Thank you all for your feedback! This is the most support I have felt for a long time and I really do appreciate it :) I hope to keep learning as I read about all of your life adventures with Diabetes.
Some of us would already classify you as having diabetes if your BG goes over 140-150 when eating a "typical" meal carb load -- 150-300g. Shooting up to 180 on a light carb load is diabetes -- I can't think of any other way to call it.
Based on what you've described, and your a1c of 5.6 means average BG of 114. Question is, what's the standard deviation around that average? You could be averaging 114 because you spend half your time generally 90-100 (fasting) and 130-140 (postprandial).
Or, you could be spending most of your time 100-110, and a small part of the time peaking over 200.
Either case is still diabetes, in the view of many of us, and the latter is clinically diabetes.
So, the key datum you're missing is whether or not you have Insulin Resistance, which can be determined with testing for hyperinsulinemia. If so, some of us would advise starting exogenous insulin immediately to give the pancreas relief, get BG under tight control, and minimize the progression of the disease.
Good luck getting the average doctor to go a long with you on that idea. Your best bet for getting medical support would be from an endo.
Oh man, that's diabetes, no question.
Welcome aboard! :-)What you’re see is the typical diabetic BG response, which doesn’t follow the peak at one hour, back (or nearly so) to normal after 2. Get used to, and find your peace with it. It’s going to be like that for the rest of your life (I’m talking about response profiles, not BG levels).
You can treat this very effectively, and get a1c’s back down into the 5’s – some around here even sport high 4’s.
What will never change (barring a cure) is the slow drop after eating. Diabetics watch their BG peak after eating, then slooowly drop back down over 2-4 hours. The best you can do is get ahead of it so the peak stays tame (I’m able to keep it under 140 most of time, under 180 almost always).
And that’s the key.
My suspicion is avoidance of the work involved in managing a patient taking insulin (or oral agents), compared to not having to treat them at all.
Give a patient insulin or beta cell stimulants, and you have to keep tabs on them. Tell them they're not diabetic yet -- well, because we don't have to amputate your foot now -- is diagnose and forget, for the doctor.
Also, there is no doubt a legitimate concern with these treatments patients will screw it up and kill themselves, or wind up in the ER. I succeeded in getting CGM and pump therapy even as a T2 because I did a lot of research, educated myself, and built my case before I went to my endo. My preparation, enthusiasm, technical nitpickiness, etc. convinced her I would be a very good candidate, so she went to bat for me with insurance, and succeeded.
If a doctor has confidence in you, like anyone, they'll be more willing to allow you responsibility over riskier things. No doctor wants to be in the defendants seat explaining why they gave an insulin prescription to someone who clearly had no intention of doing anything more than guessing with it sometime around mealtime.
I cannot imagine eating 150-300 g of carbs at one meal. I would be asleep within an hour to an hour and half. Maybe I am misunderstanding what Low carb really is. I thought if I stay under 60 during a meal I wouldn't go over 140 2 hrs post. What is a reasonable amount of carbs to eat without expecting a huge rise in blood sugar?
I can't imagine it either. I don't go full low carb as suggested by Bernstein. I shoot for between 40 and 60 carbs per meal and if I'm lucky I can manage it. I do inject insulin so I have some leeway
There is no magic carb number. It all depends on your body and the treatment plan that you use. There are varying levels of things such as remaining pancreas function and levels of insulin resistance.
Generally speaking the lower carb you can stand the better, especially if you are controlling with oral meds or diet and exercise or both.
It is, as Gary, says, very individual. When you say, "I thought if I stay under 60 carbs during a meal I wouldn't go over 140 2 hours post" you are talking about without insulin? If I, as a Type 1 who made only a small amount of my own insulin ate 60 carbs (or 30!) and took no insulin I would be in the 300s! So that shows the variations! We are in a very different category and how much you will change remains to be seen. For me, again, as a Type 1 if I get over abou5 50 grams of carbs per meal I find it unpredictable to dose with my normal I:C ratio - sometimes it works, sometimes not. And if those 50+ grams include some of my problem foods such as rice or cereal it's anybody's guess how it would turn out! For me, I vary in my carb intake from about 50-70 a day. I consider this "moderate low carb". That works for me and I sometimes am lower (as in the 30s) and sometimes higher, as in 100. I am able to remain a vegetarian and as a "foodie" eat the foods I enjoy. We have people on this board who eat true Bernstein low carb (30 per day) and people who successfully eat a more typical American carb load of 200 a day. Levels of IR matter, as well as endogynous insulin and activity level.
But as a pre-diabetic, not on insulin, you will have to find your own "sweet spot" by "eating to your meter" - that is, eating a favorite meal, testing two hours later and doing this a few times to see if that food or amount works for you. And just when you figure things out, unfortunately, it will change!