Pre-Diabetes is not Destiny ... Part 2

I have a frankly terrible family history of diabetes.  The Matriarch's side of the family is riddled with it, and recently the Patriarch was diagnosed as diabetic as well.  All the cases in my family involve Type II diabetes, not always weight related (but often weight related).

A couple of years ago I was worried about my eyes and paranoid that I might have been experiencing optical changes associated with uncontrolled Type II diabetes, and I purchased a portable blood sugar test kit.  In fact, I was experiencing what is known as "old glasses prescription", and as soon as my vision went back to normal I put the test away in my desk.

Coward that I am, it took me almost a year to actually crack open the kit and test my fasting blood sugar.  I knew that if the numbers were in the diabetic range, I would have to adopt some pretty severe lifestyle changes over and above all the things I was already doing.  If the numbers came back in the pre-diabetic range, that was not good either, because it would be a huge red flag telling me that my lifestyle change was no longer optional.

Of course, anyone who has read this blog knows that the test came back in the pre-diabetic range. 

As you can see, that first month I did not have any normal readings, and my highest reading at 6.8 mmol/L was only a cream-filled donut away from the 7.0 mmol/L that is the threshold of diabetes.  As it was, the average fasting blood sugar of 6.3 mmol/L was much higher than I was personally comfortable with. Cue the pouting and petulant whining on my part before I decided to suck it up and look at what I could do to reduce my fasting blood sugar numbers.

It turns out that everything I was doing - - watching calories, reducing alcohol consumption, being carb-aware, exercising and losing weight - - are all things that help reduce blood sugar.  I was already doing all the right things, I just needed to keep doing them over and over again, repeated forever.

And my hard work paid off.  Sure, there were hiccups along the way, but since last July as I have lost 81.4 pounds, I have also lost 0.9 points of blood sugar.

In fact, this month I had normal average fasting blood sugar. (!!!)  Cue the sounds of angels singing.  Yes, I still had elevated results during the month, but my highest reading this month was 5.9, a far cry from 6.8 from when I started.  More than 63% of my readings were normal, in fact, and I even had a couple of readings in the 4s. 

This is such a major, huge, massive big deal.  For one thing, it shows me that pre-diabetes is a red flag, but it does not mean that I will inevitably get Type II diabetes.  Yes, my family history is a nightmare, but I know about it and know what to watch for.  I started taking control over my diabetic destiny last January when I began working out, and I'm not going to stop any time soon.

Another thing that is a big deal is the fact that on average, my fasting sugars were normal this month, without the need for medication or draconian lifestyle changes.  By exercising regularly and being aware of what I am consuming, I have improved my lifestyle to the point where my blood sugar is naturally declining. 

I still believe that being pre-diabetic is a little bit like being an alcoholic - - you are never not an alcoholic, you are just an alcoholic who has not had a drink in a while.  In my case, no matter what my sugars are, I will always be a pre-diabetic by dint of my family history - - but I will be a pre-diabetic with normal blood sugar, so help me god. 

I will keep sticking to my plan and hopefully next month will be even better.  My objective now is to try and string along 3 consecutive months of average fasting blood sugar.  Part 1 is done - - I've got one month in the bag.  Let's hope next month is as good. 

Yipee Ki-Yay M----- F------!

I have now lost 98 pounds, which is the same weight as the "98 pound weakling" featured in the old Charles Atlas advertisements in the back of comic books.  I have now lost as much weight as an official person.  Sure, a tiny person, but a person nonetheless.

With this loss, I am pleased to report that I am officially back on track after our little Italian visit and scale calibration induced deviation from the plan last week.  I am feeling a little saucy today because I not only got back to my two-weeks ago low, I managed to lose a bit more, erasing last week like it never happened.  And we shall never speak of it again. [grin]

The lesson I learned from all this is that consistency is critical - - staying on track with my eating and plowing through my exercise 6 days a week even when I had gone up meant that my gain last week was just a blip, nothing more.  And we all have blips - - much as I would like to see it happen, no one's weight loss path is perfectly linear in only a downward direction.  Everyone gains occasionally, and we all plateau from time to time. 

The important thing is not how you got there when the scale shows you something you don't want to see, it's what you do.  Do you give up and start binge eating again on the premise that you gained anyways, what's a little "cheat day"?  Do you stop exercising because it's too hard to do if it's not going to pay any dividends?  The correct answer is "No", because you can't let minor blips get the better of you.  Because then they turn into major problems, rather than minor blips.  And it's much more difficult to fix a major problem, I will tell you right now.  The way to succeed is to keep consistently working your plan, even in the face of adversity or minor setbacks.  As the wise people over at Tristar Gym say, "If you're tired of starting over, stop giving up". 

I have to admit that this week the news that the Patriarch was diagnosed with Type II diabetes threw me for a bit of a loop.  On sober reflection after I let all the emotion drain away, I think it's because "there but for the grace of god goes I" - - he and I are so similar attitudinally, emotionally, and physically, that it's as if I am looking in a mirror.  A mirror that knew he was pre-diabetic last year and did nothing.  I discovered I was pre-diabetic last year as well - - maybe even around the same time - - but the big difference is that I took it as the wake up call that it was, and motivation to keep on my eating plan and exercise regimen.  

I suppose what really threw me and made me feel just a little sorry for myself is the realization that if I stop working out and stop eating well, I will absolutely become diabetic.  With my family history, and with the Patriarch's demonstration of the progression from pre-diabetes to Type II diabetes, there's simply no other conclusion that I could draw.  And before, I suppose in the back of my dinosaur brain I had thought that I would not become diabetic, simply because my mother (and her entire family) was diabetic.  I thought that I could live as I wished, and diabetes would be something for other people.  But now I have to face the fact that if I do nothing, I will (much more likely than not) also get Type II diabetes.

That is not to say that it is inevitable that I will become diabetic, on my current path - - just the opposite, in fact.  I am losing weight more or less consistently (ahem) each week (recent blips excluded), and have significantly improved my eating habits, both in terms of quality and quantity.  I do 55-60 minutes of cardio exercise 6 days a week, and weights 3 days a week for a further 30 minutes each day.  My resting heart rate was 47 the last time I checked, and my blood pressure was 115/61.  I have lost 98 pounds, or more than 29% of my starting body weight.  All of these things are positive, and you can see the results in my fasting blood sugar numbers, which have declined from the mid-high 6s to 5.7 mmol/L.  Given more time, and more weight loss, I expect to see those sugars decline still further.  Eventually, I will have enough normal readings that I no longer qualify as pre-diabetic. 

I just wish wasn't so clear what my path could be.  I would like to pretend that I have some choice in the matter, you know?  I would like to think that I would still be working out every day and eating well just because it's the right thing to do, not merely because I have a significant looming health issue I am trying to avoid.  I suppose anyone who has ever experienced a lifestyle-related health issue (heart attack, high blood pressure, knee and back issues) is in the same boat. 

Next week will be better, as I will have processed all of this diagnosis-related angst, and will be back in my normal routine. 

Biology is not destiny

I got a disturbing telephone call today that I am, frankly, still processing.  It was my father (who I will dub "the Patriarch" for the purposes of this blog), telling me that he had recently been diagnosed with Type II diabetes, with a blood sugar of 9 mmol/L (normal is up to 5.5 mmol/L). 

Not only that, but he had been diagnosed with pre-diabetes last year, and told that if he did not lose weight and change his diet, he would be at high risk to get - wait for it - Type II diabetes.  It doesn't take a rocket scientist to guess which lifestyle he chose.

Now those of you who read this blog know that I do not have diabetes myself, but I still test my fasting blood sugar every morning because the Matriarch and virtually everyone on my mother's side of the family is a Type II diabetic.  With them it's not necessarily weight related, either, as my mother was diagnosed as a diabetic when she weighed 115 pounds (she's 5'2"). 

With a family history like mine, it was almost inevitable that I would be at a high risk of getting diabetes, and sure enough, when I first tested myself last July, the numbers were high.  Not high enough to be in the diabetic, thank god, but high enough to put me in the pre-diabetic range.  Since the treatment for pre-diabetes is simply to lose weight and reduce carbs, I was already doing exactly what I needed to do.  Still, I regarded those fasting blood sugar readings as a wake up call, and extra reinforcement (if I ever needed any) that I had to stay on my program of working out 6 days a week and eating healthy every day.

This news from the Patriarch has, I confess, thrown me for a loop.  I knew the Matriarch's family history was dismal, but I always assumed, down deep in my heart, that the Patriarch's side of the family would keep me relatively healthy.  And to a degree, this is the case.  Where my mother's family has a history of high blood pressure, I have normal blood pressure.  Where my mother's family has high cholesterol, I have always had normal cholesterol.  These are gifts from my father's side of the family, and I have appreciated them - - especially when I see what my mom goes through with her health issues.

But now, both sides of my family history have Type II diabetes.  I suddenly went from a high risk to a stupidly high risk.  It's almost as if my family is trying to kill me, at least endochrinologically (which I know is not a word). 

The ray of hope in my future is the fact that, unlike the Patriarch, I took the pre-diabetes warning to heart, and worked at changing my lifestyle.  Where he did not exercise, I regularly exercise, at a high intensity.  Where he drinks Coke and eats potato chips, I drink tea and water and eat almonds and low fat cheese and vegetables and fish. 

And my efforts have been paying off, slowly but surely.  My sugars back in July were averaging 6.3 mmol/L (where 7.0 or greater is diabetic).  Last month they were averaging 5.7 mmol/L - - almost in the normal range.  This month is a little hinky, but then, so was October (I suspect this is not the smooth linear improvement I would hope for, but rather a herky-jerky decrease in fits and starts).  As long as the overall trends are in the right direction, and I am continuing to get at least some normal readings each month, I'm happy. 

I am still obese (Class I), so it's natural that my sugars would still be elevated.  Eventually, however, I am going to get to be 'merely' overweight, and within 35 pounds of my goal - - I think we'll see a step-change improvement in the numbers at that point.

For now, however, I need to be confident that just because both my father and my mother have Type II diabetes (<gnashes teeth>), it doesn't mean that I will inevitably get diabetes.  Sure, I think we can all agree that if I stopped working out and went back to my old eating habits, I would be certain to get diabetes sooner rather than later.  But as it stands now, with my diet and active lifestyle, I just don't see my future as written in stone like that.  I think the future - - at least as regards to diabetes - - is mine to write, and I want to write a story that involves normal fasting blood sugar levels.  It's a matter of time, but I know I can get there, family history be damned.

No more Obese Class III, but troubling blood sugars...

First, for the win.  Today when I weighed myself and the scale showed 270.2, which gives me a BMI of 39.9.  This is significant because it moves me from Obese Class III to merely Obese Class II (at least according to the Government of Canada).  In other words, I have gone from an "extremely high" risk of developing health problems, to a "very high" risk of developing health problems.  I don't think anyone has ever been so happy to have a "very high" risk of developing health problems!

This is a wonderful milestone, especially considering that when I started working out, my BMI was a whopping 49.3.  And it only took 8 months of working out 5-7 times per week!  Ha!  It has taken 8 months of diligent effort, but that effort is clearly paying dividends, so there.

I am giddy with excitement.  Hitting 270 pounds is my next weight loss target, and I am within spitting distance of hitting it.  This weigh-in does not officially count, of course, because I only log my Friday weights, but I hope to keep the numbers in this 270 pound range and not lose too much ground by the end of the week.

I am particularly happy because this result came after Thanksgiving meal at my parents' place.  I was diligent about planning ahead and sticking to my food plan, logging everything.  I still had cake (2 birthday cakes) and pie (pumpkin, natch), as well as stuffing, mashed potatoes, gravy and turkey, but I had much smaller portions than I ever have had in previous years.  And no seconds for me.  For the first time that I can remember, I was the adult with the least food on my plate. 

On the good side, I was not depriving myself, because I got to eat everything that was served.  On the down side, I did feel like I had to exert iron-willed self-discipline, because it turns out that what I was used to eating at Thanksgiving dinner was nowhere near a portion.  More like 3 or 4 portions.  Of everything.  Plus seconds.  Changing that pattern is still work for me, but it appears that I was successful this year, at least.  Yay for that.

Photo courtesy Graham Colm, licensed CC-BY-SA

On the troubling side, my fasting blood sugar numbers have been running higher this past week than they were last month, to the point where this morning's test had a result of 6.7 mmol/L (where normal is 5.5 and diabetic is 7.0).  (With the exception of Thanksgiving), I am not doing anything from a consumption point of view that is different than before, so I am at a loss to explain why the numbers have been creeping up last week.

I am particularly concerned because the risk of pre-diabetes progressing to full-blown diabetes is supposed to be significantly reduced if you lose 15% of your body weight, which for me is right around 270 pounds, i.e., where I am today. 

I think that today's higher blood sugar readings can perhaps be explained by the astonishing number of carbs consumed yesterday, what with the 2 cakes, 1 pie, and all the other high carb and high sugar foods I was consuming yesterday.  Looking back at my food diary for yesterday I can see that my carbs were 225g, which is about 25g - 40g higher than usual, so today's reading is likely predictable. 

But the Nerd and I have been eating healthy foods this month, as we have been doing for months, and I am not indulging in cakes and pies on a daily basis. 

I am probably just being alarmist, and this is a minor uptick in an overall downward trend line.  With my food consumption and exercise habits, the weight is continuing to come off pretty consistently, and over time, the risk for diabetes will similarly decline.  But it's still something that I will keep watching, because knowledge is power, and you can't address a problem of which you are unaware.

Is "Pre-Diabetes" like being "a little bit pregnant"?

Photo courtesy CollegeDegrees360, licensed CC-BY-SA

I was talking to my mother on the weekend at our regular coffee/shopping trip, and she said: "Pre-diabetes doesn't exist.  You're either diabetic, or you're not.  If you're numbers are over 6, you're diabetic."  She said it with conviction, too.

Two things to note here.  1. My mother is an insulin-dependent type 2 diabetic.  Her strong convictions come from experience.  2. My mother does not know I have fasting blood sugar levels that are higher than "normal" but less than "diabetic". Would it have changed her position if she had known?  Who knows?  She's stubborn, so I will say that the knowledge likely would not have changed her viewpoint.  She's funny that way, sticking to her guns when she thinks she's right.

In the "pre-diabetes exists" camp is the preeminent peer-reviewed medical journal, the New England Journal of Medicine.  In its August 9, 2012 edition [citation: N Engl J Med 2012; 367:542-550], Dr. Silvio Inzucchi writes:

"Type 2 diabetes is preceded by a lengthy asymptomatic stage, termed prediabetes, which is characterized by mild hyperglycemia, insulin resistance, and early decrements in insulin secretory capacity."

Given the fact that the NEJM has published an article about diagnosing diabetes that directly refers to pre-diabetes as an actual thing, presumably the leading medical establishment (not to mention the CDA and ADA) hold fast to the idea that there is a grey zone between "normal" blood sugar and a level of high blood sugar that is symptomatic of diabetes.  This grey zone is pre-diabetes.  My mom, unlike Dr. Inzucchi, has not had her opinion that pre-diabetes does not exist published in a peer-review journal.  I will have to defer to the experts, while respectfully allowing my mother to believe what she likes. 

I am able to be convinced of the existence of pre-diabetes if only for the fact that if any elevated blood sugar level meant that you are diabetic, the cutoff levels would be different.  If normal is 5.5, a diabetic would have sugars at 5.6, not 7.0, which is the current accepted level.

Compounding my frustration and uncertainty is the fact that sources do not agree.  I am frankly surprised that almost 100 years after Banting and Best discovered insulin, the medical establishment does not definitively know how to cure diabetes, or even how to define diabetes. 

I suppose the question for little miss hyperglycemic over here is: "what would I do differently if I were a type 2 diabetic, as compared to a person with pre-diabetes and a terrible family history"?  The answer is: "Nothing". 

The CDC says that healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.  Further, lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58% during a 3-year period in one large prevention study.

Anyone who has looked at my food diary could tell you that, thanks to the Nerd, I am well on the way to eating healthy, every day.  As for physical activity, I work out for 40 minutes on the elliptical machine, 6 days a week, and I go for incremental walks at least twice a week.  I walk to and from work.  With my job and the hours it demands, it is difficult for me to be any more physically active (although I am certain I will find a way, with time).  I also test my fasting blood sugar every morning, so I know exactly where I stand.

I am doing all the right things.  I just get frustrated that doing all the right things is not resulting in instant reductions of my blood sugar levels.  I guess the biggest problem for me is that changes in my blood sugar levels are so gradual, and intermittent, compared to my weight loss, which is more predictable. 

Lifestyle change takes time to kick in.  I just hope I have time for it to kick in before I kick over to being a full-blown diabetic.

Busy week!

Another week in the books, and another 6 days worked out.  From Sunday to Friday morning I spent 30 minutes on the elliptical each day, tracking my heart rate zones with the DigiFit app and pacing my intervals using the Lolo Beatburn app. 

Past three week weight history

The net result is another 1.1 pounds lost, for a total of 39.7 pounds lost overall, along with many inches.  I am feeling generally pretty good (more so when I lose weight, because of the positive reinforcement), and find that I am ever so slowly becoming more active.  For example, I am just as likely to walk to work as I am to take the streetcar, which is a huge step forward from a mere 27 weeks ago when even walking to the corner would have me puffing and clutching my back in agony.  Heck, even walking a block and a half was difficult, and when you are that physically limited, your world gets very small indeed.

I have been very impressed with yet another new app - TactioHealth.Yes, yes, I know I have a lot of fitness apps.  But in my defence, I am constantly whittling down the assortment to a core set of apps I use every day.  TactioHealth is one of them.

In brief, TactioHealth provides you with a snapshot of your general health, using figures you either input manually, or electronically (for example, it talks to my Withings blood pressure monitor, Withings electronic scale, and Fitbit Ultra tracker).  Its main screen is a user-friendly dashboard with a snapshot of where you stand - weight, blood pressure, body mass index, resting pulse, body fat, waist measurement, cholesterol, and fasting glucose.  Based on the numbers, it will give you colour coded warnings - red for high, orange for warning, and green for OK. The image on the left shows a sample dashboard - trust me when I say that it is not mine, because mine has a heck of a lot more red on it. 

This app is full of information in the pull down buttons, and everything can be explored for more detailed views.  I like the big picture that this app provides me, with all my info at a glance. 

On the good side, or bad side, depending on how you look at it, this app has motivated me to test my fasting glucose.  There's a convenient button for tracking it and everything, assuming, of course, that you have a glucose testing kit.  I have a history of diabetes in my family (mother, uncle, aunt), as well as a history of high blood pressure, strokes and heart attacks.  And cancer.  Let's not forget all the cancer. 

Assuming for the moment that I cannot do anything about cancer that I am not already doing, I can be aware of some of those other red flags.  For example, I am very happy to know that I do not have high blood pressure, unlike many others in my family.  This eliminates one risk factor for heart attack and stroke.  Yes, yes, I am still morbidly obese - - a term that did not get its name because it was good for you - - but I am working on that.  If I keep working out as I am and eating healthy, I will eventually only be "obese", and then the world is my oyster!  A delicious, delicious oyster.

Back on topic, I picked up a blood sugar analyzer last year during a minor health scare.  I never used it at the time, but suddenly I felt motivated to try it this week.  I have to confess that I have always been afraid to test my sugars, because as an overweight woman with my family history, the results were likely to come back terribly high. 

I finally bit the bullet and tested myself this week.  First off, I was incredibly inept at working the testing unit and strips my first time out.  I couldn't even get a damn blood drop the first dozen or so tries.  I know I retain water, but that's a little nuts.  After adjusting the puncture depth and wasting one test strip (a costly mistake, as these things cost about a dollar a pop), I was finally able to get a number:  6.2 mmol/L.  The numbers were not good, but not as bad as they could have been. 

The normal range is 3.89 to 5.55 ish, depending on the scale you use.  A range of 5.55 to 7.0 is "pre-diabetes", which means that I am officially at an elevated risk for diabetes.  Not that I didn't really know that, what with my weight and family history, but it's a little scary seeing it spelled out so clearly.  Anything higher than 7.0 as a fasting glucose level is official, full blown diabetes.  Wilfred Brimley level diabetes.  Paula Deen level diabetes.  Delta Burke level diabetes.  You get the picture. 

The bad news is that I am at an elevated risk of the big D.  The good news is that I am already doing exactly the things I am supposed to do to reduce the risk - exercising 30 minutes a day at least 5 days a week, eating healthy, and drinking lots of water.  I have already lost around 11% of my original body weight, which apparently reduces your risk of progressing to full blown diabetes significantly.  Obviously, there's still an awful lot more weight I can lose.

The next step will be to look at some diabetes cookbooks and see what other changes I need to make to my diet to really help reduce the risk of progressing into full blown diabetes. 

I have to admit that it is pretty depressing to have lost the amount of weight I have, and to have made all the positive changes in my lifestyle, to still be pre-diabetic.  Perhaps I am looking at this the wrong way, though - - I am pre-diabetic now - maybe last year my fasting glucose numbers would have qualified me to be a full blown diabetic, and these figures represent a huge improvement. 

Regardless of the view I take (the glass of diabetes is half full, or half empty), I need to be aware of the reality of these numbers and what they mean.  I need to make even more lifestyle changes to ensure that I am doing what I can to control my sugar levels, and to keep from moving into full blown diabetes.