Pre-diabetic and really confused

I am completely confused about how blood sugar control is working in my body. I am not worried about my numbers (in fact, I'm quite pleased), but I am totally confused as to what is going on and was hoping someone could supply a reasonable answer (I'm drawing a complete blank).

I'm a 39 year old woman, active (exercise 6-7 days a week) and normal weight, with a history of blood sugar problems. In 1995 (in college) I was diagnosed with reactive hypogycemia (and checked my sugars for 2 months to figure out how to eat - basically the same reduced carb approach as diabetes). I had gestational diabetes three times - 2002, 2005, 2006) (on insulin the first time since I wasn't diagnosed until the third trimester and had trouble getting my fasting and post meal numbers under control, but controlled by diet and exercise the next two when diagnosed at 14 weeks). In 2010 I was diagnosed with prediabetes and tested for about a month to see what I needed to change in my diet. So, I have had four episodes where I have tested my sugars regularly and (other than my first pregnancy) I still have the records. I typically had fasting numbers in the 90s (sometimes low 100s) and 2 hour post numbers between 100 and 120 when I was watching what and how I ate. I have been eating a balanced carb/protein diet for most of my life and 2 years ago I gave up wheat (I also have endometriosis and that led me to remove wheat from my diet).

So, here is my confusion: About 6 months ago I switched to the South Beach diet since my a1c numbers remained in the prediabetic range. Recently I've been super exhausted and not felt great so I got some strips and started testing. My numbers are terrific - I mean I have NEVER seen such good numbers in any previous testing experience. My fasting numbers are in the 80s, my 1 hour post meal numbers are typically under 100 (and almost all have been under 120 even when I push the number of carbs I feel comfortable eating). I've even seen several post meal numbers in the 70s (numbers I have never seen - in college my low numbers were in the 60s never in the 70s). So, clearly, my exhaustion is not blood sugar related. What I am wondering is if something like the South Beach diet can have that much of an affect on the way my body handles blood sugar? I am thrilled, but I want to figure out what the change is so that I can keep it up! FWIW, my a1c in Dec 2012 was 5.8 and my fasting was 94.

Again, I want to emphasis that I am not worried (nor am I bragging!), I am just very confused. Anybody have light to shed on this?


South Beach is a sort of "Good Carb" low Glycemic Index (GI) diet. If you have significantly reduced your carb in take but not really gone low carb, your body may just be starving for carbs to raise your blood sugar levels. On a low carb diet, if you "adapt," your body switches to fat burning. But with South Beach, you should still be carb adapted and if you don't eat enough carbs you can feel fatigued. This may explain the "great" blood sugar numbers, your body cannot sustain your blood sugar as well. In fact, people starting Atkins have named this the "Atkin's Flu." Apparently some people find relief by adding salt to their diet through drinking bouillon. I might suggest trying the bouillon and upping the complex/low GI carbs and protein in your meals and seeing if that helps.

Here's a video that can help explain the metabolic changes that happen when you restrict carbs. I hope this can shine a light on Brian's explanation.

It might be useful to count carbs for several days to see what your level is. If it's 75g/day or below you are burning fat for most of your energy needs and may need to add extra salt to your diet. This is because with the changes in your metabolism this level of carb consumption your kidneys will excrete more sodium and it needs to be replaced. This little tidbit, which I learned from Dr. Phinney, made a dramatic improvement in how I felt on a low carb diet.

Seems to me that with the amount of exercise you are getting maybe you simply need more carbs, but it could just be some other nutritional deficiency as well. Some diets might not be good for some people. With me, my lipids have always run low and in the right ratios, so going low fat probably wouldn't work for me. I feel a full blood workup would be a good idea. Also, have you gotten the antibody screenings for T1 since it appears that you aren't a typical type 2. I'd do C-peptide also. I think metformin was decreasing some of my vitamin levels (B and/or D) causing me energy and depression issues, and vitamin supplements really helped. But it also turned out I was LADA type 1, so starving myself of carbs didn't work....I needed insulin.

Thank you for the feedback. I'd not really given much thought to whether I am getting enough carbs. I'm suspicious about that, however, since I was much more strict about my carb level when I first started the South Beach diet (6 months ago) than I have been recently. However, I'm not much of a salt eater, so I will check and see if that could make a difference. Thanks!

I will try to keep track of the actual amount of carbs I eat in a day. I haven't paid much attention to it, but I feel like I get around 120 or 130 grams (based on the last time I paid attention). It would be interesting to see if I have gone lower than that without realizing it. I will also consider the salt - that is totally new to me. Thanks!

Thanks for the advice. I mentioned above that I will try to track my carbs, I assumed I was getting enough but I haven't been paying much attention since I assumed following a reasonable diet would account for that. I've been exercising this much for a couple of years now (brought my a1c down from 6.1 to 5.8).

As for getting a full blood work up, that makes sense. I tried to schedule a doctors appt when I first started feeling so exhausted but my schedule wouldn't work - I will make a renewed effort to see if I am deficient in something (like my guess of iron). I am curious to see what my a1c looks like now to compare with my meter readings. As for LADA - I've had problems of some sort for most of my life, I assume if I was any form of type 1 I would have found out by now. I do keep it in mind, however (good friend of mine growing up was type 1, so I learned a lot before I had to deal with my own issues). Thanks!

You've been doing the exercise for years, but not the diet, and my thought was that maybe you've been restricting carbs more with the diet.

Regarding LADA and type 1. It can be a slow progression, and maybe slower if you are doing everything right (low carb and exercise). I had diabetic symptoms (chronic foot issues) for close to 10 years before my erroneous T2 diagnosis, and then it was another couple of years before I needed to get on insulin, a year before getting diagnosed as LADA T1 (positive on all antibody tests). I didn't have regular physicals, but the practice I was using should have been able to put some of those pieces together. When I got my BG under control those issues slowly went away. Anyway, if you have good insurance I'd at least run it by a good endocrinologist and see what they think. I'd at least want them to do a c-peptide to get some idea of how much insulin your body is producing.

Salt should not be an issue if you are at 120 to 130. The problem arises when you start using fat as a primary fuel and your metabolism changes, for most this takes place around 75g but I would have to assume each person would be different. I'm at 30 to 50 g/day and salt made a tremendous difference in how felt. Hope you get this sorted out, your numbers are excellent!

Thanks for all your suggestions. I am keeping track of my carbs and activity level now. I will play around and see what happens.

Regarding LADA - is it possible for the blood glucose to dramatically improve? I ate a bunch of white rice with my dinner last night, just to test what was going on, and 1 hour later my bg was 97. I would NEVER have expected that. I understand how my sugars would be good from eating reduced carbs, but I don't understand how it would be good when I eat the wrong amount/kind of carbs.

Quick speculation/possibilities...
1.Your insulin producing beta cells aren't being stressed at all, and can handle an occasional bowl of rice after not producing much insulin, or 2. It could be what is often called a honeymoon period.

With the LADA my point is mainly that I think it is worthwhile for you to get the testing done. My other thought was that you might be starving your body of carbs (and/other nutrients) given your exercise level and going low carb. So for me, I'd see a doctor, have some tests run, mention your energy levels, and see if they find anything. Then if they don't find something, try eating a few more carbs and take a daily multivitamin.

With type 1 diabetes, one's body attacks (is allergic to) insulin producing beta cells in the pancreas. With children, the process is generally very fast. My belief is that it is because their immune systems are extremely responsive to new attacks. With adults, the process is pretty slow, lasting years, and probably isn't as complete. With my LADA (late onset type 1) there were times/days where I could eat a lot of junk food with minimal BG increase, and other days where small amounts shot me up. This can make management pretty challenging at time, and to me is a good reason for eating lower carbs for LADA.

With typical type 2, the diabetic is insulin resistant (cells don't respond well to insulin) and over time the diabetic's pancreas often loses a lot of its ability to produce insulin due to their increased need. Type 2 diabetics, typically have (either triggering their diabetes, or resulting from it) excess weight/fat in their midsection which increases their need for insulin. Typically (at least without good management) their insulin producing beta cells are under constant demand for more insulin, and slowly burn out.

Assuming you are type 2, switching to a low carb diet while exercising would decrease the demand on your beta cells. They would be able to rest and also their stores of insulin might be maximized, so handling a one time bowl of rice might be manageable.

In your case from what I gather, you don't have the belly weight typical of type 2s, and you are both exercising a lot while eating a low carb diet. So your body's demand for insulin is probably really low.

Thanks for the feedback. I was just thinking that my sugars are doing better because my pancreas can handle the occasional surge required since most of the time the insulin demand is so much lower. I have scheduled a doctors appointment to get my blood work checked out. I have been feeling better lately (whether that is due to the multivitamin I've started taking, the lower stress I'm under at the moment, or the few additional carbs I've added back), although my energy is still lower than I would like (or need).

I really appreciate the information I am getting here - I could search the internet for hours without learning as much. I would not describe myself as skinny because I have a lot of muscle. I have very little fat, but what little I have tends to be in my middle (or the three over 9 lb babies stretched me out to the point I can't recover - I'm 5'1" and 122 lbs). I haven't got a clue as to whether my problem comes from insulin resistance or not enough insulin, but low carb and exercise sounds like the best response for either. I'll keep up as best I can!