Diagnosed as Pre-Diabetic

Diet and Nutrition
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Is anyone else pre-diabetic or controlling early stage diabetes?

I’ve had two fasting blood sugar readings between 100-120, and I tested last night about 7-8 hours after eating a late lunch at the airport and it was right at 122. I’m just curious what foods to avoid or what works to maintain gains, because my physician pushes the standard ADA diet, whereas a lot of online resources push lower carb. I’m not sure either of these are optimal for the lifter, and my doctor even said he’s not a nutrition expert and had limited nutrition classes in med school, acknowledging that there is even conflicting information on this topic in the medical community right now.

So if you’ve had firsthand experience, or know someone that has, I’d like to know what works best, carb vs. fat intake, foods to avoid (obviously processed carbs in high amounts are not good), etc. I’d really like to get this under control, but I cannot stand super lower carb either. I’ve been doing 200g on training days 4x week and app. 100g on non-training days.

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http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/#8

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[quote]EyeDentist wrote:
http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/#8[/quote]

Thanks for sharing, that’s pretty thorough, and far better than the pamphlet they sent with the last labs.

I could probably stand to lose 10-15 lbs of fat, I’m sure that would help. It looks like they endorse controlling fat/calorie intake overall.

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This is opinion, I can’t prove the conclusion. It’s based on years of considering a very large number of studies and coming to overall opinion rather than actual proof of why adult-onset diabetes is so drastically more prevalent today than in the past.

As adult-onset diabetes, as well as metabolic disorder, are so drastically more common today than previously, most likely – but not necessarily – your early stage problem isn’t genetically inevitable for you, but is caused by actions particularly with diet. (For many inaction, lack of exercise, is likely a major part of their cause, but this doesn’t sound like it applies for you.)

I believe the four principal dietary causes are, the first two being in no particular order, and using the word “abnormal” in reference to the sorts of diet man had had for many thousands of years prior to the 20th century and the high rates of development of diabetes and cardiovascular disease:

Abnormal fructose intake, including from sucrose
Abnormal linoleic acid intake (historically under 10% of fat intake, now 20-30% or more)
Abnormal relation between phytonutrient intake and carbohydrate intake. In other words, it used to be that carbohydrates came along with various beneficial substances provided by the plant. For some time, the population has had high carbohydrate intake but low intake of these materials.
Abnormal relation between protective-fatty-acid intake and linoleic acid intake. (Low DHA/EPA vs linoleic acid.)

Your carbohydrate intake sounds very reasonable; the only area where it might be problematic is if fructose is over say 25 g/day (this is not a magic figure but seems a good general guideline.) If your extra 100 g is mostly pre and during workout and the remainder mostly post workout, then this sounds very suitable already. Some do benefit over a period of time from going still lower on non-training days but this may well not be necessary for you.

On linoleic acid, the amount in your body is likely too much if over the last few years a fairly large percentage of the fat in your diet has been from vegetable oils in prepared foods; from soy, corn, safflower, sunflower etc oils that you’ve purchased yourself, from nuts other than macadamia or hazelnuts; or from chicken or pork raised with today’s animal feed. It may help, slowly over time, to cut such intake. It’s certainly historically abnormal, and leads to oxidative damage.

On the third point, at your carb intake this balance is likely not an issue, but some concentrated phytonutrients might help.

A person of course has the same genetic code throughout life, but the gene expression – how much enzymes, signaling molecules, proteins, receptors etc they make – varies according to exposure. There are many changes associated with development of diabetes and metabolic disorder; some phytonutrients act towards reversing those changes.

The fourth point is simple, more intake of wild-caught cold-water oily fish and/or a quality DHA/EPA supplement.

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[quote]JR249 wrote:

[quote]EyeDentist wrote:
http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/#8[/quote]

Thanks for sharing, that’s pretty thorough, and far better than the pamphlet they sent with the last labs.

I could probably stand to lose 10-15 lbs of fat, I’m sure that would help. It looks like they endorse controlling fat/calorie intake overall.[/quote]
I think a more precise evaluation is that they cite a study which combined three changes at the same time: lowered fat intake (and without particular consideration of types of fats), reduced calories, and increased exercise.

This does not show that in general lower fat intake would reduce risk of diabetes or metabolic disorder or help reverse it, or that all types of higher fat intake act towards causing diabetes. Certainly many populations have had high fat intake with near zero adult onset diabetes rate, so it cannot be in and of itself causative.

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Good reply, Bill. Both of my grandfathers are type II diabetics, although neither one was ever a poster child for optimal nutrition or exercise regimentation either.

I’ve always had a propensity to carry fat in the abdominal region, and I was downright obese until fifteen years ago. Though my carb and macro intake remains mostly on point, I do have the propensity to go off track and cheat once or twice every week or two, and if I do it’s not uncommon to polish off 6-8 large cookies or 3-4 servings of ice cream. This isn’t exactly a binge by any means, but I’m certainly not as strict with my diet as some are here, and there are some days I may be over on carbs or fats by 100-200 calories too.

At this point I think the best approach is to dial in the macros to be more consistent, less cheating, and whittle off 10-15 lbs. I can always adjust carb intake on training days down a bit (25g - 50g) if I find it is causing an issue. Fat intake otherwise really isn’t problematic for me, because I’ve never been big on adding butters or oils to side dishes, nor do I tend to fixate on the fattier cuts of meat. I do think that could stand to up the intake of cold water, wild caught fish though.

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[quote]JR249 wrote:

At this point I think the best approach is to dial in the macros to be more consistent, less cheating, and whittle off 10-15 lbs. [/quote]

Yes. IMO, the main takeaway point from the link I provided is that the loss of 5-7% of BW is associated with a reduction in the risk of tipping over from pre- to frank DM. I suspect how one gets the weight off is likely less important.

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Type 2 diabetes is metabolic but also almost certainly has autoimmune roots: Type-2 diabetes linked to autoimmune reaction in study | News Center | Stanford Medicine

The pancreas becomes stressed by high blood sugars due to insulin insensitivity, but the insensitivity and possibly pancreatic destruction both may be autoimmune mediated.

Basically if you are prediabetic, the hope is that you can control blood sugar well enough to let the pancreas out-live and out-recover the rate of damage.

The autoimmune component may be transient as well, or periodic/acute. And so I would add something to Bill’s points which is to preserve gut integrity. Gut integrity is caused in part by grain fiber sources, possibly bean and other grain toxins, and sometimes specifically gluten, and lactose and really any food that you find yourself sensitive to.

Gut integrity can be maintained or improved by eating fermented vegetable products, probiotics, and also getting cellulose, pectin and potato fiber, and also dietary butyrate from animal fat. The gut bacteria will make butyrate from fiber sources, but psyllium is known to cause colonocyte abrasion and leaky gut. Rice is low fiber so it tend to be better. I have also read that NSAIDS and artificial sweeteners compromise gut integrity and allow autoimmune flare-ups

Another problem with going to high linoleic oils is that it can lead to choline deficiency that causes hepatic insulin insensitivity and as a result diabetes. http://perfecthealthdiet.com/category/disease/diabetes/

Low linoleic
Low fructose (as well as keeping alcohol at <1 drink a day which basically acts similarly to fructose to build fat in the liver)
low GI meals with <30% carbs.

Also there is some evidence that going under 20% carbs, or about 100 grams a day can reduce insulin sensitivity, so I wouldn’t go lower long term, but going lower for a couple of weeks might help destress the beta cells.

Obviously insulin sensitivity is the key right now. If you are above 120 8 hours after eating you practically qualify as fully diabetic which would suggest that your beta cells may be beyond the point of any return. Especially on a 200 gram carb diet. If you are prediabetic and you can keep your blood sugar down your beta cells have a chance.

Have you checked 1 hour after eating carbs? Its much more definitive.

Some people on a low carb diet have slightly higher fasting blood sugar just because they have more gluconeogenesis, but over maybe 105 would be real rare, provided the test was accurate.

Also do you eat plenty of animal products now? You can cause diabetes by not eating enough choline rich foods even on a low carb diet.

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[quote]mertdawg wrote:
Have you checked 1 hour after eating carbs? Its much more definitive.

Some people on a low carb diet have slightly higher fasting blood sugar just because they have more gluconeogenesis, but over maybe 105 would be real rare, provided the test was accurate.

Also do you eat plenty of animal products now? You can cause diabetes by not eating enough choline rich foods even on a low carb diet. [/quote]

I haven’t done so 1 hour after eating, but I will do so tonight, as I have a pan full of small red potatoes boiling now.

I do eat quite a bit of animal products, including fish, beef, chicken, liver, Greek yogurt, some butter sparingly, and also some pork eaten sparingly.

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Didn’t your doctor do a hemoglobin A1C test?

Here is the deal. Your diet does not look problematic. It looks ideal in terms of macros.

You don’t have any dietary deficiency that would possibly cause insulin resistance.

Blood sugars can be pushed up by short term stress (you mentioned a flight), altitude, jet lag, general fatigue, stimulants such as sinus medications and caffeine, and your fasting levels might actually look slightly high because you don’t eat a lot of carbs so you probably have some natural gluconeogenesis going on.

What were your “two fasting readings” between 100-120? Without an A1C test it is plausible that you had high morning fasting blood sugars because you are hyp-O glygemic and you get a cortisol kick at night, or the somogye effect (morning cortisol to get you going).

Did you have black coffee before the test or any other stimulant?

Your fasting reading is high but that alone does not indicate anything wrong IF the fasting blood sugar is high due to gluconeogenesis on a fairly low carb diet. A 101 for example for someone on low carbs indicates NOTHING and is not a health issue. It is only a problem as it predicts diabetes, and since the low carb diet explains the higher fasting blood sugar then its not indicative.

Try to go through and answer the questions I’ve asked.

Also what is the family history of diabetes? IF you have it, you may have late onset type 1 rather than type 2.

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I’ve had three fasting blood draws at the doctor’s office during routine blood work for the annual physical that’s now covered under the Affordable Care Act.

Last year when I had my physical it was measured at 101, and since my liver enzymes were high, I went back for a re-test and it was back in the mid-90s, which he said was acceptable. Those two times I had consumed only coffee prior to the test, but after discussing that with my physician, I avoided coffee this year prior to the physical. When I had my physical a few weeks ago, it was lab tested at 110 (fasting), so I went for a follow up and it was 107 (fasting), and then this morning I tested it with a kit and it was 122 (fasting). Those last three readings were taken sans coffee consumption. Correction on the earlier comment - the most recent labs were each between 100-110, the only reading over 120 I’ve had was on the home test kit and that was actually 122 today, as noted.

After the last follow-up, he recommended coming back in for an A1C if it continues to test high at home, with a possible consideration of Metformin. I have a home test kit that I was given to use right before I went to AZ. I didn’t take it with me, but got home yesterday. He said that the latest two readings from the lab are officially “pre-diabetic readings” for my age range.

Both of my grandfathers have type II diabetes, but my parents are not. My maternal grandmother died of colon cancer in her 40s and was not diabetic at the time of her death, and my paternal grandmother is not diabetic. However, all of the above have had open heart surgery too.

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[quote]mertdawg wrote:

Have you checked 1 hour after eating carbs? Its much more definitive.

[/quote]

It is 133 mg/dL exactly one hour after finishing eating the last bit of dinner. I had 7-8 small red potatoes that were boiled and then topped with a pat of butter and some pepper, 1 cup of cherry Kefir, some asparagus, mixed veggies (low GI) and some liver with onions and mushrooms. (850 cal, 87.5 g carbs, 4 g fiber, 65g protein and 28g fat)

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IF you get a chance to do a 2 hour post test, do it. Also do you have test solution with your device to see if it is in range?

I will try to respond early tomorrow, but 133 1 hour after FINISHING 87 grams of carbs even with a mixed meal is not indicative of a problem at all.

The home test at 122 may also have explanations, if you were travelling and tired (blood sugar rhythms tend to give a little bump around 8-9 PM even if you haven’t eaten in a while.

So the question I have to research is whether 2 morning tests, one at 101 and one somewhere between 107-110 can be explained by a generally fairly low carb diet. They do sound high even in this instance, but not nearly as bad as what I had thought before. I thought you were getting 122 fasted in a lab result. A home test can score 122 and be as low as 107-112, which with a normal 8-9 pm bump due to fatigue cortisol would not make me think much of it.

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The advice from mert is sound. The blood glucose tests are only a snapshot. I’m surprised they’re having you go through all this without doing an A1C. Consider this simply a description of our experience, rather than advice - YMMV.

My experience is that my wife is prediabetic. Her A1C has been as high as 6.4. Her fasting tests at that time were coming back at 110-120, as I recall. In the six months prior she’d gone from being very active at work to very sedentary, along with having other risk factors.

She had a consult with an RD after the 6.4 result, who advised her to eat a diet of mainly protein and plants, shoot for daily carb intake of 120g, eat high protein snacks, and avoid all sugar and “white” carbs aside from beans, while admitting “I shouldn’t tell you that, but you’re on the small side, so 120g will be fine.” This was far better advice than I’d been expecting. She also recommended daily non-strenuous cardio, such as walking or bike riding, on top of traditional cardio and weight training.

She asked, and they actually recommended against having her monitor her blood sugar at home. they said at that point, it would just cause her unneeded stress, that they wanted her to follow the plan and not react to the numbers on a home tester.

She stuck to the diet strictly and somewhat followed the activity recommendations for six months and came back with an A1C of 5.7, with other big improvements to her weight and bloodwork.

In the years since, she has had ups and downs in adherence, mostly due to her high-stress job. My observation has been that her activity level has been the most important factor in her test results. Even when she’s eating well, if she’s not active her weight and blood glucose numbers rise; not exercising also exacerbates her stress, making her lose sleep and stress eat.

They put her on the lowest dose of metformin after her most recent A1C came back still in the prediabetic range; we are waiting to see what difference that makes.

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A lot of advice and discussion beyond me, though I was/am in a similar boat, although my BS was like 99, 101 etc., “borderline”- I brought it down a bit (tho measurably) by:

  1. Losing about 12 pounds
  2. drinking some vinegar everyday (or eaten in the form of a few pickles), especially before bed http://care.diabetesjournals.org/content/30/11/2814.full
  3. Walking further everyday-I walk 1.1 miles to and from work, I go for walks on weekends, I walk to the grocery store, if I drive, I park far so I have a small walk in and out etc.
  4. I started playing racquet sports on my non-lifting days (but keep my macros as if these were ‘sedentary’ days) this is how I lost weight, but it additionally acts as another activity.
  5. I eat a lot of cinnamon and spices on my carb heavy meals-not sure where I saw it but spices/cinnamon tend to lower blood glucose by slowing absorption from gut.
  6. I also do eat a good amount of prebiotic fiber and probiotic foods-usually fullfat greek yogurt with a very small amount of raw honey and some cooked oats mixed in, topped with cinnamon.

These are just some of my simple things, obviously not to take the place of actual medical advice or any of the advice above, just my experience and probably healthy things for anyone to do. I’ve been doing this stuff for years now.

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[quote]ja3 wrote:
I’m surprised they’re having you go through all this without doing an A1C.
[/quote]

Especially since they already sent blood to a lab to test blood sugar.

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I did a little research.

  1. It looks like pre diabetes used to require a fasting blood glucose of greater than 110. They pulled it back because they want to catch more people who might be moving in that direction. Prediabetes Definition | What Is Prediabetes? | Diabetes Self-Management

“Until recently, a normal fasting blood glucose level under 110 mg/dl was considered to be normal and fasting blood glucose in the range of 110 to 125 mg/dl indicated impaired fasting glucose (IFG), or prediabetes. In late 2003, an international expert panel recommended that the cutoff be lowered to 100 mg/dl, so now people with a fasting blood glucose level of 100 to 125 mg/dl are considered to have prediabetes.”

So you need to view fasting blood glucose as a screening test designed to help the most people catch a potential problem. Having a fasting blood glucose of 107 by itself does not indicate any health status (it could show stress or infection or immunization can even raise it for a couple of weeks), but the only health issue is that it predicts future diabetes.

  1. Low carb diets can RAISE your fasting setpoint. Again not indicative of health issues as it does not predict diabetes in this case.
    https://www.paleohacks.com/ketogenic/the-high-blood-glucose-dilemma-on-low-carb-lc-diets-14400

  2. A couple of reasons that people may get surprise high fasting blood sugar in the morning: Allergies, Sleep apnea (stress related cortisol) overactive adrenals, Delayed gastric emptying after a large dinner before bed, Sleepwalking with sleep eating.

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800×600 74.3 KB

Here is a graph showing the circa 8:00 pm bump, basically just from being awake all day your body sends out a little dose of stress hormones in case you have to stay awake to defend the camp from cave lions. Once you settle down it drops off.

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Lots of good pointers, I’m going to go back and have the A1C test over the high morning readings at home.

It’s a brand new test kit that was given to the MD as a sample, and it came with extra test strips, but I’m not sure if there’s something in the box to test accuracy - I can check on that after work. I tested last night again right before bed, about 3-4 hours after that last meal, and it was down to 86, which is good.

I tested at 17% BF with calipers last summer. I’m probably 17-20% right now, so admittedly I could stand to drop 10-15 lbs at the minimum, as that’s just extra fat that’s not necessary. I’ve been doing a variation of 5/3/1 since last June, though I was doing much lower carb intake up until this past winter (averaging less than 100g/day), so that could explain a lower set point?

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I had a 99 and 95 morning fasting blood sugar and my doctor (who is a hypoglycemic distance runner who wakes up with 57 blood sugar), told me that I should try to get my BMI down from 29 to 25 (which is lower than my fat free BMI). My A1C was 5.1 which would indicate an average blood sugar of 100. My post meal peaks were 110.

Yes, a long period of very low carbs can lower your set point and also slightly lower your insulin sensitivity.

That is why I would not recommend going under 100 grams a day if you turn out to be prediabetic.

The stress on your pancreas is not really due to high blood sugars per se (which I may have mentioned earlier) but a combination of 2 things:

Total daily carb load which depends a little on the balance of fructose, glucose polymers, fat, and protein. Protein for example can stimulate insulin and can also turn to glucose 2-5 hours down the line.

But to keep it simple, you want low carbs, BUT you want high insulin sensitivity. If you take total carbs divided by insulin sensitivity you basically can estimate stress on the pancreas. Insulin sensitivity can drop from a few factors.

Low vitamin D and sun exposure
Sedentary behavior
High bodyfat

Large carb meals in a short period of time (so big carb meals aren’t bad because they spike blood sugar more, but because you become acutely less sensitive to insulin with a lot of carbs in a short period.

Lots of carbs OR Very low carbs. (less than 20% or 100 grams per day).