Basics: my readings are normal, I’m ok right?

I regularly see people on reddit asking other members to diagnose them based on a few glucometer readings. The expectation being that if your glucometer doesn’t show massive spikes after you eat, you’re fine. No diabetes. No need to worry.

The bad news is that it’s not that simple. We can define diabetes as a glucose intolerance disease. Or even a glucose toxicity disease, since the result is destruction of beta cells, liver damage, kidney damage, retina damage, and even brain damage. Anything that shows a non-normal reaction to sugar is a sign that the disease is already there and progressing.

By the time your glucometer shows that your body doesn’t react normally (let’s define “normal” as fasting glucose < 100mg/dl, glucose back at < 140mg/dl 2 hours after glucose ingestion, HbA1c < 5.7%), it’s already too late: the damage is done. Your body by that point is already no longer working and you have to switch to repair mode, make lifestyle changes, and aim for remission.

Like with most medical conditions, there is no clearly defined cut-off point that will lead to diabetes or not. It’s a continuum. Which means that you’re damaging your body before you can see any sign of it. Before your body is so damaged that it can’t react normally to the conditions you put it in, you might have already started on your way to diabetes without knowing it.

The real test would be a test of insulin levels. Up to 10 years before diabetes signs appear (before high glucose levels), you can develop extremely high insulin levels due to insulin resistance. Incidentally, high insulin levels can also predict several age-related diseases (hypertension, diabetes, cancer, heart disease, etc.). Unless systematic testing is done, you can’t know this is happening in your body.

The question is therefore that of the difference between reaction and prevention. If you wait to see that your body is glucose intolerant through some test, you can only react to the condition: it’s too late. You will potentially be diabetic for the rest of your life and you have been for many years without knowing it. At best you’ll be able to manage it and get into remission. The best response is therefore prevention.

We know what conditions are favourable to the development of diabetes: excess glucose intake, leading to inappropriate fat deposits in liver and pancreas, and interaction with insulin. The only decent course of action is to make sure these conditions don’t exist.

It’s of course easy to say for someone who hasn’t done that. But take the lesson from those who have ended up with diabetes: you don’t want it and you can prevent it (ignoring special genetic predispositions and exceptions). Look at what is a good diet (most likely low carbs) and move to it even if you don’t have diabetes.

What amazes me is how little education and prevention is done for such an avoidable disease.

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