2019-02-18 Borderline Type 2
Monday, February 18, 2019
I've been feeling a little "off" for a while now, pretty much since we moved back from Seattle 4 years ago. Nothing dramatic, just... if I eat a donut on an empty stomach, I feel kind of sick later. If I eat a meal with too many carbs, especially simple carbs, I don't feel great, and I get ridiculously hungry about an hour later.
Little background: my sister has PCOS, and my dad has Type 2 diabetes. My sister was diagnosed in college. She was found unconscious in a bathroom, from what we now suspect was a severe hypoglycemic episode (she passed out because her blood sugar dropped too low). The doctors at the university hospital where she was taken by campus security were less than helpful - being a college-aged young woman, they insisted she was either pregnant or on drugs, and refused to believe her when she insisted both were impossible. Eventually, my mom helped her find an endocrinologist, and she was properly diagnosed. My dad was diagnosed at age 50 after a lifetime of high activity (cross-country runner through college, life-long distance cyclist who racked up thousands of miles per year, taught me how to play basketball in middle school, lift weights in high school, and road bike with him). Two years of back-to-back non-sport-related injuries had reduced his exercise level way down (broken elbows from a fall on the ice in our driveway, twisted his ankle landing wrong while climbing some stairs, etc.) shortly before his diagnosis.
So, yeah - I've got some super-fabulous genes in here.
Anyway, I started having some hair growth on my neck (which is a sign of PCOS). I never had trouble getting pregnant with my two kids and one miscarriage at 10 weeks, so it seemed unlikely, but worth testing for.
As part of the testing, I did a 2-hour fasting glucose tolerance test - fasting pull, 75mg of glucose, post-prandial pull at 2 hours.
My fasting glucose was 103mg/dL, considered "pre-diabetic" or "at risk" at over 100.
My post-prandial was 206, just over the 200 cut-off. This was marked as "provisional Type 2 diagnosis", meaning that this number by itself isn't considered diagnostic on its own, but a signal to do further testing.
My a1c was normal, as was my fasting insulin. My endocrinologist refused to do an insulin test beyond the fasting insulin.
My other hormone levels, considered diagnostic markers for PCOS, were normal.
So the good news is: no PCOS!
The bad news is: I am nearly considered Type 2 diabetic.
I have an appointment to speak with my endo at the beginning of March. She left some comments in my file about possibly starting Metformin or a different drug that is injected once per week. The injectable made my dad really ill, and my sister has said Metformin messes with her GI tract - she takes it to help with the insulin resistance that is part of her PCOS, but it also makes it necessary for her to drink kefir daily to keep her gut happy.
I was angry, sad, frustrated, all the emotions.
I was angry because I've spent pretty much my entire life trying to take good care of my body. I've never drunk soda on any kind of a regular basis, I've been physically active for my entire life, structuring my adult life to live in walkable areas to include "accidental" exercise in my daily routine, getting around the various cities I've lived in via bike and walking, learned yoga, continued swimming, dancing, etc. I learned how to cook well at a very young age, and have pretty much always cooked for myself. In college I did eat in the dining hall, but I also made at least one meal a week in the dorm kitchen. I know how to prepare vegetables, and I enjoy them. I like fruit, and enjoy trying new and unusual produce. I've always lived on a pretty limited food budget, so I'm used to using meat as a flavoring, not as the main part of a meal. I bake a lot of my own baked goods, and use high-fiber whole-grain ingredients.
Then I turn around and watch other people in my life (not my immediate family) eat junk, complain about exercise as if it's the most horrible torture on earth, not understand why on earth I'd rather spend 4 hours on a bike than in a movie theater on a Saturday, and not gain a pound or have any serious risk of diabetes.
I'm sad because I'm 14 years younger than my dad was was he was diagnosed, and I've know that if I want to live long enough to be a grandparent, I have a very, very long road ahead of me, filled with medication, food restrictions, potential health issues like heart attack or stroke, etc.
I'm frustrated because I feel like I ended up in this position not only because of my genes, but because of the totally screwed-up way we and our parents were taught was the "healthy" way to eat during the low-fat craze of the late '80s and early '90s. I look at my dad's siblings, especially his 3 sisters, and then I look at my female cousins. We're all considered obese (we're also all tall, so that means we all weigh over 200 lb), yet my aunts are not - they're roughly the same heights and builds as all of us, yet with body fat percentages in the "healthy" or just over the border into "overweight" range.
I think this is mostly due to their diets full of in-season produce (because that's what was cheap) and naturally higher-fat foods (because regular cheese and milk was cheaper and would stretch further than skim milk) and more naturally active lifestyles (because everyone was poor, the family only had one car, and if you wanted to get somewhere, you walked or hopped yourself on a bike, plus if you wanted any pocket money, you pulled thistles or detassled corn in farmers' fields surrounding the medium-sized town they lived in).
For right now, I'm eating a reduced-carb diet (aiming for 30% or less per day, without taking out any carbs for fiber, aiming for 35+ grams of fiber per day - doing this mostly through choosing non-starchy veggies in place of most carb-heavy foods and only having sugar-sweetened items if I can immediately follow the meal with a brisk 10-15 minute walk). I'm also continuing to train for my triathlon goals, and am adding in some weight-lifting every Friday, aiming to increase that to also lifting on Mondays (my gym was closed today).
I'm not sure how the conversation with my endo is going to go. I have an appointment with a dietitian about a week AFTER the endo (dietitians are hard to get appointments with - I scheduled this appointment the day I had my first appointment with the endo, the follow-up endo appointment was scheduled almost 2 weeks later, and I was still able to get in with her before the dietitian appointment).