If my BG averages are OK, do the occasional spikes matter?

[dbrandn]

I am new at this and I am so glad to find this forum. This is my first post and I have lots of questions . . .

If my BG averages are OK (high normal), do the occasional spikes matter? Do occasional spikes lead to a change in diagnosis? Should I insist that my doctor (family practice) request more tests? OGGT? (She said it wasn't needed) Does my diagnosis even matter at this stage since I am already changing my lifestyle? Should I see an Endo at this early stage since it is only prediabetes?

My doctor suggested that I lose weight by watching portion size and exercise. She wrote the Rx for a glucometer when I I asked. She has scheduled another Ac1 in May to compare results.

I was tested Feb 09. Fasting BG 116, Ac1 5.8

Since I have changed my diet from the typical American diet to a low carb diet (average about 50 gms/day, I have lost 12 pounds and am no longer overweight (based on BMI). I continue to exercise about 30- 60 minutes per day as before and hope to lose more weight.

But, there has been no change in my fasting BG numbers since I began testing, in spite of the weight loss and diet change.

I check my blood sugar each morning and it is still generally under 120. However, it can be higher, sometimes over 126 -- once it was 131. I test, randomly, two hours after a meal and it is usually in the target range (120-140). However, once it was at 260 (jelly beans, --felt sick and learned lesson!) If I go off my diet plan and have a little fruit or milk then my BG will go over 150, each and every time. So, I don't do that anymore.

I had gestational diabetes. My mother was diagnosed with T2 diabetes at age 40. I am 57 so I've been fairly lucky so far. My cholesterol numbers and blood pressure are great.

Is there anything to be gained at this point in being aggressive in treating my prediabetes? I am lucky -- I have good insurance so that isn't a consideration.

Thanks everyone!

[Brian23]

If you dont mind me asking, what is your age, height, weight? How active are you? Maybe a LADA?

[dbrandn]

Thanks for the reply.

I'm a 57 year old woman. 5'6" 153 pounds. I walk my dog twice a day for a total of at least an hour every day -- sometimes more. I go to the gym a two or three times a week but I don't work myself as hard as I probably should.

As for LADA? I never even heard of LADA before these forums. I suppose it is possible. The doctor didn't suggest it, but she is an all purpose doctor so perhaps it is off her radar.

[foxl]

I know we all lose beta cells as we age, but you do sound quite slender for a type 2.

It could be genetic ... but your lipids, your weight ... how's you blood pressure? Not metabolic syndrome.

[dbrandn]

My blood pressure has always been in normal range, that is under 120/80.

[dbrandn]

One other thing -- I did just loose 12 pounds by changing my diet and I was a few pounds overweight a couple of months ago. Prior to the low carb diet I found it nearly impossible to budge the pounds. It seemed that I always ravenous, even after eating.

It is clear that my body doesn't play nice with carbs. I haven't been hungry since I changed the way I eat -- that is, except for the expected appropriate hunger at meal time.

Is that consistent with LADA?

[foxl]

Sure, something is up, either way, with your glucose regulation.

Could be insulin resistance or could be inadequate insulin production ...

[perrylang]

What type of diet are you on?

For me I eat a 300 Cal Breakfast at 10 I have 100 cal snack at 12 I have a 600 cal lunch and 2 pm I have a 100 cal snack then at 6 I eat a 600 cal dinner and at bed time I eat another 100 cal snack.. A client that comes in to the lawfirm I work at says he also drinks a small glass of wine and he has been doing alot better and his pulseox readings have gotten alot better

[dbrandn]

It's great that you have found a diet that works for you.

I'm eating a low carb diet for the first time in my life. I had been eating a diet with lots of complex carbohydrates and low fat. I thought it was the healthiest way to eat, but It didn't work for me. I gained weight, was tired, hungry and didn't feel well. I know from observation that not everyone has this outcome when they eat lowfat, but I sure did.

My new diet varies from day to day but I can usually keep it to around 50 gms/day. I try to divide those grams into 10 breakfast, 10 lunch, 20 dinner and the balance for a snack and, of course, the red wine at dinner. Some days I go over this plan, but this is my goal. I'm only two months into it so there will most likely be some tweaking with time. I have learned that I feel lousy when I eat too many carbs at once so I am no longer tempted.

I am not counting calories, but I enter my foods into FITDAY and I have noticed that I have reduced my calorie count since I have reduced carbs. I just don't use the calorie count to influence my choice of food any more.

This is working for me because I was hungry most of the time when I counted calories. And I ended up "cheating" and gaining weight.

[sumi]

Hi dbrandn
Welcome to the forum. It sounds like you got right on top of things immediately. Great work! Your numbers do seem a little high considering the amount of effort that you are putting in and your diagnosis. I really don't know what to suggest except to 'keep an eye on things' ( that's probably what the doctor would say!). Perhaps you could see an endocrinologist for some better insight into what is going on. Please let us know how things develop, if for no other reason than just plain nosiness.;)

[Ronin]

Hi Dbrandn!

Welcome to DF! First of all, let's put the Pre-D diagnosis in perspective. This is a warning and it seems as though you have responded to that warning. Swithcing to a lower carb diet and regular exercise will probably bring things into control, but that takes some time as your body adjusts to the new regemen.

Looking at your age, height, and weight your BMI might be okay but be honest with yourself and answer the question: are you fit? (Hint, muscle doesn't jiggle when you walk.) Chances are you aren't at peak fitness. Adding lean muscle tissue will increase your sensitivity to insulin and therby reduce your overall BG levels.

To the question you posed to the forum: spikes are normal as your body reacts to what you eat or do. The key right now is to do frequent testing. I know that it is expensive but right now you need to see how your body reacts to specific foods and activities. That knowledge will allow you to modify the way you live specific to dealing with your BG levels.

Finally, the question of LADA or potential of Type-1.5. There is a simple test for this -- A C-Peptide reading will show how much insulin your body is producing. This can be an isolated test or in conjunction with an OGTT. There are many adults diagnosed as Type-2 who are actually Type-1.5 or LADA because their MD never checked their C-Peptide levels.

Finally, don't panic (easy for me to say now, but I panicked when I first was diagnosed as Pre-D). This is not a death sentance, just a warning. We're all here to help each other.

[PERKDOUG]

If my BG averages are OK (high normal), do the occasional spikes matter? Do occasional spikes lead to a change in diagnosis?

The general consensus says spikes are indeed bad. My sources indicate you should avoid all spikes over 140. The peak for the prediabetic comes usually at 45 minutes to 1 hour after first bite. Two hours after first bite is too late except for diabetics with delayed stomach emptying. Do some testing and see for yourself what is the best time to catch the spike peak. A little walking after an over indulgence can really attenuate the spike.
Of course, you did not define "occasional". Maybe once a month going to 150 is not important, but who knows?

[dbrandn]

Thank you all for the quick and kind responses. You have all given me much to think about. I am so glad that I have found this forum, and found such great support.

Now, I still have much work left to do to get fit. In the meantime I plan to see an endocrinologist, but I don't think I need to rush. I need to take a deep breath.

As far as the high readings, they are occasional because I am being very, very careful about my diet right now. I test foods and then adjust accordingly. Unfortunately, the usual suspects (wheat, milk, fruit, potatoes, etc) will cause a spike--over 140, each and every time. Shoot, an ounce of strawberries will push me over 150. So, I don't eat them. If I eat carefully then I can stay at or under 140 at two hours. I will start testing more often to find out when I peak. Thanks for that suggestion.

Thanks again everyone.

Deborah

[PERKDOUG]

Shoot, an ounce of strawberries will push me over 150. So, I don't eat them.

Deborah

I eat strawberries with heavy cream and always with other low carb foods as a finish to a meal. The fat cream slows the glucose digestion. Try it!

[Dan Gato]

Deb,

Why don't you start with a low dosis of Metformin.
Its side effect is lose weight.
Congrats on your low carb diet, & your weight loss, it looks
that you have a good hadle early on this condition.

[PJinIL]

Hi there! I know you posted some time ago, but I, too, and 57 and was experiencing the same kind of spikes you had. My morning fasting BG was between 107-111 consistently and I could spike to 160 after a high carb meal.

First, I test-test-test! Morning, 2 hr. after each meal and random at 1 hr. to see how certain foods affect me. I completed a class on managing pre-diabetes and like you, I was keeping to <50 carb grams a day. The doc said that is a big no no! 40 carbs PER MEAL is what he said a woman my age (57) needed to stay healthy, no more. But <50 can put your body in ketosis which is bad. (that makes it like an Atkins diet..you sure lose weight, but in a way bad for your body)

I also learned that a normal reading NEVER goes over 140. Regardless of what one eats, a non-diabetic's (or non-pre) body can manage whatever is thrown at it. You will find if you research 3 approved views on what the "normal" BG levels are, but I agreed with my doc that the lower ranges (approved by the assoc. of endocrynologists) was the safer bet. Here they are:

Fasting morning: <100
2 hrs. after the first bite of a meal <140

The American Association for Diabetes has a great board and there I learned to test test test - docs will maybe check you every six months, but diabetes is such a serious disease that I wanted to take control in knowing where my BG was and how to control it before it got to Type 2.

Here was my meals for a yesterday:
Date 5/7/09 Cal/ Carb
B - 1/2 bagel 144/ 27.9
B - 1 microwaved egg 71/ 0.2
B - V8 low sodium 50 10/0
B - 2T Smart Balance 100/0
L - tuna 60 0/0
L - V8 low sodium 50 10/0
L - Henri's dressing 240 18/0
L- 2 ritz LF cracker 30 4.4/0
L- peanut butter 190/ 7
S - apple 74/ 16.7
crab cake 197/ 0
steamed broccoli 50/ 10
D - 1/2C milk 2% 122/ 11.4
Totals 1378/ 115.6


Yes, I keep a spreadsheet with my daily intake and BG readings. I am still new to being pre, but know from a friend's experience that you can rapidly slide into Type 2 and I will do anything to prevent that. So, until I know exactly how I react to food at different times of the day and feel my BG is under control I will test multiple times daily, then go to maybe twice a day. I have no insurance coverage for the strips, but it's worth it to me to give up something else to buy the testing strips.

Alot of info, but hope you find something useful in it!

Cheers!

[ShottleBop]

So what were your readings? And do you take any meds? I can tell you that if I had 40 grams of carbs in a meal, my BGs would go through the roof. Yesterday, I had a carne asada salad for lunch. No dressing (I tested it with a Clinistick, and found it had sugar in it), but the salsa, and a very small amount of corn, took me to 138 within an hour.