Recently diagnosed at risk - looking for some pointers

[Steve J]

I was diagnosed as at risk in September last year (HbA1c = 42; a year previously it had been 39). At the time I had (what I considered to be) a reasonably healthy diet. I’m a skinny old bloke (8st 10lb, 5’ 6”, 72 y), so I can’t afford to lose weight. And I’m pretty active (regular hill walking and rowing machine use).

With the promise of another test in January, and at the suggestion of the nurse, I made some changes to my diet. For 3 - 4 months I had no cake, biscuits, confectionary, sugary drinks; no toast and jam at breakfast; fewer sandwiches during the week; I aimed to replace lost calories with more nuts, peanut butter and eggs. But my January result increased (to 45), so I guess I need to take a harder look at the carbohydrates in my diet.

This prompts a few questions in my mind.

1. I read elsewhere that I should aim for 130 g / day of carbohydrate. I’m sure there will be information on the internet on the carb content of various foodstuffs so I can do the calculation, but is there a recommended source of this information?

2. Similarly, I know there is no shortage of dietary advice out there, but again, where would be the recommended place to start?

3. And finally, should I be thinking about checking my blood glucose levels to see the impact of further changes to my diet (if so, how do I go about this), or would it be as well to wait for my next HbA1c test towards the end of April?

Apologies for all the questions, but any pointers to where I should start would be much appreciated.

Thanks

Steve

 

[childofthesea43]

I was diagnosed as at risk in September last year (HbA1c = 42; a year previously it had been 39). At the time I had (what I considered to be) a reasonably healthy diet. I’m a skinny old bloke (8st 10lb, 5’ 6”, 72 y), so I can’t afford to lose weight. And I’m pretty active (regular hill walking and rowing machine use).

With the promise of another test in January, and at the suggestion of the nurse, I made some changes to my diet. For 3 - 4 months I had no cake, biscuits, confectionary, sugary drinks; no toast and jam at breakfast; fewer sandwiches during the week; I aimed to replace lost calories with more nuts, peanut butter and eggs. But my January result increased (to 45), so I guess I need to take a harder look at the carbohydrates in my diet.

This prompts a few questions in my mind.

1. I read elsewhere that I should aim for 130 g / day of carbohydrate. I’m sure there will be information on the internet on the carb content of various foodstuffs so I can do the calculation, but is there a recommended source of this information?

2. Similarly, I know there is no shortage of dietary advice out there, but again, where would be the recommended place to start?

3. And finally, should I be thinking about checking my blood glucose levels to see the impact of further changes to my diet (if so, how do I go about this), or would it be as well to wait for my next HbA1c test towards the end of April?

Apologies for all the questions, but any pointers to where I should start would be much appreciated.

Thanks

Steve

The average hba1c for NON-diabetics aged over 65 is about 47.5 and the threshold of 42 in current use to diagnose pre-diabetes was set years ago by a tiny trial of participants all aged under 40. I see no reason to think you’re anywhere near pre-diabetic.

 

[Proud to be erratic]

Hello @ Steve J, welcome to the Forum. I'm an insulin dependent diabetic, so far from a perfect person to answer your questions. But I did wonder if there is any history of diabetes in your family?

I was diagnosed as at risk in September last year (HbA1c = 42; a year previously it had been 39). At the time I had (what I considered to be) a reasonably healthy diet. I’m a skinny old bloke (8st 10lb, 5’ 6”, 72 y), so I can’t afford to lose weight. And I’m pretty active (regular hill walking and rowing machine use).

Your summary doesn't make you a natural candidate for this contradictory disease, but being active will definitely help you.

With the promise of another test in January, and at the suggestion of the nurse, I made some changes to my diet. For 3 - 4 months I had no cake, biscuits, confectionary, sugary drinks; no toast and jam at breakfast; fewer sandwiches during the week; I aimed to replace lost calories with more nuts, peanut butter and eggs. But my January result increased (to 45), so I guess I need to take a harder look at the carbohydrates in my diet.

Those alterations seem very appropriate and yet a small increase in your latest HbA1c must feel a bit disappointing to you. Well done on taking such a positive view of "taking a harder look at the carbs in my diet".

This prompts a few questions in my mind.

1. I read elsewhere that I should aim for 130 g / day of carbohydrate. I’m sure there will be information on the internet on the carb content of various foodstuffs so I can do the calculation, but is there a recommended source of this information?

Many of us use the book "Carbs and Cals" for core info. There is also an app which I tried for a year and abandoned, mainly because it was expensive and I didn't find it so comprehensive as the book. I kept my book pristine for about a year and then realised I should also add my notes about foods I regularly turned to. So it got many positive notes inside. I decreasingly need it these days I'm thoroughly familiar with most foods I eat!

There is also nutritional data including carbs in small print on the back of any foods in packets from retailers and for the odd one-off I just ask Google for the carbs in "X UK". That removes the US confusion over fibre!

2. Similarly, I know there is no shortage of dietary advice out there, but again, where would be the recommended place to start?

I'd start with this Forum, not least the Learning Zone (orange tab on the drop down menu which needs it's own registration). The chef Caldesi produced a couple of books that others have suggested are good; he is T2.

3. And finally, should I be thinking about checking my blood glucose levels to see the impact of further changes to my diet (if so, how do I go about this), or would it be as well to wait for my next HbA1c test towards the end of April?

Testing with a finger prick lance that produces a drop of blood to put on a test strip and get a snapshot reading can be helpful. The no it generates is not the same as an HbA1c which is a look at your last 3 months of blood glucose behaviour. FPs are sort of akin to having a speedometer in your car; you know where you are right now but not 30 seconds before or after. Such BG tests are of zero use if random and need to be part of a structured process to get a daily reference point (perhaps on going to bed and on waking to see how night fasting has been FOR YOU and then before a meal and 2 hrs later to see how YOU managed that meal.

I'm personally not convinced you need to get into this fp process yet. Your 42 is a modest "flag" and maybe further changes are needed to your diet, then see how you get on with a new HbA1c in 3 months time. If you enjoy alcohol wine and spirits without mixers should be fine (in moderation); some beer can be carb heavy for some people and fortified wines or liquers are high carb

Apologies for all the questions, but any pointers to where I should start would be much appreciated.

Thanks

Steve

 

[Leadinglights]

I think you may be getting overly concerned as even though you have had a slight increase in your HbA1C but you are still in what is prediabetic range however there is some new thinking that thresholds should be more lenient for people who are older and there should be personalised approach which would take into account other risk factors.
Staying active and being watchful of your diet to eat one which is 'healthy' for your own circumstances.
Clearly you don't need to lose weight so if you reduce carbs then making sure you have enough protein and heathy fats will help with that.
I post this link so you can see what meal options there are even though it is designed to help people reduce blood glucose and lose weight there may be something which will help you. https://lowcarbfreshwell.com/

 

[Steve J]

The average hba1c for NON-diabetics aged over 65 is about 47.5 and the threshold of 42 in current use to diagnose pre-diabetes was set years ago by a tiny trial of participants all aged under 40. I see no reason to think you’re anywhere near pre-diabetic.

Thanks for this reassuring observation. I’m not a medic but do have a scientific background and am curious to understand more about these alternative thresholds for older folks. Is there any published research on this topic you could point me to please?

 

[Steve J]

Hello @ Steve J, welcome to the Forum. I'm an insulin dependent diabetic, so far from a perfect person to answer your questions. But I did wonder if there is any history of diabetes in your family?

Your summary doesn't make you a natural candidate for this contradictory disease, but being active will definitely help you.

Those alterations seem very appropriate and yet a small increase in your latest HbA1c must feel a bit disappointing to you. Well done on taking such a positive view of "taking a harder look at the carbs in my diet".

Many of us use the book "Carbs and Cals" for core info. There is also an app which I tried for a year and abandoned, mainly because it was expensive and I didn't find it so comprehensive as the book. I kept my book pristine for about a year and then realised I should also add my notes about foods I regularly turned to. So it got many positive notes inside. I decreasingly need it these days I'm thoroughly familiar with most foods I eat!

There is also nutritional data including carbs in small print on the back of any foods in packets from retailers and for the odd one-off I just ask Google for the carbs in "X UK". That removes the US confusion over fibre!

I'd start with this Forum, not least the Learning Zone (orange tab on the drop down menu which needs it's own registration). The chef Caldesi produced a couple of books that others have suggested are good; he is T2.

Testing with a finger prick lance that produces a drop of blood to put on a test strip and get a snapshot reading can be helpful. The no it generates is not the same as an HbA1c which is a look at your last 3 months of blood glucose behaviour. FPs are sort of akin to having a speedometer in your car; you know where you are right now but not 30 seconds before or after. Such BG tests are of zero use if random and need to be part of a structured process to get a daily reference point (perhaps on going to bed and on waking to see how night fasting has been FOR YOU and then before a meal and 2 hrs later to see how YOU managed that meal.

I'm personally not convinced you need to get into this fp process yet. Your 42 is a modest "flag" and maybe further changes are needed to your diet, then see how you get on with a new HbA1c in 3 months time. If you enjoy alcohol wine and spirits without mixers should be fine (in moderation); some beer can be carb heavy for some people and fortified wines or liquers are high carb

Thanks for the detailed reply. It is much appreciated. I will take a look at the “Carbs and Cals” book. I the meantime I have found the DUK carb reference list which has enough to get me going in terms of calculating my carbs inputs. I have also found the recipe finder on the website which has more than enough inspiration for me. I take your point about the finger prick tests: there is plenty I need to do to get the basics in place first, before I worry about the fine tuning.

Your response has also prompted another specific question in my mind, and having delved though some of the discussions in the forum, I think I am better starting another thread … (Not too sure on the forum protocols in this respect.)

 

[Steve J]

I think you may be getting overly concerned as even though you have had a slight increase in your HbA1C but you are still in what is prediabetic range however there is some new thinking that thresholds should be more lenient for people who are older and there should be personalised approach which would take into account other risk factors.
Staying active and being watchful of your diet to eat one which is 'healthy' for your own circumstances.
Clearly you don't need to lose weight so if you reduce carbs then making sure you have enough protein and heathy fats will help with that.
I post this link so you can see what meal options there are even though it is designed to help people reduce blood glucose and lose weight there may be something which will help you. https://lowcarbfreshwell.com/

Thanks for pointing out the new thinking on more appropriate thresholds for older people. This echoes childofthesea43’s point, and I am curious to understand more.

Thanks also for the link to recipe ideas: there is clearly no shortage of good resources out there!

 

[Leadinglights]

Thanks for pointing out the new thinking on more appropriate thresholds for older people. This echoes childofthesea43’s point, and I am curious to understand more.

Thanks also for the link to recipe ideas: there is clearly no shortage of good resources out there!

I personally think having a monitor actually help with getting the basics right as it tells you what you can eat that you may think you need to exclude as well as what it is better to avoid or only have in small portions.

 

[Proud to be erratic]

I personally think having a monitor actually help with getting the basics right as it tells you what you can eat that you may think you need to exclude as well as what it is better to avoid or only have in small portions.

I certainly agree @Leadinglights that having a monitor does play a big part in getting the basics right. I'm just not convinced @Steve J that your basics are particularly wrong. But if you have other health issues that are attracting concerns and you are relaxed about taking on a structured commitment to monitor your BG and find optimum foods for your personal metabolism to manage your consequent BG - go for it. It's just a matter of finding a balance between caring for yourself appropriately vs getting sucked into potentially obsessing about nos and figures that can display a higher level of accuracy than is actually occurring. It's easy for a glucosemeter manufacturer to display a reading to one decimal place, when rounding that no up or down to the nearest whole no is still just providing a "ball park" figure and when the TREND of BG change is far more relevant. Well that certainly is for me as someone who is insulin dependent. Perhaps I see this from a slightly different perspective and should now step back a bit here.

 

[Docb]

Hi @Steve J and welcome to the forum. I'm in the same age bracket as you, same height but not so skinny. The point you raise is interesting.

My way of thinking is that the idea that 42 and 48 are some sort of magic numbers which mark boundaries between healthy and unhealthy or safe and unsafe can be unhelpful. What would be helpful is a bit more breakdown of that ever increasing cohort of people diagnosed with diabetes or at risk of diabetes in order to get a better perception of the risks being run by different subsets of that cohort. The idea that people like you and me (old, thin and wearing out) are in the same boat as those at the other extreme (young, overweight and piling up risk for their long term health) just does not seem right.

My last HbA1c was 55 mmol/mol. My DN was happy with that but my data indicated a slow but steady increase in BG and so a second pill (forxiga) was introduced, not to get my HbA1c down but to attempt to check the increasing trend. I am content that at this level I will not get the short term problems associated with diabetes and the risks of something else getting me are far higher than the risk I have of complications of diabetes dominating my rapidly diminishing later life. I could no doubt spend much time and intellect effort on trying to get my Hba1c down by trying to lose more weight and maybe trying to devise a diet with a lower carb intake than my current 120-150 g/day but I cannot see sufficient gain to make it worthwhile.

A point of view somewhat different to the norm, but then I made a living from thinking differently, and I doubt I will ever change.

 

[Exflex]

Hi @Steve J, I’m in a similar boat to you having had an Hb1Ac performed ~1 month ago, recorded as being 44. My GP said I’m mid range in the Pre-Diabetic scale and noted on my records I’m planning to alter diet.
I’m reading Dr David Cavan’s book ‘ How to Reverse Type 2 and Pre-Diabetes’
Link: https://www.amazon.co.uk/How-Revers...7082915&sprefix=dr.+david+cavan,aps,54&sr=8-1
What I’ve come to understand is that this condition is progressive if steps are not taken. I’m a bit (moderately?) overweight and this situation leads to a non-alcoholic fatty liver and fatty pancreas that act like a positive feedback system increasing serum BG. The fatty liver doesn’t respond as it should to insulin (turning off glycogen release to the blood) and basically leaks glycogen. The fatty pancreas impedes insulin production. I’m wondering if in older people (I’m 72) it’s many years of assault that causes a gradual build up of fatty liver and pancreas, and so the BG increases. I’ve not read of any tests such as ultrasound to check the state of the two organs, so I guess it’s an assumption made by those in the know.

 

[childofthesea43]

Thanks for this reassuring observation. I’m not a medic but do have a scientific background and am curious to understand more about these alternative thresholds for older folks. Is there any published research on this topic you could point me to please?

Yes, here is one such study:

Preventing misdiagnosis of diabetes in the elderly: age-dependent HbA1c reference intervals derived from two population-based study cohorts - BMC Endocrine Disorders

Background Measurement of gylcated hemoglobin A1c (HbA1c) plays a central role in monitoring quality of antidiabetic therapy and in the diagnosis of diabetes. Several studies report increased levels of HbA1c in nondiabetic elderly. However, this observation did not reach incorporation into daily...

bmcendocrdisord.biomedcentral.com

 

[Steve J]

Yes, here is one such study:

Preventing misdiagnosis of diabetes in the elderly: age-dependent HbA1c reference intervals derived from two population-based study cohorts - BMC Endocrine Disorders

Background Measurement of gylcated hemoglobin A1c (HbA1c) plays a central role in monitoring quality of antidiabetic therapy and in the diagnosis of diabetes. Several studies report increased levels of HbA1c in nondiabetic elderly. However, this observation did not reach incorporation into daily...

bmcendocrdisord.biomedcentral.com

Thank you. I will take a look.

 

[Steve J]

Hi @Steve J, I’m in a similar boat to you having had an Hb1Ac performed ~1 month ago, recorded as being 44. My GP said I’m mid range in the Pre-Diabetic scale and noted on my records I’m planning to alter diet.
I’m reading Dr David Cavan’s book ‘ How to Reverse Type 2 and Pre-Diabetes’
Link: https://www.amazon.co.uk/How-Reverse-Type-Diabetes-Prediabetes/dp/1838954589/ref=sr_1_1?crid=3IR5BMNCLZ9OP&keywords=Dr.+david+Cavan&qid=1707082915&sprefix=dr.+david+cavan,aps,54&sr=8-1
What I’ve come to understand is that this condition is progressive if steps are not taken. I’m a bit (moderately?) overweight and this situation leads to a non-alcoholic fatty liver and fatty pancreas that act like a positive feedback system increasing serum BG. The fatty liver doesn’t respond as it should to insulin (turning off glycogen release to the blood) and basically leaks glycogen. The fatty pancreas impedes insulin production. I’m wondering if in older people (I’m 72) it’s many years of assault that causes a gradual build up of fatty liver and pancreas, and so the BG increases. I’ve not read of any tests such as ultrasound to check the state of the two organs, so I guess it’s an assumption made by those in the know.

Thanks for the link. I will follow this up.

 

[Steve J]

Hi @Steve J and welcome to the forum. I'm in the same age bracket as you, same height but not so skinny. The point you raise is interesting.

My way of thinking is that the idea that 42 and 48 are some sort of magic numbers which mark boundaries between healthy and unhealthy or safe and unsafe can be unhelpful. What would be helpful is a bit more breakdown of that ever increasing cohort of people diagnosed with diabetes or at risk of diabetes in order to get a better perception of the risks being run by different subsets of that cohort. The idea that people like you and me (old, thin and wearing out) are in the same boat as those at the other extreme (young, overweight and piling up risk for their long term health) just does not seem right.

My last HbA1c was 55 mmol/mol. My DN was happy with that but my data indicated a slow but steady increase in BG and so a second pill (forxiga) was introduced, not to get my HbA1c down but to attempt to check the increasing trend. I am content that at this level I will not get the short term problems associated with diabetes and the risks of something else getting me are far higher than the risk I have of complications of diabetes dominating my rapidly diminishing later life. I could no doubt spend much time and intellect effort on trying to get my Hba1c down by trying to lose more weight and maybe trying to devise a diet with a lower carb intake than my current 120-150 g/day but I cannot see sufficient gain to make it worthwhile.

A point of view somewhat different to the norm, but then I made a living from thinking differently, and I doubt I will ever change.

Hi @Docb. Thanks for these observations. I agree. There must be so much data out there calling for a good statistical analysis which would be so useful.

 

[Drummer]

@Steve J I am just coming up to 73 years old and was diagnosed back in 2016. Eating 40gm of carbs a day keeps my blood glucose numbers in normal levels, after meals usually under 7mmol/l but despite eating the same things at the same rate for years my HbA1c has inched up.
I started off eating 50gm of carbs a day and got to 41 after 6 months, then a couple of 42s so I decided to drop the carbs to 40gm. A year later I was hopeful of high 30s. No, it was 42 again.
The blood glucose is still low, so it is perhaps the slower rate of replacement of blood cells which is significant in later life.
Later life eh - how did that happen?
At least in the last half decade I have regained some strength and stamina, and lost a load of weight eating what some regard as shamelessly high amounts of meat, fish, eggs, cheese, having coffee with cream and concocting various desserts using gelatine, sugar free jelly, full fat yoghurt, berries, more cream or sometimes real custard.

 

[Exflex]

As we age things start going wrong, the tired knees, immune system, plumbing - you name it, lot’s deteriorate; the pancreas too maybe. As we strain the pancreas through bad eating, and it gets fatty, maybe it’s heading in one direction gradually downwards. Cell reproduction goes wrong with age and that’s part of the reason why we die.
All of this is me guessing, of course, basically I really don’t know.

 

[Steve J]

@Steve J I am just coming up to 73 years old and was diagnosed back in 2016. Eating 40gm of carbs a day keeps my blood glucose numbers in normal levels, after meals usually under 7mmol/l but despite eating the same things at the same rate for years my HbA1c has inched up.
I started off eating 50gm of carbs a day and got to 41 after 6 months, then a couple of 42s so I decided to drop the carbs to 40gm. A year later I was hopeful of high 30s. No, it was 42 again.
The blood glucose is still low, so it is perhaps the slower rate of replacement of blood cells which is significant in later life.
Later life eh - how did that happen?
At least in the last half decade I have regained some strength and stamina, and lost a load of weight eating what some regard as shamelessly high amounts of meat, fish, eggs, cheese, having coffee with cream and concocting various desserts using gelatine, sugar free jelly, full fat yoghurt, berries, more cream or sometimes real custard.

@Drummer. Thanks for your reply. What is surprising to me (as a newbie - I guess it’s obvious to everyone else here) is that there are so many variations in folks’ internal chemistry. It’s tempting to say that each of us is unique in this respect, but I can’t help wondering if there is a finite number of categories, and that it might help if we each knew which box we were in.

 

[Docb]

@Drummer. Thanks for your reply. What is surprising to me (as a newbie - I guess it’s obvious to everyone else here) is that there are so many variations in folks’ internal chemistry. It’s tempting to say that each of us is unique in this respect, but I can’t help wondering if there is a finite number of categories, and that it might help if we each knew which box we were in.

Agree with you @Steve J, and the one thing that frustrates many of us is the way Diabetes is talked about in the outside world with very simple stereotypes and often not even distinguishing between T1 and T2. As for those who use "diabetes" as marketing opportunity the less said the better.

Like many things it comes down to better education but that is another thing that is easy to say but very hard to do.

 

[Steve J]

As we age things start going wrong, the tired knees, immune system, plumbing - you name it, lot’s deteriorate; the pancreas too maybe. As we strain the pancreas through bad eating, and it gets fatty, maybe it’s heading in one direction gradually downwards. Cell reproduction goes wrong with age and that’s part of the reason why we die.
All of this is me guessing, of course, basically I really don’t know.

@Exflex. I count myself lucky that I’ve got so far in life without any major problems. But it’s been a bit of a shock how quickly so many things have begun to deteriorate since I hit 70. It’s definitely a case of “managed decline” on several fronts.