Scared of probable progression from pre diabetic to diagnosis of T2

[Gardengnome]

I haven’t posted on here for a long time but was diagnosed as prediabetic ten years ago aged 71 after tests had revealed hypertension and high cholesterol. Each year the HBa1c has risen and last year it had jumped to 46 which didn’t seem to give the nurse any concern, apparently in view of my age, now 81.
The. next test is due soon and I am apprehensive it will be over 48 particularly as I have developed symptoms, namely vaginal itching and more frequent trips to the loo, especially at night, often three
times. I also have a tester and have noticed some very high readings lately after eating.
If as I anticipate the test result is over the 48 mark what changes can I expect to make in terms of medication?

 

[JoKalsbeek]

I haven’t posted on here for a long time but was diagnosed as prediabetic ten years ago aged 71 after tests had revealed hypertension and high cholesterol. Each year the HBa1c has risen and last year it had jumped to 46 which didn’t seem to give the nurse any concern, apparently in view of my age, now 81.
The. next test is due soon and I am apprehensive it will be over 48 particularly as I have developed symptoms, namely vaginal itching and more frequent trips to the loo, especially at night, often three
times. I also have a tester and have noticed some very high readings lately after eating.
If as I anticipate the test result is over the 48 mark what changes can I expect to make in terms of medication?

Good morning, @Gardengnome ,

If you're actually diagnosed a T2 diabetic, the odds are you'll be initially offered Metformin to get your blood sugars down some. It doesn't do a whole lot, just tells your liver not to dump glucose, and make you a smidge more insulin-sensitive. It doesn't do anything about what you eat, so you might want to look into changing your diet some if you're symptomatic (with the itching and weeing, which you don't want to continue I imagine), and https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some make better choices for your blood sugars, if you haven't looked into that yet.

On top of that, if you're not already on them, newly diagnosed T2's are usually offered statins as well, which is a bit weird as they tend to up blood sugars.... And getting your blood sugars under control through diet, should, after a few months, make your cholesterol come down as well, after a slight initial rise. So if you don't have cardiac issues already, maybe give those a pass. If the ticker's already protested in the past though, or you have familial high cholesterol, and you're already on them, by all means, stick with 'em.

There's a lot you can do yourself that could get things sorted without medication, but you do want to get the itching and weeing looked at, in case it's a bladder infection rather than a yeasty one. You might need antibiotics or a cream, whatever is going on.

Good luck eh.
Jo

 

[EllieM]

I also have a tester and have noticed some very high readings lately after eating.
If as I anticipate the test result is over the 48 mark what changes can I expect to make in terms of medication?

Just wondering what you mean by very high readings?

My father (now 93) has had T2 for about 20 years now, and they are a lot more relaxed about his hba1c levels than they were when he was in his seventies.
So I wouldn't necessarily assume that they'll want to medicate even if you do come up as officially diabetic.

But if you're actually getting symptoms associated with high blood sugars (usually those over 10mmol/L because that is the point that sugar is passed through the urine), it's definitely worth getting that checked out. (Having had both thrush and UTIs in the past, both presumably caused by too high blood sugars, I would recommend talking to your GP about your symptoms and getting them treated.) I stress that I'm not a doctor, so don't know if you actually have either of those conditions.

Good luck and please don't panic. There are a lot of treatments available for diabetics in your situation and you don't even know if you are diabetic yet.

 

[Gardengnome]

Good morning, @Gardengnome ,

If you're actually diagnosed a T2 diabetic, the odds are you'll be initially offered Metformin to get your blood sugars down some. It doesn't do a whole lot, just tells your liver not to dump glucose, and make you a smidge more insulin-sensitive. It doesn't do anything about what you eat, so you might want to look into changing your diet some if you're symptomatic (with the itching and weeing, which you don't want to continue I imagine), and https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some make better choices for your blood sugars, if you haven't looked into that yet.

On top of that, if you're not already on them, newly diagnosed T2's are usually offered statins as well, which is a bit weird as they tend to up blood sugars.... And getting your blood sugars under control through diet, should, after a few months, make your cholesterol come down as well, after a slight initial rise. So if you don't have cardiac issues already, maybe give those a pass. If the ticker's already protested in the past though, or you have familial high cholesterol, and you're already on them, by all means, stick with 'em.

There's a lot you can do yourself that could get things sorted without medication, but you do want to get the itching and weeing looked at, in case it's a bladder infection rather than a yeasty one. You might need antibiotics or a cream, whatever is going on.

Good luck eh.
Jo

Thank you for your reply perhaps I’m
starting to panic as it’s time soon for the annual review and blood tests.I don’t want a diagnosis of diabetes .
Over ten years ago I was diagnosed with hypertension and do take meds for that. I know that is a risk for type 2 and predictably the following year the hba1c was 41 and I was diagnosed prediabetic. I lost over 2 stones at that point and did all I could to improve my lifestyle all to no avail as it rose again the next year. In fact it has continued to rise except for a year when it stayed the same. It has never gone down despite following advice on this site re low carbing. When it was 46 last year I really took little notice as the nurse wasn’t concerned. Now I’m panicking that it will have risen over the threshold.
Some years ago I went on a online diabetes prevention course. It makes me yawn even thinking about it it was so boring. I think I stuck it for three sessions then dropped out. I do need to see about the itching, it’s gone on too long and I thought the trips to the loo were normal for an 81 yr old.
I refused statins some years
ago. I was offered them because my Qrisk was high but as I wouldn’t be able to enjoy my breakfast with grapefruit I wasn’t going there.

 

[Gardengnome]

Interesting that they are relaxed about your father’s hba1c now he’s 93. If the worst happens I hope I’ll get the same relaxed attitudes. Metformin always sounds decidedly unpleasant with its raft of
horrid side effects.

 

[EllieM]

Metformin always sounds decidedly unpleasant with its raft of
horrid side effects.

Many medications have side effects and as metformin is very commonly prescribed you hear about all the problems. My dad is on metformin and doesn't have issues with it and when I went on a medical study to see if metformin helps T1s I had no issues. (Though I never found out if I was taking metformin or a placebo).

 

[JoKalsbeek]

Thank you for your reply perhaps I’m
starting to panic as it’s time soon for the annual review and blood tests.I don’t want a diagnosis of diabetes .
Over ten years ago I was diagnosed with hypertension and do take meds for that. I know that is a risk for type 2 and predictably the following year the hba1c was 41 and I was diagnosed prediabetic. I lost over 2 stones at that point and did all I could to improve my lifestyle all to no avail as it rose again the next year. In fact it has continued to rise except for a year when it stayed the same. It has never gone down despite following advice on this site re low carbing. When it was 46 last year I really took little notice as the nurse wasn’t concerned. Now I’m panicking that it will have risen over the threshold.
Some years ago I went on a online diabetes prevention course. It makes me yawn even thinking about it it was so boring. I think I stuck it for three sessions then dropped out. I do need to see about the itching, it’s gone on too long and I thought the trips to the loo were normal for an 81 yr old.
I refused statins some years
ago. I was offered them because my Qrisk was high but as I wouldn’t be able to enjoy my breakfast with grapefruit I wasn’t going there.

Maybe we can go over your daily diet, what you're eating and drinking now in detail, and if there's any room for improvement? I mean, you mention grapefruit.... And citrus fruits are rather carby. If you absolutely cannot live without it, maybe have it after dinner instead, maybe a smaller portion, and make sure you have something fatty to go with it to mitigate the spike, like cream or full fat yog for pud? In the morning we tend to generally be more insulin resistant, so you might spike less in the evening on the same foodstuffs. It is something that might merit an experiment? Sometimes, some things are just not optional to give up, and fall under the non-negotiable category. See if we can find work-arounds, why not go for them.

Do you test before a meal and 2 hours afterwards? That might help some when it comes to adjusting what you're eating, maybe.

But really... If I look at all the conditions I have? Diabetes is the one causing me the least trouble. There's no shame in needing a little medicinal help like metformin. I just responded badly to it, so it wasn't an option for me. But it might well be for you. Diabetes does by no means mean you're destined for blindness and missing legs. You already know low carbing is a rather important component, and honestly, if you ate like regular people do, it is quite likely you would've been a raging diabetic already. And you're not, you're just barely on the threshold. You're doing well, believe it or not. Could it be better? Maybe, yeah. Likely. With more dietary tweaks or maybe metformin or something else... But you're on the right path already, even if it may not feel like it. Take heart. You're alright.

Hugs,
Jo

PS: Should you implement more dietary changes, keep an eye on your blood pressure. Less carbs often equals less salts, and your blood pressure could drop a tad low.

Edited by mods to remove medical advice

 

[Gardengnome]

Thanks for the reply.

My diet is really fairly normal I think. Breakfast is typically grapefruit, 2 eggs, poached or boiled and tea and brown toast. Never eat cereal these days and have found that keeps the weight off.
Lunch comprises usually home made vegetable soup, perhaps some salami and/or cheese. Last summer I grew some amazing tomatoes and would have a plate of them with basil and burrata cheese drizzled with best olive oil. Can’t wait for this years harvest! Finish with fruit.
And the evening meal will be fish or meat simply cooked with plenty of vegetables. I wouldn’t deny myself any mayo or other sort of sauce. And for pudding it’s usually fruit or yogurt of some sort.
I do like my puddings though and find it hard to give them up. It all sounds fairly good but of course I do like cakes and biscuits as well as the good things! No fast or junk food and no ready meals.

Are you saying that full fat Greek yogurt is better than fat free? And butter on bread rather than with none at all?

I’ve always struggled with my weight. About a year ago I started at slimming world as I’d felt my weight was creeping up due to too many biscuits probably Years ago and before slimming world I was a member at weight watchers for years and lost
stones and stones . Always the same ones and always the weight crept back. I think maybe these slimming clubs get the weight off easily but then it’s actually unsustainable and it all piles back on. Weight watchers was the worst.
Ten years ago when I was diagnosed with hypertension I did all I could to lose the extra weight and when prediabetes came along I adopted low carbing. Actually it did keep the weight off and easily too. It soon became a way of life. I feel I’ve adopted too many bad habits of late and will work at getting back on track and ditching the potatoes and rice and pasta. Having said that I’m definitely perceived as slim though I don’t see that.

I’m sure my BP won’t ever get too low. I keep an eye on it and do home monitoring which is especially useful when I go for the annual check up. Otherwise it would be through the roof and as a result I would probably be on a much higher dose of meds.

 

[Gardengnome]

Any day now I will get a message from the surgery to make an appointment for the annual review so will keep you posted as to what happens with the hba1c.

 

[ATB123]

Interesting that they are relaxed about your father’s hba1c now he’s 93. If the worst happens I hope I’ll get the same relaxed attitudes. Metformin always sounds decidedly unpleasant with its raft of
horrid side effects.

If you do need to take it, for most people it's OK, and the slow release version is much more gentle than the standard release. I did take metformin before my diagnosis changed, felt very nauseous on standard, switched to slow release and no further problems. I would just see how you get on if that's what is offered to you. It has other benefits as well I believe its seen as cardio protective which is always a bonus