Are you or I pre diabetic?

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I ordered some olive leaves to give them a try 

[3NUMBAS]

A ‘hidden health crisis’ in the UK is now 'affecting 12 million Brits'

 

https://www.manchestereveningnews.co.uk/news/health/hidden-health-crisis-uk-now-30945964.amp
 

A worrying one in five adults are thought to be living with high blood sugar levels, with millions completely unaware of it

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It crept up on me, undiagnosed until I needed an abcess drained. HbA1c was 88 mmol/mol, so full blown T2.

 

The latest thinking is that for many T2D is caused by about half a gram on the pancreas, which is of little comfort, because currently you can't just get rid of that 0.5g.

 

The approach to remission is through rapid weight loss; everym fat or skinny, has to lose 15kg quickly (8-12 weeks), usually on 800kcal a day. That's a tough ask for many people. The rapid loss promotes loss of fat around the liver and pancreas before anything else. BMI is not much use as an indicator. The original research derives from the 1950s, when preparing patients for bariatric surgery; these patients are very overweight, and typically have to fast before surgery. The fasting doesn't make them skinny, but it triggers some physiological changes.

 

Islets of Langerhans cells in the pancreas produce insulin. The thinking is fat basically kills these cells off, which is why T2D was considered a chronic, lifelong condition. But trials seem to point to, for those who can lose the weight quick, the pancreas cells being able to regenerate, and differentiate, as long as its not more than 6-7 years since diagnosis. Its uncertain if that means its bck to normal, or if you will be forever watching what you can eat. Some of the rsearchers refer to reversing T1D, but overall, they are preferring the term remission.

 

I've lost about 13 kg in 3 months so ok. I'm still figuring out what I can eat. A burger bun absolutely kills me for 2 days. Bread, even sour dough, is no good. Cooked rice that has been frozen, I'm ok with.

 

If you end up on Metformin, you might have heard about side effects. I had gut rot for the first month, very painful. Metformin does a few things, though no one really knows how it works, despite the refined drug being in use for 100 years. It blocks glucose release from the liver. It also likely interferes in how starch is digested.

 

Cooked starch is bad for us, because amylase in the mouth, and maltase in the small intesting, render it to glucose quickly, which goes straight into the bloodstream.

 

If starch isn't broken down in the small intestine, then its fermented in the large intestine by bacteria. This is probably where most of the side effects emerge from. Fermentation can result in gas. And gas in the stomach is pain. But the interesting aspect about fermentation is that the starch isn't broken down to glucose, but is broken down to Acetyl CoA, which is fuel for the muscles. Probiotics and time help with the side effects.

 

Rapid cooling or freezing of cooked starch is considered to promote essentially a crystallised version ("resistant starch") that maltase and amylase can't touch (the crystallisation is irreversible, even if the food is warmed). How much of this resistant starch is formed is uncertain; probably not that much, but for me, with rice at least, it seems to be enough. But also freezing cooled rice forces me to freeze it in small batches, which is probably the major outcome.

 

HbA1c is done every 3-4 months; thats how long your red blood cells live for, and its a sort of rolling average proxy for blood sugar. The numbers have no physiological meaning except to define a threshold for diabetes.

 

There isn't a direct relationship between capillillary (finger) blood glucose and HbA1c; you can conert to get an approximate level.

 

When I started I was 88 mmol/mol HbA1c and 14mmol/l finger blood sugar, both very deranged values.

 

I don't have a CGM, so estimate by bloods twice daily, with a 60 day rolling average of 5.5mmol/l, which I think is ok, and showing the metformin and adjustment in diet is getting the blood sugar under control. 5.5mml/l should be HbAc1 32mmol/mol or 5.1%, but I don't think it will actually anywhere near that. I'd be overjoyed if its 40. I generally avoid carbohydrates, but they are not completely eliminated.

 

Metformin seems to have caused me a bit of neuopathy in the feet; apparently it blocks Vitamin B12 absorption. But the scariest aspect for me is retinopathy. I have a spot in both eyes; the optician is confident that now my glucose is under control, this will be inconsequential, but there is still the fear.