Is it possible to be prediabetic, but not progressing to diabetes?

#1

I realize that sounds (possibly is) oxymoronic, but it has been puzzling me for several years. My blood sugars have always been weird, but since my first pregnancy 13 years ago, my sugars have always run slightly high. I was GDM for three babies and none had any birth complications. I have an A1C from after my first pregnancy and before my second that was 5.6. Fast forward 6 years and I have an A1C of 6.1. Increased my exercise and stopped eating carbs without fat and/or protein and over the last 5 years I have maintained a level right around 5.8. This despite a low c-peptide score (near the normal minimum to below the minimum on the chart from the lab). Over the last 6 months life has been stressful and I have been very busy and gotten little exercise, little sleep, and been very stressed out. And... nothing has changed - still A1C around 5.8 and low c-peptide. I'm just wondering if it is theoretically possible that this is a normal state for me and I am not destined to progress to full-blown diabetes.

Just curious if I am living in a fantasy land. Thanks!

#2

Absolutely.

Type 1 diabetes is an autoimmune disease where the body misidentifies and attacks and kills the beta cells that produce insulin, and that's a progressive process.

But Type 2 is just everything else, impairments in the body's ability to use and/or produce insulin, for varied reasons, often but not always including being overweight, and there's no inherent reason that needs to progress, especially if you're not doing things that exacerbate it.

An additional reason you might display the symptoms you do is because of more rare monogenetic diabetes (MODY), where gene defects hamper your body's ability to function normally. For example, MODY2 manifests as a "broken thermostat" where the body just auto-regulates to a higher baseline blood glucose level. No reason these variants need to be progressive, either.

Finally, it's worth emphasizing that diabetes is a spectrum, not a set of binary categories. We need diagnostic thresholds, but really everyone is somewhere on that spectrum. Part of the aging process involves moving toward the diabetic end of the spectrum, too.

What's your fasting blood sugar, i.e. at what level do you typically wake up? How high do you spike after a significant carb meal? Do you or have you used any meds? You sound quite a bit like a MODY2 case, actually, and it might have started with pregnancy simply because that's the first time you were actually tested.

#3

Yes it is. Some people can keep it at bay for many years or avoid it with various measures. My neighbor has had pre-diabetes for years. Her father had type 2 which began in his 70's,or are least that was when he was diagnosed I think. I really hope you will not progress to full diabetes :-)

#4

Well there is a old saying about a duck!
If you change your live style, and you diet and exercise a lot you’d won’t progress, but since I was diagnosed a T2 changed my life style and diet and exercise a lot, I am a well controlled t2.
Bottom line labels don’t count, how we deal with it all does. )
It is about taking care of yourself?

#5

Hi,

I am something like you. I had severe GD wth 2 pregnancies (both with insulin). Since then, I continue to use insulin to control blood sugar, but am not totally dependent on it.

Don't seem to be progressing - and can manage quite well with basal insulin and low carb eating, and bolus in small. amounts only. I don't present as a typical type 2, and I have other autoimmune conditions. Am thinking either mody (my sisters are also having blood sugars higher than normal, but not terrible), or some weird permutation of type 1.

I am just glad that I don't seem to be progessing and hope that my relatively easy control can continue indefinitely. My latest Hba1c was 5.0, and while I did work on this number (insulin, testing, low carb), it was not an all consuming effort.

#6

Unfortunately the real question isn't about progression from pre-diabetes to diabetes. The real question is whether you can halt the progression of diabetes and maintain tight control and do so without needing escalating amounts of medication and insulin. I believe that for many people early intervention with a low carb diet and lifestyle changes can be very successful. You will still have diabetes but you can slow or even halt it's progression. It will never go away but it may well be long-term controlled. That being said, if you have a condition like LADA or some forms of T2 it may progress anyway. But at least you can look back and say you did everything you could.

#7

Thanks to everyone for your encouraging words! I do sometimes feel like I am wasting precious resources worrying about something that I can't make better, yet doesn't seem to be worsening. My lifestyle modifications are very modest given that I've always had some blood sugar issues, but if that's all it takes I can walk around with a big grin on my face. When my A1C refused to budge even though I went low-carb and increased exercise (always been a healthy weight) and then my c-peptide came back pretty low my doctor told me I was the type of patient that would eventually end up on insulin. I've only recently begun to think that maybe that isn't the case since it has been almost a year since that experience and my sugars are right where they were at that time. The information you have all provided is great and I will be doing some more research, just to satisfy my curiosity.

#8

Thanks for your response! My fasting sugar has really improved when I started monitoring my carb intake and reducing it significantly. I went from near 100 to mid-80s. My fasting sugar was always in the 90s, even back when I was diagnosed with hypoglycemia 20 years ago. It is nice to have it drop down to a more normal level. My spikes after a high carb meal are typically to around 160 at the 2-hour mark. I don't usually eat enough carbs for that to happen (although on Sunday I was at my nephew's birthday party at Chuck E. Cheese's and really hungry and ate 2 small pieces of pizza and a piece of the birthday cake, so I'm far from perfect). I am currently on metformin. I am guessing it is helping, but very hard to tell. No one in my immediate family has diabetes - my father has hypoglycemia and my mother has always run slightly high fasting sugars (~110) but nothing classified as diabetes. She is 69 and has an A1C of 5.9.

#9

Could you tell us the amount of carbs you are eating per day on average?

#10

I typically eat 15-30g at each meal or snack. I eat small frequent meals as that seems to work best for me. So, in a typical day I eat about 120g to 150g of carbs.

#11

The average is good although you seem to cope by eating many small meals. Usually healthy beta cells can produce 20 units of insulin per hour and more. Please allow me the following simplification: 1g of carbs will raise your blood glucose by 3 mg/dl. Thus 30g will raise you by 90 mg/dl. Then let us assume that one unit of insulin will lower you glucose level by 45 mg/dl. In this scenario you will need to produce 2 units of insulin to cover the 30g. In addition to that your beta cells have to produce insulin constantly to cover the carbs from the liver. This is hard to guess but let us assume this needs an additional unit per hour. Now 3 units per hour is just a fraction of the 20 units a healthy beta cell mass can produce. It is the explanation why low C-peptide can still be sufficient to cover your current eating pattern. You are still glucose intolerant to higher amounts of carbs. Your doctor can determine the extent of your intolerance with a glucose tolerance test. So you still have a form of diabetes.

The question is how hard the beta cells have to work to keep your insulin needs covered. If your C-peptide levels are going lower and lower over time then this is an indicator that more and more beta cells are dying. This is something to expect if the residual beta cells have has to operate at their maximum capacity all the time. I would be surprised if this does not progress further. Just be aware that this can progress to a stage where even your low amounts of carbs cannot be covered anymore. Being mentally prepared makes it easier to find the right moment to ask for exogenous insulin. I just wish it will continue as positive as it is right now.

#12

Well, that makes sense. And gives me motivation to keep doing what I am doing. I like your analysis.

It is likely I will progress eventually, but I hope that is far in the future!

#13

Your C-peptide levels will also vary greatly depending on glucose levels at the time they are taken. A low-normal C-peptide by itself means next to nothing. If your C-peptide is low-normal while your glucose levels are highly elevated at the same blood draw, it is cause for a lot of concern.

#14

Hmmm. I wondered about that. The test has always been done at fasting and my fasting numbers have really improved with the lower carb diet.

#15

So if your glucose levels were normal without medical intervention (meds) and your c-peptide levels were anywhere near normal… It means your cells are getting an adequate amount of insulin to keep your glucose in check, at least while fasting. Might be worth keeping track of some readings 1-2 hours after meals, but don’t get all obsessed yet. If you are often seeing numbers significantly elevated, say 150+ it is probably worth following up with your doctor-- might justify an ogtt-- oral glucose tolerance test (if you haven’t already had one)-- to see to what extent you are struggling after meals. It sounds like you’re doing the right things by eating right and exercising.