Newly diagnosed - lots of questions

Nezelette said:

Hi everyone,

I was diagnosed with prediabetes a few days ago and I am determined to turn things round!

It was a big shock and disappointment because I am healthy in many ways, which makes it hard to "make a fresh start" etc. I have a normal BMI, I eat well (low card already, lots of veg - mainly salads, chicken, no junk food), I drink very rarely, I have low blood pressure and I'm only 39... I was told, upon diagnosis, to exercise 5 days a week for 1/2 hour, but I ALREADY do that, and have done for many months. I am a runner, and I also do workouts and pilates. It feels very unfair, to be honest. My mother has type 2 diabetes, so that must be a factor, but she has always eaten too much and been overweight, with a very carb-heavy diet and almost no exercise at all.

Here are my questions:

• How can I "change my lifestyle", as the doctor said, if I already had a healthy, active lifestyle? I feel very down, because I feel there is very little I can do...
• I have had an underactive thyroid for 12 years, but it has been totally under control through medication. Could it be related?
• The blood test also revealed sightly elevated LDL cholesterol. I am reading that people are on low carb, high fat diet (which is what I have been on too, to an extent). Wouldn't that be dangerous for my cholesterol levels?
• Do I need a glucose meter, or is it only if I develop full type 2 diabetes?
• I live in Thailand and have been eating a fair amount of fresh fruit (mango, melon, pineapple... perhaps 4 servings a day). Could that be the culprit?
• I have symptoms that worry me and upset me... I have put on about 8 pounds even though I exercise a fair bit, I have a dry mouth all the time, I get light headed when I'm hungry, I am absolutely exhausted (I work full time with 2 kids too)

Sorry to moan! I have been down and feeling sorry for myself. I hate feeling out of control and ignorant. Any help would be greatly appreciated.

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Hi and welcome. The good news is that we can probably answer all of those questions, and give you some further info to read about it. Try not to worry as I'm sure you can get your blood sugars down soon.

Firstly, 20% of T2 diabetics are normal weight, so prediabetes and diabetes are not always related to obesity:
http://www.phlaunt.com/diabetes/14046739.php

Can you tell us what your blood test result was... do you know if you had an HbA1c test or was it another kind? The other kinds of tests may also be useful for you, depending on what your day to day blood sugar levels are like. I think you should ask for another HbA1c test in 3 months to check how things are going. If your symptoms get worse or don't improve after a few weeks you should ask for a fasting blood glucose test.

If you are already doing all the things the doctor said then please don't beat yourself up about it, you are doing fine and there is no need to do more exercise unless you want to, for example.

Hypothyroidism can be related to diabetes but I don't know much about it. Others will know more.

Slightly elevated LDL cholesterol on its own is usually nothing to worry about. There are other measures like Triglycerides and HDL cholesterol and the ratios between them, which are also important. In general, eating more fats does not increase cholesterol, eating too many carbs does.

A glucose meter would be a great idea. I can give you a link to the one with the cheapest test strips in the UK if you like. The more expensive meters/strips are slightly more accurate, but this is usually only necessary for T1 diabetics.

Yes, eating 4 servings of tropical fruit a day is not good for a low carb diet. If you cut out fruit except for berries and maybe one apple a day, you should notice an improvement. You could still have a piece of fruit sometimes as an occasional treat, especially once your levels are stable.

Your symptoms suggest high blood sugars, and they should resolve as your levels come down. However, you should tell your doctor about them in case there is another cause.

I will tag @daisy1 who has some newbie info she can post.

Here is some more reading about prediabetes/diabetes if you are interested in more info:
http://www.phlaunt.com/diabetes/14045524.php

Please feel free to ask any questions

Nezelette said:

I guess this was the wrong place! I will post again in Newly Diagnosed...

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It's the right place, I was writing a long post while you were posting. I'm sure others will see your post and reply over the next few days.

Nezelette said:

I really appreciate you taking the time to write a reply, thank you so much.
I went out to buy a meter yesterday. My fasting blood sugar was 102 on the day I got diagnosed, and 100 this morning, so perhaps getting better already (although I guess it fluctuates a lot). I didn't have any of the other tests. The doctors can be a bit hit and miss here. I have another appointment in 6 months, which seems like a long time away. Maybe I will try to get another one sooner. Thanks again!

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I'm glad you found the info helpful
A FBG of 102 is 5.7 (in the units we tend to use here) and that's a normal/non diabetic level. Prediabetes starts at 6.1. So now I'm wondering if the doctor made a mistake? I would ask for an HbA1c test in the next week. If the result of that test is at the high end of normal, then doing the same things you would do if you had prediabetes will help prevent getting prediabetes. A low carb diet is good for almost everyone. And it would probably mean you could still enjoy eating some tropical fruit every day

One thing you could do is test before an ordinary meal and again 2 hours after, and let us know the results. This might give us a clue as to what's going on. And I think you should see you doctor about your symptoms, as they are not explained by your FBG result.

Sorry this is a bit confusing but it's important to get an accurate diagnosis. I think this is the reason why the official guidelines say doctors should base a diagnosis on 2 test results taken on different days.

Nezelette said:

It's weird, the Thai doctor said over 100 is prediabetic, and I showed the results to my Australian doctor friend who said the same thing. Do you think there are different official limits in different countries? That's possible, right? In a way, I'm glad the limit is low, as I can keep a good eye on things before they get worse.

So what would be a normal reading after a meal?

Thanks!

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That does seem odd, because I thought the Australian level would be the same as the UK.

I've now double-checked where I got my info from on the website this forum is on, DCUK:
http://www.diabetes.co.uk/pre-diabetes-tests.html


However, the jolly website contradicts itself!
http://www.diabetes.co.uk/diabetes_care/fasting-blood-sugar-levels.html

"The results of a fasting test with respect to glucose levels in the body are as follows:

• Normal: 3.9 to 5.5 mmols/l (70 to 100 mg/dl)
• Prediabetes or Impaired Glucose Tolerance: 5.6 to 7.0 mmol/l (101 to 126 mg/dl)
• Diagnosis of diabetes: more than 7.0 mmol/l (126 mg/dl)"

So I think it's safe to say you are just on the borderline of being prediabetic... which is still a good thing. I think your doctor was being very proactive about getting it under control, which is great. Too many doctors sit back and do nothing until the person get diabetes and maybe even has some damage from high blood sugars.

Sorry to have put you wrong (due to the DCUK website putting me wrong). I try to make the info I give people as accurate as possible.

All good in the end though.

CatLadyNZ said:

I'm glad you found the info helpful
A FBG of 102 is 5.7 (in the units we tend to use here) and that's a normal/non diabetic level. Prediabetes starts at 6.1. So now I'm wondering if the doctor made a mistake? I would ask for an HbA1c test in the next week. If the result of that test is at the high end of normal, then doing the same things you would do if you had prediabetes will help prevent getting prediabetes. A low carb diet is good for almost everyone. And it would probably mean you could still enjoy eating some tropical fruit every day

One thing you could do is test before an ordinary meal and again 2 hours after, and let us know the results. This might give us a clue as to what's going on. And I think you should see you doctor about your symptoms, as they are not explained by your FBG result.

Sorry this is a bit confusing but it's important to get an accurate diagnosis. I think this is the reason why the official guidelines say doctors should base a diagnosis on 2 test results taken on different days.

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In light of the problem I had with DCUK website info, I want to change what I suggested above.

I think HbA1c tests can be really useful as they show what your BGs have been doing over several months instead of one snapshot in time. But they are not essential in borderline prediabetes. So, up to you... if you want better info on your BGs for comparison later, ask for an HbA1c, if you're happy with using FBG instead, that's ok too.

I'm not so hung up on tropical fruit as I was before, since your prediabetes is only borderline. If you find it doesn't cause too much of an issue for your BGs, then enjoy it. But if you want to drive your BGs down as much as possible, then limit it. The testing before eating and 2 hours after could help with this.

Nezelette said:

I really appreciate you taking the time to write a reply, thank you so much.
I went out to buy a meter yesterday. My fasting blood sugar was 102 on the day I got diagnosed, and 100 this morning, so perhaps getting better already (although I guess it fluctuates a lot). I didn't have any of the other tests. The doctors can be a bit hit and miss here. I have another appointment in 6 months, which seems like a long time away. Maybe I will try to get another one sooner. Thanks again!

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Again, to revise my earlier post... a repeat test in 6 months would be fine. You could ask for one in 3 months if you want to show your improved results... but if you are home testing then there's not much to add by having a lab FBG test.

Also, your own meter may be inaccurate by up to 15%, so pay attention to trends rather than small changes like 2 points.

@Nezelette

Hello and welcome to the forum

Here is the information we give to new members and this should help you to lower your levels. Ask more questions if you need to and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

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 over 150,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

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

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 bloodglucose 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.