Why?

[lingofreaky]

Hello, no idea why I have a reading of 43 as my diet and exercise are great. In fact everything is great. Absolutely fed up with being flagged up.

 

[Rachox]

You say your diet is great, could you give an example of what a typical days food is for you? We may be able to tweak things for you to lower your HbA1c

 

[lingofreaky]

Hello thanks for replying. I don't always eat breakfast but about 3x a week it's porridge with ground almonds, pumpkin seeds, flax and/or chia seeds, goji berries or half a dozen cranberries, a date and sometimes about 15 blueberries.
Lunch is a wholemeal chicken or tuna sandwich (2 slices of bread) spread with olive oil, a little vegetable soup, an apple and 2 squares of dark chocolate.
If no breakfast I have an afternoon snack of pistachio nuts, occasionally with a tiny piece of cheese.
Dinner is often fish like salmon or seabass or could be chicken (no skin) with potato (fist size and always with skin on) with either a very big salad or half dinner plate piled up with two or three green veg, followed by a banana and low fat plain yoghurt.
On holiday I can't keep to this more than 70% of the time especially if staying in a hotel. I've been eating like this a good 2.5 years. Sometimes it feels like I'm not eating enough and it's like I'm going low.

 

[Rachox]

Many of us type 2s eat low carb to control our blood sugars and keep our HbA1c in the non diabetic range, carbs turn to sugar once digested. You could cut down your carbs a bit, so reduce or remove the following from your diet. Porridge, bread, potato (check the soup for potato). Then pick berries rather than dates or banana which are both very sweet.
You shouldn’t have to change too much as you are only just into the pre diabetic range.

 

[Mark Rawlinson]

Can you speak with your Diabetic Nurse or Dr regarding this ?
I see you are on no medication

 

[KennyA]

Hello, no idea why I have a reading of 43 as my diet and exercise are great. In fact everything is great. Absolutely fed up with being flagged up.

One of the problems is that the officially recommended (since 1985ish) "healthy diet" is anything but for anyone with problems handling glucose. The recommended diet is strongly carb based and iirc advises around 300-350g carb per day. All carbs turn to glucose when digested and you are eating some items that are pretty high in carb. There are some good guides as to the estimated carb content of food here: https://www.dietdoctor.com/low-carb/foods

Having said all that, there is some acceptable error in HbA1c tests and it's possible your result might vary slightly - eg it could equally be 41 or 45. They are, very occasionally, very wrong - I had an A1c test at my GPs a year or two ago that returned a value in the 50s. I challenged that and the lab test came back at 38, which is expected around where I've been since 2020. I try to stay around 20g carb/day, because my diabetic symptoms started with an A1c around 42-43ish.

Some people also report that A1c increases slowly with age. This doesn't seem to have happened to me (69 in a couple of weeks), but it might make some sense for others.

 

[Resurgam]

Hello thanks for replying. I don't always eat breakfast but about 3x a week it's porridge with ground almonds, pumpkin seeds, flax and/or chia seeds, goji berries or half a dozen cranberries, a date and sometimes about 15 blueberries.
Lunch is a wholemeal chicken or tuna sandwich (2 slices of bread) spread with olive oil, a little vegetable soup, an apple and 2 squares of dark chocolate.
If no breakfast I have an afternoon snack of pistachio nuts, occasionally with a tiny piece of cheese.
Dinner is often fish like salmon or seabass or could be chicken (no skin) with potato (fist size and always with skin on) with either a very big salad or half dinner plate piled up with two or three green veg, followed by a banana and low fat plain yoghurt.
On holiday I can't keep to this more than 70% of the time especially if staying in a hotel. I've been eating like this a good 2.5 years. Sometimes it feels like I'm not eating enough and it's like I'm going low.

The pistachios are quite high in carbs as they are not a true nut - a drupe, if I remember my botanical classification. Maybe 20%, so something I avoid.
I am a full on type 2 so I avoid all grain, all high carb fruit and veges, I do eat things called berries but tend to limit blueberries as they are quite high carb.
Many type 2s eat full fat proteins and limit carbohydrate, and see normal numbers.
I eat cheese with tomatoes, occasionally with a salad of coleslaw carrot cucumber celery beetroot and tomatoes as a meal when the weather is warm
Since diagnosis 10 years ago I have not eaten bananas. but can't say I have missed them all that much.
As you are starting off in the lower range you could well find that altering just one or two food choices could do the trick, but the information that the 'healthy' diet is wrong for those unable to cope with carbs is often never given by HCPs dealing with diabetes. I managed to keep my blood glucose levels normal for years and was considered to be in remission after two or three low HbA1c tests..

 

[becca59]

I’m a type one and to eat porridge, potatoes, bananas, bread, I would need to inject quite a lot of insulin. So tend to give them a wide berth as I prefer to inject low amounts. Plus low fat yoghurt is a definite no. More carbs than full fat, and nowhere near as tasty or filling.

 

[SepticTank]

While I wouldn't deny my pre-diabetic status I'm still a little skeptical about my recent type 2 status as the qualifying bloods were pulled while I was suffering a head to toe eczema attack - since when I have learned that BG levels increase when the body is under duress.
Might seem like clutching at straws but could it be that you were under the weather in some capacity when they took your bloods and that they were artificially high at the time?

 

[Resurgam]

While I wouldn't deny my pre-diabetic status I'm still a little skeptical about my recent type 2 status as the qualifying bloods were pulled while I was suffering a head to toe eczema attack - since when I have learned that BG levels increase when the body is under duress.
Might seem like clutching at straws but could it be that you were under the weather in some capacity when they took your bloods and that they were artificially high at the time?

I wish I could say 'oh yes' but the HbA1c test shows how things have been for the last three months, possibly a little more, indicating how much glucose there has been in the blood attaching itself to the red blood corpuscles.

You have been alerted to your situation early - I was left untested for ten years after a flagged result which allowed me to reach quite high numbers, but I did manage to reduce down by avoiding high carb foods, and fairly swiftly too. Hopefully a few months of lower carb daily intake will drop you back into normal figures.

 

[lingofreaky]

While I wouldn't deny my pre-diabetic status I'm still a little skeptical about my recent type 2 status as the qualifying bloods were pulled while I was suffering a head to toe eczema attack - since when I have learned that BG levels increase when the body is under duress.
Might seem like clutching at straws but could it be that you were under the weather in some capacity when they took your bloods and that they were artificially high at the time?

Very likely as my cat died in June and I miss her very much.

 

[lingofreaky]

If I cut anything out I'm going to lose weight, that's the point. I play tennis and walk briskly so I need carbs but I never have white floor, rice etc.

 

[MrsA2]

It's not exactly cutting things out, it's replacing carbs with protein or fat instead. You'll still feel full and satiated just not having your bg rise too much. There's no need to be hungry or too skinny
For example instead of a chicken sandwich, have a bigger portion of chicken with salad and mayo. And follow it with nuts and seeds and plain creamy yoghurt.
Contrary to what we've been told for years, we don't need carbs to live, or exercise. There's people run marathons on zero carbs, they just make sure they've got the right nutrition from other sources such as eggs, meat, fish, veg in sufficient quantities

 

[MrsA2]

This is a good thread with examples of what works for many of us.

Post in thread 'What have you eaten today? (Low carb forum)'

Thursday at 6:16 PM

Breakfast LC granola with kefir then LC toast with nut butter
Lunch mackerel pate with a few LC seeded crackers and a few nuts
Dinner pork in a mushroom sauce and veggies ( broccoli and green beans) followed by a few berries and cream.

• shelley262

 

[SepticTank]

I wish I could say 'oh yes' but the HbA1c test shows how things have been for the last three months, possibly a little more, indicating how much glucose there has been in the blood attaching itself to the red blood corpuscles.

You have been alerted to your situation early - I was left untested for ten years after a flagged result which allowed me to reach quite high numbers, but I did manage to reduce down by avoiding high carb foods, and fairly swiftly too. Hopefully a few months of lower carb daily intake will drop you back into normal figures.

I don't disagree, although I was led to believe that it may also be influenced more greatly by recent activity, admittedly my example was not the best to highlight that!

From what I understand, besides lowering carbs the goal is to eliminate simple carbs and aim to consume only complex carbs obtained from higher fibre, lower starch sources, making my body do the hard work to get those sugars and not relying upon the endeavours of messrs Tate&Lyle, etc

 

[KennyA]

I don't disagree, although I was led to believe that it may also be influenced more greatly by recent activity, admittedly my example was not the best to highlight that!

From what I understand, besides lowering carbs the goal is to eliminate simple carbs and aim to consume only complex carbs obtained from higher fibre, lower starch sources, making my body do the hard work to get those sugars and not relying upon the endeavours of messrs Tate&Lyle, etc

Personally I don't see any difference in impact between simple or complex carbs. Carbs in equals glucose in, so I choose to limit all carbs, not just sugars.

"Recent activity" as far as the HbA1c test goes means the last month. That's assumed to contribute about 60% of the overall result. Two months back is 30%, and three months back contributes 10%. (Source for this and the info below is Bilous and Donnelly, Handbook of Diabetes).

That's because RBCs are being replaced all the time, so around 90% of the cells that were alive three months ago have already died and aren't around to be sampled. The A1c is used precisely because it gives a longer term view of overall blood glucose levels and isn't susceptible to the normal ups and downs in blood glucose from a range of stimuli you'd see with fingerprick testing.

There are also a number of conditions (anaemia is one) that can affect RBC numbers and can lead to skewing an HbA1c result:

Table 3.2
Use of HbA1c >6.5% (48 mmol/mol) as a cut‐off for making the diagnosis of diabetes offers some advantages but there are several disadvantages.

Advantages
• Avoids the need for a fasting blood sample, and the preanalytical instability of glucose measurements.
• HbA1c reflects glycaemia over several weeks.
• Lower biological variability of HbA1c compared with FPG or 2 h glucose.
• Virtual absence of significant retinopathy among people with HbA1c < 6.5%.

Disadvantages
• HbA1c measurements can give spurious results in: anaemia (Fe‐deficiency), haemoglobinopathies, renal failure, different ethnic groups.
• Diagnosis by HbA1c will identify a different population to that diagnosed by Fasting Plasma Glucose.
• Distribution of HbA1c values varies in different ethnic groups.
• HbA1c increases with age
• Some patients and ethnic groups may be diagnosed with diabetes by some criteria but not others


B&D also say in relation to the current practice of not diagnosing T2 unless the HbA1c is >48:

The potential value of screening for diabetes is to facilitate early diagnosis and treatment. About 20% of newly diagnosed type 2 diabetic subjects already have evidence of vascular complications, such as retinopathy, the prevalence of which increases with diabetes duration. This suggests that complications begin about 5–6 years before a diagnosis is made, and that the actual onset of (type 2) diabetes may be several years before the clinical diagnosis.

 

[Resurgam]

I don't disagree, although I was led to believe that it may also be influenced more greatly by recent activity, admittedly my example was not the best to highlight that!

From what I understand, besides lowering carbs the goal is to eliminate simple carbs and aim to consume only complex carbs obtained from higher fibre, lower starch sources, making my body do the hard work to get those sugars and not relying upon the endeavours of messrs Tate&Lyle, etc

You really need to check on how you deal with carbs of all sorts and not accept statements about there being different qualities of carbs.
My gut just rips out the carbs from anything I consume - simple or complex is irrelevant, and it makes it seem effortless. I need to regard all carbs in the same light, with no resistance to digestion, and GL or GI high or low means nothing at all.

 

[lingofreaky]

Can you speak with your Diabetic Nurse or Dr regarding this ?
I see you are on no medication

I shall be doing and will discuss what it might be other than diet. AI thinks 15 years of hot flushes and therefore little bursts of cortisol making my liver think I'm going low and producing glucose. Of course AI isn't always right.
I am not going to cut complex carbs as I'm only a size 8. Just don't want more than one chicken breast or 2 salmon fillets at dinner with my veg or salad...I need carbs because I'm so active.

 

[KennyA]

I shall be doing and will discuss what it might be other than diet. AI thinks 15 years of hot flushes and therefore little bursts of cortisol making my liver think I'm going low and producing glucose. Of course AI isn't always right.
I am not going to cut complex carbs as I'm only a size 8. Just don't want more than one chicken breast or 2 salmon fillets at dinner with my veg or salad...I need carbs because I'm so active.

I go a bit stronger and say that AI is rarely useful when it comes to advice on T2 issues - and using AI as a source on this forum isn't permitted as a result. Of course your liver is producing glucose. It's what they do, all the time, for everyone - non-diabetics and diabetics alike. But that isn't the issue - if our livers didn't do that we'd have a real problem.

I think (and I might be wrong) that your statement "I need carbs because I'm so active" is indicative. I'm active too - football twice a week, pilates, etc, and I don't eat carbs in any quantity. I have plenty of energy. The NHS dietitian at my introductory course in 2020 said it explicitly - carbs are unnecessary in your diet. As has been said above, we do quite well on fats and proteins.

It seems from your (slightly) abnormal BG level that you might actually have a problem processing glucose. The graph below gives you an indication of where you are compared to the distrubtion of BG levels in a non-diabetic population. If your system has a problem dealing with glucose, and you eat large amounts of carbs, you are loading your system with something it has difficulty dealing with, and therefore your BG will tend to rise, as it has, and stay elevated.

This does not of course rule out other causes of your BG rise, and if you're concerned those would have to be investigated. But if it is only a mild bit of insulin resistance it is relatively straightforward to do something about that.

Edit - I posted the wrong version of the graph - it shows BG values in percentages. 5.5% is 37 mmol/mol: 6.0% is 42 mmol/mol; and 6.5% is 48mmol/mol. The second graph shows a similar pattern.