I am 29 and yesterday I found that I have 9.3% a1c.

[azee]

Hi everyone!
I hope everyone is doing great! My father was checking his sugar level(He is not diabetic) and I asked him to check mine too. I found that it was 188 with fasting without any symptoms. I visited the doctor and he asked for a1c. The report came and it was 9.3%. The doctor read my report and gave me tablets. I am a software engineer so most of my work is done sitting using a computer and I had little exercises. Now my goal is to reduce it to 6% or 5% I know it's very hard but I am determined. I have a few questions:

1. At this age, is not it dangerous to have diabetes? If I maintain my sugar level will I see any complications in the coming years?
2. My height is 5.11 and my weight is 72 KG. Do I have to reduce my weight? Or do I have to just maintain my healthy diet?
3. I am doing 30 minutes of running and 15 minutes of walking and 12 minutes of belly exercise is that enough?
4. In my country, we normally eat 2 wheat bread each of these has 15g corbs. Is that too much? Or should I consult nutrition to suggest my diet?

It's been a year since I was not gaining weight. Maybe it was because of my diabetes. But now I am happy that at least I found out what was the issue.

 

[harbottle]

Hello! I'm a fellow software engineer.

It's not unheard of for young people who are slim to get T2 diabetes - I work with someone who was diagnosed at a young age when they were not overweight. If you can't lose any weight, a healthy, low carb diet will help (As will the pills.) along with exercise.

The exercise sounds more than enough. I tend to do 30 minutes of walking a day, usually around the University campus and country park I work on.

15g of carbs isn't a huge amount - I'd eat something with that many in it every now and then - but the best thing to do would be to get a blood glucose meter and see what levels you are before you eat and two hours later. Maybe try 1 and if the blood sugar levels rise too much, cut the portions down. In the UK it's recommended to be:

Between 4 and 7 before meals (72-126 in your units)
Less than 8.5 two hours later. (144 in your units)

Not sure what the recommendations are for your country.

 

[rebrascora]

If you are relatively young and not overweight by the look of it then it is more likely that you are Type 1 and they should be doing tests to check on that.

 

[everydayupsanddowns]

Welcome to the forum @azee

While people of Pakistani / SE Asian heritage are statistically more likely to develop T2 diabetes, I agree with @rebrascora that it would be worth keeping an open mind about your diabetes type as you are not overweight, and not very old. Unintentional weight loss would be another reason to suggest further investigation.

Maintaining blood glucose levels in a healthy range should reduce your risks of developing long term complications from your diabetes. It’s not a guarantee, but it really helps reduce your risk. Even quite modest improvements in blood glucose management can have a large impact, so no effort is wasted.

 

[azee]

@everydayupsanddowns, @rebrascora and @harbottle thanks for replying. My health professional described it as type 2.
Today I took tablet and checked my level after 10 hours fasting. It was 147. My question is, would tablet be more effective after some days or its outcome can be seen on daily basis? I mean if with tablet it’s 147 so I have to change my diet and excersie to keep it under 100 to 130?

 

[rebrascora]

What is the name of the tablets. Some work quite quickly but others build up in your system over days and weeks.

If you are actually type 2, (rather than Type 1 as we suspect) then adjusting your diet will be important as well as the medication and doing exercise.

 

[azee]

@rebrascora please see image below. BTW impressed by your diabetes journey .

 

[rebrascora]

Ooh! That is interesting! I was almost certain that they would have started you on Metformin, which is the first line Type 2 medication used here in the UK.
The one you have is a combination drug which I thought was used for people who are overweight.... but I may be wrong about that as I am no expert on Type 2 meds and really only know about the ones I have tried myself.
I am pretty sure the "flozins" work by encouraging your kidneys to remove glucose from your blood into your urine at a lower level than they normally would, so it is important to drink plenty of water and you will likely need to wee a bit more often as a result and I think the Sitagliptin helps to encourage insulin production and also help you feel full sooner, so discourage you from eating too much. As I said I have no experience of those two medications, either singly or combined so be guided by what others say here if they contradict what I have said above.
I would not expect a noticeable improvement for a few days anyway.

 

[harbottle]

Sitagliptins inhibit a substance that breaks down incretins, which are generated after eating - these stimulate the beta cells to produce insulin and stop alpha cells producing glucagon. (They normally have a short life span, the drug inhibits the substance that breaks them down.) By increasing their life span, they can bring down levels after a meal.

I believe the incretins are also involved in the signalling for 'fullness' and can reduce appetite.

Both of these drugs start to act fairly quickly, but the next hba1c will give a better idea of how effective they have been... You should see some changes to finger prick readings, though.

(I don't think Sitagliptin helps much with fasting glucose, as it's mainly active in post-meal mechanisms.)

 

[azee]

Ooh! That is interesting! I was almost certain that they would have started you on Metformin, which is the first line Type 2 medication used here in the UK.
The one you have is a combination drug which I thought was used for people who are overweight.... but I may be wrong about that as I am no expert on Type 2 meds and really only know about the ones I have tried myself.
I am pretty sure the "flozins" work by encouraging your kidneys to remove glucose from your blood into your urine at a lower level than they normally would, so it is important to drink plenty of water and you will likely need to wee a bit more often as a result and I think the Sitagliptin helps to encourage insulin production and also help you feel full sooner, so discourage you from eating too much. As I said I have no experience of those two medications, either singly or combined so be guided by what others say here if they contradict what I have said above.
I would not expect a noticeable improvement for a few days anyway.

Thanks for writing. First of all, can I ask you how did you manage "Aug 2022 HbA1c 45"? I mean your diet plan, exercise, and overall lifestyle? You mentioned "Sitagliptin helps to encourage insulin production and also helps you feel full sooner" does it mean that it is not producing insulin by itself but helping my system to produce it? I am already eating moderately because over eating spikes my sugar levels. Before that, I used to overeat a lot. My doctor asked me to come back in 10 days and monitor my sugar level I guess he will change my medicine after 10 days.

 

[harbottle]

That medicine makes your pancreas produce more insulin after eating.

 

[azee]

Sitagliptins inhibit a substance that breaks down incretins, which are generated after eating - these stimulate the beta cells to produce insulin and stop alpha cells producing glucagon. (They normally have a short life span, the drug inhibits the substance that breaks them down.) By increasing their life span, they can bring down levels after a meal.

I believe the incretins are also involved in the signalling for 'fullness' and can reduce appetite.

Both of these drugs start to act fairly quickly, but the next hba1c will give a better idea of how effective they have been... You should see some changes to finger prick readings, though.

(I don't think Sitagliptin helps much with fasting glucose, as it's mainly active in post-meal mechanisms.)

Thank you for spending the time to reply to my message. Can ertugliflozin hurt my kidneys in long term? I am sorry I know you are not a doctor but maybe can guide me.

 

[rebrascora]

Thanks for writing. First of all, can I ask you how did you manage "Aug 2022 HbA1c 45"? I mean your diet plan, exercise, and overall lifestyle? You mentioned "Sitagliptin helps to encourage insulin production and also helps you feel full sooner" does it mean that it is not producing insulin by itself but helping my system to produce it? I am already eating moderately because over eating spikes my sugar levels. Before that, I used to overeat a lot. My doctor asked me to come back in 10 days and monitor my sugar level I guess he will change my medicine after 10 days.

I follow a low carb higher fat way of eating. I don't have a meal plan as such, I just don't eat carb rich foods like bread and pasta and rice and potatoes and cereals and exotic fruits. I base my diet on meat and dairy and eggs and non starchy vegetables. It is however important to note that I am actually Type 1, not Type 2, so I need to inject insulin, because my body doesn't produce it as my immune system killed the cells that produce it. As regards exercise I walk as often as I can and I have horses to look after and land to maintain so my lifestyle is quite active and physical.

Type 2 is where your body becomes resistant to the insulin you produce or can't regulate the insulin and glucose levels effectively, perhaps because you have visceral fat in and around your liver and pancreas. The two main recognized lifestyle approaches with Type 2 are a crash diet like the Newcastle or Fast 800 diet which usually involve meal replacement shakes for 8-12 weeks to lose approx. 15kg. This burns off any visceral fat around those important organs which regulate blood glucose. The key thing is that the weight loss needs to be maintained.
Alternatively, following a low carb way of eating as I do for the rest of your life, which can seem tough at first but once you get your head around it is actually really satisfying and tasty.

As regards the Flozin medication, here in the UK our annual diabetes checks usually include kidney function, so if there were any issues with such medication it would be picked up before it became a problem and the medication changed, but in a healthy individual, the risk to the kidneys should be minimal.