Hi All!

[turlo]

Hi All,

14 months ago I was advised by my GP that I was close to prediabetes after a blood test came back with HbA1c levels of 41mmol. ( I had a leg ulcer, lower leg circulation issues and was feeling tired and light headed quite often, so they wanted to check for diabetes) I also had high cholesterol and BP, so i decided it was time to address these issues.

Through improved diet & weight loss my HbA1c levels have reduced to 39 in just over 12 months (my GP would only give me a blood test every 12 months unless my symptoms worsened).

During this I've managed to lose all the weight I feel is realistic (3.5 stones) and my BMI is now 21.5. A lot of the symptoms I was experiencing have improved greatly as well, although not totally gone.

I follow a lowish carb mediterranean diet with a focus on minimising processed foods - to achieve weight loss I followed a very low carb diet for 3 months aiming for less than 50 carbs per day but struggled to keep this up as I lost weight and increased my activity levels.

Carb wise I now consume between 120-130g per day including any carbs from fruit, veg and dairy products. About 50% of my carbs are from grains such as oats, wholegrain rice & ww bread and the rest come from fruit, veg and dairy products(greek yogurt, cheese & milk)

At my last appointment with my nurse they advised i should aim to lower hbA1a further as it was still a little high and to come back in 12 months for a check up and another HbA1c test

My main questions that I'm looking for some guidance on are 1) should I expect to see a further reduction in my blood glucose levels over time following the same diet or would I need to look into making some modifications such as further reducing carb in intake? 2) what's the best way of monitoring progress considering i won't get another blood test for 12 months (unless I go private for a blood test,which I might do in 6 months)?

I'm very keen to keep on top of this after a good few years of neglecting my health!

Many thanks

Ian

 

[PerSpinasAdAstra]

Hi and welcome. Congratulations on the weight loss - no small achievement and something to be very proud of 🙂

I subscribe to Prof Roy Taylor's ideas on how Type 2 diabetes develops and the role of liver fat, weight loss and carb intake. If you're not familiar, this long interview with him will explain how weight loss affects pre-diabetes and Type 2 - Link

As you have lost 3.5 stone and as you did not have a HbA1c in the diabetic range to begin with I don't think you'd see much impact from further reducing your carb intake. In fact you might be able to eat pretty much whatever you like (within reason) without moving your HbA1c by a single digit. To confirm that though you'd need to do some testing.

The gold standard for experimenting around meals is a Continuous Glucose Monitor (CGM). The problem with these is that they are expensive. You can get one free trial of a FreeStyle Libre 2 on this site - Link Each sensor lasts 14 days after which time they need to be replaced, so 14 days for free, lots of money after that - currently £51.74 + VAT per 14 day sensor if you buy them directly from the manufacturer. While wearing one you can experiment with eating different meals and see a live graph of your blood glucose levels. For each 2 week period you can generate a report from a website based on your blood glucose levels what will roughly estimate what your HbA1c would be if that 2 week period were representative of your general lifestyle over the 90 days leading up to an actual HbA1c blood test. The estimate is not perfect, the estimated number will likely not match a real life HbA1c test, but the method is consistent between reports. As such, if you were to eat as you currently do for 2 weeks while wearing a sensor, generate the report, feast on pizza and chips and mighty mounds of pasta for another 2 weeks while wearing a second sensor, then generate a second report, you could compare the Glucose Management Indicator (GMI) number (HbA1c estimate) between the two reports and evaluate the relative effects of your diet choices. If you do this - please please share some screenshots of the graphs - I for one would be wildly curious to see what a Big Mac and large fries does to the blood glucose levels of a non-diabetic, so I can do the experiment for myself - for scientific purposes of course 😉

A cheaper option is a finger prick blood glucose meter. The meters with the cheapest strips are perfectly adequate for testing your response to different foods/meals relatively cheaply. The Contour Blue meter for example has test strips which cost around £10 for 50 - so 20p per test. A Type 2 diabetic might test immediately before eating and 2 hours later and look for a rise in the reading of (ideally) no more than 2 mmol/L, and hope to stay below 8 mmol/L at the 2 hour mark. That's an indicator that a body has handled the carbs in the meal very well (for a Type 2 diabetic) - a very 'safe' meal to eat. The problem is for a pre-pre-diabetic those numbers are much less meaningful - you might be able to eat a few pieces of cake and still stay well below that level at the 2 hour mark.

I'm of the view that eating lots of carbs cannot cause Type 2 diabetes so long as you keep your body weight stable, and so long as your blood glucose is at 8 mmol/L or below 2 hours after eating something then it's not going to do you much harm. If it's at 7 mmol/L or below all the better. If you're back down to 6 mmol/L or below 2 hours after the Big Mac and large fries don't worry about it - eat whatever you like though watch your weight, don't drink too much alcohol, and do get plenty of exercise (which might help lower your HbA1c by a smidge). In your case, according to the school of thought I follow, all you need to do is keep excess fat out of your liver and you'll never develop Type 2 diabetes.

I hope that helps - and the very best of luck! 🙂

EDIT - I posted the wrong Roy Taylor link. The one above is an hour-long presentation of his work - this link is the longer interview with a little more information: Link

 

[Martin.A]

what's the best way of monitoring progress considering i won't get another blood test for 12 months (unless I go private for a blood test,which I might do in 6 months)?

I'm very keen to keep on top of this after a good few years of neglecting my health!

Many thanks

Ian

I do finger prick tests every day on waking and sometimes 2 hours after meals, and record the results in a spreadsheet. By inserting a trend line I can see whether my levels are trending upwards (hopefully not), downwards (ideally) or are flat. I've accumulated 5 years worth of readings to date. Currently the line is pretty flat and has been for some time, so I'm happy that things seem to be under control. This isn't going to tell me what my HbA1c would be next time but it can give a rough idea of where it might be. Historically I've found it to be accurate to within a couple of points.

 

[PerSpinasAdAstra]

Hi All,

14 months ago I was advised by my GP that I was close to prediabetes after a blood test came back with HbA1c levels of 41mmol. ( I had a leg ulcer, lower leg circulation issues and was feeling tired and light headed quite often, so they wanted to check for diabetes) I also had high cholesterol and BP, so i decided it was time to address these issues.

Just had a thought - were you prescribed a statin for your high cholesterol by any chance?

If so, that might be why you're HbA1c hasn't dropped further. 20mg Atorvastatin for example (often the first-line prescription for high cholesterol) will raise your HbA1c by maybe 5%. The nurse who advised you that your HbA1c was still a little high may not have taken this into account (many GPs aren't even aware of this effect).

Atorvastatin Causes Insulin Resistance and Increases Ambient Glycemia in Hypercholesterolemic Patients - PMC

We investigated whether atorvastatin might decrease insulin sensitivity and increase ambient glycemia in hypercholesterolemic patients. Clinical trials suggest that some statin treatments might increase the incidence of diabetes despite reductions ...

www.ncbi.nlm.nih.gov

 

[Leadinglights]

Any thing below 42mmol/mol would be considered as normal so it is a surprise that you have been advised to get it lower.
Some people however low on carbs they go will never get lower that high 30ies.
You seem to be doing everything right diet wise and many find around 100g carbs per day is where they need to be to maintain a normal HbA1C.
Just in case some new ideas on diet would be helpful then have a look at this link. https://lowcarbfreshwell.com/

 

[Martin.A]

Any thing below 42mmol/mol would be considered as normal so it is a surprise that you have been advised to get it lower.
Some people however low on carbs they go will never get lower that high 30ies.

I thought that, too. 'At Risk of Being At Risk of Diabetes'. Never heard that one before.

 

[everydayupsanddowns]

My main questions that I'm looking for some guidance on are 1) should I expect to see a further reduction in my blood glucose levels over time following the same diet or would I need to look into making some modifications such as further reducing carb in intake? 2) what's the best way of monitoring progress considering i won't get another blood test for 12 months (unless I go private for a blood test,which I might do in 6 months)?

Welcome to the forum Ian @turlo

Well done for focussing on your health, losing all that weight, and adapting your diet to better suit your BG levels, and reducing your HbA1c.

You’ve made loads of progress in relatively few months. It might be that if you stick with your current menu and level of activity you might see your levels continue to drift gently downwards, but if you wanted to err on the side of caution, then a few modest tweaks to your current menu might be worthwhile.

Several T2 members here find it helpful (and fairly cost-effective) to use an affordable BG meter, both to check their body’s reaction to different foods, and also to just keeping an occasional check on waking levels to see how things are going.

 

[Lucyr]

The gold standard for experimenting around meals is a Continuous Glucose Monitor (CGM). The problem with these is that they are expensive. You can get one free trial of a FreeStyle Libre 2 on this site - Link

Pre diabetics aren’t eligible for a free trial, you need a diagnosis of diabetes.

 

[PerSpinasAdAstra]

Pre diabetics aren’t eligible for a free trial, you need a diagnosis of diabetes.

Indeed, good point. They might check.

 

[Lucyr]

Indeed, good point. They might check.

I don’t think abbot would be allowed to check the your NHS record as they won’t have access to that, but it’s part of the terms and conditions that you have to agree to for the trial. And obviously you can’t agree that you’ve been diagnosed with diabetes if you’ve only been diagnosed at at risk of diabetes.

 

[turlo]

Any thing below 42mmol/mol would be considered as normal so it is a surprise that you have been advised to get it lower.
Some people however low on carbs they go will never get lower that high 30ies.
You seem to be doing everything right diet wise and many find around 100g carbs per day is where they need to be to maintain a normal HbA1C.
Just in case some new ideas on diet would be helpful then have a look at this link. https://lowcarbfreshwell.com/

Thank you for the link to lowcarbfreshwell site - I'm going to look switching some of the red carbs I still consume for green foods such as beans & pulses.

With regards to the nurses recommendation to reduce my blood glucose levels further, she said the symptoms I had been experiencing (leg ulcer that took 9 months to heal, blurred vision, dizzyness & tirdness during the day) coupled with a HbA1c at the high end of normal were signs that I could still be at risk. While these symptoms have improved over the last 12 months with a reduced carb/sugar diet & weight loss, they've not completely gone away yet.

 

[Leadinglights]

Thank you for the link to lowcarbfreshwell site - I'm going to look switching some of the red carbs I still consume for green foods such as beans & pulses.

With regards to the nurses recommendation to reduce my blood glucose levels further, she said the symptoms I had been experiencing (leg ulcer that took 9 months to heal, blurred vision, dizzyness & tirdness during the day) coupled with a HbA1c at the high end of normal were signs that I could still be at risk. While these symptoms have improved over the last 12 months with a reduced carb/sugar diet & weight loss, they've not completely gone away yet.

If you get a blood glucose monitor if you haven't already got one the you could check your swaps are not increasing your blood glucose more than your red foods.

 

[snowball12]

Just had a thought - were you prescribed a statin for your high cholesterol by any chance?

If so, that might be why you're HbA1c hasn't dropped further. 20mg Atorvastatin for example (often the first-line prescription for high cholesterol) will raise your HbA1c by maybe 5%. The nurse who advised you that your HbA1c was still a little high may not have taken this into account (many GPs aren't even aware of this effect).

Atorvastatin Causes Insulin Resistance and Increases Ambient Glycemia in Hypercholesterolemic Patients - PMC

We investigated whether atorvastatin might decrease insulin sensitivity and increase ambient glycemia in hypercholesterolemic patients. Clinical trials suggest that some statin treatments might increase the incidence of diabetes despite reductions ...

www.ncbi.nlm.nih.gov

I had never heard of this before regarding Asorvastatin. I struggle with fasting sugar levels. Thank you

 

[PerSpinasAdAstra]

Thank you for the link to lowcarbfreshwell site - I'm going to look switching some of the red carbs I still consume for green foods such as beans & pulses.

With regards to the nurses recommendation to reduce my blood glucose levels further, she said the symptoms I had been experiencing (leg ulcer that took 9 months to heal, blurred vision, dizzyness & tirdness during the day) coupled with a HbA1c at the high end of normal were signs that I could still be at risk. While these symptoms have improved over the last 12 months with a reduced carb/sugar diet & weight loss, they've not completely gone away yet.

I have read one other account on another forum of a person who experienced diabetes symptoms long before HbA1c levels rose to the level of prediabetes. That person was eventually diagnosed as Type 2, though after years of unpleasant symptoms. It does happen it seems, and your doctor was good to spot it, though I couldn't begin to explain it.

That person took to an extremely low carb diet and the symptoms disappeared. This might be worth a try to see if your symptoms disappear. Unfortunately it's very difficult to do that while also addressing risks associated with cholesterol. Extreme low carb means high saturated fat, unless a person gets most of their calories from things like avocados and oily fish. Not cheap, and not an easy diet to stick to. The first-line prescription for raised cholesterol is a statin, and it's very difficult to get a doctor to prescribe an alternative, because guidelines (I'm currently doing battle trying to get me some Ezetimibe to take in combination with a lower statin dose and having little success so far).

I hope you figure it out, and the very best of luck!

 

[trophywench]

I disagree entirely that anybodies diet should be lower carb and HIGH fat - I firmly believe in lower carb and NORMAL fat. So you use normal amounts of butter or lard or olive oil or whatever fat is appropriate for whatever it is you are cooking and eating.

 

[PerSpinasAdAstra]

I disagree entirely that anybodies diet should be lower carb and HIGH fat - I firmly believe in lower carb and NORMAL fat. So you use normal amounts of butter or lard or olive oil or whatever fat is appropriate for whatever it is you are cooking and eating.

I don't think a very high fat diet is a generally a good idea either, but if you go low enough in carbs either high fat or high protein (or a bit of both) is a necessity in order to keep your weight stable. 20 grams of carbs a day (extreme Keto levels) and a typical amount of fat means masses of meat or fish or whatever, which is hard to stick with (I know I couldn't eat a diet that was pretty much just big piles of meat) and probably bad for the kidneys. A typical Keto diet involves loads of fatty foods. The person I referred to puts double-cream in his coffee for example - a way to help get his daily calories in.