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Prediabetes questions

N

nabilla

Well-Known Member
Messages
82
Type of diabetes
Prediabetes
Treatment type
Diet only
Hi, I recently got told I was prediabetic. My Hba1a is only 42. It's a total shock. I went to the doctors due to blood in stool as well as a general sense of tiredness and a low-grade fever that comes and goes as well as muscle and joint aches. She took blood and I have low B12, thrush and prediabetes as well as a positive qfit test (being referred to colorectal department ). BMI is about 21 and I eat almost entirely cooking from scratch. Blood pressure on low side of normal whole life. All the dietary changes suggested are things I do anyway-- low carb, good proteins, plenty green leafy veg. I already eat very small portions of potatoes/rice/don't like pasta and very rarely eat bread. I drink very moderately (red wine or a couple.of G&TS with maybe two binge sessions per year if I'm lucky, but stopped when I got told about the prediabetes. I do yoga every morning and do a brisk walk 5 days a week to and from work. I don't drive so go everywhere on foot or occasionally take a train if I'm going somewhere further afield. I understand all types of people get diabetes. What I'm a little concerned about is how I can go further with my diet and lifestyle without it becoming too austere. I will try and reduce my BMI further as I read that even if you have a healthy BMI then losing weight helps control your diet. However, I don't actually want to lose weight as when I weigh less than I do now, I look drawn and unhealthy. Help!
 
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Hi and welcome to the forum @nabilla . It can be very frustrating when you are doing everything right and you find you have raised blood sugars. Firstly, 42 mmol/ls is only just in the prediabetic range. The prediabetic range is between 42-47 mmol/ls. There are a number of adjustments you can do which may drop your blood sugars and take you out of the Prediabetes range.

Being prediabetic means you have very likely developed some insulin resistance. That means your body‘s cells and liver have become less responsive to the insulin your pancreas is secreting. When your cells become less sensitive to insulin, your cells become less efficient at absorbing the glucose from your blood. (Insulin is the key that opens up your cells to glucose.) It is not fully understood why some people develop insulin resistance, what Is known is that Insulin resistance is nearly always the driver of type 2 diabetes. Exercise may reduce your insulin resistance, especially resistance type exercises that force your muscles to work. Walking definitely helps, you may wish to up the intensity, may be going up and down stairs, may be some repetitive weights. All these things can help.

Diet is another area you could tweak. Eating carby meals can also increase insulin resistance, as your body has to produce more insulin to overcome your insulin resistance and the carbs you are consuming. High amounts of circulating insulin will raise your insulin resistance, so dropping back on some of those carbs will help. I know you said you eat very few carbs, I’m thinking just reducing them a little further plus increasing the intensity of your exercises maybe all you need to do to drop you back into the normal blood sugar range.

Might I suggest you get yourself a blood sugar meter from the chemist. These meters are always helpful to see how your body Is responding to the food you eat. The most effective way of using these meters is when we take a reading (a finger prick ) just before a meal and then 2 hours after. You are looking to keep your readings within 2 mmol/s of your first reading. If your second reading is over 2mmol/ls above your first reading then you have eaten more carbs than your body can handle.

I am sure other members will jump in here to give you some dietary advice. There are many members here who have been in your shoes and have been shocked that there blood sugars are raised, but they have been very successful at bring their blood sugars back down into the normal range.
edited for clarity.
 
Thanks @Melgar. This is all really useful, although I do already do resistance training both through weights and core work with yoga I maybe need to increase this further. It just feels like too much! I'm wondering if it might be LADA. I imagine NHS won't test for that unless I become diabetic. Do you know if it's worth paying for the GADA antibody test at this stage? I'm also not sure why my B12 is low and why I have blood in my stool, although the referral to colorectal should investigate that. My brother and cousin both have ulcerative colitis so I may have something like that. I can see there's a connection between B12 deficiency and diabetes but can't get my head around it. I've also had two near fainting episodes with very high heart rate whilst showering or getting out the bath. I had this previously, about two years ago. I basically start shaking, sweating profusely and feeling as though I'm going to faint. My main concern is that the high blood sugar is a symptom of something that is not prediabetes. Anyone have experience of similar symptoms?
I have ordered a blood finger prick test kit which should arrive Tuesday.
 
Hi @nabilla - welcome and congratulations for taking the step of getting in touch.. it's a bigger thing than I was able to do for months, and just being able to throw thoughts into a safe space and get a pile of support from people going through the same thing was invaluable.

I had a similarly confusing entrance in to the world of Diabetes. I was cutting down on drinking, and doing more exercise, and counting calories religiously. After three hard years of this, I was finally at my ideal weight, and had only taken a blood test as part of a regular post 50 check up. I couldn't have been more surprised to take the call that my blood sugars were dangerously high, and the short version is that it took eight months before I got fed up getting no cohesive answers, that I started to learn for myself what I needed to do to help.

One critical thing that I went through, and sounds like you are too, is that I kept tripping up over whether I was LADA, or actually Type 2 (I realise you are neither and prediabetic, just hold for a second...) - I couldn't really make sense of it; they both presented with too much blood sugar, but one seemed to be more linked to auto-immune failure or some mechanism that nobody could explain that had to do with my pancreas... I felt that I was somewhere trapped in the middle...

What I realise now, is that we tend to think of Diabetes in relation to Glucose, when it's really all about our hormones being out of balance. As a way of wrapping your head around it, we have a control mechanism that is stuck in high gear. There are lots of ways it can start, but when it gets going, the effect is to make the situation worse. The key driver for storing energy is insulin, and of course I'm describing insulin resistance. You may already have had some explanations as to what this is, and it is complicated for sure, but a simple (and safe, meaning based on good science) way of thinking about it is that too much of a good thing leads to resistance to that thing - could be insulin, coffee, exercise, but also anything like alcohol, nicotine, heroin for that matter.. you need more to have the same effect).

A high blood sugar level means that you are needing to produce elevated insulin in order to clear it out of your blood. We are designed to do this, because we are not evolved to deal with lots of sugar in our blood, and historically there wasn't much to deal with at any given time. So, once is fine; over and over, we slowly start to develop resistance to the insulin that is clearing out the sugar. Over (much longer) time, that leads to increasing blood glucose levels, and can then lead to many other outcomes, only one of which is T2DM.

The good news is that the initial need for that insulin is the need to clear out sugars that result from food (not just eaten sugars, but starches which break down quickly into sugars) - and that the reverse is true; many people have great success in reducing insulin resistance (prediabetes) by reducing the need for the insulin in the first place, by reducing the carbs (read sugars and starches) and replacing them with healthy fats (by which I mean anything other than seed oils). Fats do not require insulin to digest, indeed we as a species have a wonderfully complex system of controlling them.

Where you take that is entirely up to you - I would thoroughly support the suggestion to use a CGM, as it's the only way to know for sure what your body does with any given food. You will have your own thoughts on diet, and what you like... try to think of this as the start of a journey of stripping away what you've been told about diet, and understanding yourself better..

You are already doing a fantastic job of looking after yourself - this is bound to feel like too much, but most of that is (in my opinion) because most of the prevailing guidance is wrong and unhelpful. You are closer to being on the right track than you think!!
 
Hi @nabilla
I am also Prediabetic with a similar BMI to you
"I will try and reduce my BMI further as I read that even if you have a healthy BMI then losing weight helps control your diet."
There is little evidence to support this idea for your weight and blood sugar level.
Most research has been done with people with BMI of over 27 - often much over.
One study for under 27,

Aetiology of Type 2 diabetes in people with a ‘normal’ body mass index: testing the personal fat threshold hypothesis

Abstract. Weight loss in overweight or obese individuals with Type 2 diabetes (T2D) can normalize hepatic fat metabolism, decrease fatty acid oversupply to β cells and restore normoglycaemia. One in six people has BMI <27 kg/m2 at diagnosis, and their T2D is assumed to have different aetiology...
portlandpress.com

Looked at people with BMI of less than 27. There were 20 people in the study, all with Diabetes.
The target for improvement was HbA1c of less than 48. After the weight loss, the average BMI was still higher than yours. 14 out of 20 people got their HB1Ac to below 48 (average 46).

Clearly that is significant for them - but you are already below their figures.
I think the steps you have taken, including ordering a meter are very good.
You may be able to tweak the content of your diet, but I would not assume that losing more weight will solve
 
Thanks Redshank and Chris24Main for both of your very thoughtful and useful responses.

My glucose.monitor arrived today but I've been unable to get blood. I e tried 5 times, using the different depth settings and keeping hand low, shaking it before piercing it, and even tried a bit of massage. I'm not well at the moment (fever and body aches and heart rate at over 100 when lying down--usual RHR is 68-70. Have a sore head too. Not sure if this is all connected or not. No cough or any other respiratory symptoms. I'll call the doctor tomorrow if I'm still unwell and try another finger prick test later. Any tips.on drawing blood appreciated. I've been asked to stop donating blood as they never get a full bag but I do have blood pressure on the low side.of normal so ot may be that.
 
Tips on finger prick BG testing.

1. Finger must be clean, dry and warm. False readings can easily occur if it has touched something sweet or is wet.
2. Best sites for pricking are at the sides of the fingers - NOT the pad, because the skin is much thicker on the finger pad so would ned more depth in order to reach blood which would itself hurt more, plus you're always using the pad, so that often hurts after being pricked and can get dirt in it.
23. Several BG meter's test strips (such as the TEE2 that I use) accept blood best from a horizontal finger with the test strip applied vertically to a small(ish) drop of blood. This seems counter intuitive since against gravity, but it just seems to suck the blood up into it.

Shaking the hand is good to get blood flowing into it and so is a gentle massage, but applying too much pressure will force out some other fluid and distort the reading.
There are some You Tube videos on taking BG readings for some different BG meters, but it's a knack and different meters may require differences in technique.
 
@nabilla I can relate to what you are saying. I too am lean, BMI 19 , low normal C-peptides so Insulin Resistance is unlikely, although IR can fluctuate even in healthy none diabetic individuals, but I am not over producing insulin to counter IR. I’m fit, I do 25,000 - 30’000 steps a day, I do weights and resistance training, my RHR is around 62, at night it is in the 50’s. Very low triglycerides , I eat a healthy diet of chicken and fish, I don’t drink or smoke. So where do we go with this. I’m on the same page as you. Now my Dr blows hot and cold on the LADA .,I already have an autoimmune disorder and my brother is Type 1.

My advice if you are looking to have some private blood tests to determine what your pancreas is doing would be to check your C-Peptide levels. A cheaper option than antibody tests as they can be pricey and there are four types, not just GAD. There is a direct correlation between insulin and c-peptides. Both insulin and C-peptides are produced by the pancreas. C-peptides are measured rather than insulin as insulin has only a very short shelf life whereas C -peptides are more stable . If you are producing a lot of C-peptides it means you are producing a lot of insulin. High insulin levels in your blood would suggest the pancreas is having to produce a lot of insulin to counter the Insulin Resistance to get the glucose out if your blood and into your cells. High insulin production is associated with Insulin Resistance and Type 2 diabetes.

Not wanting to jump the gun here as your blood sugars are only slightly raised, but If you do get your C-peptides tested and your tests show you have low C-peptides then your GP may test for autoimmune antibodies. Although as I say your blood sugars are only slightly raised. There are 4 antibodies types associated with the development of T1DM / LADA, islet cell autoantibodies (ICA), antibodies to insulin (IAA), glutamic acid decarboxylase (GAA or GAD) and protein tyrosine phosphatase (IA2 or ICA512)
I hope that helps.
 
Thanks so much--it worked using the warm hand and I realised I'd been pricking my index finger pad over and over so switched to the side and soaked hand in water for 4 mins and it worked. Also, lucky to have found a good reading--5 on waking. I've switched to a very low carb diet (all refined carbs gone, no carbs like pasta/rice/potatoes, but still eating plenty veg as not ready to go full carb free) thanks a lot for your help
 
That's all really helpful --like a dummies guide to what I've been reading and struggling to summarise in my head! Thanks so much for taking the time. I had no idea about the c-peptide test and I see it's cheap for the NHS and I have a nice doctor so she may be able to get one done. If not, as you say, my bloods levels are on the lowest side of high, so I can also play a wait and watch game and use the blood monitor as a few folk have suggested to see what affects me most. It sounds like you're having to fight very hard to keep your own sugar levels in range and I have a great admiration for what you're doing. I also know that it can feel good to get super healthy, so I'm trying to see this as a challenge and I feel lucky that I do enjoy eating healthy and keeping fit already as it won't be too much of a shift in gear. I will miss my red wine and milk chocolate most, but maybe over time I'll not even care or will find a way to have the odd glass on holiday or on my birthday. Thanks so much for your support.
 
@nabilla Many people eating Low Carb find that their tastes change and so milk chocolate becomes too sweet. Lots transition to dark 85% and above, which gives the option for a stronger chocolate taste and so possibility of just eating a few squares instead of a whole bar.

As for alcohol, like many I find that a glass or 2 of red wine (because it tends to be lower in carbs) is compatible with my T2D remission.

By the way I too am/was a slim T2D, about 10% of Type 2's are not fat or barely overweight. Unfortunately, it seems just as hard, or harder for us to get into remission than for many of the more typical Type 2's.
 
Thanks ianf0ster. I'm realising I may have had slight misconceptions about type two diabetes, despite being aware people of all shapes and sizes get T2D. Good learning point and I imagine it's much harder for people who have higher BMIs as anyone I've told so far has met me with disbelief, although I imagine over time that may tip over into encouragement to relax a bit with carbs etc...
I'm very happy to hear about your wine. I will reintroduce further down the line and use a finger prick test to understand how it affects me. I don't like dark chocolate but I used to. I did find the carrots I ate yesterday super sweet, and that after only 5 days on a lowish carb diet (I've done keto before so I do understand I'm still eating cards with the veg/fruit etc). So I'm encouraged by your information and will try some high cocoa dark chocolate further down the line. It makes sense. However, I'm sorry to hear that it's still a struggle for the 10 percent. I think I've spent the past week hoping someone will say this is all a big mistake and I don't have to change anything, but I realise that, like millions of others, I do and that I'll feel better for it whether it goes away for good or not. Can it go away for good? I can't find that answer on Google!
 
We talk about remission rather than cure. I have come across people who say they are cured, but I doubt them. I', pretty sure that if I start eating Low Fat High Carb like my GP, the media and the NHS advise, (which I did for over 10yrs) then my higher Blood Glucose levels would return.
I'm actually like how I'm eating now, more than on Low Fat High Carb, so it's not risk I'm willing to take.
 
Ah ok, well that's not what I wanted to hear in terms of a cure but it's good that remission is at least something that can be worked towards. I switched immediately from low fat strained greek yoghurt to full fat version but then I got a diabetes cook book and it suggested tiny amounts of cheese (matchbox??) and low fat everything. What diet are you on? Is it low carb high fat? Or no carb high fat? Can you please recommend some cook books or websites with info or recipes?
 
nabilla said:
I've switched to a very low carb diet (all refined carbs gone, no carbs like pasta/rice/potatoes, but still eating plenty veg as not ready to go full carb free)
Click to expand...
Well done! You might like to share a typical day's menus here, as there may be something you are seeing as very low carb but is not. Eg when I began what I thought was a very low carb diet, I imagined walnuts were carb-free, so if I still felt hungry at the end of a meal I would eat them by the handful. I thought grapefruit were low carb because they taste so sour, so I ate a half grapefruit, without sugar and was surprised when my bg rose unacceptably high. (The sour taste of grapefruit does not stem from lack of sugar!)

Are you aware of the low carb rule of thumb that vegetables that grow above the ground are mostly OK, (eg celery, lettuce, spinach, avocados, mushrooms) but those that grow below (eg carrots, parsnips, beetroot) are not?

You might find Diet Doctor helpful on what you CAN eat https://www.dietdoctor.com/low-carb
Scroll down for my favourite visual guides on the low carb items in every food group. Don't forget, eating low carb is not just about what NOT to eat. Once you are cutting the carbs you can/must increase the fat and protein foods. This can allow some delicious meals. (Think melted butter, full-fat cheese.)

Dennis Pollock of the Youtube channel "Beat Diabetes" https://www.youtube.com/@beatdiabetes3
offers lots of encouragement to test and that we can reverse diabetes. He also offers lots of "cheat" low carb recipes for cake, ice-cream, pancakes - you name it!.
Good luck!
 
Hi, thanks so much for the links!

I'm weighing all my food and calculating the carbs in grams. The past week, my daily carbs have been between 34g and 62g. I've not been testing as I currently have a chest infection that isn't responding to antibiotics and steroids (two rounds so far) and folk on the forum advised that steroids and illness skew your BG.

Today I had full fat greek yoghurt with some chia seeds, killed flax, a few Brazil nuts, and some.blueberries and strawberries for breakfast; homemade lentil, tomatoes and low carb veg soup with livlife low carb bread and butter (1 slice, plenty butter); eggplant stuffed with lamb and feta with a green salad for dinner, with some greek yog and berries. I've not calculated the carbs for it yet
 
69g carbs today and that's me done eating. I'm trying to stay fairly low carb whilst I try and get better. Once I've recovered, I'll start testing again. For example, I know some people can't deal with pulses, and I'm having small amounts of these just now. I'm trying to get plenty calories from fats, especially olive oil and rapeseed as well as meat and fish and eggs as well as small amounts of nuts and things like chia seeds and milled flax. I've also upped my greens and find I can eat a lot more and they taste less bitter. Water tastes sweet now. Does anyone else get that? Oh and I like dark chocolate now, having really disliked it previously (1 square of 90 percent lindt straight after dinner every so often). Going to try making some puddings when I'm better
 
You are doing brilliantly!

FWIW for me (full keto), not only does water taste sweet, but different brands of bottled water taste noticeably different from each other. Interesting how carbs and sugars dull our taste receptors and then we have a desire to eat more of them. It's really liberating when we get those levels down.
 
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