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lostoptimism

Really Pre-Diabetes?

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lostoptimism

Hello all, been a lurker for a few days but decided to sign up. I am a 30 year old male, 5'11 and currently 194LBS (going to stabilize at 177). Doctors even said they don't understand where the weight is, "wearing it well"/muscle I suppose. I haven't drank alcohol in 3 years, recently quit smoking. LDL Cholesterol under control, Trigs normal.

Since I cannot get a reputable answer anywhereelse , I' though I'd ask those with experience.

My [new] doctor has diagnosed me with prediabetes. Another Doctor told me it is not prediabetes and just diet. Who do I believe? I visited this doctor for a routine checkup and was diagnosed with prediabetes whereas others have told me not to worry and another doctor said it is not.

FBG #1-102, (At 216 LBS)  8 Hour Fast
FBG #2-107 (At 202Lbs) and A1C-5.3% 12 Hour Fast

Both times I had heavy meals before starting to fast for the test, which meant going straight to bed within the hour after eating.

I usually eat a lot of high carb food. and have been for the past 2 years, about 2500kCal a day-worth. (will be stopping)

The night before each fasting (almost immediately went to bed after eating).

#1 I had a sandwich, a lean cuisine and 2 bowls of cereal (Honey nut cheerios)
#2 I had a lean cuisine and a bowl of cereal (chocolate lucky charms)

How is the second number higher than than first with less weight and less food?

I work from home (still exercise! lol) so I usually get up around 12-1PM and took both of my tests within an hour and a half of waking up (office is down the street).

Only one person in my family has type 2 and it was due to morbid obesity (400+ LBS) and that is an uncle (diagnosed age 45) whom I never talk to/see (10 years?). Everyone else is good and some have similar tests to my own, non diabetic.

What is your take on this? I'm going nuts here. Is the new Dr. wrong/trying to scare me? or is the other doctor correct and it seems normal?

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meyery2k

@lostoptimism - Welcome!

 

To break this down as best I can.  Many here, including me, consider prediabetes to be diabetes that is just not bad enough to be clinically called this.  You want to avoid diabetes.  The doctors are providing data and opinions.  You will need to discern what to do with it.  I wish I had the opportunity to be called with pre-diabetes.  I have been able, with diet and exercise alone, been able to put my diabetes in remission (doctor's words), but it will never come off the chart.

 

The A1c is a good indicator that you are not diabetic.  5.3 is considered normal.  The A1C determine the overall average of your glucose over a roughly 3 month period.

 

Now - Are you insulin resistant?  You cannot determine this with the data you have provided.  Here is a way to check this.

 

Before you eat, take a test and record the results.  Eat and then test about 2 hours after you eat.  Your glucose level should be close to where you started.  If it is elevated, then test at hour 3 and hour 4.

 

Here is an example.  I test before eating.  Start at 90.  I decide to ignore my diabetes and eat some cheesecake.  At 2 hours, I will be at least 140.  I will stay there for anywhere from 4 to 6 hours.  I am insulin resistant.  Eventually it goes down but it is not a normal response.  If I keep up with carbs, then I build up a feedback of too much insulin/too much glucose and find myself back to diabetic conditions.

 

Meters have an error range of 15% so those 2 reading, taking that into account, are not statistically different.  You might also want to try testing immediately upon waking.  Your liver dumps glucose into your bloodstream to give you the energy to get up.  If I test right when I wake, I am in the 80's.  If I delay then I am usually in the higher 90's.

 

In regards to your uncle, there is some thought that obesity might be another symptom of diabetes.  It may be a protective response to create fat to combat hyperinsulinism and hyperglycemia.  I went low carb, got my diabetes under control,  and am no longer morbidly obese.  I lost over 100 pounds.  Some interesting stuff here to consider.

 

Glad you found us.  I hope you will find this to be an informative site. ~ Mike

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Kit

Few points to make.  Morbid obesity, inactivity, and similar are not requirements for T2 diabetes.  This is old outdated information.  I did not become diabetic but sitting on my rear eating junk food and watching TV.  I actually ate massively better than the examples you give.  :)

 

But, your labs are interesting and they will tell most of the story.

 

A normal A1C range can vary from lab to lab.  The only my old doctor office used stated non diabetic was 4.0 - 5.6.

The lab my current doctor office uses says its 4.8 - 5.6.

Either way, it looks like the current tendency is to lean towards 5.6 as being the high end cut off.

 

An A1C of 5.3 is within normal range, though approaching the top end.

Your morning fasting readings are a little high, but not massively so.

So both doctors are kind of right.

 

So are you prediabetic  Are you diabetic?  That is an interesting question.

There is no such thing as pre diabetes.  It is T2 diabetes in an early stage where glucose levels are only mildly elevated.

The precursor to T2 diabetes isn't pre diabetes but hyperinsulinism which is larger than normal levels of circulating insulin.  It is thought that this is the "cause" of T2 diabetes as the body's cells become numb to the higher than normal circulating levels of insulin and start to ignore it.  (This is a little simplified but will help get the idea.)  This leads to insulin resistance, which can actually be happening for years before you ever see a rise in blood glucose levels.

 

Without more tests it is difficult to say exactly what is happening with you.  The best would be an oral Glucose Tolerance Test (OGTT) with insulin assay.  Basically what you do is drink a pre set large amount of straight glucose and then they track your blood glucose levels and insulin levels over a course of about 4 hours.

 

However, Its a rare doctor who is going to order this test to be done and insurance may not even pay for it.  So its sadly unlikely to happen.

 

The impaired fasting numbers say something very likely might be starting to happen.  The normal range A1C says that if something has started to happen, it hasn't gone very far yet.

 

If I were you, I would take the following steps.

 

Minimize or eliminate simple sugars out of your diet.  The cereals you mentioned are just junk food, full of sugar, fast acting carbs (which the body turns directly into sugar), and lots of artificial crap.  There is no situation where they are part of a healthy diet.

 

Along with the point above, start trying to minimize or eliminate junk foods from your diets, especially items that are heavily processed.  Another case of real food is much better for you than stuff that comes from a drive through window or out of a box.  Start looking at shopping the outer edge of grocery stores.  Produce, meat, dairy and similar.

 

In regards to fruit.  Fruit is also full of sugar.  There's a reason they call it nature's candy.  You may want to limit the amount of fruit you eat over the course of a day.  For some reason, as soon as people realize they either have diabetes or might be developing diabetes, they start massively increasing the amount of fruit in their diets.  Never understood the logic in that.

 

For now, focus on trying to improve the quality of the foods you eat and avoid simple sugars.  Keep paying attention to those tests (I'm guessing you might be able to get your doctor to rerun them once a year) to see if anything changes.  if anything changes for the worse, you can take more drastic steps.

 

 

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