IGT now type2?

Hi!

Metformin is unlikely to allow you to get away with a few “extra carbs”. Its effect is relatively mild when compared to hypoglycaemics. Mostly it blocks the liver from manufacturing too much glucose when you’re not eating, rather than dealing with large amounts of exogenous glucose when you do. Other more serious drugs will have a greater effect but won’t reduce your chances of complications.

You will not do your condition any favours by attempting to find ways to put more glucose into your body. Of course if you feel that you need to then that’s a different matter, but a lot of people develop and maintain muscle mass and tone without the aid of carbohydrate.

COLC1 said:

Be kind to a newbie, I am 83, 181cm and 72 kg, definitely not overweight, 11 years ago I was diagnosed with impaired glucose tolerance (IGT). During those years my fasting glucose has fluctuated between 5 to 8.3, during that time my HbA1C has remained fairly constant at between 5 an and 5.5, however my last test was 6.1 and I am afraid I might be losing the battle. I follow a low carb diet as best I can but cannot afford to lose any weight, my main enemy seems to be bread, yet I am able to eat chocolate, also Vetta high fibre spaghetti. I use a BGL meter regularly mainly to establish what food I can eat, but confounded by the different readings one gets from the same meal on different day. I have limited my bread intake to “Tip Top Sandwich Thins” which contain 45g Carbs, 9g Protein, 4.8g Fibre per 100g, I usually have half of one of these; particularly hard, as my hobby is baking bread!!!

So here is my predicament; I am very exercise conscious, my daily regime consists of stretching exercises, 30 minute on exercise bike at maximum tension, weight lifting, concentrating on squats, bench presses, bicep curls etc. Despite this I am losing the battle to increase or even maintain my muscle tone. When I was first diagnosed I was a similar weight but I had great muscle tone; the IGT diagnosis and subsequent reduction in carbs has changed all that.

If I am prescribed medication, I assume it will be Metformin, what can I expect from this drug? Is it effective enough to enable me to get away with the few extra carbs I need to progress, what about side effects?

Any constructive comments would be most welcome.

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I thought muscle mass was more of a protein issue (?), and that shouldn't be much of a problem. It can cause a slight increase in glucose, but nothing as dramatic as carbs would. I keep botching converting the HbA1c to something I understand, but if I'm right you're just barely prediabetic? There's keto breads to try if you really like to bake bread, (check dietdoctor.com for those), maybe that'd help... But for me, I'd just load up on eggs and such...

Metformin, as stated, doesn't do much for carbs ingested, it just tells your liver to cool it with the glucose dumps. It is the first port of call is you are diagnosed a full-fledged T2, but it won't specifically do what you're hoping for, I'm afraid. Side effects could be nil, could be severe intestinal problems (the never ending runs, basically). Maybe weight gain.

You don't have to be obese to be a T2 (10% are slim at diagnosis and never were overweight to begin with). But I know on keto, my weight loss stalls when I eat a lot of nuts. So if you have to resort to eating lower carb to get your HbA1c lower, adding extra nuts would maybe help maintain weight. Just guessing though.

Tagging @daisy1 for the info sheet!
Welcome, hope we can help!
Jo

COLC1 said:

Despite this I am losing the battle to increase or even maintain my muscle tone. When I was first diagnosed I was a similar weight but I had great muscle tone; the IGT diagnosis and subsequent reduction in carbs has changed all that.

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Hello COLC1 and welcome I'm probably asking a silly question, but are you aware that at 81 you need more protein to maintain your muscles than you did when you were younger? Perhaps take a closer look at your protein intake. I really have no idea how much you should be having, but maybe worth finding out?

@COLC1
Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it both interesting and helpful.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

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Hello and welcome to the forum.

Metformin can have an affect on the gastric system. We all react differently and the affect is often known as 'Met tummy' for some people the effects are mild and temporary, for others there is a need for a slow release version of the drug and still others do not get troubled by Met tummy at all. The effects range from mild gastric upset for a couple of weeks to an inability to leave the bathroom and anything in between.

I would not worry to much about the 6.1 that is still very good and you seem to be doing really well with your diet and exercise

COLC1 said:

Thanks for the prompt replies so far, To clarify a couple of points; I am way over the protein RDI already, Breakfast alone supplies me with around 40g, almost half of my target of 75-80g.
If I ate any more nuts I would be climbing trees!

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If you’re consuming heaps of nuts you’re probably already getting way more carbohydrate than you think.

Hello @COLC1 and welcome to the forum,

Your HbA1c is 43mmol/l in new units, and is only marginally above normal. (42 to 47 is pre-diabetic). According to some research our blood sugar levels do increase a little as we get older, so in my opinion I don't think you should be worrying too much. I understand that your levels have trended upwards and that is causing concern, but with very little alteration to your diet you can stop this in its tracks.

How many carbs do you eat? Are you eating plenty of fats? I no longer count my nutrients but when I was doing I was eating more protein than you do, and am a strong believer that as we age we need more - particularly for people that exercise as much as you do, around 90 to 100g. I am female, do not exercise other than dog walking, and am 71. Providing you have no kidney problems, perhaps increase your protein - more eggs, cheese, meat and fish. In my opinion this is far preferable to increasing carbs.

You are highly unlikely to be prescribed medication until your HbA1c climbs a lot higher than it has so far. My HbA1c on diagnosis was 53 (7%) but medication was never mentioned, and has not been mentioned since. Another point regarding Metformin - it is an appetite suppressant and is more effective in those with weight to lose. It may not even be suitable for you.

Seconded on the eggs. A meal in a shell. Loaded with energy and extremely nutrient dense.

I ate eight of them yesterday

Hi.

As folk age, they do tend to lose muscle mass and gain abdominal fat which might be one factor contributing to the age related increase in prevalence of T2DM. It sounds as if you are doing a very impressive exercise regime (I would never be patronising), and this is what preserves muscle mass eg Nordic cross country skiers in their 70's have low risk of T2DM, and are lean. All attempts to find drugs to help have failed to correct this problem. I am no expert on diet. But it sounds to me like you are doing a great job with the exercise - perhaps you should look at a few other folk your age to compare muscle mass and abdominal girth - you would find that you are better than most/all.

The fasting glucose is not a good test for diagnosing diabetes in folk aged more than 60-65; it misses folk who have diabetic post challenge glucose values. But your HbA1c of 6.1% is pretty good even if you may have had diabetes longer than you think.

In terms of drug treatment, no diabetes tablet is going to put muscle mass on. Apart from Prandial GLucose Regulators (which are little used in the UK), all tablets have a similar HbA1c reduction. It was about 1995 that the Americans discovered that metformin was as effective as glibenclamide sulphonylurea (glyburide in american) [ https://www.ncbi.nlm.nih.gov/pubmed/7623902 ].

So, one might go for metformin, and in an octogenarian, I would wonder about the usual 1 in 3 risk of diarrhoea or nausea, but also some folk just go off their food and lose weight - just something to be aware of. I would be reluctant to give an octogenarian a sulphonylurea cos of the risk of hypos, but there are other useful drugs such as the gliptins or the prandial glucose regulators. I would suspect that someone in their 80's would have normal 80 year old kidneys which may not quite be good enough for SGLT-2 inhibitor. So a choice of drugs.....

But at the end of the day, with an HbA1c of 6.1 %, one might not rush in with tablets - it is totally up to the clinician to discusss the options with the patient and to come to a joint decision - this is the first paragraph of all NICE guidelines. One hopes that the clinician has the time and knowledge to cope.

Best wishes

COLC1 said:

I eat plenty of those now; will keep it up.
I said earlier I use test strips mainly to see what I can eat safely, the inconsistency, is an eye opener. Here is one example that really puzzles me, I can eat a slice of bread or a slice of pizza for instance, and my readings can spike to 11 or more, I can eat chocolate, say 3 triangles of a Toblerone bar and my level remains in the healthy range, the same with a few spoonfuls of ice cream, totally confusing.

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Not really confusing if your tests are 2 hours after first bite. The 2 hours is just a guideline. Some foods spike early because they are fast release carbs. Some foods spike later because they are slow release. The more fat in the food, the lower the spike will be but the longer it will last. What you can't do is compare spikes between different foods. When you eat your toblerones and ice creams, I suggest you test at an hour, or even earlier. You could be spiking without knowing it. Also, our bodies are unique. I can eat a few potatoes for example without any significant rise at any time, but many people cannot. It also depends on the time of day when you eat these foods. Most people will see larger spikes in the mornings but the same food eaten at evening meal will have much less of a spike. Exercise also plays a part, but I'm not an expert on that although I do know that if I clean a load of windows in the house my levels rise quite a bit, so if I then ate something my spike would appear higher simply because I started higher.

COLC1 said:

I eat plenty of those now; will keep it up.
I said earlier I use test strips mainly to see what I can eat safely, the inconsistency, is an eye opener. Here is one example that really puzzles me, I can eat a slice of bread or a slice of pizza for instance, and my readings can spike to 11 or more, I can eat chocolate, say 3 triangles of a Toblerone bar and my level remains in the healthy range, the same with a few spoonfuls of ice cream, totally confusing.

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It might well be there are far more carbs in the bread and pizza than in a couple of tablerone pieces or ice cream. (Or they may be your personal triggers as for each of us they are different) You’d have to weigh portions and calculate the carbs to know though. I wouldn’t consider different responses to different foods confusing though, just ...different

Also worth remembering that ‘carbs’ will often increase blood glucose more than ‘sugar’. Sucrose (sugar) is only 50% glucose. The rest is fructose. Fructose doesn’t actually raise your blood glucose if it’s already elevated - it is metabolised almost straight away into fat by the liver, and contributes directly to fatty liver and insulin resistance. Fructose is public enemy number one for causing and exasperating insulin resistance, but when it comes to raised blood glucose, flours and starches are generally worse.

I wonder at what age a slightly raised HbA1c ceases to become a concern and other aspects of your health and enjoyment of life become more important?

Mr_Pot said:

I wonder at what age a slightly raised HbA1c ceases to become a concern and other aspects of your health and enjoyment of life become more important?

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I think sometimes they make it up as they go along.
My father in law had an HbA1c of 57mmol/mol, aged 86.
The nurse told him (and I quote), that 'he was heading towards diabetes' and, if he could, he should have more bread and fewer cakes.
This was a man who only ever ingested sugar in his tea, detested cakes, sweet stuff and chocolate, and made his own bread for 20 years.

Obviously, I nearly spontaneously combusted.
But Mr B managed to direct the explosion so that no one was actually harmed, and my In Laws never saw the explosion at all
It later turned out that diabetes was the least of PaInLaw's problems, and no dietary changes were ever implemented in the few months he was still with us.

Moral of the story: always check up on medical/diet advice you are given.