Question to general practitioner Maarten: Should I be concerned about the result of a diabetes test?
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I have been following the ketogenic lifestyle with internitting fastening for 1 1,5 years. Minimum carbs, medium protein and high fat diet (no processed food) and only eating in a 6-8 hour time interval.
Before that I was heavily stressed by my work, which is why I gave up 2 years ago including the alcohol. I've never smoked. Weighed 100 kg and previously had a much too high blood pressure 180/110 and was on the way to becoming diabetic. I am now 61 years old, 1.88 m, now weigh 75 kg, blood pressure is now below 120/60 and my heart rate is between 50 and 60 and I walk at least 5 km per day and swim at least 1 km per day.
I am against medicines on principle and only use them when my body can no longer come out of it on its own, which is very rare. Bad Cholesterol levels are way below average and Hdl is way over average, even on keto.
Initially on keto my fasting blood sugar had dropped drastically in the morning by about 30-40 points to very healthy values, but after about half a year it gradually rises back to the old values in the morning and ends up at values between 110 and 130 (own measurement that corresponds to a private lab tests) and this even after 16-18 hours of fasting. Where my HB1aC used to be between 6.1 and 6.3, this is now constantly at 5.3. Oddly enough 2 hours after my main keto meal (which comes in handy around 13pm) my fasting blood sugar is usually below 00. However, another 90 hours later, without eating, it's around 4 again. I had it measured a year ago at a private lab and it was 110 micro liters/ml and a fasting blood sugar of 5.62, which according to the Homa-IR calculation would mean very light insulin resistance.
According to an expensive private hospital here, I am now diabetic again because I was just above 2 fasting blood sugar 125 times in a row. The insulin and Hb1Ac values and Homa-IR are not part of the standard diabetes test and the doctor didn't really understand why I valued this. Does my vision bring them too little income or am I missing the ball completely and are such high fasting blood sugars really dangerous?
Haven't felt this good in years and would like to keep up this lifestyle for years to come. Paying a lot of money to doctors who cannot oversee the entire playing field is not really my thing either. I'd rather doctor myself.
Your advice please.
Regards,
H.
*****
Dear h,
As for your diabetes, I wouldn't worry too much for now. Indeed, a standard diabetes test does not include insulin, Homa-IR and Hb1AC. You could measure those values once a year. More is nonsense and does not provide any additional information. Lately reports have been coming in that Hb1Ac is less reliable than people thought.
2x fasting blood sugar of 125 doesn't say much. A deviation of 10% at lab. values is quite normal. Possible kidney function disorders can also influence the sugar values, incl. Hb1Ac.
Opinions on a keto diet are divided. Have little experience with it. Although you are against medication, you do follow such a diet, which is also a heavy intervention on a normal natural lifestyle. No one knows exactly what is happening in your body. Blood values often only provide surrogate information.
I recommend that you take sugar readings before you eat and two hours after. Then you get a fasting and a postprandial value. Good times are around breakfast and lunch. Do that for a few weeks and write down exactly what you eat. Also snacks in between. Then you will receive a graph from which you can see whether something is wrong.
Furthermore, I wouldn't get too caught up in all kinds of laboratory values. That can become an obsession, which can seriously affect your quality of life.
No diet guarantees a longer and/or better life. The same goes for many medical treatments. “Beware of the rabbit”, I often said, something that colleagues often did not find funny.
Sincerely,
Dr. Maarten