Pre-diabetes or nothing to worry about??

[abchance0330]

I am a 40 year old active female, no weight issues (5’10, 130Ibs), 18% body fat.  Slightly high Fasting Blood Glucose levels on 3 different recent occasions led to Doc sending me for an Oral Glucose Tolerance test, which came back fine but due to the higher fasting blood glucose levels, he instructed me to test at home myself for a few months to figure out what is going on.  Numbers are great on most days that I eat my normal healthy diet, but on the weekends when I spurge more, my numbers are sometimes staying around 130 until 4 hours after I have eaten!  I have had 2 different opinions from the Docs on this.  One says this is totally normal, and the other calls it pre-diabetes.  Hoping some of you with experience can help me out?

I eat around 130 carbs daily during the weekdays (Breakfast: plain organic oatmeal, ground turkey. Snacks: seeds & nuts, Lunch: spinach & broccoli salad w berries & banana.  Dinner:  lean meat with more veggies).  On the weekends I do splurge more, for example on Saturday I may have 3 slices of pizza instead of the salad for lunch.  And on Sunday I may have a burger and fries at a restaurant for one meal.  And I may have a serving of ice cream at some point too.  I have heard eating “low carb” can cause your blood sugar to go extra high when you do splurge on carbs, so I wonder if that is what is happening with me?  I don’t know if my usual 130ish carbs counts are “low carb” though?  And if this is the cause, maybe I need to eat more carbs during the week to avoid the spikes when I do splurge?  Or maybe I need to totally give up the splurges?

Fasting Blood Glucose at lab: 101, 105, and 107 mcg/dL on 3 different occasions
Oral Glucose Tolerance Test at lab:  GLU GTT-FAST:  99 mg/dL, GLU GTT-2HR:  84 mg/dL
Insulin:  7.6 uIU/mL (range of 2.6 - 24.9)
Examples of Blood Glucose testing at home during week when I am eating less carbs:
Fasting:  90, 95, 100, 103, 106
1 Hour after Breakfast of plain organic oatmeal w skim milk and ground turkey:  157, 117, 100, 93, 106,
2 Hours after this same breakfast:  98, 94, 85, 88, 83
1 Hour after lunch of spinach & broccoli salad with berries and banana:  104, 89, 99, 102, 101
1 Hour after dinner with lean meat and veggies:  95, 88, 99, 95, 100

Examples of Blood Glucose testing at home during weekend when I eat more carbs:
Fasting:  90
1 Hour after plain oatmeal w skim milk:  117
2 Hours after plain oatmeal w skim milk:  94
1 Hour after 3 slices pizza:  162
2 Hours after 3 slices pizza:  140
1 Hour after hot fudge sundae:  145
2 Hours after hot fudge sundae:  108

Different day:
1 Hour after chicken and rice with veggies:  144
2 Hours:  131

Different day:
1 hour after pizza:  130
2 Hours:  111

Different day:
1 hour after sausage, egg, and cheese quesadilla with hash browns:  79

Different day:
1 hour after ice cream sundae with hot fudge:  126
2 hours:  134
3 hours:  123
4 hours:  94

Different day:
1 hour after restaurant hamburger & fries:  140
2 hour:  129
3 hours:  123
4 hours:  88

Also, I did have an HA1C (5.3) a little over 4 years ago, because my eye doctor found a lot of cataracts and also some retinal hemorrhages and damaged blood vessels in my eyes.  I also had a few spells of double vision back then.  All of this has resolved, but we never really found a cause, and I know eye problems like this can sometimes be related to diabetes, so that is only reason I mention this.  Again, this was over FOUR YEARS ago, and my yearly eye exams have been clear since (except for the cataracts which of course don’t just go away).  

If this is prediabetes, what can I do to reverse it?  Everything I read says to lose weight, which I am right on the border of underweight as it is.  I exercise 6 days a week, walk about 3 miles a day, and then run about a mile as well, plus about 30 mins of strength training 3-4 days per week.  I get 8 hours of sleep and am not especially stressed out or anything.  Other than cut out the 2-3 splurge meals I have per week, I am not sure what else to do?  Isn’t FOUR hours a little long after eating for blood sugar to go back down?  Or could this all be due to the lower amount of carbs my body is used to getting through the week?

Thank you so much and sorry so long!  

[ScalpMassager]

Oh!  And, considering your general fitness level and exercise efforts, I think a useful fasting glucose level to aim for achieving with improved diet and destressing routines would be around 80 (and urge you to not settle for just squeaking under 100).  

Normal's 70 - 99,  but considering the typical condition of the population of patients that that includes, I do think you ought to be at the lower end of that normal range.

[ScalpMassager]

(I noticed 3 mile walks are part of your routine -- I was thinking more in terms of one or two 6 to 10 mile weekly walks)

Are you sedentary?  (exercise notwithstanding, does your life and routine consist of sitting more than half your waking hours?)  Sedentary people, regardless of exercise, are at risk (sitting to excess, is being seen as the new bad habit, and comparable to smoking for health consequences).  

Swapping some of that sitting time for some time on your feet ought to help (and suspecting that, it's part of my reason for suggesting long walks).

[ScalpMassager]

You're having eight or more splurges a month while you appear to have prediabetes.  Those are including pizzas, hot fudge sundaes, and hamburgers&fries.

I urge you to cut down to one or two splurges a month.  But you may want to transition to this level over two or three months, and may find halving some of the splurge quantities a useful interim step.  

It's REALLY hard to break an established habit without repercussions, merely modifying habits can be so much easier, so I suggest modify a habit by perhaps making up for the missing splurges by swapping those ones for snacking on air popped popcorn without oil or salt.  Your weight and body fat levels are fine so if you're hungry, add a serving of your healthier food choices as needed.

You might give thought to destressing (you say you're not especially stressed, but to me that suggests you're coping with stress, I urge you to sneak in some quiet 'me' time every day).  And perhaps replace some of your more vigourous workouts each week with long walks?  (I get a lot more out of such long walks when I'm not plugged into some music.)

[prediabetes]

oh sorry is 7.6 your fasting insulin and 2.6 - 24.9 normal fasting range? then is ok, i was thinking for OGTT your range was 2.6-24.9 which low. ignore what i say before please. look like you have prediabetes insulin resistance.

[prediabetes]

Insulin:  7.6 uIU/mL (range of 2.6 - 24.9)

that a bit low, for OGTT?

maybe you develop type 1?

if you had prediabetes your insulin should be much higher, because predibetes is insulin resistance and body produce extra insulin to compensate. but your insulin seem lower than normal.

[abchance0330]

Thank you so much for your advice.  I am concerned it could be prediabetes also.  I can't figure out why I passed that Oral Glucose Tolerance Test though, when clearly certain foods are spiking me much higher than that Glucose drink did?  

And of course, some Doctors only look at that one OGTT test and not the whole picture, and say I am fine, especially when they see I am not even close to being overweight...so tell me to do nothing.  I say some of those numbers are too high - lets get them down asap!

I do eat Paleo through the week so I will keep that up, thank you.  It is very interesting which foods cause a spike and which do not.  I thought for sure that restaurant egg, sausage, & cheese quesadilla with hash browns would spike me, but I was only 79 after that!  Pizza is a whole different story though.  

Thanks again for all your help.

[Super_sally888]

Don't give up the splurges, change to things that don't spike your blood sugar.  Meats are likely ok.  Nuts. etc. 1 piece of pizza instead of 3 - or learn to make low carb pizza instead of buying it out. :)

[Super_sally888]

Hi,

I think this is prediabetes.  

You cannot afford to lose weight, in fact it would be ideal if you could gain a little.

From what you are describing your diet is low fat.  I think you should cut  back the carbs further and add more unprocessed healthy fats.  

The diet should follow the paleo principles.  Low carb, moderate protein, high fat.  Fat can come from unprocessed nut oils (coconut, olive), cream, butter, cheese, animal fats and lard, eggs, avocado, nuts.

Use your meter to work out what foods don't make you high and then you can focus on these.

Pizza is a tough one because it is high carb, but it digests slowly due to all the fat and can cause you to become high much later.  This could explain the 4 hours to come down.

You could also go to watch the lectures on Utube at Bernstein Diabetes University for heaps of information about managing diabetes / prediabetes with low carb.

You probably should bget your Hba1c tested every 6 months or so, so you can monitor if there are changes.  5.4 gives you an average blood sugar of about 110.  A normal blood sugar average should be < 100.   So only slightly high, but warning enough that you need to take action and change your lifestyle now.