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Diagnosed pre-diabetic with HbA1c of 5.3
Old 04-05-2013, 04:54 PM   #1
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Diagnosed pre-diabetic with HbA1c of 5.3

Hello all,

I've browsed the ER forum for about 7 years now but only posted here and there. This is turning out to be my introductory thread. I always assumed I'd write one when finally had some sort of financial question. Didn't think the first would turn out to be a health issue. Know I need to find a good diabetic forum, but since this is now my "one and only" am first writing here.

Plus, I'm ***really*** grateful to some of you all. If my main contribution to the ER forum is this, then so be it. It is this: Cannot for the life of me figure out why we are hearing so much about the explosion in diabetes without it being accompanied by advice to and guidelines for testing blood sugar levels *after* meals. General mandates to eat "healthy" and "exercise" just aren't good enough.

Briefly, am a single mom with one kid, a teen, still at home. Retired now about 5 years. Financially stable. Made a few really good decisions before/during the Great Recession in large part due to ER forum.

To get to it:

Just diagnosed impaired glucose intolerant, aka pre-diabetic. Normal weight, low (70 mg/dL to 80 mg/dL) fasting glucose with hbA1c's that consistently fell at 5.3 to 5.4 over the last 6 years. Low blood pressure, high HDL, seemingly no metabolic X syndrome (skinny middle !!!). Exercise. What I thought was a relatively low-risk genetic inheritance (maternal with mild diabetes "caused" by overweight then easily controlled with weight loss) that upon further questioning turns out to be more ominous.

What led to the diagnosis were posts on this forum that I acted on a year ago when fasting glucose came in just *too* low (64 mg/dL). Read that abnormal blood sugars levels are just that abnormal (high or low). Bought a glucose meter. First tests in the winter of 2012 were promising, falling way below pre-diabetic levels. Many meals showed "rock solid."

The endo initially was concerned the low fasting was medically significant for a non-diabetic reason and had me test levels throughout the last year. Tried a couple of test meals. Noticed that, depending on the carb - fat - protein composition, glucose levels could take longer than the so-called "norm" to fall to fasting levels even though the absolute values were relatively low. Endo mentioned reactive hypoglycemia was a possibility and, if so, it could be a precursor to diabetes. Given my low glucose levels, he predicted no decline in ability to tolerate carbs for about a decade.

Stupidly, did not test more meals until preparing for this year's annual check-up. Only see an endo due to mild thyroid issues. Was *not* pleased to see glucose levels had risen 30-40 mg/dL on the test meals pushing me into the pre-diabetic range. Really *NOT* pleased to find it was possible to "pass" 200 mg/dL on a meal making me technically diabetic although due to the strong second-stage insulin release the endo says no, his diagnosis is pre-diabetes. Won't quibble for, as he says, it's all a continuum.

In retrospect, I probably entered my decade of reactive hypoglycemia when my fasting glucose levels *fell* (from 80-90 mg/dL to 70-80 mg/dL). Given work/kid commitments, tended to eat dinner right before bedtime, resulting in lows. Probably not coincidentally, it was then then (early 50s) I noticed odd but mild inflammatory flare-ups that tend to go away. Bottom line is I've already blown past reactive hypoglycemia to pre-diabetes.

Didn't ask for an OGTT that ironically I may still pass per the ADA guidelines. One of the test meals has me ingesting almost 200 carbs. (This, however, includes a lot of fructose.) Even today, I can return to 100 mg/dL after 2 hours on that meal. It's the one hour reading that has disintegrated. As for 100 % glucose (rice), the quantity that I can tolerate also has fallen. Last year, 60 grams was fine, this year *not* leaving me close to the pre-diabetic cut-off at 2 hours.

***Btw, the endo says that much of this is "statistically" normal as you age. In other words, it is statistically normal to progress towards diabetes on the American Diet. Have found studies that suggest only about half of middle-aged Americans remain completely normal. The question is who falls off the cliff? Fear "thin" pre-diabetics with a genetic history like me may not fare well.***

This is what my testing showed (for me):

Most meals, of course, include a fat and protein component. Fat is the big mediator. As the carb count climbs, fat for me can act to smooth the spike keeping even 1 hour pp under 140 md/dL. However, fat with a *high* carb count seems to work (again, for me) to prevent the second stage insulin release from working effectively. The fat seemingly "captures" and holds the glucose in place. Predictably, high protein/fat but low carb meals are fine. The worst is high protein/fat plus high carb. The typical American meal. That's diabetic range.

I've read a couple of books (Bernstein, Jenny Ruhl), pulled up journal articles, browsed through some websites (primarily Blood Sugar 101).

Due to the strong remaining second-stage insulin release, endo is confident this is type 2. That matches Bernstein/Ruhl, so okay though no further tests (other than quarterly HbA1cs) are planned.

Endo is comfortable the theory that beta cells in the pancreas die from "overwork" has been disproved (believe Jenny Ruhl concurs here) but admits it's still not clear whether eating in a manner that keeps glucose levels close to fasting results in a better outcome than simply maintaining glucose levels under 140 mg/dL. Perhaps following ADA guidelines (ugh), he suggests eating to maintain glucose levels under 140 mg/dL at *2* hours. I'm not, if only because of measurement error.

The endo is reassuring (or tries) about the future since I'm "catching" this at the very earliest stage of the diabetic curve. Prescribed Prandin to lower blood spikes for those times when I eat a large carb-laden meal (holidays, special occasions, travel, caught out without healthy food etc.). Said if I progress, would move to Metformin. Seemed to imply my current age (60) + progression/maintenance time before diabetes + time required to develop complications post-diabetes would get me to a ripe old age! Nice guy, really.

QUESTIONS
This is the only forum I haunt and so am posting here knowing this is a topic that periodically comes up. Probably need to get onto another website. In the interim:

1. Any recommendations for a good diabetes forum?

2. Still unsure about diet. Wanting to eat responsibly but with so much to learn am now losing weight I don't have to lose. For now, am being careful to keep low/moderate carb meals with low fat separate from paleo meals of high protein/fat. Working to time meals. Part of the weight loss is due to getting busy, not eating, then being restricted in the amount I can ingest at any one time. Small carb meals that the remaining first stage insulin release can handle may be preferable to large, less frequent meals. The Zone diet this isn't!

Think Jenny Ruhl (Blood Sugar 101) is great but simple carb counting doesn't work for me. It's the entire meal that needs to be considered.

Anyone have suggestions about sources/approaches for pre-diabetics/diabetics that advocate eating carbs at different times than high fat meals with moderate low-fat protein? Have looked at various paleo websites. Not particularly liking meat etc., I'm just not there yet.

3. How does exercise work to maintain glucose levels? Just ate a high carb/high fat test meal in 15 minutes followed by 30 minutes of exercise. The 1 hour pp reading (at 1 hour) remained identical to the same meal without exercise (right at 140 mg/dL). However, post-exercise glucose levels fell to about 100 pp then "stuck" (it's that fat). Without the exercise, levels would have "stuck" much higher.

So, for me exercise does not seem to be able to replace the first stage insulin release but does help the second stage. Does that make sense?

Sorry for the length. If and when I get on to a diabetes forum I may break this into short, separate posts. But here, feel more confident it's not overkill ...

What I find of most concern is the rapid disintegration in glucose control from last year to this. Know I don't fall into the dataset of those who just need to watch their diet and lose a few pounds. With a teen, this is worrisome.

Everylady
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Old 04-05-2013, 05:23 PM   #2
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I'm a little confused. A1C of 5.3 isn't bad.

Quote:
For someone who doesn't have diabetes, a normal A1C level can range from 4.5 to 6 percent
A1C test: Results - MayoClinic.com
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Old 04-05-2013, 05:53 PM   #3
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Quote:
Originally Posted by EveryLady View Post
This is the only forum I haunt and so am posting here knowing this is a topic that periodically comes up. Probably need to get onto another website. In the interim:

1. Any recommendations for a good diabetes forum?

2. Still unsure about diet. Wanting to eat responsibly but with so much to learn am now losing weight I don't have to lose. For now, am being careful to keep low/moderate carb meals with low fat separate from paleo meals of high protein/fat. Working to time meals. Part of the weight loss is due to getting busy, not eating, then being restricted in the amount I can ingest at any one time. Small carb meals that the remaining first stage insulin release can handle may be preferable to large, less frequent meals. The Zone diet this isn't!

Think Jenny Ruhl (Blood Sugar 101) is great but simple carb counting doesn't work for me. It's the entire meal that needs to be considered.

Anyone have suggestions about sources/approaches for pre-diabetics/diabetics that advocate eating carbs at different times than high fat meals with moderate low-fat protein? Have looked at various paleo websites. Not particularly liking meat etc., I'm just not there yet.

3. How does exercise work to maintain glucose levels? Just ate a high carb/high fat test meal in 15 minutes followed by 30 minutes of exercise. The 1 hour pp reading (at 1 hour) remained identical to the same meal without exercise (right at 140 mg/dL). However, post-exercise glucose levels fell to about 100 pp then "stuck" (it's that fat). Without the exercise, levels would have "stuck" much higher.

So, for me exercise does not seem to be able to replace the first stage insulin release but does help the second stage. Does that make sense?

Sorry for the length. If and when I get on to a diabetes forum I may break this into short, separate posts. But here, feel more confident it's not overkill ...

What I find of most concern is the rapid disintegration in glucose control from last year to this. Know I don't fall into the dataset of those who just need to watch their diet and lose a few pounds. With a teen, this is worrisome.

Everylady
First, you clearly have good understanding and high motivation. Don't worry, you will do fine. My Dad was intelligent, had high motivation, but none of the things like meters that help us today, yet he did fine. He was also lean and exercised regularly his entire life.

For me, Jenny Ruhl rules. She isn't selling anything, she is smart, and she hates phonies. All good traits in my book. I really don't bother with forums, so I have no ideas on that. Use Google and Pub Med and read the people who know something.

Are you sure you have really cut carbs enough? I use a scale, and I have also cut whole categories of carb foods completely from my diet. IT's been years, and I have not progressed to being a diabetic. At 5'10", I weigh 150 and have never weighed more than 160 in my life. There are plenty people in good condition who get sugar troubles.

RE: exercise, I don't think it has any effect at all of insulin release, but more with uptake of glucose into cells, especially muscle cells. Some of this is insulin dependent, some uptake by other pathways not using insulin.

Easy going exercise works better for sugar control than hard going. Try to find a meal plan that does not push you over 140mg/dl, then get on your exercise bike or whatever and just go at a relaxed rate ay for 15 minutes. Check your blood, see what has happened. Just vary things until you are satisfied that things are going well.

About your child- that is harder, because if there is one thing kids like it is carbs. Good luck with it, and s/he may never have any problems.

PS, the people who just have to lose some weight are fat people. Not necessarily really fat, but too fat for their metabolism. But people like me and you and I think about 20% of all diabetics are lean. Our problem, whatever it is, is not weight or fat. It annoys me when people who know nothing like to talk about diabetes being a self inflicted disease; for the most part, it is not.

Ha
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Old 04-05-2013, 05:59 PM   #4
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Quote:
Originally Posted by braumeister View Post
I'm a little confused. A1C of 5.3 isn't bad.


A1C test: Results - MayoClinic.com
I think she said she went over 200mg/dl on a GTT or other carb challenge. A1C can be misleading-if someone is too high for some time, it can be that by going too low, the A1C stays normal or nearly normal. My last A1C was 5.3, and I have never had one higher than 5.8, but if I had a big slice of pie and tested with a meter it would look bad indeed. I am not going to do that.

Ha
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Old 04-05-2013, 06:18 PM   #5
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+1 on Braumeister comment re your A1C results. While the purist can get excited about it, it is well in the range of results for normal. I found this posting very helpful in appreciating the wide variations of results that are still "normal" The Normal A1C Level - A1C and blood sugars - Diabetes.
As you expand your research in diabetes, you will find how much politics are in play between the various interest groups in setting the so called "limits"
Personally, I found sustaining a low carb discipline as effective as any action in keeping my blood sugar down. My A1C is 5.1. I went back and reviewed my various medical checkups and found fasting glucose results from 15 years ago as high as 108 and as low as 94. The 108 came back when the threshold was 120 and it did not even generate a flag for the physician. As your endo probably told you, genetics has as much to do with blood sugar impact as life style.
Chris Kessler's blog has a lot on diet and diabetes. One posting you may also find of interest is Why hemoglobin A1c is not a reliable marker
Good Luck and stay cool--your values while high may in fact be your normal.
Nwsteve
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Old 04-05-2013, 07:29 PM   #6
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Originally Posted by braumeister View Post
I'm a little confused. A1C of 5.3 isn't bad.


A1C test: Results - MayoClinic.com
Pretty easy to get confused with a post that long and wordy. It is true that most pre-diabetics and diabetics are diagnosed higher *then* work to achieve levels below 5.7.

The 5.3 is so low because I was already eating relatively "healthy" food in reasonable quantities. More, the A1C is, of course, an average. For me, highs well above 140 mg/dL are being counterbalanced by lows that fall into the 50s. I can drop 100 mg/dL in an hour; declines like that even from non-diabetic levels are not thought healthy for small blood vessels. Reactive hypoglycemia. More, have read highs above 140 mg/dL murder the pancreatic beta cells that release insulin.

There's no need for me to abandon the relatively healthy diet to eat to achieve a higher A1C, which would almost certain happen. The measurement that matters (post prandial) shows up on a glucose meter. Based on the meter readings above 200 mg/dL I can achieve on a typically American high carb/high fat/high protein meal, some endos might slap a "diabetes" diagnosis on even without an OGTT? Didn't think to ask the endo about an OGTT. Mainly because figure there's a chance I could "pass" it since the second-stage insulin release remains strong enough to handle large loads of carb only (no fat).

What concerns me is the slippage in postprandial glucose control from 2012 to 2013 shown using a glucose meter. Same diet, same HbA1c. Last year I wasn't pre-diabetic, this year I am.

Being upset and worried and not liking any of "this," I just want to *know.* The endo says no to type 1.5, which is a relief. Like Ha says, the popular press has it that type 2 can be avoided. Wish it were. The endo says "genetics." I think there doesn't have to be an autoimmune attack going on for type 2s to have beta cells that die on their own.

The only difference between this year and last was a bloody cruise I took in August where I ate like a pig for a week. Came home 5 pounds heavier. More, I'd previously injured a tailbone that I was nursing and cut the exercise until it healed months later. After the cruise, I experienced the intense sugar cravings and continuous hunger pains that Jenny Ruhl (Blood Sugar 101) describes as preceding the weight gain common to many type 2s.

Sheer will power got me through it (months long) without overeating; hence the still low A1C. So either I killed off a bunch of beta cells during that cruise or they have a genetically-determined expiration date. Time will tell ... aaaaagh.
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Old 04-05-2013, 07:44 PM   #7
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Suspect some people do this out of the false hope that they can control their destiny through behavior (I don't smoke, therefore I won't get lung cancer; I don't drink, therefore my liver will be OK, etc.) The last thing a person with a disease needs is to be made to feel guilty on top of it all.

My limited understanding of diabetes (it's in my family) is that conscientious people do best, because they monitor and self-regulate. It sounds like OP is one of those folks. Best wishes for a long, symptom-free life to come.

Amethyst

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It annoys me when people who know nothing like to talk about diabetes being a self inflicted disease; for the most part, it is not.

Ha
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Old 04-05-2013, 07:53 PM   #8
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Are you sure you have really cut carbs enough? I use a scale, and I have also cut whole categories of carb foods completely from my diet. ... IT's been years, and I have not progressed to being a diabetic. ... RE: exercise, I don't think it has any effect at all of insulin release, but more with uptake of glucose into cells, especially muscle cells. Some of this is insulin dependent, some uptake by other pathways not using insulin. Ha
Yes, I'm still holding on to those carbs! Per the meter, a low to moderate amount remains fine for me as long as in a meal separate from later consumed fats, even protein. The concern I had/have is whether requiring the beta cells to produce insulin to cover them is wise. The endo (and I believe, Jenny) say it's okay. Appreciate, though, that diabetes (high glucose levels) is a symptom. Several underlying metabolic conditions could precede it so who knows for any one individual.

I'd hoped, Ha, you'd reply knowing you were another thin but glucose-challenged person. Good to hear you've been stable for years.

And, yes, exercise can help with insulin resistance and does nothing for insulin insufficiency. Got lost in that long post of mine myself. From what I've read, it is difficult even with insulin to replicate a missing or, in my case, diminished first stage insulin release. In a normal person, the release occurs almost instantaneously minimizing post-meal spikes. So guess it makes sense that this afternoon's test exercise post high-carb, high-fat meal did nothing for the one hour post-prandial reading but did seem to help with the subsequent measurements.

Does that square with what you've been achieving on the rowing machine? Or do you not drive up your blood sugars under any circumstances. Not even to test?
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Old 04-06-2013, 08:48 AM   #9
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Technical read, but may find this interesting (if you haven't seen it already).

Diagnosis and Classification of Diabetes Mellitus

Agree that content of the whole meal needs to be considered. Most info on glycemic index of various individual foods was collected when that food was eaten by itself.
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Old 04-06-2013, 09:42 AM   #10
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OP,

This is the best diabetes forum I have come across. I would try posting your situation there as your situation is well beyond my knowledge base:

Diabetes Forums
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Old 04-06-2013, 10:25 AM   #11
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Originally Posted by EveryLady View Post
Anyone have suggestions about sources/approaches for pre-diabetics/diabetics that advocate eating carbs at different times than high fat meals with moderate low-fat protein? Have looked at various paleo websites. Not particularly liking meat etc., I'm just not there yet.
I don't know that these sources will answer your question exactly but they should give you a place to begin your research (there are, of course MANY more but these are the ones I follow):

Dr James Carlson Low Carb Nutritional Expert
Empowered Sustenance - Eat well and heal!? (I highly recommend)
Fat Head - Blog site for the comedy-documentary Fat Head
Gary Taubes
Hyperlipid
Jimmy Moore's Livin' La Vida Low Carb Blog
The Blog of Michael R. Eades, M.D. A critical look at nutritional science.
Perfect Health Diet - A diet for healing chronic disease, restoring youthful vitality, and achieving long life
The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D.
Seth's Blog
The Paleo Dietitian's Blog
Zo Harcombe; Obesity Researcher, Author The Harcombe Diet


And for the Thyroid issue:
Home | Stop The Thyroid Madness
www.thyroid-s.com
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Old 04-07-2013, 02:10 PM   #12
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For me, Jenny Ruhl rules. She isn't selling anything, she is smart, and she hates phonies. All good traits in my book. I really don't bother with forums, so I have no ideas on that. Use Google and Pub Med and read the people who know something.

Ha
agree 100% with Jenny Ruhl she has a way of explaining it to the everyday
person. She use to post on Dr. Bernstein's Diabetes Forum back when
I read every post after getting some pretty high blood sugar levels . It is still a great place to get info. but Jenny Ruhl's book
is a must read.
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Old 04-07-2013, 02:26 PM   #13
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Jenny Ruhl's Blog can be found at http://diabetesupdate.blogspot.com/feeds/posts/default
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Old 04-08-2013, 02:06 PM   #14
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OP,

This is the best diabetes forum I have come across.

Diabetes Forums
Thank you so much. Briefly looked at a few forums but just didn't have the emotional energy to figure out which *one.* And want to keep it at that - just one. Need to get on to new recipes and more productive exercise etc. Currently have a stack of almond flours, Da Vinci syrups and the like on the top of the fridge but have yet to try them out.

Too, many thanks to others for the cites. Last night before bed, started going through them. Turned out not to be the most soothing bed time reading. Later dreamt I had gone completely bald, probably not desirable since "EveryLady" is a lady.

The main thing is it was just downright nice to hear helpful words. Plus, guess the forum was venue for me to get on my "buy a meter" soapbox that I know most friends won't want to hear. So there, I've kept quiet. What Amethyst says rings so true.

Similarly, I haven't spoken to my brothers since the last endo visit knowing this is news they *really* don't want to hear. One is a confirmed vegan, the other two are in the midst of non-related health issues. Of my 3 maternal cousins, did discover one has a HbA1C of 6.1. Her GP told her to ignore it since the result was "barely over the line." She's another thin (possibly) Pre-D at a skinny 105 pounds, but is stressed to the max dealing with my aging aunt. So I don't have the heart yet to call her.


Again, thanks.
Everlady.
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