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Advice, please.

G

GaryL-1957

Member
Messages
6
Type of diabetes
Prediabetes
Treatment type
Diet only
Hi,
I'm new to the forum, and to diabetes. I need some advice but before asking for that, I'm sure it would be useful if I gave my related background.
I'm a 66-year-old runner: I've always run and still run competitively, to something like county level.
Probably at least partly as a result, I've never been over weight, or really had any health problems. I hardly drink, smoked only briefly in my youth and have had a broadly healthy diet, although I have eaten a lot of cakes and puddings!
At the behest of friends and my wife, (knowing that I have that sweet tooth), I tried a continuous glucose monitor (CGM) about five years ago. It was clear even then that I am a 'spiker' but my doctors advice was that there was nothing to worry about as my HbA1c was within the acceptable range.
I had another go with a CGM a few months back and it showed that my general blood glucose levels had increased, both spiking after food but also when fasting. A repeat of the HbA1c test has confirmed that I've just gone over into the pre-diabetic range (at 6%).
Since then, so for the past two months, I've been following a low-carb diet. Over that time, I've lost about 3 kg; my current BMI is 21.6.
I had been hoping that the diet would have resulted in me having improved control of my blood glucose so I've started another round of using a CGM. Very disappointing! I actually seem to have deteriorated. For example, I had what would seem to be a good low-carb lunch of avocado and bacon (albeit on a small piece of toast, but even then only totaling 37gm of carbs, according to Cronometer) and my blood glucose rocketed up to a peak of 12.4mmol/L, and stayed generally high for a couple of hours (and even now is at 6.7).
So I need advice on how to control my blood glucose levels. Am I going to have to reduce my carbs intake further? Do I need to consider medication? Any other suggestions?
Many thanks for any responses.
Gary
 
66 year old footballer here.

I think you might benefit from doing a set of BG tests around various foods, keeping a food and activity diary and recording your levels. You might start seeing exactly what's going on. CGMs are great at showing you patterns and changes over time but can suffer from some accuracy issues: it's usually recommended that you check them against fingerprick tests. CGMs don't measure blood glucose directly while fingerprick testing does.

It could be (for instance) that you're particularly bad at dealing with bread carbs - I have that problem with bith bread and pastry, but I can tolerate carbs from legumes pretty well.

The other thing is that many things affect blood glucose other than food. Exercise, stress, outside temperature, illness - those sorts of things over which you have little control - see attached link

42 Factors That Affect Blood Glucose?! A Surprising Update

Adding 20 new factors, a whole new category on behavior and decisions, and research on unexpected things that impact blood sugar and diabetes
diatribe.org
 
Ditch the toast and your lunch wouldn't have had a noticeable effect. Spikes in themselves are not the problem. The problem is once Insulin resistance rears it's head, the levels drops too slowly, that is the problem. That is why your Hba1C is now at pre diabetic levels. This is why many of us reduce our carb intake to the point that the spike is low enough, that our Insulin response can cope with it. With the reduced amount of Insulin needed, this allows some improvement in Insulin sensitivity.
We are all unique, and the level we need to drop our daily carb intake to can range from below 20g to as much as 150g. The only way to find out is to test pre meal before the first bite, and 2 hours later, to gauge the result. As long as the rise is no more than 2mmol and below approx' 8mmol. Then that meal was fine, this way you can weed out the offending foods, and will find your daily level of carb intake.
 
Everybody's BG spikes after eating carbs. The pancreas doesn't start responding (producing insulin to reduce BG) until the BloodGlucose is high enough to be reduced.
A BG at the 2hrs after first bite mark, of around what it was before eating is the response of a normal non-diabetic so without knowing what it was just before you started eating, your BG may actually be better rather than worse.
The approach I used to get me from fully T2 to being in non-medicated remission is described in this blog post by one of our members:

The Nutritional Thingy

There’s a few things you should know. 1. Practically all carbs turn to glucose once ingested , so not just straight sugars, but starches...
josekalsbeek.blogspot.com
 
GaryL-1957 said:
I had what would seem to be a good low-carb lunch of avocado and bacon (albeit on a small piece of toast, but even then only totaling 37gm of carbs
Click to expand...
Something seems to be off with your carb count here, or you had a very large piece of toast.
Avocado has about 3.8 grams of carbs for the whole thing on average, carbs in bacon should be negligable at 0.5-2 grams of carbs per 100 gram.
Where does the 37 grams of carbs come from?

Whatever the actual carb count, would you have liked your meal without the toast, or with substituting something for the toast?
How long after eating did you spike, and what as your number before eating and two hours later?
 
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You've had some really good advice and insights so far, so I won't repeat those.

However, picking up on @Antje77's post, some low carb bread options (should you want them):

Bread - Livlife, available from Waitrose. 3.4g carbs per slice (regular bread of any type is 15-25g of carbs per slice at best). Sure, the slices are small and it's £2 for a small loaf, but it's higher protein and fibre than regular bread and 2 slices accompanied by fats/protein have no impact on my BG readings. Toasts well, freezes well too.

Rolls - I personally use https://handcraftedbread.co.uk/product/low-carb-bread-rolls/

Pizza bases - https://handcraftedbread.co.uk/product/low-carb-pizza-base-pack-of-4/

Sausage rolls - https://ketoroma.com/products/keto-sausage-rolls

Sweet treats - https://ketoroma.com/collections/cake-cheesecake-slabs (tried a couple of these products, they're a good supplier with decent low carb "sweet" options in my opinion - useful for special occasions like birthdays/Christmas).

Ketoroma have a limited production capacity, so don't be discouraged by "out of stock" items, just check back later. Also, credit goes to @MrsA2 for recommending this supplier to me.

Other commonly recommended suppliers of low carb bakery are:

Low Carb Treats | Low Carb | Deliciously Guilt Free

Deliciously guilt free, low carb desserts. Satisfy your sweet tooth with low carb cakes that taste like heaven. Low carb doesn't have to mean low on taste!
deliciouslyguiltfree.com

Diabetes friendly, Low Carb & Keto Fresh Bakery

Discover the delicious and healthy world of SRSLY's keto bakery. Indulge in low-carb, diabetes-friendly breads that are packed with flavor and quality ingredients.
srslylowcarb.com

I haven't tried these two suppliers, but others on here have and report a good experience.

Edit: Just to add that I don't have any affiliation to the suppliers in this post and I'm not incentivised by them in any way.
 
Last edited:

Hi,
No advice from me , I’m only a novice but I will share with you my experience.
We are similar ages , I’m 66 next birthday. I had a warning of raised BG some years ago , I stopped drinking beer and that sorted it. Unfortunately over time I lapsed and was pre diabetic at a test in July.
This time I took it seriously and cutout all pasta, rice, pastry and once again beer.
I also used a CGM , I used it to formulate a list of good and bad foods ( it proved pastry spikes me badly but beans are no problem for example)
So over a period of a few weeks I managed to formulate a diet that was varied but did not spike my BG.
Right now I’m not using a CGM ,!there is no need as I’m not consuming anything that will cause a spike. I do have one put by, I’m going to use it in January when I’m due another A1C test. I’m expecting/ hoping for a result of around 5.5.
BTW I was / am overweight but ( without really trying) I’m losing a pound a week. In a few weeks time I hope to be close to 25 BMI and I’ll embark on a C25K. Oh my


Merry Christmas!
 

Hi Gary,

You sound like a similar profile to me when I crept into the prediabetes zone 3 years ago - slim, keen runner, sweet tooth. Unfortunately the 1st two bits don’t give you a free pass from diabetes, something I didn’t fully grasp at the time.

Similar to you also I had quite sharp spikes on a CGM, following relatively modest amounts of carbs.

When I got the diagnosis, thankfully I found this forum & took fairly radical action straightaway.

My advice? Cut out the carbs as much as possible & that means saying goodbye to bread, although there are some decent low carb bread options out there. Try and get below 50g a day if possible. Your running may suffer initially as you transition to running off fats, but you will adapt after a few weeks. Watch for muscle loss also, I didn’t unfortunately & ended up losing a fair bit of muscle in the first year of low carb which I’m now addressing.

The good news is if you do the above you should see a fairly rapid improvement. You then have to maintain it !

Good luck.
 
Hi Dan,
That's really helpful, thanks.
I've been low carb for a couple of months or so but only hitting 100g/day at the moment, so I need to try harder!
On the muscle loss, presumably you're just doing weights regularly now? My running club has a fitness session once a week that generally involves weights but I'm thinking I need to do more, not just for the diabetes but to maintain muscle mass as I get older. Can I ask how often you work on that?
Best wishes,
Gary
 
I'm pretty much a beginner on this subject compared to the likes of KennyA (whose input I've found invaluable when asking for help myself). However, I do have a very similar profile, being a 65-year old prediabetic runner (currently borderline), who has recently been learning from (and slightly unnerved on occasions by) a CGM. So, a couple of points that might help, one on detail, one broader:
+ I experimented a bit with toast (the one 'carb' food I struggle to do without!), and found that the only bread that I could keep at a reasonable level was wholemeal sourdough. Everything else sent my blood sugar as high as yours. Even then, to keep it low, I had to eat something like some Greek yoghurt beforehand. Eating food with the toast alone didn't work (except for eggs - minimum of two). Indeed, I've subsequently found sequencing food to be one of the few 'hacks' that actually works for me. But, as KennyA says, it's all very individual!
+ I couldn't cope with very low levels of carbs and running anything more than 35-40 minutes - I never adjusted. The CGM helped me work out that rather than just working blanket 'low carbs', it's as much about what carbs that really matters: as a result of CGM testing, I do similar to that noted above, and generally don't eat rice, pasta, pizza, potatoes, porridge (my biggest 'spiker') and 'sugary' foods, keeping totals below 100g per day, but things like pulses I eat a-plenty (barely affect graph). I don't get over-exercised about fruit or root veg either (although do avoid parsnips and sweet potatoes!). TBH, I've found (for me) it's working on UPFs that has made the really big difference. My one exception on the carb front is during longer races - I find higher carb foods make absolutely no difference to the graphs but invaluable at keeping me going at sufficient intensity - I don't need/use them when on long bike rides etc when working at lower intensity (I've upped the gym work and cycling in recent years. and reduced my actual running to 3, occasionally 4, sessions max per week, focusing running training more on specific quality sessions, eg hill reps, intervals).
Hope that helps. I'm currently not using a CGM, but come the new year intend to go back on to it for a few weeks to review what I'm doing and do some further learning and work on combinations, sequences etc. It was certainly revelatory in terms of what affected me specifically, and made me realise quite how individual diet is.
 
Some great informative answers on here regarding food choices etc .

My input regarding the running. I've competed for over 15 years in triathlon, for the last 10 been prediabetic so did a lot off digging around and reading up on the association between high bloods/foods/sport etc - Have a look at MAF method by Phil Maffetone https://philmaffetone.com/ this basically "runs" on the theory that you need to become fat adapted, the majority of your runs are low heart rate enabling you to run faster for longer at a lower heart rate thus reducing the needs for carbs. (several years ago i did do the 2 week the carb tollerance test). If you don't already do this then it is quite difficult to get your head round running slower to get faster but it does work for the majority of people

I moved on from the MAF slightly but still run the majority of my runs at low heart rate usually no more than zone 2 in 5 rate zone, this has worked very well and I tend to now only fuel for very long runs and rides with carbs during the rides or in races, and even then not much.
 
Hi,
Thanks for this - it's very interesting and helpful. I'll try experimenting.
Just as an aside, I wonder how many other runners there are that don't realise they might be creeping towards being pre-diabetic or are already over the threshold. I hadn't given it much thought but have a good friend who is a dietician; he suggested I try a CGM ... largely due to my obvious sweet tooth! Might running mask the condition? I'd be interested to hear how you and others discovered your situation.
 
Hi Gary,

HistorIcally never enjoyed weights, always been a runner who reluctantly did a few weights! When I was diagnosed as prediabetic it was during Covid lockdown and that meant I did no real weights at all as gym was shut, which was a big factor in the loss of muscle.

Now going 3-4 times per week, so far so good but early days still for me. Most of the blood sugar improvement was diet driven.

Main reason i mentioned it was your BMI is already low, so presumably you don’t want to lose weight particularly, which is something it’s hard to avoid when you go low carb. I dropped from a BMI of 25 to 21 in 12 months for example. Building a bit of muscle can help offset things a bit, as can upping intake of healthy fats.
 
GaryL-1957 said:
Might running mask the condition?
Click to expand...
There's an often quoted mantra on here that
"You can't out run a bad (for you) diet"
Each of our bodies are unique and what works for one may not for another. The prediabetes predisposition has probably been being held back by your fitness regime, but would tend to 'win out' in the long term no matter what you do, other than making dietary changes.
I'm by no means a fitness person ( dancing and walking are about it) but the changes to what I eat made huge changes
 
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