DUK would like to meet!

What is the difference between pre-diabetic and insulin resistant? I have not been able to work this out :? Around 3 years ago, I was told I was insulin resistant based, on an impaired fasting glucose test.

Seems to me that all are quite vague terms and what people need is some more precise numbers and an explaination of what they actually mean. I didn't understand what my GP was saying to me, why it was a problem. If I knew then what I know now :shock:

Spiral,

I too am very confused by it all Spiral.

I was diagnosed as Type 2 diabetic with fasting blood glucose levels of 7.4, 7.7 and 7.4 and an HbA1c of 5.7%. That was nine years ago - it meant very little to me then.

My condition gradually progressed to a highest HbA1c of 9.4%.

However, these days, my fasting blood glucose levels never reach 7 and my last two HbA1c readings have both been 5.3%. I am still on metformin - and might be wrong - but I'm absolutely convinced that I'd be able to maintain those levels if I came off medication. How? By cutting my carbohydrate intake further than I have needed to do so far if that ever became necessary. What does that make me now - diabetic, insulin resistant - or pre-diabetic perhaps?

John

wallycorker said:

Spiral,

I too am very confused by it all Spiral.

I was diagnosed as Type 2 diabetic with fasting blood glucose levels of 7.4, 7.7 and 7.4 and an HbA1c of 5.7%. That was nine years ago - it meant very little to me then.

My condition gradually progressed to a highest HbA1c of 9.4%.

However, these days, my fasting blood glucose levels never reach 7 and my last two HbA1c readings have both been 5.3%. I am still on metformin - and might be wrong - but I'm absolutely convinced that I'd be able to maintain those levels if I came off medication. How? By cutting my carbohydrate intake further than I have needed to do so far if that ever became necessary. What does that make me now - diabetic, insulin resistant - or pre-diabetic perhaps?

John

Click to expand...

John.

You are a well controlled Diabetic, you probably always will be until someone finds a cure. Maybe ?

This is how I see it too - well controlled diabetes. While I may be able to get away with eating off plan every now and then, I would not be a well controlled diabetic if my blood sugar went up to those frighteningly high levels again. These days they come down to my current normal fairly quickly. If I was doing it every day, they wouldn't. So I have to continue to activley manage my diabetes by diet. I wonder if this makes me pre-diabetic. Perhaps I could go and spead some low carb heresy at DUK... :twisted:

A well controlled diabetic is still a diabetic and it "aint gonna go away." By all means try and practise good control and if you need medication to do this then so be it. If it becomes an obsession then life passes you by in the process. An epitaph on your tombstone may well read " Here lies John Doe, a diabetic" if that is all there is in your life. We are defined by more than our medical status. Live life to the full, treat your diabetes with respect and enjoy all aspects of your life. We only pass this way once and it is not a rehearsal.

Spiral said:

What is the difference between pre-diabetic and insulin resistant? I have not been able to work this out :? Around 3 years ago, I was told I was insulin resistant based, on an impaired fasting glucose test.
Seems to me that all are quite vague terms and what people need is some more precise numbers and an explaination of what they actually mean.

Click to expand...

Spiral. Noticed this hadn't been answered.

Basically Diabetes just doesn't hit you one morning on waking. It is developing over a period of yours.
You are not quite at the stage where you are definitely Diabetic. You are generally above what would be considered 'normal' and below what is considered Diabetic.

A person who is pre-Diabetic doesn't normally get all the complications that we might get. Glucose levels aren't that high to cause them. You would have a much higher risk of developing heart disease and other problems as compared to a non Diabetic. It also has much in common with insulin resistance syndrome or metabolic syndrome.

The numbers often quoted for being pre-Diabetic are before eating between 5.5 - 7 mmol/l. One hour after eating between 7.8 - 11.1 mmol/l. If dignosed then you can go on to make lifestyle changes, diet, exercise and sometimes medication as well. That way you can avoid full blown Diabetes.

Insulin resistance is a condition in which cells, particularly those of muscle, fat, and liver tissue, display "resistance" to insulin by failing to take up and utilize glucose for energy and metabolism (insulin normally promotes take up and utilization of blood glucose from the blood stream). In its early stages, the condition is asymptomatic, but may develop into Type II Diabetes. Although there are several established risk factors, the underlying cause is unknown.

Hope that helps.

The term prediabetes is really an American term, in the UK they tend to use either impaired fasting glucose (ifg)or impaired glucose tolerance.(igt)
You have igt if after a glucose tolerance test:
your blood glucose level after 2 hours is:
above 7.8 mmol/L, and
below 11.1 mmol/L

You have ifg if fasting glucose is
above 6.1 mmol/L, and
below 7.0mmol/L
These are not diabetic levels . At this stage (for some people) lifestyle interventions might prevent or delay the onset of overt diabetes. Like any cut off point they have been decided by commitee. Some authorities want these figures reduced so intervention starts earlier. A 2006 review revisited the matter, they decided to retain the present levels. The report has quite a bit about the risks as glucose levels increase but also of the difficulty of defining normal levels. One important recommendation was

The current WHO definition for Impaired Glucose Tolerance (IGT) should
be maintained for the present.Consideration should be given to replacing this category of intermediate hyperglycaemia by an overall risk assessment for diabetes, cardiovascular
disease, or both, which includes a measure of glucose as a continuous
variable

Click to expand...

In the text they suggested using some sort of prediction scores which, in addition to plasma glucose, also include other risk factors for diabetes and cardiovascular diseases. This presumably would require some sort of mass screening/health checks.
http://www.who.int/diabetes/publications/Definition and diagnosis of diabetes_new.pdf

Spiral and Wally I don't know how much you know?
insulin resistance intro version
http://medweb.bham.ac.uk/easdec/prevention/HBA1c & type 2 diabetes.htm#what
Bit more detailed and from the point of view of prediabetes but from US so blood test figures in mg/dl not mmol (the HDL fig would be .9mmol/l the trigs fig is 2.8mmol/l , the glucose levels as above)
http://diabetes.niddk.nih.gov/DM/pubs/insulinresistance/

My eyes have been opened since my diagnosis and I'd say I was now a fairly knowledgable diabetic.

I was commenting, not very cleary I acknowledge, that the inforamtion we are often given is vague and non-specific, pretty pointless to be honest. I have rung the surgery to be told my results are "satisfactory" when what I actually want are the numbers.

I also recall popping in to the surgery and being very pleased with one of my early numbers which was still diabetic but an improvement on the previous test. The receptionist then got quite concerned and told me that the number she had just given me was not a good one :roll: I knew that, I also knew it was an improvement.

When I was told I had impared fasting tolerance/insulin resistance/whatever I was following that wonderful heathy plate diet, with lots of starchy carbohydrate :? The only thing that was suggested was that I lose weight and my GP told me what a horrid condition diabetes was. Ironically, I thought that I had the diet sussed :roll:

I beleive that by getting to grips with my diabetes now I will be able to enjoy life with my feet on later - this is why I need normal readings now. I'm not obsessing, I have made an informed decision to manage my condition through diet and the minimum medication possible.

I may have rejected the conventional wisdom given by my the NHS in that I test regularly and low carb. Just look at my results - blood sugar readings that look relatively normal 97 day average 5.5mmol) and massive weight loss.

I'm diabetic, I can never take my eye off that ball, but I know that there is a lot I can do to help myself manage my condition. And time taken now will help me to be a lot more relaxed about it. Others may make different decision. If I can help another diabetic get control of their condition through what I have learned then I will share that info with them. That isn't being obsessive, that is what self help is about.