Confused Pre-diabetic

[TBLuther]

Hi everyone

I was diagnosed as pre-diabetic in Jan 23 with a HbA1C of 42. At that time my BMI was 19, exercised daily, daily intermittent fasting (15hrs), predominantly plant based diet & drank moderately.

To try & reverse this, for the last 3mths I’ve had no alcohol, added sugar, saturated fats or white carbs. Reduced calorie intake further (including fasting 1day/wk), increased my cardio exercise from 3 to 5x/wk and my BMI dropped to 17.

My April HbA1C was 39, which whilst great that I’m technically no longer ‘pre diabetic’, was a meagre outcome for a very disciplined 3mths & 1 which I doubt I can maintain

I’ve just been advised (not by my GP) that the HbA1C isn’t how I should have been tested and the oral glucose tolerance test is more accurate

Does anyone have any suggestions please?

I’ve looked at the diabetic tests on this website but still not sure which ones I should/shouldn’t have

Also - if I am pre-diabetic, are there other ways to manage it in addition to diet/exercise?

Thankyou!

 

[ajbod]

The colour of carbs is irrelevant, they are all bad for anyone with sugar disregulation. Cut down the carbs, and INCREASE the fats. IGNORE the calories, eat enough to feel satiated, and most importantly NOT hungry.
Non diabetic numbers are great whatever they are, provided they ARE NON DIABETIC. being lower means nothing, you just need to stay in the race (the human race).
The most important thing to know, is that EVERYTHING you previously were told was HEALTHY to eat, with sugar disregulation issues, ISN'T.
Just about everything you were told was bad for you, ie fat ISN'T.
Only eat things that are natural, as in how it grew, whether animal, or above ground vegetable. Natural fats, ie the fat on meats, butter, cream, proper olive oil. Avoid grains and vegetable oils, and most fruits, berries in moderation are ok.
Hba1c is the correct test, you are not in the diabetic range at 39, so your only thing to watch, is that it doesn't climb back into prediabetic range.

 

[KennyA]

Hi everyone

I was diagnosed as pre-diabetic in Jan 23 with a HbA1C of 42. At that time my BMI was 19, exercised daily, daily intermittent fasting (15hrs), predominantly plant based diet & drank moderately.

To try & reverse this, for the last 3mths I’ve had no alcohol, added sugar, saturated fats or white carbs. Reduced calorie intake further (including fasting 1day/wk), increased my cardio exercise from 3 to 5x/wk and my BMI dropped to 17.

My April HbA1C was 39, which whilst great that I’m technically no longer ‘pre diabetic’, was a meagre outcome for a very disciplined 3mths & 1 which I doubt I can maintain

I’ve just been advised (not by my GP) that the HbA1C isn’t how I should have been tested and the oral glucose tolerance test is more accurate

Does anyone have any suggestions please?

I’ve looked at the diabetic tests on this website but still not sure which ones I should/shouldn’t have

Also - if I am pre-diabetic, are there other ways to manage it in addition to diet/exercise?

Thankyou!

Well done! Normal HbA1c BG range is 38-42 - that means that almost all non-diabetic people have an HbA1c result somewhere in that range - attached graph might help. It seems that these days a few people are being told that they are "pre-diabetic" with a reading of 42. I don't know why this is happening. The A1c test, like all tests, is not completely precise and your actual reading could well be a bit lower, or a bit higher.

The thing is, if the 42 is a true reading, you really don't need to do much to knock a couple of points off it. I don't know what you've been told (I'm guesssing it might have come from someone from the USA on the internet), but the A1c is the correct test (I have never had an OGTT). What you've done is to achieve normal levels within a few weeks, which is a great success and is kind of the point.

To reduce BGs is relatively simple. Reduce or remove carbohydrate (all carbohydrate is digested to glucose no matter how it's advertised) from your diet and replace it with protein and fat. That means eliminating/reducing bread, rice, pasta, sugar, root vegetables, most fruit etc. and increasing meat, fish, and dairy. What you've done in three months is fine, and it's up to you whether it's sustainable or needs to be sustained. I choose to eat a much more restrictive (in terms of eliminating carbs) diet because I'd rather do that than have the diabetic symptoms I used to have.

 

[JoKalsbeek]

Hi everyone

I was diagnosed as pre-diabetic in Jan 23 with a HbA1C of 42. At that time my BMI was 19, exercised daily, daily intermittent fasting (15hrs), predominantly plant based diet & drank moderately.

To try & reverse this, for the last 3mths I’ve had no alcohol, added sugar, saturated fats or white carbs. Reduced calorie intake further (including fasting 1day/wk), increased my cardio exercise from 3 to 5x/wk and my BMI dropped to 17.

My April HbA1C was 39, which whilst great that I’m technically no longer ‘pre diabetic’, was a meagre outcome for a very disciplined 3mths & 1 which I doubt I can maintain

I’ve just been advised (not by my GP) that the HbA1C isn’t how I should have been tested and the oral glucose tolerance test is more accurate

Does anyone have any suggestions please?

I’ve looked at the diabetic tests on this website but still not sure which ones I should/shouldn’t have

Also - if I am pre-diabetic, are there other ways to manage it in addition to diet/exercise?

Thankyou!

Well, your HbA1c is beautiful now, I'd never call that meagre. Should you think you should be aiming for something like 20 or so, that'd mean you'd be hypo all the time and quite likely, dead as a rusty doornail. The test you mention is useful in some cases, like when trying to establish gestational diabetes or reactive hypoglycemia, but for you, mainly useless. The HbA1c was exactly what you needed to know.

So... How to make a low carb diet sustainable for you...? What do you struggle with most? https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help a little with the diet, and while exercise is important, it's diet that can keep you from becoming diabetic. You can't outrun a bad diet, so that's the main thing. If you can't keep up the cardio, cut back to your usual frequency, just keep the diet up in whatever way you can, with or without days of fasting. Mind you, alcohol isn't an absolute no-no. https://www.dietdoctor.com/low-carb/alcohol might help there. (No beer for the most part, but hello, whiskey!). As for plant-based, was that a choice made due to the pre-diabetes or for other reasons? Because eggs, meat, poultry, fish and dairy are usually very low to no carbs, and excellent sources of protein and fats. You don't have to go hungry.

What do you struggle with? Because you might not have to, to stay healthy and maintain the ground you've gained!
Jo

 

[NathonalCoalBoard71]

Firstly you've done well to be so disciplined and the result is you've put your diabetes into remission.
Some people, most people in fact, have a reduced tolerance for carbohydrates and you can see this by the normal range of hba1c (23-37) wherein the lucky few eat carbs a lot and never gain weight or have abnormal blood sugars/blood pressure/visceral fat.
It seems you are not in this group so what you choose to do now will impact your future health but has got to be sustainable for life. The tone of your post is frustration, disappointment and possibly a fear of what's needed next (more white knuckled discipline as you avoid life's pleasures)?
I personally think that your strategy should be to triage carbohydrates by what yoru body can tolerate regardless of the colour of the carbs! (all glucose as others have said). Unless you are the kind of carb addict who can't eat just one biscuit? If that is the case then abstinence is the easiest choice in my opinion.
If you know that there's is no physiological need for carbs and that includes fibre, this can liberate you to choose the food we evolved on before the advent of agriculture (meat with the fat it comes with, eggs, a little dairy). Trying to do low fat and no sugar/glucose isn't healthy and is very hard because you will miss out on the vitamins and minerals best enabled by fat!
In our culture that promotes low sat fat, 'healthy' wholegrains and 5 a day (none of this based on strong evidence) it is hard to go 'against the grain' but you may find yourself feeling a lot better for it and also be able to keep weight stable with good hba1c results.

 

[TBLuther]

Thankyou everyone with the feedback - that’s super helpful. I’d been following my UK GP’s advice which was absolutely no animal fats - so had cut out all red meat, butter, cheese, yoghurt.
It sounds like oats, low sugar muesli should be removed instead? I was only having bread once/wk as a treat & don’t tend to eat potatoes/rice/pasta so am pretty restrained on the carbs already

 

[KennyA]

Firstly you've done well to be so disciplined and the result is you've put your diabetes into remission.
Some people, most people in fact, have a reduced tolerance for carbohydrates and you can see this by the normal range of hba1c (23-37) wherein the lucky few eat carbs a lot and never gain weight or have abnormal blood sugars/blood pressure/visceral fat.
It seems you are not in this group so what you choose to do now will impact your future health but has got to be sustainable for life. The tone of your post is frustration, disappointment and possibly a fear of what's needed next (more white knuckled discipline as you avoid life's pleasures)?
I personally think that your strategy should be to triage carbohydrates by what yoru body can tolerate regardless of the colour of the carbs! (all glucose as others have said). Unless you are the kind of carb addict who can't eat just one biscuit? If that is the case then abstinence is the easiest choice in my opinion.
If you know that there's is no physiological need for carbs and that includes fibre, this can liberate you to choose the food we evolved on before the advent of agriculture (meat with the fat it comes with, eggs, a little dairy). Trying to do low fat and no sugar/glucose isn't healthy and is very hard because you will miss out on the vitamins and minerals best enabled by fat!
In our culture that promotes low sat fat, 'healthy' wholegrains and 5 a day (none of this based on strong evidence) it is hard to go 'against the grain' but you may find yourself feeling a lot better for it and also be able to keep weight stable with good hba1c results.

OP has not been diagnosed as diabetic - and in fact has not been out of normal range - so cannot be "in remission".

 

[NathonalCoalBoard71]

OP has not been diagnosed as diabetic - and in fact has not been out of normal range - so cannot be "in remission".

Op had not reached the point where a diagnosis of diabetes is given and one reading of 42 doesn't mean op is a diabetic of course. But getting to pre diabetes suggests the op's blood glucose has been raised and in conjunction with chronically raised insulin levels, doesn't this mean it is a pathological state that should be reversed out of. I've never understood why it is called pre diabetes since the condition is a continuum. Hence if I weren't already type 1 I would treat my 'pre diabetes' as if it was the full blown version.

 

[KennyA]

Op had not reached the point where a diagnosis of diabetes is given and one reading of 42 doesn't mean op is a diabetic of course. But getting to pre diabetes suggests the op's blood glucose has been raised and in conjunction with chronically raised insulin levels, doesn't this mean it is a pathological state that should be reversed out of. I've never understood why it is called pre diabetes since the condition is a continuum. Hence if I weren't already type 1 I would treat my 'pre diabetes' as if it was the full blown version.

Thank you for recognising that your statement "you've put your diabetes into remission" was not helpful to the OP.