So, have I got diabetes?
Before anyone throws a chair at a computer screen, asking how can someone maybe have diabetes, let me explain to you how diabetes is measured and diagnosed; it will probably explain a lot of what I'm wanting to say here.
6 years ago when I was pregnant with my daughter, I had what's called "gestational diabetes" - diabetes during pregnancy. We knew this because early in the pregnancy I was sent for a glucose tolerance test where I was asked to drink a large sugary drink and for the next 2 hours my blood sugar levels were monitored to see how my body coped with carbs.
The answer was: it didn't. Not very well, anyway.
I spent the remainder of that pregnancy keeping in strict control of my diet, and towards the end of the pregnancy used a medicine called Metformin because my doctors were concerned about the fact that I wasn't able to put on weight. They could see that baby was growing, but my weight stayed the same, so technically I was losing weight.
About half of women who experience gestational diabetes, will go on to develop diabetes later in life. One way to think of it is, pregnancy is like a stress-test which shows body's reduced ability to produce insulin when increased load is required. As insulin-producing ability then decreases with age, women who had diabetes during pregnancy are just already "closer" to that borderline.
During pregnancy, the guidelines I was given from the hospital for blood sugar monitoring were this:
* less than 5 mmol/l on an empty stomach ("fasting"),
* between 6-7 mmol/l an hour after having started eating ("post-food").
I never had any trouble with fasting levels (mine were usually around 4.6) - only with post-food numbers, and gradually I learned to choose my food very well to stay within the required limits. It marked the beginning of my interest in LCHF food.
Another thing I need to explain here is glycated hemoglobin, also known as Hba1c.
Hba1c is, basically, a long-term blood marker which shows how high average blood sugar levels have been in the last 3 months. Unlike finger-pricking blood tests which show, exactly, how much glucose is in the blood at any given time, Hba1c doesn't measure highs, it doesn't measure lows - it only measures the average. And in a normal, healthy person Hba1c is usually between 20-40 mmol/mol.
Now, there are actually two reasons why someone's Hba1c may be normal. It may be that 1) the person's insulin production is very strong, so even though they eat a diet of ice cream and soda drinks, their glucose level never gets high enough for long enough to be reflected back in their Hba1c levels.
But there may also be another reason. Even a person with a 2) compromised insulin-production (ie, diabetic) can have normal levels of Hba1c because blood glucose levels go up in reaction to eating carbs. If a person doesn't it enough carbs, then their glucose levels will never get high enough to be reflected back in their Hba1c levels.
So, basically, if you sent a person for a glucose tolerance test (like is customary in pregnancy), then they may totally fail the test - and you'd be inclined to say that they are "diabetic". However, that same person may have an entirely normal Hba1c level because if they 1) modify their diet and 2) do exercise, then although their body doesn't produce a lot of insulin, it doesn't matter because their diet doesn't require a lot of insulin.
And in New Zealand, at least, diagnosis of diabetes is made not in response to glucose tolerance tests, but according to Hba1c levels. As long as person glucose levels are kept normal, it doesn't matter what their body would do if they drank a large glass of sugar water - there is no need to label them "diabetic" if their diet is not causing them to have high blood sugars. That is also why some people may be heard saying that "they've reversed their diabetes" - meaning, they've changed their diet and lifestyle so that their Hba1c levels drop back into normal range.
5 years ago, a couple of months after having given birth, I performed a couple of 'random' blood tests to get an idea on how my body was functioning post-pregnancy. I learned that if I ate what's considered 'normal' food in our society, something that is high in carbs (pasta, pie, potatoes etc), my post-food glucose levels would go above 8 mmol/l, sometimes even 9 mmol/l. My doctor at the time explained to me that it is not a problem as long as: 1) Hba1c levels remain normal and 2) fasting glucose remains low.
They explained to me that, basically, increase in fasting numbers is the first real sign of trouble in the insulin-production, and as long as mine remain at less than 5 mmol/l, all should be well, providing I eat a healthy diet - something reasonably low in carbs.
And THAT, long story short, is where I discovered the first signs of trouble two weeks ago. I pricked my finger in the morning, right after getting out of bed, and discovered that after 14 hours of not eating, my blood glucose was...
I think the exact words that went through my head were this: "Shit. Here we go"
Because, look, THIS IS NOT YET DIABETES and I know that. I know that! In fact, someone with actual diabetes might look at this number and think, "Oh, come on Maria, mine is 13." Whatever.
But the point is: ever since having gestational diabetes, I have lived in the knowledge that one day I will, probably, develop diabetes. It fits my medical history, and my family's medical history. And although I feel equipped to deal with it - though I wish it may never come - keeping an eye on it NOW gives me a chance to take care of my health before any potential damage from high glucose levels is made.
I have watched for years as my Hba1c levels have crept up, despite my relatively conservative consumption of carbs. 31 mmol/mol, 33, 35. The latest blood marker on my Hba1c level was 37 - just 3 digits short of the considered "normal range". I have not descended into panic over these numbers - rather, I have acknowledged them as the quiet progression of age and disability, and have offered them the respect they deserve.
Which still doesn't mean that I was prepared to see 6.7 mmol/l on a glucose monitor one morning.
That number - before any food has been consumed, in fact, more than 12 hours since last food had been consumed - has nothing to do with my self-control. It is a number I cannot affect. That number is a reflection of my hormones kicking in in the morning, getting my body ready for raising from bed, my metabolism converting energy stored in my tissues into blood glucose - and my pancreas not being able to deal even with that.
It is not diabetes (I think some countries draw the line at 7 mmol/l on empty stomach) - but it is a first real warning sign of the gradual degradation in my insulin production.
So, do I have diabetes? No. Maybe. If someone sent me for a glucose tolerance test - the way diabetes was diagnosed in the old times - then it's anyone's guess whether I would fail it. I think I probably would.
But I don't. At the moment it only matters what my actual blood sugar levels are doing - not what they would in the face of a fictional glass of sugary water - so for the moment, I don't.
And I intend to keep it that way. For a long, long time, if I can help it.