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How were you diagnosed? Prediabetes

Cocosilk

Well-Known Member
Hi Folks,
I'm just wondering how you were diagnosed with Prediabetes?

Was it a HbA1c or an OGTT?

And what kind of results got you this diagnosis where you live? (I believe some of us come from outside the UK).

I'm in Australia and recently did a GTT with these results:

Fasting: 4.4 mmol
1h: 12.1 mmol
2h: 6.5mmol

They didn't diagnose me with anything. They only suggested I "may have glucose intolerance" and to "come back in one year for further tests."

Fasting levels at home are typically 4.8 - 5.2 while eating low carb and breastfeeding.

This past couple of days I tried reintroducing carbs and this morning my fasting was 5.2, but then climbed to 5.4 in the next hour before I ate. I guess that's typical foot on the floor when you have an excess in your liver.

Otherwise, after 6 months of low carb and while breastfeeding, I sometimes would get a 4.8 that goes back to 4.6 with further fasting...
 
I was ill for months, constantly thirsty, peeing like a tap, exhausted etc etc. Went to the GP many times and he never diagnosed it (which is another story on its own). But had a holiday booked which we was told would be ok to goto, as soon as the airplane took off I fell unconscious due to DKA, there was a doctor also flying on the plane who mentioned whether we had checked for diabetes. Had to wait for plane to land and spent two weeks abroad in hospital recovering. I was quite young, but can only imagine what my parents went through.
 

So I'll assume that my pancreas is still functioning then. You are right because I have done 3 tests in a row with my metre and the difference can easily be half a mmol. So I guess that could be in either direction and it doesn't mean anything much if it's only 0.2 mmols.


So I've looked at this link and I see:

For the majority of healthy individuals, normal blood sugar levels are as follows:

  • Between 4.0 to 5.4 mmol/L (72 to 99 mg/dL) when fasting
  • Up to 7.8 mmol/L (140 mg/dL) 2 hours after eating
In Australia they won't even diagnose prediabetes until your fasting hits 6.0 mmol. I'm wondering how it is in Europe and the USA. Probably similar to the UK, isn't it?

I also wonder if I'm getting 8+mmol 2 hours after a meal with a small amount of carbs (I say small because I could have had a lot more of the sweet potato and rye pancakes that contributed to a one-hour spike of 11mmol that left me still in the 8s at 2 hours), even if I won't be diagnosed officially using a home metre, I should probably just assume I have a problem.

I would like a proper diagnosis but I'm probably not going to do another GTT anytime soon and if I stick with low carb eating, my HbA1c won't reflect how glucose intolerant I actually am.

I just imagine that before people develop insulin resistance, they can eat carbs, only spike to about 6 mmol, and probably return to base or fasting (in the 4s) within 2 hours. Is that how it works or does it take 3 or 4 hours for everyone to return to base?

Am I right to assume that if you sit 2 or 3 mmol above your starting point at 2 hours postprandial that you probably already have some level of insulin resistance?
 

Oh dear, what a traumatic experience for you!

In other words, don't wait to be diagnosed if you already have a hunch...

I'm sorry you had to go through that.
 
In the US, pre-diabetes is usually classified as a fasting glucose over 99 mg/dL (5.5 mmo) and under 126 mg/dL (7.0 mmol). Alternatively, HbA1C of 5.7 to 6.4. Frequently fasting glucose over 99 mg/dL is referred to as impaired fasting glucose. Most doctors test fasting glucose and a standard lipid panel (LDL-C, HDL-C, TG, and Total) as routine test. Some will add a HbA1c. OGTT are rarely done anymore. Where I live I haven't been able to get a doctor to order an OGGT or even a fasting insulin test.

In a standard lab panel, I had a fasting glucose at 107 md/dL (5.9 mmol) which was right after a very stressful event. That got me started looking into my blood sugars. Earlier and later labs showed fasting glucose in the high 80s or low 90s. (In the last four months of eating lowish carb - 80 to 140 grams/day, fasting glucose labs have come down to 84 and 83, so about 7% lower than eating higher carb). Based on the single lab result of 107, my primary care doctor said that I had "impaired fasting glucose" and that I was insulin resistant. He wouldn't however agree to order a fasting insulin test to confirm how insulin resistant. Another doctor ordered a HbA1c and when he saw it was 5.0% (31), he said confidently that I have no blood sugar issues.

Doctors frequently aren't very helpful here, in part, because of the abysmal private insurance system we have, but we can, however, order lab tests online completely outside of the insurance system. (A doctor who has never seen you and who knows nothing about you actually signed the lab order.) The lab draw is made at one of two big national labs - Labcorp or Quest - and you can see the results online about a week later.

I just ordered my own tests which came back:

Fasting glucose 83 mg/dL (4.6 mmol/L)
Fasting insulin 4.1 uIU/mL
HOMA-IR 0.8 (insulin sensitive)
HbA1c 5.0%

That correlates pretty well with the my most recent standard lipid panel:
TG/HDL of 50 mg/dL / 48 mg/dL = 1.04 ratio

Interestingly, my HbA1c didn't change at all after 4 months of reduced carbs. Lower carbs have had a small effect on TG bringing them down from about 70 to 50 mg/dL. I would imagine my insulin would have tested a bit higher if I had had it tested when TG were at 70.

I also ordered an Apo-B since the doctors wouldn't order one. I came back at 61 mg/dL (normal <90 mg/dL, target for extreme risk patients <70 mg/dL). I guess that is reasonably similar to the last two LDL-C which were 53 mg/dL and 69 mg/dL.

My lab tests would seem to say I am healthy, but from testing on my own meters, I know that I have carbohydrate tolerance issues - at least with some large quantities and with some specific types (e.g. hamburger bun spikes me, but whole grain bread I tolerate relatively well).

It appears that my meters consistently read higher than the labs results on fasting glucose. For the latest test, I checked immediately after the lab draw and the meters read:

Relion Premier 97 (5.4)
Contour Next 91 (5.1)
Contour Next One 90 (5.0)
Lab result 83 (4.6)

For the previous test the meters were a bit closer to the lab result, but all the meters were still a far bit higher.

When I get a reading over 140 mg/dL on my meter after eating carbs, due to the accuracy of home meters I can't be quite sure whether than is really 120, 140 or 160, but my guess is somewhere between 120 and 140. But when I see a 170 on the meter and retest on another meter and get 155, I am rather confident that is not a healthy 120 or below reading and probably is above 140 which would put it in the pre-diabetic range.

My concern is to avoid big glucose spikes now, but without the unintended consequence of reducing glucose tolerance (e.g. from eating too much saturated fat?), and to prevent an increase in problems of glucose regulation to would lead to pre-diabetic cardiovascular complications (grandfather died of a heart attack in mid-50s) and certainly try to avoid going down the path to diabetes (grandmother).

At least in my testing, it appears that when I eat more saturated fat my glucose tolerance worsens. The blood sugar takes far longer to drop to baseline. (My body handles a hamburger on a big white bun quite terribly. Not that I frequently eat such ****** food, but from testing I know my body doesn't have a healthy reaction). Also, my fasting glucose seems to be influenced by how much animal protein/fat I eat (I have read that gluconeogenesis is supposedly demand based so I am not sure why protein would have that effect). When I eat a lot of meat my fasting glucose the next day is higher (at least the reading on the home meter seems to be consistently a bit higher).

I would like to know why my body doesn't handle carbs normally. I am not sure if I should order my own OGTT with insulin. (I don't see any point in ordering one without insulin). It would be nice to know if my glucose spikes because of a weak insulin response or because of some type of insulin resistance under stress of lots of carbohydrates. I don't know quite what I would do with the result at this point. If the test shows, high insulin under load, I suppose I could try to lower insulin resistance. If the test shows weak insulin response, what would I do?
 

Would a weak insulin response imply that your pancreas is not able to produce enough insulin anymore? Is that what happens when T1 is developing? I wonder how that looks in the very early stages.

I wonder too if once a person has developed an intolerance to glucose, is it like with some allergies where repeated exposure causes stronger allergic reactions.

What carbs are you eating still that are causing the most worrying spikes for you?
 

I more or less stopped eating things which I have seen cause spikes. Anything made with refined wheat flour is the worst- although I seem to do fine with a truly whole grain/seed bread. I have figured out that I can generally eat a half cup of beans, sweet potato, and similar carbs in one meal with meat or fish, salad or other non-starchy veggies and the spike stays low - about 6.5 or less.

I didn’t have much of a sweet tooth in the past, but now I pass on sweets and any junk food completely. What concerns me is having to limit beans, starchy vegetables, etc. I also don’t seem to be very insulin resistant so it must be s weak insulin response? Failing pancreas?
 

I'm about the same with bean and other legumes, rice and starchy vegetables. But I would ideally only include the half cup portion of them with one of my meals and have lower carb for the other meals like slow cooked meat (with bones and fat) and spinach but skip the starches or other carbs that might usually go with such a meal.

I had some pork belly with one roasted white potato today. One seems to be okay for my levels. But if I ate that for all 3 meals, my levels seem to rise by the evening meals and sometimes I have higher fasting levels as well. My fasting insulin was still classed as normal but I think it's slightly elevated, which would show a little insulin resistance.

If the pancreas is failing, as in type 1 diabetes, can the progress (it's decline) be stalled if you stay very low carb?
 
I suspect that a lot of people become fully diabetic before diagnosis - I am one, and I suspect from how I feel now, that I was beyond prediabetes for years - if not decades, but never had a blood test.
I did have urine tests - but I never had a positive one even testing at home after diagnosis.
 
Hi coco silk I am also from Australia and I am prediabetic thru ogtt my hba1c at the time of diagnosis was 5.1 but 2 hour reading was 8.7 fasting was 4.7 I think.
Main thing is having gd pregnancy put us on risk of diabetes I was checking my previous reports after my 1 gd pregnancy my ogtt results were absolutely normal with 2 hours reading of 4.5
now within 5 years it is 8.7
 

Did you eat low carb once you had the gestational diabetes?
And have you had a fasting insulin and HOMA ir done to know how insulin resistant you are?
I convinced one GP to let me have the HOMA and it came back at 1.2 but I think it might be 1.4 sometimes with my home bg readings being slightly higher.
Ideal is under 1 but they won't blink and eye till you're over 2 on the HOMA I don't think.

I've gone back to a keto day yesterday. Ate more meat than I have in a while. I struggle on keto while breastfeeding and not getting enough sleep with baby though so I'll be up and down again with carbs over the next week or so. My biggest problem is remembering to pull back on the fats when I add back the carbs! So easy to put weight on again otherwise.
 

What is HOMA ?
Well I can totally understand how difficult it is with breastfeeding, I was doing low carb high fat diet and lost almost 12 kg
 
hazelzac said:
What is HOMA ?
Well I can totally understand how difficult it is with breastfeeding, I was doing low carb high fat diet and lost almost 12 kg
Click to expand...

The only weight I lost fast was 10kg of baby weight in the first 2 months after having my 3rd baby and while I was still eating low carb. Then I stopped losing weight and am stuck around where I was when I fell pregnant (the 3rd time). I have about 5kg to lose to get back to what I was before having babies, and probably another 3kg to be at a more ideal weight.

The HOMA- ir test checks what your insulin levels are doing in relation to your blood glucose to estimate how insulin resistant you are. From what I can tell, knowing your insulin levels is more important in the early stages than knowing your blood sugar levels because the insulin levels climb first to keep your blood sugar stable so by the time your blood sugar is climbing, you are already at the next stage of metabolic dysfunction.

They don't routinely check insulin though, God only knows why not.

You might find this talk interesting (or not.. ha ha). But he talks about the relation of HbA1c and insulin in there somewhere, as well as lots of other things.
 
My prediabetes was picked up as an HbA1c test as part of a routine blood test carried out because I am on medication for high blood pressure.
 
I was having my regular blood pressure check with the practice nurse at my GP surgery as I have high blood pressure. I mentioned I also had high cholesterol and that my level hadn't been checked since I started on statins around 6 years previous. She ordered a full blood work-up and my HbA1c came back as 42 mmol/m. She advised a healthier diet, but also managed to get me on a Diabetes Prevention Program which involved a basic health assessment.

Now, I know I'm a bit overweight and might be described as 'barrel shaped', but the healthcare professional said for my height, weight and waist measurements, my BMI was 44 and in the Obese bracket. Then she said, to slim down into the Overweight bracket, I would need to shed about 4 stones! This was the real kick up the backside I needed to sort myself out. Joining this Forum earlier in the week has opened my eyes to what is possible. I'll take my time to plan what I need to do food-wise, what sort of diet to follow, etc, etc, so I don't fail at the first hurdle. Wish me luck!
 
 
I'm assuming that I have pre diabetes, over the last few weeks I've had a funny kind of ache in both big toe joints, also a.... like a damaged nerve in the middle finger on right hand. I've got just a little over weight and am taking some supplement B12 tablets, I'm not on any other medication. My Dad had Type Two Diabetes pretty badly and I'm determined NOT to go down his route. I have a diabetes meter which I've just started using again after having it a couple of years.
 
mouseee said:
@Mister LJ You say you are presuming you are prediabetic. What makes you think that? Have you spoken to a Dr or nurse?
Click to expand...
errrrm apart from what I put in post #18 I guess I'm being a bit paranoid, not been to a Dr or Nurse in years.... I'm aiming to collect some data first before I visit them.
 
Interesting question as I was informed by a poster on here that one couldn’t be diagnosed with Prediabetes. In my case I just missed out on T2 diagnosis as I didn’t show two consecutive HbA1c tests. Just the solitary one test at T2 levels. So I was designated at Prediabetes levels and this came about as I had developed high blood pressure and they decided to test my blood to try and give me a fuller check as a consequence.
 
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