Prediabetes/the range/the future

[Danny90]

Hello, I am 32 years old, recently in Germany I was diagnosed with diabetes

The range of results here in Germany is very different from those in the UK and here an hba1c of 5.8 is considered prediabetes.

I talked to three doctors about it, two of whom considered me diabetic, and one of them told me: “No, I'm not. Anyway, I started exercising, regulated my food, and followed a low-carb diet.”

I am confused and going crazy, I want to know if I can at least delay or prevent the disease, I don't want to live with medications and drugs from now on.

thanks

 

[JoKalsbeek]

Hello, I am 32 years old, recently in Germany I was diagnosed with diabetes

The range of results here in Germany is very different from those in the UK and here an hba1c of 5.8 is considered prediabetes.

I talked to three doctors about it, two of whom considered me diabetic, and one of them told me: “No, I'm not. Anyway, I started exercising, regulated my food, and followed a low-carb diet.”

I am confused and going crazy, I want to know if I can at least delay or prevent the disease, I don't want to live with medications and drugs from now on.

thanks

Go low carb and you'll likely manage to stay in the prediabetic or non-diabetic range, no meds required. Now you know you don't process carbs well, you can act on it.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html should help some. You probably won't have to go that far, but it's a place to start.

Good luck!
Jo

 

[KennyA]

Hello, I am 32 years old, recently in Germany I was diagnosed with diabetes

The range of results here in Germany is very different from those in the UK and here an hba1c of 5.8 is considered prediabetes.

I talked to three doctors about it, two of whom considered me diabetic, and one of them told me: “No, I'm not. Anyway, I started exercising, regulated my food, and followed a low-carb diet.”

I am confused and going crazy, I want to know if I can at least delay or prevent the disease, I don't want to live with medications and drugs from now on.

thanks

Hi and welcome to the forums. Short answer is - yes, you can "delay or prevent" the disease and you don't have to live with medications and drugs. Low-carbing - particularly eliminating or greatly reducing high carb foods like bread, potatoes, rice, pasta, pastry, sugar, most fruit, etc can reduce blood glucose relatively quickly and sustainably.

However - your 5.8% is equivalent to 40 mmol/mol which is a normal result in the UK. The normal range for people without diabetes is between 38 and 42 - normal, because that's where most non-diabetic people are. The attached graph shows that.

The pattern of "diagnosis of diabetes" at a particular HbA1c level (48mmol/mol or 7.5%) is relatively recent. Unfortunately it doesn't recognise the fact that people (as I did) can experience diabetic symptoms long before they reach that level. There are currently five standard definitions for "pre-diabetes" but lowering the bar (as has happened recently in the USA) doesn't seem to have any benefits.

Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes | BMJ Open Diabetes Research & Care

 

[Danny90]

I'm really grateful for your answers but how can we explain why we have a different prediabetes ranges in USA,DE and UK ?
Today I was really destroyed because of my doctor, he said: your father has diabetes that means you are not in pre-diabetes range but you are a diabetic....

 

[KennyA]

I'm really grateful for your answers but how can we explain why we have a different prediabetes ranges in USA,DE and UK ?
Today I was really destroyed because of my doctor, he said: your father has diabetes that means you are not in pre-diabetes range but you are a diabetic....

I can't really explain it. There doesn't seem to be any clinical or health benefit, as evidenced by the BMJ study.

I have a suspicion that there might be money to be made in changing definitions. There is currently a drive in the USA to allow HbA1c tests to have an allowable error of 10% - this is explicitly so that (less accurate) home HbA1c testing kits can be marketed for profit. It's usually called "net-widening" - redefining people who were normal yesterday as having a problem today. The individuals haven't changed, but the standards have.

 

[Danny90]

لا أستطيع أن أشرح ذلك حقًا. لا يبدو أن هناك أي فائدة سريرية أو صحية ، كما يتضح من دراسة المجلة الطبية البريطانية.

لدي شك في أنه قد يكون هناك أموال يمكن جنيها من تغيير التعريفات. يوجد حاليًا محرك أقراص في الولايات المتحدة للسماح لاختبارات HbA1c بأن يكون لها خطأ مسموح به بنسبة 10٪ - وهذا صريحًا بحيث يمكن تسويق مجموعات اختبار HbA1c المنزلية (الأقل دقة) لتحقيق الربح. عادة ما يطلق عليه "توسيع الشبكة" - إعادة تعريف الأشخاص الذين كانوا عاديين بالأمس على أنهم يواجهون مشكلة اليوم. لم يتغير الأفراد ، لكن المعايير تغيرت.

I have read about that how they make money from this war on diabetes
I have another question please: I have had insulin resistance for long time, does that mean that my pancreas is destroyed? Or maybe somehow damaged?

 

[KennyA]

I have read about that how they make money from this war on diabetes
I have another question please: I have had insulin resistance for long time, does that mean that my pancreas is destroyed? Or maybe somehow damaged?

Insulin resistance doesn't mean not having insulin. That's what happens if the insulin producing cells in the pancreas stop working for whatever reason. T2s like me have plenty of insulin.

Insulin resistance is where your body produces enough insulin, but your cells have become resistant to its effects. Insulin is what gets glucose out of the bloodstream into the cells. If it isn't working, several things might happen. The amount of glucose in the blood rises. Glucose gets converted to bodyfat. And the amount of insulin being produced increases.

This can then lead to even more insulin resistance and things continue. Does that make sense?

 

[Outlier]

I can't really explain it. There doesn't seem to be any clinical or health benefit, as evidenced by the BMJ study.

I have a suspicion that there might be money to be made in changing definitions. There is currently a drive in the USA to allow HbA1c tests to have an allowable error of 10% - this is explicitly so that (less accurate) home HbA1c testing kits can be marketed for profit. It's usually called "net-widening" - redefining people who were normal yesterday as having a problem today. The individuals haven't changed, but the standards have.

There are quite a few medical conditions where the criteria have been progressively lowered to widen that medication net. For instance, "ideal" blood pressure has reduced steadily over the years. Periodically, some scientific Poo-Bah suggests that everybody over a certain age should be given this or that drug - statins for example.

Couldn't possibly be due to profit-making for Big Pharma, could it?

 

[Danny90]

لا تعني مقاومة الأنسولين عدم وجود الأنسولين. هذا ما يحدث إذا توقفت الخلايا المنتجة للأنسولين في البنكرياس عن العمل لأي سبب من الأسباب. T2s مثلي لديها الكثير من الأنسولين.

مقاومة الأنسولين هي المكان الذي ينتج فيه جسمك كمية كافية من الأنسولين ، لكن خلاياك أصبحت مقاومة لتأثيراته. الأنسولين هو ما يخرج الجلوكوز من مجرى الدم إلى الخلايا. إذا لم تنجح ، فقد تحدث عدة أشياء. ترتفع كمية الجلوكوز في الدم. يتحول الجلوكوز إلى دهون الجسم. وتزداد كمية الأنسولين التي يتم إنتاجها.

هذا يمكن أن يؤدي بعد ذلك إلى المزيد من مقاومة الأنسولين وتستمر الأمور. هل هذا منطقي؟

I'm really thankful for your answers, yesterday I was with the doctor at the beginning he said " I'm not gonna say it is diabetes etc" ,after he knew my father is diabetic he said " yes it is diabetes, you are pregnant or you are not you can not be a little bit pregnant " and he was laughing .... he said that I have no insulin resistance but my insulin is defective.... yesterday I was really destroyed because everything I have been told was like ( you are diabetic) I asked him about the ranges difference in other countries for diagnosing diabetis and he said no no 5.8 is pretty hight even with insulin resistance, it should not be like that.

 

[Danny90]

هناك عدد غير قليل من الحالات الطبية حيث تم تخفيض المعايير بشكل تدريجي لتوسيع شبكة الأدوية تلك. على سبيل المثال ، انخفض ضغط الدم "المثالي" بشكل مطرد على مر السنين. بشكل دوري ، يقترح بعض العلماء Poo-Bah أن كل شخص فوق سن معينة يجب أن يعطى هذا الدواء أو ذاك - الستاتين على سبيل المثال.

لا يمكن أن يكون ذلك بسبب جني الأرباح لشركة Big Pharma ، أليس كذلك؟

This is my problem, I'm prediabetic in Germany, but I'm not in UK or Canada, Australia, Sweden etc... I really need this hope that I could fix something but my doctor was very hard with his words and descriptions

 

[IncogKeto]

Its not nice when medical professionals are insensitive and flippant, so I can empathise.

I have had insulin resistance for long time

How do you know that you have insulin resistance?

he said that I have no insulin resistance but my insulin is defective

How does that doctor know that you don't have insulin resistance?
What tests did he perform that established that?
How does he know that your insulin is defective?
What test results is he using to draw that conclusion?

 

[Danny90]

Its not nice when medical professionals are insensitive and flippant, so I can empathise.

How do you know that you have insulin resistance?

How does that doctor know that you don't have insulin resistance?
What tests did he perform that established that?
How does he know that your insulin is defective?
What test results is he using to draw that conclusion?

I knew that because of the signs of insulin resistance that I had in my body , skin tags appeared, fat , high blood pressure etc ...
He thinks my father is diabetic and I must be diabetic also ,that is why he said that I have not enough insulin, my pancreas is damaged, my insulin is defective etc .... I really was sad because how many bad things he said : (((((((

 

[IncogKeto]

Do you have access to any previous HbA1c results?
How long ago did you start believing that you had insulin resistance?
What did you decide to do about it?
Did you actually do it?
When did you start doing the things you mentioned in your original post - exercising, regulating your food and following a low carb diet?
What type of diabetes does your father have?
How old are you? [Do not answer that (or in fact any of my other questions) if you are not comfortable doing so.]

 

[Danny90]

Do you have access to any previous HbA1c results?
How long ago did you start believing that you had insulin resistance?
What did you decide to do about it?
Did you actually do it?
When did you start doing the things you mentioned in your original post - exercising, regulating your food and following a low carb diet?
What type of diabetes does your father have?
How old are you? [Do not answer that (or in fact any of my other questions) if you are not comfortable doing so.]

Of course it is ok to me to answer and I'm really thankful for your answers:
My first hbc1a was at 15.06.2023
I have a fat belly since I was in my twenties .
I was trying to do sports but I was losing weight very slowly.
Keto diet helped me with losing it but after I stopped the diet the big belly reappeared.
After getting my first hbc1a I started doing that I was 113 kilograms now I'm 101, low carbs, 2 meals per day, sport, no suger no sweet things etc...
My father has diabetes type 2 .
I'm 32 years old I'm 191cm tall it is around 6 feet.
I'm gonna be thankful if you have any advice

 

[ianf0ster]

Of course it is ok to me to answer and I'm really thankful for your answers:
My first hbc1a was at 15.06.2023
I have a fat belly since I was in my twenties .
I was trying to do sports but I was losing weight very slowly.
Keto diet helped me with losing it but after I stopped the diet the big belly reappeared.
After getting my first hbc1a I started doing that I was 113 kilograms now I'm 101, low carbs, 2 meals per day, sport, no suger no sweet things etc...
My father has diabetes type 2 .
I'm 32 years old I'm 191cm tall it is around 6 feet.
I'm gonna be thankful if you have any advice

Hi @Danny90
From what you say (about height, weight and belly fat) you are overweight , but not badly overweight. But you are aware of the possibility of T2 Diabetes (because of your father). This is something you can probably avoid, so don't worry just continue to take some action. Most people don't get serious about carbohydrates and weight until thing are much worse than with you.

I'm having some difficulty understanding the time of the various things you mention:
If you have managed to reduce your weight from 113Kg to 101kg since 15.06.23, then that isn't slow at all. That's around 2kg per week which is good!
Controlling Blood glucose for a T2 diabetic is a lifetime thing - there is remission, but no cure. So for example if I stopped eating Low Carb and started eating all those bananas and bread I used to eat my BG levels would (eventually) rise back into the T2 Diabetic range. But if I keep on eating Low Carb (which I enjoy) then there is no need for that to happen.

If you have lost those 12Kg in anything less than 3 months, you are doing fine! The only question is : Is this something that you can sustain?
- If it is then just keep doing what you are doing! Even if it isn't sustainable you may still be able to relax your diet a little and reduce your exercise a little. Exercise for weight loss is over-rated because doing more exercise makes people more hungry and so they eat more!

 

[Danny90]

Hi @Danny90
From what you say (about height, weight and belly fat) you are overweight , but not badly overweight. But you are aware of the possibility of T2 Diabetes (because of your father). This is something you can probably avoid, so don't worry just continue to take some action. Most people don't get serious about carbohydrates and weight until thing are much worse than with you.

I'm having some difficulty understanding the time of the various things you mention:
If you have managed to reduce your weight from 113Kg to 101kg since 15.06.23, then that isn't slow at all. That's around 2kg per week which is good!
Controlling Blood glucose for a T2 diabetic is a lifetime thing - there is remission, but no cure. So for example if I stopped eating Low Carb and started eating all those bananas and bread I used to eat my BG levels would (eventually) rise back into the T2 Diabetic range. But if I keep on eating Low Carb (which I enjoy) then there is no need for that to happen.

If you have lost those 12Kg in anything less than 3 months, you are doing fine! The only question is : Is this something that you can sustain?
- If it is then just keep doing what you are doing! Even if it isn't sustainable you may still be able to relax your diet a little and reduce your exercise a little. Exercise for weight loss is over-rated because doing more exercise makes people more hungry and so they eat more!

Thanks for your comment, I'm scared to have diabetes at this age my hba1c is 5.8 what do you think about this, many articles said it could be normal again even with no actions or treatment, of course I'm not gonna ignore this sign, but do you think that I'm a diabetic person? I mean could something be wrong with the description of my doctor?

 

[ianf0ster]

Thanks for your comment, I'm scared to have diabetes at this age my hba1c is 5.8 what do you think about this, many articles said it could be normal again even with no actions or treatment, of course I'm not gonna ignore this sign, but do you think that I'm a diabetic person? I mean could something be wrong with the description of my doctor?

I couldn't diagnose even if I wanted to, but if you don't change anything, then in 6 weeks time your HbA1C will be lower tan it is today which is lower than it was 6 weeks ago because HbA1C measures the effect of glucose on your red blood cells and they live for about 12 weeks - so it is like a 3 month average and only around 15.9.23 will they all have only been exposed to your current blood glucose levels. That should still continue to improve a little even without any changes to what you are doing.
This means that it is quite possible that even by German standards you will either be in the normal range or only just in the pre-diabetic range.

 

[CatsFive]

Anyway, I started exercising, regulated my food, and followed a low-carb diet.”

You are doing the right things. Plenty of people here have gone from a clear diagnosis of diabetes to in remission (e.g. pre-diabetic or less) with low-carb and exercise.

An HbA1c of 5.8% equates to 40 in mmol/mol which are the usual UK units. That's below the range for pre-diabetes in the UK, which is 42-48. The changes you have made to your lifestyle should bring it down further.

BTW I think the German definition of pre-diabetes is 39–47 mmol/mol (5.7–6.4%). AFAIK Germany has a lot of undiagnosed diabetes, and the earlier it's found the better in so many ways.

You need to find a diet you can follow for life, and ditto with exercise. I'm a big fan of walking as it's very cheap, weight-bearing but relatively low impact, alongside Pilates or Yoga. However I am lucky in that I live in a semi-rural village and I can go for a decent walk from my house with almost none on a busy road, and with a bit of up & down as well. If you live in a very urban area you might want to look at alternatives.

 

[Danny90]

All what I want to believe is that the range in UK is the right range ( prediabetes hba1c is 6% to 6.4% ) of course I'm gonna be careful with everything I eat/do ...but really that is better for me because I feel I'm guilty about this result.

 

[ajbod]

With your father being diabetic, you are most likely genetically predisposed to developing it, that is what the one doctor must have been trying to convey to you.
Insulin resistance develops over many years, long before it becomes apparent via blood tests. Your Pancreas will not have been damaged by this, but will most likely have been working harder, to produce extra Insulin to overcome the resistance. This increased Insulin in the system means weight gain is much easier, and shows by the weight increase post Keto.
Exercise whilst good for you, as a way to lose weight is all but useless. The restriction of Carbohydrates is far and away MUCH more effective.
Restricting carbs lowers the blood sugar level, this in turn reduces the Insulin level. This allows some improvement in the Insulin resistance.
As you have done Keto before, you know you can get yourself sorted by going Keto again, the difference this time is that once you've reached a weight you're happy with, DON'T go back to how you always ate before, but increase carbs a little, until you hit the spot where your weight is stable.
Every Country throughout the world, have their own medical boards etc, they dictate the diagnostic levels, very often it's just different to others, to prove they know best. Nobody can say who is right or wrong, as individuals we all react differently, so a few points here and there on an Hba1c mean very little. Your numbers say no by British levels, but since you've had skin tags, and by ancestral evidence, you are on the cusp. So now is the time to take action. whether diagnosed or not, you ARE at the top end of normal, so some action is advisable. But it is not a drastic situation, just a wake up call.