Diagnosed with pre-diabetes

[CarlosTJ]

Morning all,

I've recently been diagnosed with prediabetes with a HbA1c reading of 44 so bang in the middle of the prediabetic range.

I've had a brief discussion with a diabetes nurse but haven't really been given much information to work with and have found many contradicting sources on the internet so was hoping that people in a similar position can help me with a few questions I have if they'd be so kind?

Firstly, I've massively reduced my carb intake and am limiting myself to either two slices of granary bread or a wholemeal pitta per day and maybe 4-5 steamed new potatoes and have completely cut out eating biscuits, cakes, crisps etc so essentially a low carb moderate fat diet. Does this sound right?

Secondly, I've bought myself an accu-chek instant blood glucose monitor for finger prick tests. I've not been told to do this but I'm trying to understand what my numbers are like so may be going a bit OTT in doing so but I've noticed I have elevated blood sugar when I've fasted overnight. I've only done the fasting tests twice but both results were 6.9 and 7.0 which sounds too high and with 7.0 being actually diabetic not prediabetic? The non-fasting tests I've done 2hrs after eating appear to be normal in the range of 5.6 to 5.8 so I'm quite concerned that my fasting blood sugar levels are suggesting I'm more likely to be diabetic not pre-diabetic?

Some background about me which may be pertinent: I'm 44, male, clinically obese but active and I've struggled with a binge eating disorder and have massively abused alcohol for decades so I'm guessing my insulin resistance has been born from this, the alcohol in particular as my poison of choice was always beer and cider.

This has been a massive wake up call for myself and I've quit alcohol and have now been alcohol free for seven days.

If anybody could answer these questions for me it would be much appreciated and if anybody can offer further advice to help manage and hopefully reverse my prediabetes that would be amazing.

Thanks for reading, CTJ.

 

[Lamont D]

Tagging @JoKalsbeek for the nutritional thingy.

Hi @CarlosTJ ,
It seems you have got a start on things, but refining those details in which you need to sort out.
Fasting isn't the most important reading, but the early days of testing is to discover which foods spike you.
So testing pre meal and 2 hours after.
If your two hours reading is less than two mmols higher than your pre meal reading, that is fine.
If it is higher, something in that meal is causing it.
He careful of the breads.

Take things slowly, reducing your carbs, increase your protein and saturated fats, increase your activity, all slowly.
I don't know whether you can keep up with the alcohol, but instead of the carb laden beers etc, find an alternative.

Keep asking.

 

[CarlosTJ]

Tagging @JoKalsbeek for the nutritional thingy.

Hi @CarlosTJ ,
It seems you have got a start on things, but refining those details in which you need to sort out.
Fasting isn't the most important reading, but the early days of testing is to discover which foods spike you.
So testing pre meal and 2 hours after.
If your two hours reading is less than two mmols higher than your pre meal reading, that is fine.
If it is higher, something in that meal is causing it.
He careful of the breads.

Take things slowly, reducing your carbs, increase your protein and saturated fats, increase your activity, all slowly.
I don't know whether you can keep up with the alcohol, but instead of the carb laden beers etc, find an alternative.

Keep asking.

Hi there, thanks for this, very helpful. I don't think I'm really helping myself by diving into it all myself as I haven't even had my initial call with Liva yet but the diabetes nurse I spoke to only gave very brief information.

I'll definitely look at testing pre and post meals though, especially this evening as I'm at the in-laws for a roast dinner so will be able to see how I react to that.

Would you say that the 2hr post meal reading I've been getting between 5.4 - 5.7 are normal for prediabetes/non-diabetic? I don't seem to have been anywhere near the ranges suggested as a maximum in advice I've found (7-8.5 post meal), I only seem to get that high in the morning. Having said that, the roast today may send me up to that level.

Again, thanks for getting in touch.

 

[Lamont D]

Hi there, thanks for this, very helpful. I don't think I'm really helping myself by diving into it all myself as I haven't even had my initial call with Liva yet but the diabetes nurse I spoke to only gave very brief information.

I'll definitely look at testing pre and post meals though, especially this evening as I'm at the in-laws for a roast dinner so will be able to see how I react to that.

Would you say that the 2hr post meal reading I've been getting between 5.4 - 5.7 are normal for prediabetes/non-diabetic? I don't seem to have been anywhere near the ranges suggested as a maximum in advice I've found (7-8.5 post meal), I only seem to get that high in the morning. Having said that, the roast today may send me up to that level.

Again, thanks for getting in touch.

The roast meat will be fine.
The veg should be fine.
The roasties, may not, could be better if done in goose fat.
The rest I suspect will spike you.

The hba1c test is the standard norm for diagnosis.
However, there are so many aspects of testing that can impact fasting tests.
A finger prick test is only a snapshot of your blood glucose levels at that time.
There are so many variables, to get an absolute accuracy.
Then the accuracy of the glucometer, is not very precise.
It is just a case of being around that figure. To give you an approximate reading.
So, I couldn't even think of giving you, if you are prediabetic or T2.

It is not what you are, but how you control it.
Whether prediabetic or T2, being proactive with your diet and exercise will be a game changer, and not lead to T2, high spikes and more importantly, lower your hba1c levels.
And as you have said, need to lose some weight, that could happen without the carbs and sugars.

Keep asking.

 

[Jo123]

Hi, well done on your good work so far.
I was diagnosed pre diabetic in 2008. I've maintained normal hba1c's ever since. The morning fasting readings were the last things to come down, but I was getting normal hba1c's despite this. What really brought them down the morning readings was finishing eating anything by 7pm, then not eating till 7.30 in the morning.
I continue this now except when we eat out or on holiday. The low carbing I continue all the time.

 

[KennyA]

Hi and welcome. It's not really possible to draw a firm conclusion from a fingerprick test in isolation - everyone's blood glucose varies all the time in response to various stimuli. Food (mainly carbohydrate) is the most significant but your liver will adjust your levels in response to things like stress, illness, ambient temperature, exercise, time of day....

The fingerprick testing regime I'd advise is to test immediately before eating, and then two hours later. You are NOT testing to see "how high you go". You are testing to see how well your insulin response dealt with the raised blood glucose from your digested food. What you're looking for is for the second reading to be within 2mmol/l of the first, and not above 8.5. If so, that shows that your system can handle the glucose resulting from whatever it was you ate.

Couple of wrinkles with this. Alcohol with food will give you a lower blood glucose reading, because the liver prioritises metabolising the alcohol and stops topping up your blood glucose. However the carbs have still gone in and still have to be managed. This is the case even when there are no carbs in the alcohol itself (spirits, for example).

Secondly the high point - the glucose peak - will probably be somewhere in the first hour after eating. This happens to everyone, and it doesn't take much to push BG high. For example - a small latte will take me from 5ish to 9.6 in 30 minutes, and back to 5ish by the hour, just from the lactose in the milk. If you test in the first hour, you might see some figures that at first sight look really bad - but those are before your system gets to work.

Finally there are carbs hidden everywhere in processed and prepared food. Supermarkets add sugar to meat to brown chicken skin, for example. Gravies and soups have thickener which is usually a form of starch, and is pure carb. I read the small print on labels, and generally don't buy.

You may find that it's worth testing around the carb-heavy items - bread, pastry, pasta, potatoes, rice, fruit, sugary things - first. These are liable to be the things that have most impact on your levels and (in my case anyway) they had to go.

best of luck, ask as many question as you like.

 

[JoKalsbeek]

Morning all,

I've recently been diagnosed with prediabetes with a HbA1c reading of 44 so bang in the middle of the prediabetic range.

I've had a brief discussion with a diabetes nurse but haven't really been given much information to work with and have found many contradicting sources on the internet so was hoping that people in a similar position can help me with a few questions I have if they'd be so kind?

Firstly, I've massively reduced my carb intake and am limiting myself to either two slices of granary bread or a wholemeal pitta per day and maybe 4-5 steamed new potatoes and have completely cut out eating biscuits, cakes, crisps etc so essentially a low carb moderate fat diet. Does this sound right?

Secondly, I've bought myself an accu-chek instant blood glucose monitor for finger prick tests. I've not been told to do this but I'm trying to understand what my numbers are like so may be going a bit OTT in doing so but I've noticed I have elevated blood sugar when I've fasted overnight. I've only done the fasting tests twice but both results were 6.9 and 7.0 which sounds too high and with 7.0 being actually diabetic not prediabetic? The non-fasting tests I've done 2hrs after eating appear to be normal in the range of 5.6 to 5.8 so I'm quite concerned that my fasting blood sugar levels are suggesting I'm more likely to be diabetic not pre-diabetic?

Some background about me which may be pertinent: I'm 44, male, clinically obese but active and I've struggled with a binge eating disorder and have massively abused alcohol for decades so I'm guessing my insulin resistance has been born from this, the alcohol in particular as my poison of choice was always beer and cider.

This has been a massive wake up call for myself and I've quit alcohol and have now been alcohol free for seven days.

If anybody could answer these questions for me it would be much appreciated and if anybody can offer further advice to help manage and hopefully reverse my prediabetes that would be amazing.

Thanks for reading, CTJ.

Hi @CarlosTJ , and welcome!

First off, here's the Thingy https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html, which I'd been tagged in for. It's the basics of low carb, made relatively simple. And while yes, it is one in the many, many, maaaany sites on the internet that tell you what to do, and they do tend to contradict one another, you've already taken a very good step in the right direction: You got yourself a meter, so you can find out what works for you. The meter won't try to sell you on anything or push some dietary dogma or other, it'll just let you know whether something spikes you or not. Makes it easier to see what is true for you, rather than shouty websites vying for attention (and often times, your money!). Also, yeah, alcohol consumption can alter your blood glucose results, so going on the wagon there, will paint a clearer picture of what's going on. Excellent choice.

With a HbA1c of 44 you're in the prediabetic range. The blood glucose being relatively high in the morning has to do with your liver dumping stored glucose to "help" you start your day, rather than you consuming it. The rest of the day you seem to be doing fairly well around meals so far, so... I think you'll be back into the normal range fairly fast. Maybe ditch the breads and potatoes too. Those are high carb after all.

I don't know whether binging is still an issue, but if it can't be helped, try redirecting it. Go for foods that are low to no carb, when the urge hits. Cheeses, eggs, cold cuts, olives, that sort of thing. If it feels decadent enough to scratch the itch, but not spike blood sugars, there's something to be gained there, if need be.

Good luck!
Jo

 

[Outlier]

Obviously you will have to introduce your friends and in-laws gradually to your new healthy diet, but just in case you feel despondent about the roast dinner thing, I still have roast dinners - I love 'em - just have extra meat (with the fat) and lots of different leafy veg, no spuds or Yorkshire pud, and instead of thickened gravy I have plenty of meat juices from the roasting tin, with a bit of butter or olive oil if there isn't enough. This is about change not deprivation!

 

[CarlosTJ]

The roast meat will be fine.
The veg should be fine.
The roasties, may not, could be better if done in goose fat.
The rest I suspect will spike you.

The hba1c test is the standard norm for diagnosis.
However, there are so many aspects of testing that can impact fasting tests.
A finger prick test is only a snapshot of your blood glucose levels at that time.
There are so many variables, to get an absolute accuracy.
Then the accuracy of the glucometer, is not very precise.
It is just a case of being around that figure. To give you an approximate reading.
So, I couldn't even think of giving you, if you are prediabetic or T2.

It is not what you are, but how you control it.
Whether prediabetic or T2, being proactive with your diet and exercise will be a game changer, and not lead to T2, high spikes and more importantly, lower your hba1c levels.
And as you have said, need to lose some weight, that could happen without the carbs and sugars.

Keep asking.

So, as we were discussing this, a little update on the meal yesterday in which I experimented a little bit given I wanted to see how my body reacted as you suggested...

The meal consisted of roast chicken, broccoli, carrot, green beans, onion sauce, 3 roast potatoes, 2 chipolatas and gravy followed by strawberries and raspberries with a scoop of ice cream (which was the experimental part given ice cream is full of sugar).

My numbers were 5.6 pre-meal and then 6.3 within 2hrs of my first bite of food so well within the 2mmol/l post meal range so I'm pretty happy, if I understand this correctly, that I don't have to worry about those foods in those quantities going forward as they were also more than enough.

This morning my fasting bloods were down on both previous days at 6.7 but as my post meal measurements are fairly normal I'm guessing this is the figure I need to concentrate on by not eating late in the evening etc? I've read about normal hormone release spiking fasting sugars even in non-diabetics so this is the confusing part for me really.

 

[CarlosTJ]

Hi, well done on your good work so far.
I was diagnosed pre diabetic in 2008. I've maintained normal hba1c's ever since. The morning fasting readings were the last things to come down, but I was getting normal hba1c's despite this. What really brought them down the morning readings was finishing eating anything by 7pm, then not eating till 7.30 in the morning.
I continue this now except when we eat out or on holiday. The low carbing I continue all the time.

Hi Jo123, thanks for this, it's definitely something I'll look into doing, thanks for replying

 

[CarlosTJ]

Hi and welcome. It's not really possible to draw a firm conclusion from a fingerprick test in isolation - everyone's blood glucose varies all the time in response to various stimuli. Food (mainly carbohydrate) is the most significant but your liver will adjust your levels in response to things like stress, illness, ambient temperature, exercise, time of day....

The fingerprick testing regime I'd advise is to test immediately before eating, and then two hours later. You are NOT testing to see "how high you go". You are testing to see how well your insulin response dealt with the raised blood glucose from your digested food. What you're looking for is for the second reading to be within 2mmol/l of the first, and not above 8.5. If so, that shows that your system can handle the glucose resulting from whatever it was you ate.

Couple of wrinkles with this. Alcohol with food will give you a lower blood glucose reading, because the liver prioritises metabolising the alcohol and stops topping up your blood glucose. However the carbs have still gone in and still have to be managed. This is the case even when there are no carbs in the alcohol itself (spirits, for example).

Secondly the high point - the glucose peak - will probably be somewhere in the first hour after eating. This happens to everyone, and it doesn't take much to push BG high. For example - a small latte will take me from 5ish to 9.6 in 30 minutes, and back to 5ish by the hour, just from the lactose in the milk. If you test in the first hour, you might see some figures that at first sight look really bad - but those are before your system gets to work.

Finally there are carbs hidden everywhere in processed and prepared food. Supermarkets add sugar to meat to brown chicken skin, for example. Gravies and soups have thickener which is usually a form of starch, and is pure carb. I read the small print on labels, and generally don't buy.

You may find that it's worth testing around the carb-heavy items - bread, pastry, pasta, potatoes, rice, fruit, sugary things - first. These are liable to be the things that have most impact on your levels and (in my case anyway) they had to go.

best of luck, ask as many question as you like.

Thanks for this reply Kenny, makes a lot of sense so will definitely look at testing before and after meals, especially ones that I've not eaten yet since starting lower carb eating. Thanks again

 

[CarlosTJ]

Hi @CarlosTJ , and welcome!

First off, here's the Thingy https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html, which I'd been tagged in for. It's the basics of low carb, made relatively simple. And while yes, it is one in the many, many, maaaany sites on the internet that tell you what to do, and they do tend to contradict one another, you've already taken a very good step in the right direction: You got yourself a meter, so you can find out what works for you. The meter won't try to sell you on anything or push some dietary dogma or other, it'll just let you know whether something spikes you or not. Makes it easier to see what is true for you, rather than shouty websites vying for attention (and often times, your money!). Also, yeah, alcohol consumption can alter your blood glucose results, so going on the wagon there, will paint a clearer picture of what's going on. Excellent choice.

With a HbA1c of 44 you're in the prediabetic range. The blood glucose being relatively high in the morning has to do with your liver dumping stored glucose to "help" you start your day, rather than you consuming it. The rest of the day you seem to be doing fairly well around meals so far, so... I think you'll be back into the normal range fairly fast. Maybe ditch the breads and potatoes too. Those are high carb after all.

I don't know whether binging is still an issue, but if it can't be helped, try redirecting it. Go for foods that are low to no carb, when the urge hits. Cheeses, eggs, cold cuts, olives, that sort of thing. If it feels decadent enough to scratch the itch, but not spike blood sugars, there's something to be gained there, if need be.

Good luck!
Jo

Hi Jo, thanks for this, much appreciated! I'll have a good look at the link you sent later on when I get on my break. Glad I'm doing what seems to be the right thing and thanks for explaining the morning spike I'm having, which sounds like it's fairly normal so would effect all diabetics, prediabetics and non-diabetics.

With regards to the snack foods suggested, great shout. I do have high triglycerides that also needs addressing so have been trying to keep egg consumption below two per day but as with the mixed messages on the net with diet in general, I see the same contradictions when it comes to eggs and cholesterol advice. The way I view it is having a couple more eggs on some days is still better than having a massive burger or cake/biscuits (which is obviously the case for blood sugar anyway but in general with the whole egg cholesterol debate etc.).

 

[CarlosTJ]

Obviously you will have to introduce your friends and in-laws gradually to your new healthy diet, but just in case you feel despondent about the roast dinner thing, I still have roast dinners - I love 'em - just have extra meat (with the fat) and lots of different leafy veg, no spuds or Yorkshire pud, and instead of thickened gravy I have plenty of meat juices from the roasting tin, with a bit of butter or olive oil if there isn't enough. This is about change not deprivation!

Ooooh that still sounds amazing! Thankfully a few spuds didn't send me over 2mmol of my pre-meal measurement so can have them if I choose to but will still make the effort not to, it's more a case now of being able to resist them haha

 

[KennyA]

Thanks for this reply Kenny, makes a lot of sense so will definitely look at testing before and after meals, especially ones that I've not eaten yet since starting lower carb eating. Thanks again

I should also have said - keep a record. I wrote everything down for a couple of years - food eaten and BG readings. The results from your meal look fine in themselves, but as you say it is a high carb meal and you may want to limit the amount of glucose stress you place on your system. I assume you didn't have any alcohol with it?

...normal hormone release spiking fasting sugars even in non-diabetics so this is the confusing part for me really.

If you're talking about insulin release, insulin lowers bg, it doesn't raise it. You'll see higher insulin levels following higher blood glucose, not the other way round.

The levels you're seeing in the mornings are little to do with what you ate the night before - any derived glucose will have been dealt with much more quickly. Morning levels are almost invariably down to what your liver is doing. Livers regulate blood glucose levels and add glucose to the blood all the time, to maintain it (at around 4g of glucose) at what it believes are useful levels. Many of us find that our livers dump glucose in the small hours to get us up and going - my morning readings on the rare occasions I do them are usually still (after five years) the highest I'd see all day.

It's not really possible to do much about the liver's preferences without medication. Metformin interferes with the glucose top up, although the medical world still says " the mechanism by which it does this is not fully understood". Alcohol will also interfere with the process as the liver prioritises metabolising alcohol over maintaining blood glucose. My liver slowly came to accept that I didn't need the high levels of glucose that I'd previously had, but that took about six months to start to change.

 

[JoKalsbeek]

Hi Jo, thanks for this, much appreciated! I'll have a good look at the link you sent later on when I get on my break. Glad I'm doing what seems to be the right thing and thanks for explaining the morning spike I'm having, which sounds like it's fairly normal so would effect all diabetics, prediabetics and non-diabetics.

With regards to the snack foods suggested, great shout. I do have high triglycerides that also needs addressing so have been trying to keep egg consumption below two per day but as with the mixed messages on the net with diet in general, I see the same contradictions when it comes to eggs and cholesterol advice. The way I view it is having a couple more eggs on some days is still better than having a massive burger or cake/biscuits (which is obviously the case for blood sugar anyway but in general with the whole egg cholesterol debate etc.).

Cholesterol does get a whole lot of the same contradictory advice blood sugar management does.... Mind you, most of the cholesterol that floats around in our bodies we make ourselves: it's not coming from what we eat anywhere near as much as you'd think. (Also, our brains are made up of cholesterol for a large part, so it's not all bad! ). Keep in mind that cholesterol transports fats, so when you start a low carb diet, your cholesterol can go up for a bit, but that's because it's working to help you get rid of the fats, as you lose weight on the diet. It's carrying the stuff out, and will drop back down when you need less of it. For me, and quite a few others, going low carb improved/normalised cholesterol in the long run. Took about 6 months for me, I think, but it's been a while so it might've been longer or shorter, but it did happen. And believe me, I eat a LOT of eggs. At one point, about 4 a day, every day! Drawback on cholesterol is that it flucuates much slower than blood sugars do, and it's not something you can easily/cheaply test at home regularly. So once every 3 to 6 months if you want to see what's working for you would be more of use than say once a month, while blood sugar tests are very informative on a daily basis. So I'd say, go with your gut on this one. Anything I tell you is annecdotal, after all, and I don't live in your body.

 

[Grant_Vicat]

Hi Jo, thanks for this, much appreciated! I'll have a good look at the link you sent later on when I get on my break. Glad I'm doing what seems to be the right thing and thanks for explaining the morning spike I'm having, which sounds like it's fairly normal so would effect all diabetics, prediabetics and non-diabetics.

With regards to the snack foods suggested, great shout. I do have high triglycerides that also needs addressing so have been trying to keep egg consumption below two per day but as with the mixed messages on the net with diet in general, I see the same contradictions when it comes to eggs and cholesterol advice. The way I view it is having a couple more eggs on some days is still better than having a massive burger or cake/biscuits (which is obviously the case for blood sugar anyway but in general with the whole egg cholesterol debate etc.).

Many Type 2s have found that reducing carbs and relying on natural fats (as found in meat, cheese and real cream etc) not only improves control, but also general energy and Cholesterol levels. It sounds unbelievable, but many will bear this out. It looks like you're well on the way!