Confused about my readings and need advice on what to do next

[tr4e]

Greetings everyone,

1st post. I am not sure if I am posting in the correct forum but below is my story (45 Yr old male).

30th May 2024 went to GP for full bloods:
* HBA1C = 38 (It has never been at 42 or above)
* Fasting Blood Sugar = 6.1
* Liver and kidney functions all good.
* Urine check all good.
* Height 179cm, Weight 65kg, BMI well within healthy weight range.
* GP requested me to repeat tests again in 6 months.
* Since the results I have read a lot online about limiting carbs etc so I'm learning day by day.
* In recent weeks I have increased my activity levels (10,000 steps and lift dumbells 3 times a week).
* No genetic or family issues to worry about re diabetes.
* I have greatly reduced my simple carbs intake such as sweets, fizzy drinks etc.
* I do suffer with anxiety and as a result tend to focus on worst case scenarios.

I am finding it very difficult to limit my carbs and keep the calorie levels up so as not to fall into the underweight category.

My questions are therefore as follows:

1. Are my blood results of big concern?
2. Why do the HBA1C and FBS differ?
3. How do I keep to my current BMI without limiting carbs or should I limit them or just go with Low GI/GL carbs?
4. I am doing more physical exercise so I need to account for this in calorie intake but am finding it very difficult to hit the daily calories without looking at eating carbs (all be it "good" ones). What should I do?

Thanking you all.

 

[Melgar]

Hello and welcome to the forum tr4e , you have come to a great site. Prediabetes is exactly that, your blood sugars are raised, but not high enough for you to be diagnosed as diabetic. Your fasting blood sugars may be seen as your baseline blood sugars, that means these are your blood sugar numbers after not eating over night. Morning fasting blood sugars can be influenced by what is called dawn phenomenon. What that means is your blood sugars can rise when you first get up as your body prepares for activity. This DP can skew your FBS figures.
HbA1c ‘s are calculated over the last three month period , they can be influenced to a greater degree by the last month, but in general they are based on your last three months of blood sugar. That is what your HbA1c represents. Your FBS is simply a snap shot of what your blood sugars are at in that moment. Any diagnosis is based upon your HbA1c not on your FBS.
As for dropping your carbs and not wanting to lose weight, I’m in that same position, my BMI is 19. I don’t want to lose anymore weight. I exercise and do some weights to achieve this. After a very low carb diet, weights are the most effective way of bringing down your blood sugar. That is my opinion. Members here will very likely jump in here with some dietary advice. I will leave it up to them to discuss diets, in particular dropping down your carb intake.
It is easier and more enlightening to think in terms of carbs, not calories. It’s the carb numbers you need to concentrate on rather than the calories.

im sure other members here will comment too.
Once again welcome to the forum.
Mel

 

[ianf0ster]

Hi @tr4e and welcome to the forum.
I would answer your questions as follows, but there is no universal agreement:

1. In the UK an HbA1C reading of less than 42 is considered to be 'normal' rather than pre-diabetic. In some other countries (at least in the USA) the pre-diabetic level is lower. But your blood results seem fine to me.

2. HbA1C and a fasting Blood Glucose (sugar) test are measuring quite different things. Blood glucose varies during the day: sleep, digestion of food, exercise, stress and even temperature can change it minute by minute. So your fasting BG reading may well have been different a few minutes earlier or later. The HbA1C on the other hand measures the effect of glucose on the red blood cells themselves. They are refreshed around very 3 months, so an HbA1C reading can be considered as an average of all those instantaneous Bg levels for a whole 3 month period (though slightly skewed to the last few weeks).
Because they are measuring very different things, the FBG and the HbA1C are also measured in completely different units.

3. What you eat and how much of it, is entirely up to you. Do you have a reason (apart from Blood Glucose) for you to limit carbs?
I limit carbs because I'm Type 2 diabetic and I prefer to avoid any unnecessary medication, so I limit the carbs I eat - all carbs not just simple ones.

4. Do you have any reason to be accounting for calories? Calories are not equal as a measure of human food. The effect on the metabolism of 100 kCal of
sugar or flour or mashed potato is very different from that of 100Kcal or cauliflower. Most people seem to overlook that important fact.

 

[tr4e]

Hi @tr4e and welcome to the forum.
I would answer your questions as follows, but there is no universal agreement:

1. In the UK an HbA1C reading of less than 42 is considered to be 'normal' rather than pre-diabetic. In some other countries (at least in the USA) the pre-diabetic level is lower. But your blood results seem fine to me.

2. HbA1C and a fasting Blood Glucose (sugar) test are measuring quite different things. Blood glucose varies during the day: sleep, digestion of food, exercise, stress and even temperature can change it minute by minute. So your fasting BG reading may well have been different a few minutes earlier or later. The HbA1C on the other hand measures the effect of glucose on the red blood cells themselves. They are refreshed around very 3 months, so an HbA1C reading can be considered as an average of all those instantaneous Bg levels for a whole 3 month period (though slightly skewed to the last few weeks).
Because they are measuring very different things, the FBG and the HbA1C are also measured in completely different units.

3. What you eat and how much of it, is entirely up to you. Do you have a reason (apart from Blood Glucose) for you to limit carbs?
I limit carbs because I'm Type 2 diabetic and I prefer to avoid any unnecessary medication, so I limit the carbs I eat - all carbs not just simple ones.

4. Do you have any reason to be accounting for calories? Calories are not equal as a measure of human food. The effect on the metabolism of 100 kCal of
sugar or flour or mashed potato is very different from that of 100Kcal or cauliflower. Most people seem to overlook that important fact.

Thank you for your replies to date. I'm very appreciative that you've given the time to reply.

@ianf0ster I have no reason other than blood sugar to lower my carb intake. My fear is my current weight is on the lower side of a healthy range. I dont want it to drop any further. I was using calories to monitor this, all be it with wiser food choices than say high GI foods.

Would you say that based on info I have given to date and my current readings that my best approach would be to cut all simple carbs and continue on with improved exercise whilst looking at low GI foods to provide those good quality calories to maintain my weight?

Or how would one maintain their current weight by limiting carbs to say 130g per day? It seems very difficult to come up with a weekly food plan of say breakfast, mid morning snack, lunch, afternoon snack, dinner, evening snack without going above 130. (I am seeing a dietican in 3 weeks and the advanced food temple she has sent me is to be completed before our initial assessment and it includes fo the "6 meals").

I should.also add that my water intake has been increased considerably from what it was. How big a part would this play on helping the numbers?

 

[ianf0ster]

@tr4e Now your questions have got a lot more difficult to answer, because every person is different, we are individuals with different genes, different goals, different strengths and weaknesses.

I have already said that I don't feel your Blood Glucose and HbA1C figures to be a concern. Since my T2 diabetes remission, I maintain similar levels to yours. I do limit my carbs, but only in order to have blood numbers that good. If I didn't limit my carbs they would be worse and if I limited my carbs even more the blood numbers would be lower.

The balance for me feels right about where I am now. II no longer measure my daily carbs and I have never counted either steps or calories. I'm 73yrs old, enjoy the food I eat and unless my Blood Glucose gets worse I don't plan to change either what I eat or how much exercise I take.

When I first got my HbA1C down, I decided that I had lost more weight than I was comfortable with. So I increased the amount of fat I eat (eggs, cheese) rather than the amount of carbs (to me fat is more tasty) and got my BMI back up to 23. Perhaps somebody younger who likes exercise could have done that by eating more protein and doing (more) weight bearing exercise instead eating that extra fat.

Breakfast is an easy meal to eat low carb. Just eat meat, fish, eggs, cheese, full fat plain Greek yogurt with a few nuts or a few berries for a either a zero carb or low carb meal. I used to have eggs for breakfast, but no I'm fat adapted and so don't feel hungry until lunch at the earliest. In fact, on weekends and holidays I rarely eat before 15:30 hrs.

Being hydrated is important, but for me water has no direct effect on my BG levels apart from tending to make my stomach feel fuller, so if I drink a lot I may eat less food.

 

[KennyA]

Greetings everyone,

1st post. I am not sure if I am posting in the correct forum but below is my story (45 Yr old male).

30th May 2024 went to GP for full bloods:
* HBA1C = 38 (It has never been at 42 or above)
* Fasting Blood Sugar = 6.1
* Liver and kidney functions all good.
* Urine check all good.
* Height 179cm, Weight 65kg, BMI well within healthy weight range.
* GP requested me to repeat tests again in 6 months.
* Since the results I have read a lot online about limiting carbs etc so I'm learning day by day.
* In recent weeks I have increased my activity levels (10,000 steps and lift dumbells 3 times a week).
* No genetic or family issues to worry about re diabetes.
* I have greatly reduced my simple carbs intake such as sweets, fizzy drinks etc.
* I do suffer with anxiety and as a result tend to focus on worst case scenarios.

I am finding it very difficult to limit my carbs and keep the calorie levels up so as not to fall into the underweight category.

My questions are therefore as follows:

1. Are my blood results of big concern?
2. Why do the HBA1C and FBS differ?
3. How do I keep to my current BMI without limiting carbs or should I limit them or just go with Low GI/GL carbs?
4. I am doing more physical exercise so I need to account for this in calorie intake but am finding it very difficult to hit the daily calories without looking at eating carbs (all be it "good" ones). What should I do?

Thanking you all.

I'd echo what's been said above. Your blood glucose levels are normal - I'm attaching a graph to demonstrate this. Almost every non-diabetic person's HbA1c will fall somewhere between 36 and 41. If your levels have never reached 42 you are not pre-diabetic. You have no apparent reason to lower your carbs to reduce blood glucose levels, and from what you say not for weight loss either.

What may be confusing things is that the CDC in the USA has recently and arbitrarily changed its classification of "pre-diabetes" to include what the rest of the world has always thought of as "normal" blood glucose levels. No-one else has followed. It may be just a co-incidence that the CDC is also offering a blood glucose reduction programme, at a price.

This small study (link below) shows daily variation in blood glucose levels in non-diabetic subjects using constant glucose monitors. Subjects were definitely not eating low-carb diets. The units given are in mg/dl, in which 80mg/dl is roughly equivalent to 4.4 mmol/l, 100 to 5.6, and 120 to 6.7.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

www.ncbi.nlm.nih.gov

Your fasting blood glucose is a measure of the glucose in your blood at the time of the test, and depends a lot on what your liver does; amongst many other things the liver constantly adjusts blood glucose in response to or anticipation of the body needing additional fuel. There's no way to affect this directly by diet. The liver will eventually get used to different levels, but this takes time.

The HbA1c does not measure blood glucose directly, but instead counts the number of a particular type of haemoglobin protein molecules in red blood cells that have had a glucose molecule attached to them. As red blood cells live around 3-4 months, it's a reasonably useful proxy measure for the level of blood glucose over that time, heavily skewed towards the most recent month. It has a couple of wrinkles - for example, if your blood cells are longer or shorter lived, this may affect the test.


In shiort, on the information you've given, there's absolutely nothing that jumps out and says "needs to be looked at". As you say you do have anxiety, please be aware that the stress of worrying about your blood glucose when there's no apparent need can be a problem in itself.

 

[tr4e]

Thank you all for your replies and input. Just to clarify my recent Fasting Blood Sugar was 6.1mmol/L. I wasn't sure what the units were until I rechecked them there. From what I could see before I posted this was borderline prediabetes. However I take on board your advice above.