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Pre diabetes: Expert recommendations?

P

Philgk

New Member
Hi all.

Any recommendations please for a really good medical expert on diabetes… specifically for a non typical pre-diabetic.

Please see below:

I’ve been prediabetic for 12+ years, with constant HbA1c at 44.
Always healthy eating, not overweight, lots of exercise etc.
Think it’s largely genetic, as siblings also prediabetic.
No health issues until 2024 diagnosed diabetic peripheral neuropathy ( nerve damage in right foot). This has focussed my mind on trying to reduce HbA1c, but after eight months reduced carbs, & increased exercise, I’ve list a few pounds of fat & gained muscle, but still same 44 reading.

I’ve read all the generic “at risk of type two” info … I’m already doing it all & it’s not working.

I think my foolish body thinks 44 is a normal level … so won’t allow me to get it any lower.
I’ve also tried a CGM - and my blood glucose spikes and drops on its own … but rarely drops under 8. So constantly just above the 4-7 normal range. Again … my body naturally reduces the blood glucose level after eating , but seems to think 8 is ok instead of say 6.5 !!

I’m trying to find someone with REAL medical expertise, who might have an answer.

Thanks.

P
 
Welcome to the forum
People don't necessarily have medical knowledge but a wealth of knowledge based on their own experience.
One thing that comes to mind is that many think they eat healthily but it is still too high in carbohydrates for many to tolerate so you say you are having reduced carbs but how much are you actually having. Many who are dietary managed need to be less than 100g carbs per day.
It might be worth reviewing your diet. The rule of thumb is that a meal shouldn't cause an increase of more than 2-3mmol/l from before eating to 2 hours after or more than 8-8.5mmol/l
You may glean some ideas from this link https://lowcarbfreshwell.com/
 
Last edited:
I got under 8mmol/l at the 2 hour test after meals by testing and adjusting carbs and foods - then I stuck to the same meals and my numbers gradually went down, and down - sometimes to under 6 as my metabolism sorted itself out.
I think that the concept of lower carbs lower glucose lower HbA1c, all better, is rather lost on many medical people.
My daily limit is 40 gm of carbs but I can eat well enough on that, so I do.
 
Philgk said:
Hi all.

Any recommendations please for a really good medical expert on diabetes… specifically for a non typical pre-diabetic.

Please see below:

I’ve been prediabetic for 12+ years, with constant HbA1c at 44.
Always healthy eating, not overweight, lots of exercise etc.
Think it’s largely genetic, as siblings also prediabetic.
No health issues until 2024 diagnosed diabetic peripheral neuropathy ( nerve damage in right foot). This has focussed my mind on trying to reduce HbA1c, but after eight months reduced carbs, & increased exercise, I’ve list a few pounds of fat & gained muscle, but still same 44 reading.

I’ve read all the generic “at risk of type two” info … I’m already doing it all & it’s not working.

I think my foolish body thinks 44 is a normal level … so won’t allow me to get it any lower.
I’ve also tried a CGM - and my blood glucose spikes and drops on its own … but rarely drops under 8. So constantly just above the 4-7 normal range. Again … my body naturally reduces the blood glucose level after eating , but seems to think 8 is ok instead of say 6.5 !!

I’m trying to find someone with REAL medical expertise, who might have an answer.

Thanks.

P
Click to expand...
forum.diabetes.org.uk

Any advice/help appreciated ? Treatment induced neuropathy

Hi. I'm a newbie, but unfortunately not to being type 2 diabetic. I have had diabetes for over 20 years I rapidly reduced my hba1c from 80mmol in January to 50 mmol in July, everyone pleased about it (Including me) but then in September had sudden numbness/pain and weakness in legs and feet...
forum.diabetes.org.uk forum.diabetes.org.uk
Another thread running atm re neuropathy.

I'm not very good with tech stuff but I think that's worked.
 
Hi and welcome.

Can I ask who diagnosed peripheral neuropathy and what tests they did?

The reason I ask is that I had been lead to believe that diabetic neuropathy usually affects both legs/feet/hands/arms ie bilaterally rather than just one. I stand to be corrected on that but I know that once you have a diabetes label, it is very easy for health care professionals to assign any ailment you suffer to the diabetes, when sometimes it isn't and in your case with just being at risk of diabetes means you are at low risk of developing complications. Not saying it can't or doesn't happen but you have to be pretty unlucky, which all makes me wonder if your peripheral neuropathy diagnosis is correct.
I do believe that there is a range of normal with many functions of the body including blood glucose levels and there are always outliers slightly beyond that range which may still just be normal for that individual.

I am not saying that you don't have peripheral neuropathy or that you are not at risk of developing diabetes, but I am perhaps slightly sceptical, especially as you have taken steps to address the issue and not seen any improvement. I look forward to your reply to the question about how low carb you went, but I just think it doesn't quite add up. I think you are right that there may be a genetic element to having a slightly raised HbA1c but it may have something to do with your familial blood composition than a predisposition to diabetes.

Can you describe the pain/discomfort you get in your foot?

Those are just my very non expert, non professional thoughts on your situation.
 
rebrascora said:
Hi and welcome.

Can I ask who diagnosed peripheral neuropathy and what tests they did?

The reason I ask is that I had been lead to believe that diabetic neuropathy usually affects both legs/feet/hands/arms ie bilaterally rather than just one. I stand to be corrected on that but I know that once you have a diabetes label, it is very easy for health care professionals to assign any ailment you suffer to the diabetes, when sometimes it isn't and in your case with just being at risk of diabetes means you are at low risk of developing complications. Not saying it can't or doesn't happen but you have to be pretty unlucky, which all makes me wonder if your peripheral neuropathy diagnosis is correct.
I do believe that there is a range of normal with many functions of the body including blood glucose levels and there are always outliers slightly beyond that range which may still just be normal for that individual.

I am not saying that you don't have peripheral neuropathy or that you are not at risk of developing diabetes, but I am perhaps slightly sceptical, especially as you have taken steps to address the issue and not seen any improvement. I look forward to your reply to the question about how low carb you went, but I just think it doesn't quite add up. I think you are right that there may be a genetic element to having a slightly raised HbA1c but it may have something to do with your familial blood composition than a predisposition to diabetes.

Can you describe the pain/discomfort you get in your foot?

Those are just my very non expert, non professional thoughts on your situation.
Click to expand...
Mine can be one side, both sides, face one side foot the other...varies. As I type can feel face starting left temple, left cheek.
 
In the early noughties, I dropped the grill pan - a full double width one, stove enamelled 'heavy metal' one vertically downwards onto the nail bed of my left big toe whilst I was drying it up after dinner whilst in France in our motorhome. It hurt that much it rendered me entirely unable to speak for almost half an hour. That may not sound significant to anyone that doesn't know me - but anyone that does know me will immediately know that it was. I literally couldn't even utter the SWEAR words I was thinking. Or cry. Had the same overall effect on me as being comprehensively winded. Just without the visible bruising next day though. Since then I've had less feeling in one side of the end of that big toe and if you look at the nerve pattern in a healthy big toe, the nerve going to that one branches in two - so I evidently only damaged one branch. D consultant smiled and said 'Diabetic neuropathy!' and I responded with 'Oh come on now doctor S - how long have you been a diabetes consultant ? cos I've had diabetes for 30 something years - and I've so far never ever seen anyone suggest that diabetic neuropathy can be unilateral. So, have you?' And - no, he hadn't. And he still hasn't.
 
Leadinglights said:
The rule of thumb is that a meal shouldn't cause an increase of more than 2-3mmol/l from before eating to 2 hours after or more than 8-8.5mmol/l
Click to expand...
Thanks for that ...yes with CGM my blood glucose peaks after a meal, then drops back down within two hours.. to around 8mmol/l. So it makes me think my body is reacting OK to the glucose, BUT just doesn't want tp push by background blood sugar level below 8, to a healthier 5-6.
 
Thanks all... the nerve damage has been diagnosed by a highly experienced physio, and a neurologist who did electrical tests. They both say YES it can be one sided in some cases (my left foot has very slight symptoms, compared to right) .

It's impossible to say 100% if it is caused by diabetes - there's apparently no test to show that. They have to make a best guess as to likely cause. As my HbA1c is constantly in the pre-diabetic range, it makes sense to try to tackle that as most likely cause. Obviously I don't want it to get any worse, so willing to try all sorts of things to arrest it, and who knows maybe reverse it a little.

My prob is I've been on 120-140g carbs a day for six months, and it's had no impact on my HbA1c. Any less carbs and I won't have enough energy to fuel my active lifestyle. BMI is 23... could go lower but I'm trying to build muscle. (ps: BMI is a pretty terrible crude measure).
 
Fuel is not a problem. Your body can run on fat instead of carbs, but you do need to increase your fat and protein intake when you go lower carb. I know that we have been told for years that fat is bad but I find my body runs better on it and is more healthy (several health issues have dramatically improved) and cholesterol levels have come down slightly from when I was on a high carb, low fat diet and my cholesterol has stayed below 5 for the last 6 years since diagnosis and going low carb. I aim for about 70g carbs a day, sometimes lower, sometimes a bit higher.
 
Philgk said:
My prob is I've been on 120-140g carbs a day for six months, and it's had no impact on my HbA1c. Any less carbs and I won't have enough energy to fuel my active lifestyle.
Click to expand...

That is simply not correct. Protein and healthy fat are essential micronututrients. Carbs are not. If you want to get back to normal HbA1c levels (say 32-38) you will have to lose some weight to get rid of any excess visceral fat. That means carbs down to around 50g/day (weight loss) not 130g/day (weight maintenance). Success is not guaranteed as too many beta cells in your pancreas may be too damaged to recover. The experts say the only way to find our is to try.

Some links:

- realmealrevolution.com/the-books (get a copy of the original RMR book with the essay by Prof Tim Noakes)

- Roy Taylor, Achieving T2D remission (May 2023):

- Information for Doctors:

-
- The nuts & bolts of drug free T2 diabetes remission by Dr David Unwin: 


Research early time restricted eating (eTRE) - roughly eat before noon to minimise muscle loss (10% v 30%).
Also try 5:2 fasting or similar.

Good luck
 
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