I am thin (5’7’’ and 130 pounds) 37 years old man. I was at higher normal range or borderline fasting glucose level for many years. My oldest record showed an 95 mg/L back in October 2009, and I also caught an after meal glucose of 139 mg/L in September 2009 (don’t know how long after meal though). From 2009 to 2017, my fasting glucose was anywhere from 84 to 102 (mostly around 90). I was always told “this is absolutely normal”. I got an read of 146 in March 2016 after meal (don’t remember how long after lunch) in a company wellness event. The physician asked me to discuss this with my primary doctor. I then lowered my carb intake and saw my doctor a week after. My doctor ordered HbA1C and the result showed 5.4%. I was told by my doctor that my glucose was completely normal. I backed to my old diet soon after.
I exercised almost daily from 2011 to early 2016, and then less often since may 2016. My body weight increased a little bit to about 140 pounds. I have been had a minor fat deposit on my liver since 2014. However, it was not significant enough to make a fatty liver diagnose.
I discovered an elevated fasting glucose of 106 mg/L in a routine blood work 4 weeks ago. I then ordered a Bayer Contour Next glucose meter and tested my glucose very often. I got my highest fasting read of 113 mg/L after a few days. While my fasting glucose is around borderline of 100, my biggest problem is after meal glucose spikes. I am very sensitive to high carbohydrate foods. A small bowl of brown rice with plenty of veggie and meat sends my one hour glucose over 170. I’ve never tested my old diet which I eat a large bowl of white rice, mashed potato or noodles. I guess it’s over 200 for sure. I used to eat lots of fruit after meal. My refrigerator was stocked with tons of oranges, kiwi grape and watermelon all year round. I didn’t realize they were toxic to me until the recent high glucose test result drived me to learn more about diabetes.
I lowered my carb intake significantly in the last 4 weeks. I completely eliminated high GI carb foods from my diet. I only eat beans and small amounts of brown rice occasionally. I increased my exercise intensity a lot. I now exercise every night. Mostly combining HIIT, strength training and stretch from 30 to 60 minutes. My fasting glucose can be reduced by about 10 mg/L if I exercise the night before and eat less carb for dinner. My fasting glucose is range from 83 to 93 in the last a few weeks after my lifestyle change. However, I find moderate amount of ketones in my urine (15 to 40 mg/L). In the last a few days I increased my carb intake a little bit. I consume about 100g to 150g carb from beans and fruits. But my kento is still at lower amount presence (about 15 mg/L).
I recently learned that there’s another type of diabetes called type 1.5 or LADA. The facts that I am thin and have hypothyroidism make me believe I well fit into this category. I went to see my primary doctor and asked for testing for c-peptide, insulin and GAD antibody. I just got my results from my doctor. The c-peptide and insulin again at borderline lower normal range. Fasting C-peptide is 1.2 ng/mL (reference value 1.1-4.4), fasting insulin 3 uIU/mL (reference value 2-27). My GAD antibody is <5.0 unit/mL (reference value <5.1). I also tested for Addison’s Disease. My Cortisol AM is 16.71 ug/dL (reference range 5.00 - 25.00). My last HbA1C test showed 5.3%. My primary doctor told me that I don’t have diabetes. However, I still think my insulin production is impaired as the insulin and c-peptide are at borderline normal value.
A very high fiber meal can mitigate the altitude of spikes, but increased the longitude a lot. My blood glucose can be at 125 after 3 hours if I eat fair amount of black beans and brown rice with some fat and protein. My fasting glucose can still reach high 90s even with limited carb intake and intensive exercise. My problem the current tests doesn’t justify a diabetes diagnosis, while I personally believe that I am developing LADA.
What can I do at this time? Any suggestion will be appreciated!!!
It sounds like you got an early warning for LADA. The only thing you can do is be ready to start insulin therapy. You might prolong your production of insulin by using rDNA insulin when you lose enough production to need it. There is no way to STOP what’s happening, unfortunately. But knowing may help you to accept it sooner.
@Timbeak48 Thank you for the comment. That’s what I think as well. I don’t know how long has my glucose been impaired. I guess it might be at least 8 years since 2009. I am afraid that another 8 years of this uncontrolled spikes can trigger complications. Should I start insulin sooner?
Your story sounds just like mine. I’m pre-diabetic and I’m currently on a meal-time insulin. I’m quite skinny too (BMI 18) and have so far tested negative on all the antibody tests.
Consistent fasting glucose of > 95 definitely fits the definition of pre-diabetes. My glucose for a few years was flucutating between 95 and 105. My doctor after seeing the trend had me test a1c and also ordered a glucose tolerance test which both resulted in pre-diabetes numbers (a1c of 6.2%, 2hr post at 160). I was immediately told to exercise and reduce my carb intake and I was referred to a pre-diabetes education class. At the time I was not prescribed any medication. Since improving my diet and exercising more, my fasting glucose is lower than before, currently in the 80’s. But I still see a big spike in bs after a meal. Because of the spike, I’m on insulin now. This is also because I’m currently pregnant and I need a certain amount of carbohydrate in my diet but must also tightly control bs levels (< 130 for 1hr post meal). Otherwise my doctor probably would have told me to just stay on the low carb diet and exercise regularly.
Oh, how much carb do you eat per meal? I was told to keep my carbs between 30-45 g per meal when I was first diagnosed as prediabetic. You might want to start measuring your glucose levels more frequently to see how much you can tolerate. You should eat enough carbs to keep your 2hr post meal number below 140.
Hi @Viennetta. It’s very frustrating to dealing with this prolonged uncertainty. Glad you have find good ways take your blood sugar under control now. Seems this is not a typical pre-diabetes though. I’ve seen people who are overweight and pre-diabetes can very easily reversed with weight loss and better diet. I feel it’s difficult to me. I don’t have much to lose and exercise helped a little on fasting glucose but not spikes
It highly depends on what kind of carb I eat. I find black beans are best carb for me. I can eat a half can of black beans, it’s about 70g of carb (125 after 2 hrs). However, a cup of non-fat yogurt with 12g of sugar can send my one hour blood sugar to 150. I tried a small sweet potato with lots of veggies and some meat. My one hour BS was 170. I must mix fat and protein with carb. My dietitian asked me to eat about 45g carb every meal. I have to be creative to prepare meals with limited carb options. I find I can tolerate fruits better than stach. I now add a little more fruits. I tested a lot these days to find the pattern of how I react to foods.
Do you walk after your meal? You should go on a walk 15 min after your meal. 15-20 minutes will do. I walk 20+ minutes after lunch and 40 min after dinner and the walk does wonders for my bs.
You must take into account the protein. If you balance protein with carb it prevents spikes. There is enough protein in black beans to help the carb release more slowly into your system preventing spikes. However, there is NOT enough protein in most fruit yogurts to do the same, so you will tend to spike.
The key is to mix protein and carb together to prevent spikes. We do this a family, even the non-D folks as it is not an unhealthy thing to do… you shouldn’t be afraid of carb, just understanding and learning what works will help you understand your body better. I can’t to this day do pasta, doesn’t matter what protein I have, it just spikes me like crazy.
Learning by reading books helps, Think like a Pancreas is good reading you can understand simple vs complex carbs.
Thanks for this tip. I am glad you find that helpful. I didn’t try after every meal, but I generally work out every night about one hour after dinner. It does help me lower my blood sugar after meals. I can even get a few scores lower on my next fasting level. I will definitely try walking after lunch to see if it helps. Thanks you very much for this information.
Yeah, I’ve learned a lot on how different food combinations act on me in the last a few weeks. However, I still feel I could do better. However, I sometimes feel very frustrating as everything is at borderline. Without a clear diagnose, I don’t have enough tool and skills to deal with the higher levels of my glucose.
I am reading Dr Bernstein book. Tried to lower my total carb intake. I lost about 10 pounds very quickly. It did help me a little bit on blood sugar. I lowered my fasting BS to 80s. And the spikes are a lot smoother. However, my doctors warned me that it’s dangerous. I may lose muscles. I can also detect moderate ketones in my urine.
I increased a little bit carb intake in the last a few days. I find my fasting glucose back to lower 90s (92-93). I split my meals, use beans and smaller amount of fruits with fat and protein. It helped on spikes. However, they are way far from ideal levels. I am wondering if I should push my doctor to make a clear diagnose to get insulin to help me on spikes. I am highly believe I am a case of slow onset of LADA because there are so many factors that matches (thin, thyroid problem, lower level of c-peptide and insulin). I heard that insulin might help on preserving beta cells. Wondering if it can help both on my BS management and preserving pancreas function. I guess my primary doctor might consider me crazy though. She is still believe I am not diabetic. She doesn’t even worry about my spikes. Should I get a referral to an endocrinologist?
I would certainly get an endo on board. Remember the A1C is an AVERAGE… In my case the number is currently quite low because when you average 60 with 200 you get an acceptable level of 130 … fact is neither is really acceptable… Also with all of your other auto-immune wonder if anemia comes into the picture, it too can mess with the A1C … I AM speaking from experience on both sides here…
This is an important point and one too often overlooked. It is indeed an average, and an average, by definition, conceals the peaks and valleys. Those peak and valleys are terribly important where BG is concerned, and the A1c masks them pretty thoroughly. Some of the post-meal spikes you listed suggest that there could indeed be more here than meets the eye.
Disclaimer: I am a pro-insulin bigot. I limped along for years as a T2 with mediocre control before I finally decided to get serious and learn everything I could about how to tame this beast. It wasn’t long before I figured out that insulin was the only thing that would give me the sort of rigorous control I sought. I bought some syringes and some R insulin (both of which are available without a prescription where I live), started pre-bolusing for meals, marched into my doctor’s office, told him what I was doing, and asked for prescriptions.
Insulin is far and away the most powerful tool in the arsenal. It’s a two edged sword, but most things with real power are. With education, experience, and proper respect, it can be a total game changer. Though it’s not standard practice (yet), it’s becoming more common to prescribe it even for early cases of T2, if only on a temporary basis to stabilize things before embarking on a more long-term strategy for control.
All that said, I’m a believer. If you have a choice of tools, why not use the most effective one there is? So in answer to the question: that’s a strictly individual choice that everyone must weigh and determine for themselves, preferably with the advice and involvement of an up-to-date medical team. But I certainly would not rule it out as an option.
Hi David, thank you very much for your kindly suggestions. Just a few weeks ago, I still had the impression that insulin was a dangerous drug for anyone. However, after I learned more knowledge about diabetes and my poor control of after meal blood sugar. I start to believe insulin may help me eventually. I have had higher “normal” fasting blood sugar levels for at 8 years. My after meal spikes currently scare me. I am not sure how long this problem has been with me. At least I have a 139 mg/L after meal reading back to 2009. Although I don’t have any sign of complications now, I am afraid of developing it after extended prolonged after meal spikes. The problem is that my current lab results doesn’t support any type of diabetes diagnose, they are all at borderline normals. My doctor’s diagnose currently is “elevated blood glucose”, not even pre-diabetes. I don’t understand why my doctors are ignoring my spikes while every information available online suggests that it’s a problem!
LOL. Your response (or rather, your doctor’s response) managed to push another of my hot buttons.
Numbers like 139, 146 and 170 are not the work of a normal, happy pancreas. IMHOP there is no such thing as “pre diabetes”. Being “partially” or “almost” diabetic is in the same class with being a little bit pregnant. Either your body can control its blood sugar without outside help, or it can’t. Binary choice. Black and white. “Pre diabetic” is a semantic cop-out and an oft-used excuse for not taking the condition seriously, or waiting until it gets worse. Talk about a self-fulfilling prophecy!
I suspect that most doctors are hesitant to prescribe insulin as it takes paying attention, analyzing the results, and making adjustments. Personal motivation is a big deal, here. Effective insulin dosing is as much an art as it is a science and it takes a lot of practice to get good at it.
Now with the advent of closed loop systems, I think the science will eventually overpower the art aspect but it will make our lives easier.
The reasons behind doctors’ hesitation are pretty well documented. Yet another reason why it’s imperative for patients to educate themselves and take control their own destinies.
I have had the same exact experience. Normal fasting, normal A1c but high post meals. Couldn’t get a diagnosis either but I decided to put myself on a very low carb diet and lots of exercise. I have a very tight control so impossible to get a diagnosis now. But I am feeling much better and knowing that I am delaying the inevitable helps me stick to my routine on most days. In the last few months, I noticed that my fasting glucose increased by about 10 points. So I suppose sooner or later the tests will catch up with the reality of what I already know. In the meantime, I decided to stop wasting my energy trying to get a diagnosis and be happy that I have managed to do a good enough of a job to feel better and keep my numbers low enough so I am still undetected.
I am 64 years old. Normal hgA1c. Diagnosed nearly 2 years ago with LADA. All I do is a ketogenic diet, and check my blood sugar once a day (postprandial…always under 100). I’ve lost 80 pounds, near goal weight now. Got very sick with C Diff this summer. Had Fecal Microbiome Transplant and feel pretty well now. See my endo next week for a six month checkup. I know I’m still in the honeymoon period and want to do everything possible to stay here until I die!!! I won’t be a happy insulin dendent person, I can tell you that - but if it’s my fate, I’ll do my best!! Thanking God for blessings!!
