Should I see an endocrinologist for a second opinion?

@Timothy – How do you square Virta’s findings with the conclusion that “prediabetes is not reversible”?

Type 2 Diabetes Prevention Focused on Normalization of Glycemia: A Two-Year Pilot Study

Virta studied the effects of its intervention in patients with prediabetes and found that only 3% of trial participants progressed to type 2 diabetes over a two year period. Over half of participants achieved normoglycemia, with 75% of patients retained at the two-year mark.

I acknowledge that the underlying conditions that bias a person’s disposition towards T2D is not likely reversed and a return to an unhealthy dietary habit will return that person to prediabetes/T2D. But the fact remains that adherence to Virta Health’s lower carb protocol leads most participants to return of normal blood sugars, elimination/reduction of diabetes medications, significant weight loss and normal unmedicated blood pressure.

I think that @BBrandt247’s chances to reverse prediabetes are very good if s/he employs a system like Virta uses.

Yeah I was mainly just concerned about the fasting number. Not sure if I should start avoiding carbs

I am not convinced that Type2 is anywhere near as progressive as the medical trade makes it out to be which is why Virta is so successful. Experience shows that you start with oral medications which nicely keep you under control for a while but then over time start going out of control and deal with that issue using insulin. I believe that oftentimes, once you are under control, you feel no compunction to adjust your diet and exercise, actually sinning becomes normal because the pill takes care of it until bg is back out of control which leads to insulin. Then Virta comes along and puts the patient on a healthy food and exercise program and voila, all the so-called past progression is gone in a fairly short period of time. To a large extent, I think the progression is a progression of bad habits rather than a progression of diabetic disease.

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Wait so I do have prediabetes?

No, I don’t know that. I should not have written that I think your “chances to reverse prediabetes are very good.” You report only one concerning number so far, the 123 mg/dL fasting glucose. Your 4.7% A1c shows your overall glucose control is excellent.

The missing piece of the puzzle is how much insulin your body makes. A fasting insulin test would be good info but a C-peptide blood test would be better.

If your body is only able to maintain blood glucose control by overcompensating with insulin production then that suggests prediabetes/T2D. Most clinician’s see diabetes as a disease of glucose abnormality. Really, it’s abnormal amounts of insulin that define diabetes.

If your excellent overall glucose (4.7% A1c) is only achieved by your body’s heroic production of voluminous insulin amounts, then that is not healthy in the long term. If, however, your body is able to control glucose and produce a 4.7% A1c while holding the c-peptide levels in the normal range, then you are golden.

If the c-peptide shows a low or edging toward the lower limit then that could mean slowly developing T1D or latent autominnue diabetes in adults (LADA).

Sorry for my sloppy comment.

Looks like I should get those tests. Can a normal PCP run those or do I need an endo?

Any doctor can order a c-peptide or a fasting insulin blood test. Doctors generally shy away from ordering unfamiliar tests or whose meaning they do not understand. No, you do not need an endo to order these tests.

Sometimes I think doctors resist ordering some blood tests since the medical group they are a part of do not believe them to be appropriate or useful. Other times I suspect that arguing with a payer about insurance eligibility encourages them to be very conservative and avoid these “wasteful” conversations.

I think the term reversal is a term that is misleading.
The condition and the symptoms can certainly be reversed.

When you take the pressure off the pancreas and cells of the body, you will drop down the sugar levels and essentially feel better.

This does not change the disease process of insulin resistance. It just pushes below the threshold.

Insulin resistance is a progressive disease, so eventually it will rear its head again.

Insulin exacerbates insulin resistance. So as your body produces more insulin to combat high sugar, it makes the resistance more.

If you change your diet and exercise and lose weight, you reduce the resistance and you slow the progression way down. You can go years with normal sugars if you keep it up and your arteries and heart and kidneys will be healthier.

This does nothing to change the underlying condition you simply are holding off progression for a time. I think it’s a great way to do it. I think everyone who suffers from it should try to keep it at bay. But reversing it is not an accurate term in my opinion. If that were true a person who has held off with a good healthy diet could go back to unhealthy foods and would not see any issues with sugar.

Think about the millions of people who live on super high levels of carb and never develop insulin resistance.

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People who use the reverse are careful not to imply a cure. I’ve always preferred the term, remission, to reversal.

I don’t think that progression of T2D is absolute. That is old medico thinking and many people have now restored normal glycemia without or greatly reduced levels of drugs.

Progression of insulin resistance is not a given. Many people have held the progression of T2D at bay for many years, even decades. And they’ve done this largely without the help of traditional mainstream medical thinking.

That’s fair.
I’m coming from a pathology point of view.
I studied arterial samples during my time as an undergrad.
The damage to blood vessels is permanent. This damage caused more resistance.
The correlation to glycemic/hyper insulin damage to insulin resistance is well documented.
The type of damage from glucose and insulin is very specific.
Yes with good control we can stop it in its tracks.
We can not heal it. It will sit there as is. Until it progresses.
If your control is so good maybe it will not progress.
It is very difficult to maintain good glucose for a life time.

So maybe we are saying the same things from a different perspective.

There’s a technique to this. After you poke the finger, completely encircle that finger with the thumb and forefinger of the opposite hand, then pull towards the poke (in the direction of that fingertip). This raises the blood pressure in the end of the finger and makes the blood come out. For accurate measurement, this technique needs to be relatively fast and gentle, because squeezing too hard for too long will alter the BG reading.

I can give one example. Over a decade ago my wife started doing fingersticks once every couple weeks or so because she has a family history of type 2. At first her BG was in the 90s, but over the course of a year or so her fasting BG gradually rose to 135. She did not want to develop full type 2, so she lost weight, started exercising, and started eating better (not low-carb). Over the course of a year her fasting BG dropped back to the high 90s, and a decade later her A1C is still down in the high 4s. She may indeed develop type 2 in the future, but it’s certainly worthwhile to try to reverse the progression and get a remission. Doesn’t always work, but it can sometimes work out really well.


I have always said if the gene is there you have it in the background. My sister is skinny,exercises, eats healthy. Her Dr. said she is preD. She said she may be that way the rest of her life, unless she gains weight, stops walking miles a day. It very much runs in our family. Nancy50

“Any doctor can order a c-peptide or a fasting insulin blood test.”

My now EX doctor told me that she doesn’t think that they do or can order those kinda blood tests. *EYE ROLL *

The ability of any doctor to order a blood test and willingness to do so are two different things!

Sometimes insurance won’t cover blood tests ordered by the “wrong” doctor, so if your doctor says another specialist needs to order it, sometimes it may be more about not wanting you to be surprised with a large bill…

I wonder if it’s also a judgement of “medically necessary”, vs “nice to know”.

Many tests can be ordered without doctor, but full self-pay.

It can be either or both. But I did have a specialist hesitate to order a test not because he had a problem with my having it, but because he knew from experience that coverage could be an issue. When I told him that I was fine with that and would be ok paying the bill if it came to it, he said ok. I said that in part because I hadn’t had issues having other specialists run that specific test that falls outside of their area before on my current insurance, so I suspected risk was relatively low, but I appreciated the concern.

I finally got the contour next one meter and I actually can get blood (I usually need to use the second chance feature, not sure how accurate it is).

Okay so I haven’t changed my diet and my fasted glucose at the doctors lab went down from 123 mg/dL to 107 mg/dL. A1C went up but is still great at 5.0% (up from 4.7%).

I’ve been using the contour next meter and when I wake up it’s been almost always 96 mg/dL, but ranges from 94-99 usually. Today it was 78. I do have palmar hyperhidrosis (my hands sweat excessively for no reason). I do try my absolute best to dry them, but a tiny bit of sweat does come back almost instantly and not sure how much this can impact glucose readings.

Before my blood draw, according to my meter my glucose was at 97 mg/dL. Thus, I’m wondering how much stress impacts glucose readings. It’s either stress or the normal error margin of the meter, or both.

But overall, I wonder if stress can impact fasted glucose readings because I hate blood tests. And if so, how do interpret everything?

Some more numbers:

1 hour after eating 96g of carbs (Trader Joe’s blintzes), blood sugar is 121 mg/dL. I assume this is a good reading.

2 hours after chipotle (brown rice, beans, corn) I got 117 mg/dL. I had also exercised a bit right after checking that number so not sure how much that impacts numbers.

Fasting levels have never exceeded 100 at home in the morning.

You sugars seem pretty close to normal.
Sweat has about the same glucose concentration as interstitial fluid. That’s the fluid that cgms test. So it’s not likely throwing off your finger stick if it’s a little wet.
If you want to get a clear picture of your glucose, I
Suggest you try a cgm like the LIBRE. You can just buy enough for a month. Pay out of pocket if your insurance won’t pay it.

It will give you some piece of mind.