PreDiabetes

The Client

My client, Ms M, is a 53 year old post-menopausal British Asian, living and working in Berkshire as a GP.  She’s overweight, particularly around the middle, with consistent and prolonged stress levels.

Of more immediate concern to Ms M than her weight levels were her blood sugar levels.  Her mother, brother and all her cousins on her mother’s side were diabetic and were on Metformin to treat the condition. 

For the majority of patients diagnosed as being pre-diabetic by their GP it is highly plausible that the condition can be reversed

As a GP she was aware of the low risks of Metformin but was determined to address her own blood sugar levels through lifestyle changes.  She recommended these regularly to her own patients and wanted to practise what she preached.  She told me, at the time of our initial consultation that her HbA1c level was 41.  This takes her, just, into the pre-diabetes stage of developing Diabetes Mellitius.

For the majority of patients diagnosed as being pre-diabetic by their GP it is highly plausible that the condition can be reversed through lifestyle changes.  Even for those that are Type II Diabetic there still remains the chance that the condition can be improved even if not reversed (dependent on how long the diabetes has been active and how much damage has been done to pancreatic beta cells).

She had previously reduced her HbA1c to 36 through losing weight via a very low calorie diet and exercising.  She was disappointed that the level had crept back up again.

Other Investigations

Sub-clinically Hyperthyroid.  Very low TSH 0.003 T4 around 21/22.

Cholesterol levels good

Blood Pressure levels good.

Vitamin D status unknown.

The Protocol

Two of the most important steps you can take to reduce blood sugar is to lose weight and to increase exercise.  Ms M had already taken steps to lose weight by following a very low calorie restricted diet.  And indeed, this is one of the NHS’s recommendations to reduce high blood sugar levels.  However, as she found, very low calorie diets are not sustainable.  I also believe that, followed for any prolonged period, they can have a negative effect on thyroid function.

With a busy GP’s lifestyle it had also left her with a habit of snacking on protein bars for breakfast and for lunch. 

She exercised regularly with a particular interest in cricket and road cycling which should help maintain adequate Vitamin D levels.

The strategy behind my program for her was multi-encompassing: attending to her weight, exercise, thyroid and menopausal health:

Blood sugars

Get her Vitamin D levels tested. There are associations between Vitamin D deficiency and Type II Diabetes onset, as a British Asian with a desk-bound job she’s in at-risk group.16:8 Intermittent Fasting.  She already regularly skipped breakfast so this isn’t too much of an accommodation to make to her existing eating pattern.Low GL diet for the rest of the time.  No processed foods, sugar or refined carbohydrates.  Nothing that could be digested quickly, spiking blood sugar and therefore insulin.Make sure she plans her mealtimes and eats her 7-a-day removing the dependency on protein bars and ensuring she’s getting a swathe of nutrients.Particularly chromium and magnesium rich foods.

A proper meal at lunch, after the 16 hour fast, to stave off mid-pm snacks.Increase phytoestrogens in her diet.  The post-menopausal body loves to deposit weight around the middle (maybe because adipose tissue is an endocrine organ producing oestrogen among other hormones).  By introducing plant-based oestrogens into her diet the propensity for middle-aged creep may lessen.Equally take steps to reduce stress.  Stress, through the action of cortisol, also encourages weight deposition, particularly around the middle.

I recommended a private thyroid test to get a broader picture of all her thyroid hormones as opposed to just TSH and T4.Encourage T4 to T3 conversion.  She may have a lot of T4, but unless we have test results we do not know if that T4 is being utilised.Ensure T3 uptake once the conversion has taken place.Interestingly her asthma inhaler contained the glucocorticoid steroid Fluticasone.  Glucocorticoid steroids can downregulate synthesis of Thyroid Binding Globulin which may result in higher levels of free T4. As above high stress levels are associated with adrenal exhaustion which again is linked to hyperthyroidism so steps need to be taken to reduce stress levels.

The Outcome

I saw Ms M weekly as part of a 12 week weight loss program so was able to monitor carefully the changes she’d put into place.

She got on very well with the Intermittent Fasting and had taken pains to improve the quality of her diet replacing the protein bars with whole food and homemade lunches. This gave her the energy to get through her afternoon without eating the obligatory sweets and biscuits that hover around most GP’s surgeries.

She had her Vitamin D levels checked which were low and so, short term, we supplemented with a therapeutic dose of Vitamin D. 

She never followed-up with a private thyroid test but was intrigued to understand the link between her asthma medication and its possible impact on thyroid function.

She was taking steps to increase exercise, HIIT training to reduce blood sugar levels, as well as yoga to reduce stress.

By the end of the 12 weeks she had lost a respectable 6kg but more importantly was happier with her weight distribution and was happy to see the re-emergence of her waist.

However her weight gain was incidental to her main concern which was that of her blood sugar levels.  Not only had her HbA1c level dropped to 39 which is in the normal range but she admitted to me that her starting level was really 46 not 43 so she’d actually had a drop of 7 points. 

She was very happy to not have to start medication.  She’d made life-long habitual healthy changes which would not only keep her blood sugar low but would undoubtedly have further health dividends.

For more information on pre-diabetes, Type I or Type II Diabetes please contact me at saffron@thislifenutrition.co.uk.

* HbA1c.  Haemoglobin is the protein within red blood cells that carries oxygen throughout your body, it become ‘glycated’ when it naturally joins with glucose in the blood.  Measuring HbA1c allows your GP to measure the amount of sugar in your blood over a longer period, around 3 months, than simply measuring blood glucose done with a finger prick test.

By Saffron Rogerson

28 April 2020