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Blood sugar below 48 but several diabetes symptoms

S

SilentP

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Hello

I am currently being tested - bloods done today.

Without going into detail at this stage, I have a number of potential diabetes symptoms that are gradually becoming more troublesome. The most recent is numbness in two of my toes.

My annual test for blood sugar has consistently been in the low 40s, with one reading of 45.

I am 67 and generally fairly fit and healthy with a decent diet. My brother and my son have had type 2 diabetes for some time, but they are both well overweight with poor diet and lifestyles. My father was German Jewish (genetic predisposition?) but did not have diabetes.

My question is about the blood sugar level. Is the diabetes threshold cut and dried or can I actually be diabetic at my levels?

I am not trying to talk my way into a diabetes diagnosis but would like to understand how far too pursue the investigations and to rule out other causes. If there is no other cause identified I intend to research and pursue the low carb approach in preference to taking the meds.

Thanks for reading this far
 
SilentP said:
My question is about the blood sugar level. Is the diabetes threshold cut and dried or can I actually be diabetic at my levels?
Click to expand...
Low 40's is probably pre diabetic..anything 42 or over is classified as such and 48 or over T2..
But yes you could well be hovering on the edge of T2.
 
I never felt well when eating a normal diet - and although the possible genetic link is further back many of my mother's side of the family - particularly the blonde ones, either ate low carb or developed diabetes in later life.
Now that I am diagnosed, I find that my tolerance for carbs is well below the level which many people can manage.
 
SilentP said:
My annual test for blood sugar has consistently been in the low 40s, with one reading of 45.
Click to expand...
While not diabetic that sounds like you come in to prediabetic territory, which tends to progress into diabetes unless you change something (reducing carbs seems to be very effective for most people). To be honest, the dividing lines between diabetic and non diabetic are fairly arbitrary. We had a discussion about this recently and I came to the conclusion that they draw the line at the point where people start to get more likely to have long term eye issues.
Remission target - 5.7% or 6.5% Hba1C | Diabetes Forum • The Global Diabetes Community

Weight gain (as in your brother and son) is a symptom of T2 diabetes, as high sugars and high levels of insulin (T2s are insulin resistant so tend to produce lots) lead to weight gain.

Oops, I forgot to say, welcome to the forums.
 
Thank you for those informative replies. Will look at them in more detail. They seem to back up my suspicions.

I spoke with Diabetes UK a few months ago and the advisor was adamant that there was no such thing as pre diabetes.
The nurse I spoke with today was pretty firm on the level needing to be 48 for a diagnosis.
It seems that the reality is less clear cut.

Assuming that my blood tests do not suggest something else, it seems sensible to assume that I need to take some action. I try to avoid any meds if I can and the low carb approach appeals as a promising option.
 
Hi. Actually there isn't any such thing as pre-diabetes if you think about it. Diabetes is a spectrum and the level of 48 is arbitrary but not a bad choice. At your level of HBA1C it's unlikely that the numbness is due to high blood sugar (diabetes) as your level is near normal. I suspect there may be other causes? What do you mean by a 'decent' diet?
 
Not a full reply (it's past my bedtime).

The nurse said that my blood test will be an average of the last 3 months. I understand that BUT...
is it correct to think that your current blood sugar level can fluctuate a lot and that some symptoms may come and go during the day as your level rises and falls?
 
Yes I wondered this. I think that you will probably only get symptoms when your blood sugar is high for a period of time. My blood 2 hrs after a bad choice meal was 11.2 (had no symptoms) but then 30 mins later in the low 8’s. I don’t kno; mayb I am wrong. Night. X
 
My (limited) understanding is that a lot of diabetic symptoms (other than short term thirst) are supposed to only happen after years of elevated blood sugars. So it's usually better to investigate non diabetic causes. (Even though I've been T1 for over 50 years I still visit my doctor with non diabetic issues). There are also plenty of issues that are a bit more common for diabetics than non diabetics but still happen to plenty of non diabetics (eg frozen shoulder), or just get sped up by diabetes (eg cataracts).
 
I got pretty severe neuropathy, including numb toes, when I was 36; my doctor said it was partly due to prediabetes, but more to do with my hyperlipidemia. Apparently hyperlipidemia and high triglycerides can cause, accentuate or exacerbate neuropathy. If you have NAFLD or bad trigs, that could be one of the other possible causes for you to rule out.

If I were you, I'd eat less carbohydrate, stick to lean meat and green veg, and lay off alcohol (if you drink). For diabetes alone, you can eat fat, but if you are getting checked for cholesterol alongside high blood glucose, etc, then you won't go far wrong with lean meat and greens.
 
Blood sugar is only really the overflow. The measurable symptom of too much sugar in the whole body. Years of hyperinsulinemia can drive glucose deep into organs, tissues, nerves, eyes etc. This is why type 2 diabetics using gallons of exogenous insulin to control blood glucose don’t have better long term outcomes. People can and do suffer poor health from many years of borderline blood glucose.
 
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Great to have so many informative responses.

I am very pushed for time today, so will respond to some of the points raised and then provide a bit more detail on my symptoms (mainly from the info I have sent to the surgery). Later on it may be sensible to raise some specific questions in the appropriate specialist sub-forums here.

"Weight gain (as in your brother and son) is a symptom of T2 diabetes"
I understand that, but they were both overweight and had poor lifestyles for many years prior to diagnosis. My son has Asperger Syndrome and after many failed support arrangements has only recently moved to a home where he can be properly helped with his lifestyle (he has lost 4st in a year there) and his blood sugar is much lower (he is on metformin).

"What do you mean by a 'decent' diet?"
Very little sugary food and drinks (Lightish drinker. Symptoms may be slightly worse after drinking alcohol a bit more or more regularly)
Love my white carbs but have cut them down and intend to take that further. Bread nearly always wholemeal. I usually fast until late morning and feel more energised than when I have breakfast. Sometimes have half a banana before going to exercise classes, which I do most mornings. A particular weakness is around 8pm when I get a craving and have a cup of oats with milk and honey or some crackers. Am trying to cut that out from now on. Have been eating more unsalted nuts. Eat quite a lot of veg and fruit. Nurse advised to combine some fruits with meals.

"I think that you will probably only get symptoms when your blood sugar is high for a period of time"
Feels that way. See symptoms below.
Is there a easy, reliable way of testing - without pricking if possible?

"So it's usually better to investigate non diabetic causes"
Hopefully the blood tests will help clarify this. Some of my symptoms could also be caused by MS and no doubt other conditions.

"more to do with my hyperlipidemia"
Slightly elevated levels but not that high for my age. See symptoms below...


SYMPTOMS

I do NOT have excessive thirst or hunger

Separate post to follow....
 
SYMPTOMS

I do NOT have excessive thirst or hunger

Had a urine test earlier this week and kidney function is fine. Blood,being tested for thyroid, liver, B12 folate, blood count, PSA

Previous HbA1c levels have regularly been in the low 40s, highest 45.
June reading was 42, lower than the 45 last November. It is possible that it was reduced slightly by the probiotic supplement I had been taking, which reduced my 'bad' cholesterol level and improved my ratio. The supplement contained a 'natural' statin (Red Yeast Rice) but I stopped taking it when I noticed some numbness in my toes in case it was because of the statin.

Numbness in toes and lower leg: (Toe numbness confirmed by a nurse this week)
This is fairly recent (just over 3 months since I first noticed it (was wearing a pair of crocs and it felt like there was material under my big toe and there wasn't) and intermittent. Usually under my big toe and the index toe on my right foot. In the last few weeks I have also noticed some very mild numbness in the calf area of both legs, especially first thing in the morning.
My balance in gym classes may have deteriorated and is noticeably worse standing on my right leg compared to my left. My right calf is slightly smaller than my left calf (probably after an injury).

Exhaustion
Several times a week I feel very exhausted for a few hours and often spend an hour or two in bed during the day. This has been worse over the last few months but I have experienced it to some extent for over 30 years (I believe starting as a post viral issue). It is more than simple tiredness (see sleeping below)
I have not eaten much or any breakfast for several years and usually feel more energised than when I do have breakfast.

Vision
Have had double vision (not close up) for a couple of years and have glasses with prisms. Now wear reading glasses for mobile phone and tablet use, which may help. Left eye can tilt inwards unless I concentrate to stop it.
Some days it is not a problem at all. On other days it is more persistent, especially if I am tired.
Had a recent eye test. I paid for the additional scan and the consultant did not identify any signs of issues that could be caused by diabetes but said that my variable double vision could be associated with fluctuating blood sugar levels. They recommended some eye exercises for the double vision.

Sleeping
I usually drop off to sleep quite quickly but I can have a lot of trouble getting back to sleep after getting up for the toilet. Usually taking an hour or more.

Urination
I need to urinate more frequently and sometimes urgently (prone to leaking soon after the urge). I have been examined for this in the past and declined medication for it. Over the last year or two it has started waking me up once or twice a night. This in spite of drinking very little in the evenings. The quantity of urine produced is still usually quite substantial each time I go. It can sometimes smell slightly sweet and be a bit cloudy.

Fungal infections
I have had occasional infections in my groin for many years. A cream I use has usually dealt with this. Earlier this year, but better recently, these flare-ups became more persistent and I was also getting them in my armpits for the first time.
I have had fungal toe nails on my right foot for over 20 years (especially the big toe that is now often numb) and some (fungal?) skin problems on the same foot

Smelly sweat
Not sure if I have been sweating more in bed but have recently noticed the bed clothes getting quite smelly (a slightly sweet smell that my wife complains about!)
 
Hi

About 10 years ago I was experiencing a few symptoms which made me wonder if I was diabetic, such as extreme energy slumps after lunch, skin infections and a few other things. I was around 17 stone but cycling regularly. I had tests done to see if I was diabetic twice but both time came back negative. Then in 2016 I was diagnosed as type 2 diabetic. Since then I have lost 5 or 6 stone and exercise more regularly and harder, and I have cut most carbs out of my diet. But the point is you can take action if you think you are a risk, such as going on a low carb diet and using exercise to help manage your blood sugar, to avoid becoming diabetic. Then you won’t be forced to do it, or take medication for it. Good luck



 
Hi, welcome to the forum,. The "diagnosis at HbA1c of 48" is a recent introduction. The current level was chosen by the medics about 15 years ago because moderate retinopathy is rare beneath the 48 figure, and it was a compromise - they would all (internationally) accept that a 48 A1c reading meant diabetes.

However the diagnosis point has been moved on a number of occasions and could be moved again. So, according to the medics, A1c of >48, you're diabetic, beneath 48 you're not. Except that it doesn't actually work that way. It's one of those things where having a backstop figure hasn't really benefitted those patients with symptoms at lower BG levels.

I had diabetic symptoms - oedema, water retention, blistering, cuts not healing, weight gain, foot neuropathy, night sweats, frozen shoulder, skin infections, exhaustion, xerostomia, etc long (up to ten years) before my BG reached 48. I was firmly told that I wasn't diabetic despite my range of diabetes symptoms. And, like you, I didn't have the "frequent urination" one. Officially I have been in the diabetic BG range for a maximum of only four months!

My opinion is that if you have diabetic symptoms you have diabetes. It seems that some people can tolerate higher levels of blood glucose than others - I now have a low normal HbA1c but I still have some symptoms - mild neuropathy and night sweating, mainly. It seems probable that these would get worse with only a small rise in BG - I'm not about to test that. Low-carb worked for me very quickly, and if only I'd tried it in 2011 (despite what the medics said) I would have avoided a lot of discomfort.

I would avoid formally being diagnosed if you can - it can affect things like life insurance. You can start to turn things around very quickly, and medical involvement isn't essential. Best of luck.
 
@SilentP
Possibly time to mention the difference between HbA1c and Time In Range as a measure of possibility of complications.
This is more for T1s using a Constant Glucose Monitor such as the Libre, but is still useful for T2s.

You can have a reasonable HbA1c even if you have very high BG levels if these are combined with very low BG levels.
So you could be hitting damaging BG levels but running only a pre-diabetic HbA1c.

The ways to test for this are:

(1) a finger prick campaign where you test before a meal then e.g. 30,60,90,120,180 minutes after first bite. I note that you don't want to finger prick if possible, which suggests that you aren't at the moment which suggests in turn that gritting your teeth and testing for a few days might give you a lot more information.

(2) Use a Freestyle Libre for 2 weeks. There is (or was) a free trial for first time users of the Libre 2. This should give you a 24 hour trace of what your BG is doing and give you some idea if your HbA1c represents a steady BG level or a very jagged line.

https://www.freestylelibre.co.uk/libre/ shows an offer of a free trial when I look at it, although I am not a first time customer.
 
Thank you both for the further very informative replies.

Will not be taking things much further, other than limiting my carbs, until a telephone appointment with a GP next Friday, to take stock after my blood results. Will insist on a face to face appointment after that if I think it's needed.

The FreeStyle Libre trial sounds worthwhile to understand my pattern.

Am very much hoping that lifestyle changes will do the job. Even with that I am a little concerned that the neuropathy could be permanent and that the double vision may not be resolved.
 
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