Vegetable intake when trying to move from low carb to even lower carb (as a vegetarian)

i don't think it's the weight loss that skewed the Hba1c. Rather the fact i'd eaten under 20g of carbs a day for 2 of the 3 months prior to the pre diabetic diagnosis.
Waist went from 42" to 34".

ajbod said:

i don't think it's the weight loss that skewed the Hba1c. Rather the fact i'd eaten under 20g of carbs a day for 2 of the 3 months prior to the pre diabetic diagnosis.
Waist went from 42" to 34".

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Is that skewed (implying false)? Or is it reflecting your status over the previous few months (as it’s expected to do) even if that wasn’t your status 6 months earlier? At the time of the test you WERE achieving prediabetic results.

What it doesn’t say is what was happening further back in time (pre keto) but then it never will. I’d love to know what my meter readings were before I originally went keto on diagnosis for example as I only tested after I changed my diet, but nothing can go back in time and tell me that same as “what what if I hadn’t done keto“ questions in your situation.

My meaning for skewed is that it was artificially low due to 2 months of strict keto influencing the Hba1c. I believe i must have been diabetic for about 2 to 3 years previous. I had bad carb comas, and terrible peripheral neuropathy, and several funny turns, to the point i had to lie down and sleep for half an hour to recover. But surprise surprise, doctors weren't interested.

ajbod said:

My meaning for skewed is that it was artificially low due to 2 months of strict keto influencing the Hba1c. I believe i must have been diabetic for about 2 to 3 years previous. I had bad carb comas, and terrible peripheral neuropathy, and several funny turns, to the point i had to lie down and sleep for half an hour to recover. But surprise surprise, doctors weren't interested.

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And my point is that it wasn’t artificial. It really was that low. Even if keto got it that way.

What it wasn’t is reflective of how you’d been previously or how you’d have been on a “typical“ diet.

I know my Hba1c was correct at that point in time. But it was skewed because had i not done Keto it would almost certainly have been higher, and in the subsequent months would have returned to it's (normal) higher level, without myself or my doctor being aware, until much later when i was diagnosed as diabetic. Having been diagnosed with Peripheral neuropathy 3 years before, without an Hba1c being done, i think it safe to assume i was almost certainly diabetic prior to my later diagnosis.

ajbod said:

I know my Hba1c was correct at that point in time. But it was skewed because had i not done Keto it would almost certainly have been higher

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So it didn't skew your hba1c, that simply reflected the situation as it was at that time, but it may well have skewed your diagnosis.

Antje77 said:

So it didn't skew your hba1c, that simply reflected the situation as it was at that time, but it may well have skewed your diagnosis.

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Funnily enough, my wife asked me the other night "what would have happened if you'd put off going to the doctor, done keto for 6 months, then had a blood test for diabetes?"

I don't think she was quite expecting my answer that it would potentially have missed that I'm full blown T2 diabetic, maybe only putting me in pre-diabetic ranges at worst. With the rising popularity of low carb and keto, particularly for younger generations, it does present a potential challenge for diagnosis.

Paul_ said:

Funnily enough, my wife asked me the other night "what would have happened if you'd put off going to the doctor, done keto for 6 months, then had a blood test for diabetes?"

I don't think she was quite expecting my answer that it would potentially have missed that I'm full blown T2 diabetic, maybe only putting me in pre-diabetic ranges at worst. With the rising popularity of low carb and keto, particularly for younger generations, it does present a potential challenge for diagnosis.

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I missed out on official diagnosis because of covid lockdowns. By the time of my second test I'd read, researched, keto'd, lost 3 stone and lowered bg

It does happen

lovinglife said:

It opens a conundrum that if you adopt a keto way of life before diagnosis and never have and continue to and have none diabetic HBa1C results then are you at that point not diabetic because you pass the diagnostic tests? You can technically only be diagnosed if you have a test of 48 or over for a full T2 diagnosis

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For the 10-20% of T2 diabetics who aren't overweight and don't have any other related conditions, some of which may also be doing low carb/keto for lifestyle/fitness reasons, it's of particular concern I think.

lovinglife said:

Why? They’re not diabetic

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Ah, I see what you mean now! My brain was going off on a completely different tangent. It's been a long day!

lovinglife said:

Why? They’re not diabetic

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Are you meaning that once under the magic 48mmol (assuming no diabetic medication is being used) a previously diagnosed t2 no longer is diabetic - ie cured? It’s a debate I’ve seen here a number of times over the years. Medically it seems it is more the definition of remission rather than cure.

Are we sure that there is no remaining detriment despite normal levels? Are we truly back to the same condition we were in before we became diabetic in every respect? Sure hba1c is normal but how many other non measured aspects of our health are returned to normal. Eg insulin resistance, first stage insulin response or any of the many other things being diabetic changes.

I guess we need to consider if the diagnosis that might have previously happened at one point in time is important if you are maintaining sub diagnostic levels now and in the future?

You don’t need medication.
The foot checks could reasonably be self administered by most
With retinal scans available at high st opticians you could watch out for at least the more significant eye issues yourself.
The 6mthly/annual hba1c would still be useful considering you did likely cross the line unnoticed once previously and might again but if you maintain your new control you need to consider if that is likely or not or could you get sufficient information anyway, eg by fingerpricks/cgm or a cooperative GP doing regular tests anyway.

The big one is - are complications from diabetes any more likely than for someone who has the same current non diabetic hba1c but never crossed the line previously. As those complications are the focus of most of the regular monitoring. And I don’t think there’s been enough long term research into people in long term remission yet to answer that as they’ve only just acknowledged it’s even happening in the last few years. It’s looking positive for sure but not yet established in enough long term research conditions.

Also surely there have always been people that lost weight/exercised/changed diet and crossed this threshold in both directions unnoticed.

lovinglife said:

No my point was one of @Paul_ post he said

With the rising popularity of low carb and keto, particularly for younger generations, it does present a potential challenge for diagnosis.

If they’ve led a keto low carb lifestyle, as a lifestyle choice in general not because there is signs of diabetes then have a routine Hba1C that comes back not diabetic and continue to have none diabetic Hba1C because of their chosen lifestyle then they are not diabetic or ever have been.

Of course all that could change if they decided in the future to go the high carb way of life, but even then it’s not a given that people who eat high carb will be eventually become diabetic.

So it doesn’t present a challenge for diagnosis

Hope I’ve explained that better than it reads lol

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Yeah, my mind went down the route of "what if they were in diabetic ranges, but asymptomatic so never diagnosed, then for reasons unrelated to diabetes went on low carb/keto for a long duration?"

Would there be any possible consequences or complications from being in remission without knowing it, even if on low carb?

I'm guessing we're into a very rare, albeit non-zero probability scenario there, but that's the tangent I was off on.

lovinglife said:

Hope I’ve explained that better than it reads lol

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Yep. Got your meaning now thanks.

I had symptoms 4 years before a pre diabetic diagnosis.