Pre diabetic trying keto and IF couple questions pls

[exmoortom]

Hi Everyone

I'm 39 and recently had a blood test for a cancer scare (luckily all ok there), in the phone call with Dr he said i'm all ok and at the end just said:

"oh but you're pre diabetic so be aware of that"

"i'm what? What is it? What should i do"

"there are online resources for that"

"..."

So i was left a bit worried at the seemingly throwaway statement at the end, and immediately began researching on internet and books. I read all of Fung's book that evening lol. I think i understand a fair amount about it but had a few questions i was wondering if anyone knowledgeable enough could kindly shed some light on.

1. What is actually the difference between pre and t2? I understand the figures but what does it mean? If i go across to T2 does something fundamental "break" in my internals which can never be undone, or have they basically picked an arbitrary figure that's been agreed upon to be classed as T2?

2. With regards the above i see many, Fung included, saying IF can cure T2. Is it a cure or is it just, managed or in remission, and he's using semantics? If its a cure could that person then eat "normally" and their blood work be ok? Or is it just that cos you're not eating any carbs you're merely just not aggravating the condition. (e.g cats give me asthma, i avoid cats and don't have asthma - but my asthma isn't cured)

3. Can pre diabetes be "cure" if the above can't?

4. I have a "safe AQ" testing machine from amazon i've been using but still a little confused with numbers etc. Could someone please tell me an ideal range in fasted state and post meal state, or the best way to test if i'm improving?

Thank you for any answers, sorry about the novel.

 

[ianf0ster]

Hi @exmpoortom and welcome to the forum.
Here is my best attempt at answering your questions:

1. It is a fairly arbitrary threshold between 'pre-diabetes' and Type 2 diabetes. The moderators tend not to agree with me but I consider the Type2 designation to be merely the point at which the risk of diabetic complications (blindness, amputations etc.) is high enough for doctors to take it seriously. Different countries can have slightly different ranges for 'pre-diabetes' as well as different measurement systems. In my opinion most people with 'pre-diabetes' will progress to Type 2 diabetes if neither they nor their doctor takes some action.

2. & 3. 'Cure', 'Remission' , 'Reversal' are all fairly contentious words with regard to Type2 diabetes. Some people (very few indeed) have claimed to gave 'cured' Type 2 Diabetes such that they can now eat the same old garbage that they ate before their T2 diagnosis. Personally I'm doubtful of such claims, though they may be correct for anything up to a few years or so.
In my opinion when a poor way of eating causes metabolic disease, then you may well be able to reverse it by eating better, but reverting to eating the same old garbage will ultimately bring on the metabolic disease again.

Remission/ control such that the person no longer meets the criteria for Type 2 diabetes or pre-diabetes, is certainly possible and has been achieved by many people (several thousands if you apply fairly relaxed criteria), using a few different methods. For many/most who do it using the Low Carb 'Way Of Eating' approach, this appears sustainable over decades.

4. I'm not familiar with that particular testing machine. In the UK we measure Blood Glucose in mmol/L - millimoles per litre (in the USA, Germany and some other countries it is measured in mg/dL - milligrams per decilitre). What constitutes a 'good' number depends very much upon when the blood is tested since readings vary considerably depending upon when they are taken, what the last meal eaten was, when that meal was eaten, plus exercise, infection, medications etc. etc.
The Fasting blood glucose number is the trickiest of all, so personally I only measure something that I can control - which is the effect of a meal on my BG. I aim for an increase of no more than 2.0 mmol/L from just before a meal to 2hrs after 'first bite' . Though the actual profile of BG after a meal over the next minutes/hours depends upon many factors including the time of day, how long the meal took, how many carbohydrates were eaten, whether they were eaten near the start of the meal or towards the end etc.

 

[LittleGreyCat]

@exmoortom I would regard this as a wake up call.

One view on progression to full blown T2 diabetes is:

1. You body (possibly due to eating too many carbohydrates) begins to develop Insulin Resistance (IR). Your body reacts to the IR by producing more insulin to keep your BG normal. At this point it is probable that only a test for insulin production can show that anything is going on. [The NHS doesn't test for this.] A side effect over over producing insulin is that you store more fat and become more hungry for carbohydrates. Which in turn increase IR and drives up insulin production. This is sometimes referred to as Metabolic Syndrome. It also supports the view that you don't cause diabetes by getting fat, but the Metabolic Syndrome (which is a precursor to diabetes) drives a vicious circle which makes you fat. So becoming fat is a symptom not a cause.
2. After a time (years, even decades) your pancreas can't keep up with the ever growing demand to produce more insulin to overcome the ever increasing IR. At that point your BG starts to creep above normal (pre-diabetes), and generally gets progressively worse if you don't take action and change something.
3. After some more time your pancreas is struggling more and more and your BG gets high enough for you to be diagnosed with full blown T2.
4. Sometimes, after this extended period of abuse your pancreas starts to flame out and the amount of insulin it can produce decreases. The IR doesn't decrease though unless fairly drastic action is taken.
5. The smoking, guttering ruins of you pancreas gives up entirely and to survive you have to inject insulin.

Under this view, if you can take action before Stage 4, then you can reduce IR, reduce the load on your pancreas, and return to "normal" BG control, which could be viewed as remission or cure.
Note however that you have only dropped back to Stage 1 where your pancreas can manager to overwhelm the IR. Unless the IR is vastly deduced it is relatively easy to tip the balance the other way and get back into Stage 2.

If you follow this view, then having demonstrated that you can overwhelm your pancreas then you should aim to treat your pancreas as gently as possible, by not eating things (carbohydrates) which make it work hard, and also by losing fat stores which contribute to IR.

I wouldn't really consider anyone cured - just my personal prejudice - because once you have demonstrated that you can overwhelm your pancreas then you know that you can do it again if you follow the same lifestyle.

Noting the oft quoted 80:20 rule that 80% of overweight/obese people do not develop T2 diabetes.
So presumably either they don't develop IR or they have a rough, tough pancreas that can handle anything.

 

[exmoortom]

Hi @exmpoortom and welcome to the forum.
Here is my best attempt at answering your questions:

1. It is a fairly arbitrary threshold between 'pre-diabetes' and Type 2 diabetes. The moderators tend not to agree with me but I consider the Type2 designation to be merely the point at which the risk of diabetic complications (blindness, amputations etc.) is high enough for doctors to take it seriously. Different countries can have slightly different ranges for 'pre-diabetes' as well as different measurement systems. In my opinion most people with 'pre-diabetes' will progress to Type 2 diabetes if neither they nor their doctor takes some action.

2. & 3. 'Cure', 'Remission' , 'Reversal' are all fairly contentious words with regard to Type2 diabetes. Some people (very few indeed) have claimed to gave 'cured' Type 2 Diabetes such that they can now eat the same old garbage that they ate before their T2 diagnosis. Personally I'm doubtful of such claims, though they may be correct for anything up to a few years or so.
In my opinion when a poor way of eating causes metabolic disease, then you may well be able to reverse it by eating better, but reverting to eating the same old garbage will ultimately bring on the metabolic disease again.

Remission/ control such that the person no longer meets the criteria for Type 2 diabetes or pre-diabetes, is certainly possible and has been achieved by many people (several thousands if you apply fairly relaxed criteria), using a few different methods. For many/most who do it using the Low Carb 'Way Of Eating' approach, this appears sustainable over decades.

4. I'm not familiar with that particular testing machine. In the UK we measure Blood Glucose in mmol/L - millimoles per litre (in the USA, Germany and some other countries it is measured in mg/dL - milligrams per decilitre). What constitutes a 'good' number depends very much upon when the blood is tested since readings vary considerably depending upon when they are taken, what the last meal eaten was, when that meal was eaten, plus exercise, infection, medications etc. etc.
The Fasting blood glucose number is the trickiest of all, so personally I only measure something that I can control - which is the effect of a meal on my BG. I aim for an increase of no more than 2.0 mmol/L from just before a meal to 2hrs after 'first bite' . Though the actual profile of BG after a meal over the next minutes/hours depends upon many factors including the time of day, how long the meal took, how many carbohydrates were eaten, whether they were eaten near the start of the meal or towards the end etc.

Thank you very much for the detailed and thorough reply. much appreciated. I'm in the UK, i think the machine i have might not be that great tbh, is there one that people on here regard as a fairly reliable one?

I did 3 tests today on mine, i was 4.5m when i woke, 5.2 at 12 (dunno why it went up i was still in fasted state, and then 5.2 again 2 hours after i ate lunch, which was low carb.

 

[bulkbiker]

1. What is actually the difference between pre and t2? I understand the figures but what does it mean? If i go across to T2 does something fundamental "break" in my internals which can never be undone, or have they basically picked an arbitrary figure that's been agreed upon to be classed as T2?

Arbitrary figure .... if you have an HbA1c above 40 mmol/m then you are likely to already be susceptible. The 42-47 "pre-diabetic range" means you likely already have developed the problem and the 48 or higher range just means its more definite.

2. With regards the above i see many, Fung included, saying IF can cure T2. Is it a cure or is it just, managed or in remission, and he's using semantics? If its a cure could that person then eat "normally" and their blood work be ok? Or is it just that cos you're not eating any carbs you're merely just not aggravating the condition. (e.g cats give me asthma, i avoid cats and don't have asthma - but my asthma isn't cured)

Eating "normally" kind of depends on when "normal" started.. more than 10,000 years ago pre grains and farming most of what is currently considered "normal" didn't even exist. With things like potatoes not arriving until 500 years ago so they definitely aren't normal and as for bananas...

3. Can pre diabetes be "cure" if the above can't?

As implied above pre-diabetes is just less badly disregulated blood glucose than "proper" T2. Cured is one of those words that means different things to different people. By every diagnostic measure I am cured (apart from maybe mild insulin resistance).
I however have no wish to put myself through hell again by eating carbohydrates.. why would I? I no longer really consider them as suitable food for humans.

4. I have a "safe AQ" testing machine from amazon i've been using but still a little confused with numbers etc. Could someone please tell me an ideal range in fasted state and post meal state, or the best way to test if i'm improving?

How much are the test strips? That would be my criteria for a machine..
Ideally I aim for 4-6 mmol/l at all times pre and post prandial and fasting.

 

[exmoortom]

@exmoortom
Noting the oft quoted 80:20 rule that 80% of overweight/obese people do not develop T2 diabetes.
So presumably either they don't develop IR or they have a rough, tough pancreas that can handle anything.

Thank you for the reply and all the information very much appreciated. One thing i read, and again don't know how true it is how the evidence, but people who store fat more visibly would be less likely to get T2 than someone who would instead store fact more internally (on organs like the liver etc). Maybe be rubbish of course lol.

 

[bulkbiker]

Thank you very much for the detailed and thorough reply. much appreciated. I'm in the UK, i think the machine i have might not be that great tbh, is there one that people on here regard as a fairly reliable one?

I did 3 tests today on mine, i was 4.5m when i woke, 5.2 at 12 (dunno why it went up i was still in fasted state, and then 5.2 again 2 hours after i ate lunch, which was low carb.

Lots of us use the Tee2 from Spirit Healthcare
https://shop.spirit-health.co.uk/collections/tee2
Cheapish strips and seems pretty reliable.
No problems with mine.. call them up and they'll likely send you a free meter with an order fro strips.

 

[exmoortom]

Arbitrary figure .... if you have an HbA1c above 40 mmol/m then you are likely to already be susceptible. The 42-47 "pre-diabetic range" means you likely already have developed the problem and the 48 or higher range just means its more definite.


Eating "normally" kind of depends on when "normal" started.. more than 10,000 years ago pre grains and farming most of what is currently considered "normal" didn't even exist. With things like potatoes not arriving until 500 years ago so they definitely aren't normal and as for bananas...

As implied above pre-diabetes is just less badly disregulated blood glucose than "proper" T2. Cured is one of those words that means different things to different people. By every diagnostic measure I am cured (apart from maybe mild insulin resistance).
I however have no wish to put myself through hell again by eating carbohydrates.. why would I? I no longer really consider them as suitable food for humans.

How much are the test strips? That would be my criteria for a machine..
Ideally I aim for 4-6 mmol/l at all times pre and post prandial and fasting.

Thanks for reply. Made me feel much better tbh. I also will likely not eat grains again after researching a fair amount into it, although i am mising some stuff massively - but then again i'm only a week in.

The test strips came with the machine all together it was £20 which probably means it isn't great lol.

So would a non diabetic never have a reading above 6 then?

 

[bulkbiker]

So would a non diabetic never have a reading above 6 then?

Not at all.... depending on what they ate some non-diabetics can go a lot above 6 mmol/l .
I just try and maintain lower levels for my own health and wellbeing.
In the early days I was around 9 and 10 a lot of the time.

 

[exmoortom]

Lots of us use the Tee2 from Spirit Healthcare

In the early days I was around 9 and 10 a lot of the time.

Ok thank you for all the info . Just gone and bought the Tee2 now!

 

[KK123]

Why are they so casual about telling people they are 'pre diabetic' as if it were nothing? If you had a smear test for example which came back with 'pre cancerous cells' I doubt they would dismiss it so easily and although they are very, very different, they are both potentially impactive on your health negatively. Give the diagnosis or pre diagnosis AND the research & information to go with them! I know not everyone will then take it seriously by any means but when you're waved off with a dismissive attitude people assume or think it's nothing so never follow up or realise there are things you can do about it.

 

[exmoortom]

Why are they so casual about telling people they are 'pre diabetic' as if it were nothing? If you had a smear test for example which came back with 'pre cancerous cells' I doubt they would dismiss it so easily and although they are very, very different, they are both potentially impactive on your health negatively. Give the diagnosis or pre diagnosis AND the research & information to go with them! I know not everyone will then take it seriously by any means but when you're waved off with a dismissive attitude people assume or think it's nothing so never follow up or realise there are things you can do about it.

I know, it's worrying. And it's just purely by luck i even found out, they were testing for something else! I could have just gone on for another load of years with it and then got full blow diabetes without knowing. They wanted me to wait 9 months for a throat exam! I know there is a pandemic but crazy. So i've gone private now and in 3 months get test to see where i am after this fasting and diet i'm on.

Thanks for all the help everyone

 

[KennyA]

I was told I was "pre-diabetic" and in complete ignorance I thought this was like being "pre-dead". I took no notice. I was, at the same time, told I was definitely NOT diabetic, so I had no explanation for the quite severe symptoms I was having. Just about a year in now since diagnosis and BG is normal, symptoms going or gone, six inches gone off waistline....it's a scandal that people with high or rising BG aren't routinely told that low-carb can change that really quickly.