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
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
It is true that most pre-diabetics and diabetics are diagnosed higher *then* work to achieve levels below 5.7.
