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May 15, 2013 03:44 PM

Prediabetic to Diabetic- what to do?

Didn't want to hear this, but my doctor said my recent blood tests (Ac1 went from 6.2 to 6.7) moved me from pre diabetic to diabetic. I am a 50 yr. old female, w/ high blood pressure, sleep apnea, & currently already on a bunch of meds. I really would like to counter this w/ an aggressive dietary approach, (low-carb, primal), & I hate to give up my beer, but I guess I have to. On the plus side, my cholesterol is fine (I think I should quit taking simvistatin), & she also thinks I need to quit taking hydrochlorothiazide. Any advice on what to do first?

I'm planning on increasing my physical activity, & have ordered a fit bit flex.

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  1. Welcome to a club no one wants to join! Since folks with HbA1c at 5% and above are diabetic, in terms of the effects and damage by diabetes, your doctor waited awfull long to diagnose. The treatment for each is the same.

    Here's the very best single guide for getting a handle on your personal optimal diet you're ever going to see: Once you have tight control, you may find you can have a beer in the evenings. A small bit of alchohol with a meal actually keeps blood sugar from spiking as much.

    Hydrochlorothiazide is known to cause diabetes, as do statins, beta blocking bp drugs.

    Use the guide in that link. Cut the starches, fruits and added sugars and google up the myriad good low carb recipes online.

    Check out this chowhound thread, too:

    26 Replies
    1. re: mcf

      Thanks, I'm going in tomorrow to pick up testing stuff, & they want to start me on Metformin. I'm still kind of in shock, & trying to figure things out. I've read your earlier posts & bookmarked that site. Guess I should just take it a day at a time...

      1. re: thistle5

        This is about the rest of your life, so yes, treat it like a marathon, not a sprint. I think you'll find that cutting carbs will make such dramatic changes that you will find your meds no longer necessary, or lower dosages at least.

        If not, you have to investigate other causes of diabetes, it's not just an insulin resistance disease.

        1. re: mcf

          It's just a little strange, to go from someone who thought she ate ok, to someone who has to pay attention to it, & that's some whining I won't be doing after tomorrow, I realize I've been skating by for awhile...& I'm also someone who hates to go to the doctor, & will let Rxs lapse-now I need a mammo/ pap, colonoscopy, & more labs in a month, need to quit my bitching, & try to man up....

          1. re: thistle5

            It took me years to adjust my diet to where it's ended up. One thing I can tell you is that if you make the changes, you're going to be amazed by how many things get better that you never suspected were diet related.

            That's what happened to me, anyway. Feeling so much better and less like a ticking health bomb is very reinforcing.

          2. re: mcf

            I recently passed from pre- to full-blown diabetic, too. I've been on Step One of the phlaunt pamphlet for about a week, "Eat whatever you've been eating and write it all down."

            I've been eating everything I like, including pasta and ice cream. My numbers have gone from a low of 161 to a high of 445 (after all-you-can-eat pasta @ Lidia's).

            Tomorrow or the next day, I intend to move to Step Two, "For the next few days cut back on your carbohydrates." We'll see what happens. I really hate having to give up eating food I like (no, sugar-free jello is not dessert).

            1. re: Jay F

              No sugar added flourless chocolate cake is, so is no sugar added mousse, flourless peanut butter cookies, no sugar added cheesecake... SO much better with the FAT!

              Oh, and baked rhubarb cobblers with nut crumb topping, too, and fresh whipped cream!

              1. re: mcf

                I'm not at the no-sugar "dessert" stage yet, mcf. I just want to get through today, using Step 2, "For the next few days, cut back on carbohydrates."

                Today I had 1/2 c. pistachios, in shell, salted, for breakfast.

                Lunch: 2 scrambled eggs (large) with mushrooms and parmigiano-reggiano.

                That's it so far.

                I had to reorder those strips the blood goes on, so I won't know my blood sugar for another few days.

                For dinner, I'm going to have two chicken tenders, sauteed in butter and EVOO, with a lemon-butter pan sauce. Plus broccoli/almonds/garlic/RWV & EVOO.

                I read a carbohydrate calculator page, on which I found this info:

                <you need 1670 Calories/day to lose 1 lb per week, you should take 178 (40%) - 334 (75%) grams of carbohydrate for your energy needs. (55% = 245 grams, 65% = 289 grams)>

                Do you know what it means, beginning at "you should take"?


                This is the page:

                1. re: Jay F

                  Ignore that terrible advice! Your brain and body do not need dietary sugar, your body makes what you need from protein and slowly. Carbs get stored as fat ,because they all metabolize faster than you can utilize them at those levels, peak, then crash you.

                  It looks like you're not eating much in the way of vegetables. Even Atkins induction calls for several servings of salad and non starchy veggies per day.

                  Good luck with all your experimentation.

                  1. re: mcf

                    I don't know how to recognize terrible advice yet, so thanks for the info. I do get that carbohydrates metabolize as fat, but that's about it.

                    Today I've eaten mushrooms at two meals, and broccoli at one. That's pretty vegetable-y for me. I didn't buy salad yesterday as I was afraid of it going bad. I'll get some tomorrow.

                    I've never been a big vegetable eater, and most of the ones I like are contraindicated (potatoes, cooked carrots, beets).

                    EDIT: I just found this grilled asparagus recipe.


                    I can't grill, but I can roast it. I think I'll try this or the cauliflower tomorrow, plus salad, with the rest of the chicken.

                    And I'm going to make chili soon (ground turkey, ground ancho, garlic, onion, green pepper, canned tomatoes, canned kidney beans).

                    1. re: Jay F

                      Every gram of carb you eat metabolizes to glucose. The excess beyond your immediate needs gets converted to fatty acids for storage in fat cells.

                      Using your glucose meter and dietary changes, you'll become very expert on what's good or bad advice and won't need anyone to tell you anything.

                      You might find that grilling and high temp roasting veggies, or having them with butter, cheese, olive oil and spices or herbs makes them a big treat. But take such big changes at your own pace, you'll find your way.

                      1. re: Jay F

                        Try steaming cauilflower, puree it with shredded swiss, butter, S&P in the food processer. Better than mashed potatoes!

                        1. re: treb

                          I will try this. Thanks. I can't promise you I'll find it better than mashed potatoes, but I will try it. It sounds easy, at least, and I love swiss cheese.

                      2. re: mcf

                        As you are finding your way around in a new dietary world, an appointment with a registered dietitian is helpful even if insurance doesn't cover it and you have to pay for it. And, note well, a "nutritionist" can be anything and does not have to meet state standards, while a "registered dietitian" does.

                        1. re: Querencia

                          Bad advice. They tell diabetics to eat hundreds of starch and sugar grams of carbs per day. Food lobbies own the us dietetic association and its curriculum.

                          Thankfully, the invention of glucose meters allows us to find our own, individual healthiest way of eating.

                            1. re: Querencia

                              That's correct, and this advice is also given by the American Diabetes Association and the National Library of Medicine:


                              1. re: GH1618

                                It's terrible advice no matter where it comes from via corporate dollars.

                                Fortunately, we are empowered to reverse instead of progressing in the disease by the invention of meters that allow self monitoring. That demonstrates better than anything how damaging and corrupt those recommendations are.

                      3. re: Jay F

                        445! Darlin, you've been an undiagnosed diabetic for years, if not decades!

                        Most type 2 diabetics have lost 50% of their pancreatic insulin producing cells by the time of diagnosis because the screening methods used are failures. Fasting tests fail to diagnose 70% of women and 48% of male diabetics compared to 2 hour post meal testing. If they used 1 hour post meal, I guarantee you both would be 100% missed.

                        I would never have been diagnosed had I not bought a meter and used that testing regimen you're doing now. Yet I had diabetic kidney damage for over a decade and developed severe neuropathies. Ignored and undiagnosed by my doctors.

                        1. re: Jay F

                          Jay add to what mcf said, and not to be an ass...but take this for what it's worth.

                          Big picture wise? You're ahead. My H had undiagnosed Type II D for years. His first sign of trouble? A stroke, albeit not a catastrophic one, but still.

                          We keep sugar free jello around for a sweet grab-and-go, but believe me, you can eat very well without the sugars. And your overall health will improve, too. I'm not diabetic, but I am glad that I too have been forced to think about what I eat.

                    2. re: mcf

                      mcf -

                      I respect your views on nutrition and your obvious wealth of knowledge about diabetes.

                      But I wouldn't even speculate or hint at whether it is a good idea for someone to stop taking a diuretic or a beta blocker over the internet. That is a job for a doctor with access to someone's full medical history, bloodwork, ejection fraction, etc. Way too many other factors involved.

                      Hope this doesn't sound harsh.

                      Statins... over dinner, I might share my thoughts with friends, etc, though I won't give any opinions on them here.

                      1. re: cowboyardee

                        Read my comment more closely. I didn't prescribe, I said that's a typical outcome. Studies have shown it over and again, even very recently, with low carb.

                        I mention it because a lot of folks see their bp drop like a rock at initiation of low carb and that can get dangerous with those meds.

                        And if a person doesn't know that, they don't know to discuss a different regimen to to more closely monitor bp after changing the diet.

                        My comment did not tell the OP to stop meds, my presumption is that is a discussion the OP will have with the prescriber.


                        "From baseline to three weeks, patients on the low-carb diet reduced their use of conventional oral antidiabetic medication by 86%. Those on the low-fat diet reduced them by only 6% by the end of three weeks, but intake went down another 57% by the end of their two-week low-glycemic diet phase. "And still they had improvements in glucose," von Bibra said. Medications other than oral ones for diabetes, such as antihypertensive drugs, were not changed in anyone during the study.

                        In the low-glycemic-diet group, mean systolic blood pressure declined from 127 mm Hg to 118 mm Hg (p<0.002) after three weeks; diastolic pressures also fell (p<0.04). Neither changed after three weeks for those initially on the low-fat diet, but both "improved in the same direction" as those in the low-glycemic group after two weeks on the low-glycemic diet, von Bibra said."

                        1. re: mcf

                          I read your comment. My thought is that even mentioning some of the known risks of diuretics and beta blockers without including a full disclaimer that we cannot accurately assess whether dropping those medications would be a good idea... is getting onto pretty shaky ground. I provide that disclaimer not just in response to you but also as a warning to the OP.

                          I can think of a few conditions in which dropping a beta blocker or a diuretic could very extremely dangerous (as well as other situations where discontinuing their usage is beneficial or necessary). Those two classes of drugs are given for more reasons than just BP control, and frankly IME, a lot of people don't even fully understand why they're taking the medications they're on, so discussions about the intersection of BP, diabetes, and medications could be very misleading.

                          1. re: cowboyardee

                            Those facts about certain drugs have been widely reported in the media, first of all.

                            Second of all, I'm not a parent to other posters, I'm a peer, sharing information they can use their adult judgment about without you or I sanitizing it for them.

                            1. re: mcf

                              I don't think I've sanitized anything.

                              I'm advising against putting much weight into tidbits of information about drugs that interact with your systems in very complex ways.

                              I'm not opposed to spreading information. I understand this will sound impolite, but please excuse my bluntness:

                              If another poster had mentioned the link between beta blockers, hctz, and diabetes, I probably wouldn't have posted. But you slid the mention into posts on a subject where you are obviously very well read. That has the potential to give the impression that you also know quite a bit about those drugs. And I don't get the impression that you do. Limiting the scope of a conversation about BBs or diuretics to diabetes and blood pressure is kinda dangerous if you give the impression that those factors are the only ones someone needs to understand or be concerned about.

                              One example (of many): if you consider stopping a beta blocker due to BP and diabetes concerns, you should be very sure that you aren't prescribed said BB for dysrhythmia control. I could go on and on, but even then I could not cover all the bases the OP would need to understand about these drugs in this kind of format.

                        2. re: cowboyardee

                          EXACTLY RIGHT. None of those drugs "cause diabetes".

                          1. re: sal_acid

                            Actually, YES, some of them do. Beta blockers, statins, diuretics. That's why, for instance, there is a change in the advice to use two of those as first line bp drugs.

                      2. Hi!

                        Listen---you can do this. My husband is 48 and living with Type II diabetes. He went from being insulin dependent to metformin, and like you, is managing BP and other issues (for him, atrial fib). Our goal is to get him on a MINIMUM of meds, and to use diet to improve both of our lives! Your meter is your Jay F noted, you gotta test test test....and colorful veggies are your friend too.

                        Instead of focusing on what you can't have, think of what you can have---luscious seafood, chicken, and beef dishes. Gorgeous summer salads. Cream in your coffee. Good butter and cheese. Nuts of yummy almonds. You can do it!

                        And thistle5...the folks on this board have good advice. I have found, in the words of Good Willing Hunting, they are wicked smart! I came to this board confused and with head swirling last July and mcf, Good Health Gourmet, sedimental, sueatmo and others rocked my world---in a good way. Don't bum out. It's not easy, but you can do it.

                        You can do it! You too, Jay F!

                        1 Reply
                        1. re: pinehurst

                          My head is swirling. But thanks, Pinehurst.

                        2. The number one best thing you can do is lose weight.

                          11 Replies
                          1. re: grampart

                            FALSE. Even with zero weight loss, the number one thing best to control diabetes is carb restriction. It works right away even without exercise and weight loss.

                            It's not the lbs lost that make you healthier, it's the healthy changes you make that lead to weight loss that are.

                            1. re: mcf

                              This might be true for the diabetic issue, but sleep apnea is mostly a weight issue (and a very serious one). Carb restriction alone wont help with that, although most low carb diets will usually help you lose weight unless you are calorie sensitive (like I am). Then you have to pay attention to both in order to lose weight.

                              I keep within my BMI ( which is thin) but I need to lose a mere 10 lbs right now (or before the end of July ) to have my wetsuit fit correctly. I keep all carbs to under 100 a day with most of those from veg...No weight loss. None. Add calorie restriction= weight loss. Everyone is different and it has been shown that if you are stalling in weight loss or remain overweight on carb restriction, then calories become important.

                              Sometimes people go a little crazy on low carb at first as they don't know exactly what to eat and they start compensating with large amounts of butter, mayo, bacon, etc. not always good for weight loss and not always good for other health conditions for everyone.

                              1. re: sedimental

                                My husband is skinny as a twig and has moderate to severe sleep apnea. Explain.

                                1. re: coll

                                  Central sleep apnea, brain/endocrine in origin. My skinny kid has it, with no obstruction, too.

                                  1. re: coll

                                    In the context of the OP, weight is likely a contributing factor, unless the OP just referenced that for no other reason.

                                    There can be many causes of sleep apnea.

                                    1. re: sedimental

                                      Sorry I missed the part where weight was mentioned?

                                      1. re: coll

                                        The OP did not mention it. I did, and grampart did.

                                        Weight is often an issue in the scenario the OP posted and keeping a healthy weight and fitness level (mentioned) is really important in taking charge of your health in general.

                                        If the OP is thin and fit, then obviously, the OP already knows all this and needs no advice from me :)

                                        Edit: when I said " referenced that for no other reason" I meant the sleep apnea.

                                  2. re: sedimental

                                    Actually, sleep apnea can be central, as in brain/endocrine related or weight related. In either case, low carb should help some, possibly. I'm only saying that overall health and wellness improve in unexpected ways.

                                    It's a health adjustment, not magic!

                                    People with certain unsuspected endocrine issues will often not have the miraculous results that others do. I never got the strong appetite suppression when I switched to low carb.

                                    But I did maintain my weight on 50% more calories than the 800 I had to eat on high carb/low fat, and I lose on more calories this way, too. Just as most comparison studies demonstrate. It's not all about calorie restriction and every BODY is different. :-) The test test test flyer helps folks find what works best for themselves.

                                    1. re: mcf

                                      I don't think we fundamentally disagree about any of that.

                                      I might put more emphasis on not being overweight and overall health and fitness level than you do too.

                                      But,(and I might be wrong)but the way the OP describes her health issues, it sounded as if weight was likely an issue too. I think when it is, then a weight loss approach is a good idea (not just carb restriction for blood sugar control).

                                      1. re: sedimental

                                        No, I doubt you put more emphasis on them as good things than I do. I just know that diabetes can be tightly controlled without them.

                                        Fitness, activity and weight control have all sorts of other benefits.

                                        Most folks on boatloads of meds have weight issues. Many will have them no matter how much they eat or exercise and rarely do doctors investigate the obvious endocrine factors because they are so trained as mere prescribers, sadly. Many of those drugs cause elevated blood sugar and weight and appetite.

                                        Honestly, the weight point is moot; if one switches to carb restriction, and tests glucose post meals, if not very ill with endocrine derangement, the weight loss will happen. For most, not all. Then more careful evalution is needed.

                                        Vicious cycle. :-/

                                        1. re: mcf

                                          I agree that losing weight will likely improve all of my health conditions, by the BMI chart, I am overweight, but not obese. However, since another medical condition that hit me last year (labyrinthitis for 4 months), my physical activity level has decreased sharply. This diagnosis is just the kick in the pants I needed to get back on track.

                                          My sleep apnea is mild & hypertension is congenital, I've been on meds for 10 years. I've also got a referral in to the cardiologist to followup on my sleep apnea, since it's been 5 years since I had a sleep study. I have excellent medical care, but I realize that I need to take the lead in improving my health, by educating myself & monitoring my progress.

                              2. Read up on whatever you can find on high intensity interval exercise--HIIT, HICT, Tabata. WRT diabetes, there is growing evidence that this style of exercise-- very brief periods of near max exertion--have a significant effect on insulin sensitivity, much moreso than longer workouts at lesser intensity.

                                There is a great video on PBS called "The Truth About Exercise with Michael Mosley". He uses himself as a guinea pig and the pre and post lab results are pretty compelling.

                                2 Replies
                                1. re: splatgirl

                                  I agree, the exercise I was doing before my weird mystery illness set in, was the US Army's functional fitness program, which is similar to Crossfit-different exercises, no recovery time, I was probably the oldest person there, w/ some health issues, but the instructors were great, & I probably got into the best shape of my life- now my goal is to get back to these classes....

                                  1. re: thistle5

                                    I am a fan of Tabata training and I am in my 50's.

                                    If you are checking out Primal, this site is great:


                                    Mark is also in his 50's and this site is a great resource for healthy food choices, education and discussions about fitness and goals. This is not a "diabetic" site, but a Primal site. Easy enough to tweak anything there to meet your needs.

                                2. Follow your doctor's advice and don't rely on "alternative" approaches.

                                  13 Replies
                                  1. re: GH1618

                                    Doctor's advice is almost always wrong, written by drug and grain and sugar lobbyists in this case. Harvard researcher got it right: "Drug companies own medicine."

                                    If you eat crap, they profit.

                                    1. re: mcf

                                      I agree, doctors usually admit they are not qualified to give advice about diet. They give no advice about how to cook to meet your needs. They just give a few pat phrases and encourage you to look elsewhere for the info. The "elsewhere" they encourage are places with corporate stakeholders.

                                      I would encourage someone looking to create a specific eating and cooking plan for their own health issues to look at health and fitness sites/blogs/forums, University sites, herbal and alternative sites, and check out Primal diets(low carb, high veg and protein) no processed food and anti inflammatory diets. Try to develop an eating plan to help with specific problems.

                                      The really nice thing is that your body will tell you when your diet is working for you.

                                      1. re: sedimental

                                        I agree with all of that, but not that primal is necessary to achieve all the benefits, though it's certainly one very healthy approach.

                                        I have inflammation markers near zero despite having severe inflammatory causing health conditions in my body. I eat plenty of dairy, clean meats, fats and and low carb veggies. I don't aim for anti inflammatory, but any diet that stops hyperinsulinemia will reduce inflammation by allowing the body to make adequate enogenous steroids and their delivery transport proteins.

                                        High insulin levels inhibit them.

                                        1. re: mcf

                                          Yup. Inflammation is an undiagnosed and often ignored issue.

                                          I suppose the reason I tend to mention it in these types of discussions, is that so many "healthy diets" don't address really important food prep issues like oils, using herbs and spices, using things like flax, hemp, chia, specific nuts, turmeric, cinnamon, etc. Look up anti inflammatory foods and you will find them listed there.

                                          1. re: sedimental

                                            We're doing a lot of the same things, but with different process, I think. Because I care a great deal about the quality of our foods, I don't buy inflammatory type oils, or meats and dairy. I use a lot of the typically recommended spices and herbs, but that's because I love Indian and Moroccan foods and a lot of fresh herbs and spice flavors in general.

                                            So I eat for quality and also for tight carb and glucose control (and my husband does, too, with no health or weight issues, just for health and prevention) and that pretty naturally leads to lower inflammation status.

                                            1. re: mcf

                                              What are inflammatory oils, meats, and dairy, please?

                                              1. re: Jay F

                                                The fats from feedlot beef and dairy are higher in pro inflammatory fats and arachidonic acid and lower in anti inflammatory CLA and omega 3s. The fats in grass fed and finished beef (pastured chickens, eggs, wild fish) have more favorable ratios of omega 6- omega 3 fats. Some oils tend to be very high in omega 6s, so more pro inflammatory. Sunflower, corn, soy, mixed vegetable oil, for example. Mixing one with walnut oil or ollive oil can improve that, but I just cook with more favorable oils and avoid overheating them to their smoke points.

                                                Grass fed and finished milk products also have favorable fat profiles.

                                                Not surprisingly, all are associated with lower CVD risk even when high in saturated fats.

                                                1. re: mcf

                                                  I use olive oil for almost everything.

                                                  When I make my own mayonnaise, is canola oil bad?

                                                  I'll remember "grass fed and finished." When I buy eggs and cream, I buy the good stuff rather than the more processed. Is it enough just to buy cage free eggs? I have a feeling I'm going to be eating eggs fairly often now.

                                                  1. re: Jay F

                                                    Some say canola is okay, some say no. I just avoid it but will eat something made with it for me. Cage free is a sort of misleading description for what can be bad conditions and it won't tell you what the hens are eating.

                                                    Eggs are best from pastured hens, beef is grass fed and finished, or 100% grass fed. Dairy from grass fed cows will usually just say "grass fed" like Organic Valley, or local brands you can find in stores or your farmers' market.

                                                    It's up to you how expensive you want your eggs to be. Here's a guide to most of the big producers of eggs:


                                                    1. re: mcf

                                                      Thank you so much, mcf. You've been an enormous help.

                                                      1. re: Jay F

                                                        Good luck figuring out what works best for you. I hope you'll keep us in the loop as you work it all out and get results.

                                      2. re: mcf

                                        If your doctor is almost always wrong, you have the wrong doctor. Mine aren't, and they certainly aren't shills for grain and sugar companies.

                                        1. re: GH1618

                                          I make it a policy to avoid back and forth with folks who have opinions based upon their own personal beliefs.

                                          The ADA and the AHA promote starchy, low protein and fat diets for diabetics and heart disease and a lot of drugs to compensate for the inevitable bad results. The dietetic association pushes starches and sugar at diabetics like crazy.

                                          That's not because good science says that's healthy. I don't know your personal doctor, and you know nothing about how carefully I screen my own. I don't follow doctor's orders ever, I partner 50/50 with good docs and where we disagree, they respect my right to my decision making.