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Hb1ac of 42: time to take this seriously

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Hi everyone,

Nice to meet you all. [squints] Good-looking crowd!

So, in December I had a Hb1ac test and it came back as 42.

This did not surprise me, for several reasons.

First, all my life I've had an extremely sweet tooth. In 2021, and especially over the summer months, my overindulgence in bad foods became so extreme that even I cared.

Over the summer, and well into the autumn, and to varying degrees ever since, I was sitting motionless on my couch trying to meet deadlines. I would sometimes keep working for 20 hours at a stretch, and on a couple of occasions, over 30 hours. I knew full well how unhealthy this was, but this was some of the most critically important work I've ever done, so I had no good choices.

I should add that I had been in the habit of exercising at least 30 minutes a day, at least 3 times a week. The minimum would be 25 minutes of HIIT followed by 30-35 minutes of calisthenics, including stretching. During the extreme summer of work, I fell below that, and I still don't always manage it as my workload continues to be extreme (though it is finally stabilizing). I know full well how bad this is.

In December I got tested, and was referred to the NHS's prediabetes program.

The program is very much geared towards weight loss. It involves the Oviva app, which requires you to start with a picture of yourself standing on the scale, showing your weight. I'm well within the healthy weight range and always have been, although my preferred weight is quite a bit lower than it is now. I'm preparing to start a calorie cut, but that's not especially for health reasons, it's just preference, and I do find that my blood pressure etc. is far better at the thinner end of the range.

It also gives you a lot of tutorials about healthy eating, and (to be fair) a tutorial each on weight maintenance, weight loss, and weight gain. There is some demonstrably bad advice in the weight loss section, as it suggests a ballpark calorie target that is far too low for most people (which is something that really grinds my gears, but I won't digress about it here). However, it does seem to try to be thorough about giving you all the information to make your own choices. I appreciate this approach, as I think it's much better than the "trickle truthing" by which a lot of public health advice gets communicated.

However, it's also fairly confusing due to the state of existing knowledge, I guess. Diet advice amounts to: go low carb, but don't go low carb, or maybe you could go low carb. Go low fat and look at traffic lights on labels, it suggests. Why - because low fat usually means lower calories? Or because low fat will somehow improve my blood glucose? It isn't necessarily clear.

So I have kind of tried to track my carbs, but not really. I started by reducing the amount of added sugar I take in, which is a huge change, but it wouldn't be enough even if I had cut out added sugar altogether, which I haven't. (I've had two cans of 7-up in the past week. 15g sugar each. Previously I would have consumed much much more. But I shouldn't be consuming any.)

Even by a conservative estimate, cutting out added sugar wouldn't be enough, as I need to cut starches way down and eschew potatoes and non-basmati white rice. Okay, I can do that. Or sort of do it. It's an improvement, but is it enough?

One concrete suggestion was to limit carbohydrates to 50g per meal and 15g per snack. That seems do-able, but it still adds up to fairly high carbs in any given day. But then again, it's not clear to me whether a low-carb diet is necessary or desirable for me.

Looking at the threads here, I guess you would all say that low-carb is The Way. I suppose if I'm going to continue here, this is what I've got to commit to. It may be the single thing that is necessary for me to succeed - if it's not already too late. Looking back I can say I've made drastic dietary changes in 3-4 months, but I guess I needed to be more drastic.

It does make me a little sad, because I don't have time to spend with friends or family, or to watch TV or listen to music or read books, or go out anywhere. It seemed like crisps were the one pleasure still available to me, and I have given in to them this week as well (150g eaten in the past week). I don't mean to moan too much, as I'm overall very privileged, and I also know that it's my responsibility to improve my life so that I'm not chained to my desk. Sometimes, however, you are up against circumstances and you have to make critical choices.

You also get a coach, and so they have texted me suggestions like "I can teach you to read labels so you know when you're eating added sugar! Did you know peanut butter can contain added sugar?" Yeah, I know, and even I wouldn't eat peanut butter with added sugar. I also once consumed a bag of commercial sweet-and-salt popcorn because that was the only food available (I'd taken a relative to hospital and gotten home late). To that, I got the suggestion that plain unsalted popcorn would be a great healthy substitute! I replied that that didn't sound appealing and I would rather snack on nothing (factually true) and I guess I lost the sympathy of my coach there. I mean... I don't have to be overjoyed at the idea of eating unsalted plain popcorn as a snack (if I had the time to pop it, which I don't). I just have to eat it, or not, and I choose to not.

So I guess the glucose monitor will arrive in a couple of days and I'll discover that nothing I've done has made a blind bit of difference because multigrain bread is still terrible.

Sigh... oh well, back to work.
 
Hi @NoMoreSugarBaby , welcome to the forum.
Even by a conservative estimate, cutting out added sugar wouldn't be enough
Your hba1c of 42 is exactly on the threshold between pre-diabetic and non diabetic.
Cutting out some sugar may well be enough to get it down to normal levels again.

The 'avoid fats' advice only has to do with cutting calories, fats do not raise blood glucose. :)
 
Thanks, @Antje77! Not that I'll take it as an excuse to go back to my old ways, but that is very encouraging to read.

I did think that the advice to cut fats was about weight rather than glucose. It's an example of how overfocussed the discussion is on weight. Not to mention that low-fat foods are not necessary for weight loss, they're just a shortcut to reducing calories. I appreciate that a public health app + diet coach isn't going to order me around, and that giving the necessary information on a subject where there's a lot of contradiction, controversy and overlap is inevitably gonna be confusing. And another limiting factor is that I don't really want to do this - I'm just grudgingly accepting that I have to. If it's like this for me, what must it be like for people who aren't scientific researchers?
 
And I've been moaning a lot, but I should add this.

Since I improved my diet even to the extent I have - eschewing white bread for multigrain, albeit store-bought and therefore ultra-processed multigrain; and eschewing crisps for... okay ONE piece of fruit at a time, like the app says... or some cheese... my appetite is much smaller.

When I was eating tons of added sugar, it was more difficult to stick to maintenance calories because I would just get hungrier and hungrier. I knew the cause of my increased appetite was most likely poor nutrition, but I couldn't motivate myself to break the habit. I'm just nowhere near as hungry now. And although I like a sugary drink sometimes (at the end of a day when I accomplished a lot, it is the reward I would choose if I had free choice) and I like crisps, I don't like either as much as I used to. And then not in nearly as large quantities.

I know some people say that after embracing "clean eating", junk food makes them vomit, their bodies just can't tolerate it any more. Well, if they say so. But I've also done clean eating in the past, and I still freaking loved junk food. I did love it, I do love it, and I will love it.

HOWEVER I'm also not surprised that I want less sugar and starch than I used to, because our appetite grows with what it feeds on, and I'm experiencing the proof of that myself right now. I still feel there is something missing where reward used to be (partly due to the pressure of my current lifestyle) but that doesn't mean it's as hard as it was in the beginning. Healthy foods are, in fact, delicious (as I have always found when I've motivated myself to choose them) and thoughts do begin to wander towards healthier foods when teatime rolls around.
 
Low carb doesn't mean weight loss but if you need to lose weight it is usually more effective than calorie restriction. To avoid too much weight loss eat more unprocessed fat (eg butter on green veg, oily salad dressings).

Any ordinary bread, pasta, rice is high carb regardless of the colour or type.
 
Both are high carb. And neither may prove to be a problem, seeing how close to non diabetic you are.

Yes. But one is more nutritious. And one of the concrete pieces of advice from the Oviva app was to eat only one piece of fruit at a time.

Prior to that I'd thought I was finally succeeding in cultivating a good habit by eating two pieces of fruit for breakfast and then with lunch.

Anyway, thanks @Antje77, I feel encouraged.
 
Hi @NoMoreSugarBaby just a couple of thoughts, why not diet/Zero fizzy drinks? If you are cutting out sugars, the originals might end up tasting too sweet soon anyway. At your levels you could probably eat a small/individual pack of sweet & salty popcorn, about 10g carbs (yes it looks like if sneeze and you'll loose the lot at first), but with decreased appetite you will find it enough of a treat.

I started on about the carb amounts that you stated and thought it was way too low and I'd never be able to cram my meals into that limit, but I don't really go above 30g per meal, and don't really snack anymore, but try to keep below 10g if I do. Nuts are good, and 90% Lindt chocolate and 10cal jellies are the best! Bananas and apples are the devil's work, but strawberries are good, pick your fruit wisely.

Good luck:)
 
Looking at the threads here, I guess you would all say that low-carb is The Way. I suppose if I'm going to continue here, this is what I've got to commit to. It may be the single thing that is necessary for me to succeed - if it's not already too late. Looking back I can say I've made drastic dietary changes in 3-4 months, but I guess I needed to be more drastic.

You don't have to commit to low carb to post here, there are other dietary choices, it's just that low carb is the one that seems to work well for many of the T2s and prediabetics who post. You may need to develop a slightly thick skin if you adopt a high carb diet but forum rules mean that if anyone tries to bully you for it they will get sanctioned. (The rules are in the signature of all the moderators on the forum, including me.)

Remember that many of the posters on very low carb diets are full blown T2s, you aren't, your body is just having a bit of difficulty coping with the stress and diet you're now having. (And yes stress can push bgs up.)

My advice would be to cut down the carbs a bit and see what your meter says. No need to panic. (Or blame yourself for your slightly faulty genetics).

And welcome to the forums.
 
Crisps you can replace with cheese crisps. Simply cut pre sliced cheese (gouda or emmental work well) into shapes. Put on baking paper into microwave or oven. Microwave in 30 second burts until they turn drier and crisper. They will crips up even more as they cool. Oven 200° for about 10 minutes.
Can add seeds, spices, flavourings.
Keep airtight.
 
You may need to develop a slightly thick skin if you adopt a high carb diet but forum rules mean that if anyone tries to bully you for it they will get sanctioned.
Oh sure, that's not what I meant, I only meant that there's a lot of conviction coming through that low carb is the fastest and most reliable way to gain control of the blood glucose, so accepting reality would probably mean fully committing to that. I'm pretty relieved by the replies that it's not that black and white. To tell you the truth, I deeply love carbs, profoundly. I'm never going to give carbs up, though I might let carbs down.

Cheese crisps... I could take a potato peeler and shave little sheets of cheese off a big block of cheese, which would be very satisfying in and of itself. I like this idea.
 
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