Yet Another Newbie .. !

[Macloud]

Got another shot across my bows from the GP recently about my elevated blood pressure (BP) and reminding me that my HbA1c figure had languished at, or slightly below, 43 the for best part of 5 years now .. and what was I going to do about it ? A long-term, pre-diabetic, Type 2, dieting back-slider thus.

So I resolved again to cut out the chocolate, cake, and biscuits and ice cream, etc., and to make a further attempt to lose weight .. and keep it off.

But the final straw that has pushed me to dare to expose myself to this website’s scrutiny is that my dear wife has recently also been found now to have an HbA1c value of 42 and therefore declared pre-diabetic also. This has really woken me up !

However .. there is a difference in our situations. While I have a BMI of around 29 and am clearly overweight, hers is a comparatively skinny 19 ! So how come pre-diabetic ?

It seems to me that the traditional method of tackling diabetes is overwhelmingly predicated on losing weight and I believe that will work for me .. provided I keep at it and avoid my traditional relapse after a couple of months. But what of the close-to-underweight situation, like my wife ? How does one tackle that ?

Any advice appreciated. I am a bit stumped.

 

[Leadinglights]

Welcome to the forum to you both. As you have been given a prediabetes diagnosis it is a nudge to watch your carbohydrate intake as all carbohydrates convert to glucose and your body is struggling to cope with it. Some modest changes are probably all that is needed.
If you are reducing carbs then making sure you have enough protein and healthy fats is important. There may be some ideas in this link that will suit you both as it will make life easier if you are eating the same meals. https://lowcarbfreshwell.co.uk/
In your cases watching portion size and cutting out some of the high carb big hitters rather than a wholesale cutting out of foods. It is a matter of good choices of the carbs you do have.

 

[Vonny]

I was very overweight when diagnosed but since losing weight through cutting out/down carbs and increasing exercise I've manage to get to below pre-diabetic levels. My sister, however, who was a chubby child but who got skinny at 15 and has kept her weight off for the past 55 years, was diagnosed as prediabetic a couple of years ago. She followed my lead on the carbs and has successfully returned to <42. As @Leadinglights says, modest changes are probably all that's required. Best of luck to you both 🙂

 

[everydayupsanddowns]

Welcome to the forum @Macloud

Sorry to hear about both you and your wife both being told you are at risk of diabetes.

Perhaps it will be easier as a team together? Particularly if you are aiming for a reduction in sweet stuff, and a few tweaks to your main meals with some possible swaps and portion reductions to lower their glucose-raising potential?

We’ve had lots of members who have successfully made some fairly modest changes which have had a big impact, and steered them back below the prediabetes threshold.

 

[Spathiphyllum]

Got another shot across my bows from the GP recently about my elevated blood pressure (BP) and reminding me that my HbA1c figure had languished at, or slightly below, 43 the for best part of 5 years now .. and what was I going to do about it ? A long-term, pre-diabetic, Type 2, dieting back-slider thus.

So I resolved again to cut out the chocolate, cake, and biscuits and ice cream, etc., and to make a further attempt to lose weight .. and keep it off.

But the final straw that has pushed me to dare to expose myself to this website’s scrutiny is that my dear wife has recently also been found now to have an HbA1c value of 42 and therefore declared pre-diabetic also. This has really woken me up !

However .. there is a difference in our situations. While I have a BMI of around 29 and am clearly overweight, hers is a comparatively skinny 19 ! So how come pre-diabetic ?

It seems to me that the traditional method of tackling diabetes is overwhelmingly predicated on losing weight and I believe that will work for me .. provided I keep at it and avoid my traditional relapse after a couple of months. But what of the close-to-underweight situation, like my wife ? How does one tackle that ?

Any advice appreciated. I am a bit stumped.

With a BMI of 29, you are probably pre-Type 2.

With a BMI of 19, your wife is extremely unlikely to be pre-Type 2; she is more likely to be early-stage Type 1. She should be given a C-peptide test and autoantibody tests to find out.

You may have to apply a lot of pressure to your GP to get the proper tests for her; my GP wanted to declare me Type 2 "because of your age" even though my BMI was 16! Fortunately, I managed to pressure my GP into e-mailing the hospital diabetes team for advice-- and the hospital team immediately called me in and did the proper tests and found I was Type 1, which of course requires completely different treatment from Type 2.

Lean on your GP as hard as you have to in order to ensure that your wife gets the proper tests to ensure that she gets the right diagnosis and treatment.

 

[ianf0ster]

Hi @Macloud There are skinny Type 2 diabetics (as many as 10%), so a skinny pre- Type 2 isn't that unusual, I was one. By following doctors advice I put on weight and became fully Type 2!
I then knew that 5 a Day, Eat Well Plate , Low Fat and Whole Grains were making me worse, so I followed a Low Carb way of eating (eat to your meter and don't eat when not hungry) getting into T2D remission in about 6 months.
And although I didn't have much weight to lose, just that Low Carb (without cutting calories) did reverse my weight gain so I now weigh what I did over 20yrs ago.

 

[Spathiphyllum]

Hi @Macloud There are skinny Type 2 diabetics (as many as 10%), so a skinny pre- Type 2 isn't that unusual, I was one. By following doctors advice I put on weight and became fully Type 2!
I then knew that 5 a Day, Eat Well Plate , Low Fat and Whole Grains were making me worse, so I followed a Low Carb way of eating (eat to your meter and don't eat when not hungry) getting into T2D remission in about 6 months.
And although I didn't have much weight to lose, just that Low Carb (without cutting calories) did reverse my weight gain so I now weigh what I did over 20yrs ago.

Ian-- there are "skinny Type 2 diabetics" in the sense of Type 2s who are not overweight in BMI terms, meaning they have BMIs of 25 or less. But, from what I've read, it is extremely rare for anyone with a BMI of less than 23 to develop Type 2 or even pre-Type 2.

In fact, you seem to be a great example of this! Looking at the facts you give in your signature, and comparing to a BMI chart: If, when you weighed 170 lbs, your BMI was 26.6, you must be about 5' 7". And at that point your HbA1c was over 48, so you were diabetic. When you got down to 147 lbs, your HbA1c went into the pre-diabetic range (42-47); at that point your BMI will have been about 23.

When you got down to a BMI of 22.2, you stopped being even pre-diabetic; your HbA1c went back into the normal range (41 or less).

 

[Macloud]

Hi Folks ! And thanks for the welcome and various advice snippets. I am at the bottom of a learning curve here (my wife is even lower !) and I will sift through this stuff eventually, I'm sure. I am impressed with the data that some of you publish here for public scrutiny. It would seem that both our remedial tasks here are trivial by comparison with many others' who have been successful. It gives us confidence that we will also be successful in putting this pesky Diabetes stuff behind us before too much time has passed.

M.

 

[Deleted member 21371]

Ian-- there are "skinny Type 2 diabetics" in the sense of Type 2s who are not overweight in BMI terms, meaning they have BMIs of 25 or less. But, from what I've read, it is extremely rare for anyone with a BMI of less than 23 to develop Type 2 or even pre-Type 2.

In fact, you seem to be a great example of this! Looking at the facts you give in your signature, and comparing to a BMI chart: If, when you weighed 170 lbs, your BMI was 26.6, you must be about 5' 7". And at that point your HbA1c was over 48, so you were diabetic. When you got down to 147 lbs, your HbA1c went into the pre-diabetic range (42-47); at that point your BMI will have been about 23.

When you got down to a BMI of 22.2, you stopped being even pre-diabetic; your HbA1c went back into the normal range (41 or less).

That's a valid point.

I reversed my diabetes only when I got I to a "healthy" BMI range.
As you say, 26.6 isn't skinny, I think I had to get to low 20's as well.
So like @ianf0ster maybe losing that couple of stones made the difference, but I'd be wondering at below 20 as well.

 

[Spathiphyllum]

That's a valid point.

I reversed my diabetes only when I got I to a "healthy" BMI range.
As you say, 26.6 isn't skinny, I think I had to get to low 20's as well.
So like @ianf0ster maybe losing that couple of stones made the difference.

Yes; and also my main concern is for Mrs Macloud. Talk of 'skinny Type 2s', or 'skinny pre-Type 2s', is misleading; when you're down near the bottom of the official BMI 'healthy' range and still have HbA1c of 42 or more, alarm bells should go off as to whether it is actually Type 2.

(And the bottom of the official BMI 'healthy' range is 18.5, so, if Mrs M's BMI is only 19 ...)

On the one hand, it would be great if Mrs M did turn out to be pre-Type 2-- because then she could reverse it, and Mr M would be right in his confidence that both he and Mrs M will be "successful in putting this pesky Diabetes stuff behind us before too much time has passed." If she is actually Type 1-- there is no way to reverse T1; we T1s are stuck with "this pesky Diabetes stuff" 24 hours a day, 7 days a week, for the rest of our lives.

On the other hand-- if she is actually Type 1 but is treated as Type 2, that could do her real harm. She could end up not getting the correct diagnosis until after being rushed to hospital with DKA; and DKA can be fatal.

 

[Dishevelled]

Ian-- there are "skinny Type 2 diabetics" in the sense of Type 2s who are not overweight in BMI terms, meaning they have BMIs of 25 or less. But, from what I've read, it is extremely rare for anyone with a BMI of less than 23 to develop Type 2 or even pre-Type 2.

In fact, you seem to be a great example of this! Looking at the facts you give in your signature, and comparing to a BMI chart: If, when you weighed 170 lbs, your BMI was 26.6, you must be about 5' 7". And at that point your HbA1c was over 48, so you were diabetic. When you got down to 147 lbs, your HbA1c went into the pre-diabetic range (42-47); at that point your BMI will have been about 23.

When you got down to a BMI of 22.2, you stopped being even pre-diabetic; your HbA1c went back into the normal range (41 or less).

I was diagnosed Type 2 in December with a BMI of 22 so there are some of us skinny ones out there.

 

[Spathiphyllum]

I was diagnosed Type 2 in December with a BMI of 22 so there are some of us skinny ones out there.

The problem is: *How* were you diagnosed as Type 2? Was it just 'Your HbA1c is over 48, your age is 56, therefore you must be Type 2?' That's what my GP did, and my GP was wrong...

 

[Dishevelled]

The problem is: *How* were you diagnosed as Type 2? Was it just 'Your HbA1c is over 48, your age is 56, therefore you must be Type 2?' That's what my GP did, and my GP was wrong...

Initially, yes but they did a full range of blood tests and scan soon after. Maybe I should be worried now? Oh, and how did you know my age? 😉

 

[bulkbiker]

Initially, yes but they did a full range of blood tests and scan soon after. Maybe I should be worried now? Oh, and how did you know my age? 😉

 

[Spathiphyllum]

Initially, yes but they did a full range of blood tests and scan soon after. Maybe I should be worried now? Oh, and how did you know my age? 😉

If they gave you C-peptide and autoantibody tests, that's great! What were your results?

(As Bulkbiker points out-- if, when registering, you input your age, your age appears on your profile.)

 

[Dishevelled]

I don't recall being given C-peptide or autoantibody tests. Just my HbA1c which was 115 and had come down to 72 after three months on 2 Metformin tablets a day (plus diet changes).

I'm due for a follow up in the next few weeks so will ask them then. Is there anything I should look out for?

 

[Leadinglights]

Those 2 tests are used to help diagnose Type 1 or LADA when people present with high HbA1C, being not overweight or losing weight so don't fit the normal profile of Type 2.
Also when dietary measures and oral meds are not effective in reducing blood glucose people may be misdiagnosed as Type 2.
People do seem to be being diagnosed as Type 1 at any age not just the young which was always assumed to be the case.

 

[Spathiphyllum]

I don't recall being given C-peptide or autoantibody tests. Just my HbA1c which was 115 and had come down to 72 after three months on 2 Metformin tablets a day (plus diet changes).

I'm due for a follow up in the next few weeks so will ask them then. Is there anything I should look out for?

If the metformin seems to be helping, that's great! The hallmark of Type 2 is insulin resistance, and metformin increases insulin sensitivity. On the other hand, people can have some insulin resistance and also have the autoimmune disease which is Type 1.

So, just in case-- if you haven't had C-peptide and autoantibody tests, meaning you haven't had a definitive exclusion of Type 1-- keep an eye on your weight! And in the opposite direction from the way Type 2s need to keep an eye on their weight ...

The classic clinical feature of untreated Type 1 (and the *only* treatment for Type 1 is insulin) is unintentional weight loss. (Before insulin treatment was discovered, Type 1 was invariably fatal-- because, without enough insulin, your body basically can't make use of your food, so you starve to death no matter how much you eat. Unless you die of DKA first.)

With a BMI of 22, you may not be used to weighing yourself regularly! If not-- get into the habit. If you want to intentionally lose a little weight, ok-- not too much, though! But, if you start shrinking unintentionally-- or the metformin stops working-- make sure you get further tests. Fingers crossed you are one of the rare Type 2s under BMI 23-- so you can reverse your disease and live happily ever after!

 

[Dishevelled]

Thanks for the replies, and sorry for hijacking this thread. @Spathiphyllum , you're right, I've been lucky in never having to weigh myself. I'll start now.

I don't know if this is relevant, but I have never had a "sweet tooth" and don't eat sweets, chocolate or any sweet puddings.

 

[Spathiphyllum]

Thanks for the replies, and sorry for hijacking this thread. @Spathiphyllum , you're right, I've been lucky in never having to weigh myself. I'll start now.

I don't know if this is relevant, but I have never had a "sweet tooth" and don't eat sweets, chocolate or any sweet puddings.

Ha. I've never had a 'sweet tooth' either. And, before I was diagnosed, I didn't have scales, ate lots (of normal healthy food), thought I had recently maybe dipped a little under my normal weight, which is BMI 18.5-- and therefore was horrified when, on a routine health check, it turned out I had somehow mislaid 6 kilos ...

No need to apologise for "hijacking", though! Misdiagnosis of older people is a serious problem. And, returning to where we started, which was concern for Mrs M: at BMI 19, she cannot afford any unintentional weight loss (any more than I could). Especially as-- I don't know her age, but Mr M's profile says he is 77. If Mrs M is also in her 70s-- being underweight would be especially bad for her. Anyway-- best wishes to all!