Prediabetes Fruit in diet

[MDHalstead]

I guess if you exercise a lot. Fruit is ok?

 

[Robbity]

It can still raise glucose levels. So you need to test to find out which fruit in what quantities may be OK for you.

I can eat berries and other low carb fruits in small quantities (usually around 50-75g weight), and do so most days. I eat them with cream, creme fraiche, etc, and mainly as part of a larger meal. That way I'll get very little in the way of spiking. I love fruit so for me it's a bit of a compromise if I want to keep to a pretty low carb diet (under 50g carbs a day) long term, and so far i've been able to manage this for just on three years now, and reduce and keep my glucose and HbA1c levels down in the lower pre diabetic range, from an initial well and truly diabetic HbA1c of 60-62 at then end of 2013.

Ribbity

 

[RodBallantyne]

For a long time we have been told to eat five a day of fruit and veg, and I am sure this is good advice. However, I find that fruit elevates BS. What do we do about oranges, apples, melons, pears etc., that I am sure are healthy. I have always enjoyed them but do I now have to give them up. Opinions please.

We are all different but there is a lot of misinformation out there, so beware! The important measure of BG is your average over time so the HbA1C is the measure to concentrate on, not temporary spikes picked up on meters. Strawberries, blueberries and raspberries will do you little harm if eaten in moderation. Likewise apples have many good things in them so don't dismiss them. Water melons are very good as they contain lots of minerals and lots of Lycopene and not much carbs. Oranges are something to only have once in a while as they do have lots of fructose. The main thing is to be sensible and to take exercise regularly particularly High Intensity Intermittent exercise 3 times a week. The BBC Horizon programme highlighted the benefits of this for diabetics and the on-going research at Nottingham University and Loughborough University is showing good results.

 

[Brunneria]

The important measure of BG is your average over time so the HbA1C is the measure to concentrate on, not temporary spikes picked up on meters.

I disagree.
I find the HbA1c a waste of time in reflecting my personal situation, since individual glycation rates can affect it so much, and because it fails to record the damaging effect of high blood glucose after meals.

On the other hand, controlling the individual blood glucose rises and drops after eating, and maintaining a small standard deviation seems to benefit individuals.
http://spectrum.diabetesjournals.org/content/25/3/149

My personal experience of this is that if I keep my blood glucose as level as possible, I feel well.
Yet if I keep the same overall HbA1c, with larger blood glucose swings, I start getting stabbing pains in my feet and feel far worse.
This difference is apparent within a single week of switching to the 'worse' bg control regime, so I shudder to think how it would impact over months and years of trusting to just HbA1cs...

 

[Bluetit1802]

I agree with @Brunneria 100%.

I have learnt to ignore my HbA1c results and to rely on my finger pricking and Libre sensor. It is the swings up and down that cause the problems. An HbA1c only gives a very rough average, and will never show these swings. The amount of variance is what is important.

 

[Robbity]

We need real time results.

Our own testing regime can keep us well controlled and healthy, and is I believe one of the most important things we can do to control our diabetes - as long as we're prepared to learn to use the result of those tests and checks. Our HbA1c will (hopefully!) keep the doctors happy, but as far as I'm concerned being given an average measure of how I'm managing once every 3, 6, or at worst 12 months is just flying completely blind and (to mix my metaphors) could well be an unhappy case of shutting the high glucose stable door far too late after the now well and truly diabetic horse has bolted...


Robbity

 

[fletchweb]

For a long time we have been told to eat five a day of fruit and veg, and I am sure this is good advice. However, I find that fruit elevates BS. What do we do about oranges, apples, melons, pears etc., that I am sure are healthy. I have always enjoyed them but do I now have to give them up. Opinions please.

My diet is rich in fruit but I cut down on other carbs as a replacement for the fruit. For breakfast this morning - all I had was a tangerine - I didn't need anything else - no breads, cereals etc. I also find that some fruits have less of an impact than others - blueberries for example. Absolutely wonderful For my noon time meal I plan to have a salad - here again no breads - evening meal I'll have some protein/meat. I probably don't eat five a day but that sounds like an arbitrary number. My advice, if you're going to cut down on anything - cut down on breads, potatoes, cereals if they're in your diet and replace it with fruit. See if that helps. Good luck! I can't imagine giving up on fruit and veggies - or meat for that matter

 

[Prem51]

Hi @fletchweb With respect though, you are Type 1 and able to balance your bs level with insulin. Type 2, or pre-diabetics trying to avoid becoming Type 2, can't do that.

 

[BrianTheElder]

I disagree.
I find the HbA1c a waste of time in reflecting my personal situation, since individual glycation rates can affect it so much, and because it fails to record the damaging effect of high blood glucose after meals.

On the other hand, controlling the individual blood glucose rises and drops after eating, and maintaining a small standard deviation seems to benefit individuals.
http://spectrum.diabetesjournals.org/content/25/3/149

My personal experience of this is that if I keep my blood glucose as level as possible, I feel well.
Yet if I keep the same overall HbA1c, with larger blood glucose swings, I start getting stabbing pains in my feet and feel far worse.
This difference is apparent within a single week of switching to the 'worse' bg control regime, so I shudder to think how it would impact over months and years of trusting to just HbA1cs...

This is something that has been at the back of my mind for some time...
I see a lot of posters recommending testing often and they are obviously committed to that.
But is more damage done to organs by short sharp shocks or long term abuse? Obviously both can cause damage so should be avoided.
I would be interested if you can point me to any research on this that points in either direction.
In my own case, I avoid both by keeping my carbs very low all the time. This makes for a limited diet, lacking in variety, so I just have to console myself with eating the food I really love all the time. That makes it easier to forget wholemeal bread, chocolate cake, seafood pasta and roast parsnips.

 

[Bluetit1802]

My diet is rich in fruit but I cut down on other carbs as a replacement for the fruit. For breakfast this morning - all I had was a tangerine - I didn't need anything else - no breads, cereals etc. I also find that some fruits have less of an impact than others - blueberries for example. Absolutely wonderful For my noon time meal I plan to have a salad - here again no breads - evening meal I'll have some protein/meat. I probably don't eat five a day but that sounds like an arbitrary number. My advice, if you're going to cut down on anything - cut down on breads, potatoes, cereals if they're in your diet and replace it with fruit. See if that helps. Good luck! I can't imagine giving up on fruit and veggies - or meat for that matter

Too much fructose (fruits) has been shown to be a cause of fatty livers, which is exactly what Type 2's do not want.

 

[Bluetit1802]

This is something that has been at the back of my mind for some time...
I see a lot of posters recommending testing often and they are obviously committed to that.
But is more damage done to organs by short sharp shocks or long term abuse? Obviously both can cause damage so should be avoided.
I would be interested if you can point me to any research on this that points in either direction.
In my own case, I avoid both by keeping my carbs very low all the time. This makes for a limited diet, lacking in variety, so I just have to console myself with eating the food I really love all the time. That makes it easier to forget wholemeal bread, chocolate cake, seafood pasta and roast parsnips.

@tim2000s is the expert on glycaemic variation I believe. He may have some useful links for you.

 

[MikeTurin]

I agree with @Brunneria 100%.

I have learnt to ignore my HbA1c results and to rely on my finger pricking and Libre sensor. It is the swings up and down that cause the problems. An HbA1c only gives a very rough average, and will never show these swings. The amount of variance is what is important.

The problem with HbA1c is that being a moving mean, you'll see an uprising of the values after the damage is done.
I'm talking as an engineer here: you have to protect an electric appliance and toy install a circuit breaker. Circuit breakers have a thermal overcurrent trigger that will open the circuit if the current is over the rated value for some times, and this will save the motor if is overloaded, but there's also a magnetic trigger that opens the circuit in case of a sudden current spike and protect the system if a short circuit happens, because you could have different things that could go wrong.

Or for another analogy https://en.wikipedia.org/wiki/Mayday_(TV_series)

If you have an extra set of measures the better, as a safety check. I normally use cheap urine test strip to check if something is going really wrong, like a failing glucose meter. Having a 3-month control is useful.

The elephant in the room is the fact that test strips are rationed and nobody at the hospitals teach how to use them for T2 people.

 

[Brunneria]

But is more damage done to organs by short sharp shocks or long term abuse? Obviously both can cause damage so should be avoided.
I would be interested if you can point me to any research on this that points in either direction.

It is an interesting one, isn't it?

When I first came across the idea it was explained to me that it is the area under the curve that is important, rather than the height of the spike or the width, of it. So that, effectively, it didn't matter whether the area under the curve was a sharp mountain peak, or a wide low hummock, if they were the same area, they would do the same damage.

But (temporarily) setting aside science for a moment, this makes no sense to me. If high levels of glucose in the bloodstream kill beta cells, then the greater the concentration, the more beta cells die... And if you take a toxin, any toxin, there are different levels which cause different amounts of damage. Generally speaking, the higher the dose, the more the damage. Arsenic is actually good for you in small doses, makes you temporarily ill in low doses, and kills you outright in larger ones. But comparing one toxin (Arsenic) with another toxin (sugar) is a common sense view, so it won't pass muster for many on here. Fair enough.

Scientifically, there is quite a lot of debate on the subject, but I like to remember a few details that rarely show up in the studies. Things like The Last Meal Effect, which affects low carbers and non-low carbers differently, and governs how effective our bodies are at releasing insulin at short notice (and therefore the amount of spike we get from the same amount of carb). Also insulin resistance, which can vary daily (mine does). Plus, most fruit spikes us hard and fast. Unless we test every 10 mins for the first hour, we may miss a high rapid peak and think that because it was back down to 'OK levels' by one or two hours, that piece of fruit was fine. Well, not in my book.

There are a few references in the link I posted earlier.

And here is a link to the Jenny Rhul bloodsugar101 website citing a number of studies showing the safe upper limits of blood glucose before organ damage begins. Having looked at the studies and discussed them, she reaches the conclusion that the safe upper limit is 7.8mmol/l I find the argument convincing.
http://www.phlaunt.com/diabetes/14045678.php
The higher the blood glucose is raised, the worse the damage.
So I am very happy with a wide long hummock that tops off at 7.7mmol/l (although I would prefer 7, to allow a safety margin). Doesn't matter how long, or how wide. But I am NOT happy with a sharp spikey peak from a fruit salad that takes me to 14mmol for an hour, then takes another hour to subside to the 7s.

The following links are taken from the 101 website

This one shows that beta cells not killed yet killed off by high concentrations of glucose have a better chance of recovering if removed from the glucose, or put in a lower concentration (so I want to avoid those high concentrations!)
Determinants of glucose toxicity and its reversibility in pancreatic islet Beta-cell line, HIT-T15.Catherine E. Gleason, Michael Gonzalez, Jamie S. Harmon, and R. Paul Robertson.Am J Physiol Endocrinol Metab 279: E997-E1002, 2000.

This one shows that it is the one hour reading which is more important than the 2 hour reading when looking at heart disease correlation
Inflammation markers and metabolic characteristics of subjects with one-hour plasma glucose levels. Gianluca Bardini et al. Diabetes Care Published online before print November 16, 2009, doi: 10.2337/dc09-134

And the really scary thing I take from the many studies Jenny Rhul quotes is the links between diabetic complications and pre-diabetes. The take home message is that all the time we were unknowingly crawling along through pre-D with no idea it was happening, and blood glucose levels not even considered to be diabetic, we were already taking damage, and getting a head start on retinopathy, neuropathy and all those other gifts we hate to get from diabetes.
Association of A1C and Fasting Plasma Glucose Levels With Diabetic Retinopathy Prevalence in the U.S. Population: Implications for diabetes diagnostic thresholds Yiling J. Cheng et al. Diabetes Care November 2009 vol. 32 no. 11 2027-2032. doi: 10.2337/dc09-0440
Glycemic Thresholds for Diabetes-Specific Retinopathy: Implications for Diagnostic Criteria for Diabetes:The DETECT-2 Collaboration Writing group. Stephen Colagiuri et al. Diabetes Care Published online before print October 26, 2010, doi: 10.2337/dc10-1206

I realise that most of those links don't directly address whether a high mountain spike is worse than a low wide hummock. However, they give masses of info that encourages me to maintain tight control at all times, and the general message that higher is worse. Personally, I equate control to avoiding high spikes, and reducing the size of my hummocks whenever possible! But given the choice, I would hummock every time.

But this link (again from bs101) addresses the affect of high spikes on renal failure.
Short-term peaks in glucose promote renal fibrogenesis independently of total glucose exposure.T. S. Polhill, S. Saad P. Poronnik,G. R. Fulcher, and C. A. Pollock. Am J Physiol Renal Physiol 287: F268-F273, 2004.
The authors conclude,
These results support the recommendation for postprandial monitoring of glucose levels in patients with diabetes mellitus and imply that important differences in end organ damage could occur in individuals with similar HbA1c but different postprandial glucose levels.They go on to explain that their findings prove that it is not glycation (the attachment of glucose molecules to proteins) that destroys the kidney tissue so much as the effect of the fluctuations of blood sugar on gene expression.
They urge more attention to eliminating spikes.

Finally, my own experience (mentioned in a previous post) has utterly convinced me.
We went on holiday last October. I was wearing a single Libre sensor for the week before the holiday and the week of the holiday. The difference was that I low carbed in week 1 of the sensor, and ate bread, chips and cake in week 2. HbA1c remained constant throughout (the Libre gives you a HbA1c score for the last 7,14 and 30 days). The difference was that I got stabbing pains in the instep of my left foot as from the increased blood glucose fluctuations. 3 days after returning to my usual low carb diet, the pains stopped, and I haven't had them since.

 

[BrianTheElder]

It is an interesting one, isn't it?

When I first came across the idea it was explained to me that it is the area under the curve that is important, rather than the height of the spike or the width, of it. So that, effectively, it didn't matter whether the area under the curve was a sharp mountain peak, or a wide low hummock, if they were the same area, they would do the same damage.

But (temporarily) setting aside science for a moment, this makes no sense to me. If high levels of glucose in the bloodstream kill beta cells, then the greater the concentration, the more beta cells die... And if you take a toxin, any toxin, there are different levels which cause different amounts of damage. Generally speaking, the higher the dose, the more the damage. Arsenic is actually good for you in small doses, makes you temporarily ill in low doses, and kills you outright in larger ones. But comparing one toxin (Arsenic) with another toxin (sugar) is a common sense view, so it won't pass muster for many on here. Fair enough.

Scientifically, there is quite a lot of debate on the subject, but I like to remember a few details that rarely show up in the studies. Things like The Last Meal Effect, which affects low carbers and non-low carbers differently, and governs how effective our bodies are at releasing insulin at short notice (and therefore the amount of spike we get from the same amount of carb). Also insulin resistance, which can vary daily (mine does). Plus, most fruit spikes us hard and fast. Unless we test every 10 mins for the first hour, we may miss a high rapid peak and think that because it was back down to 'OK levels' by one or two hours, that piece of fruit was fine. Well, not in my book.

There are a few references in the link I posted earlier.

And here is a link to the Jenny Rhul bloodsugar101 website citing a number of studies showing the safe upper limits of blood glucose before organ damage begins. Having looked at the studies and discussed them, she reaches the conclusion that the safe upper limit is 7.8mmol/l I find the argument convincing.
http://www.phlaunt.com/diabetes/14045678.php
The higher the blood glucose is raised, the worse the damage.
So I am very happy with a wide long hummock that tops off at 7.7mmol/l (although I would prefer 7, to allow a safety margin). Doesn't matter how long, or how wide. But I am NOT happy with a sharp spikey peak from a fruit salad that takes me to 14mmol for an hour, then takes another hour to subside to the 7s.

The following links are taken from the 101 website

This one shows that beta cells not killed yet killed off by high concentrations of glucose have a better chance of recovering if removed from the glucose, or put in a lower concentration (so I want to avoid those high concentrations!)
Determinants of glucose toxicity and its reversibility in pancreatic islet Beta-cell line, HIT-T15.Catherine E. Gleason, Michael Gonzalez, Jamie S. Harmon, and R. Paul Robertson.Am J Physiol Endocrinol Metab 279: E997-E1002, 2000.

This one shows that it is the one hour reading which is more important than the 2 hour reading when looking at heart disease correlation
Inflammation markers and metabolic characteristics of subjects with one-hour plasma glucose levels. Gianluca Bardini et al. Diabetes Care Published online before print November 16, 2009, doi: 10.2337/dc09-134

And the really scary thing I take from the many studies Jenny Rhul quotes is the links between diabetic complications and pre-diabetes. The take home message is that all the time we were unknowingly crawling along through pre-D with no idea it was happening, and blood glucose levels not even considered to be diabetic, we were already taking damage, and getting a head start on retinopathy, neuropathy and all those other gifts we hate to get from diabetes.
Association of A1C and Fasting Plasma Glucose Levels With Diabetic Retinopathy Prevalence in the U.S. Population: Implications for diabetes diagnostic thresholds Yiling J. Cheng et al. Diabetes Care November 2009 vol. 32 no. 11 2027-2032. doi: 10.2337/dc09-0440
Glycemic Thresholds for Diabetes-Specific Retinopathy: Implications for Diagnostic Criteria for Diabetes:The DETECT-2 Collaboration Writing group. Stephen Colagiuri et al. Diabetes Care Published online before print October 26, 2010, doi: 10.2337/dc10-1206

I realise that most of those links don't directly address whether a high mountain spike is worse than a low wide hummock. However, they give masses of info that encourages me to maintain tight control at all times, and part of that control is avoiding high spikes, and reducing the size of my hummocks whenever possible!

But this link (again from bs101) addresses the affect of high spikes on renal failure.
Short-term peaks in glucose promote renal fibrogenesis independently of total glucose exposure.T. S. Polhill, S. Saad P. Poronnik,G. R. Fulcher, and C. A. Pollock. Am J Physiol Renal Physiol 287: F268-F273, 2004.
The authors conclude,
These results support the recommendation for postprandial monitoring of glucose levels in patients with diabetes mellitus and imply that important differences in end organ damage could occur in individuals with similar HbA1c but different postprandial glucose levels.They go on to explain that their findings prove that it is not glycation (the attachment of glucose molecules to proteins) that destroys the kidney tissue so much as the effect of the fluctuations of blood sugar on gene expression.
They urge more attention to eliminating spikes.

Finally, my own experience (mentioned in a previous post) has utterly convinced me.
We went on holiday last October. I was wearing a single Libre sensor for the week before the holiday and the week of the holiday. The difference was that I low carbed in week 1 of the sensor, and ate bread, chips and cake in week 2. HbA1c remained constant throughout (the Libre gives you a HbA1c score for the last 7,14 and 30 days). The difference was that I got stabbing pains in the instep of my left foot as from the increased blood glucose fluctuations. 3 days after returning to my usual low carb diet, the pains stopped, and I haven't had them since.

Thank you for your efforts in replying so thoroughly.
I will read that all with great interest.

 

[Robbity]

This is something that has been at the back of my mind for some time...
I see a lot of posters recommending testing often and they are obviously committed to that.
But is more damage done to organs by short sharp shocks or long term abuse? Obviously both can cause damage so should be avoided.
I would be interested if you can point me to any research on this that points in either direction.
In my own case, I avoid both by keeping my carbs very low all the time. This makes for a limited diet, lacking in variety, so I just have to console myself with eating the food I really love all the time. That makes it easier to forget wholemeal bread, chocolate cake, seafood pasta and roast parsnips.

It's quite possible to keep carbs very low and eat a varied and healthy diet. I bake my own low carb bread and cakes (including yummy chocolate ones) using nut and seed flours. I think I actually have a better and more varied diet now than I have done for years...

I've chosen to test regularly, and try to keep my glucose levels low with minimum spikes, and a low carb high(er) fat/ketogenic diet helps me to do just this:



(Average levels recorded by Freestyle Libre sensor for Jan 2017; sensor actually reads approx 1-1.5 mmol below my finger prick tests - so realistically between 5.5 and 7.5 max.)

Robbity