[Rad Warrier]

First, should 'Prediabetes' be a hyphenated word, like Pre-diabetes? Either way, the wavy red underline comes up, for the full word in the non-hyphenated case and only for the 'Pre' part in the hyphenated case, showing there is something wrong with the spelling whether the hyphen is there or not. Regardless, I am forging ahead without the hyphen (as with comma and other punctuation marks, my policy is to do away with the hyphen when in doubt.)

Now, let me come to the crux of the matter. I just found that Janet Ruhl (well known as Jenny of Blood Sugar 101) has recently written a nice article on Prediabetes. She appears to say that all prediabetics need not, and will not, proceed to become full blown diabetics. But those who have the defective gene will. She also seems to say that although it has been claimed that one third of the US population has prediabetes, the alarmist prediction that all these people will eventually become full blown diabetics is baseless. Full blown diabetics will remain 9% of the population in the foreseeable future as they always were in the past, she says if I understood her correctly. Read on, the article is interesting.

Regards,
Rad

 

[onlymep]

yeah interesting article Rad.
I got diagnosed with type 2 in 1998 and I don't recall hearing the word 'prediabetes' back then. But nowdays they diagnose people with it all the time. I think it's like a prevention thing really to ward off possibility of becoming diabetic. You will also find that prediabetes is also tied in with "metabolic syndrome" which means that there are a number of contributing factors affecting your metabolism (sugar level, blood pressure, cholesterol level, family history, etc.). I've been labelled as having "metabolic syndrome" as I have a few contributing factors (basically a few of the precursors like family history, etc). So people who have been labelled with this are still at high risk of developing serious health issues if they don't watch their lifestyle. In my case I obviously had my beta cells being destroyed as I now don't produce enough insulin anymore and I need insulin. I found the paragraph about 'fructose' very interesting as I think it's true. I'm currently doing a low FODMAP diet which is focused on avoiding foods with fructose and lactose (fructose being the main focus though). My BGLs are playing up at the moment and it's possible lack of fructose in my system could be partly why? I've just about finished my 3rd week on the diet. But I have to say I don't feel too well... and at this point I don't know whether it's my diet, BGLs, or something different. But maybe just reducing fructose foods is the way to go for most diabetics too... you'd be surprised just what foods has fructose. Surprisingly not all fruits have fructose as people believe. The following foods have fructose:
FRUITS: apples, pears, nashi pears, peaches, mango, watermelon, cherries, apricots, lychee, nectarine, plums, prunes, persimmon, custard apple, tinned fruit in natural juice.
VEGETABLES: asparagus, beetroot, brussels sprout, broccoli, cabbage, fennel, garlic, leeks, okra, onions, peas, shallots, sugar snap peas, snow peas, avocado, mushrooms
LEGUMES: chickpeas, lentils, red kidney beans, baked beans
CEREALS: wheat & rye (eg. bread, pasta, couscous, crackers, biscuits, cakes)
DAIRY (lactose): cow/goat/sheep milk and icecream, yoghurt, soft & fresh cheeses (ricotta, cottage)
HONEY
SWEETNERS: honey, corn syrup, sorbitol (420), mannitol (421), xylitol (967), maltitol (965), isomalt (953), and any other sweetners ending with '-ol'.

There you go I just told you all the stuff I can't currently eat because it has fructose

 

[Shanny]

That's a good read, Rad . . . thanks for passing it along. I hope people pay attention & don't just brush off "pre"diabetes, as meaning they're still safe so far, and don't have to do anything about it. I would just as soon they'd forget all the "pre" stuff. You either have it or you don't. Ah well - nobody asked me, did they?

 

[AtticusFinch]

interesting article

 

[Wink]

This makes my head hurt - I don't have enough background to understand the technical articles and I'm pretty much confused. LOL

I'm not sure if I'm technically diabetic or not. My A1C at diagnosis was only 5.7 and as soon as I quit eating 90% carbs in my diet, my fasting number dropped to an average of about 105 or so and my A1C to 5.2 .

At diagnosis my doc said we could call it pre-diabetes but from reading here and elsewhere I told him I preferred not to sugar coat it and call it diabetes as I thought the "pre" designation was just an earlier place on the same road. So we called it diabetes.

I am insulin resistant. One half an apple spikes me over 140 at one hour, but I can eat just about anything and be back around 105 after two hours. I do recover from the spike fairly quickly.

Doc has also told me that if I get my weight back to normal before doing too much damage to my pancreas that I might be able to once again eat anything without any spike. He's good, and he has patients who have done this. So maybe insulin resistant isn't diabetes and maybe the insulin resistance can be reversed???

Am I actually diabetic? I don't know for sure. What I do know for sure is that right now carbs cause a spike, I know a spike damages my body, so I know that for now I'll keep thinking and acting as if I'm diabetic. I'm thinking the label isn't as important as protecting my health.

 

[RobertIA]

Wink,

I am happy to see that you are taking it seriously and are trying to keep the numbers prediabetes. Gretchen Becker has also written about prediabetes, has a book about it, and writes about diagnosing diabetes. Her blog about prediabetes is here - Understanding Prediabetes - Diabetes and her blog about diagnosing is here - Wildly Fluctuating: Diagnosing Diabetes.

Rad, I disagree with Jenney on this one. I don't feel that it is as high as forecast, but the rate is going up according to the CDC and I have a greater respect for their forecasting - they are possibly too high this time, but it is increasing.

For other reading on prediabetes, I have a blog here - Exploring Diabetes Type 2: Many Think of Pre-diabetes as Non-Diabetes. This is a topic for much debate and a few years ago, the numbers for diabetes were higher. Right now it is some of the medical community that is not on board with the lower diagnosis numbers - officially 126mg/dl and will just say that your need to watch your diet as your sugar is a little elevated.

 

[onlymep]

that's interesting Wink.... here you are diagnosed as type 2 diabetic if your
HbA1c test is 7mmoL or higher.... below 7 is considered to be normal.
I don't know about what the so called 'prediabetic' range is... maybe it's between 6-7 or something? but I don't think you can technically say you're 'diabetic' unless you are >7. I would think 5.7 would be classed as normal (I'd personally be happy with that number... the lowest I've ever got to is 7.2 on A1c test). Insulin resistance could be an issue I guess. I've mentioned already that there is a thing called "metabolic syndrome" where you have a number of contributing factors that could lead to serious health issues (this includes sugar level issues). Maybe that's what you have mostly? They tend to treat that with diet and exercise mostly and they like to throw in Metformin to assist too.\
I posted a link today on another post too for LADA (another type of diabetes) which is interesting as a lot of people diagnosed with type 2 actually have LADA. I'm one of them as far as I'm aware from what was explained to me by endo.

 

[RobertIA]

Onlymep, the following table may be of help - Printable Diabetes Chart- Convert HbA1c to estimated Average Glucose(eAG).

In the US, prediabetes is defined as 100mg/dl to 125mg/dl or A1c of 5.1 to 6.0. Diabetes starts at 126mg/dl or just above 6.0. The chart can be printed out and used for a handy reference. Hope this helps.

 

[Wink]

I wasn't diagnosed based on my A1C which wasn't that bad at all.

At my routine physical my fasting was 126 and my doc does further testing for anything over 115. So a week later at testing my fasting BG was 155 and my glucose tolerance test result was 292 at 1/2 hour, 348 at one hour, 281 at 2 hours, and 106 at 3 hours.

Technically, I think the diagnosis was based on fasting over 125 on two separate occasions. I'm sure I read somewhere that the "rules" require two separate tests to base it on tolerance tests or fasting levels. Probably doesn't make much practical difference.. I obviously needed to get control of my BG.

 

[Wink]

I forgot... I wanted to thank you, Bob, for the links. They were very helpful and I agree with her that my early diagnosis of a problem was a great gift - giving me the opportunity to get a handle on this before things got any worse. Thanks!

 

[Strawberry]

I have found all of your posts to be excellent. I just wish I had the chance to read something like this many years ago. In spite of the fact I am type 1, I think I could have avoided the situations that allowed neuropathy to develop. I'm not the brightest bulb in the lamp, but I just don't understand pre-diabetes. I've heard pre-diabetes compared to being a little bit pregnant - either you are or you're not.

I have a family member who says she is pre-diabetic........however she is now on Lantus and Humalog. She also says that her doctor told her IF she can lose her weight she will probably be able to stop her insulin. I can't voice my opinion to her but I have to question in my own mind if her doctor is being truthful with her. I've watched her at various family functions and she doesn't have a clue about restricting carbs, portion control and/or drinking full sugar soft drinks. Plus I've never seen her test her BG before or after a meal. I have also never seen her do her injections. She is a young woman and could really turn her situation around. I feel sorry for her.

Bob - Thanks for providing the link for average glucose.

 

[onlymep]

Onlymep, the following table may be of help - Printable Diabetes Chart- Convert HbA1c to estimated Average Glucose(eAG).

In the US, prediabetes is defined as 100mg/dl to 125mg/dl or A1c of 5.1 to 6.0. Diabetes starts at 126mg/dl or just above 6.0. The chart can be printed out and used for a handy reference. Hope this helps.

that's interesting Bob - thanks.
there's a massive doc with link available on our Diabetes Australia website that our medical practitioners here obviously follow the guidelines for diagnosis and treatment for type 2. The doc does seems to refer to 6% as 'normal'. In the doc it basically says:
What are the targets for blood glucose control?
Recommendations:The general HbA1c target in people with type 2 diabetes is ≤ 7%. Adjustment to diabetes
treatment should be considered when HbA1c is above this level. (Grade A)
Targets for self-monitored blood glucose levels are 6–8 mmol/L fasting and preprandial,
and 6–10 mmol/L 2 h postprandial. (Grade C)
also....
"fasting blood glucose levels of 6–8 mmol/L and 2h post-prandial
levels of 6–10 mmol/L are associated with an HbA1c ≤ 7.0%."
on the same website there is a section on 'pre-diabetes' and how it's diagnosed. Basically anything above 6.1 is classed as 'pre-diabetes' and anything below that is 'normal'.
Link: http://diabetesaustralia.com.au/en/...s/Diabetes-Information-Sheets2/Pre-Diabetes1/

It's interesting how there are different rules for diagnosis.

 

[jwags]

Thanks for the link Rad. I like reading Jenny's blog but somehow I missed that one. I think what she is saying is if you are dx'd as prediabetic it is still important to check your bgs to keep them low. This way you can avoid a lot of the damage. Unfortunately I was dx'd as a full blown diabetic and have worked for 4 years to get my bgs under 100 most of the time. As a full blown Type 2 I have found I need to keep my bgs below 110 or lower, 2 hours after I eat otherwise my HbA1c starts to rise. If I followed the ADA recommendations of 140-180 I doubt I would have lowerd my HbA1c and would probably be on tons of meds or insulin right now. I think many doctors treat PreDiabetes like it is not serious. I think if you are aware of it and make necessary changes you can prevent it from being serious. But if you ignore it, it can morph into full blown very quickly. I didn't have any family history, I was not terribly overweight, ate whole grains, fruit and tons of fiber. I did everything right and still got it. I think now in the US they are dx'ing it at earlier stages which I think is good.

 

[Shanny]

that's interesting Bob - thanks.
there's a massive doc with link available on our Diabetes Australia website that our medical practitioners here obviously follow the guidelines for diagnosis and treatment for type 2. The doc does seems to refer to 6% as 'normal'. In the doc it basically says:
What are the targets for blood glucose control?
Recommendations:The general HbA1c target in people with type 2 diabetes is ≤ 7%. Adjustment to diabetes
treatment should be considered when HbA1c is above this level. (Grade A)
Targets for self-monitored blood glucose levels are 6–8 mmol/L fasting and preprandial,
and 6–10 mmol/L 2 h postprandial. (Grade C)
also....
"fasting blood glucose levels of 6–8 mmol/L and 2h post-prandial
levels of 6–10 mmol/L are associated with an HbA1c ≤ 7.0%."
on the same website there is a section on 'pre-diabetes' and how it's diagnosed. Basically anything above 6.1 is classed as 'pre-diabetes' and anything below that is 'normal'.
Link: Pre-Diabetes - Diabetes Australia

It's interesting how there are different rules for diagnosis.

And for our personal purposes, there's no knowing right or wrong, is there? We must decide how conservative we want to be in managing our disorder. We must decide whether to place our lives and our wellbeing in the hands of researchers/scientists/politicians who know nothing about BEING diabetic, and furthermore, are influenced by outside agencies and associations who have an enormous financial stake in the outcome.

If a preponderance of evidence says that damage occurs beginning at 140 (7.7), then I will do everything in my power to keep my levels below that, regardless of what the supposed experts in ANY country decide upon. It's me living my life, and me taking responsibility for myself. I will review the studies and decide exactly how strict I wish to be. And I will not be sitting here in 15 years with a prosthetic leg, saying "b-b-b-but the doctor said 180-200 (10-11) was okay after meals . . . and I trusted him."

 

[Checochinican]

Fantastically valuable topic for me right now - thank you for posting!

I am going to study it further, follow all the links, review the experiments. I'll start testing one hour after meals, rather than just two hours.

Agreeing totally with Shanny, as usual.

 

[jwags]

When I was first diagnosed 4 years ago my CDE told me to keep my bgs below 180. I remember her checking my bg and it was 177 and she told me that was good. For a few months this was the advice I followed. I then found Dr Bernstein's book and read where damage really started. Over the next 4 years I have worked to lower the top level. For awhile I was happy with 140, then 125 and now am happy with 110 and below. As we age we have enough problems without worrying about diabetes complications. Luckily my doctors thinks below 6 is a good goal for me.

 

[Shanny]

Luckily my doctors thinks below 6 is a good goal for me.

Under 6 is the goal my doc set also . . . and I'm not there yet!

 

[onlymep]

And for our personal purposes, there's no knowing right or wrong, is there? We must decide how conservative we want to be in managing our disorder. We must decide whether to place our lives and our wellbeing in the hands of researchers/scientists/politicians who know nothing about BEING diabetic, and furthermore, are influenced by outside agencies and associations who have an enormous financial stake in the outcome.

If a preponderance of evidence says that damage occurs beginning at 140 (7.7), then I will do everything in my power to keep my levels below that, regardless of what the supposed experts in ANY country decide upon. It's me living my life, and me taking responsibility for myself. I will review the studies and decide exactly how strict I wish to be. And I will not be sitting here in 15 years with a prosthetic leg, saying "b-b-b-but the doctor said 180-200 (10-11) was okay after meals . . . and I trusted him."

Good onya Shanny... everyone has to know for themselves what they will and won't accept.... I agree with you there. Although I have to say I'm one of those people who does put at least some trust in my medical professionals as they've done the training, not me. I realise that there can be some financial interest by drug companies... but my personal experience is that my docs do geniunely care and do their best to help me.... it's all a science afterall and not everything is perfect 100% of the time as we wish it was.
One thing I've learnt and learnt well since being on insulin is that it's important to know your 'safe' level. Aiming for lowest BGL for me is no longer the focus as it once was. I aim to be in safe levels now... and boy do I know what happens when you're not.

 

[Shanny]

put at least some trust in my medical professionals as they've done the training, not me.

Hey Mep? You've heard the one about the medicσl student who ranked LAST in his class of 500 students?

He still gets to be called "doctor", and he still gets a license to practice medicine on real live people.

'Tis almost too true to be humorous . . .

 

[Strawberry]

I see an Endocrinologist who told me that anything under 7% was good.....which I guess is all that he expected from me. I've had a hard time keeping my A1C under 6.5% and sometimes I don't succeed. My last one was 5.9% which is a first ever since diagnosis.

I am grateful for the people who post here and share their thoughts and experiences so that other people, like me, can learn from it.