Prediabetic BG but underweight, seeking advice.

[tpower]

Hi. I woke up with fasting BG of 6.6 mmol/l today ( prediabetic, right?). After 23 g carbs breakfast 8.7 mmol/l . The spikes get worse later in the day if I eat that amount of carbs. It is a long story, but discovered a couple of years ago that even moderate carb ( 20-40g ?) meals spiked my BG up to 12 mmol/l two hours after. At that point my HbA1c was 37 ( reflecting the ups and downs). At time was also loosing weight ( from 46 kg to 40 kg), and suffering from myriad of other unexplained symptoms which have now cleared. Since then I cleaned up my diet ( vegetarian so not fully low carb, but healthy carbs spread out during the day. Dropped all sugar, potatoes, rice, grains, most fruit and increased fat a lot) and have been exercycling minimum 20 min per day. Doctors tell me to just ignore the spikes and that there is nothing I can do since I am already slim. I am struggling to keep my weight on ( just skin and bones), even though I eat 1700 -2000 Kcals per day. Can anybody on this forum give me advice? Am I doomed to gradual decline to diabetes or am I just worrying about nothing? I would like to gain weight but there might not be much sympathy out there since most people on this forum seem to have the opposite problem. I have read loads of research about the BG spikes causing plenty of accumulating organ damage so I now try to stop the spikes. However my fasting BG has deteriorated a lot in just one year ( up to 6.8 mol/l) and not able to change that. I am a vegetarian so would appreciate more low carb high fat meal ideas too to help me gain weight.

 

[Safi]

Hi @tpower - sorry to hear of the trouble you're having in gaining weight & getting your doctors attention re: the high post prandial spikes. There are several approaches that you can try in order to gain weight but I'd highly recommend that you first get tested to see if you do in fact have Type 1.5 diabetes aka LADA. There is a sub forum on this site dedicated to that particular type where you should be able to get some advice on which tests to request your doctor run.

In the meantime if you give us an idea of what you are eating & the amounts you are eating we may be able to give some advice re: weight gain.

 

[tpower]

Thanks for your reply. I had a GAD antibody test three years ago and at the time it came back negative. Is it possible for the this to change over time? Should I have that rechecked?
Usually for breakfast I have coffee with low fat milk, a piece of glutenfree sourdough toast with tahini and a kiwifruit. Morning tea two hours later is decaf coffee with milk and half a piece of toast with butter. Rest of the day can't eat bread because spikes get worse. For lunch a salad with what I have in the garden( mixture of lettuce, parsley, coriander, mung bean, broccoli and alfaalfa sprouts, a tablespoon hummus, 4 olives, olive oil and a boiled egg. After that flat white decaf coffee , 3 low carb crackers with herb butter and low carb sugar free cookie ( Linseed, chia, sunflowerseed flour, sugar free chocolate and stevia). Afternoon snack handful of walnuts. Dinner at 5.30 pm usually three veg ( green veg. , small serving pumpkin, salad) and a serving of protein ( eggs, tofu, tempeh or fish) and 1/3 glass low alcohol wine. Evening snack 7 pm licorice tea and 4 squares of dark chocolate. That's it more or less it, apart from indulging in a croissant once in a while ( has to be followed with exercise otherwise bg will spike) . Haven't got exact carb count at hand right now, but when I last counted the calories it was at least 1700. What do you think?

 

[Safi]

GAD antibody tests can be a bit unreliable I'm afraid - a good place to start would be a c-peptide or fasting insulin test to see how much insulin you are actually producing. If you are producing plenty then it would point to Type 2 but if it's low then you are likely one of the other types. Given how light you are (you don't mention your height but 40kg is very light for an adult!) I'd be amazed if you were producing too much insulin. Its clear that your diabetes is not weight related & your doctors need to dig deeper.

Regarding your current diet I can see a few things you might change or add. Firstly I'd skip the low fat milk & start adding heavy cream to your coffee. Skim milk is higher in carbs & obviously a lot lower in calories. Tahini is a good choice but I'd also look at having some scrambled eggs - extra calories & protein there. At lunchtime I'd add some more fat in the form of avocado or mayonnaise. Nuts are a excellent source of low carb calories (macadamias are particularly good) so I'd try & up my consumption of those as well. You could cut out the toast I guess but It's really not that much.

Again, I highly recommend further testing because your weight is clearly too low & your post prandial numbers are too high just to let it slide. Keep in touch with the forum - there are plenty here who will prove far more helpful than me!

 

[Safi]

OOPS! Forgot to mention that fruit & root vegetables can be problematic as well - I'm just loathe to tell you to cut anything as you obviously need to gain some weight!

 

[tpower]

Hi. Thanks so much. All your advice is very good. Unfortunately the endocrinologist I saw recently refused all the tests ( c-peptide and insulin) because my HbA1c is still normal. It looks like over here in New Zealand that is their main criteria and everything else is ignored ( at least if you are slim). I found it really odd. My GP is more sympathetic but can only order limited tests. I will talk to him again though. I suspect that I am not producing enough insulin or definitely clearly lacking phase one insulin production, after one hour there is a weak response so eventually bg comes down after spike. If lower carb diet and exercuse haven't made a difference and I am underweight, does that mean I might be on my way to being type 1 diabetic?
I see you have brought your BG to really good range from prediabetic. What is your diet like?

 

[Safi]

Don't get me started on the trials of being a thin pre-diabetic - if one more doctor looks at me in amazement & says "but you're not overweight!" I'll explode. It is entirely possible to be a thin Type 2 diabetic but they should at least rule out other possibilities particularly when diet & exercise don't appear to help & weight loss continues.

Anyway my own diet is probably lower carb, higher fat & higher calorie than yours. I don't eat breakfast as such but I do have a few rather creamy coffees over the morning. Lunches tend to be big salads with some protein (tofu/egg/nuts) with both vinaigrette & mayo or avocado or I might have a low carb flaxseed muffin (recipes all over the place for these) with some butter, cheese & a handful of nuts. Dinners tend to vary more - low carb veg curries with cauliflower rice, soups with cheesy almond bread (recipe on this site), omelettes feature regularly, many variations on salads with protein/fat. I don't tend to snack often but I do manage to work a lot of macadamias & almonds into my diet. I have maybe 4 slices of Burgen soy & linseed bread per week - oftentimes I'll only have one or two. I don't eat meat but I do eat a lot of eggs & cheese & cream & butter & I have just now pulled a low carb spinach & feta quiche out of the oven My BMI now sits at a fairly steady 20 - sometimes I drop a bit but it self-corrects. Maybe have a look through the 'what have you eaten today' thread in the low carb sub section of the forum for other ideas.

The only way to know what type you are is to receive the appropriate testing I'm afraid. Did your doctor at least give you a glucose tolerance test?

 

[tpower]

OMG such a relief to hear from another prediabetic thin person Such a frustrating journey with doctors! I have felt so alone with this. Your diet is somewhat similar to mine. I used to do better when I was eating cheese, but a year ago I developed a food intolerance to cheese (and peanut butter) after having had 6 causes of antibiotics within just 12 months ( tooth root canal infection). Before that had managed to get my weight to 45 kg on lower carb higher fat diet but then dropped back to 40kg ( I am 157 cm tall , 55 years female). Still haven't recovered from the antibiotics but slowly better with probiotic supplements. BG deteriorated during that time too. I used to love my coffee with cream but GPs told me 15 years ago to cut it out because of high cholesterol. However that no longer worries me so going to try cream again
Three years ago OGTT was 7.2 after two hours. I believe it would be somewhat worse now judging from my own checking with glucose meter. The curious thing is that first thing in the morning I am more glucose tolerant than rest of the day.
BMI currently 16.5 ( used to be 18 )

 

[Safi]

Bummer about the cheese - it's excellent weight gain food. Infections are tricky because they can be caused by high blood sugar but they can also be the cause of high blood sugar. You sure did need a lot of antibiotics - might be worth making sure you're getting enough pre-biotic fibre along with the pro-biotics so the good gut bugs have enough to eat

You did pass the OGTT but it's still possible that you were in the very early stages of some kind of diabetes. Perhaps all that is left for you to do is eat according to the food pyramid, keep a very close eye on your blood sugar & take those results to the doctor.

 

[kokhongw]

Avocado, nuts and bulletproof coffee (butter/coconut oil) seems to help me gain some weight...

 

[tpower]

Thanks for all your advice. Great talking to you Safi. I probably should do the OGTT again since it has been a few years and BG has got clearly worse despite diet and exercise. I will continue to do my best balancing diet and weight. I get it, fat is the key to gaining weight

 

[Safi]

Been a pleasure to try & help @tpower - hope things improve & that you keep us updated.

In terms of weight gain I actually find extra protein helpful and for weight maintenance I keep up the higher calories & fat. Some people get blood sugar spikes from higher protein but perhaps because I'm early pre-diabetic its not such a problem for me. I also try to get some not-too-stressful muscle building exercise (yoga/resistance bands/light weights) & some gentle cardio (hiking/kayaking) - these build my appetite and give the sugar in my blood some place to go. I'd certainly avoid too much full-on cardio as it can be counterproductive for both blood sugar & increasing weight.

Best of luck & take care

 

[Kristin251]

@tpower , @Safi had gave you great advice.
I'm now LADA, at 53 years old (DXd at 50) but was un/misdiagnosed for who knows how long. INSIST on a cpeptide and GAD. YES, ABSOLUTELY THINGS CHANGE. I've always been thin and low carb but I wasn't diagnosed correctly and lost weight until I was 94#'s standing 5'8 and skin and bones. My BMI was about 16! If you are LADA and or don't make insulin bread and carbs will only raise bs and not let it come down. You won't get nutrients, just high bs. It won't make you gain weight. It will just raise bs. Eat a more protein fat rich bf to help keep things stable through the day. If you can. Carbs are worst in the morning.

Once I started on insulin I gained my much needed weight back and it stopped right where I left off. Nobody wants to take insulin but I'd fight anyone who tried to take it away from me now. I'm still very low carb and very low doses but sometimes we just need it.

I ate and ate until I was sick and still dropped weight. No idea why docs fight those tests. Mine did too. At the end of the day I won actually won a small malpractice monetary settlement for negligence for not doing the tests. Please insist.

 

[tpower]

Thanks Kristin251. Great to hear your story. I do wonder if something similar is going on with me. It has been so frustrating to be constantly dismissed by medical professionals. All other causes for weight loss have been ruled out, by the way, and still they don't believe me. I am always told that I am just not eating enough ehich is insulting. I think I will show your message to my GP if that's OK.

 

[Safi]

This http://www.tudiabetes.org/forum/t/m...person-with-adult-onset-type-1-diabetes/41884 link will give you info on getting the full tests for LADA/Type 1.5/Type 1 @tpower - point 3) in particular as copied below.

3) Get a correct diagnosis: many if not most people with adult-onset Type 1 diabetes are misdiagnosed as having Type 2 diabetes. It is important to get a correct diagnosis to get the correct treatment (exogenous insulin); being treated as if you have Type 2 diabetes may be extremely harmful. Get the full suite of autoantibody testing (Glutamic Acid Decarboxylase Autoantibodies (GADA), Islet Cell Cytoplasmic Autoantibodies (ICA), Insulinoma-Associated-2 Autoantibodies (IA-2A), zinc transporter (ZnT8), and Insulin Autoantibodies (IAA, Footnote 2). Don’t just get GADA, because many people with adult-onset Type 1 diabetes are only ICA positive. Antibody testing is the gold standard test for Type 1 autoimmune diabetes: if you are antibody positive, you have Type 1 autoimmune diabetes. The suite of antibody testing, full price, costs ~$750 at Mayo Clinic. The c-peptide test, which shows how much insulin you are producing (virtually all children and adults with new-onset Type 1 diabetes are still producing some endogenous insulin), is useful, but does not provide a definitive diagnosis.

 

[tpower]

That's great info. I will copy that and show my GP. I am prepared to pay for these tests myself in order to get to the bottom of this weight loss.
By the way, re protein. I have recently noticed a new development. If I now eat a high protein low carb dinner, I still end up with quite high BG many hours later. If I then go to bed without bringing it down ( by exercycling) I will wake up with high fasting BG too.

Do you have any experience with herbal supplements that help lower postprandial BG? I have tried a few with mixed results.

 

[Safi]

Its not unusual for protein to lead to an extended rise. I don't often eat lots of protein in a single meal - I try to spread it over the day - but if I do eat a lot for dinner then I will see a higher fasting the following day. A good mix of fat & protein works better for me. Having said all of that my blood sugars rarely (if ever) break 6mmol & even my 'higher' fastings are in the low 5's. I believe @Kristin251 has to carefully watch her protein so that may be another arrow in your quiver to take to the doctor.

I've not tried any of the herbal supplements but if you search the forum you'll no doubt find someone who has.

 

[tpower]

Thanks again. This has all been so helpful. I am going to chew my GP's ear off next time, armed with all this info

 

[Alexandra100]

Thanks again. This has all been so helpful. I am going to chew my GP's ear off next time, armed with all this info

Hello, I'm a skinny pre-pre-diabetic (recent A1c 41) with a BMI of under 16.5. I strongly recommend you to get hold of a copy of one of Jenny Ruhl's books. She is a long-term diabetic who has survived intact to be over 70 and has spent years researching and sharing info on diabetes. She also has a site:

http://www.phlaunt.com/diabetes/

I have read her more recent book "Your Diabetes Questions Answered". By her own account her earlier book "Diabetes 101" is more detailed about the research studies on which she has based her ideas, and therefore a heavier read. She is very sane, explains about LADA, and even has a chapter explaining why our GPs are so useless to us and how to get the best out of them! Ruhl says that skinny T2s have more trouble than most controlling our bgs, probably because we produce very little insulin.

I am considering seeing a diabetes specialist privately, partly in the hopes he will tell my GP to get me tested for LADA. However I am holding off for now, as currently I am keeping my bg mostly under 6 and certainly under 7 by restricting my carbs. The snag is, I can't seem to run at all well on this regime and that is wrecking my morale. I am also considering privately seeing a sports dietician who also covers diabetes. I have an NHS appointment for November with a general dietician, but I doubt if she will be able to address my problem in fuelling sporting activity.

Interestingly, like you I can cope with carbs better for breakfast and seemingly not at all in the evening. Most people seem to experience the opposite.

Good luck with getting a diagnosis soon!

 

[Resurgam]

I suspect that two lots of multiple antibiotics which did not work put me on course for diabetes way back in my teens and twenties, one for simple tonsillitis and then for tonsillitis with serious complications which had the GP calling around twice a day until he brought some brand new antibiotics for me, and I was better in a couple of days.
I think that set me on course for diabetes long ago.