Sudden jump in HBA1c/FBG

Thirteen years ago, at the age of 39, I was diagnosed with Type 2. My fasting blood glucose was 7.8 and my HBA1c was also raised; a glucose tolerance test had a starting level of 7.1 and a two-hour level of 11.0. My doctor prescribed me Atorvastatin for slightly raised cholesterol, and I lost some weight over the next three months. At the end of the period, we repeated the GTT and this time got a starting level of 6.1 and a two-hour level of 7.7.

Over the intermediate thirteen years, my blood sugars have remained in the prediabetic range, with my HBA1c gradually decreasing from 6.4 (in June 2016) to 6.3 (June 2017) and 6.1 (June 2018 and June 2019). A few months prior to the 2018 test, I came off Atorvastatin as my cholesterol was now off the bottom end of the normal range. In June 2019, with my total cholesterol having increased from 5.12 to 5.99 (in both cases, with fairly low HDL and pretty low triglycerides), my doctor restarted me on Atorvastatin.

Three months later, I had my HBA1c checked again, to see whether restarting the statin had had any effect, and was shocked to find that it had soared to 7.0. I asked to switch to a different statin (Pravastatin, which is not associated with any increase in blood glucose) and had a fasting blood glucose test done in between the two statins. This came in at 8.2.

It looks as though Atorvastatin was not the culprit for the sudden increase, and I have simply run out of luck with diet (which involves eating only once a day), though it's a hell of a coincidence after thirteen years. I'm seeing the nurse for a diabetic check on Friday, and am wondering whether I should go straight onto Metformin or should attempt another diet, which could buy me another few years before needing medication. What does everyone on here think?

I eat out seven days a week. The cuisine varies, depending on which restaurant I visit, but usually takes the format of a three-course meal. My favourite foods are meat, fish and dairy – my perfect main course would be something like fillet steak in a blue cheese sauce, cod mornay or lobster thermidor. Generally, however, I eat a wide range of foods groups including some bread and potatoes, and always have either a pudding or the cheese board. At our June meeting, my doctor told me she thought I was eating too much protein and not enough carbohydrate, and I tried to include a little more of the latter in my diet, which may also have affected the HBA1c. I'm baffled by the 8.2 FBG result, however, and was surprised when the hospital marked it as "acceptable" in the app.

My doctor was concerned as my urine creatinine was about twice the upper limit of normal, commenting that I was "beginning to leak protein". My microalbumin is pretty low, however, and my albumin:creatinine level is only 0.2, so I'm not sure whether to be concerned about this or not.

I have never done any glucose testing at home, as my previous doctor thought it would reduce my quality of life without much significant benefit.

That's definitely an option, as fats are my favourite type of food (I love anything dairy-related). I can't see myself giving up carbs entirely, as I like puddings, as well as some bread and potatoes with my meal. Would losing some weight over the next couple of months (maybe via a 5/2 diet) assist?

I think my then-doctor took the view that since my levels were not in the diabetic range, I didn't need to worry too much. I used to get my HBA1c and FBG tested annually, and go on a 5/2 diet for a few weeks if either seemed to be creeping upwards.

Generally, a typical restaurant meal will comprise bread, a starter, main course, and dessert or cheese. My tastes definitely tend towards meats, fish and dairy, as I noted, but main courses will usually be served with vegetables and/or potatoes. Aside from the one time I eat per day, all I consume is water (several litres a day).

The diets mentioned above look interesting, and I shall investigate them further.

That's an amazing achievement, Rach! My rather idiosyncratic diet has kept my numbers in the prediabetic zone for thirteen years now, but for some reason the strategy is now failing. I'll definitely have to try something, or I will end up on Metformin.

My real fear is that if I don't keep my HBA1c under control, I may eventually end up on insulin. My doctor said that is extremely unlikely, but I'm still concerned.

That's pretty much what my doctor said, citing the case of her own mother, who "is 80, has been diabetic for 40 years, eats complete rubbish, and has never taken insulin in her life".