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Prediabetes Prediabetes or "perfectly normal"?

A

Anirac

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Hi everyone,

I've been reading a bunch of forum posts here while trying to figure out what was going on with me, and now that I've done a bit of testing, I'd like to hear your opinion. I was told that everything looked fine, but some numbers were marked as unusual by the lab, and based on my research, they don't exactly look "perfectly normal" to me either (but I'm not an expert).

Background: I got a meter because I was experiencing some scary hypos. I've had issues with hypoglycemia for many years, but didn't think much of it - just carefully planned meals to avoid it, and never left the house without some kind of sugar in case it would hit. This past year, the episodes seem to be harder to prevent, and they also progress very fast (hence the scary part). I have never measured lower than 3.1 (55), but I noticed that postprandial numbers went pretty high (like 10.9 two hours after eating a serving of white rice). I had no idea that reactive hypoglycemia was related to diabetes (doctors have always commented on my low fasting glucose that I certainly do not have diabetes), but after reading a bit, it seems that it can be?

Test results:

Fasting glucose: 4.4-5.0. Not sure it matters, but until 6 months ago, it's never been over 3.8.

Hba1c: 5.6% (I'm wondering is if this is artificially low because I rarely eat high carb meals?).

OGTT:
Glucose (0-60-120 min): 5.0 - 8.6 - 8.0
Insulin (0-60-120 min): <2 - 27.0 - 47.2 (this was marked as out of range by the lab)
After OGTT:
Measured glucose at home at 2½ hours: 7.5
Very suddenly felt hypo at 3½ hours: 3.1

Postprandial (2 hours after eating): Always below 11, but I never eat very large meals and rarely eat very GI foods. Some foods get me close to 11 (serving of rice or 2 slices of pizza), which seems reasonable, but oddly enough meals consisting of vegetables, legumes and olive oil result in a reading of 7.5-8.3 - isn't that also a little high for very low GI meals? If I stick to very low carb meals, I'm usually almost back to the baseline after two hours.

Any thoughts or suggestions? I'm feeling a little lost here. I understand that I don't have diabetes, but I would of course like to avoid getting it.

In case it helps - I'm female, 37, BMI 21.8, body fat 18.9, reasonably healthy lifestyle.

Thanks in advance!
Ani
 

Hi and welcome to the forum.

I have reactive hypoglycaemia and I can understand what you are going through.
We have our own sub forum on Reactive Hypoglycaemia, use the forum symbol at the top of the page and scroll down.
Have a read then ask more questions.
Are you on any meds for other conditions, or allergies or something like lactose intolerance?

Keep safe
 

Thanks Lamont!

I will definitely have a look at the hypo forum!
I do feel like my hypoglycemia is quite easily managed by eating a low carb diet, or even just avoiding refined carbs (too much fruit in particular, most importantly steering clear of fruit juice). I had no clue that it could be related to hyperglycemia/diabetes until recently.

I'm on thyroxine because I'm hypothyroid. Other than that no meds.

Recent tests revealed extremely high HDL cholesterol (and very high total cholesterol for that reason), but with only borderline LDL and low triglycerides. It turns out that I'm a cholesterol responder, and some kind of dietary saturated fat makes my HDL sky high and increases LDL. This was actually the reason for my recent hypoglycemia problems - I removed several foods (e.g. dairy/butter and anything coconut) from my diet for three weeks, and doing so naturally increased carbs... but at least total cholesterol dropped 40% points in those three weeks. Now I just wish I knew which one was the cause...

What I'm wondering right now is whether it's really correct that the results of the OGTT were "normal"? As far as I understand, anything over 7.8 (140) after two hours is prediabetic, so perhaps the doctor thinks that slightly over is also "ok"? Also, shouldn't insulin ideally drop between 1hr and 2hrs?

- Ani
 

Hypoglycaemia is usually caused by either meds, insulin, steroids or intolerance to carbs. Your fasting levels and probably your hba1c levels will be normal. That is usual in Hypoglycaemia. It is postprandial when things 'react'.
If you spike high after food, it is not diabetes because that is measured by your hba1c levels, and because your fasting levels are normal, you are non diabetic.
BTW, your thyroid condition can skew blood glucose readings, but if in control you can judge if you are ok.
Your insulin levels before food should be normal, if you are healthy. However, for instance, my insulin levels at the time of eating are low and the initial insulin response is low, then because, my blood sugar levels rise quickly, my pancreas will react with too much insulin. This drives the blood sugar levels down into hypoglycaemic levels.
So, insulin levels in the first or second hour could be low because of how high the glucose derived from the food.
I can only tell you that it is dietary if you have Hypoglycaemia, to control your blood sugar levels. And a carb is a carb.
I have problems with all carbs. But you may be able to tolerate a certain amount, but only trial and error using your glucometer and my best advice is to keep a food diary.
This will help you with your doctors and you can show them how certain foods effect your body. It will help them with a diagnosis and treatment.
Have you a specialist endocrinologist? if not, a food diary will convince your doctor to get a referral. Only tests can determine diagnosis.
Have you had any other tests?
What dietary advice have you had?
Keep safe
 
Hi Lamont,

The tests were ordered by my endocrinologist, who also told me that anything higher than 7.8 at 120 minutes in the OGTT would be "impaired glucose tolerance". This is why I'm confused now - both Hba1c and OGTT were borderline normal, with the former being at the limit and the latter being slightly over...yet his response was that "everything looks fine".
We did not specifically discuss reactive hypoglycemia, and I didn't bring it up either, as I didn't make the connection between that and prediabetes, and because I find that I can manage it by eating fewer carbs. My concern is if I shouldn't be "doing something" since the tests results are borderline, but I'm leaning towards just considering myself prediabetic to be safe (and for that reason stick to a low carb diet with more focus on never "cheating", since it seems clear to me that my body doesn't tolerate carbs). Does that make sense?
No tests besides the ones above, and no advice (dietary or other), since presumably I'm "fine". It seems that doctors are just testing to see if you have full-blown diabetes, and then everything else is considered normal :/

- Ani
 

Hi again,
Hope you have started looking at the Hypoglycaemia sub forum.
Impaired glucose tolerance is also known as prediabetes, but that doesn't mean that you will get T2 diabetes!
The problem with this diagnosis is that you may have a border line hba1c and fasting levels but it does not mean that you can't do something about it!
What drew my attention to your post was the post prandial readings at 3and a half hour. Having a Hypoglycaemic episode at this time is clear that you have too much insulin and the balance of hormones produced by the food or drink in your test caused this reading.
Yes, it does make sense, as I have just described, a low carb diet is probably the best treatment, if you find a good balance of protein and fats, your Hba1c and fasting levels will lower back into normal. I have often called Hypoglycaemia as carb intolerant to let other know what my condition is about.
Do you have another appointment with your endocrinologist?
The reason I ask is, if you do hypoglycaemic episodes, you need to persuade your specialist to do a extended oral glucose tolerance test, which is up to five hours, instead of the usual two hours test. This would give your doctors a chance to do other blood panel tests, a c-peptide and GAD, possibly an insulin levels test, and more importantly see the Hypoglycaemia episode around the three and a half hours.
This is what happens to me. It is called ' Late Reactive Hypoglycaemia'.
But only tests can confirm this!

Hope this explains this a little more.

Keep safe, keep asking.
 
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