Pre diabetes?

[Bubbles254]

I recently had an a1c test which came back at 36 which I thought was ok.

I have however been trialling a cgm and have been pretty shocked by my glucose spikes and dips.

I generally eat fairly low carb but I do tend to have a small slice of sourdough with peanut butter for breakfast. Yesterday I also had a small slice of quiche for lunch around 1cm of crust, rest of plate was salad.

The breakfast resulted in a spike to 8.9mmol/l followed by a dip to 3.4mmol/l. Lunch had a spike to 8.5mmol/l, I then had a low carb dinner and my line was flat.

Based on this does it suggest pre diabetes? The spikes are well above the guidelines of 7.8 post meal for non diabetics.

I don't see how the ac1 is at all reliable if it is an average and I am having dips too which reduce the average.

Why are you checking your blood sugar when you’re nowhere near pre-diabetic, let alone diabetic? Seems like a recipe for paranoia. There’s nothing wrong with you.

A1c is an average over the last 3 months. Spikes and dips after eating are completely normal - this is how your body works.

I am prediabetic and was in the diabetic range for a short period.

It sound like you are the "worried well". Why on earth would you be monitoring your blood sugars with a result of 36? I certainly wouldn't be concerned about the odd bit of bread and pastry.

Someone posted much the same a couple of weeks back. Was it you OP?

Also why is a well person trialling a cgm? Do you choose to do this or were you asked to?

If this is true, do you want to have diabetes? I really wouldn't recommend it.

My DH is a diagnosed T2D and now has a normal hba1c as he eats low carb. If he ever cheats blood sugar will shoot up - he’s very much still diabetic, just diet controlled. The guideline is to test 2 hours after eating - it’s normal to have a spike if it is back in range 2 hours post prandial, and it’s BG remaining high that is damaging. I’d make a mental note your insulin response might be blunted and carry on moderating carb intake.

This is obviously not the right place to post about preventative health. I think it is useful to understand the impact of different food on your health to prevent diabetes developing. Plus the dips in my blood glucose explain the dizziness I have been experiencing so I can now make changes to my diet to help prevent them.

@Patchworksack thank you for this information, it is useful to know that it is the 2 hour point that is the useful measure. So it is the duration of peak rather that its height that is the important measure?

I still don't understand how ac1 though is that useful a measure if I have a lot of lows in the hypoglycemia range as well as highs.

I still don't understand how ac1 though is that useful a measure if I have a lot of lows in the hypoglycemia range as well as highs.

Because the average is more diagnostically useful than snapshots?

If you are seriously concerned about short term reactions to carbohydrates, ask for a glucose challenge test.

Yes it's the duration of the rise that you need to know. If you have returned to a normal low after 2 hours, you're not pre-diabetic.

The HBA1c is useful as it shows what range your average bloods are at. Your level of 36 is nowhere near pre-diabetic.

A couple of years ago I tried a CGM through the Zoe project. I noticed the blood sugar spikes which although they are considered not medically significant, absolutely tracked the times when I either felt terrible or found it really challenging to control my eating.

Well, to be honest, was overeating.

I started eating low carb high fat and, a year later, tried another fortnight wearing a CGM. I was delighted to say that my spikes had modified considerably and these lower fluctuations were around a new mean, which had dropped from around 7mmol to around 5mmol.

This was absolutely in line with how much better I felt and how much more energy I have. As a very welcome side effect, my BMI dropped from above 40 to around 24. I'm expecting to drop further and at some point stabilise now that I understand (and have objectively proven) the link between stable blood sugar and my desire, even drive, even insatiable drive, to overeating.

Eating low carb (definitely not no carb) high fat keep my blood sugar and thus my weight stable.

Absolutely a win for me, which I intend to repeat every year or so, to check that I remain on target with exceptionally level blood sugar.

Op, are you overweight? Do you eat a balanced diet without too much reliance on carbs and sugar? That's where you need to put your energy.

Continuous glucose testing is very OTT unless you are overweight or are pre diabetic. You've had the test for diabetes and are still not happy. Why are you so focused on this issue?

Just eat well, possibly a low carb diet and enjoy your good health.

Personally I don't monitor my blood sugar levels and managed to get from just in the diabetic range back to pre diabetic. I am continuing to low carb and hope to be out of the prediabetic range soon, if I'm not already.

@knittingaddict I think cgms will be recommended for everyone in a few years, just as step and other fitness trackers are now. There is a lot of research showing how harmful glucose spikes are even in those that do not have a diagnosis and it is really useful information to have to know how to minimise them to prevent long term health impacts.
https://med.stanford.edu/news/all-news/2018/07/diabetic-level-glucose-spikes-seen-in-healthy-people.html

@FinallyHere great to hear how wearing a cgm really helped you to improve your health. I was wondering about joining zoe but was put off by the cost so am just doing a little test myself to see what foods I react to. Can I ask how specific is the food advice from zoe, how do they identify what foods you react to it you are eating a mixed meal?

how specific is the food advice from zoe

I was very excited about the idea of the Zoe project and personalised recommendations. So much do that by the time they invited me to sign up, I had read and listened to everything they had published, so found the actual programme a little disappointing.

The CGM was really interesting but by the time I received their recommendations I had worked out all the things that spiked me and was already avoiding them.

Now that I have heard what they offer, I wouldn't have bothered but until I did it, I wouldn't be so confident that I had followed their research.

Overall all good but possibly overkill.

@FinallyHere Thanks for the feedback. I have listened to all their podcasts too so I am not sure what else I will get from it. Was the advice on the gut microbiome and fat regulation helpful.

I ate a normal diet yesterday without trying to be too healthy just to see my response and my glucose was terrible. I ate a lot of salad and veg but did eat a homemade fruit crumble which caused the second massive spike to 9. This was with trying to mitigate the impact with exercise too.

I was hypoglycemic all night as well which probably explains why my sleep has been poor lately. I am surprised at quite how bad it is given my ac1 of 36. There must be so many people causing themselves massive health problems without knowing it.

I don't suppose it is worth taking the results to my gp, will just take the necessary changes myself.

Looking at the last chart you were less than 9. Maybe between 8 and 8.5. How long after eating was that?

I'm no expert, but isn't that spike in the normal range?

It logged 9, not sure why it plotted lower, maybe becuase it takes an average rather than a point in time.

Normal 2 hours post meal is meant to be under 7.8 for non diabetics, under 8.5 for type 2.

I ate a 2.30pm and it was 9 at 90 min past meal. 8.2 at 2. 15 hours pist meal.

@Bubbles254

Overall, I'm glad I did the Zoe project work, because it provided me with independent, objective confirmation that I understand how my body responds to different foods. It was a a birthday present in one of the lock downs, where there wasn't much else to do.

That's confidence it built will I think stay with me so probably in balance worth doing for me. All my estimates of how I would respond to different challenges were spot on. That information is a part of me now, without any effort I have drastically reduced how much sugar and simple starch I consume.

This is knowledge so far beyond the realm of any GP that I don't think I would even try asking them about it. I'm very glad to have this knowledge and act upon it myself.

I feel, and yes look, too, so much better. Genuinely transformational.

OP your HBA1c was within completely normal range so you are not pre-diabetic. However you do sound very anxious.

Sorry my italics failed here!
But I also meant to say that the reason the HBA1c is useful is because it gives the average over three months which is much more clinically relevant/ useful than testing daily. Your spikes are normal. If you know that there are foods that cause you to slump afterwards then absolutely adapt your diet. But you are not diabetic or pre-diabetic.

My point is that I am getting very high (9) and very low (3) readings so my average (HBA1C) will look good as they cancel each other out. My readings post meals are in the diabetic range, my nighttime readings suggest hypoglycemia.

Lots of healthy people have these spikes and dips. Knowing your blood glucose readings on a minute by minute basis will not make you healthier and may adversely affect your mental health. Step away from the CGM, eat a salad and go for a nice walk.

But there not "real" hypos as your pulling yourself out of it and going back up, real hypos keep going down and down.

Put the CGM away, they should be banned unless you're truly diabetic give nothing but health anxiety
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