Diabetes Risk and Weight Loss: Key Insights for Health

Q: Diabetes Risk and Weight Loss: Key Insights for Health

Dear Mr. ABC： Please read the following two points： 1. According to the American Diabetes Association's diagnostic criteria for diabetes： a. Fasting plasma glucose level ≥126 mg/dL after fasting for 8 hours or more, b. Plasma glucose level ≥200 mg/dL during

Regarding diabetes and weight loss?

Hello Dr.
Hsiao,
Last year's health check report indicated that my fasting blood glucose was elevated (101 > 100) and my hemoglobin A1c was normal (5.7 < 6.7).
The year before, my fasting blood glucose was 85 (normal < 100) and my hemoglobin A1c was 5.4 (normal < 6.7).
Concerned that the annual health check might be too infrequent, I purchased a GM700S blood glucose meter at the end of May to monitor my levels.
I am not taking any specific medications, but I occasionally use muscle relaxants like Muscular or Salonpas for muscle soreness.
In June, I recorded 19 data points:
- Fasting in the morning: Average 83 mg/dL, highest 90 mg/dL
- Pre-dinner: Average 90 mg/dL, highest 101 mg/dL
- 0.5 hours post-dinner: Average 146 mg/dL, highest 187 mg/dL
- 1 hour post-dinner: Average 150 mg/dL, highest 188 mg/dL
- 1.5 hours post-dinner: Average 131 mg/dL, highest 160 mg/dL
- 2 hours post-dinner: Average 118 mg/dL, highest 142 mg/dL
My height is 168 cm.
My weight has changed significantly: I weighed 42 kg at high school graduation, 55 kg at university graduation, and after starting a sedentary office job, my weight increased to 62 kg at the beginning of this year.
Since around March, I have reduced my weight from 62 kg to 54 kg.
I started avoiding all sugary beverages and late-night snacks in March and slightly reduced the starch content in my main meals (still consuming rice and noodles).
I run 2-3 times a week.
Previously, I would almost daily consume afternoon tea (700 cc of sugary drinks) or canned soda, and I would have late-night snacks (primarily dumplings, instant noodles, or noodles from 7-11) every couple of days.
Question 1: After 2 hours (3 instances exceeding or close to 140), and within 2 hours (maximum value exceeding 180 on 3 occasions, and 2H >= 140 not on the same day), could this indicate that I am on the borderline of diabetes or in the early stages? Is it necessary for the 2-hour postprandial blood glucose to be below 140?
Question 2: Is there a standard for the maximum value within 2 hours?
Question 3: Is there a better way to express that the 2-hour postprandial blood glucose should be < 126 mg/dL?
Question 4: Could changing my dietary habits lead to such significant weight loss? (An average of 2 kg per month) I am a bit concerned as the weight loss seems excessive.

ABC, 20~29 year old female. Ask Date: 2016/06/25

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
ABC:
Please read the following two points:
1.
According to the American Diabetes Association's diagnostic criteria for diabetes: a.
Fasting plasma glucose level ≥126 mg/dL after fasting for 8 hours or more, b.
Plasma glucose level ≥200 mg/dL during a 2-hour oral glucose tolerance test, c.
HbA1c (glycated hemoglobin) ≥6.5% (must not have any disproportionate hyperglycemia and the testing method must comply with the international certification standards NGSP and DCCT), the above a, b, and c conditions must be confirmed by two separate tests.
d.
Clinical symptoms of diabetes (such as polydipsia, polyuria, polyphagia, weight loss, etc.) with any plasma glucose level ≥200 mg/dL (this condition only needs to be met once).
2.
Generally, postprandial blood glucose levels gradually rise, peaking two hours after a meal, and then gradually decline.
If high-sugar or high-calorie foods are consumed and there is sufficient insulin secretion, blood glucose levels may spike rapidly; they can even reach their peak one hour after eating before gradually declining.
The term "postprandial two hours" refers to the two hours starting from the beginning of the meal.
In medical practice, for convenience in treatment or discussion, postprandial blood glucose levels are usually measured at the two-hour mark, and fewer people use the one-hour postprandial blood glucose level as a standard for discussion or treatment.
Normal postprandial plasma glucose levels in healthy individuals are below 140 mg/dL, while those with impaired glucose tolerance have postprandial plasma glucose levels between 140 and 180 mg/dL.
If postprandial plasma glucose levels exceed 180 mg/dL, the risk of diabetes should be considered.
Question 1: Since the amount of food consumed varies each time, your postprandial blood glucose levels will also fluctuate.
Therefore, the standard practice should be to undergo a glucose tolerance test at a hospital, which involves measuring blood glucose levels after an 8-hour fast, then consuming a glucose solution made from 75 grams of glucose, followed by another blood glucose measurement.
Clinically, this is how a more accurate diagnosis is made.
Of course, you can also monitor your postprandial blood glucose levels at home and make appropriate dietary adjustments, which will help with blood glucose control.
Question 2: As mentioned earlier, normal postprandial plasma glucose levels are below 140 mg/dL, while those with impaired glucose tolerance have levels between 140 and 180 mg/dL.
If postprandial plasma glucose levels exceed 180 mg/dL, the risk of diabetes should be considered.
Question 3: To my knowledge, it is rare for individuals to claim that a postprandial two-hour blood glucose level <126 mg/dL is a better indicator.
However, for some healthy individuals, there are indeed cases where excellent insulin secretion or rapid secretion leads to postprandial two-hour blood glucose levels not only below 126 mg/dL but even below 100 mg/dL.
Question 4: Generally, the desired weight loss rate is about 0.5 kg per week; therefore, losing 2 kg over two months should be reasonable.
In fact, whether for weight loss or diabetes prevention, slowing down meal pace, eating until 80% full, avoiding high-sugar, high-fat, and high-calorie diets, exercising more, getting enough sleep, and reducing life stress are likely to yield ideal results.
I recommend that you discuss your concerns in detail with your family physician.

Reply Date: 2016/06/25

More Info

Understanding diabetes risk and weight management is crucial for maintaining overall health, especially for individuals who have experienced fluctuations in blood sugar levels and weight. Based on your health history and recent changes in your lifestyle, let's address your concerns systematically.

Question 1: Is there a risk of diabetes given the post-meal blood sugar levels?
Your post-meal blood sugar readings indicate that you have experienced values exceeding 140 mg/dL at the 2-hour mark on several occasions. According to the American Diabetes Association (ADA), a blood sugar level of 140 mg/dL to 199 mg/dL two hours after eating indicates impaired glucose tolerance, which is a precursor to type 2 diabetes. A level of 200 mg/dL or higher suggests diabetes. Therefore, your readings do place you at the higher end of the risk spectrum, and it is advisable to monitor these levels closely.

Question 2: What is the standard for blood sugar levels within 2 hours after eating?
The ADA recommends that blood sugar levels should ideally be below 140 mg/dL two hours after eating for individuals without diabetes. For those with prediabetes or diabetes, the goal is often to keep levels below 180 mg/dL. However, consistently exceeding these levels can indicate a need for further evaluation and potential lifestyle modifications.

Question 3: Is there a better benchmark than 126 mg/dL for 2-hour postprandial blood sugar?
A postprandial blood sugar level of less than 126 mg/dL is generally considered optimal, especially for individuals managing diabetes. This benchmark indicates better glycemic control and reduces the risk of long-term complications associated with diabetes. Regular monitoring and maintaining levels below this threshold can be beneficial for your health.

Question 4: Can dietary changes lead to significant weight loss?
Yes, dietary changes can significantly impact weight loss. Reducing or eliminating sugary beverages and late-night snacks, as you have done, can lead to a caloric deficit, which is essential for weight loss. The average weight loss of 2 kg per month is a healthy and sustainable rate. However, it is important to ensure that your diet remains balanced and provides adequate nutrition. Rapid weight loss can sometimes lead to muscle loss or nutritional deficiencies, so it’s crucial to monitor your overall health during this process.

Additional Considerations
1. Regular Monitoring: Continue to monitor your blood sugar levels regularly. Keeping a log can help you identify patterns and triggers that may affect your glucose levels.

2. Dietary Balance: While reducing sugar intake is beneficial, ensure that your meals are balanced with adequate protein, healthy fats, and complex carbohydrates. This balance can help stabilize blood sugar levels and support weight management.

3. Physical Activity: Incorporating regular exercise, such as running, can improve insulin sensitivity and help manage weight. Aim for at least 150 minutes of moderate aerobic activity per week, along with strength training exercises.

4. Consult Healthcare Professionals: Given your concerns about diabetes risk and weight loss, consider consulting with a healthcare provider or a registered dietitian. They can provide personalized advice and may recommend further testing, such as an oral glucose tolerance test, to assess your glucose metabolism more accurately.

5. Mental Health: Weight loss and dietary changes can sometimes lead to stress or anxiety about health. Ensure you are also taking care of your mental well-being during this transition.

In summary, while your current blood sugar levels suggest a need for vigilance, your proactive approach to diet and exercise is commendable. Continue to monitor your health closely, and don’t hesitate to seek professional guidance to optimize your health outcomes.

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