interpret them? That is, what should my goal be?

Thank you very much for reading and helping out!

Thank you very much everyone for taking time to read and reply!

@Bluetit1802 Regarding reasons, he said that I'm on a very very edge of what's normal. I believe he meant the edge between normal and prediabetic? He also mentioned that my insulin levels should have gone to a lower value after 2 hours.

@catapillar Yes, I'm paying him privately but he told me to come for control after one year. So, I thought if he'd want to get more money from me, he'd tell me to come sooner and more often.

One thing I didn't mention are my fasting blood glucose results from previous years which are:
2014: 5.31
2015: 5.68
2016: 5.62
march 2017: 6.05 (this is when they told me I should see an endocrinologist)
dec 2017: 6.01 (the test from my first post)

There is somewhat of a general upwards trend but I thought it's not something to worry about too much.

I also didn't say my age which is 39.

@Bluetit1802 , you mentioned stress. The test didn't start well, the nurse didn't put the cannula in my vein correctly, so there was some strange reaction where the vein had a spasm and didn't let the needle in. I was in cold sweat and some strange feeling of fury overwhelmed me, narrowing my field of vision. I've never experienced anything like it. We waited a bit for me to calm down and tried the other arm after a few minutes which went just fine. Could that stress have raised my blood sugar so fast, that is, in a few minutes? If so, that initial glucose measurement of 6.01 could be wrong.

I understand you're not doctors, but your comments confirmed that I'm right to have doubts about taking the therapy. Thank you very much. I should ask for an opinion of another endocrinologist I guess.

Thanks @Bluetit1802 , yes I was thinking about that. But I didn't know what to aim for and when to test so I thought if there's a guide. Okay, so I should find food that doesn't rise my blood glucose more than 2mmol/l after 2 hours.

Is there any advice on when is the best time to exercise? Is it ok that I exercise on an empty stomach first thing in the morning as it delays breakfast? I thought that might be raising my glucose in the morning because maybe my body is expecting the exercise so it gets prepared by raising glucose for energy? I'm not sure if that works that way

Or is it best to exercise after the largest meal?

Sorry, I'm swamping you with questions. If you know of a good online guide please let me know. That's what I was looking for all over, but all I've found is "lose weight" advice. And I'm already very slim, always have been, and I actually always struggle to gain weight. I've managed to gain about 5kg in the last 2 years and was really happy about it and now it seems I have to lose it I'll look like a strawman.

@Alison Campbell Thank you for taking time to help out. If you don't mind me asking, what is your FBG now, 6 years after diagnosis?

Yes, I've stopped eating after 7PM, but now I'm only eating two times a day. I'll try to reorder my breakfast and lunch times as well so as to have 3 meals.

And thank you for the link. Now, in the link it says: A truly normal A1c is between 4.6% and 5.4% and my result is exactly 5.4%. So it seems that's another value that's right at the upper limit.

I've also researched a bit, looking at OGTT curves online and I think I found out what my doctor found suspicious. Turns out that glucose shouldn't go above 10mmol/l during OGTT, which is something called renal threshold. I've only researched this for past two hours so I'm not sure. Anyways, my OGTT shows values above 10mmol/l at 30 and 60 minutes.

I've decided to buy a glucose meter and a treadmill

As for the low carb diet, I never really was a fan of carbs. I never liked sweets, even as a kid. I don't like bread or rice. I even can't eat ketchup and various sauces from a supermarket because I find them too sweet. I just buy pressed tomato and make my own ketchup So avoiding carbs should be fairly easy, just limiting potato, pasta and fruit I guess.

I just hope I'm not being misdiagnosed and actually developing Type1. I've learned that there are more autoimmune tests that should be done for Type1, not only anti GAD. Like Islet Cell Cytoplasmic Autoantibodies (ICA), and Insulin Autoantibodies (IAA).

@DCUKMod Thank you for info. I've googled "first phase insulin response" and found a bunch of new information.

@jadeashton24 Thank you for being reassuring. I hope you're right and that this is not the beginning of something. I so hope scientists will find a cure for diabetes soon and make it a thing of the past. I feel a bit embarrassed that I've come here freaked out by my doctor and test results which are nothing compared to what people with diabetes have to go through.

Thank you @Bluetit1802 and @Alison Campbell . Alison, so your FBG remained almost the same as it was in 2011. Seems like you've stopped the progression.

@kokhongw That's what I've also found today by using google image search My graphs are similar to the Pattern 3 graph in that paper. I mostly differ from that pattern in that my levels come back down more after 2 hours. They say that Pattern 3 patients had a higher chance of developing diabetes than patterns 1 and 2, but patterns 4 and 5 are at the most risk.

I'll definitely buy a measuring kit and take frequent measurements for a week to see what more data will show.