Sudden increase in FBG, A1c still OK

[Aggie123]

Hi, I used to be on a forum similar to this, but it's been a few years now.  I was diagnosed pre diabetic in 2013 at age 49.  At that point I shifted to a pretty strict low carb diet, which I have maintained since.  During these 7 years, my A1c has consistently been in the 5.6 to 5.9 range (I get tested twice a year) and my fasting is high 90s to about 105 with the lab test.  However, the test I took a few weeks ago had a FBG of 120 which is far above anything I've seen.  I have a home meter which is usually pretty accurate. My A1c at the same time was still 5.7 which is normal for me.

So this was upsetting, but it's also confusing because the A1c is the same.  I've always seen that my FBG when I wake up does continue to rise unless I eat something; it can go up 10 points in an hour.  But this is more because 40 min before the test my home meter said 100.

In a possibly (?) related development, my triglycerides, usually quite low due to low carb diet, were also elevated slightly out of range.

Now the last three months have been undoubtedly super stressful. I took early retirement as a high school teacher at age 57 rather than deal with how school will be next year.  The whole Covid thing has been awful, along with all the other issues right now. Pretty much we've been mostly sheltering for 4 months, still walking 3 to 4 miles a day though.

Does anyone know why my fasting spiked like this and if there is anything I could or should do about it?  I am a strict low carb dieter already.  Just wondering if the disease is progressing in spite of that.

[skb]

Hi Aggie,

Once again a warm welcome to you. Here's my  worth to the several issues raised by you.

We're all old forum hands just like you having been on many diabetes forums over the years. Finally, we just created a small space for ourselves here, but each one of us is a veteran with forums.

Over the years I have come to believe that there is no such thing as a "family history" for disease, well almost all disease. It's just that families share the same lifestyles and eating habits and therefore they seem to have the same conditions (good and bad).

Secondly, none of us believe in the term "pre-diabetes" being used for the Glucose Intolerant condition. You are either diabetic or not. I like the term Metabolically Challenged as the Type 2 is nothing but a metabolic condition as opposed to the auto-immune Type 1.

Coming to the question of your single reading of 120, I wouldn't know what to think of it because it is just a single isolated reading. My question would rather be, Why aren't you testing everyday ? As you would know the A1c is sort of an indicator of your average BG levels for the past 90-120 days as against the BG number tested for any given moment. If you test some more, you will have a better idea where you actually stand and maybe, some of that stress will go away.

As for cholesterols, again my views are quite opposed to mainstream beliefs and for good reason. What was your TG number that has you worried. Without knowing the number or the other numbers it would be hard to say anything.

Hope the above is clear and that this helps a bit with the tension and stress.

[Aggie123]

Well, I should explain farther (was a science teacher for 27 years so pretty meticulous). My dad and all 8 of his siblings have or had type 2, as did their mother.  My nephew is type 1, one of my two brothers is about the same as me.  Most of the people in question are not overweight; I am 5 foot 6 and 140 pounds (which is not as thin as I was as a young adult but not overweight).  I do believe there is a genetic component in my family, and that diabetes is not all lifestyle related, although obviously lifestyle habits need to be altered to control diabetes. Specifically a low carb diet. My dad's family members developed diabetes in middle age, and so their lifestyles and diets were very different by that age.  Very, very different, haha.

I believe I am metabolically challenged as you are, but that my case of diabetes is mild currently (which is what they would perhaps erroneously refer to as pre diabetes), and I would like to keep it that way.  My dad, age 92, has been 'diagnosed' for 20 years but the bar of what is considered diabetes was lowered since then (in other words, he was probably diabetic long before). He uses metformin and does not need insulin.  His mother, on the other hand, died at 79 from diabetic complications, having had two toes amputated and insulin dependent.  So I think there are different 'levels' of the seriousness of the disease. My dad does not eat low carb at all and his diabetes still never got bad enough for insulin and probably never will, according to his doctor. 

My triglycerides were barely out of range at 153, but they are usually in the low 100s so that was quite a jump. I am not 'concerned' about it per se, except it was strange that FBG and triglycerides, both of which are raised by carbohydrates, were both unusually high on this test.  I was wondering if there was a link between them.

For several years after I was diagnosed I tested a lot.  I was able to tell which foods to avoid.  But my numbers were very stable in lab tests and with my meter. I kept the same diet and eased up on the testing because after that long I wasn't getting any new information.  I will probably test more often now, in the sense that I want to see if anything is happening now that is different. I kept records of every test, what I ate, what the numbers were, etc. and I still have those notes.

I had tested for about a month before the lab test and I didn't really see anything too unusual.  That's why the number threw me.

[skb]

Well, with such large numbers within the family I can understand why you feel that way. Some years ago, I was reading through an article (wish I had saved that one) from one of the foremost researchers and scientist on the human genome from South America, and he was categorical that in his experience he had not come across any gene that was susceptible to or promoting disease in its very makeup.

As far as testing is concerned a 'normal' A1c has not stopped any of us from testing multiple times a day. I agree that every test ought to have purpose and must reveal something meaningful. Sometimes they also help with keeping a check on things and that is a good enough purpose. I now test 2 times a day but there were times when that number was 20 or greater.

Your TG though a bit higher are nothing to be alarmed at, though IMHO, I would always like to have and have been seeing 2 digit numbers. If your TG/HDL ratio is under 2.0 then that is the best, if not, try and keep it as close to 2.0 as possible.

[Aggie123]

The genetic basis would indeed be difficult to discover; it is possible that the interaction of several genes, along with environmental factors, is involved. There is also the possibility of epigenetic factors (genes switched on and off, by some life experience, which can be inherited in that way-- this has been studied for diabetes with some positive results).

My HDL is always around 60.  Therefore my ratio has been 2 or below with my triglycerides in the 90 to 120 range as usual.  This last test would put the ratio above 2.

My testing at home gives a range of between 90 and 115 nearly all the time.  It is rare for me to see a reading over 120, and then only if I have eaten at a restaurant where it is harder to be sure about the ingredients.  It is very rare to see a number below 90.  I had tested quite a bit with this blood test upcoming and the numbers were the same range, 90 to 115, generally in the low 100s... which is why this particular fasting result was upsetting.  I have ordered some new test strips on the off chance something is wrong with my current ones.  But I have two vials now, ordered at different times, reading the same, so it doesn't seem too likely that they are the issue.

[skb]

My HDL is always around 60.  Therefore my ratio has been 2 or below with my triglycerides in the 90 to 120 range as usual.  This last test would put the ratio above 2.

That being the case, I wouldn't worry about the 150.

I recently saw a 68 BG number, post my evening workout. It's one of the lowest numbers I have ever seen having clocked a few in the low 70s. In the morning I have alwaus tended to be higher. The DP is my faithful friend.

It could be that your one strip was contaminated and the entire box of strips need not be suspicious, but new strips is a good idea.

I hope you are getting familiar with the other forum features. Have you tried the BG Tracker yet or read through the Forum Links in the Right Panel ? Some interesting stuff there. We used to have a Downloads section as well, but it has been disabled because Google perceives it as a security threat.