New Borderline Prediabtic

[Grace04]

Hi All, I’m new here having just had a second A1c test at 42. They weren’t consecutive so as yet I’ve not been tagged as predibetic, if possible I’d like to keep it that way. My previous 42 was last summer and the follow up was 40.

I’m not really sure where to go from here. I saw a practice nurse, who admitted she couldn’t offer a lot of help diet wise. Suggest wholemeal bread, rice and pasta. More veg less potato and cutting out sweets treats. Well, I already do these things. Other than not eating sweet treats. I have to confess to enjoy a drink and cake in the afternoon, not every afternoon but probably four a week.

My partner and I are pescatarian, only eating fish once a week. We already have wholemeal bread and pasta. Our rice is a mix of basmati and wholemeal. So I don’t feel I can make a lot of changes here.

She also suggested more exercise. At present I do a fair bit of walking and I’m an active gardener, but I guess I could do mor.

Any advice on how I go about lowering the reading would be appreciate. Also looking at the site a number of people, who aren’t diabetic, seem to be monitoring their blood glucose, should I be doing this? If so what monitors are recommended and how often do I test?

Thank you in advance for any pointers,

Grace

 

[KennyA]

Hi and welcome to the forums.

I'm afraid your nurse hasn't been very helpful. You are not diabetic and you really want to keep it that way. There is at least one tweak you could make.

Your A1c results are in the normal range (38-42) , albeit at the top end of normal. There's a 5% possible error in the test but with three all around 40-42 it's probably safe to assume you're somewhere in that region. I'm also assuming you're not currently doing fingerprick testing using a blood glucose monitor.

The thing is that if you want to reduce your blood glucose levels by diet that means reducing the intake of both sugars and carbohydrates. Wholemeal bread/ rice/ pasta/ whatever doesn't help with this - it's still carb. Some people report it slows glucose uptake, but it still goes in and winds up being converted to glucose. Fingerprick testing would show you a baseline blood glucose before eating, and then a test two hours later shows the net result of what you ate. Most non-diabetic people largely return to around baseline by then. NB - there is allowable error (15%) in fingerprick testing as well as the odd rogue test - so no-one should be stressing about either a single reading or minor differences.

My advice would be (given where you are, and what you want to achieve) to reduce your carbohydrate intake, if only by a moderate amount. Maybe the afternoon cakes could be scaled back a bit? Your choice.

 

[Grace04]

Hi Kenny and thank you so much for your reply.

It‘s interesting that you say I am not, tho only by a hair’s breadth, in the prediabtic range. That was how I read it but the nurse said if the next reading was 42 or more I would be prediabetic. Anyway that aside it’s useful to know that wholemeal or not bread, pasta etc can create extra glucose So should be avoided.

I will have to do some reading into low carb diets. We eat our main meal at lunchtime and our evening meal is very often something on toast. I only have one slice. I’m not sure what I could have instead but I’ll try to find something. The cake can go, except as an occasional treat.

I will also look at getting a monitor so, as you say, I can see what works for me.

Thank you again,

Grace

 

[catinahat]

I think if I were in your position rather than going to the expense of testing, with frankly fairly inaccurate meters, and then puzzling over what the numbers mean.
I would start by keeping a food diary of everything you eat or drink for say, a week. Note down the amount of carbs you are eating in each meal, see what your average daily total of carbs is. In other words, how many carbs are you eating, to give you the HbA1c number you have got.
I know this has been mentioned by KennyA but your body can't see if something is wholemeal or brown, you need to count all carbohydrates.
Once you have a good understanding of where your carbs are coming from, it should be relatively simple to reduce the amount and your HbA1c.
Less spaghetti and more sauce, bacon & eggs on a plate instead of a sandwich, a salad with your chicken in place of the chips, have a look at the fruit in your diet, see if you can choose something with less carbs.
You shouldn't have to make any major changes, just small tweeks and a few better choices should do it.

 

[KennyA]

Hi Kenny and thank you so much for your reply.

It‘s interesting that you say I am not, tho only by a hair’s breadth, in the prediabtic range. That was how I read it but the nurse said if the next reading was 42 or more I would be prediabetic. Anyway that aside it’s useful to know that wholemeal or not bread, pasta etc can create extra glucose So should be avoided.

I will have to do some reading into low carb diets. We eat our main meal at lunchtime and our evening meal is very often something on toast. I only have one slice. I’m not sure what I could have instead but I’ll try to find something. The cake can go, except as an occasional treat.

I will also look at getting a monitor so, as you say, I can see what works for me.

Thank you again,

Grace

I'm attaching a graph that shows how HbA1c scores are distributed for non-diabetic people - it's the mmol/mol figure you've been given. It's not a big range - 38-42 is normal - ie "normal" because most non-diabetic people are in there. You are close to >42 - but you're also not far from 38 either.

Unless your A1c has been creeping up (your medical records should show this) 40-42ish may just be where your blood glucose normally is.

Your nurse is technically correct in that if an A1c score is >42 you will be told you're "pre-diabetic" - a term invented to cover people in the gap between "normal" blood glucose levels and an automatic diagnosis of T2 at >48. Given the test error there are undoubtedly people termed "prediabetic" who are actually in "normal" range and vice versa. This is why single tests are potentially difficult to interpret and you have to look at the trend.

"Pre-diabetic" isn't a diagnosis of anything, but if your BGs move out of normal range it is a sign that you might well not be handling carbs as well as you once did. My A1c climbed steadily out of normal range year on year and no-one told me about it - I was reassured several times that I wasn't diabetic. Being alerted (hopefully unnecessarily) is better than that .

I'm really not sure about recommending testing in your situation. Meters are fallible and some people can become obsessed with repeated testing and worrying about miniscule and meaningless variations in results. On the other hand I don't think it does any harm to see how various foods affect you and it provides very useful - essential - information if you want to limit carb intake.

I'm tagging @Rachox who has a list of available meters - I think she's updated it recently and I don't have the newest version.

 

[Grace04]

I'm attaching a graph that shows how HbA1c scores are distributed for non-diabetic people - it's the mmol/mol figure you've been given. It's not a big range - 38-42 is normal - ie "normal" because most non-diabetic people are in there. You are close to >42 - but you're also not far from 38 either.

Unless your A1c has been creeping up (your medical records should show this) 40-42ish may just be where your blood glucose normally is.

Your nurse is technically correct in that if an A1c score is >42 you will be told you're "pre-diabetic" - a term invented to cover people in the gap between "normal" blood glucose levels and an automatic diagnosis of T2 at >48. Given the test error there are undoubtedly people termed "prediabetic" who are actually in "normal" range and vice versa. This is why single tests are potentially difficult to interpret and you have to look at the trend.

"Pre-diabetic" isn't a diagnosis of anything, but if your BGs move out of normal range it is a sign that you might well not be handling carbs as well as you once did. My A1c climbed steadily out of normal range year on year and no-one told me about it - I was reassured several times that I wasn't diabetic. Being alerted (hopefully unnecessarily) is better than that .

I'm really not sure about recommending testing in your situation. Meters are fallible and some people can become obsessed with repeated testing and worrying about miniscule and meaningless variations in results. On the other hand I don't think it does any harm to see how various foods affect you and it provides very useful - essential - information if you want to limit carb intake.

I'm tagging @Rachox who has a list of available meters - I think she's updated it recently and I don't have the newest version.

Thank you so much for taking the time to this further explanation. It’s really helpful.

I totally agree that it’s better to be alertEd than for things to be left to progress over time that you could have done something about.

I think I will get a monitor. That way I can, even if just in the short term, see what works for me. I’ll also keep a diary of carbs so I can see where I can tweak things. I’m going to cut out potatoes, limit bread and not have cake (or maybe just once a week or so as a treat).

I’m certainly more aware now than I was first thing this morning and that has to be a good thing

 

[Grace04]

I think if I were in your position rather than going to the expense of testing, with frankly fairly inaccurate meters, and then puzzling over what the numbers mean.
I would start by keeping a food diary of everything you eat or drink for say, a week. Note down the amount of carbs you are eating in each meal, see what your average daily total of carbs is. In other words, how many carbs are you eating, to give you the HbA1c number you have got.
I know this has been mentioned by KennyA but your body can't see if something is wholemeal or brown, you need to count all carbohydrates.
Once you have a good understanding of where your carbs are coming from, it should be relatively simple to reduce the amount and your HbA1c.
Less spaghetti and more sauce, bacon & eggs on a plate instead of a sandwich, a salad with your chicken in place of the chips, have a look at the fruit in your diet, see if you can choose something with less carbs.
You shouldn't have to make any major changes, just small tweeks and a few better choices should do it.

Thank you for this. I will keep a diary, but monitor too just to get a feel of what I can and can’t eat. Your dietary pointers are a big help.

 

[Life-without-chocolate]

Hi Grace, Im in a really similar situation, other than only having had a first blood test after beginning to feel not quite right, and the HbA1c coming in at 41.9 along with a few other results being not what they should be (I'm also borderline hypothyroid and menopausal) so my GP is repeating mine at the 3 month mark as Id already made a huge change to my diet as soon as I had the results back but my appointment was 2 weeks later.
Like you, I always thought my diet was pretty ok? I've just retired from a lifetime of shiftwork and my meals were all over the place.
As soon as I got the results back, I switched all carbs from white to wholemeal and halved the portion size of each that I had. I cut out all processed sugars (Im a bit of a chocaholic) I bake cakes on the side and have stopped nibbling the cake trimmings and now make every meal from scratch, so I can limit the sugars or at least know what sugars are there.
My biggest struggle, is the evenings, when its my chill time, with tv, cup of tea and chocolate, so trying to cut that out is very hard.
I dont have the answer for you I'm afraid, but I can say, you're not on your own with being new and unsure of the best route (and I was a medical professional, so already had some of the answers)

 

[Mrs HJG]

@Grace04 one thing to bare in mind, if in the 3 months prior to your HbA1c you are ill, particularly with covid, or are on antibiotics, steroids or all sorts of things, these will affect your result, so you could cut the carbs and be heading for a great reduction and have it blown out the water by a week of CV19 etc. Make sure you make a note of anything that could cause your BG to temporarily increase to avoid a mis-diagnosis.

My top treat tip : try Lindt Excellence 90% chocolate, a couple of squares may (hopefully) be eaten with minimal effect, or dunked in greek yogurt for added impact-reduction if you like! @Life-without-chocolate you might like this too.

 

[NathonalCoalBoard71]

I think there are great tips here and whilst you probably don't feel unwell and could just see what happens next time you are tested you might want to buy a meter and run the fasting and post meal tests to see if you are in range (4-7) within 2 or 4 hours after a meal like 'something on toast' versus fish and veg versus cake!
Next add a walk after the meal to see what happens then.
If you were to find that your blood glucose is elevated above 7 when you wake up and remains above 7 after 4 hours then that would suggest you're not tolerating carbohydrates very well (I'd d expect you to have rises after toast/cake).
The other things that come with problems managing blood glucose are:
Thickening waist (more than half your height)
High blood pressure (more than 140/90) or being treated for BP
Lipids e.g. triglycerides higher than your HDL cholesterol if you can see that info on your patient records.
If you have any of these other signs on top of the raised hba1c I'd consider making changes like a bit more exercise and a bit less cake/bread/pasta/rice (its all glucose to your body btw so forget 'healthy wholegrains). That means more protein and fat including dairy as well as nuts. One meal at a time is a good way to gradually get into this if that's what you decide!

 

[Grace04]

@Grace04 one thing to bare in mind, if in the 3 months prior to your HbA1c you are ill, particularly with covid, or are on antibiotics, steroids or all sorts of things, these will affect your result, so you could cut the carbs and be heading for a great reduction and have it blown out the water by a week of CV19 etc. Make sure you make a note of anything that could cause your BG to temporarily increase to avoid a mis-diagnosis.

My top treat tip : try Lindt Excellence 90% chocolate, a couple of squares may (hopefully) be eaten with minimal effect, or dunked in greek yogurt for added impact-reduction if you like! @Life-without-chocolate you might like this too.

Hi and thank you so much for this. I brought myself a monitor and have been watching my BG levels for a couple of weeks now. It has gone high, well what seems high to me on the odd occasion, but generally it within normal limits. So 12.3 is the highest I’ve recorded, that was one evening after a carb heavy supper. The next was 8.4. This was following some Easter egg chocolate, naughty but nice.

Apart from those times about 2 hours after eating it’s generally between 5.2 and 6.5. So I have been wondering if something else is going on. I’ll do as you suggest and record anything that could be affecting it.

Also thank you very much for Lindt chocolate suggestion. I’ll get some on my next trip to the supermarket.

 

[Grace04]

I think there are great tips here and whilst you probably don't feel unwell and could just see what happens next time you are tested you might want to buy a meter and run the fasting and post meal tests to see if you are in range (4-7) within 2 or 4 hours after a meal like 'something on toast' versus fish and veg versus cake!
Next add a walk after the meal to see what happens then.
If you were to find that your blood glucose is elevated above 7 when you wake up and remains above 7 after 4 hours then that would suggest you're not tolerating carbohydrates very well (I'd d expect you to have rises after toast/cake).
The other things that come with problems managing blood glucose are:
Thickening waist (more than half your height)
High blood pressure (more than 140/90) or being treated for BP
Lipids e.g. triglycerides higher than your HDL cholesterol if you can see that info on your patient records.
If you have any of these other signs on top of the raised hba1c I'd consider making changes like a bit more exercise and a bit less cake/bread/pasta/rice (its all glucose to your body btw so forget 'healthy wholegrains). That means more protein and fat including dairy as well as nuts. One meal at a time is a good way to gradually get into this if that's what you decide!

Thank you, this is all very good advice. I do now have a monitor and have been testing for a little over two weeks. In that time my reading has been over 7 six times and almost always in the evening. This is a time when I’m more likely to eat carbs, so they could be the problem. It’s always been below 5 first thing in the morning.

I am working to reduce the carbs so hopefully I’ll get so I don’t have readings over 7 at any time. The pointers I’m getting on here, such as the ones you’ve kindly given me, are really helping me achieve that.