Interesting article on the "new' IFG levels

[felinefan67]

Here's a link:

Increased Mortality Risks of Pre-Diabetes (Impaired Fasting Glucose) in Taiwan -- Wen et al. 28 (11): 2756 -- Diabetes Care (http://care.diabetesjournals.org/cgi/content/full/28/11/2756)

and an excerpt:

In summary, there was an overall J-shaped relationship between all-cause mortality and FBG. IFG, traditionally defined as 110–125 mg/dl, is an independent risk factor and should be aggressively treated as a disease, because it produced a significant increase in combined CVD and diabetes mortality risks in this Asian population. The increase in risk and the predictive value of IFG disappeared when IFG was defined as 100–125 mg/dl, making the necessity of the new IFG definition questionable.

[BlueSky]

... The increase in risk and the predictive value of IFG disappeared when IFG was defined as 100–125 mg/dl, making the necessity of the new IFG definition questionable.
The idea of treating people with so-called pre-diabetes (BG of 100-125) is to stop, or at least retard, progression to full blown T2 diabetes. Achieving this is worth the effort IMO, regardless of whether these people have increased CVD risk or not. As they say in the classics, there is no point in shutting the door after the horse has bolted :o .

[felinefan67]

I guess the point of the article is that the 100-110 IFG group had little to no increase in mortality related to CVD AND Diabetes, whereas the 110-125 group did, so the lowering of the FBG was not really necessary?? That's what I got out of it, although I will agree that by lowering it, it will "scare" more people into action to lose weight and watch what they eat.

I'm in that 100-110 category (3X's at 102 on a home meter) and it DID make me change my life (hopefully forever). I lost weight and exercise now and my FBG, post pranadial have been perfectly normal for weeks now. My FBG was 99 last Dec, and my April A1C was 5.8. all normal according to my Doc. I hope the 102 reading for three weeks straight (in late March) was a dawn phenom or an error % in my dad's meter.

My doc doesn't consider me Pre-D, but I kind of do. Except for this last week (horrible eating, drinking, and minimal exercise) I've been good and the results are speaking for themselves. I really don't know though if my high normal will stay that way or eventually creep up into consistant elevated FBG and then to type 2 eventually. That's what is scary for me: the unknown. That's why I'm more careful now than before that 102 reading showed up.

[BrianSCohen]

Felinefan,

Thanks for this article. I find this kinda comforting. I continue to struggle with elevated IFG, generally averaging 110-120 mg/dL. I certainly appreciate that an unattended IFG is a sign of bad things to come. But for myself, I struggle with whether the elevated IFG itself is a major risk. Should I seek more aggresive treatment to lower it or should I just monitor it? Based on this article, perhaps I should not worry so much about it, it is not that great a risk.

[BlueSky]

... I struggle with whether the elevated IFG itself is a major risk. ...
I suspect that blood glucose itself at these levels (100-110) don't do much harm. As a T1, my blood glucose has been way higher than IFG levels for the last 30 years, and I haven't had any problems. The real problem with T2 is the insulin resistance and elevated insulin levels that go with only slightly elevated blood glucose. They result in all the metabolic syndrome problems (weight gain, high blood pessure, increased inflammation, higher CVD risk), which occur even at normal blood glucose levels.

[Larry H.]

(My doc doesn't consider me Pre-D, but I kind of do. Except for this last week (horrible eating, drinking, and minimal exercise) I've been good and the results are speaking for themselves. I really don't know though if my high normal will stay that way or eventually creep up into consistant elevated FBG and then to type 2 eventually. That's what is scary for me: the unknown. That's why I'm more careful now than before that 102 reading showed up.[/QUOTE]

My situation is something like that. I had a few warnings of it being near the 125 point or over a bit a few times. But who knows what it did when I wasn't aware.. I have dropped about 30 pounds and the fasting readings at first were staying nearer that 100 - 110- range. But two years into this, and as you say, a few weeks of rather poor choices of food at times, plus due to so much weight loss I also rationalized I could eat a bit more to not loose even farther. Now I find my self at times getting higher readings than I was, and gradually the amounts of carbs I can get by with seems to be dropping. Not that I don't still see pretty fair numbers some of the time. Particularly now that I am more active in the yard again. But the long term prospects of staying very low will either take a diet I can barely live on, or perhaps giving in to medications I have steadfastly refused to start at the time.. So far it has been pretty good, but as those here tried to tell me from the start, its more or less a one way street over time..
I found my self getting fasting readings near the 120 range for a few weeks and that scared me into getting back a tighter control of my carbs. Its pretty surprising just how much a lot of activity and a mild reduction in carb intake can show results. This noon I had a half sandwich, some chips, low carb ice cream with strawberries on it and sugar free chocolate sauce. At two hours I had a 107. Which is pretty darn low for me.. but I had pushed my reel lawn mower for about an hour before lunch, plus my morning half hour walking in the basement.. I can see the exercise dropping the numbers though. Sometimes its also seems to make them go up, but that is usually temporary and latter I see these better overall numbers..

[BrianSCohen]

Bluesky,

I understand that in a type 2, usually the damage comes from insulin resistance and the spikes in blood sugar that comes after a meal. In my case, I follow a low carb diet and seem to have reasonable responses to meals. My pre dinner readings over the last year have averaged 90-100 mg/dL and after dinner readings have averaged 100-110 mg/dL.

After my diagnosis, I gave myself an oral glucose tolerance test and passed, with a 2 hour reading of 131 mg/dL (and that was with an elevated fasting level starting at 118 mg/dL). In my case, I don't seem particularly insulin resistant. I do however have some sort of dysfunction with ongoing morning glood sugar readings averaging 110-120 mg/dL. If my fasting levels go much higher, it places too large an insulin load on me and I will see a rise in postprandial levels.

My conflict is whether to argue for more aggresive treatment of my fasting levels with my dr or just wait it out until it shows up in my HbA1c (6.2% right now) and postprandial response. Everyone reacts to elevated blood sugar levels differently, I would just like to do what I can to avoid complications later in life.

[Tropo]

My FBG was 99 last Dec, and my April A1C was 5.8. all normal according to my Doc. I hope the 102 reading for three weeks straight (in late March) was a dawn phenom or an error % in my dad's meter.


Things are not always as they seem. My HbA1c is slightly lower (5.7) than yours yet my fasting glucose levels are higher than yours, and often over 110. They're rarely under 100.

There are people with IFG (impaired fasting glucose) who have normal or near normal post-prandial readings. There are also people with normal fasting levels yet they have impaired glucose tolerance.

I suspect we represent the 2 different groups.

[Tropo]

Here's a reality check that few people seem to comprehend. Keeping BG at normal or near normal levels with strict dietary control does not mean that a person is normal, or even pre-diabetic. This gives the mistaken belief that the condition is curable, whereas in reality it is only controllable.

A lot of people say they're cured because they eat well (now) and have normal BG levels (now)...whereas before they were showing high numbers.

A normal diet consists of a decent quantity of carbohydrates. I would only consider a person is normal if they can eat a reasonable quantity of carbs and still post perfectly normal numbers.

The reality is that a lot of people (perhaps myself included) are actually full T2's on a normal diet.

I'm at a point were I can eat normal quantities of carbohydrates and post HbA1c's of 5.7, however I can only manage this by doing huge quantities of exercise. I spend almost 2 hours a day at the gym doing very intense exercise routines (cardio and weights).

I notice many pre-diabetics on this forum are consuming extremely low quantities of carbohydrates and exercising a lot in an effort to post normal numbers. Personally there would be a point where I would prefer to take medication than eat such diets to keep numbers low. Such low quantities of carbs would be counterproductive to my fitness, strength and health.

[BrianSCohen]

Tropo,

I find it interesting that you bring up the idea that diabetes may in fact be a disorder which has as a symptom blood sugar dysfunction. There is certainly some evidence that diabetes itself is risk factor for things like heart disease, independent of the patients blood sugar control. Personally, I am inclined to follow the primary evidence which seems strong that higher blood sugar levels are a cause of damage and should be avoided. This is why I employ diet and exercise with a target of keeping my blood sugar controlled.

I am not aware of any evidence of low carb or controlled blood sugar being counterproductive to fitness, strength or health. Do you have information on this?

[REDLAN]

I find the conclusions of this study somewhat confusing....

so who clicked the link and scrolled down through the discussion?

Anyone bother to look at the graph?

click the graph, and then tell me which plot had the LOWEST risk for all cause mortality.

that would be 110-125 mg/dl group.

so while they had an increased risk of CVD of 30% (RR of 1.3 which in epidemiological terms i.e. no proper controls is hardly anything), they had the LOWEST overall mortality, and it could legitimately claimed that they were the HEALTHIEST...

This study found an overall J-shaped relationship between all-cause mortality and levels of FBG in an Asian population, with significant increases in mortality, starting at ≥110 mg/dl as well as ≤75 mg/dl.

starting at 110 mg/dl??? Significant increases???? Really?

and here is the graph so you can make your own minds up

http://care.diabetesjournals.org/content/vol28/issue11/images/large/zdc0110550520001.jpeg

PS do not look at the line - this is a best fit line (drawn using a statistical algorithm), look instead at the plot point. The big triangle (the up and down line is the 95% confidence interval - this tells you the possible range in which the result will lie if you repeated the experiment)

[Tropo]

I am not aware of any evidence of low carb or controlled blood sugar being counterproductive to fitness, strength or health. Do you have information on this?

I stated that a low carb diet would be counterproductive to MY fitness, stength and health.

By this I meant that I could not maintain my present exercise program which involves heavy strength work and intense cardio work on a low carb diet. My goal is to get stronger and fitter and build muscle which could not be achieved to anywhere near the level I desire on a low carb diet.

If in the future I become sedentary or reduced my level of exercise greatly, then a low/er carb diet would be ok.

I've been getting regular HbA1c's to keep an eye on my BG control, and as long as they stay where they are I'll continue to eat a high carb diet. (note: my diet is also high in protein and fat).

If in the future I notice my HbA1c's increasing, then I may consider medication rather than seriously reducing my carbs if I'm still exercising to my present level.

As I said, personally I'd rather eat "normally" and use medication than consume near zero carbs. This is my personal approach and everyone has to make their own individual choices.