Branded - PREDIABETIC

[tmm99]

I just got my cholesterol, fasting glucose and A1C results back and (drum rolls pleeze..) I am now considered prediabetic!

Well, I actually did know that, but they didn't know that.
The frustrating part is that I had been semi low-carbing (at first seriously low carbing) since middle of September, but I guess I was doing something... not right.

The reason I started on low-carbing is because my last cholesterol check several months ago was not very good and my fasting glucose was 101 (70-100 normal). The doctor wrote "fasting glucose mildly elevated" and "cholesterol mildly elevated." She ordered A1C on top of fasting glucose level this second time, and for the result of the test last week, she writes "Your average blood sugar is in the prediabetic range and your cholesterol is poorly controlled.)

Here are the results from last check and from last week

Fasting glucose
101 -> 99 (normal 70-100)

A1C
? -> 5.8 (normal 4.8-5.6)

Cholesterol
Total 240 -> 243 (normal < 200) Marked High
Trig 131 -> 84 (normal < 150)
HDL 55 -> 60 (normal > 50)
LDL Calc 159->166 (normal 0-160) Marked High
Cholesterol to HDL ratio 4.4 -> 4.1 (0-4.0) Marked High
(not on the result but my Trig/HDL ratio changed from 2.38 -> 1.4)

I don't know much about the cholesterol thing, but because my triglyceride numbers went down a bunch (thanks to low-carbing) and with HDL about the same, I consider the recent test to be better than the last one. Am I wrong? LDL is calculated, so it's not accurate anyway right?

Before the test, my prediction was my A1C was low and when challenged by my doctor with high LDL (calculated), I was going to ask for LDL true test and for the fluffy test, but now, with such a high A1C, I am not going to.

Here is the thing. I have been taking my fasting glucose with my meter (TrueTest meter - which I can get the cheapest strips on amazon - around $12 per 50 strips - supposed to be calibrated/calculated to reflect the whole blood plasma level) for the last couple of months and the fasting numbers are satisfactory (for some reason, it started out good, but it started going up little by little - I was thinking liver dumping maybe? Less exercise? Supplements?? Addition of fish oil did raise my BG and stopped taking it but I was still taking Krill oil.) My most surprise was definitly the A1C. When I ate a measurable amount of carb, I tested my level every 15 minutes to see, and the numbers weren't all that bad. I have hurt my back and haven't been exercising as much, and that might be the reason of fasting BG going up, but maybe I just cannot eat any bad carbs at all.

BTW, I bought Bayer's A1C self test. My review is... it's crap. I tested it on those days below.
9/16 5.9
10/23 5.6
11/11 4.9 (I thought it was too low, so I bought another box and the second result on the same day was 4.7)
11/14 5.9 (lab drawn)

After all this, I looked up amazon for Bayer's A1C test and some said Bayer told him that the test is accurate to +/- 0.9%

My questions:

* How should I approach my doctor when I see her next time?
* How long should I wait until I get another A1C test? (some say a couple of weeks, some say 3 months. I waited 2 months since I started low/semi-low carb to take the test...)

How do I post an excel of my daily fasting values?

Any comments GREATLY appreciated!

[tmm99]

Just to add...

After spaghetti meatballs with salad and 1/2 C of cooked pasta
15 min - 117
30 min - 126
45 min - 129
60 min - 117
75 min - 110
105 min - 116
120 min - 109
180 min - 101

After eating fried chicken with 1 cup of rice
60 min - 150

After eating saucy chinese meat/veggie dishes (no rice, but corn starch in sauce)
60 min - 134

[TromboneAl]

It's scary when the numbers don't come out the way you expect. Things probably aren't as bad as they seem, and it sounds like you've got a good strategy for dealing with this.

Quote:

LDL is calculated, so it's not accurate anyway right?

From my understanding, some research shows that when Triglycerides are less than 100, the standard formula doesn't give a good indication of LDL.

http://www.ams.ac.ir/aim/08113/0014.pdf

Here is the standard formula and one to use with low trigyclerides (check it in case I copied wrong).

Friedewald Formula:

LDL = TC – HDL – (TG / 5)

Better formula for those with TG < 100:

LDL = TC/1.19 + TG/1.9 – HDL/1.1 – 38

Another study:

http://www.archivesofpathology.org/doi/full/10.1043/0003-9985%282001%29125%3C0404%3ALTLACO%3E2.0.CO%3B2

This is a good resource:

Blood Sugar 101

Good luck.

[rgarling]

Your low carb adventure has improved your metabolic situation; however, you need to get serious. Drop all grains and sugars asap. Keep that going until your next check, and ask to have your ldl measured. Most likely you are ldl, pattern A, which is a good thing. Your blood glucose will likely improve quite a bit; if not, try intermittent fasting.

[TromboneAl]

More on the calculated LDL stuff...

That second study I referenced compared the calculated and directly measured LDL for only one patient (for some reason). Here is what they found:



IOW, the calculated LDL was 172, and the directly measured LDL was about 128.

First, let's confirm the Friedewald calculation:

LDL = TC – HDL – (TG / 5)

LDL = 262 - 79 - 55/5

LDL = 172

Which is exactly what is shown in the above table.

Now, if we use the modified formula from the first study above, we'd get this:

LDL = TC/1.19 + TG/1.9 – HDL/1.1 – 38

LDL = 262/1.19 + 55/1.9 - 79/1.1 - 38

LDL = 220.17 + 28.95 - 71.82 - 38

LDL = 139

Which is pretty close.

So, in summary, if your triglycerides are very low, you may consider having your LDL measured directly, or you can estimate it with the modified formula.

[Free To Canoe]

Thanks for the blood sugar / cholesterol info. I think the LDL recalc may apply to me.
Do they rely on the ratio more than the LDL number? If so, which one?
Does losing weight help with the elevated blood sugar problem?

[jerome len]

Keep it simple!

1st of all, how old are you, are you overweight, can you excercise more, do you smoke and what other factors come into play.

Diabeties is a killer and my doc (of 21 years) scared the hell out of me 4 or 5 years, ago. She told me to change my eating habits, sent me to a dietician to improve my knowledge, yelled at me to excercise and told me to lose weight or else.

We had a mutual friend who didn't listen to her........he was younger than me and died.

I know everyone is different but it sounds to me like your analyzing a lot and hoping a future test will change everything.........if it does great but the chances of that happening are slim.

So, I gave up ice cream, all candy, cookies, pies, cakes and check the sugar content of everything I buy. I re-structured my breakfast, excercise a minimum of 30 minutes a day, limit myself to 300 cal for breakfast, 450 for lunch and a 1000 for dinner, with a late night snack limit of 300 calories.

Initially, I had to see the doc every three months and every time I saw her things improved a bit. .......again, that was 5 years ago.

Today I love my excercise, do more of it, lose a pound over month or two, took 6 inches off my waist and lost the little arthritis that I had. Was it easy? Not really but now I love salad, yams, red beans, chicken, fish, fruit etc......food that replaced french fries, eggs and bacon, fried chicken......you get the idea.

Again, everyone is different......today, I'll be 65 in three months and I don't even waste time testing my sugar.......my DW supported me in all this, lost just a couple of pounds and looks so good that everyone kids me that I have a trophy wife......far better than her sister who is fat......and who's husband has gone from a pre to a full diabetic.

Now.........moral of the story.......take this serious.......everyone is different.....but most of us can control our challenge with diet and excercise......but you do it for a lifetime.......and eventually you enjoy the changes.

If you want to look at a diet, read up on volume-etrics...sorry about the spelling. You'll find that a good salad will only have 50 to 100 calories in lettuce........maybe, close to a 1000 in salad dressing........learn everything you can......I eat lots of salad with low cal dressing.

Good luck........Most pre-diabetics can live until a 100 if they develop good habits....I hope you are one of them and you do.

[Alan]

Quote:

Originally Posted by tmm99 How do I post an excel of my daily fasting values?

To attach an Excel sheet to a post click on the paperclip and Xls files should appear as an option.

[tmm99]

Thank you everyone for your posts!

jerome,
Thank you for sharing your experience. It sounds like you are doing great. I am in my 50's, no weight problem (5 foot 4, 118 lbs). I am one of those lucky few who are thin and insulin resistent. No family history of diabetes in direct family or relatives (some of my relatives might have died too young to get there; I don't know.) I exercise, but I haven't been the last few weeks except for light workout about 2 days a week due to back pains and then I got some virus that is lingering.

rgarling,
You are probably right about this being my time to get serious. I was seriously low-carbing at the beginning (Protein Power version of Induction Phase - more moderate amount of protein with some carb than Atkins induction), but after the first 2 weeks, I reintroduced more carbs and was experimenting (which bad carbs affect my BG more etc), but I don't think I could do that.

Al,
I read some of the materials you posted here last night, and I will continue to read more over the weekend. I have also gone back to Protein Power (Eades) and been reading over the cholesterol chapter (it was kind of hard to understand before, but now I am more serious! Last night it put me to sleep... :-p) My LDL number does come out better using the modified (Iranian?) formua - from 166 to 156, which puts me in the normal range (though high normal). Do you happen to know the siginificance of "total cholesterol" and how important is the total cholesterol HDL ratio? I realize triglyceride/HDL ratio is important, but I am not sure total cholesterol and tis ratio with HDL. (Like this guy in this example you stated has a very high total... Is that considered really bad in your opinion?)

My plan
-> Tell my doctor I don't want to get on any kind of meds. I will eat better (won't tell her how) and exercise and want to get another test done (maybe cholesterol check in one month to start with?) If she insists on meds, I will change my doc.
-> I eat about every 3 hours to keep my moods steady
breakfast - 9AM
lunch - noon
another lunch - 4PM
dinner - 7PM
another dinner - 9PM
I need to change the 9PM eating habit. Plus sometimes I can't get to dinner until 8PM (and end up eating too much) - go to bed still very full. I hate going to sleep hungry or semi empty stomached, but eating close to bedtime does affect my fasting glucose
->I think I am going to keep my 1 truffle (Trader Joe's 3g carb) after lunch ritual along with my raspberries (I go through a small container of raspberries a week and I will make that the only source of fruit).
->No eating out unless it's a restaurant that serves american dishes where I can order unadultrated piece of meat with no gravy.
->Get back to exercising 6 days a week (after I get rid of this cold...)

Any suggestions ABSOLUTELY welcomed!

[tmm99]

Quote:

Originally Posted by alan to attach an excel sheet to a post click on the paperclip and xls files should appear as an option.

fasting.xls

I am not sure if it came out OK or not. Either way, I don't know excel so it's really poor presentation but this is the fasting values taken over last 3 months. You can tell my fasting BG is creeping upward...(if you can see the darn thing.)

[Alan]

Quote:

Originally Posted by tmm99 I am not sure if it came out OK or not. Either way, I don't know excel so it's really poor presentation but this is the fasting values taken over last 3 months. You can tell my fasting BG is creeping upward...(if you can see the darn thing.)

The spreadsheet works for me - well done.

[FIRE'd@51]

Not to be outdone by T-AL, here's another formula

Ave Blood Sugar (mg/dl) = 28.7 x A1c - 46.7

An A1c of 5.8 would imply an average blood sugar of 120

My understanding is that the A1c is a measurement of the percentage of red blood cells which have glucose attached. Since the average life of a red blood cell is about 90 days, the A1c is a rather slow-moving average, I believe you should wait 3 months after changing your regimen before having another A1c so that most of the red blood cells have been replaced by new ones.

[rgarling]

I am surprised someone on a low-carb plan feels the need to eat so frequently. When you eat, you should eat at least 30g of protein. Try upping your minimum meal size to that level of protein intake and see if that makes a difference. As an exercise, try to get down to 2 meals per day and feel comfortable doing that. Try eating your first meal within 30 minutes of waking. To reiterate, when you get your next lipid panel, have your ldl measured.

Read this: LCHF for beginners | Dietdoctor.com

[braumeister]

IMHO, rgarling has it exactly right. Of course, that's what I would expect here. You need to lower your triglycerides and raise your HDL. Yes, you have already done that, but you can do still better fairly easily. Just go to a VERY low carb, high fat (vlchf) regimen.

T-Al also had a very good point that standard measurements don't always work well for those of us on "enlightened" diets.

My doc is appalled at my vlchf diet, but in awe at my blood test numbers. He just scratches his head and tells me to keep doing what I'm doing.

[toofrugalformycat]

I hesitate to jump into this, being quite uninformed about low carb diets, but you did ask for suggestions. I greatly improved my blood test results (both glucose and cholesterol) and lost significant weight, with a combination of more, and more intense, exercise (most every day), eating more often but smaller amounts (I don't let myself get hungry), avoiding high glycemic index foods, minimizing grains in my diet, using only olive oil and canola oil for cooking (avoid butter and fatty meats) and drinking a half glass of wine most every night (but no other alcohol). Every body is different, YMMV. I'm a number cruncher too, but I think one can put too much energy and money (and worry) into tests - once every six months seems like enough. Also, results can vary from lab to lab. So a test should get your attention (and it has) but it's not worth panicking. Just take action (as you have) and if you find yourself worrying, go to the gym and sweat it out. And I do let myself have the occasional treat so I don't feel deprived. One day at a time.

[sundance]

Suggestion on menus or web sites. I need to motify my habits. What suggestions do U have for Breakfast?

[pimpmyretirement]

How hard are you exercising? Intensity matters.

My wife is pre-diabetic. Her mood swings between meals were a result of insulin spikes and the resulting blood sugar crashes. She found Metformin prevents it. From what I understand, preventing the spikes also helps slow the progression towards diabetes.

Taking drugs is no fun, but if the big changes in diet don't work, it could be the best thing to do for your long term health.

[obgyn65]

hello tmm99

Please check the AACE publications about glycemic control algorithms here https://www.aace.com/publications

www.emedicine.com is also quite good, especially since they included the Medscape information.

Good luck

Quote:

Originally Posted by tmm99 Any comments GREATLY appreciated!

[haha]

Quote:

Originally Posted by pimpmyretirement How hard are you exercising? Intensity matters. My wife is pre-diabetic. Her mood swings between meals were a result of insulin spikes and the resulting blood sugar crashes. She found Metformin prevents it. From what I understand, preventing the spikes also helps slow the progression towards diabetes. Taking drugs is no fun, but if the big changes in diet don't work, it could be the best thing to do for your long term health.

There is some evidence that time matters, and given equal work, intensity may in some respects be negative. See Krause, William.

[tmm99]

Thank you guys for all the suggestions.

I was doing low intensity (slow and long by "Younger Next Year" standard) on a spin bike, plus some weight training, but like I said, I hurt my back (nothing serious) so I hadn't been doing it but only twice a week for a while recently, plus more recently not exercising at all due to cold/flu (I still have some fever plus my chest is too congested.) I will go back again once my cold/flu is gone. (I have been seeing a chiro so my back is much better.) I am not sure about high intensity exercise - it affects my adrenal too much when I exercise above 130 heart rate.


About frequent meals, I have hypoglycemic tendencies, but once I started the lowcarb, I do not get the lows like I used to, which is a huge plus. Even now though, I hate to stuff myself (I just don't like the feeling in my stomach when I eat a full meal), so I usually eat to about 70% full, so I get hungry in about 3 hours even with low carb. (Often times on weekends, I eat all day long - perhaps the way Italians or Spanish may do - tapas portions!) I don't think anything is wrong with it except my last meal/snack gets too close to bedtime.

Not relating to that, but one thing I am thinking of doing is raising my fat intake going forward. When I eat just lean protein, it just doesn't stick to my ribs and doesn't give me the satisfaction protein and fat gives me.

Yesterday, I went full force with cooking. I am gonig to freeze a lot of them so when I have nothing in a fridge coming home from wo*rk, I won't have to resort to takeouts that tend to contain bad carbs, and when I get the sweet tooth, I will always have something that is low carb that I can count on.

It was excellent (I added bacon)
Cauliflower Mac and Cheese Casserole Recipe : : Food Network

I also made something similar to this (from a lowcarb book by Fran McCullough ) using erythritol and tiny bit of splenda (Thank you Al for introducing me to erythritol!)
Low Carb Almond Cookies Recipe - Food.com - 147237

And crustless quiche with Gruyer cheese (texture turned out more like deflated egg/cheese souffle but very tasty!)

And chopino (more like bouillabaisse using 8 oz tomato sauce)

and Sugar-Free Chocolate Peanut Butter Fudge - Easy Sugar-Free Fudge Recipe (need to add more peanut butter and sweetner)