Pre-diabetic - not what I wanted to hear!

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Pidgeonpost

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At risk of diabetes
Evening all, and thanks for having me!

A routine blood test in September resulted in the following entry in my patient record - "Haemoglobin A1C level - IFCC standardised (XaPbt) 43 mmol/mol", and a call from the nurse with the glad tidings.
At her suggestion I have joined a support group, and also bought a blood glucose meter - Sinocare Accu2 bargain bundle including test strips and lancets.

I've been monitoring the readings for a couple of weeks now, but I can't see where the 43 mmol/mol fits in the chart that came with the meter as the chart only shows mmol/L and mg/dL. The readings I've taken and compared to the chart show that 75% of the time I'm in the 'Normal' range (4.0 to 7.0mmol/L), the remaining readings have all been in the 'Borderline' range (7.1 to 10.0mmol/L). All a bit confusing. This chart enables me to convert 43mmol/mol to Average Blood Glucose by a bit of guesswork. Maybe I need 'The Ladybird Book for Pre-diabetics'.

Me? I'm 74, 6 feet in height, 13st 4lb (about 2lb above my normal weight). I'm pretty active on the wrinkly scale, though aerobic exercise has taken a hit as the pandemic caused two of the dance groups we belonged to to fold. We continued to walk 4-5 days a week for an hour or more, but not enough to raise a sweat due to my wife's dodgy hip. We walk the dog, but she's a very slow-walker more interested in sniffing than speed.
Diet - pretty healthy I thought - loads of veg, pulses, very little meat, though I have been known to cast caution to the wind with a sausage or bacon butty.

Got my first 1-to-1 session on Saturday, so will report back. 🙂
 
Hello. Welcome to the club no one wants to join.

The hba1c/ac1 value 43 mmol is your 3 month AVG sample taken from a vein. It's a the value the doctors will provide after blood tests.

The finger pricks you do at home are the current levels of you're blood as a snap shot at the moment you take it.

I would ignore that chart and conversion of mmol.
mg/do is the measurements they do in America I think.

There's a lot of information on this site but the good news is that your 43 is only just in the diabetes scale. 42+ is classed at diabetic.

When I found out I was 80 something mmol.

What sort of questions do you have? What do you find confusing because there's a huge number of really helpful people here.

What is HbA1c?

HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).
www.diabetes.org.uk www.diabetes.org.uk
 
Welcome to the forum
There is often confusion about the readings you get. Your HbA1C is a test that is an average blood glucose over the previous 3 months and is given in mmol/mol.
The readings you get from your monitor are a moment in time and are in mmol/l in the UK. Although related in that the higher you finger prick readings are then that will be reflected in a higher HbA1C.
Your fingerprick reading to aim at are 4-7mmol/l fasting and before meals and no more than 8-8.5 mmmol/l 2 hours after meals.
Diet is the important thing as well as being active which it sounds as if you are. Some modest changes to your diet should be sufficient to bring your level down to normal which is below 42mmol/mol so not much needed.
Being careful about your carbohydrate intake and reducing portions of the higher carb foods, bread, potatoes, rice, pasta, breakfast cereals, some fruits and cutting out things like cakes, biscuits and sugary drinks including fruit juice. Many foods regarded as healthy are not necessarily so if your body struggles to cope with carbs.
In fact, sausages are pretty OK especially good quality high meat content ones as is meat, fish. eggs, cheese, dairy and vegetables.
The book or app Carbs and Cals is a useful guide to make better food choices.
 
Thanks, @notmez and @Leadinglights for your helpful replies. I suppose like any subject that's new there's a lot of information to get your head around. The main frustration for me was not being able to directly relate the reading on the blood glucose meter to the scale used on my patient record. Without that it's difficult to know know how I'm doing judged on daily finger prick tests.
Certainly I can do some tweaks on diet, and I need to find a replacement for the aerobic exercise lost over the pandemic.
I'll be back when I've had my 1-1 on Saturday. 🙂
 
Agreed it's not easy, you've not alone.

The general information that I was given by the nurse at my first 1-1 was that every 3 or 4 months they will do a new blood test to get a new Hba1c value. Once they know you are managing well those tests will reduce to 1 or 2 per year.

As you've bought your own BG meter this page is a good one to read. The key information for you is in the bottom half but id read through the whole page. There is a handy chart at the bottom that talks about the readings from a finger test and what the targets should be. Again speak to your nurse about your targets, they'll be similar or the same as this page.

Checking your blood sugar levels

Knowing your blood sugar levels helps you manage your diabetes and reduces your risk of having serious complications – now and in the future. What are blood sugar levels? Your blood sugar levels, also known as blood glucose levels, are a measurement that show how much glucose you have in your...
www.diabetes.org.uk www.diabetes.org.uk

As leading lights said, you are only just in the diabetic range. Small diet changes should help you bring those numbers down. My first set of numbers were double yours and I'm getting my next test in a couple of weeks. I reduced the amount of carbs I'm eating by a little bit simply by changing the ratio of food on my plate meals.

Pasta or Spaghetti Bolognese for example. I eat about half the pasta I used to but I have extra sauce, veg and salad. I'm still full after every meal.

I have a cake/pudding after evening meal a couple of times a week instead of everyday.

I switched my breakfast from a honey sweetened thing to plain Weetabix.

I have 2-4 packets of crisps every week instead of 1 every day.

Hopefully for you small changes to sugar and carbs will be more than enough to show improvements.

Advice:. Make a list of questions because when you get to your 1-1 with the nurse you might forget half of them I did at my first visit even thought I had a list. Also take a pen and make notes. I left the office with less info than I got there because I forgot everything luckily I was able to recall it all on the walk back home.
 
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Hello and welcome to the forum @Pidgeonpost
You have been detected early, so the way back to normal numbers will probably not be a long one for you.
A few tweaks to the diet might be all you need.
The meat, fish, seafood, eggs, cheese - the proteins - and fats are all good for you as they do not spike glucose or a spurt of insulin.
The sausages or bacon aren't the problem, but the bread could be.
I was fully diabetic when diagnosed, Hba1c of 91. Basically, my red blood cells had a coating of glucose molecules - the corpuscular equivalent of an iced doughnut with sprinkles.
From diagnosis I stopped eating high carb foods - grains, potatoes, sweet and starchy fruits, and also cut back on legumes - peas and beans - as my meter showed that I seem to be able to extract more carbs from them than most people.
It is rather like the GI and GL advice - my gut just takes it as a challenge rather than any sort of impediment to digestion. I find that I would rather have cauliflower cheese than macaroni cheese, that bubble and squeak made from swede rather than potato is really good. I use a steamer to cook the cauliflower and a pressure cooker for the swede- I cook things in perforated baskets so I can do potato for my husband at the same time - it is only 5 minutes cooking time at high pressure, so it saves energy as well as time.
Red blood cells last around 3 months and are then broken down, so the newer ones have not been glucose coated and my Hba1c is almost normal now.
 
Thanks everyone. I suspect that bread is one area that I'll definitely have to address. I started making my own about 15 years ago and eat about 50% white and 50% wholemeal. It's an easy 'go to' when you're busy, so I'll have to reduce or cut out the white perhaps and reduce consumption overall - and find something else to take its place. Beer - well I guess it's bad news as far as diabetes is concerned even if it is only a pint a day max, and more often a half.
@Drummer - interested to see you've joined a Morris Side. I did it for over 30 years and would probably be doing it still if I hadn't had nearly 2 years off thanks to the pandemic. I was wary of starting again at 74 and after such a long gap; I didn't want to risk picking up an injury that perhaps stopped me doing other activities. Miss it, though I still play music for them! 🙂
 
There do seem to be a few lower carb beers appearing but not sure what they would be like, probably not as good as a proper real ale which is pretty high carb.
Dry Wines and spirits with diet mixers are usually OK.
Yes, my other half makes bread and I am OK with just 1 slice of wholemeal, mixed grain, seeded or rye bread, thinly cut slices. Some people make Keto breads quite successfully.
 
Pidgeonpost said:
Thanks everyone. I suspect that bread is one area that I'll definitely have to address. I started making my own about 15 years ago and eat about 50% white and 50% wholemeal. It's an easy 'go to' when you're busy, so I'll have to reduce or cut out the white perhaps and reduce consumption overall - and find something else to take its place. Beer - well I guess it's bad news as far as diabetes is concerned even if it is only a pint a day max, and more often a half.
@Drummer - interested to see you've joined a Morris Side. I did it for over 30 years and would probably be doing it still if I hadn't had nearly 2 years off thanks to the pandemic. I was wary of starting again at 74 and after such a long gap; I didn't want to risk picking up an injury that perhaps stopped me doing other activities. Miss it, though I still play music for them! 🙂
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Not really joined - in that I just happened to join in the music when I had a spare half an hour and suddenly found myself being welcomed to the practice sessions and measured up for a set of tatters.
As it is the practice season now, you might be able to ease back into dancing. Several people have left the band after stepping in to dance once or twice when there were too few dancers and gradually working their way back.
I found myself assisting in a new dance with the Longsword dancers a few weeks ago, and I am 71.
We were all rather sobered by the sudden death of a dancer at the last dance weekend of this year, but on reflection, is there a better way to go than dancing with your team on the sea front at Swanage?
I also used to make my own bread, and baked and made Yorkshire puddings - but always had to be aware of the carbohydrates in the day.
You might well be able to just be aware and decide to keep some for another day, as you are only just into high numbers. A few less carbs a bit more exercise and you could reverse back to normal quite quickly - I went from Hba1c of 91 down to 41 in 6 months, but I was just longing to stop the low fat high carb diet the GP wanted me to follow.
 
Welcome to the forum @Pidgeonpost (I fondly remember an Arthur Ransome book of that name from my childhood)

Glad you have found us. It can be very helpful to have the ‘hive mind’ of the forum to consult about all sorts of things.

Diabetes can be a very individual affair, and there’s no ‘one size fits all’ approach. Some folks here find reducing their intake of carbohydrates helps them, while for others concentrating on reducing calorie intake is a more successful strategy.

As you’ve already discovered, diabetes is a topic that can be awash with numbers, and recommended levels and targets. Some of which overlap and influence each other, but not all of which can be directly converted or deduced from each other, because often it is different things which are being measured.

Hope you get lots of answers to your questions on Saturday, and some good, practical pointers for a way forward.

Ask away here if anything you get told causes confusion, or if there’s anything you forget to ask. Chances are someone here will have asked the same question for themselves in the past. It’s like having access to 100 different GPs, and diabetes nurses, along with literally centuries of lived diabetes experience 🙂
 
Thanks @everydayupsanddowns . Had my first group session on Saturday. Very much an introduction to what diabetes is and what the course has to offer. Two weeks now to make a few mods to diet and exercise before the next one. A suggestion from the course presenter was not to get too obsessed with finger prick tests as they are just a snapshot. It may be 3 months before there's much of a difference, but a 'fasting' one on waking is probably worth doing every day. I'll continue giving it a go!
 
Hi and welcome
I get my aerobic exercise in the swimming pool. I do aquafit (the class has several gentlemen as well as ladies) or you can just do lengths. Your wife might find aquafit helpful. I too have a dodgy back and hip but find I can exercise pain free in water. I'm certainly fitter and slimmer than I was!!! 🙂
 
Felinia said:
Hi and welcome
I get my aerobic exercise in the swimming pool. I do aquafit (the class has several gentlemen as well as ladies) or you can just do lengths. Your wife might find aquafit helpful. I too have a dodgy back and hip but find I can exercise pain free in water. I'm certainly fitter and slimmer than I was!!! 🙂
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I've got into aqua aerobics twice a week as well.
Definitely recommended.
 
We had a very good 'swim and gym' deal for a few years until moving house made it a 20 mile round trip. My nearest pool is now about 3 miles away but has closed - kinda frustrating! I'm back to the 20 mile option, which isn't so good, given fuel prices, and it makes a bigger hole in the day when you consider a dog walk (sometimes two) and other activities. I'm still going to try and work something out. We have a treadmill, but it's deadly boring compared to woodland walks. I'm about to put up a shelf in front of the treadmill so I can gain a little inspiration from watching videos on YouTube. :rofl:
 
A quick question - well, two actually:

  • How often is reasonable to do finger-prick tests when pre-diabetic? I read somewhere that the first thing in the morning/fasting test is the important one. It's easy to become obsessed, and the lancets and strips get used up amazingly quickly.
  • Given that red blood cells last for 3 months, is it reasonable to assume that it's likely to be 3 months before a change is likely to be seen in glucose levels?

Thanks. 🙂
 
Pidgeonpost said:
A quick question - well, two actually:

  • How often is reasonable to do finger-prick tests when pre-diabetic? I read somewhere that the first thing in the morning/fasting test is the important one. It's easy to become obsessed, and the lancets and strips get used up amazingly quickly.
  • Given that red blood cells last for 3 months, is it reasonable to assume that it's likely to be 3 months before a change is likely to be seen in glucose levels?

Thanks. 🙂
Click to expand...
Even when prediabetic testing is a useful tool to help you reduce your blood glucose, you can reuse the lancets but obviously need a new strip each time. You need to make the testing meaningful.
By testing before you eat and after 2 hours you can find out if the meal you have had has been tolerated without increasing your blood glucose by more than 2-3mmol/l, if it is more than that then it means you need to cut out or reduce the portion of the high carb food. You would be aiming that your 2-hour post meal reading would be no more than 8-8.5mmol/l. You should soon build up a list of meals that are 'safe' and wouldn't need to test those again.
People can test every morning to monitor progress day to day, week to week etc, that essentially gives a fasting reading which again you would be aiming at 4-7mmol/l.
It is also a good idea to test if you feel unwell as that may indicate high or low blood glucose and will enable you to take action.
As soon as you make dietary change and get your levels within the guide above then you will see a reduction in HbA1C after an approx. three-month period. Higher level from the earlier weeks will drop out so the average should show a reduction.
 
Pidgeonpost said:
A quick question - well, two actually:

  • How often is reasonable to do finger-prick tests when pre-diabetic? I read somewhere that the first thing in the morning/fasting test is the important one. It's easy to become obsessed, and the lancets and strips get used up amazingly quickly.
  • Given that red blood cells last for 3 months, is it reasonable to assume that it's likely to be 3 months before a change is likely to be seen in glucose levels?

Thanks. 🙂
Click to expand...
If you test after meals and then assess how that meal affected you it should not be very long before you get a good idea of what to eat, what to avoid.
After getting my first meal sorted out I did not need to test again, as I could see that anything over 10 gm of carbs was not a good idea, and not having any carbs at all didn't work for me either.
I have not needed to test for years now as I am at the top end of normal, but when I dropped down to a maximum of 40 gm of carbs per day from 50 gm, there was no change in my Hba1c. My blood glucose levels after my evening meal were just a little lower on average after a month or so.
Your glucose levels taken in the mornings will probably be the last ones to reduce, but that is just down to biology. You could well see a lowering of after meal spikes in a very short time as it shows how you react to the meal just eaten.
 
Pidgeonpost said:
Thanks @Leadinglights and @Drummer. Very useful to know. I'll start monitoring 2 hours after eating as well and see how things shape up.
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You might also find Alan S’s test-review-adjust a helpful framework for monitoring around meals.

Blood glucose levels, like many other health markers, are in a constant state of rise and fall.

So while you are right, and the HbA1c check (which measures changes to red blood cells) is often checked every 3 months at minimum, fingerstick glucose levels - which are a snapshot moment in time - change in response to many factors inclucind carbohydrates, sugars, activity, exercise, stress, and some medications (eg steroids).
 
Stick to two hours after eating, Alan S suggestion of testing at one hour is a bit over zealous, even none diabetics can see spikes immediately after eating.
 
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