Diabetes prevention - diet & exercise

[jammy1988]

Hi, please excuse me if what follows appears to be the ravings of a paranoid person. However, with the recent diagnosis of a close family member with type 2 diabetes, I have basically decided to give myself a lifestyle MOT. In the last few months I've made significant changes to my diet (I was eating too many carbs before, especially white bread, added sugar etc., and too much saturated fat, and nowhere near enough vegetables). I've started regular exercise (at the moment 30 minutes rowing 5 mornings a week before breakfast). I've also started monitoring my nutrient intake and my blood sugar so as to get a better idea of what sort of shape I'm in and to develop a good regime.

When I started monitoring BG, I was getting fasting levels in the low-mid 4s, and I was going up to the 7s after meals (with the occasional 8 after a heavy meal). My 2hr postprandial levels were pretty much fine. A HbA1c test also came back find (about 5.3 if I recall correctly). I have, however, noted that my overall calorie intake is relatively low, normally below 2000kCal, often closer to 1500 (I'm not overweight; I'm 5ft 10 and about 65kg). I am wondering whether the low calorie intake might somehow explain the worsening BG levels I've noticed? I've been trying to push them up, but since it's mainly carbs I've cut back on, I'm reluctant to increase these in light of the BG levels.

However, recently I have noticed that things seem to be getting worse, despite my apparently beneficial lifestyle improvements. My fasting BG is up, often in the mid 5s. It seems to be slower to come down after meals, and it seems to rise unusually high for relatively light meals (recent example: roast duck breast with some sweet potato ~ 30g protein, 15g fat, 30g carb - led to a BG rise to 7.7 after 40mins, 6.8 after 1hr, 5.7 after 1.5hrs, and strangely, 6.4 after 2.5hrs). Even very low carb meals seem to cause unusual spikes, with a recent snack of courgettes with onion and chopped tomatoes seeing me go up to the high 6s quite quickly.

My BG has also proven to be particularly slow to come down in the evenings, often plateauing in the mid to high 6s for several hours right up until bedtime. Whereas before my BG would go down slightly overnight, it now tends to remain at these levels or even rise slightly, even if I eat nothing in the 3/4 hours between dinner and sleep. A few months ago my BG would drop quite normally back down into the 4s within a few hours.

I'm also trying to figure out how best to organise my exercise. If I do it before meals I then seem to get a higher BG spike after eating, particularly after dinner. If I exercise after eating, while there is an initial decrease, often to the mid 4s, this then very quickly spikes into the 7s within 20mins, often to a level far higher than I would have got without any exercise, before decreasing very gradually. Indeed, this is happening this evening, when after a light afternoon snack I spent 15 minutes cycling at a moderate pace. My BG went from 4.4 to 6.1 within 20mins, 7.5 within 40, and now seems to have levelled off at 6.8 1.5hrs later. This is rather problematic since I've yet to have dinner, which I certainly need to boost my overall calorie intake, but with my BG at that level I hardly think that's the best idea.

I just can't seem to find a diet/exercise regime that gives me good control over BG levels. I know to most diabetics these figures are not worrying - and you may find my concern rather irrational - but they are to me when they appear to have got worse, completely undermining the very point of my lifestyle overhaul.

 

[borofergie]

30g protein, 15g fat, 30g carb - led to a BG rise to 7.7 after 40mins, 6.8 after 1hr, 5.7 after 1.5hrs, and strangely, 6.4 after 2.5hrs). Even very low carb meals seem to cause unusual spikes, with a recent snack of courgettes with onion and chopped tomatoes seeing me go up to the high 6s quite quickly.

Is this a typical meal? If so it only has 375kcal, which could better described as a "snack" than a meal. That aside, if you eat carbs then you'll get a spike after a meal at about an hour, and it should hopefully subide by about 2 hours.

Somewhere else you described your diet as "low-fat, "low-carb" and "low-protein". That doesn't make any sense. You can't minimise all three.

If I had a HbA1c of 5.3%, I'd be cutting out the sweet-potatoes and upping the fat content of my meals. You probably have a bit more latitude than most of us, but you must be eating a substantial amount of carbohydrate to get your HbA1c that high as a "non-diabetic".

 

[jammy1988]

30g protein, 15g fat, 30g carb - led to a BG rise to 7.7 after 40mins, 6.8 after 1hr, 5.7 after 1.5hrs, and strangely, 6.4 after 2.5hrs). Even very low carb meals seem to cause unusual spikes, with a recent snack of courgettes with onion and chopped tomatoes seeing me go up to the high 6s quite quickly.

Is this a typical meal? If so it only has 375kcal, which could better described as a "snack" than a meal. That aside, if you eat carbs then you'll get a spike after a meal at about an hour, and it should hopefully subide by about 2 hours.

Somewhere else you described your diet as "low-fat, "low-carb" and "low-protein". That doesn't make any sense. You can't minimise all three.

If I had a HbA1c of 5.3%, I'd be cutting out the sweet-potatoes and upping the fat content of my meals. You probably have a bit more latitude than most of us, but you must be eating a substantial amount of carbohydrate to get your HbA1c that high as a "non-diabetic".

I used to eat a lot of carbs up until a few months ago (e.g. I wouldn't have thought twice about having a tin of baked beans and several slices of white bread as a meal, and I ate a lot of cakes, biscuits, chocolate, sugar-sweetened drinks etc.). But I'd cut most of those out for a while before I had the HbA1c test...(the actual figure I was given was 33, which I think translates to about 5.3%). That was a few months ago now, and over the last few days for example, my daily carb intake has varied between 120 and 180g, with no more than 60 from sugars, and those are mainly from fruit/veg. As I said, from the readings I've been getting lately, I imagine my HbA1c reading would now actually be worse, but I don't really know why. I'm jsut finding this all extremely frustrating; I can't seem to find a good balance anywhere.

 

[borofergie]

I used to eat a lot of carbs up until a few months ago (e.g. I wouldn't have thought twice about having a tin of baked beans and several slices of white bread as a meal, and I ate a lot of cakes, biscuits, chocolate, sugar-sweetened drinks etc.). But I'd cut most of those out for a while before I had the HbA1c test...(the actual figure I was given was 33, which I think translates to about 5.3%). That was a few months ago now, and over the last few days for example, my daily carb intake has varied between 120 and 180g, with no more than 60 from sugars, and those are mainly from fruit/veg. As I said, from the readings I've been getting lately, I imagine my HbA1c reading would now actually be worse, but I don't really know why. I'm jsut finding this all extremely frustrating; I can't seem to find a good balance anywhere.

If you want to cut your BG levels you have three options:
(1) Eat less carbs
(2) Eat lower GI carbs
(3) Starve yourself

(3) doesn't really work, because it's not sustainable and puts your metabolism under stress, which can increase BG levels by itself.

Your best bet is a combination of (1) & (2). If you don't like your BG reading after a meal, then eat fewer carbs (or better carbs) next time.

I'm not a Doctor, and I can't diagnose you, but I will observe that there are proper-diabetics on this forum who manage HbA1cs of around 5.3% on about 50-100g (Grazer is close on 150g).

Ignore the "from sugars" thing. It doesn't mean anything.

 

[jammy1988]

I used to eat a lot of carbs up until a few months ago (e.g. I wouldn't have thought twice about having a tin of baked beans and several slices of white bread as a meal, and I ate a lot of cakes, biscuits, chocolate, sugar-sweetened drinks etc.). But I'd cut most of those out for a while before I had the HbA1c test...(the actual figure I was given was 33, which I think translates to about 5.3%). That was a few months ago now, and over the last few days for example, my daily carb intake has varied between 120 and 180g, with no more than 60 from sugars, and those are mainly from fruit/veg. As I said, from the readings I've been getting lately, I imagine my HbA1c reading would now actually be worse, but I don't really know why. I'm jsut finding this all extremely frustrating; I can't seem to find a good balance anywhere.

If you want to cut your BG levels you have three options:
(1) Eat less carbs
(2) Eat lower GI carbs
(3) Starve yourself

(3) doesn't really work, because it's not sustainable and puts your metabolism under stress, which can increase BG levels by itself.

Your best bet is a combination of (1) & (2). If you don't like your BG reading after a meal, then eat fewer carbs (or better carbs) next time.

I'm not a Doctor, and I can't diagnose you, but I will observe that there are proper-diabetics on this forum who manage HbA1cs of around 5.3% on about 50-100g (Grazer is close on 150g).

Ignore the "from sugars" thing. It doesn't mean anything.

The starving was never intentional; I was simply overestimating how much I was actually eating until I actually started recording it and saw I wasn't getting nearly enough. The problem is I'm now developing something of a phobia of eating more because I don't want to make my BG worse than I perceive it to be.

The strange thing is I am certainly eating fewer carbs than before; I think a few months ago I was easily going over 200g per day. And I am generally eating lower GI ones; e.g. more fruit and veg, wholegrains, less potato, less pasta.

Should I just push up my protein and fat intake? For the last few days for example, my calorie intake has varied between 1200 and 1900. Carbs have been between 120 and 180g, protein between 65 and 105g, and fat between 50 and 90g (saturated between 12 and 25g).

 

[borofergie]

The strange thing is I am certainly eating fewer carbs than before; I think a few months ago I was easily going over 200g per day. And I am generally eating lower GI ones; e.g. more fruit and veg, wholegrains, less potato, less pasta.

Have you put on weight? It could be that your insulin resistance is increasing.

non-starchy veg: good
fruit: carbs
wholegrains: evil carbs
potato: carbs
pasta: see wholegrains

I think that a really good book for you to read would be Robb Wolf's "Paleo Solution", which is aimed at non-diabetics, but would give you an interesting framework for understanding what constitutes a "healthy diet". It's very readable, and even if you don't do all of it, it'd certainly make you think about how necessary carbs and grains are in your diet.

Should I just push up my protein and fat intake? For the last few days for example, my calorie intake has varied between 1200 and 1900. Carbs have been between 120 and 180g, protein between 65 and 105g, and fat between 50 and 90g (saturated between 12 and 25g).

I'd say more fat, less carbs, same protein.

Saturated fats have been wrongly vilified, I'd much rather eat animal fat than unhealthy man-made vegetable oils.

 

[jammy1988]

The strange thing is I am certainly eating fewer carbs than before; I think a few months ago I was easily going over 200g per day. And I am generally eating lower GI ones; e.g. more fruit and veg, wholegrains, less potato, less pasta.

Have you put on weight? It could be that your insulin resistance is increasing.

non-starchy veg: good
fruit: carbs
wholegrains: evil carbs
potato: carbs
pasta: see wholegrains

I think that a really good book for you to read would be Robb Wolf's "Paleo Solution", which is aimed at non-diabetics, but would give you an interesting framework for understanding what constitutes a "healthy diet". It's very readable, and even if you don't do all of it, it'd certainly make you think about how necessary carbs and grains are in your diet.

Should I just push up my protein and fat intake? For the last few days for example, my calorie intake has varied between 1200 and 1900. Carbs have been between 120 and 180g, protein between 65 and 105g, and fat between 50 and 90g (saturated between 12 and 25g).

I'd say more fat, less carbs, same protein.

Saturated fats have been wrongly vilified, I'd much rather eat animal fat than unhealthy man-made vegetable oils.

No, I don't think I've put on weight. My weight is one of the things I haven't tracked properly, but if anything I'd say I have lost a bit in recent weeks, as my low calorie intake would suggest.

If my insulin resistance has increased (and I can't see why it should) I'm still puzzled as to why it seems to be most problematic in the evenings.

 

[viviennem]

I've follwed this with interest so far, and haven't much to add to BF's comments, as my diet is on the whole similar to his; but I have two questions arising from the following quote from your original post:

(recent example: roast duck breast with some sweet potato ~ 30g protein, 15g fat, 30g carb - led to a BG rise to 7.7 after 40mins, 6.8 after 1hr, 5.7 after 1.5hrs, and strangely, 6.4 after 2.5hrs). Even very low carb meals seem to cause unusual spikes, with a recent snack of courgettes with onion and chopped tomatoes seeing me go up to the high 6s quite quickly.

30g protein, 15g fat, 30g carb = 75%. What else did it contain?

100g of duck, roasted with skin and fat, is 20g protein and 38g fat. Not eating the skin does drop the fat (10.4g) and increase the protein (25.3g). Sweet potato is 18.4g carb per 90g; to get 30g of carb you must have eaten about 150g of s.p. Your BG levels don't surprise me; the cooked sweet potato would have caused the first rise, then you started coming down nicely. Some of the protein we eat is also metabolized to glucose, but more slowly than carb, so your small rise (from 5.7 to 6.4 - 0.7 after 1 hour) could well have been due to the duck.

Fresh tomatoes and onions do contain some sugars/carbs; you say "up to the high 6s quite quickly". How much did you eat, and when is 'quickly'? I would expect your BGs to go up quite quickly after that snack, but they should be back to near your starting level two hours later.

In my opinion (though I am not medically qualified) these readings are nothing to worry about. NICE quidelines for non-diabetics are 3.5 - 5.5 fasting/before meals; less than 8 two hours after. These are the ranges I am aiming for (I'm Type 2). I am frequently below 5.5 fasting, these days, and always well below 8 two hours after eating. This doesn't mean I'm 'cured'. I eat a very low carbohydrate diet. If I went back to loads of bread and pasta and rice and potatoes, I'd be well above those readings.

As for exercise, your BGs can go up because your liver gives you an extra 'dump' of glucose to cope with the exercise you're doing. I don't know much about this because I can't do much exercise, but basically your muscles need fuel to exercise and if they don't have enough stored, your liver gives them a bit more. You could maybe have a small carby snack just before exercise - eg an oatcake with some cheese - just for fuel.

If you're worried about calorie intake, eat a bit more fat (hot roast duck with crispy skin - mmmm!). As long as you stick to natural rather than processed fats, and your low carb diet, fats won't hurt you. I don't count butter and cold-pressed olive oil as 'processed'). :wink:

I really think you're worrying a little too much. If you have cut your carbs dramatically, your body is bound to take a bit of time to settle to your new lifestyle. You are not diabetic, and if you keep on the way you are you probably never will be. Your lower carb, more exercise regime should keep you clear of the pesky condition - good luck!

Viv 8)

 

[Artichoke]

First of all, more power to your elbow for wanting to do something to prevent yourself being diagnosed with diabetes. :clap:
Since you're so motivated, I will tell you that the best way to avoid the diagnosis is to drastically cut those carbs.

Yes you will get people who'll tell you that you can eat jam and scones and all manner of Atkins bars and even sweet potatoes and sweet corn. But the only people they are cheating is themselves and a diet full of chemicals, additives,artificial sweeteners and GM soya isn't exactly healthy. Trying to replicate a carb-laden diet in a low carb way relies heavily on these things. Nor does it break the carb habit.

If you can cut out sugars, starches, cereals, processed foods and low fat diet foods (virtually fat free yogurt is virtually 100% fructose) and as many additives as you can, not only will you improve your blood glucose, blood pressure, cholesterol, trigs, liver and kidney function but also inflammation markers.

 

[borofergie]

If you can cut out sugars, starches, cereals, processed foods and low fat diet foods (virtually fat free yogurt is virtually 100% fructose) and as many additives as you can, not only will you improve your blood glucose, blood pressure, cholesterol, trigs, liver and kidney function but also inflammation markers.

...and what is more, you'll be a (wo)man my son.

 

[lucylocket61]

Borofergie:

...and what is more, you'll be a (wo)man my son.

:lol: :lol: :lol: :clap: