HbA1c won’t respond to Low Carbs, weight loss nor exercise

[IainG]

Hello, I need some help to understand what I can do next to try and reduce my HbA1c to a healthy level. I was first tested in May 2014 with HbA1c of 48mmol/mol.
I was 102Kg then, eating lots of processed food and carbs, and little exercise. I lost about 11Kg, ate less sugary things and exercised intermittently up to Feb 2019 when my HbA1c fell to the lowest result of 43.
In the last six months I have followed the Low Carb Programme (pretty well but not strictly, some days). Have lost another 8 Kg (BMI 24.7), run three/four times a week (10 to 12 miles total) including 5Km Parkrun in 25 minutes, walk another three hours a week.
My blood pressure, pulse, weight and Cholesterol have all benefitted. However my latest HbA1c on 28th July has risen to 46mmol/mol.
I don’t understand why it remains stubbornly at the higher end of the Prediabetes range.
Worth saying that I have been treated for Anxiety and Depression for about 30 years. The anxiety has, and remains, extremely high. The Depression comes and goes.
I feel weak and tired every day and whilst I put this down to the anxiety and depression, I wonder if raised blood glucose level maybe a contributory factor?
I feel that I have done all I can but without much effect on my BG level. So, any advice on what paths are open to me to discover what may be keeping my BG at Prediabetes levels, other than simply going to the GP, will be gratefully received.

 

[ert]

Welcome. It sounds like you've worked really hard and have already achieved some great results in losing weight and lowering your HbA1c. Are you taking any medications? We can't give medical advice here but it's worth going back to your GP and ask for advice. It is worthwhile testing your blood sugars with a glucometer before eating and two hours afterwards to see what is spiking your sugars (I'm assuming they're spiking for your HbA1c to be outside the normal range.) Good luck.

 

[IainG]

Welcome. It sounds like you've worked really hard and have already achieved some great results in losing weight and lowering your HbA1c. Are you taking any medications? We can't give medical advice here but it's worth going back to your GP and ask for advice. It is worthwhile testing your blood sugars with a glucometer before eating and two hours afterwards to see what is spiking your sugars (I'm assuming they're spiking for your HbA1c to be outside the normal range.) Good luck.

Thanks for your reply. I have never taken any medicines for the Prediabetes. The glucometer before and after meals sounds a useful idea. I used one in March/April this year to monitor my waking BG and found it to be higher than my previous HbA1c of 43, even during periods when I was very strict about low carbs. My BG was always greatly increased after running. The rare occasions it fell to a healthy level was if I did not exercise, but fasted all day

 

[JoKalsbeek]

Thanks for your reply. I have never taken any medicines for the Prediabetes. The glucometer before and after meals sounds a useful idea. I used one in March/April this year to monitor my waking BG and found it to be higher than my previous HbA1c of 43, even during periods when I was very strict about low carbs. My BG was always greatly increased after running. The rare occasions it fell to a healthy level was if I did not exercise, but fasted all day

What kind of excersize do you do? The strenuous kind can aise bloodsugars because your liver can chip in with some glucose-dumping. A long walk (slow, steady, long duration) is usually more effective in dropping bloodsugars than say, weightlifting. Also, anxiety can raise bloodsugars, and higher bloodsugars can affect both anxiety and depression, so it's a bit of a circle there. Maybe you should try the strict low carbing again, this time with a glucometer ( testing before a meal and 2 hours after the first bite), see whether that tells you anything. When you were at your strictest, what were you eating in a typical day? Maybe we can help with some tweaking?

Good luck,
Jo

 

[IainG]

What kind of excersize do you do? The strenuous kind can aise bloodsugars because your liver can chip in with some glucose-dumping. A long walk (slow, steady, long duration) is usually more effective in dropping bloodsugars than say, weightlifting. Also, anxiety can raise bloodsugars, and higher bloodsugars can affect both anxiety and depression, so it's a bit of a circle there. Maybe you should try the strict low carbing again, this time with a glucometer ( testing before a meal and 2 hours after the first bite), see whether that tells you anything. When you were at your strictest, what were you eating in a typical day? Maybe we can help with some tweaking?

Good luck,
Jo

Thank you, what you say all makes sense. At my strictest low carb diet, I ate breakfast of 80g blueberries and 120g full fat Greek yoghurt, lunch would be handful of walnuts and same of brasils and can of sardines in tomatoes sauce. Evening meal would be vegetarian chilli with cauliflower rice. Drinks during the day are water or coffee with a little milk.

 

[JoKalsbeek]

Thank you, what you say all makes sense. At my strictest low carb diet, I ate breakfast of 80g blueberries and 120g full fat Greek yoghurt, lunch would be handful of walnuts and same of brasils and can of sardines in tomatoes sauce. Evening meal would be vegetarian chilli with cauliflower rice. Drinks during the day are water or coffee with a little milk.

Any particular reason for the vegan chilly? I think there'd be a bit more fats in something with meat? As there's fish in your menu, are you a vegetarian who does fish? Far as I can see there's about 50 grams of carbs in that particular diet per day, rough estimate, but that would depend on how many beans are in the chili. Can of sardines should be okay unless they tossed a lot of sugar into the sauce. About 10 grams of carbs in the blueberries... It does add up, but nothing especially dramatic, far as I can see. I do think I'd get bored out of my mind, but then, I never did like sardines, haha. All in all a diet has to be sustainable. It's a long term thing, after all. Maybe a little variation? Salads with tuna or goat's cheese, olives, capers... That sort of thing?

 

[IainG]

Any particular reason for the vegan chilly? I think there'd be a bit more fats in something with meat? As there's fish in your menu, are you a vegetarian who does fish? Far as I can see there's about 50 grams of carbs in that particular diet per day, rough estimate, but that would depend on how many beans are in the chili. Can of sardines should be okay unless they tossed a lot of sugar into the sauce. About 10 grams of carbs in the blueberries... It does add up, but nothing especially dramatic, far as I can see. I do think I'd get bored out of my mind, but then, I never did like sardines, haha. All in all a diet has to be sustainable. It's a long term thing, after all. Maybe a little variation? Salads with tuna or goat's cheese, olives, capers... That sort of thing?

Thank you for your advice. I do add salad, cheese, lots of veg to vary the strict days

 

[stuffedolive]

…..
I feel that I have done all I can but without much effect on my BG level. So, any advice on what paths are open to me to discover what may be keeping my BG at Prediabetes levels, other than simply going to the GP, will be gratefully received.

IainG, don't despair, you may find that you have done much of the hard work already and prevented the development of full-blown diabetes, and all you have to do now is to keep up with the healthy lifestyle changes you have made. So congratulate yourself on that.
I have often thought the same as you. I was diagnosed nearly 20 years ago and after losing some weight, my Hba1c has bounced around the 42-48 range ever since without need for medication, sometimes at the upper end and sometimes at the lower end. I didn't used to bother testing at all, I just relied on Hba1c + lifestyle. I do test now as my latest Hba1c was the highest I had (but only 2 months after a random Hba1c which was much lower). I have years worth of diaries and testing charts and what works seems to be the obvious - keep the weight down, lots of moderate regular exercise, good low-carb diet and good sleep. Its this last one that seems to affect me most. I'm a poor sleeper, and my fasting BG is always high after a bad night. But we are all different and even small changes to diet can make a difference to our Hba1c results. You just have to experiment and find out what works for you.

 

[IainG]

IainG, don't despair, you may find that you have done much of the hard work already and prevented the development of full-blown diabetes, and all you have to do now is to keep up with the healthy lifestyle changes you have made. So congratulate yourself on that.
I have often thought the same as you. I was diagnosed nearly 20 years ago and after losing some weight, my Hba1c has bounced around the 42-48 range ever since without need for medication, sometimes at the upper end and sometimes at the lower end. I didn't used to bother testing at all, I just relied on Hba1c + lifestyle. I do test now as my latest Hba1c was the highest I had (but only 2 months after a random Hba1c which was much lower). I have years worth of diaries and testing charts and what works seems to be the obvious - keep the weight down, lots of moderate regular exercise, good low-carb diet and good sleep. Its this last one that seems to affect me most. I'm a poor sleeper, and my fasting BG is always high after a bad night. But we are all different and even small changes to diet can make a difference to our Hba1c results. You just have to experiment and find out what works for you.

IainG, don't despair, you may find that you have done much of the hard work already and prevented the development of full-blown diabetes, and all you have to do now is to keep up with the healthy lifestyle changes you have made. So congratulate yourself on that.
I have often thought the same as you. I was diagnosed nearly 20 years ago and after losing some weight, my Hba1c has bounced around the 42-48 range ever since without need for medication, sometimes at the upper end and sometimes at the lower end. I didn't used to bother testing at all, I just relied on Hba1c + lifestyle. I do test now as my latest Hba1c was the highest I had (but only 2 months after a random Hba1c which was much lower). I have years worth of diaries and testing charts and what works seems to be the obvious - keep the weight down, lots of moderate regular exercise, good low-carb diet and good sleep. Its this last one that seems to affect me most. I'm a poor sleeper, and my fasting BG is always high after a bad night. But we are all different and even small changes to diet can make a difference to our Hba1c results. You just have to experiment and find out what works for you.

Thank you @stuffedolive I’m definitely continuing with my healthier lifestyle. I know you are right that it’s good to recognise that my efforts may keep me from developing Type 2. Your point about sleep is pertinent for me. I have been an outpatient at a Sleep Disorders Clinic for 16 years. I use a full face mask CPAP for chronic obstructive sleep apnoea, and I have recently (and successfully) started to use a sleeping tablet to stop me waking after only 3 to 4 hours sleep. Sleep is still disturbed by the CPAP, but waking at 1:30am and not sleeping again due to chronic anxiety has been alleviated. Thanks again

 

[AloeSvea]

Thanks for your reply. I have never taken any medicines for the Prediabetes. The glucometer before and after meals sounds a useful idea. I used one in March/April this year to monitor my waking BG and found it to be higher than my previous HbA1c of 43, even during periods when I was very strict about low carbs. My BG was always greatly increased after running. The rare occasions it fell to a healthy level was if I did not exercise, but fasted all day

This thread is very interesting to me, as I have this stubbornly in the prediabetic range issue too. And, I find 'not eating' to be the most effective strategy for lowering BG ie Fasting! Different kinds of fasting/intermittent fasting, according to what is going on in my life and how I can fit the not eating, and therefore the lowered levels of energy and enjoyment of life, into it. Also, eating very small amounts for a couple of months - and the way to do that is by calorie restricting and counting. (My least favourite strategy, although it does allow me the most 'normal' kind of lifestyle in terms of energy, due to the drip-feeding food, as it were.)

My own understanding of the whys and wherefores is this kind of stubbornly-in-the-prediabetes-range whilst low-carb eating, is due to very high levels of insulin resistance, which is why the fasting is so effective (as not eating lowers the insulin levels like nothing else can, in my experience). I have tracked this by getting my insulin levels checked with C-peptide readings, regularly. If you want to get to know your own body better, in terms of insulin production, and glucose production by your own body (reflected usually in high fasting blood glucose readings), this is a good way to do it. (HBA1c and C-peptide readings.)

 

[bulkbiker]

Hello, I need some help to understand what I can do next to try and reduce my HbA1c to a healthy level. I was first tested in May 2014 with HbA1c of 48mmol/mol.
I was 102Kg then, eating lots of processed food and carbs, and little exercise. I lost about 11Kg, ate less sugary things and exercised intermittently up to Feb 2019 when my HbA1c fell to the lowest result of 43.
In the last six months I have followed the Low Carb Programme (pretty well but not strictly, some days). Have lost another 8 Kg (BMI 24.7), run three/four times a week (10 to 12 miles total) including 5Km Parkrun in 25 minutes, walk another three hours a week.
My blood pressure, pulse, weight and Cholesterol have all benefitted. However my latest HbA1c on 28th July has risen to 46mmol/mol.
I don’t understand why it remains stubbornly at the higher end of the Prediabetes range.
Worth saying that I have been treated for Anxiety and Depression for about 30 years. The anxiety has, and remains, extremely high. The Depression comes and goes.
I feel weak and tired every day and whilst I put this down to the anxiety and depression, I wonder if raised blood glucose level maybe a contributory factor?
I feel that I have done all I can but without much effect on my BG level. So, any advice on what paths are open to me to discover what may be keeping my BG at Prediabetes levels, other than simply going to the GP, will be gratefully received.

DO you have any idea how many carbs you are actually taking in each day? Maybe try keeping a food log for a week so you can see. It may well be that you need to reduce your carbs a bit more.
How many meals per day are you eating? That could also be a contributing factor.

 

[ianf0ster]

Hello, I need some help to understand what I can do next to try and reduce my HbA1c to a healthy level. I was first tested in May 2014 with HbA1c of 48mmol/mol.
I was 102Kg then, eating lots of processed food and carbs, and little exercise. I lost about 11Kg, ate less sugary things and exercised intermittently up to Feb 2019 when my HbA1c fell to the lowest result of 43.
In the last six months I have followed the Low Carb Programme (pretty well but not strictly, some days). Have lost another 8 Kg (BMI 24.7), run three/four times a week (10 to 12 miles total) including 5Km Parkrun in 25 minutes, walk another three hours a week.
My blood pressure, pulse, weight and Cholesterol have all benefitted. However my latest HbA1c on 28th July has risen to 46mmol/mol.
I don’t understand why it remains stubbornly at the higher end of the Prediabetes range.
Worth saying that I have been treated for Anxiety and Depression for about 30 years. The anxiety has, and remains, extremely high. The Depression comes and goes.
I feel weak and tired every day and whilst I put this down to the anxiety and depression, I wonder if raised blood glucose level maybe a contributory factor?
I feel that I have done all I can but without much effect on my BG level. So, any advice on what paths are open to me to discover what may be keeping my BG at Prediabetes levels, other than simply going to the GP, will be gratefully received.

Hi IainG,
Compared to you I'm a newbie, but perhaps I can give you a different perspective.
Firstly huge congratulations on the weight loss and on getting into and staying in the pre-diabetic range!

Second, as has been mentioned by others, stress, depression, lack of sleep, illness and other things apart from diet/exercise can affect your BG readings.

Third, it seems that for most of us, our diet has a much larger effect than does the type and amount of exercise, beyond a basic 5 x 30min walk per week.

Fourth, just 'eat to your meter' and count carbs. Small tweaks to your diet may help - for example cream in coffee rather than milk (milk contains natural sugars and the lower fat it is the worse for Type 2 diabetics), do you buy Sardines in Oil rather Sardines in Sauce - in Oil will have fewer carbs. etc.
Use your meter to test different food so that you know what works best for you. If you reduce the BG spikes, then everything else will follow - though more slowly.

 

[lindisfel]

I have come to the conclusion Hba1c is only an indicative parameter and as for deciding on the 48 threshold as being the difference between being diabetic an non diabetic, it's a joke!
It is nothing like the thresholds in physics like the freezing or boiling fixed points.

Last year I had my Hba1c done at two hospitals within a week. One said it was 44 the other 46.
Unless Hba1c was normalized for ones red blood cell life, a just out range prediabetic could be diabetic and vice versa.

I lost four stone and only saw a few percent improvement.

What is more, if one doesn't diet correctly some could lose muscle mass and fat from the wrong places which will make a lowered Hba1c harder to achieve.

It is not easy getting a cPeptide test as a prediabetic in the UK, but a poorly functioning pancreas is mostly likely the cause of my stubborn prediabetic reading. But then we should not think we are the same as others who can go from 90 to 29 in three months.

Also It must be hard getting enough protein with some diets.
D.

 

[Listlad]

I have come to the conclusion Hba1c is only an indicative parameter and as for deciding on the 48 threshold as being the difference between being diabetic an non diabetic, it's a joke!
It is nothing like the thresholds in physics like the freezing or boiling fixed points.

Last year I had my Hba1c done at two hospitals within a week. One said it was 44 the other 46.

Thanks for that. A point often overlooked. An indicative parameter that means more when viewed alongside other parameters.

 

[Auto E]

Feb 2019 when my HbA1c fell to the lowest result of 43.
However my latest HbA1c on 28th July has risen to 46mmol/mol.
I don’t understand why it remains stubbornly at the higher end of the Prediabetes range.
I feel that I have done all I can but without much effect on my BG level. So, any advice on what paths are open to me to discover what may be keeping my BG at Prediabetes levels, other than simply going to the GP, will be gratefully received.

Hi there! First off, I think a round of applause is in order for the huge lifestyle changes you have made. You are working hard and it can feel so disappointing to not see those numbers respond.
I have a couple thoughts:
1. A1C readings have a margin of error of about 6! So it's possible your A1C not only didn't get worse, but is actually better and the test just wasn't as great as you'd like.
2. If you are able to get your GP to do a fasting insulin AND a fasting glucose test, you can calculate your insulin resistance. Once you have those numbers, we can help you do the quick calculation and help you interpret it. Do it again in another 6 months and you can see from that if any improvements are coming. Just another option, but can be a pain to try to explain the test to your doc. I can usually talk them into these things, but they sort of roll their eyes at me.
And here are a few experiments to try (separately, so that you can figure out what's most effective at altering A1C or helping your mood and anxiety, etc). During each experiment, keep a food log and a brief detail of your sleep quality and mood.

Experiment 1: Consider resistance training instead of, or in addition to running. Everyone responds differently to the different exercise types, but it's possible that weight-lifting is just the trick you need to get your muscles accepting more glucose. I think it's worth a try, if you're up for giving it a go.

Experiment 2: Consider going ketogenic for awhile. It could be your body is stubbornly carb-intolerant. I know it might not be something you want to do for the rest of your life, but it would be a good experiment to see if that's what it takes to get your blood sugars lowered. Maybe try 3 months, then test again?

Experiment 3: Try intermittent fasting with your Low carb program.

Take care, and I hope you know that you are inspiring to me, even though you find yourself disappointed with your current A1C progress and still feeling tired and depressed.