OT: A1C (prediabetic-diabetic)

[carpediemracing]

So I was thrilled to see another high hematocrit number in my routine bloodwork (48.4%), which goes to illustrate that one can totally suck aerobically and still have symptoms of potential greatness.

However, what concerned me was the high level of A1C (sugar attached to hemoglobin). I've been Googling a bit but I'm wondering if someone has the Cliff Notes version of what I need to do.

What I know:
- My A1C was 6.5 % (considered diabetic). 5.7-6.4% considered pre diabetic, under 5.7% is normal. I fasted for about 12 hours before the blood was drawn but I really don't remember what I ate in the prior 24 hours.

- Glucose was 89. Apparently 90 is the high-water mark for normality and the example diabetic range I saw was 125-175.

- I've been trying to eat better, like oatmeal for breakfast (I have higher cholesterol). With a mostly carb breakfast (worst for pre diabetic) I'm woozy for a solid 4-5 hours, until I eat some protein or more carbs

- Today, first day after my shock learning, I ate a mostly protein breakfast and didn't feel that dizzy buzzy numbness around my forehead at all. I avoided significant carb intake and felt much better. I need to start logging foods so I get an idea of what I'm taking in.

So my questions:
- anyone go through this? what was the straightforward thing to do in terms of diet? Tricks/tips?
- is there a site with less complicated info than the few I tried to wade through?
- anyone with diabetes - is that dizzy buzzy numbness something you feel when things aren't right? It's like bonking but for hours.

Everywhere I looked today there were substantial carbs (I'm virtually home bound due to taking care of my dad). Breads, pastas, rices, jams, fruits, carb type veggies, snacks - birthday and holiday stuff, etc. I have to figure out how to realign my diet quickly.

Thanks in advance.

[mtb_frk]

Well, type 1 here for 18 years. My goal A1C is below 7, used to be 6.x now just over 7 last time I had it checked. There are charts online that relate that to average blood glucose levels. It's a long term test so it relates to averages, I have it done every 3 months. So what you ate the morning of the test really shouldn't cause it to be high.

How I feel:
When it's low, shaky, weak, can't think straight, cold sweats sometimes, numb mouth sometimes. Like the worst bonk ever.

High, harder to describe but increased urination, and feeling like muscles are going to cramp up.

Do you have any other of the classic symptoms? Frequent urination, thrist, blurry vision?

A 89 blood sugar level for me means it's time to eat something soon. Been as low as 30, not fun.

Go see your doctor, it's not something to put off.

[gasman]

Go see your doctor. Your fasting blood glucose was normal but A1C reflects your average blood glucose level over the last couple months. They may order a repeat A1C or they may order a glucose tolerance test-you arrive after fasting 8 hours then you drink a think glucose solution. You get your blood sugar monitored for the next 3 hours to see how your body handles the glucose load.
This is only one possible path though.
Make an appointment to see your doc and don't take advice on the Internet.

[ariw]

Type 1 here for 16 years, A1C is an average of the last 60-90 days blood glucose. 6.5 is worrisome, feel free to pm me and I will help in any way that I can

Ari

[ultraman6970]

The thing I would advice you is to find a doctor that actually does or understand cycling/cyclists too... many endocrinologists see 700 pounds couch potatoes that don't walk even to the restroom and they tend to threat you like one of those when in reality is other thing what is going on.

[nesteel]

Get a solid plan worked out now, with a competent doctor. Do not dilly dally with this. Say goodbye to sugars and carbs. Best favor you can do for yourself.
Three years out from type 2 diagnosis, and I still struggle. Worst of all is the knowledge I did it to myself because I did not take it seriously enough when they told me I was pre-diabetic.
That buzzy dizzy feeling is your blood sugar spiking. Address it now. With a doctor. Not us.

[aingeru]

https://www.drmcdougall.com/health/education/health-science/stars/stars-video/

[lzuk]

type 2- start by counting carbs and limiting to 150 grams per day and no more than 50 per meal. Try to do something physical everyday. See the doc but remember Doc's treat the symptoms not the root cause.

[buddybikes]

1. Research and schedule a GREAT endocrinologist, appts can be far out, but do now to get on their schedule. PM me if you are in the new england area
2. Have you been on any meds recently, especially steroids, steroid shots?
3. Buy glucose monitor. There are some new cheap. Walmart Relion or Freestyle Neo are 2/3 price of what most of us use. Use it daily and keep track.
4. Don't over react to the tests they do vary. My wife's hit 135, and she is non-diabetic. Stress to body can affect it. Just collect trends
5. Not sure of your age, but don't assume type 2, it could be nothing (stress to body), beginning of type 1, or even a variant - type 1 1/2. this is why a top notch diabetes specialist/endocrinologist is needed, they can they do testing to help identify. This will put on better treatment path.
6. Don't be scared of insulin, especially the long acting ones. Side effects with right dose probably less than pills
7. As with measuring sugar if you can also measure food input on average day, get a scale and measure. Do all not just carbs, as fats break down hours later into sugars (happened to me last night after pizza).
8. Personally, I would eat what you think is right for you for your exercise routine, then talk to doctors about it.
9. Google low-glycemic foods - these go in slower. For example a sweet potato goes in slower than a white potato.

[ariw]

Do not assume that you are becoming a type 2, you may be developing type 1 as an adult. I became type 1 at 25, and know a few other people who also became type 1 as adults. I was MIS diagnosed and Mis treated for a year before getting on the right track. Get an appointment with an endo ASAP.

Ari

[CNY rider]

I'm just curious.....how do you get a lab result like that without some information from your Doctor?
It's got to be scary to have that dropped in your lap. Why didn't the Doctor who ordered the test see you to discuss the meaning of it?

[malcolm]

Go see your doctor. Your fasting blood glucose was normal but A1C reflects your average blood glucose level over the last couple months. They may order a repeat A1C or they may order a glucose tolerance test-you arrive after fasting 8 hours then you drink a think glucose solution. You get your blood sugar monitored for the next 3 hours to see how your body handles the glucose load.
This is only one possible path though.
Make an appointment to see your doc and don't take advice on the Internet.

This. You don't need to be fasted for an A1c. Like gasman said it gives you an average of your blood sugar over the life of a red blood cell, typically around 120 days. Unless it's inordinately high a single fasted or non fasted blood sugar doesn't really provide much useful info, in general. The A1c is much more useful.

I'll add another see your doctor. I think the trend is becoming to start folks with high A1c but ok spot glucose on an oral agent usually metformin. I don[t think all primaries/internists are doing it at this point but it seems to be the trend. The though is you postpone full blown diabetes and potential complications.

I'll also add while it's not wrong to see an endocrinologist. It's really not the way to access health care. If you have an internist or family doc go see them first and discuss it with them and ask about an endocrine guy. In my experience it only a small number of diabetics that need endocrine management and good internist should be more than capable. So if you don't have a bunch of comorbidities or a really complicated case it just isn't necessary. If you are in a medium sized city it may be difficult to get an apt. with one as there may only be a handful in town and they will be covered up with the more complicated endocrine problems, consults as such.

[malcolm]

I'm just curious.....how do you get a lab result like that without some information from your Doctor?
It's got to be scary to have that dropped in your lap. Why didn't the Doctor who ordered the test see you to discuss the meaning of it?

Lots of independent labs are popping where if you are willing to pay out of pocket you can get virtually any test you want. A couple hours on google and a couple hundred dollars worth of lab negates the need for all those years of medical school and residency. I read most of the wiki page on string theory a few weeks ago and I'm fairly certain I'm now an astrophysicist.

This is not directed at the OP. Just answering a question and failing at being humorous.

[DfCas]

I was diagnosed 33 years ago type 1 at the age of 30.

I echo the see a doc comments but I'll explain the differences between 1 and 2 a little.

Type 1- the lack of insulin. Types 1 's always require insulin to live and will require it the rest of their life. Types 1's need a healthy balanced diet.

Type 2- usually have plenty of insulin (at least in the early stages) but the insulin receptors don't accept insulin very well or resist it. Exercise opens up the receptors and works like magic on type 2's. Type 2's may produce large amounts of insulin and may ultimately burn out their pancreas. Type 2's nee a healhy, balanced diet.

If you don't eat carbs your body will make them.

You cannot eat your way into or out of diabetes.

[numbskull]

You have mild glucose intolerance.
Your resting sugar is normal, but your glucose levels after eating are almost certainly a bit high and persist high for longer than normal (the glucose tolerance test would demonstrate this but is not likely to change management at this stage). Age and weight will likely worsen this over time, but right now it is mild.

Early treatment for this problem includes lifestyle changes and/or metformin. Both have evidence of benefit (based on decade old studies) although there is some recent evidence that the combination may not be ideal and metformin does have some impact on exercise physiology. (http://care.diabetesjournals.org/content/34/7/1469.full)

A second issue is your cholesterol. The finding of an elevated A1C predicts increased future cardiac risk. This lowers the threshold for cholesterol treatment and statin therapy is usually indicated. Statin therapy can, however, impact skeletal muscle strength (and possibly blunt response to training) although whether this occurs to some degree in most people or only in certain people remains an area of uncertainty.

If you were a couch potato this would be easier.....you'd get treated with statins and metformin. As an active cyclist you'll probably be happier if before you do anything with meds you:

Loose weight and increase your exercise frequency/duration if able
Adjust your diet
Recheck it (and your cholesterol) in 6 months

There is also the uncomfortable issue of the safety of racing in people with increased cardiac risk. Standard medical advice would be to exercise to more conservative peak workloads (i.e., not push yourself to your maximum).

[ariw]

You also need to get a c-peptide test, this will tell your doc whether you are pushing out a lot of insulin and possibly type 2, or if your insulin production has already started to wain.

Ari

[John H.]

Well, you should see a doc and get more tests as others have mentioned.
But if it is not type 1 or a genetic issue it should be largely controllable with dietary changes.
I noticed that in prior threads you made mention of weight gain and weight loss? Something in the way of 30 pounds or more.
Where do you stand with respect to weight right now?
I only ask this because weight gain often goes with a poor diet.
Seems like you need to go largely plant based and get the sugars and processed foods out of your diet?
Start a food log- Aps like my fitness pal are great.
Do a kitchen clean-up. Throw out anything that is processed, made with white flour, processed oils or sugar.
If you drink alcohol, stop. It is all empty calories.
You can make huge headway on this in 30 days-
Your goal should be not to need to take medication.

[yarg]

I am 55 and been type 1 for 3 years, and agree that with that level A1C you should be concerned. Unless you have a very good GP I would go to an endocrinologist. My GC thought for sure I was type 2 as I was fit and 52 years old. In the back of my mind I knew that could not be right as I had all the classic symptoms, pissing all the time, thirst, weight loss. I was diagnosed type 1 by endocrinologist. An endocrinologist will make the right diagnosis.

If you are type 1 and you actively manage glucose levels it ends up being a nuisance that you live with. My A1C is just above 5% and it has not affected my riding that much, again as long as you actively manage it.

Go to an endocrinologist.

[jimcav]

and let me preface this with your should indeed discuss this with your doctor

but also want to caution you to not let you OR your doctor fall into a trap of treating a lab number rather than you. what i mean is those "normal" values come from a sampling of the population and follow a normal distribution curve--which means you could be "abnormal pre diabetic" or you could be totally normal and your values are simply on the far end of the normal distribution

I once had an idiot doctor tell me i didn't have vitamin D deficiency because my number was 1 higher than that reference value--this was at a follow up appt for two vertebral compression fractures. so anyway, my point and advice is make sure you get proper evaluation and they treat you, not numbers

[carpediemracing]

Thanks everyone. I had a reply (one of my long ones) but then lost it at some point.

I happened to have just found my 1 year ago physical, A1C was 5.9%, glucose 77. Weight I think was 165? 170? I was in the middle of dieting, or maybe just starting.

Anyway, I got the blood test done as part of my physical, but the blood was drawn after my physical. That's why the blood test stuff just showed up.

My GP isn't very concerned as I gained weight quickly from about June 2015 to now (158 ish to 180 ish). He wants me to do whatever I did last year and then return in June 2016 for another test/check. I plan on a similar action plan but this time with less carbs.

In mid-June 2015 I started working at a place that might as well have been Willy Wonka's Chocolate Factory. I don't normally have sweets around but there it was basically unlimited, all day. Since we basically didn't break for meals I'd snack all day. Combined with my historically high carb diet (rice, pasta, breads).. Looking around the kitchen it's like a minefield now, all the carbs. I'm okay with it, can restrain myself pretty well if there's a reason, and now there's a reason.

Incidentally I basically don't drink alcohol. Maybe 4 or 5 drinks in 2015. (Doesn't mean I don't like it, but I am very allergic to wine which is my favorite alcohol, beer really doesn't appeal to me, and I generally don't drink much hard liquor at all). No steroid type drugs, no supplements like protein shakes or whatever. I don't even drink energy drink, just water in my bottles.

Not good with veggies, very good with fruit (unfortunately as it has a lot of carbs). For example I'd sometimes eat 1/3 of a box of the Clementines in a hour or two. Blackberries, blueberries, raspberries, apples

I also eat a lot of Junior's left overs. Carb heavy - PB&J sandwiches, various bread things (grill cheese, cheese quesadilla), ham or turkey sandwiches Even yogurt with honey (a favorite of his). Not very good for me.

One of my siblings is pre-diabetic. That's what scared me (and apparently I'm more likely to get diabetes based on race). I started Googling and got lost in details of blood testing and insulin and my mind started spinning. My sibling gave me some Cliff Notes stuff (45g carb max lunch and dinner, 15g carb for snacks, no fruit/milk early or late in day, fructose seems worse, etc.) Offered me a blood test gizmo.

The Missus is super supportive so that helps a lot. I have other challenges in my life but fortunately I can work with my diet a bit. I also do a walk every day after lunch (30-60 min, depending) and apparently that's good. Plus whatever rides I do (goal is 3x a week).

My recent extremely poor diet, the year prior's somewhat better blood work numbers, and my ability to reorganize my diet wholesale makes me think that I can work through this thing this time. It may return, of course, but now I'm much more aware.

I now recognize the symptoms of the dizziness/rush after eating too many carbs/sugar. It's not a good thing like I thought, it's a bad thing. This morning I had a virtually carb free breakfast. No dizziness, no bonking, no rush. Limited carbs to something like 150g for the day. I didn't log my food but I was hyper aware of everything I ate (no ketchup, 4g carb, etc).

[oldpotatoe]

Wife is pre diabetic, Rx metformin. A PA friend of mine said to get a Rx for it even tho I am not prediabetic, normal in that regard. Any thoughts? Sorry for the drift.

[CNY rider]

Wife is pre diabetic, Rx metformin. A PA friend of mine said to get a Rx for it even tho I am not prediabetic, normal in that regard. Any thoughts? Sorry for the drift.

I would say stick to being friends with the PA and stop getting off the cuff medical advice from him.

[oldpotatoe]

I would say stick to being friends with the PA and stop getting off the cuff medical advice from him.

He was referring to this..not necessarily 'off the cuff'.

http://www.medicalnewstoday.com/articles/280725.php

I'd talk to my very good GP before anything.

[malcolm]

He was referring to this..not necessarily 'off the cuff'.

http://www.medicalnewstoday.com/articles/280725.php

I'd talk to my very good GP before anything.

I didn't read the article OP but I'll give you my less than 2 cents. I've practiced for going on 30 years, emergency medicine so it almost doesn't really count, so huge grain of salt.

I'm not a fan of taking any medicine unless there is a clear benefit not a suggestion of a benefit. You'll see lots of things suggesting various drugs may extend life. Most recently metformin and statin drugs. Lots of folks including physicians think statins in low doses may increase longevity, likely due to anti-inflammatory effects. Some think ACE-I may also be beneficial.

Of course always have a doctor that you trust and will talk to you and if you are comfortable follow his advice if not get a second opinion and if you have a good doc he can recommend someone and shouldn't be offended by it. Or you can find it on your own.

In my mind for guys mine and your age you are already doing the most important things. Maintaining a healthy weight, staying active, and using your brain. If you have medical problems address them such as hypertension, thyroid issues, diabetes, but in my opinion and just my opinion don't look for a pill to manage what life style will likely take care of. Take them if you need them.

One last thing since I left the ER and work in a less hurried/frenzied environment I ask the older folks I see that are still vibrant and active in their 70s, 80s and 90s what they do and the answer is almost always the same. They have some sort of physical activity they do regularly it may be walking, gardening or going to the gym but something and they all are actively involved in life using their brains. You never hear any of them say they watch TV all day.

[oldpotatoe]

I didn't read the article OP but I'll give you my less than 2 cents. I've practiced for going on 30 years, emergency medicine so it almost doesn't really count, so huge grain of salt.

I'm not a fan of taking any medicine unless there is a clear benefit not a suggestion of a benefit. You'll see lots of things suggesting various drugs may extend life. Most recently metformin and statin drugs. Lots of folks including physicians think statins in low doses may increase longevity, likely due to anti-inflammatory effects. Some think ACE-I may also be beneficial.

Of course always have a doctor that you trust and will talk to you and if you are comfortable follow his advice if not get a second opinion and if you have a good doc he can recommend someone and shouldn't be offended by it. Or you can find it on your own.

In my mind for guys mine and your age you are already doing the most important things. Maintaining a healthy weight, staying active, and using your brain. If you have medical problems address them such as hypertension, thyroid issues, diabetes, but in my opinion and just my opinion don't look for a pill to manage what life style will likely take care of. Take them if you need them.

One last thing since I left the ER and work in a less hurried/frenzied environment I ask the older folks I see that are still vibrant and active in their 70s, 80s and 90s what they do and the answer is almost always the same. They have some sort of physical activity they do regularly it may be walking, gardening or going to the gym but something and they all are actively involved in life using their brains. You never hear any of them say they watch TV all day.

Great advice, thank you.

[oliver1850]

I also eat a lot of Junior's left overs. Carb heavy - PB&J sandwiches, various bread things (grill cheese, cheese quesadilla), ham or turkey sandwiches Even yogurt with honey (a favorite of his). Not very good for me.



I would urge you to start limiting Jr.'s carb intake too. He sounds like me, eating lots of sugar as a child, then graduating to lots of starch as an adult. In my 40s I would eat 3/4 lb. of raisin bread for breakfast, or a full batch of pancakes made with 12 oz. of flour and covered with syrup; two, sometimes three baked potatoes with dinner. I was 162 lbs and 6' when I suddenly stopped producing insulin. I don't know if studies have shown that it's possible to "burn out" your pancreas, perhaps someone will comment. For me it's been very hard to change my diet to the extent I should, as virtually everything I grew up liking is either high in carbs or cholesterol.