Opinions please - prediabetes/insulin resistance.

[ByJingo]

Hi
I'm looking for opinions from people who actually know about this stuff, because I've absorbed a whole lot of info in the past week or so and I'm not confident that I am correctly interpreting what I'm seeing.

Firstly, a bit of background and explanation:
I'm 32, female, BMI of around 22, mother of two, never been seriously overweight. My diet, for the last couple of years at least, I think is pretty good as far as mainstream healthy eating goes - carbs are mostly brown, lots of veg, some fruit, a balance of meat and plant proteins, plus a protein supplement and a big vitamin d supplement. However, I haven't been able to make enough breastmilk to come close to feeding either of my children and in trying to find out why that is the case, I got some blood tests done. My a1c came back as 5.2, which a support group I'm part of suggested means I'm insulin resistant, which is known to cause problems with milk supply.
I was a bit sceptical to be honest, but was pointed towards Blood Sugar 101, which I read cover to appendix, then purchased a glucose meter, hoping to rule out the possibility. Well, the first post-meal (+1hour) reading I took was 185mg/dl (10.3mmol/L)! So I carried on testing. Next test gave me 146 (8.1) at 1 hour and 122 (6.8) at 2 hours. Then I tried to do a home 2hOGTT with mini party ring biscuits (24 of them = 65g carb (it was the most appropriate thing we had in the house at the time!)) and got 130, 114, 74 (7.3, 6.2, 4.1) at 1,2,3 hours having had a fasting rate of 85 (4.7) immediately beforehand. Fasting rates taken on other mornings have been in the high 80s. I've now run out of the free strips that came with my meter and am waiting for more to be delivered, so am taking this time to try to dispel some of the slight panic I'm feeling and make a plan for how to proceed from here.

My conclusions from what I've discovered so far are:
I am in fact insulin resistant.
I'm probably regularly exceeding the 140mg/dl level at which 'diabetic' complications are a possibility.
I'm slow to process glucose ie get back to a fasting level after eating.
I'm probably not diagnosable as pre-diabetic far as the NHS is concerned and therefore they're probably not going to be interested.

So I'm thinking I need to be looking at cutting carbs to a level that my body can cope with. Which means testing lots of meals to see what makes me go high and work from there. I'm also planning to measure in ten minute intervals after a meal to see when I peak so I can measure most accurately. But I'm wondering if there's anything else I need to be trying to find out - fasting insulin level, for example - to tell me where on the road to problems I am or if I should be worrying about beta cell function etc. Or indeed whether I am on that road at all - my husband isn't fully convinced (hasn't read the literature) which is seeding doubt since I seem to be between normal and pre-diabetic. I'd like to be solidly sure I need to before starting the significant work of changing my diet properly at this point in time (with a baby and a toddler to look after).

So if you could spare the time to share them, your knowledgeable thoughts would be much appreciated, whether confirmation of my thinking, telling me I've got it all wrong, pointers of what to do next or just acknowledgement that I'm in limbo, anything really.

Thanks in advance and apologies for the essay.
Yours
Concerned Mum

 

[X-Alexxander-X]

Hi
I'm looking for opinions from people who actually know about this stuff, because I've absorbed a whole lot of info in the past week or so and I'm not confident that I am correctly interpreting what I'm seeing.

Firstly, a bit of background and explanation:
I'm 32, female, BMI of around 22, mother of two, never been seriously overweight. My diet, for the last couple of years at least, I think is pretty good as far as mainstream healthy eating goes - carbs are mostly brown, lots of veg, some fruit, a balance of meat and plant proteins, plus a protein supplement and a big vitamin d supplement. However, I haven't been able to make enough breastmilk to come close to feeding either of my children and in trying to find out why that is the case, I got some blood tests done. My a1c came back as 5.2, which a support group I'm part of suggested means I'm insulin resistant, which is known to cause problems with milk supply.
I was a bit sceptical to be honest, but was pointed towards Blood Sugar 101, which I read cover to appendix, then purchased a glucose meter, hoping to rule out the possibility. Well, the first post-meal (+1hour) reading I took was 185mg/dl (10.3mmol/L)! So I carried on testing. Next test gave me 146 (8.1) at 1 hour and 122 (6.8) at 2 hours. Then I tried to do a home 2hOGTT with mini party ring biscuits (24 of them = 65g carb (it was the most appropriate thing we had in the house at the time!)) and got 130, 114, 74 (7.3, 6.2, 4.1) at 1,2,3 hours having had a fasting rate of 85 (4.7) immediately beforehand. Fasting rates taken on other mornings have been in the high 80s. I've now run out of the free strips that came with my meter and am waiting for more to be delivered, so am taking this time to try to dispel some of the slight panic I'm feeling and make a plan for how to proceed from here.

My conclusions from what I've discovered so far are:
I am in fact insulin resistant.
I'm probably regularly exceeding the 140mg/dl level at which 'diabetic' complications are a possibility.
I'm slow to process glucose ie get back to a fasting level after eating.
I'm probably not diagnosable as pre-diabetic far as the NHS is concerned and therefore they're probably not going to be interested.

So I'm thinking I need to be looking at cutting carbs to a level that my body can cope with. Which means testing lots of meals to see what makes me go high and work from there. I'm also planning to measure in ten minute intervals after a meal to see when I peak so I can measure most accurately. But I'm wondering if there's anything else I need to be trying to find out - fasting insulin level, for example - to tell me where on the road to problems I am or if I should be worrying about beta cell function etc. Or indeed whether I am on that road at all - my husband isn't fully convinced (hasn't read the literature) which is seeding doubt since I seem to be between normal and pre-diabetic. I'd like to be solidly sure I need to before starting the significant work of changing my diet properly at this point in time (with a baby and a toddler to look after).

So if you could spare the time to share them, your knowledgeable thoughts would be much appreciated, whether confirmation of my thinking, telling me I've got it all wrong, pointers of what to do next or just acknowledgement that I'm in limbo, anything really.

Thanks in advance and apologies for the essay.
Yours
Concerned Mum

Dear ByJingo or Mum, I agree that your glucose reading after meals is high at 185 mg/dl but your HbA1c is great. I too was told that a non diabetic persons reading does not exceed 140 mg/dl. Especially after 2 hours after eating. I myself have tested my family when I was the only diabetic among us. I was the only one that my glucose would go higher than 140, usually around 180 - 190 after a meal and theirs never even got close to 140. Usually less than 110 at the same time during my test. I suggest that you seek other methods of increasing your milk production and continue eating healthy. Once you complete this mission, then seek ways to address your diabetes concerns. In case you did not know, pain and stress also elevates your glucose. Keep your focus on the more important things first, which in this case are your children. Take care, good luck and God bless you and your family.

 

[ByJingo]

Hi XX-Alexxander-XX

Thanks for getting back to me. Its good to know that you think I'm not in any immediate danger of deterioration. Just to reassure, I'm only looking at this now from a health perspective really - having tried pretty much everything in the book to increase milk production with my first child I'm content with the way feeding is going this time. I mentioned milk only to explain why an apparently healthy person was obtaining an a1c. Baby is 8 months old so I do have the capacity to make changes soon if necessary, but later might be better if that's sensible.

Once the strips arrive, one of the things I will do is check my husband's levels at the same time as mine after the same meal, thanks. I think I'll continue testing myself after some meals and see what happens over a longer period. If nothing else it'll be interesting and useful if I ever do need to get an official diagnosis.

I would still be interested to hear other peoples' assessments

 

[Alison Campbell]

Hi I am a big fan of Diabetes 101 also and I think she has some useful things to say about insulin resistance and prediabetes.

That said your HBA1C is excellent, your fasting levels are making me green with envy and your home glucose tolerence test has too many other food groups and other variables for you to take anything concrete away.

By American guidelines 1/3 of adults in the UK or US have some level of pre d or type 2 diagnosed or otherwise but you are not anywhere close to any of those markers.

I hope you don't mind me sharing my thoughts and experience. I did not know about insulin resistance and breastfeeding so thanks for that.

 

[ExtremelyW0rried]

A1c of 5.2 is totally normal though? In fact I think I've seen studies where 5.2 was the most common level of a1c to have. None of your other levels seem pre diabetic to me either. They seem normal.

 

[ByJingo]

Hi Alison
Thanks very much for your reply, I'm interested in getting any views I can from outside my 'argh, my post-meal values look scary' little box - it's somewhat reassuring to have people saying that I don't seem to be in any immediate danger.
I suspect I should have been clearer in my original post saying it's long-term risk that concerns me most - if I'm at a stage now where most people who do end up with pre-/diabetes have been, without realising it, before their (possibly sudden) diagnosis, ie they've gone from where I am to having pre-/diabetes, then I'd like to do something about it before it gets to that stage, partly since I'm guessing smaller changes would be needed now than if I got to a 'diagnosable' level. I guess there aren't many people in my situation on here (or anywhere in fact) but I don't know where else to try to get useful information. If you know of any resources that might be helpful I'd love to hear of them.
Also, I realised yesterday that my a1c result is from a period (july-October ish) when I was avoiding all bread in my diet for a separate reason, so it probably isn't a reliable indicator at this point, since I'm currently firmly back on bread.
Thanks for reading and replying, I am grateful for your time and thoughts as they've given me a more objective view of what's going on and also stimulated useful thought in different areas.

 

[ExtremelyW0rried]

Hi Alison
Thanks very much for your reply, I'm interested in getting any views I can from outside my 'argh, my post-meal values look scary' little box - it's somewhat reassuring to have people saying that I don't seem to be in any immediate danger.
I suspect I should have been clearer in my original post saying it's long-term risk that concerns me most - if I'm at a stage now where most people who do end up with pre-/diabetes have been, without realising it, before their (possibly sudden) diagnosis, ie they've gone from where I am to having pre-/diabetes, then I'd like to do something about it before it gets to that stage, partly since I'm guessing smaller changes would be needed now than if I got to a 'diagnosable' level. I guess there aren't many people in my situation on here (or anywhere in fact) but I don't know where else to try to get useful information. If you know of any resources that might be helpful I'd love to hear of them.
Also, I realised yesterday that my a1c result is from a period (july-October ish) when I was avoiding all bread in my diet for a separate reason, so it probably isn't a reliable indicator at this point, since I'm currently firmly back on bread.
Thanks for reading and replying, I am grateful for your time and thoughts as they've given me a more objective view of what's going on and also stimulated useful thought in different areas.

So you are worried you might be pre-pre-diabetic

Apart from that one reading your other numbers seem fine. You ate 65g worth of biscuits and you were ok so I don't think there's anything imminent to worry about.

 

[Alison Campbell]

Type 2 does not happen that quickly without a specific reason (physical injury, steroid meds etc) and you are now more aware than most so it is unlikely to sneak up on you. Maybe annual HBA1C tests will keep your concerns at bay.

It sounds like you want to make some changes to improve your general health and that can't be a bad thing but I don't think type 2 diabetes/food needs to be the sole focus.

 

[Glink]

Agree with the folks above; your labs look good, so while your post-meal #s look highish I would try not to stress too much. If you have test strips and a metre, you might see what foods drive you high and try to avoid those, but in general just keep an eye out and reduce the carbs that seem to drive you high.

 

[CherryAA]

Hi Alison
Thanks very much for your reply, I'm interested in getting any views I can from outside my 'argh, my post-meal values look scary' little box - it's somewhat reassuring to have people saying that I don't seem to be in any immediate danger.
I suspect I should have been clearer in my original post saying it's long-term risk that concerns me most - if I'm at a stage now where most people who do end up with pre-/diabetes have been, without realising it, before their (possibly sudden) diagnosis, ie they've gone from where I am to having pre-/diabetes, then I'd like to do something about it before it gets to that stage, partly since I'm guessing smaller changes would be needed now than if I got to a 'diagnosable' level. I guess there aren't many people in my situation on here (or anywhere in fact) but I don't know where else to try to get useful information. If you know of any resources that might be helpful I'd love to hear of them.
Also, I realised yesterday that my a1c result is from a period (july-October ish) when I was avoiding all bread in my diet for a separate reason, so it probably isn't a reliable indicator at this point, since I'm currently firmly back on bread.
Thanks for reading and replying, I am grateful for your time and thoughts as they've given me a more objective view of what's going on and also stimulated useful thought in different areas.

I think your concerns are very sensible and commendable. I only wish I had thought to think ahead 30 years ago.
"normal fasting glucose" covers a pretty wide range of results . I am myself at the moment watching in amazement as a youngster ( 27) pretty much flatlines at 4.2 all of the time, and with an OGTT result that peaked at 9.2 and returns to 4.2 within two hours. This guy is very overweight and looks like a candidate for diabetes in the future . The current indications of his problems is that his glucose also peaks to about 7.8 on exertion which isn't cool for a youngster. so he has an hba1c of 4.2 but he still needs to fix his diet.

My own view is that the western diet, including refined foods, sugar and seed oils ( vegetable seed oils) isn't good for anyone, so in practice simply making sure that your diet is relatively low on all of these, eating foods you recognise its origins mainly cooked yourself will maximise your chances of good health and minimise the risk of developing diabetes and much else.

If I were in your shoes today, I think I would be looking to gradually increase the " real food " content of what you are feeding your family and reducing the shop bought packets. It is not as hard as it first appears. For example -how about arranging your partner to give you a three hour break one day a week and using it to really tackle a bit of bulk cooking?

making a big stew pot,, home made curry, home made mince recipes, cooking a chicken, boiling some eggs. Sticking up with healthier snacks, nuts, avocados, berries, apples, in place of the sweet dish. That way you can gradually improve the health of everyone. I doubt you need to be testing everything in sight after every meal. If you are really wanting to know what is happening then maybe treat yourself to a freestyle libre for a couple of weeks and see how your body reacts to the food you eat.