Pre diabetes- long post- Extremely Confused & Alarmed

[Veggy300]

Hi. Sorry for this very long post, but I'm so confused about my new (or perhaps latent) prediabetes diagnosis which was given to me as an offhand aside during a visit to an endocrinologist regarding blood tests for possible low thyroid function (which is borderline hypo and untreated but also shifting into normal at various times). I've had the ogtt test done probably once or twice a year over the past 6 years, more as the family Dr. humouring me regarding issues over weight gain and difficulty losing. They were all normal except for the 2 repeats that I had done this year. The fasting result is always normal but the 2 hour reactive rate is now consistently 8.2 mmol. I had the hba1c test done recently and yet it shows normal.

OTOH, I've also had the IGF-1 test (acromegaly) done at the same time as the oggt test and it shows a slightly above normal level. (I also don't seem to have any outward signs of acromegaly). Also, there is no diabetes in my family at all and my 8 years older sister who drinks a fair bit and is more overweight than me and is not a vegetarian like me, had normal levels when clinically tested for this. In fact, we both had the same take out meal with high but not insane carbs and I tested our blood levels with my Contour meter and hers was well within normal and mine were high prediabetes level or slightly over 7.8 mmol (granted, I did test at 1 and 2 hours post meal).

I'm 6 years into menopause with no hrt treatment or particularly bad symptoms except for excessive belching, esophageal spasms, and a stubborn weight bmi index plateau that has me borderline obese, but not quite, despite being a long time vegetarian, having no alcohol or soda for years, if ever, and no sugary junk foods. I slowly lost around 15 pounds over the past 2 years after being mildly obese for 4 years while looking after ailing parents at home and sometimes only eating one meal a day, particularly when they were in and out of hospitals. As an aside, up until age 50, I was always at a slim to normal weight, so being borderline or mildly obese is alarming, especially when I'm having great difficulty reversing it.

A final odd symptom is that over the past year I now have somewhat thinning hair on my usally thick crown and coarse dark hair coming in gangbusters only under my chin, much like PCOS sufferers (Poly cystic ovary syndrome) of childbearing age, again something I didn't have with my periods. One of my testosterone levels is elevated, but again, only mildly, which it might have been for many years, but wasn't an issue cosmetically speaking. I've had the contrast dye pituitary MRI scan done and they said they couldn't find any tumours.

All this to say that I find all of these things converging at once and which seem not to be the typical experience of someone finding themselves suddenly labelled as pre-diabetic. Typical of most doctors, my endocrinologist will not offer me any more support on these converging symptoms except for the usual diet and exercise advice which I have been doing for the past year to little or no effect. She also won't put me on thyroid med's because of fluctuating levels and possible heart interference (which I can appreciate, having current but intermittent bouts of tachycardia, and also having had them since age 20-50 when I was a slim to normal weight). I've also had a long standing problem, which continues to this day, with frequent and heavy urination, something that began in my mid teens but which were not due not infections or bladder abnormalities.

Apart from unexplained blurry vision off and on throughout the day, I'm not constantly thirsty, don't crave sugar or particularly eat a lot of it, and as a vegetarian, have very little fatty foods, also having greatly reduced dairy over the past 4 years as mostly a milk drinker. I'm fairly physically active, and water has been my main beverage for years, but this difficultly losing weight paired with this new prediabetes diagnosis has me alarmed that every day that this condition persists (for whatever strange hormonal cocktail going on inside my body) it is doing untold damage to all of my internal organs (mild fatty liver revealed in scan 2 years ago), and with aching joints and rapdily advancing osteoarthrits at a relatively young age- late fifites. I'm anxious to stop this situation and wondered if anyone else out there with prediabetes had some of the same or similar sets of unique symptoms and if they were successfully treated either with medication, operation, or lifestyle.

 

[LittleGreyCat]

Firstly, welcome to the forum, paging @daisy1 for the welcome pack.

A few points from your comprehensive post. You seem to be eating low fat but not low carbohydrate. Also I would suggest that being vegetarian is a personal choice but not necessarily more healthy than being an omnivore.

You have signs of a fatty liver. This can come from eating too many carbohydrates. Carbohydrates are converted to glucose by the body. However the body can only store a little glucose and the rest is stored as fat.

Take a deep breath and dive into the forum, and read about various ways of eating. Don't worry that some information may conflict with what you have been told in the past. There is a lot of information to take on board.

It is good that you have a meter and are testing. Your challenge is to find a style of eating thst keeps your BG low. With luck this will also take the extra weight off as well.

 

[Chronicle_Cat]

I'm tagging @daisy1 who has an introductory post.

I agree with the above poster and it also sounds to me like you may have some insulin resistance (which leads to diabetes in many cases) which may be contributing to the weight gain. I can't speak to your other symptoms but reducing your carbohydrates will help with your blood glucose and weight as well as your fatty liver. (I've heard it is helpful also for PCOS.) The reason why a low carb diet is so helpful is because carbohydrates are broken down into the body as sugar which our bodies have a lot of difficulty managing. Sadly the "healthy diet" we've all been told to eat is too carb heavy and isn't good for the 1/3 of us who are prone to insulin resistance.

Are you a vegan or ovo-lacto vegetarian? It's difficult to eat low carb on vegan diet (although it can be done - nuts and nut butters and tofu for proteins). If you are ovo-lacto, rely on eggs and cheese (cheese rather than milk because it has a lot of sugar in it - lactose is a sugar.) As well, eliminating all grains including whole grains (wheat, rice, oats, barley), dried beans and lentils, starchy vegetables such potatoes, corn, sweet potatoes and high carb fruits especially tropical fruits like bananas and pineapples and all fruit juices. You can test these foods with your meter (test before eating, 2 hours after, if you see a rise of 2.0 mmol/l or greater, that food isn't for you. There is some individual variation but these are the foods that spike most people's blood glucose levels. I'm assuming you know about eliminating sugars.) A great source of vegetables to eat is in this visual guide: https://www.dietdoctor.com/low-carb/vegetables . Don't be afraid of fat, as you reduce the number of carbs, you need more fat to keep you from getting hungry.

I would recommend dietary changes before medication (especially for a prediabetic) as medication can have side effects. In 3 months since my Type 2 diagnosis at the end of June, I've managed to lower my hba1c from 53 (7% - diagnosed ) to 36 (5.6% - normal or near normal) without medication. There are many people here who are seeing great results with low carb diets.

BTW, I had no symptoms at all, my diagnosis came after a routine blood panel for a checkup. I'm a bit older than you are (62) and as we get older, we become more susceptible to Type 2 diabetes.

As you are prediabetic, you have time to be these changes before continuing onto a diagnosis of diabetes. Hopefully, you should be able to avoid it.

 

[Rachox]

Hello and welcome to the forum Veggy300, I am another low carb fan, as well as helping with stabilising blood sugars, helping lose weight and improving fatty liver, as a fellow sufferer of osteoarthritis (diagnosed age 45, I’m now 57) I have found low carbing helps that too. I lost a shed load of weight on it since my Type 2 diagnosis which has obviously helped my weight bearing joints but my neck and hands have improved too due I think to the anti inflammatory effect of eating lower carbs.

 

[kokhongw]

Did your OGTT includes any insulin readings?

Insulin resistance built up over the years due to repeated exposure to high levels of insulin. That would explain why even vegans would experience it as well.

 

[daisy1]

@Veggy300

Hello Veggy and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you want and someone will be able to help.


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.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

 

[Veggy300]

Thanks to everybody who replied. It seems pretty difficult to nail down just what started my slide towards prediabetes and how long it might have been in the making. It's interesting regarding carbs and the usual suspects because I don't particularly like bread, and would have a loaf in the fridge that lasted a month, or usually went stale. I also dislike potatoes. The only food I would consume alot of over the years was 2% milk. Being a fussy eater I disliked most meat, but do like fish.

Mainly I ate very little over the past recent years due to lack of interest and also fatigue from looking after ailing relatives. Since becoming a dilettante vegetarian 25 years ago I must admit that I didn't make much effort to eat properly, ie, very much, because I didn't know how to prepare proper vegetarian meals, which can take some getting used to in terms of effort. I just knew that I didn't want to eat meat and left it at that and picked at whatever I could find. I'd say that I under ate more than over.

My diet now is relatively improved in terms of quantity and enjoyment but not huge variety. 10 plain almonds, oatmeal, almond milk, 1 tbs virgin olive oil to add some fat, avacado, fish, cottage cheese, the odd egg on rye toast and occasional piece of cheese if someone brings it over. Raw cabbage and carrots are good too, since I don't like cooked vegetables very much. Green grapes and pears are nice too.

I am confused though at my consistently normal fasting blood sugar ogtt results (probably normal from years of not eating breakfast or being hungry then), followed by the higher number 2 hours later. I would never normally consume the amount of sugar presented in the ogtt test, since it's repulsive and nauseating- but I guess it's like running your car motor at full throttle to test its durability under stress and apparently mine is now not up to it.

I find it odd that my facial hair and prediabetes echos overweight PCOS sufferers when I clearly don't have this condition, at least when it comes to menopause. Also the slightly above normal IGF1 level bothers me in that I'm worried it might be involved in my situation and undermining all the exercise I'm doing along with decent eating (with over a year of food diary notation).

 

[Resurgam]

The oats, bread, grapes and pears - even carrots if eaten in quantity will all add up, and the total amount of carbs includes the starches as well as the sugars - it might be a useful exercise to estimate and record the carbs you were eating each day for a week or so to see how the various foods affect your blood glucose

 

[Veggy300]

The oats, bread, grapes and pears - even carrots if eaten in quantity will all add up, and the total amount of carbs includes the starches as well as the sugars - it might be a useful exercise to estimate and record the carbs you were eating each day for a week or so to see how the various foods affect your blood glucose

The oats, bread, grapes and pears - even carrots if eaten in quantity will all add up, and the total amount of carbs includes the starches as well as the sugars - it might be a useful exercise to estimate and record the carbs you were eating each day for a week or so to see how the various foods affect your blood glucose

Thanks for all of the detailed dietary input. I recently visited my endocrinologist and saw a stand in doctor while my usual doctor was on holiday. I brought up the 2nd ogtt test being the same as the first but she had no explanation as to why I was now pre-diabetic and said sometimes menopause can bring this on in certain people, even though no other post menopausal females in my family had this. She also saw no connection between the now heavy under chin hair growth and prediabetes, although it's funny that this exact hair growth location is often found in younger diabetic women who are overweight and have PCOS (Poly cystic ovary).

Oddly my hba1c is so far normal but I find my testing time's results confusing. When I had a low-sugar small cup of instant oatmeal as my only meal this morning I felt compelled to test with my meter right after eating (I've tested right after eating several times before with other food) It was 8.8 mmol. Less than an hour later it was 5.8 mmol. OTOH, these ogtt tests with high sugar have me normal fasting levels, but high-ish at 8.2 mmol, 2 hours later. Of course different foods, higher carbs like oatmeal apparently now show shocking spikes for me as if I had stuffed my face with candy, but other foods don't. Since I haven't eaten sugary or fatty or heavily carb type foods over the past few years while my relatives have continued to, I wonder if my body became "deconditioned" to carbs, because my older sister who drinks alcohol and eats all of the above mentioned foods and is more overweight than I am, has no blood sugar problems.

 

[Spl@]

If it helps bread and alcohol are my really big avoids, numbers go right up into double figures but very little else has that effect.

Rice, even potatoes so long as I keep the portions small are ok ish if I want to but honestly, I like eating like a caveman, meat and a big pile of veggies will have me happy as a pig in....

You do need fat though, I eat hardly any carbs now, 50g a day is more than I prefer, some days I can be in single figures, but fat. It may be butter, cream, pork fat (oh yum) if you dont have enough you get hungry, well i do, avoid diet stuff and low fat rubbish .Just make stuff fresh and you can have fantastic soups and even (fau) pasta dishes, just get arty cutting leeks as a pasta substitute.

Lastly, you got the big D, well nearly. Look at it like the smoke before a fire, you, like me have time to get in there and stamp it out. You will always have to have half an eye on it but the evidence shows. Caught early we can save our insulin system from further stress and carry on.

We will be able to have the Christmas blow out, the works party with a few beers that others would not, WE would not if we did nothing. Just keep testing, seeing what affects you and forget about "why?". You will get no good answer and just have your own mental JFK problem, forget it its done.

I took it as an initial shock, then looking past the 'omg' moment saw it as a chance to really step up and change myself.