Newbie with query

[Clay]

Hi

I'm male, in my 60s, and up until yesterday was aware I was borderline prediabetic, but to my surprise (see below) I now find I've quickly progressed, over the past 3 months or so, to being diabetic.

I'll start by apologising in advance for the length of this as a first post but thought I might as well just dive in.

I would be grateful for any views on the following. I will be discussing this with my GP but I have over a week to wait for the earliest available phone appointment and I'd like to try and gauge beforehand if my experience is fairly typical, or not.

In November last year I got a text from my GP saying that my regular blood test - a general annual test not specifically aimed at identifying or measuring impaired glucose tolerance - showed that I was prediabetic: HbA1c had risen to 43. In retrospect this should have been no surprise as I was overweight (having lost and regained weight quite a lot at times over the years) with a waistline over the recommended size limit, BMI of 28.2 as well as suffering from hypertension. I actually had a fairly good diet which I'd followed for some years before that, very similar to the Mediterranean diet and avoiding most sugary foods where I could. It's years since I pretty much stopped eating any stuff like cakes, biscuits, desserts, sweets, snack foods, fruit juices, fizzy drinks etc. However, I did eat large amounts of fruit every day, on the understanding (wrong, as it turned out) that it wouldn't have the effect on blood sugar of other sugar sources. Obviously I was eating too much anyway, good diet or not. I have no family history of diabetes.

Immediately following that text I set out to lose weight (again), maintain activity levels and further tweak my diet to address the prediabetes.

Roll on 14 weeks or so from that November result and this week I had another (private) HbA1c blood test which showed theHbA1c level has risen significantly - to 52 - which is of course firmly in the diabetic category - from that 'prediabetic' level of 43 only those 14 weeks earlier.

What makes this rise so surprising to me, however, and extremely disappointing, is that in that same 14 week period between the two tests I had managed to lose 17.5 kg (from 86.25 kg to 68.75 kg), a loss of just over 20% of my body weight. This has reduced my BMI from 28.2 to a 'normal' 22.5 and my waistline has shrunk from over the recommended maximum to well within it, with close monitoring of any carbs consumed in the diet throughout. My blood pressure has come down significantly. I've remained fairly active - I do regular longish (4 to 7 mile) walks, usually at just under 4 mph, which I think is considered brisk at my age, and some light resistance training. I do drink alcohol now and again, but very little, maybe 3 or 4 units a week at most, and not even that in the last few weeks.

The weight loss since November is what prompted me to go and have this week's blood test. I wanted to see if, with over 90 days having elapsed since the previous test, it might have had a beneficial effect. Frankly, I expected to see an improvement. Instead, however, the HbA1c numbers have gone in the opposite direction to the weight.

As I said above I will follow this up with my GP in due course but in the meantime would be interested in any views as to whether this is a normal progression in the experience of people on here who know more about diabetes. The steepness of the rise over 14 weeks certainly surprised me, I thought I was doing all the right things to prevent the prediabetes developing into T2D.

I know this post is already long (sorry) but can I just add that I seem to have successfully reversed prediabetes in the past through weight loss, without even realising I had it. Looking back recently through older blood test results in my NHS records I saw that I had in fact had an HbA1c level of 43 previously, back in May 2018 (I remember this being pointed out to me at the time as something to keep an eye on, though prediabetes wasn't specifically flagged up and I wasn't aware of prediabetes as a condition back then). However, I also note in those records that by the end of 2019, when I had my next routine blood test after that, the HbA1c level had come down to 34. By coincidence the latter test had been done at a point when, my own records show, I had just lost a lot of weight, about 16kg down from the May 2018 level. This encouraged me to think weight loss on my current diet would be likely to have a similar effect. I note also that weight loss seems to be the central plank of T2D treatment approaches such as the NHS Paths to Remission programme and the studies it is based on.

Anyway apologies again for jumping in with such a long post but I'd be grateful to know if I should be as surprised and disappointed as I am, or is my experience fairly typical? Btw I have none of the usual T2D symptoms as far as I can judge, beyond the HbA1c test result.

 

[rebrascora]

Hi and welcome.

Yes, I can understand your result must be very disappointing with the effort you have clearly put in and not typical of many experiences here but there are one or two members whose results have not responding as you might expect/hope and it is possible that they may not be Type 2 or perhaps a subset of Type 2 which doesn't respond to lifestyle changes for some reason.
There are also other things which can inflate your HbA1c, like anaemia, so that might be worth checking with your GP that your blood composition is in range. HbA1c is a measure of the amount of glucose stuck to your red blood cells over the course of their lifespan... approx. 2-3 months. Less than normal red blood cells may attract and carry more glucose molecules due to lower distribution in the blood.

Other types of diabetes like Type 1 or Type 3c can come on more slowly and initially present as Type 2 and people are often misdiagnosed simply because they are more mature adults and Type 2 is much more common. Your HbA1c result just tells you that you are diabetic not what type of diabetes you have. It is easy for medical professionals to just assume you are Type 2 particularly if you are middle aged and a bit overweight at diagnosis. There are plenty of members of this forum who were initially assumed to be Type 2 but turned out to be Type 1 or Type 3c which is a relatively new category that many GPs have not even heard of. With Type 1, your immune system mistakenly starts to kill off the beta cells in the pancreas which produce insulin so insulin production falls whereas with Type 2 at diagnosis, particularly if it has been caught early as yours has, the body is usually producing excess insulin to overcome insulin resistance and losing weight will generally restore insulin sensitivity and enable the body to rebalance BG levels. Type 2 is basically metabolic.
Type 3c involves damage to the pancreas from other means like inflammation (pancreatitis sometimes associated with gall stones), alcoholism, disease (cysts or tumours), trauma or surgery. So for example if you had a history of gall stones or abdominal pain, Type 3c might be something to consider.

Obviously your HbA1c is still relatively low which is why you are not experiencing any typical symptoms of diabetes. Many of us were diagnosed with an HbA1c in 3 figures and that is the sort of level where symptoms become apparent, so you are obviously a long way off that yet, but an increase of 9mmols/mol in 14 weeks, despite your best dietary efforts suggests it might have risen a lot quicker if you hadn't taken the steps you have over that period.

I very much doubt a health care professional would consider that you might be anything other than Type 2 at this stage but it is worth just mentioning it to them as a possibility because your levels haven't responded to the significant changes you have made and if it continues to rise and doesn't respond to oral Type 2 meds then keep pushing for additional testing for possible Type 1. If those tests were done at this stage you might find them inconclusive so rather than push for them now, just see what happens for the next few months.

I think you might benefit from investing in a BG meter to test your levels at home on a regular basis to see if particular foods are causing you problems and adjust your diet according to those results, generally testing just before and then 2 hours after meals will show you if your body is not coping well. A rise of more than 3mmols or more during that time period would indicate that there were carbs on your plate that your body struggled with and sometimes it can be quite individual as to which carbs affect which people. Porridge is one of the classic examples as it is often suggested as an ideal breakfast choice for people with diabetes because it is supposedly slow release but some of us find it is like rocket fuel whereas others find it lives up to it's slow release reputation.

Anyway, I have probably written too much and hope I haven't confused you, but just some of my thoughts on your situation.

 

[Leadinglights]

I agree that getting a blood glucose monitor so you can do some finger prick testing of your meals by testing before you eat and after 2 hours when you would aim for no more than a 2-3mmol/l increase or no more than 8-8.5mmol/l after the 2 hours. This will tell you if your meals are too carb heavy. Many feel they have a healthy diet but still may be having foods which are too carb heavy for the body to tolerate. Fruit can be especially deceiving as other than berries most are quite high carb and are foods which people tend to snack on as extras.
This link may help you see what variety of meals you can have which are low carb and is based on the suggested no more than 130g carbs not just sugar per day as a good starting point. https://lowcarbfreshwell.com/
Many find it a good plan to keep a food diary of everything you eat and drink and estimate how many carbs, you can see how far you are from the suggested amount. You can also incorporate the paired blood glucose readings as well.

 

[harbottle]

Could be liver is still insulin resistant, so morning levels may be elevated. Worth checking them.
Weight loss that's rapid may introduce free fatty acids in the blood, which causes insulin resistance.
Any hidden carbs in your meals?
Any stress or illness?

Might be worth taking some readings and seeing if there's a trend.

 

[Proud to be erratic]

Hi @Clay,
The response by @rebrascora above (#2) has so many relevant points, which are perhaps (with due apologies to her) buried within the breadth of her response. I've copied just a few of those points and pasted these below, somewhat rearranged in sequence:

"Your HbA1c result just tells you that you are diabetic not what type of diabetes you have".
"With Type 1, your immune system mistakenly starts to kill off the beta cells in the pancreas which produce insulin so insulin production falls". I would add: T1 is a very specific type of Diabetes.
...... "whereas with Type 2 at diagnosis, particularly if it has been caught early as yours has, the body is usually producing excess insulin to overcome insulin resistance and losing weight will generally restore insulin sensitivity and enable the body to rebalance BG levels. Type 2 is basically metabolic."
...... "it is possible that you may not be Type 2 or perhaps a subset of Type 2 which doesn't respond to lifestyle changes for some reason."
"Type 3c involves damage to the pancreas from other means like inflammation (pancreatitis sometimes associated with gall stones), alcoholism, disease (cysts or tumours), trauma or surgery. So for example if you had a history of gall stones or abdominal pain, Type 3c might be something to consider." I would add T3c is still a very small proportion of the total diabetic community.
"There are plenty of members of this forum who were initially assumed to be Type 2 but turned out to be Type 1 or Type 3c which is a relatively new category that many GPs have not even heard of."

Other responses introduce further "twists" in what is already a complex weave. GPs are, by definition, General Practicioners and they are not Specialists in Diabetes. Type 2 diabetes is not simple in the first place and it can be a challenge even for Specialists to seperate the different sub-sets of T2 into an appropriate and precisely correct diagnosis - from the broad Guidelines that the NICE provide to "guide" GPs. So there can be many more peripheral factors that can further explain why your initial response has not been what you hoped for or expected - and this is undoubtedly frustrating for you.

But, my non-medical thought is in line with @rebrascora: "just see what happens for the next few months". Plus buying a meter to do some structured BG testing could be very helpful to you, in assisting you to adjust your diet and reduce or possibly exclude certain meals or food types. Or structured testing could provide clearer data to allow your GP or a Specialist to review your standard T2 diagnosis. Generally Diabetes is a slow-moving foe, once the existence of elevated BG has been recognised. [NB: I don't personally think much about T2 is standard; we are all different.]

 

[HayleyR]

Hi @Clay and welcome to the forum 🙂 . As you can see already this is a great place to get information/advice based on members own thoughts and experiences. I definitely agree that a monitor would be so useful for you to see how the food you're eating affect the BG. Personally I limit the amount of fruit I eat as the natural sugars really elevate my glucose levels even fruit like bananas. I hope your follow-up appointment with GP to discuss blood test results goes well

 

[pjgtech]

Great advice above, so I'll not repeat it.
Really check what you are eating, as many foods thought to be helpful, can actually be high carb, which if you are T2, you will want to reduce or remove, eg: below ground root veg, and lots of fruit are high carb, bananas and any exotic fruits, pineapple, etc. Good luck with it and keep us updated, cheers

 

[counsellorneil]

As mentioned testing your glucose levels will be a great help in determining what is happening in your body when eating various foods. To save money, initially, rather than buying a blood glucose testing monitor, you could try to get a free trial of the FreeStyle Libre+, which will give you 15 days of continuous glucose levels, so you can see what’s happening throughout the day and overnight.

Sampling | Diabetes Care | Abbott

Claim your 15 day free sensor if you have diabetes and have not tried the FreeStyle Libre 2 plus sensor before

www.freestyle.abbott

 

[everydayupsanddowns]

Welcome to the forum @Clay

Sorry to hear your follow-up HbA1c didn’t show the reduction you might have expected given the effort you had put in, and the weight you had lost.

I think it’s perfectly natural to be a little confused, and a bit miffed about it to be honest. Try not to be discouraged - you’ve seen positive impact on your BP, and losing weight is beneficial in reducing risks of many things, so keep going, and hopefully you’ll get some clarity over your exact diabetes type, and the best management approach for you over the coming weeks and months.

Let us know how the chat with your GP goes.

 

[Clay]

Hi and welcome.

Yes, I can understand your result must be very disappointing with the effort you have clearly put in and not typical of many experiences here but there are one or two members whose results have not responding as you might expect/hope and it is possible that they may not be Type 2 or perhaps a subset of Type 2 which doesn't respond to lifestyle changes for some reason.
There are also other things which can inflate your HbA1c, like anaemia, so that might be worth checking with your GP that your blood composition is in range. HbA1c is a measure of the amount of glucose stuck to your red blood cells over the course of their lifespan... approx. 2-3 months. Less than normal red blood cells may attract and carry more glucose molecules due to lower distribution in the blood.

Other types of diabetes like Type 1 or Type 3c can come on more slowly and initially present as Type 2 and people are often misdiagnosed simply because they are more mature adults and Type 2 is much more common. Your HbA1c result just tells you that you are diabetic not what type of diabetes you have. It is easy for medical professionals to just assume you are Type 2 particularly if you are middle aged and a bit overweight at diagnosis. There are plenty of members of this forum who were initially assumed to be Type 2 but turned out to be Type 1 or Type 3c which is a relatively new category that many GPs have not even heard of. With Type 1, your immune system mistakenly starts to kill off the beta cells in the pancreas which produce insulin so insulin production falls whereas with Type 2 at diagnosis, particularly if it has been caught early as yours has, the body is usually producing excess insulin to overcome insulin resistance and losing weight will generally restore insulin sensitivity and enable the body to rebalance BG levels. Type 2 is basically metabolic.
Type 3c involves damage to the pancreas from other means like inflammation (pancreatitis sometimes associated with gall stones), alcoholism, disease (cysts or tumours), trauma or surgery. So for example if you had a history of gall stones or abdominal pain, Type 3c might be something to consider.

Obviously your HbA1c is still relatively low which is why you are not experiencing any typical symptoms of diabetes. Many of us were diagnosed with an HbA1c in 3 figures and that is the sort of level where symptoms become apparent, so you are obviously a long way off that yet, but an increase of 9mmols/mol in 14 weeks, despite your best dietary efforts suggests it might have risen a lot quicker if you hadn't taken the steps you have over that period.

I very much doubt a health care professional would consider that you might be anything other than Type 2 at this stage but it is worth just mentioning it to them as a possibility because your levels haven't responded to the significant changes you have made and if it continues to rise and doesn't respond to oral Type 2 meds then keep pushing for additional testing for possible Type 1. If those tests were done at this stage you might find them inconclusive so rather than push for them now, just see what happens for the next few months.

I think you might benefit from investing in a BG meter to test your levels at home on a regular basis to see if particular foods are causing you problems and adjust your diet according to those results, generally testing just before and then 2 hours after meals will show you if your body is not coping well. A rise of more than 3mmols or more during that time period would indicate that there were carbs on your plate that your body struggled with and sometimes it can be quite individual as to which carbs affect which people. Porridge is one of the classic examples as it is often suggested as an ideal breakfast choice for people with diabetes because it is supposedly slow release but some of us find it is like rocket fuel whereas others find it lives up to it's slow release reputation.

Anyway, I have probably written too much and hope I haven't confused you, but just some of my thoughts on your situation.

Thank you for providing such a detailed and considered response, I've already found this very helpful. Very thorough and knowledgeable and I've been picking through it. I'm not bad at searching out the more general info for myself but most of what you have suggested here just wouldn't even have occurred to me to look for, and wouldn't be in the usual online patient-targeted material anyway. It gives me a much wider background for when I speak to my GP.

Type 3C, for example, I'm not sure I'd even heard of it. I have ulcerative colitis, an inflammatory condition. It's three years since the end of the last flare-up and I don't get abdominal pain with it, there may well be no link but even if it's just a remote possibility it's one I didn't know about. Type 1 I knew about of course but as you point out there does seem to tendency in the online info to categorise it as being far less likely to occur in mature adults, and I hadn't really considered the possibility that I might be Type 1.

As a practical takeaway I'll get a BG meter, I keep a detailed record of everything I eat and drink but I didn't realise the extent to which responses might vary between individuals and, the broad brush approach having failed, I might benefit from focusing in a bit on the detail.

Thanks again.

 

[Clay]

I agree that getting a blood glucose monitor so you can do some finger prick testing of your meals by testing before you eat and after 2 hours when you would aim for no more than a 2-3mmol/l increase or no more than 8-8.5mmol/l after the 2 hours. This will tell you if your meals are too carb heavy. Many feel they have a healthy diet but still may be having foods which are too carb heavy for the body to tolerate. Fruit can be especially deceiving as other than berries most are quite high carb and are foods which people tend to snack on as extras.
This link may help you see what variety of meals you can have which are low carb and is based on the suggested no more than 130g carbs not just sugar per day as a good starting point. https://lowcarbfreshwell.com/
Many find it a good plan to keep a food diary of everything you eat and drink and estimate how many carbs, you can see how far you are from the suggested amount. You can also incorporate the paired blood glucose readings as well.

Thanks for this. Yes I think I'll take up the suggestion of starting to use a BG meter. I hadn't realised the variations in effect from person to person.

I already keep a detailed food/drink/activity etc diary but the 130g carb limit is probably something I should be looking to build in, as my approach so far has been a more general 'keep the carbs low' kind of thing. With the fruit, yes since being tested in November as prediabetic I have shifted to a large extent away from bananas, pears,apples etc towards berries. Bananas and pears in particular had been a deliberate inclusion in my diet as I think they're the kind of food that helps keep ulcerative colitis, which has flared up over the years, at bay, so I was a bit reluctant to phase them out. For the same reason I still sometimes have wholegrain bran flakes for breakfast, carb heavy though they may be.

 

[rebrascora]

Pleased some of my thoughts have been helpful in broadening your approach with respect to your GP.
We have a relatively new member (joined just before Christmas I think) who also has ulcerative colitis and is not a standard Type 2 and in fact was suspected to be a Type 1 but testing for that has surprisingly come back negative. I think his UC is somewhat further down the road than yours as he has an ileostomy but perhaps might be useful to connect with each other and compare notes, so will tag @dannybgoode.

 

[saffron15]

@Clay welcome to the forum. I sometimes feel jealous that so many people have their blood test tested for diabetes. I was tested ten years ago then not til last June when I requested a test and then had a reading of 69.

Diabetes UK has loads of information but I have been impressed with a Primary Care site in New Forest which links to lots of useful websites and has well set out info.

If you decide to do some testing make sure hands clean and warm eg hug a mug. Pricker can be low. I manage on 1or 2.
I reuse the lancet as don't share and thought changing everything wasteful. When they suggest testing after a meal 2 hours is from start of meal.

Diabetes & Metabolic Health | New Forest PCN

newforestpcn.co.uk

 

[Clay]

Could be liver is still insulin resistant, so morning levels may be elevated. Worth checking them.
Weight loss that's rapid may introduce free fatty acids in the blood, which causes insulin resistance.
Any hidden carbs in your meals?
Any stress or illness?

Might be worth taking some readings and seeing if there's a trend.

Thanks. Yes there seems to be a common thread in the replies that a BG meter is something I need to get for a sharper focus and more control.
I didn't know that about rapid weight loss and insulin resistance. I'll look into that thanks, I'm now at a 'maintenance' level weight-wise (hopefully I can keep it down this time) so if there is a problem there it might resolve.
I think I'm aware of all the carb sources, despite having cut out the obvious sweet stuff years ago I've recently focused on white rice and pasta and replaced them so I think i've covered that.
As for stress or illness, I am a bit prone to stress but I don't think it's been a recent problem. My only underlying conditions are hypertension (which has recently improved with the weight loss) and ulcerative colitis. The latter has been 'quiescent' (if that's the word) for three years with no symptoms.

I have had two bouts of what I'm fairly certain was Covid (though I didn't test, just assumed it was and isolated accordingly). One was last September and one early this month, so both would have been in the 90 days theoretically covered in the two HbA1c tests. Over the last couple of days I've seen some suggestion online of research indicating that Covid can raise blood sugar levels but nothing concrete.

Thanks again, I didn't know rapid weight loss (and mine was at least steady, exceeding a target of average 0.15 kg per day) might be a factor.

 

[Proud to be erratic]

Your UC, @Clay, albeit in remission for the last 3 years, does introduce a rationale that you could be T2 with T3c connotations - so not necessarily a "standard" T2. Are you on any medication for your UC? The UC and certain meds could in themselves bring about elevated BG.

My UC was diagnosed c.2000 and I achieved remission from that by diet and lifestyle in the next 3 years, confirmed all clear by mid 2004. I was determined to not be taking tablets for the rest of my life (I didn't know then that pancreatic cancer and hence diabetes was still ahead of me!).

 

[Clay]

Hi @Clay,
The response by @rebrascora above (#2) has so many relevant points, which are perhaps (with due apologies to her) buried within the breadth of her response. I've copied just a few of those points and pasted these below, somewhat rearranged in sequence:

"Your HbA1c result just tells you that you are diabetic not what type of diabetes you have".
"With Type 1, your immune system mistakenly starts to kill off the beta cells in the pancreas which produce insulin so insulin production falls". I would add: T1 is a very specific type of Diabetes.
...... "whereas with Type 2 at diagnosis, particularly if it has been caught early as yours has, the body is usually producing excess insulin to overcome insulin resistance and losing weight will generally restore insulin sensitivity and enable the body to rebalance BG levels. Type 2 is basically metabolic."
...... "it is possible that you may not be Type 2 or perhaps a subset of Type 2 which doesn't respond to lifestyle changes for some reason."
"Type 3c involves damage to the pancreas from other means like inflammation (pancreatitis sometimes associated with gall stones), alcoholism, disease (cysts or tumours), trauma or surgery. So for example if you had a history of gall stones or abdominal pain, Type 3c might be something to consider." I would add T3c is still a very small proportion of the total diabetic community.
"There are plenty of members of this forum who were initially assumed to be Type 2 but turned out to be Type 1 or Type 3c which is a relatively new category that many GPs have not even heard of."

Other responses introduce further "twists" in what is already a complex weave. GPs are, by definition, General Practicioners and they are not Specialists in Diabetes. Type 2 diabetes is not simple in the first place and it can be a challenge even for Specialists to seperate the different sub-sets of T2 into an appropriate and precisely correct diagnosis - from the broad Guidelines that the NICE provide to "guide" GPs. So there can be many more peripheral factors that can further explain why your initial response has not been what you hoped for or expected - and this is undoubtedly frustrating for you.

But, my non-medical thought is in line with @rebrascora: "just see what happens for the next few months". Plus buying a meter to do some structured BG testing could be very helpful to you, in assisting you to adjust your diet and reduce or possibly exclude certain meals or food types. Or structured testing could provide clearer data to allow your GP or a Specialist to review your standard T2 diagnosis. Generally Diabetes is a slow-moving foe, once the existence of elevated BG has been recognised. [NB: I don't personally think much about T2 is standard; we are all different.]

Thanks it's useful in particular to know that people with knowledge and personal experience of diabetes and its various types and treatments confirm my suspicion that GPs might naturally tend towards broader categories when diagnosing. i don't want to sound disparaging about GPs but I would have normally expected, if I go to them with an HbA1c reading of 52, that their response would be 'here's a weight loss, diet and exercise programme we've put together for T2D sufferers, and some T2D medication'. As someone who's already made those changes, with a significant negative effect, I need to be able to suggest there may be nuance in my circumstances. The advice I'm getting on here is helping me know how to do that.

 

[rebrascora]

I think I'm aware of all the carb sources, despite having cut out the obvious sweet stuff years ago I've recently focused on white rice and pasta and replaced them so I think i've covered that.

When you say you have replaced white rice and pasta, what have you replaced them with? Just to be clear, brown rice and wholemeal pasta have almost as many carbs in them as the white versions, so despite the NHS advice being to swap to brown/wholemeal versions, this really has almost no beneficial impact on lowering blood glucose levels.

 

[Clay]

@Clay welcome to the forum. I sometimes feel jealous that so many people have their blood test tested for diabetes. I was tested ten years ago then not til last June when I requested a test and then had a reading of 69.

Diabetes UK has loads of information but I have been impressed with a Primary Care site in New Forest which links to lots of useful websites and has well set out info.

If you decide to do some testing make sure hands clean and warm eg hug a mug. Pricker can be low. I manage on 1or 2.
I reuse the lancet as don't share and thought changing everything wasteful. When they suggest testing after a meal 2 hours is from start of meal.

Diabetes & Metabolic Health | New Forest PCN

newforestpcn.co.uk

Thanks for the welcome. All these replies have definitely made me feel better and more positive after a result I didn't expect.

Thanks too for that practical bit on using the meter when i get one. These are the kind of details they don't put in the instruction leaflets.

 

[Clay]

When you say you have replaced white rice and pasta, what have you replaced them with? Just to be clear, brown rice and wholemeal pasta have almost as many carbs in them as the white versions, so despite the NHS advice being to swap to brown/wholemeal versions, this really has almost no beneficial impact on lowering blood glucose levels.

To be honest, I don't have rice or pasta very often but yes that's what I used when I did, based on the NHS and other advice. I'll take that on board though and start looking at these things more closely. it's a bit of a minefield with so much information out there.

 

[rebrascora]

The same applies with bread. Wholemeal has very few carbs less than white, so as with all these high carb foods, reducing your portion size and frequency of eating is much more effective than swapping to brown wholemeal, although extra fibre is usually a good option for gut health, but reducing the portion size and frequency of those high carb foods is what will give you better results with your BG levels.
Basically anything made from grains or grain flour is likely to be high carb.... so wheat, rice, barley, oats and corn and anything made from them. Plus potatoes both sweet and normal and other root veg like casava and parsnips/carrots/beetroot to a slightly lesser extent. Interestingly the vinegar in pickled beetroot can make that a better option for some of us even though there is sugar added in the pickling process. I can eat pickled beetroot from the jar until my mouth turns numb and barely see any movement of my BG levels, but a fresh boiled beetroot will give me a rise. Being able to test and see your own body's reactions to food should really help you to fine tune your diet.