Hello

[Windstrel]

Thanks for adding me. Apologies for the long post.

I'm in the UK, 76 years young and have been prediabetic for some years but, given my lifestyle of cycling and tennis playing, didn't think I needed to do much about it. I don't take any medication except for the occasional gaviscon because I have a hospital diagnosed hiatus hernia.

My recent annual blood test came back as hba1c 42 but with elevated cholesterol and my doctor was talking about statins to reduce the risk of heart attack and stroke. I said I would prefer to adjust my diet to reduce my cholesterol.

Following a bit of research into how to improve my cholesterol, I spotted that the same combination of diet and exercise would achieve a better blood sugar level and perhaps take me out of the prediabetic range.

So I decided to target both. 8 weeks ago, I had a knee operation and had to take lots of pain killers in the aftermath so that was a good start because it made it easy to cut out the couple of bottles of red wine I probably drank on average a week. Bean and lentil stew became my evening meal, porridge with blueberries for breakfast and mackerel on toast for lunch.

The diet has worked and I'm now 12 stone 13lbs and planned to continue reducing until I get to12.5 stone. My height is 6 foot and my waist is 38 inches. Sometimes I've been losing 0.25lbs a day recently. Over the 8 weeks since my knee operation, I've rigorously followed the knee exercise plan the hospital gave me and have built up to the full range of exercises plus two half an hour walks a day (about 7000 steps). (Sadly the physio at the hospital told me playing tennis was out of the question for my new knee so I guess I'll just have to do more cycling.)

The reason for the long post is because I think I've been having hypos!

These started, I think, about 10 days ago. I was on a recreational walk more or less on the level and we came to a steep upward bit of the lane and after a few steps I started to feel ill. It got worse and I had to find somewhere to sit while my other half ran back to the car to take me home. After a while I recovered and was back to normal.

Then last weekend Friday, walking along the flat sea front at Sidmouth in Devon, late in the morning and before lunch, it happened again. I ended up spending 20 minutes in a chair in Boots the chemist while my partner got some glucose tablets. After 20 minutes I walked very slowly and with great difficulty back to our campervan where I eventually recovered.

Then on Sunday, late in the afternoon, I was watching my partner and her daughter at an open air dance. Basically I was waiting for them to finish dancing so we could go and eat. I started to feel weird and dashed to the nearest cafe, ate a glucose tablet and bought a bacon roll. I think I just about caught the hypo in time.

A week ago, I started checking my blood sugar levels with a meter and finger prices. My average is about 6.6. I set my target range to between 4 and 7. I'm 33% above and 67% in target.

Any suggestions or comments would be very helpful. Hypos, if that is what I've had, are very scary.

 

[Inka]

Welcome @Windstrel 🙂 Hypos are usually caused by insulin or a few other glucose-lowering meds. It would be unusual to get them when you’re not on such meds, as they’re caused by the meds not the diabetes.

However, there are things called false hypos. These are where a person’s blood sugar has been high for a while and then reduced to a more normal range. The body isn’t used to this normal range so it feels wrong even though it’s not and it’s not an actual hypo. In those cases, the body resets itself.

You say you’ve adjusted your diet. If you’ve made radical changes, perhaps your body is struggling with that? Perhaps eat a little more or add small snacks?

Finally, perhaps it’s nothing to do with diabetes and is due to something else, eg blood pressure, etc, etc.

 

[Leadinglights]

Looking at your age an HbA1C of 42 is at an acceptable level according to NICE guidelines and although it is important to have a good balance of good and bad cholesterol everybody need cholesterol for many processes, tissue healing, hormone production. As said you may have gone a bit too far and adding some healthy 'extras' would keep you more stable.
If you are taking blood pressure meds then your changes could mean you are now over medicated with those and your 'funny' turns could be low blood pressure.

 

[Windstrel]

Thanks for your reply. I'll look into false hypos. My blood pressure is high which I'm assuming is because I need to reduce my cholesterol. It ranges between 149/80 to 120/80. My pulse is low at about 50. I've always had a low pulse but I'm wondering if that could be a problematic factor making near fainting episodes more likely.

I'm currently doing a blood sugar test before each meal and then two hours after the meal to test the variance. I've hitherto avoided snacking because it might affect my readings.

As you say, other medical factors could be at work. I'm slightly comforted by the fact that the hospital that did my knee 8 weeks ago checked my heart to make sure they could go ahead with the op.

I've so much to learn.

 

[Windstrel]

Looking at your age an HbA1C of 42 is at an acceptable level according to NICE guidelines and although it is important to have a good balance of good and bad cholesterol everybody need cholesterol for many processes, tissue healing, hormone production. As said you may have gone a bit too far and adding some healthy 'extras' would keep you more stable.
If you are taking blood pressure meds then your changes could mean you are now over medicated with those and your 'funny' turns could be low blood pressure.

Thanks for your helpful reply. I'm not on any meds except the occasional gaviscon for my dodgy stomach due, probably to my hiatus hernia. My pulse is usually low around 50. It's a family characteristic. Maybe that's complicating matters. Healthy extras sounds nice

 

[Leadinglights]

Thanks for your helpful reply. I'm not on any meds except the occasional gaviscon for my dodgy stomach due, probably to my hiatus hernia. My pulse is usually low around 50. It's a family characteristic. Maybe that's complicating matters. Healthy extras sounds nice

If you have any more instances of feeling unwell then I would get checked out at the GP, they may want you to wear a blood pressure monitor for a couple of days.

 

[rebrascora]

Hi and welcome.

Sorry to hear you have been experiencing these unpleasant episodes. With an HbA1c of 42 I think it is highly unlikely that you would experience false hypos. Generally your body needs to have got used to much higher Blood Glucose (BG) levels for quite a while (probably persistently in double figures) in order to feel hypo at non-hypo levels and without certain diabetes medications you should not experience full hypos.

It sounds like you are using a Constant Glucose Monitor (CGM) since you mention time in range. I am not entirely sure why you have set the range as 4-7 as those are post meal readings so it would be normal to go above 7 after meals as long as you are mostly or totally below 10mmols.

To me it doesn't seem like you have gone particularly low carb as you are having porridge, bread and pulses plus presumably some veggies. Not sure why you have stopped drinking wine as that is reasonably low carb, although perhaps reducing your consumption from 2 bottles to one a week might be a reasonable compromise. Since you are still eating some carb rich foods which are mostly purported to be slow release versions, I think it is unlikely to be hypos you are experiencing, especially if the CGM is not showing your levels spiking high (above 10) and then dropping fast, as that would identify Reactive Hypoglycaemia which is the only other possible cause of genuine hypos, apart from very prolonged exercise like marathon running or endurance cycling, so I suspect the cause of your funny turns is unrelated to your pre diabetes and I definitely think you need to discuss it with your GP.
Hopefully the data from the CGM will give you some reassurance that you are not going low although CGM are not totally reliable in this respect and we would probably recommend carrying a finger prick BG meter kit with you to test when you have a funny turn rather than rely on the CGM.

Those are just my non medically trained thoughts.

 

[Windstrel]

Hi and welcome.

Sorry to hear you have been experiencing these unpleasant episodes. With an HbA1c of 42 I think it is highly unlikely that you would experience false hypos. Generally your body needs to have got used to much higher Blood Glucose (BG) levels for quite a while (probably persistently in double figures) in order to feel hypo at non-hypo levels and without certain diabetes medications you should not experience full hypos.

It sounds like you are using a Constant Glucose Monitor (CGM) since you mention time in range. I am not entirely sure why you have set the range as 4-7 as those are post meal readings so it would be normal to go above 7 after meals as long as you are mostly or totally below 10mmols.

To me it doesn't seem like you have gone particularly low carb as you are having porridge, bread and pulses plus presumably some veggies. Not sure why you have stopped drinking wine as that is reasonably low carb, although perhaps reducing your consumption from 2 bottles to one a week might be a reasonable compromise. Since you are still eating some carb rich foods which are mostly purported to be slow release versions, I think it is unlikely to be hypos you are experiencing, especially if the CGM is not showing your levels spiking high (above 10) and then dropping fast, as that would identify Reactive Hypoglycaemia which is the only other possible cause of genuine hypos, apart from very prolonged exercise like marathon running or endurance cycling, so I suspect the cause of your funny turns is unrelated to your pre diabetes and I definitely think you need to discuss it with your GP.
Hopefully the data from the CGM will give you some reassurance that you are not going low although CGM are not totally reliable in this respect and we would probably recommend carrying a finger prick BG meter kit with you to test when you have a funny turn rather than rely on the CGM.

Those are just my non medically trained thoughts.

Many thanks for your extensive and kind reply. I'm finger pricking with a True Manager Air App to get the test results.

I think I need to see my GP to look into other reasons for my fainting episodes and now have managed to get an appointment later this month

 

[Inka]

Thanks for your reply. I'll look into false hypos. My blood pressure is high which I'm assuming is because I need to reduce my cholesterol. It ranges between 149/80 to 120/80. My pulse is low at about 50. I've always had a low pulse but I'm wondering if that could be a problematic factor making near fainting episodes more likely.

I'm currently doing a blood sugar test before each meal and then two hours after the meal to test the variance. I've hitherto avoided snacking because it might affect my readings.

As you say, other medical factors could be at work. I'm slightly comforted by the fact that the hospital that did my knee 8 weeks ago checked my heart to make sure they could go ahead with the op.

I've so much to learn.

There are lots of things that it might be @Windstrel If it’s only started since you’ve changed your diet, then I’d look at that first. Have you drastically cut calories? Cut out a large percentage of carbs? Reduced grains and thus B vitamins?

If it persists, then I’d definitely be checking with your GP so they can run some tests.

 

[Lucyr]

I think I need to see my GP to look into other reasons for my fainting episodes

Are you actually fainting? Do you come round by yourself? If you’re fainting and coming round by yourself then it’s more likely low blood pressure or something unrelated like anaemia than hypos. You’d have to go very low to faint from a hypo and you would be unlikely to come round without glucagon, though you’d be very unlikely to go that low anyway because you’re not on medication

 

[Windstrel]

Are you actually fainting? Do you come round by yourself? If you’re fainting and coming round by yourself then it’s more likely low blood pressure or something unrelated like anaemia than hypos. You’d have to go very low to faint from a hypo and you would be unlikely to come round without glucagon, though you’d be very unlikely to go that low anyway because you’re not on medication

No I don't actually faint, just become extremely weak and incapable of doing anything. I've just made an appointment with my GP. As you say, it's likely not to do with my prediabetic situation. Thanks for your kind reply

 

[JimmyBlue]

Hi @Windstrel your doctor is the right person to discuss this with. Your BP ranges from the top end of what is good for people under 75 and the level at which high BP is diagnosed. However there is also a possibility of other heart conditions that may be giving you issues (e.g. brachycardia). The diabetes nurse got shirty with me when my BP was 124/72 back in March and wanted me on statins. Its now below the 120/80 level and my pulse is 45 bpm and appears to be happy with this.