Pre-diabetes diagnosed today, with the number 46 given, had to ask what it meant!

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JANGP

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At risk of diabetes
Hello to all. I understand that many have it harder than me, but it has come as a bit of a shock..
I have a long medical history, having cancer at 47, a heart attack at 59, diagnosed with heart failure at 60 and had a triple bypass at 62 (amongst other things).
I am now 67 and went to the GP last week as l was feeling so hot (with no temperature) and really anxious. I was tested to make sure my thyroid medication wasn’t too high along with the standard tests.
Thyroid levels were not high, but other things were being highlighted. Today l was told l was ‘46’ so pre-diabetic. I have to repeat renal function tests, have a bone density blood test and have Vitamin D checked.
I was put on Forxiga in January for my H.F. at KCH and am aware it is mainly prescribed for diabetics. I am now wondering if they may be something to do with my blood results.
Sorry that was so long! I’m a reasonably upbeat person really, and that sounded quite depressing!
 
Welcome to the forum, you sound to have had many health issues so this latest diagnosis must be a bit of a blow.
Forxiga is a medication prescribed to people with diabetes but usually when blood glucose is quite high and the first line medication metformin either doesn't work or cannot be tolerated. It encourages the kidneys to excrete excess glucose via urine so would lower blood glucose levels. When used in that capacity it usually need people to drink plenty to assist the process and avoid dehydration as it means frequent loo visits.
The HbA1C of 46mmol/mol is at the top end of the prediabetes range, the threshold is over 47mmol/mol.
It is obviously a good to be having those additional tests.
There may be modifications you can make to your diet to reduce your intake of carbohydrates, not just foods like cakes, pastry and biscuits and sugary drinks but things like potatoes, rice, pasta, bread and breakfast cereals, tropical fruits and fruit juice which are all big hitters as all carbs convert to glucose.
 
Welcome to the forum @JANGP

Forxiga / Farxiga is indicated for Heart Failure, Chronic Kidney Disease, and also Diabetes, so it seems likely to think it would have been for your HF at the time?

KCH has a world-renowned diabetes centre, with many leading researchers, so you’ll be in good hands there.

Prediabetes is just a shorthand for ‘at risk of diabetes’. It’s not really an official diagnosis, but it’s a flag waving for you to take some steps, and at 46 you are sailing pretty close to diabetes territory. 42-47 put you at risk, and 48mmol/mol is diabetes.

2 things you can do to help - the first is losing and extra weight you are carrying. Particularly around your middle / abdomen.

The other is to reduce the amount of carbohydrates in your diet - both the obvious sweet/sugary things, but also reducing portion size of starchy carbs (including potato, pasta, cereals, bread, rice, and many fruits)
 
Thank you for your reply.
Yes, it was prescribed for worsening heart failure unfortunately.
I am new to a lot of the facts, but am being referred to a diabetic clinic by my surgery.
I have read quite a lot, and l know weight and exercise are important. The strange thing is that l have lost 9kg; partly cutting down, and l assume partly due to the Forxiga. So l wasn’t expecting such drastic differences to my blood tests.
My other problem is exercise. With H.F. along with angina, going upstairs twice leaves me breathless and with aching legs. So l am going to need some advice from the clinic l think. I am definitely over-weight, but due to the weight loss, I would probably need to lose around 10kg.
 
Thanks to both of you for replying.
I did think that because Forxiga helps excrete glucose, it would have the opposite effect, as in NOT put me in the pre-diabetic range.
I really am a novice, and at the moment, everything I’m reading has numbers quoted from 5 to over a 100 !
I’m not even sure if glucose levels are what people check with the monitors you can buy. I have only heard it referenced as checking your ‘sugar’ level.
I have one, and my daughter took a reading for me mid afternoon. It was 8.5, but l had eaten a cake an hour before (I am ashamed to say).
I was a teacher for 20 years, but it’s at times like this that makes you realise how limited one’s knowledge can be.
Anyway, thank you again. I will come back when l have my other test results back. I am really anxious about the renal profile.
 
JANGP said:
Thanks to both of you for replying.
I did think that because Forxiga helps excrete glucose, it would have the opposite effect, as in NOT put me in the pre-diabetic range.
I really am a novice, and at the moment, everything I’m reading has numbers quoted from 5 to over a 100 !
I’m not even sure if glucose levels are what people check with the monitors you can buy. I have only heard it referenced as checking your ‘sugar’ level.
I have one, and my daughter took a reading for me mid afternoon. It was 8.5, but l had eaten a cake an hour before (I am ashamed to say).
I was a teacher for 20 years, but it’s at times like this that makes you realise how limited one’s knowledge can be.
Anyway, thank you again. I will come back when l have my other test results back. I am really anxious about the renal profile.
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Perhaps if you had not been taking it then your HbA1C would have been higher putting you in the diabetes range.
Be careful to distinguish the results from different tests, HbA1C is an average (simplistically) of your blood glucose over the previous 3 months and is given in mmol/mol and as you say the numbers can be anything from below 42mmol/mol which is normal, 42-47mmol/mol prediabetes or at risk and over that diabetes but some people are diagnosed with an HbA1C in triple figures.
The reading you get from a finger prick test in a moment in time and is in mmol/l, this varies depending on when you take the reading but the ranges to aim at are 4-7mmol/l fasting and before meals and no more than 8-8.5mmol/l 2 hours after eating. Testing before and 2 hours after meals allows you to find which foods your body cannot tolerate well but also which foods you can. That allows you to make better food choices.
 
Thank you Leadinglights, that was a useful read.
I had a very short nurse‘s appointment (as in 5 minutes), and was sent an information sheet a few minutes after l left the surgery.
So awkward as there are people more needy than me, yet l did have questions.
Not sure how long the wait is for the Diabetic Clinic, but the nurse said they will contact me.
You explained the reading fluctuations really clearly, so thanks again!
 
On a lighter note, when l sat down, the nurse literally said “you’re 46”. I half hoped she‘d read my notes incorrectly and thought that was how old l was! Then my bubble burst!
 
Hi and welcome from me too.
I agree that the Forxiga has likely saved you from becoming diabetic sooner, but a few simple tweaks to your diet should help to push things back into the normal zone.
The HbA1c is a measure of the amount of glucose molecules stuck to your Haemaglobin (red blood cells) . These cells live for about 3 months before they die and are broken down. During their lifetime in the blood stream they attract molecules of glucose which stick to them. The higher the concentration of glucose in the blood stream, the more glucose will stick to them, so this is how it is sort of a 3 month average.
Blood glucose itself goes up and down all the time throughout the day and night in response to many different factors.... something like 42 have been identified.... so it is a pretty complex business, especially as you don't have control over many of those factors, BUT the main ones of food, exercise and medication, which thankfully have the most impact, you do have control over, so whilst you can never totally control your Blood glucose levels, you can manage them reasonably effectively with those 3 things. Weight loss can also help the body to be able to regulate it's own BG levels more efficiently again.
 
Thank you so much for the information rebrascora.
As l have mentioned in an an earlier post, my surgery sent me the details of this website.
I have found it so useful to read posts, and then read them again, and sometimes even for a third time to be sure l have fully grasped the information,
Unfortunately l wouldn’t ask a nurse or a doctor to explain something 3 times, for fear of taking up too much of their time.
So the forum really has helped.
Thank you again.
 
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If it is any consolation I am like that too! It takes time for things to sink in and understand them fully and it helps to read different people's application or explanation of ideas to get to grips with the whole concept. Diabetes is extremely complicated so do be patient with yourself in taking it in and there is always something new to learn. I made loads of mistakes at first but gradually with the help of the wonderful people on this forum, I figured it out mostly, but it still catches you out every now and then, no matter how much you know.
 
Thank you. Glad to know I’m not the only one!
I am an anxious person anyway, and analyse and ruminate about everything,
I taught for 20 years and was a fairly logical person. Once my major illnesses began when l was 47, any logic, and my ability to be more positive gradually disappeared.
Off the diabetes subject l know, but in 2016 I lost my fantastic son at the age of 31. It was very sudden and as a family you can only navigate through it, and never get over it.
Just mentioning it as l have been treated for depression and stress for a fair amount of time. My Daughter has walked the same path as me, and despite great counselling, there really isn’t any emotional tools that can help.
He died from a Sudden Arrhythmia, together with his electrolytes being erratic.
I didn’t take it in at the time, but l recently remembered my Daughter saying that a nurse told her that his sugar level was also very low. That didn’t cause it, but it didn’t help.
Sorry, l won’t go off on a tangent again!
Think l will be getting my urology blood test results tomorrow.
Thank you for your support.
 
I can't begin to imagine how tough it must be to cope with such a tragic loss of a child. Sending sincerest sympathies and virtual (((HUGS))) Diabetes must just feel like the "last straw" for you at the moment, but it really does get easier and now that I have changed my diet (wasn't easy at first but needed doing and it is relatively easy now) my overall health has improved so I actually feel like I am fitter and healthier now than I was 5 years ago, before diagnosis. Hopefully, once you get to grips with it all, you will start to feel less weighed down by it. X
 
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