Prediabetes, LADA...or paranoia?!

[El_525]

Hi all, I've come for some advice after a rather unhelpful encounter with my GP.
I was diagnosed with GD during my first pregnancy (approx 4 years ago) very late. Ate a 'normal' aka sugary diet after, stopped testing (as advised!) and HbA1c was 38/39. Told this was fine and not to worry. During my second pregnancy (baby is now 1) I was diagnosed very early with GD again. Stuck to a moderately low carb/no sugar diet rigidly and maintained good levels through diet control through the pregnancy. Ate normally again after the baby was born and HbA1c was 39 at 6 weeks pp.

However, based on the early pregnancy diagnosis and some sporadic post prandial testing (e.g. 12 mmol/l one hour after half a flapjack) I suspect that I have underlying glucose intolerance of some kind. I've been following a moderately low carb diet for the last 4 months (am breastfeeding so don't want to go full keto), have lost a couple of kg weight (unintentional) but another HbA1c was still 39.

I'm 35, BMI is around 19. Family history of T2DM on both sides (but diagnosed in older and significantly obese relatives). Dad has previously been diagnosed with RA (but not on any treatment and doesn't really bother him now so ? the accuracy of the diagnosis) and I use inhaled steroids for asthma. Obviously as the parent of a 3 and 1 year old my sleep could be better!!

Gp is unsurprisingly uninterested, and basically said go away, eat all the pasta and come back when you have diabetes. I'm concerned that I'm sleepwalking into full blown diabetes and potentially my age/weight/lack of HbA1c improvement might point towards LADA? Any opinions?

 

[ert]

I don't think you will sleepwalk into anything, as you're too well informed and take an active interest. As your Doctor said, you don't have diabetes, but with GD, you have an increased risk of developing type 2 diabetes, but less likely with your BMI of 19. Stress and lack of sleep certainly can elevate your blood sugars through insulin, cortisol and oxidative stress.

 

[Doireallyneedanams]

Your hba1c is on the high side of normal so it could stay there or you could end up in the prediabetic range soon. Personally as someone who also had GD and also has siblings with type 2, I have maintained a low carb diet since pregnancy and plan on continuing.... forever. Fun!

I agree a reading of 12 after half a flapjack seems very high. Had you definitely washed your hands thoroughly before testing?

My hba1c at 37 weeks pregnant was 33 and my diet was shockingly high carb. 5 months postpartum after stripping out all refined carbs, added sugars etc and living off salads and meat, it came back at 30. I asked at the time (on this forum too) why it was such a small difference when I’d made such drastic changes and it was suggested that some people just have “their” normal range and will always hover somewhere around there. I’m going to guess that since you were diet controlled in pregnancy, when you say you do low carb, you know your stuff and there’s no chance I you’re taking in more than you think.

Have you taken any fasting reads at home?

 

[El_525]

I don't think you will sleepwalk into anything, as you're too well informed and take an active interest. As your Doctor said, you don't have diabetes, but with GD, you have an increased risk of developing type 2 diabetes, but less likely with your BMI of 19. Stress and lack of sleep certainly can elevate your blood sugars through insulin, cortisol and oxidative stress.

Thanks for your reply. I suppose my worry is that I was diagnosed with GD way before the effects of pregnancy would have had an impact on my by levels - so I suspect it's not just gestational. I don't have diabetes on paper, but I suspect if I didn't three months eating a higher carb diet my HbA1c might be higher.

 

[El_525]

Your hba1c is on the high side of normal so it could stay there or you could end up in the prediabetic range soon. Personally as someone who also had GD and also has siblings with type 2, I have maintained a low carb diet since pregnancy and plan on continuing.... forever. Fun!

I agree a reading of 12 after half a flapjack seems very high. Had you definitely washed your hands thoroughly before testing?

My hba1c at 37 weeks pregnant was 33 and my diet was shockingly high carb. 5 months postpartum after stripping out all refined carbs, added sugars etc and living off salads and meat, it came back at 30. I asked at the time (on this forum too) why it was such a small difference when I’d made such drastic changes and it was suggested that some people just have “their” normal range and will always hover somewhere around there. I’m going to guess that since you were diet controlled in pregnancy, when you say you do low carb, you know your stuff and there’s no chance I you’re taking in more than you think.

Have you taken any fasting reads at home?

Thanks, I haven't bothered much with fasting reads as they were always totally fine during pregnancy and I'm rapidly running out of test strips! The post flapjack reading was just an example, I've had similarly high results with similar foods.

That's interesting to hear the theory about a 'personal level' for HbA1c....I also made some pretty drastic changes (and obviously not perfect, but I have done plenty of low carb research) with no effect. I just wish my personal level was low 30s rather than teetering on the edge of 40

 

[Daibell]

Hi. I agree with a BMI of only 19 if you do progress to diabetes it is more likely to be LADA rather than T2. Just keep doing what you are doing and see how you go.

 

[ert]

Hi. I agree with a BMI of only 19 if you do progress to diabetes it is more likely to be LADA rather than T2. Just keep doing what you are doing and see how you go.

But don't expect the worst. It still could be type 2 insulin resistance dues to hormone levels during and after birth, breastfeeding, lack of sleep, stress etc etc