Diagnosed as Pre-Diabetic

Nutrition
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My understanding is that about 100 grams of glucose/glucose polymers produces the highest insulin sensitivity. I don’t think that having a 102 fasting blood sugar on a very low carb diet is a problem if it is from physiological insulin resistance, but consider the following:

Muscle anabolism depends largely on insulin and the response to insulin. If you are on a VERY low carb diet, then carbs are low, and insulin is low, but the ratio of carbs to insulin is higher than with 100 grams a day. Insulin also helps protein to enter muscle cells and if they are physiologically less sensitive to preserve glucose for the brain then protein will not flow into muscles as easily. Protein itself stimulates insulin and resistance to insulin means that the body has to release more insulin to get the protein into the muscle, which CAN lead to longer term insulin resistance (exposure to insulin). Its complicated because some AAs stumulate insulin and some supress it.

I will not pretend to have some special insight or say that 100-125 grams is better than 50-100. I simply know that I seem to do better at a little over 100 from a well-being perspective, feeling better and training better and better body comp, and that some very low carb guys from years ago found that eeking up to 100 grams gave them better results with health and fitness.

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Just to be clear, I was sharing what I do and have found effective for Diabetes, not trying to tell you to change how you manage your son’s. But something that is optimal for a healthy person (100 - 150 grams of carbs a day) has different effects on diabetics. Same thing with going low carb. While it is potentially sub-optimal in healthy people, it may make more sense in a diabetic, because the benefits outweigh the problems.

Diabetes kills, and does it unpleasantly. I’ve got a 5.1 HbA1C which is ideal for me, especially because I don’t get a lot of sugar lows (and those I do get are like 72 or 75). Which means I’m not fucking my hormones (being sugar high and sugar low does that), I’m not getting brain damage (sugar lows and sugar highs can do that), and my metabolism is healthy.

So is the approach I’m recommending optimal for non diabetics? Of course not. But if you do your homework into the effects of poorly controlled type 1 diabetes (anything over 5.5 HbA1C, more or less), you might start thinking a little different. It is more about finding the least bad options rather than the best.

Besides, my otherwise ketogenic diet has 4 high carb meals a week (prior to lifting), which keeps my insulin and leptin sensitivity ok and ameliorates a lot of the downsides of a true ketogenic diet.

Just a thought. I’m gonna piss of now :slight_smile:

–Me

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Believe me, I will settle for nothing less than sub 5.5 without lows, and this may require very low carbs at some point, but for now seems to be maneagable with about 30%. There is no advantage healthwise is reducing post meal peaks below about 125, and as long as my son is between 75-125 almost 100% of the time, I don’t see how lowering carbs can help.

It can increase the unpredictability of glucose produced from gluconeogenesis and lead to liver glucose leakage to turn to mild to moderate ketogenesis anyway. I mentioned before that during the “eating” period of the day his blood sugar ranges from 72 to 130, looking at 1 hour, 2 hour peaks etc. The only time he goes up to 130 is for about an hour 4-6 hours after dinner (during or after bedtime), from liver glucose release anyway and that has nothing to do with what he ate 4-6 hours earlier given that his blood sugar was 95 3 hours after eating.

lowering carbs below the 100 gram threshold should only exacerbate the problem of liver/hormone released blood sugar combined with physiological insulin resistance from VERY low carbs. Carbs can even supress the cortisol release that can cause blood sugar to rise without food. And another issue I mentioned is that if you eat protein, that protein will sit around in your blood without insulin to deal with it. Eating protein without insulin may be a harm on par with high blood sugar.

Same for high omega 6s, oxidative stress, and high blood pressure. For diabetics, high blood pressure has about twice the effect on complications as having a high A1C. A blood pressure over 130/80 is worse than an A1C of 7.0 based on the body of research. Then again if you don’t eat a lot of carbs you don’t typically have high blood pressure.

Based on the results of the first 12 weeks, I think that his A1C will be down to under 5.5 by his 6 month check without any lows. The problem I have is that the clinic doctors tend to freak out when they see A1Cs under 6.0 for kids. I think they really want to just have a standard, by the book protocol.

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Kravi, I really appreciate this discussion. I have been a “low-ish” carb advocate for several years. I have started to look at Dr. Bernstein’s videos on youtube and will get his book. If I had T1D without any beta cell function I would probably stick with very low carbs. In 3 months I’ve gone from the clinic doctors telling be that they condoned basically a 60% carb diet (because they think that fat/saturated fat causes heart disease) to getting my son under 50%, then under 40% then to about 30% carbs, and I can’t really give him less insulin anyway as he gets 1 lantus at night and 1 lantus per meal, and at least for now I have to use some starch as a vehicle to deliver fats, such as small pancakes and biscuits with tallow, butter or coconut oil, and egg yolks. I make these from scratch and a tablespoon has 4 grams of carbs and about 4 grams of fat.

My real concern with Bernstein approach, which I would take as an adult if I had to go with something and had not endogenous insulin, is that there is some evidence now that some diabetics are getting better control with right around 100 grams of carbs a day because it prevents the upregulated gluconeogenesis source of glucose that can come in spurts.

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Thanks for getting me to take another look at Bernstein. It is very informative. I tend to think that he went to an effective extreme back when it was harder to monitor blood sugars so I still think there might be merit in a look at the low end of moderate carb intake with low GI meals and low insulin. He obviously couldn’t do this when he first started because he had less information about his own blood sugar levels than we have today with a 5 second test accurate to within 10 points. But his method has an advantage in that it won’t fail if it is applied by the book, basically that:

You never eat enough to make your blood sugar high, and you never take enough insulin to make it low. That method basically works all the time except for when you are sick or under exertion and may be more sensitive to a basal dose.

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So JR249, I have been under a lot of stress particularly in the morning for the last 4 months, (my son was diagnose with type 1 diabetes). I also stopped working out about 8 weeks ago because I just hit the wall from stress, and haven’t slept well.

So I tested my MORNING fasting blood sugar and got 110 two days in a row. This is under stress of getting my kids ready in the morning, and gettng my son his insulin and the right amount of food etc, and also I drink about 3 cups of coffee, though my blood sugar is 110 before the coffee and still 110 a little later, but then comes down to 90 when the kids walk out the door about an hour later.

I checked my A1C with a home test and got 5.5

I also have fasting blood sugars in the 90s if its not in the morning.

And after meals I move around between 80-120.

I have tended to eat low carbs but I should lose 15 pounds if not more.

I have recently read that the glucose tolerance test will catch almost every case of pre-diabetes or diabetes, and furthermore the general belief is that the glucose tolerance test should be bad BEFORE the A1C or fasting blood sugars start to get bad.

So I’m going to do it at home today. If my oral glucose tolerance is normal then my fasting blood sugar is a stress issue, as the poor glucose tolerance test should precede a real fasting blood sugar issue.

I’ll let you know how it goes, and then post how to do it afterwards.

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So in an 8+ hour fasted state I took 75 grams of glucose liquid (5 bottles with 15 grams of glucose in water).

My intial blood sugar was 90

30 minutes: 143
60 minutes: 98
90 minutes: 116
120 minutes: waiting

This is pretty clearly not diabetic. I’ll wait for the 2 hour, but a 2 hour result under 140 is considered normal, 140-199 is prediabetic and 200+ is diabetic.

Other sources state that 120 in 2 hours is superior and 100 is basically perfect so we will see. <140 is definitely non-diabetic at 2 hours.

So consider that my morning fasting blood sugar (with some stress going on) is right around 110, coming down to the 90s within an hour, and my HbA1C (again with increased stress over the last few months) is 5.5. Also I have tended to be eating only around 100 grams of carbs a day for the last 2 weeks up to the last 3 days where I think I had more like 150. You are supposed to hav 150 grams of carbs each of the last 3 days prior to a glucose tolerance test, I suppose so your liver/muscles are not empty which can give a supercompensation effect. I haven’t really counted but I had mashed potatos for dinner last night, and some tostadas with beans and some ice cream the day before and a banana and almond butter. I really just don’t eat much sugar.

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So to my surprise, after the 30, 60 and 90 minute test being normal, the 120 minute test came up at 156! That is considered to be prediabetic.

It seems very odd to me though that 75 grams of pure glucose would put me at 143 at 30 minutes, 98 at 60, 116 at 90 minutes and 156 at 2 hours because the blood sugar peak from straight glucose is supposed to happen at around 45 minutes.

0: 90
30: 143
60: 98
90: 116
120: 156

I will check again to see if it goes higher. It may demonstrate some kind of delayed gastric emptying or even celiac and might also matter in my son’s diagnosis as he is considered to be type 1, but I have recently found that my dad probably had diabetes that went undetected due to them only looking at fasting blood sugar, and because he was big. He had neuropathy and died of a foot infection.

And his brother, my uncle has diabetes, and their dad, my grandpa had diabetes, and I think that my great grandfather had it too.

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So really wierd, I am back to 96 after another 30 minutes.

0:00- 90
0:30- 143
1:00-98
1:30-116
2:00-156
2:30-96
3:00-72
3:30-81

that’s long enough

So really, pretty normal blood sugar on average after 75 grams of glucose, but the weird bump at 2 hours.

The reason that this is important to me is that my son sees a similar anomaly. He takes insulin and eats. His blood sugar is maybe 100 when he eats. It pretty much stays that way, or even goes down to the 90s for 2 hours and then jumps 20-30 points or even later if it is more starch.

And after all of that, it turns out that I was supposed to be allowed to drink water during the test, and I didn’t drink any, and feel pretty dehydrated at this point. I think that my blood sugar pattern was odd, but not really similar to what a pre-diabetic would expect. Most pre-diabetic patterns I see in graphs show a clear peak around 30-60 minutes which slowly falls over a few hours. In my case, I handled the first hour perfectly going from 90-143-98. And when I hit 156 at 2 hours I was back to 96 in 30 minutes. Seems like some over-response to stress that is causing some kind of dumping from the liver.

Anyway, maybe I just need a vacation.

70

Nursing/Strength+Conditioning Student here:
I am wondering if anyone here who IS a diabetic has tried or is currently using a system such as Keifers Carb Back Loading ?
Also, what have you found to be the most basic yet best all around training protocol ?
Is anyone doing CarbBackLoading and a 5/3/1 or Westside protocol ?

I may never practice as a Nurse but I will continue with my Strength/Conditioning/Nutrition education.

And with the 300% increase in Obesity / Diabetes over the last 20 years…I know where my clientelle will be coming from.

Once again, Thanks to EyeDentist, BillRoberts, Mertdawg and Kravi for all the information overload !

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[quote]killerDIRK wrote:
Once again, Thanks to EyeDentist, BillRoberts, Mertdawg and Kravi for all the information overload ![/quote]
Great thread indeed, although a lot of it has gone over my head.

For the slightly-less-intelligent readers, what are your opinions on the best way of avoiding diabetes type II?

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[quote]theBird wrote:

[quote]killerDIRK wrote:
Once again, Thanks to EyeDentist, BillRoberts, Mertdawg and Kravi for all the information overload ![/quote]
Great thread indeed, although a lot of it has gone over my head.

For the slightly-less-intelligent readers, what are your opinions on the best way of avoiding diabetes type II?

tweet[/quote]

  1. A balanced diet should mean less than 40% fat, 30 is better and 20 may be better (plus post workout carbs). Avoid more than 40% carbs at any meal or overeating, or eating without doing any activity (mental or physical). You can exercise before dinner, but if you are not going to be active in the afternoon, you should eat a light and early dinner. (around 4 hours before bed). There is f-ing no reason to eat carbs before bed unless you trained hard in the afternoon or REALLY hard in the morning.

  2. Avoid being 10 pounds over your ideal weight for your current muscle. Really avoid being 20 pounds over. Fat absorbs blood sugar from insulin and so as you gain fat you need to become insulin resistant to maintain normal blood sugar! Normal blood sugar does not mean you are not producing a shit load of insulin (and stressing the pancreas) to keep it normal

  3. If you are overweight/fat then losing fat and improving diet can have a fast affect because in the beginning of insulin resistance your pancreas grows more beta cells to produce more insulin. The problem is that once you start seeing high blood sugar your immune system will attack beta cells even with type II and once they get a taste for beta cell antigens they will come back for more.

  4. Strength training plus cardio work best though its hard to tell if the cardio works mostly by weight reduction or some other effect. Adding muscle gives your body a place to put blood sugar fast, especially if you get <40% carbs. Avoid too much of either type of training as stress raises blood sugar. Exercise should be small effective doses. 30 minutes of intervals or fast walking. 40-80 minutes of weight training. Too much aerobic exercise kills by producing free radicals. No one should ever run more than 25 miles in a week if health is the goal. I trained in exercise physiology in Boulder CO where running was huge, and the grad professors still all knew that statistically runners started to die more when they hit 25 miles a week (average over 6 months). And that already meant they were healthy enough to GET to 25 miles a week. Almost all of the health benefits occured at 15 miles a week-like 93%. That would be about 90 minutes of hard aerobic exercise for most people. With muscle, you should never tear down tissue (not just muscle but connective tissue) faster than you can recover for any extended period of time. IF you have chronically sore joints then you have to do something about it. If you have trouble sleeping then there is a problem.

  5. I think avoid wheat and grain fiber as it can allow viruses to pass through the gut lining and provoke an autoimmune response. Never take NSAIDS more than once for a bout of pain. Avoid them if at all possible. They compromise the gut lining. Avoid artificial sweeteners. Eat probiotics, and probiotic containing fermented veggies at least once a week. Eat some potato starch with them.

  6. Avoid Omega-6s, don’t overuse omega 3s. At this point I’d prefer <8 omega 6 and 2 omega 3 to going higher on omega 3s because they are even more oxidative. Minimize “sugar”. 50 grams a day netting 25 fructose is the LIMIT unless you are depleting liver glycogen. Keeping liver glycogen and muscle glycogen a tad low most of the time gives you a place to put excess fructose and blood sugar.

  7. Do stay hydrated. Don’t overdo it but do drink water about 2 hours after each meal, 8-12 ounces.

Sleep 7 hours every night and 20-30 minutes ONLY for a nap in the day. Go to bed early and wake up early.

Don’t stay in front of the computer for much time each day. Don’t sit down if you can stand.

It may sound odd, but probably half of our calories should come from beef fat and some dairy fat/butterfat. Saturated plant fat and monounsaturated plant fat is overrated. Butter fat is over 25% oleic acid! I am not sure if you can get too much butter fat, but I do not believe that you can get too much of your calories from beef fat. It is literally the 1 non-toxic source of calories that we have available (grass fed is even better).

This of course is all opinion-thinking out loud.

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Thanks mertDawg,

Points 5,6 and 7 were all new to me.

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In my opinion, there are a few carbs rules that are overstated here.
Fructose (from whole fruits ONLY) should not be taken into account IF taken periWO
Potatoes, rice and other starchy carbs are not any better/safer than wheat or even oats and such grains. That’s huge glucose sources : high glycemic loads should only be taken around workout once again. No difference between fructose and other sugars (i’m not talking about artificial sugars here, which should be avoided plain and simple. Your brain will adapt in no time)

I have gone very high on carbs in my diet and thanks god my tests are ok, but everything feels much better with a high, slow-digesting, quality protein intake, and various sources of good fats

IMO 20/40/40 of such carbs/proteins/fats is good

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[quote]mertdawg wrote:

And after all of that, it turns out that I was supposed to be allowed to drink water during the test, and I didn’t drink any, and feel pretty dehydrated at this point. I think that my blood sugar pattern was odd, but not really similar to what a pre-diabetic would expect. Most pre-diabetic patterns I see in graphs show a clear peak around 30-60 minutes which slowly falls over a few hours. In my case, I handled the first hour perfectly going from 90-143-98. And when I hit 156 at 2 hours I was back to 96 in 30 minutes. Seems like some over-response to stress that is causing some kind of dumping from the liver.

Anyway, maybe I just need a vacation.[/quote]

Thanks for taking the time to share all of that, this has been a very informative thread!

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By the way. I’m not prediabetic. I had a fasting blood sugar of about 99-103 under stress which is not valid and my fasting morning has been 83-93 for the last 2 days. It is even lower other than first thing in the morning, 70-85.

I decided to go true low carb for two days and check every 2 hours, and I go between 70 and 95 (95 after 2 cups of coffee and 6 grams of sugar from half and half) and back to 75 in an hour. Basically I sit around 70-90 all day long on low carbs and having one day to carb up might solve the problems of chronic low carbs.

When I got about 25% carbs, my post meal spikes (from about 35 grams of carbs with other foods) was about 110 so moderate/low carbs have me going from 70-110-70 while very low carbs have me going from 70-95-70. Not sure if that really matters for health. Some believe that going up above 100 (but not over 140 for long or very often) a couple of times a day helps the pancreas thrive properly.

If your liver glycogen is depleted a little, the liver just sucks up blood sugar as it comes.

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mertDawg and co.; what are you thoughts on intermittent fasting and its effect on the development of diabetes type II?

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IF was designed to get the immune system to activate to clean up damaged, mutated or precancerous cells, which are broken down and used as fuel in a fasting state. It is possible though that this could activate the immune system to seek out pancreatic beta cells IF the person is susceptible to autoimmune destruction of beta cells. We believe know that type II in the LATER stages is mediated by an immune response so I am not sure.

In general though:

Eating in a small window, like basically just lunch and dinner has two big advantages for prediabetics. 1 you avoid eating during the “dawn” effect when you typically become insulin resistant around the time you wake up. No carbs for breakfast seems to make sense. 2 you generally keep your liver glycogen a little low so there is less likelyhood of glucagon and stress hormone stimulated glucose leaking and you have the “space” to put blood sugar. Basically if liver and muscle glycogen is low, insulin sensitivity is high, (unless blood sugar gets VERY high in diabetics due to lack of insulin.

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[quote]tontongg wrote:
In my opinion, there are a few carbs rules that are overstated here.
Fructose (from whole fruits ONLY) should not be taken into account IF taken periWO
Potatoes, rice and other starchy carbs are not any better/safer than wheat or even oats and such grains. That’s huge glucose sources : high glycemic loads should only be taken around workout once again. No difference between fructose and other sugars (i’m not talking about artificial sugars here, which should be avoided plain and simple. Your brain will adapt in no time)

I have gone very high on carbs in my diet and thanks god my tests are ok, but everything feels much better with a high, slow-digesting, quality protein intake, and various sources of good fats

IMO 20/40/40 of such carbs/proteins/fats is good[/quote]

Also wanted to mention that I would NOT go 40% protein if you are into pre-diabetic numbers. I will try to find this whole article. There are several others as well. Mechanism of action of whole milk and its components on glycemic control in healthy young men - PubMed

I’ve read it before and it is consistent with other nutritional science. Basically, protein and fat both reduce the GI of carbs, but protein does it by STIMULATING more insulin secretion, which only serves to raise insulin resistance. It may help save beta cells by preventing high blood sugar peaks, but you won’t improve insulin sensitivity until you stop secreting so much insulin. Cells become resistant due to exposure. Fat on the other hand reduces GI by slowing gastric emptying.

Here’s another (full) study. http://jn.nutrition.org/content/136/10/2506.full Again protein works for non-insulin resistant individuals:

“Our results are hard to explain but could be consistent with the hypothesis that fat reduces glucose responses via GLP-1 mediated effects on gastric emptying, whereas protein reduces glucose due to amino-acid mediated effects on insulin secretion. However, the results of this pilot study do not allow anything but speculation as to the mechanisms involved, and further studies are needed to investigate how fat and protein affect postprandial responses in normal and hyper[I] subjects.”

So once you are insulin resistant, protein just promotes even more insulin secretion. Yes it protects from super high blood sugar peaks, but it does nothing to improve insulin sensitivity and get you back to normal. Protein will also use up available insulin in the blood so again maybe no peaks, but constant pancreatic stress.

IR people should definitely consume low carb, high fat and also fairly low protein in my opinion until A1C is back to at least 5.5-5.7 (IMO). I’ve seen that Leucine, gram for gram stimulates more insulin than glucose! and it may even make you hypo while causing a large insulin secretion. Again its not that you are killing your stressed pancreas, but you are keeping it depleted and raising IR.

Honestly after seeing the different effects of very low (<50 g) and moderate low (125 g) carbs, if I were prediabetic, A1C 5.7, I’d chose LOW carb, high fat, and NOT high protein until the number get good. But you can even have a good A1C with IR if your pancreas is secreting a sh*t lowd of insulin. There is some test that measures both blood sugar and insulin in response to a glucose tolerance test. I will look into it. It is the only real way to know your status.

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Here is some of the problem with going super low carb and then carbing up once a week: Insulin Sensitivity and Glucose Tolerance Are Altered by Maintenance on a Ketogenic Diet - PMC

Carbs are simply handled better if you get 100-150 grams a day consistently rather than going low and then trying to bring back metabolism and carbing up once a week.

In my experience, metabolic rate drops even at about 100 grams of carbs a day, and carbing up once a week corrects this, but not requiring as much insulin to handle the carbs. Furthermore you get an even better (IMO) glycogen supercompensation when carbing up on a low/moderate carb diet than a very low carb diet (because the VLCD makes you insulin resistant).

On the other hand, the fact that you are insulin resistant on a very low carb diet is likely the result of cortisol upregulation/insulin supression to maintain fasting blood sugar. This suggests to me that the very low carbs ARE good to promote improvement in insulin sensitivity over the long run. So there is logic in the formula of going very low carbs for a few weeks to months and then SLOWLY increasing carbs to the 100-150 gram range where you will see the most sensitivity to your insulin. Sensitivity to insulin prevents spikes which damage tissues. Low insulin (from very low carb diets) improve long term sensitivity upon returning to more moderate carbs, but they subject you to spikes if you carb up from a very low carb state.

This peripheral resistance by the way is the reason that you are supposed to have at least 150 grams of carbs a day for 3 days before a glucose tolerance test. People on low carb diets or who had just been fasting would fail the second hour because the low carb diet puts the liver into glucose secreting mode. The glucose gets pulled into the liver fine in the first hour but the liver is still actively trying to keep blood sugar up and spits it right back out.