Pre-D: Fact or Fiction?

[Ronin]

Fellow Pre-D's:

I've been living with the diagnosis for a while and have noted that there seem to be more than a few schools of thought on the Pre-Diabetic Diagnosis. Therefore, I think it is time for those of us living with the Diagnosis to talk about the implications of the diagnosis. To kick things off, I'll start with my opinion, and I'm sure your opinion will be different. But, perhaps we'll be able to come up with some common insights.

About me: I'm a pretty active guy being a very avid tandem bicyclist riding over 100 miles/week and doing a full upper body Bowflex routing 3-times per week as well. Looking back at my medical records (I keep copies of my stuff going back a long time) I have found that my FBG levels have been over 100 for the past 15 years. Only two-years ago, when the Pre-D diagnosis was introduced, was I given the diagnosis. Until then I was considered "High-Normal." I did have a cholesterol and triglyceride problem that has been resolved by a low-fat diet and lots of exercise.

Now, about this diagnosis: From what I have been able to dig-up this was a decsion by various leaders in the health field to attack the "epidemic" of early onset Type-2 Diabetes by getting peoples attention before they develop full-blown Type-2. The thought was that they would capture a lot of teenagers in the at risk category. What actually happened was that a lot of 50-plus folks have been swept into the Pre-D universe -- so many that a fourm like DF now has a separate category for us. I think that ignoring the age factor is a real problem because there seems to be at least one group that thinks that your BG levels have to never go above 120 and always-always-always rapidly return to between 70 and 80 mg/dl within two hours of eating or you are headed for diabetic ****. Sorry, I cannot acccept that because, at 60, I realize that all of my body functions have slowed -- including glucose metabolism.

There is another theory which is being called "The Metabolic Disorder" which uses more than just BG levels to diagnose your condition and a sliding scale for each measurement. The key factors considered are:


HbA1c below 6.5%
Blood Pressure below 120
LDL Cholesterol below 80
HDL Cholesterol above 55
Triglycerides below 80
Microalbumin below 30
Annual retinal exams showing no evidence or retinopathy
(Source: Know Your Numbers, Outlive Your Diabetes by Jackson and Tendrich_

By this set of criteria I am not at risk of the Metabolic Disorder even though my FBG levels are usually above 100. Albeit my 2-hour post prandial readings are below 130 unless I have a large amount of carbohydrates in that particular meal.

A question is: will every person diagnosed as a Pre-Diabetic become a Type-2? I don't think so, because a good friend was similarly diagnosed and he was a latent Type-1.5 and his pancreas quit about two years ago and is now well controlled on insulin.

Did this diagnosis help or hurt me? Overall it scared the $#!^ our of me at first. I dropped an additional 20 pounds but nothing much else has changed. I eat fewer carbs, a bit more protien (a lot more salads to keep the protien moving), and all my Metabolic disorder critera are in the good end of the range.

Personal Summary: I'm testing four times per day FBG, and 2 hour Prandial and the results are boringly normal. I also use a good home testing HbA1c kit monthly. Knowledge helps but I also realize that I can be fairly normal in my eating and have the occasional high-carb splurge without any significant effect. So, for me it was an awakening but perhaps over blown.

What is your experience -- perhaps somebody who is in the research end of things is reading this stuff and might learn something from those of us who have the diagnosis.

[rzrbks]

I think this is what's known as preventative medicine, which to my way of thinking, even tho I'm an old Phart too, is what medicine should be about.

1. Cheaper for all concerned if caught before actual onset of disease.

2. "An ounce of prevention is worth a pound of cure."

3. Has this been a "Bad Thing" for you?

4. Good for you for taking positive steps, too many, even if given the same info you got, will continue down path of stupidity----if the smart ones take care of themselves then the stupid ones will be fewer in number and less of a pain for everyone else.

[baskar20]

Hi Ronin,

I am very happy to see the wordings as "boringly normal". I want everybody's results to be like that.

This shows that you ar working very hard and also taking care of your diet very well. Congratulations!

I am also Pre-diabetic like you. My Doctor prescribed Avandamet. But I am not taking that.

The problem with me is that my FBG will always be normal. My 2 hr OGTT showed the glucose level be 174 and the insulin levels to be 298 iU. Hence, the Doctor told me that I am diabetic. Fasting BG was 83 and fasting insulin was 10 iU.

In one way, it helped me to start taking care of the diet soon. May be a three or four years before the full blown diabetes.

Even now, if I eat white rice or pizza, my blood glucose level goes to 250 to 300 mg/dl. If I eat low carbs, I am okay.

Yours may be a similar case. Did your Doctor do a OGTT for you?

Baskar

[Ronin]

Baskar, et al.,

Actually, I did a home grown OGTT with my trusty BG meter and three GU-Packs (25 grams of carbs per pack - sicky sweet - these are a cycling staple for long duration riders). The results were: at 30 minutes BG went from 106 up to 140, at 1-hour up to 170, at 1:30 down to 160, at 2:00 down to 125, at 2:30 back down to 110. Can't say that I liked the "sugar rush." An MD might have diagnosed an "Imparied Insulin Response" but all-things-considered when I went over the results with my primary care, she was impressed although she maintains the Pre-D Diagnosis.

I've eaten all kinds of stuff and done testing including rice, pasta, even chocolate cake -- the highest I've ever hit was 180 and it didn't stay there for more than about 15 minutes. I can say that I've never seen 200 mg/dl. I do find that portion size matters a lot. What most people consider a portion for one is usually a portion for one small family or one very large person.

[princesslinda]

I've read that the post-meal #'s are the first to show any abnormal blood sugar elevation. Apparently for some time, your body has enough time to do what it needs to do overnight and the fastings can still be normal. A few months before my diagnosis, I had fasting blood work drawn that came back with a normal fasting level. At diagnosis, my A1C came back 9.6! so the doctor said i'd probably had diabetes a few years before diagnosis. I can relate symptoms of diabetes retrospectively about a year and a half before definitive diagnosis.

Interstingly enough, I can now control my post-meal levels easier than my fasting ones.

[baskar20]

Princess Linda,

I was thinking that the FBG will creep up gradually and also the A1C along with that. I think the main problem is that the Doctors are not catching it early enough. When FBG goes higher, only then they test A1C etc., and it is too late..

Ronin,

I think you are doing better than me with respect to the OGTT.However, I still feel that you should continue with the low carb and exercise regimen.

I guess the insurance companies / pharmaceutical wanted more people to be diagnosed as diabetics / pre diabetics so that they can generate more revenue for themselves. Hence they lowered the limits for diagnosis.

Baskar

[princesslinda]

Baskar I agree. I'm thinking that not all pre-diabetics will eventually become diabetics, but all T2s have been pre-diabetic, whether we knew it or not. Unfortunately so many of us don't go to the doctor for an annual checkup until we're older, so this isn't usually caught for many of us until we reach full-blow T2. I know i've had annual gynecologic exams for years, but basically all they do is a urinalysis, which usually doesn't show anything until urine spills at blood sugars around 170 or so. Had I had a regular physical, with my family history, they would have probably did the appropriate blood tests and caught me in the pre-D stage....of course, I "helped" things along eating as if there were no tomorrow and being lazy. No point in wondering what "might have been," but I do hope all the pre-D's here will keep close watch and be able to avoid T2.

[baskar20]

Ronin,

I also noticed that you are taking Niaspan. I have been taking 2000 mg Niaspan since 2000. My HDl increased from 28 to 40 md/dl.

However, I now understand that Niaspan could cause the early onset of diabetes and currently I stopped that. I have not yet done my cholesterol testing yet.

But I find a good difference in the blood glucose readings. When I was on Niaspan the same food used to spike my BG a lot more than now.

Not sure about the effect on HDL though. Will I go back to 28 mg/dl? I have to wait till my next lipid profile test.

Baskar

[cherokee_psh]

Much like Ronin, I too was caught by the OGTT. My fasting number were fine and remain fine. Breakfast was my biggest problem. Two hours after I was averaging 180 on a regular basis. The other meals numbers were fine. Also the A1C was climbing, 5.1 at diagnosis (5/2004) to 6.3 this past May. I went on metformin (only) and my reading are much more normal. I did make some changes and dropped some weight didn't change much for me. Seeing how I have/had diabetic parents genetics may be part of the equation for me.

[Ronin]

Hi Everyone:

I appreciate the insights that are coming out. I tend to agree that all Type-2's have, at one time, been diagnoseable as Pre-Diabetic. However, I have to say that I am becoming more-and-more an advocate of the Metabolic Disorder hypothesis. That means that the indicators are multiple and not limited to BG levels, other factors are included and indicate an overall and much larger problem. This would tend to explain why it takes dietary changes and serious exercise to alleviate the onset of not only Diabetes but other serious consequences like related cardiovascular problems. It would seem that the health consequencs take more than one single trigger.

A few clarifications:

I take Niacin not Niaspan (which is a prescription medical dose of Niacin that costs a lot more than the stuff you get at your local suplament store). Yes, I get Niacin-Flush and it doesn't bother me and no I don't take asprin to counteract the flush -- I tried that and almost destroied my stomach. As far as my lipids go my last test resluts were: Cholesterol = 161, HDL = 80, LDL = 63, and Triglycerides = 91.

I was diagnosed as a Pre-D based on FBG levels -- the OGTT was a home based "experiment" as was the one time I managed to shoot my BG levels up to 180 which was the result of a large slice of Lemon merangue Pie along with a large glass of sweetened Ice Tea (apx 150 g. of glucose in one sitting) I have to admit it tasted better than the GU that I used for my OGTT.

I have no plans to change my current regimine of lowered carbohydrate consumption and maintaining my daily exercise routine. However, I'm not concerned about furhter dramatic lowering of my glucose levels and won't be "doing a Bernstein" any time soon.

I'm quite satisfied and my daily testing is to make sure that nothing is going wrong. Yes, I'm a bit obsessive/compulsive on health topics as I was when I was first diagnosed with high cholesterol almost 30 years ago when my father died of diabetic heart complications. FWIW when my father was my current age he was already dead for seven years! (53 was a really weird year for me!)

I have a question for Rzrbks: What was your experience as your pancreas began to fail to produce sufficient insulin? That might give some insight to other Pre-D's who may be slipping towards Type 1.5.

Now, I know there are more Pre-D's lurking out there, I do want to hear your story as do a lot of others so please chime in on this thread.

[ladytaz]

Though I'm not a Pre-D (dx'ed T2 - possible 1.5 - still need tests to determin that) ... once, years ago (1993) I was, though it was called "Borderline Diabetic" back then ... my OGTT at that time was 140 (by TODAY's standards, I was already "full blown" Diabetic) ...

I personally think it has NOTHING to do with ANTHING one does ... either you're predisposed to it or you aren't. Period. If you're gonna get it, you're gonna get it. Nothing you can do to "stop" it. Maintaining it, well, that's a different story. No matter, either you're gonna get or you aren't.

Ronin, you are a good example. You've been very healthy, at least since your "Pre-D" diagnosis, and you maintain that health. Though, you do what you do, you're STILL "Pre-D". No matter what you've done to "improve" your health.

****

What one does or doesn't do, has nothing to do with a T1.5 diagnosis ... it runs along the lines of T1. It's gonna happen NO matter what one does.

T2 ... Honestly, I feel the same way. One may be able to "put it off", but essentially, they're still T2. Just give'em an OGTT!

My sis is an example. She's been dx'ed T2. She does SO very well with so many foods! Her BG is pretty much always VERY good (5.8 A1c). But, with certain foods (rare, they are), her BG raises considerably.

With an OGTT, it was way too high (I don't remember the exact number now, but it was TOO high - in the 200's somewhere). She has, on more than one occasion, said to me, I don't think I'm Diabetic! I tell her, YES you are! Just by how your body reacted to that OGTT, and how your body reacts to those certain foods! Those that DO NOT have Diabetes, if they eat "this or that", their BG does NOT go, and stay, for a long period of time, above 150! I think it's finally "sunk" in with her.

[plluna51]

When I was diagnosed in Feb 2007 all I was told was that I had diabetes. I had a few of the symptoms, abnormal thirst and more than normal urination, usually two or three times during the evening while sleeping. I actually had the physical because I thought the Prostate might be the reason for the frequent urination. Also my father passed away from prostate cancer and my sister was bugging me to get a complete phy7sical, something I had not done in more than 20 years. Diabetes was not even considered. It was quite a` shock when my doctor told me I had diabetes and told me he was prescribing Metformin and Avandia. At that point I should have began asking questions but I was speachless.

Once the shock wore off I started doing some research purchased a few books. The first one I bought and read was Gretchen Becker's The First Year: Type 2 Diabetes. It was after reading this book and seeing my nutritionist that I made the decision to "change my ways". I also bought software to download my meter readings to my laptop. I also purchased a program called Fitday and began logging in everything I ate. This program allows you to see all the nutritional values of the food you eat. You can also record your daily activitity to monitor the calories that one burns daily.

One question that I have it if because of my 9.6% A1C and 231 FGL I must have been type 2. Am I still type 2? I am no longer on medication. My last A1c on 6/92007 was 6.2. My FGL is now regularly in the 80s and my GL two hours after meals is between 110and 130.

I would like to do a monthly A1C test. What home tests do you reccomend?

Louie

[volleyball]

While there is no one size fits all or even most, I think the prediabetic term is more for doctor pigeon holing. A prediabetic can get by without medicine and a diabetic needs medicine. Though some that say they are pre are on meds while some type 2 take nothing and have similar results.
I look at it as I am type 2. Plain and simple. If I don't watch it, my BG will go way higher than a non diabetic.
In a small way, I look at it like a recovering alcoholic, may never get drunk but the propensity is there.

[Dan Gato]

Ronin, good thread.


It's OK that some people are pre-D & control their bg's with diet & exercise.
It's also OK to be ocassionally over 150, or 170.
But what you should do is read here on the Forums & also read other research papers, if people are with sustained elevated BG's they'll have really bad complications. & these complications don't start overnight, it takes a while & the persons aren't aware of the harm being done to them.

Ronin, If you at 60 don't have any complications, that is great.

I went to see the eye doc, he told me that he has seen serious eye damage, & that it happens to people that have too much bg's fluctuations, & that the damage to the eye nerves start at bg's over 150.
I've read that damage to the other organs start at 140 ( regardless of any D diagnosis) & reversal of damages could be done with "normal" bg's.
I've read that non-diabetics have A1C's of: 4.2 to 4.5. I'm far away from that.

I low carb & take meds to control my D. I'm T2.
If I eat a high carb meal my bg's would get very high, even taking by meds, I'm a low dosage for now.

The more carbs a person eats, they're causing beta cells burn out, which is the main cause for D.
I need to preserve my beta cells.

Ronin, et al, have you had a c-peptide test?
do you have any minor complications?

[didi1]

Hi there.
I had a physical and a ogtt was ordered too. The blood work did include a c-peptide test. Afterwards, I too was in shock about the dx. 142 at 2 hr and a high c-peptide (I think it was 12.1 at some point. ) I just remember being speechless too and did not ask any questions either. Went home crying. I Do remember the doc saying "insulin resistant" or something. After the shock, did some research but any help here is greatly appreciated.
ogtt 1 hr 169
ogtt 2 hr 142
c-peptide 2 hr 12.1
A1c test 5.3 at General Doc
A1c test two weeks later 4.9 at Endo's Office
fasting BG 82-86
post pranials 2 hr 88-95 most times (occasional 105 after more carbs)
Doing low carb diet, exercise, no meds.
I did read about pancreas burn out "Bernstein's book" and I wonder how far am I along? Should I be on medication too?
thanks

[Ronin]

Hi Dora!

All of us Pre-D's are why I started this thread. Trying to figure out exactly what this particular diagnosis means. Take a minute and go back to the original posting in this thread and take a good look at all the factors that are part of the "Metabolic Disorder" panel. My guess is that your numbers there will tell you a lot more about your general health than the total focus on BG levels.

To be sure, BG levels are very important, but while you may be "Insulin Resistant" (i.e., your body isn't effectively using the insulin being produced) if you are overweight and could still use a bit more exercise it can be turned around.

Generally, the numbers you posted are pretty good for a non-medicated person. Yes, you have an impaired insulin response based on OGTT, but your body is managing glucose based on your diet and exercise pattern. It's pretty clear that your body is not suffering the toxic effect of excess glucose floating around in your blood stream. I will also say that it is my opinion that as long as you can stay away from medications the better for your overall health as all of the meds have serious side-effects. They may be in your future, but you are controling your BG levels quite well now. Be happy about that.

Part of what I see in your post here (as well as your other posts) is that the Pre-D diagnosis is working as the ADA wants it to work -- to get your attention and get you to change your diet and exercise patterns.

One other thing, if your pancreas is producing insulin, more than your body is using right now, your beta-cells are not burning out at the moment. Beta-cell burnout is seen when the insulin production falls and cannot match the needs of the body. Weight loss and exercise can sensitize your body to insulin so that what is produced gets used.

If you can stick to the Bernstein method good for you. Of course, I'm a bit older than you so our conditions do differ. As it says on the cover of The Hitchhikers Guide to the Galaxy "DONT PANIC!"

[BlueSky]

.... if your pancreas is producing insulin, more than your body is using right now, your beta-cells are not burning out at the moment. Beta-cell burnout is seen when the insulin production falls and cannot match the needs of the body......
The idea is that beta cells burn out because they are having to produce excessive amounts of insulin. So they do in fact "burn out" while insulin levels are high. Insulin production falling is the result of beta cells having burned out.

There is a lot of built-in redundancy in the design of the pancreas. With T1s, blood glucose only starts rising after 80% of the beta cells have been destroyed. There is no way of knowing when beta cell loss starts with T2. But it is thought to be quite early in its development. And the only way to stop it is to reduce pressure on the beta cells to produce excessive insulin. Hence the emphasis on diet and exercise. :D

[Ronin]

BlueSky, et al.,

I cannot disagree with the argument stated in the reply: "The idea is that beta cells burn out because they are having to produce excessive amounts of insulin. So they do in fact "burn out" while insulin levels are high. Insulin production falling is the result of beta cells having burned out."

That being said, there is a much deeper question when it comes to the diagnosis of Pre-Diabetes. One side of the argument is that if you are genetically programmed to have your beta-cells die out, the best you can do is postpone the die off. The other argument is that controling diet and increasing activity (a.k.a., exercise) can prevent the onset of Type-2 Diabetes.

While it is true that the modern diet contains a lot more carbohydrates than our ancient ancestor's diet, why doesn't everyone become Type-2 Diabetic as a result of overloading their systems? Why is it that some of us become "Insulin Resistant" while others living exactly the same life-style never become Insulin Resistant.

The question that all of us who have been diagnosed face is: are we only postponing the inevitable genetic failure of the pancreatic system? Or, is there something else going on?

The advocates of the Metabolic Disorder cast a wider net and see elevations of BG levels as one marker among many that indicate that a particular individual is on the road to a general systems failure.

People like Dora, who have embraced the Full-On-Bernstien approach do get great results. People like me, who limit but do not eliminate carbohydrates to the extent that Bernstien recommends get similar, albeit not as dramatic results.

Since Pre-D is a rather new diagnosis we still don't know what is happening to the people who fall into the Pre-D category yet don't make any lifestyle changes. Do they develop Type-2 or Type-1.5 Diabetes, and if so is that progression faster or at the same rate as those who respond to the changed regimine? Also, is there a coorelation between BG levels and age (I think that there is, but that is only my unscientific opinion.)

A better diet with regular exercise is a good prescription for anyone regardless of their BG levels or age. However, those of us who have been classified as Pre-D still have the lingering question of how effective our actions are going to be. Are we actually preventing the onset of Type-2 or Type-1.5, or are we merely postponing the inevitable?

I would still like to hear more about the progess of Type-1.5 (which I understand to be an adult-onset form of Type-1) to see if there is a coorelation between the Pre-D's and Type-1.5's in the more general sense. I have a personal friend (who is not, and never has been Insulin Resistant) who's pancreas failed a few years ago and is now an official Type-1.5. In many ways I am exactly where he was about 15 years ago.

[BlueSky]

.... we still don't know what is happening to the people who fall into the Pre-D category yet don't make any lifestyle changes. Do they develop Type-2 or Type-1.5 Diabetes, .... Are we actually preventing the onset of Type-2 or Type-1.5, or are we merely postponing the inevitable?

I would still like to hear more about the progess of Type-1.5 (which I understand to be an adult-onset form of Type-1) to see if there is a coorelation between the Pre-D's and Type-1.5's in the more general sense. I have a personal friend (who is not, and never has been Insulin Resistant) who's pancreas failed a few years ago and is now an official Type-1.5. In many ways I am exactly where he was about 15 years ago.
Ronin,

The only pre-D who becomes T1.5 is one who has been mis-diagnosed. Early T1.5s look like pre-diabetics (early T2) because their Oral Glucose Tolerance Test profile is similar. But it is a completely different condition. Insulin resistance is normally not an issue with T1.5 and supplemental insulin is the only sustainable treatment. Insulin resistance is an essential characteristic of Pre-diabetes.

The main discernable differences between T1.5 and Pre-D is insulin levels and the presence of auto-antibodies. With T1.5, isulin levels are low-normal, with Pre-D they are high. So if you think you may be T1.5, have an or C-peptide test done. Also have a GAD ant-body test done, although it is not always positive for T1/T1.5s.

If you are in fact T1.5, yes, exercise and diet won't change the long-term outcome. But if you are Pre-D, exercise and diet will keep you healthy. You are unusual in that you have had raised blood sugar for such a long time. And I can see how getting clarity on what is causing it would be useful.

[Harold]

Ronin you might find the Position Statement (http://www.aace.com/pub/pdf/guidelines/IRSStatement.pdf) interesting. Excerpt;ACE and AACE are pleased that several points in the statements referenced above reflect thinking that was promoted in the ACE 2003 Position Statement on the Insulin Resistance Syndrome (IRS),4 a terminology which ACE and AACE feel more clearly describes the Syndrome.4 This landmark document focused specifically on insulin resistance, which is a well-studied pathophysiological perturbation that is clearly associated with an increase in the risk of a number of disease consequences. The concept of IRS is based on this pathophysiology and is designed to predict and prevent such consequences, based on ACE’s and AACE’s growing understanding that resistance to the metabolic actions of insulin is a major driver of atherosclerosis and diabetes, and may play roles in diseases as disparate as infertility, malignancy, and abnormalities of liver function. As noted in the position statement, “IRS is used to describe the cluster of abnormalities that are more likely to occur in insulin resistant/hyperinsulinemic individuals.”4

ACE and AACE specifically distinguished IRS from type 2 diabetes and cardiovascular disease (CVD), since one of their most important clinical goals was to identify individuals at risk before such consequences occurred. ACE and AACE also stressed the importance of expanding the concept of insulin resistance beyond CVD and recognizing other associated disease consequences, such as polycystic ovary syndrome and non-alcoholic fatty liver disease. ACE and AACE are pleased that the recent statement of the American Heart Association/National Heart, Lung, and Blood Institute endorsed the utility of the post-challenge glucose for early recognition of individuals at risk, which was an important contribution of the original ACE position statement.

This Statement (http://www.aace.com/pub/pdf/guidelines/OutpatientImplementationPositionStatement.pdf)
gives a little more detail. Question 1: Are we intervening early enough to address glycemic control and
insulin resistance in glucose intolerant states?
No.
Numerous studies have shown that significant cardiovascular disease develops years
before the onset of diabetes (8-10). Hyperglycemia has been shown in epidemiologic studies to
have a strong association with cardiovascular disease. In the absence of an intervention,
impaired glucose tolerance (IGT), characterized by postprandial hyperglycemia, often
progresses to type 2 diabetes.
- 2 -
2
There are sufficient data to recommend intervention to prevent progression of IGT to
type 2 diabetes. Large randomized controlled studies have shown the effectiveness of lifestyle
interventions in preventing the progression of IGT to type 2 diabetes; a 58% reduction was
demonstrated in both the Diabetes Prevention Program (11) and Diabetes Intervention Study
(12).
Clinical trials have also shown several pharmacologic agents to be effective in reducing
IGT conversion to type 2 diabetes. These include the DPP (Metformin) (11), STOP NIDDM
(acarbose) (13), TRIPOD (troglitazone) (14) and XENDOS (orlistat) (15). Although
troglitazone, a thiazolidinedione, is no longer on the market, several thiazolidinediones with
similar properties are currently being studied. Currently, only orlistat is an approved
pharmacologic treatment for the prevention of type 2 diabetes.
Patients with IGT frequently have increased cardiovascular risk factors. Treatment of
these risk factors is necessary to reduce cardiovascular events. Epidemiologic studies have
shown postchallenge hyperglycemia to be a strong independent risk factor for cardiovascular
disease. Thus, another potential benefit of treating the hyperglycemia associated with IGT may
be the subsequent reduction of cardiovascular disease. The STOP NIDDM study showed that
reducing postprandial hyperglycemia using an alpha-glucosidase inhibitor delayed the
progression from impaired glucose tolerance to type 2 diabetes and was associated with a
significant reduction in cardiovascular events (13). This is not a recommendation to initiate
non-approved pharmacologic therapy in patients with impaired glucose tolerance.
Regarding the diagnosis and treatment of diabetes, current recommendations for
diagnosis and treatment are adequate (16). Studies have shown when current glycemic goals
are achieved early, beta cells are preserved (14). Further, early glycemic control in diabetes has
been shown to provide residual long-term benefits in reducing vascular complications (17).
Reports have shown that clinicians often have difficulty following these recommendations,
resulting in a substantial delay in treatment.

Suggest reading both in their entirety for a better understanding.

[Ronin]

Everyone:

Many thanks to BlueSky & Harold for the clarifications. This information helps me (and I hope my fellow Pre-D's) understand more about what is going on with my body/our bodies.

On a personal level, I have read the extended versions of what Harold cited and find that, based on my personal HbA1c numbers as well as the criteria for Metabolic Syndrome I'm not in a lot of difficulty (yet). However, reading these articles I did see a lot of my father and I think I know now what actually killed him as is related to diabetic consequences in his cardio vascular system.

I am hopeful that there are more Pre-D's following this thread as there is so much useful information contained in the postings. Keep the data coming as well as the individual stories.

Most of us Pre-D's are still in various stages of dealing with the diagnosis, which are probably the same as the stages of grief (with a healthy dose of denial and barganing). Good, solid information is critical to managing the situation.

I can say that my post-prandial BG levels are always below 140 mg/dl although my FBG's tend to be over 100 but below 110 as long as I practice good carbohydrate management.

I'd still like to learn more so keep the information flowing.

[Ronin]

Hi Everyone!

There is an article in the 20 August 2007 edition of the NY Times that directly addresses the "Metabloic Syndrome" (http://www.nytimes.com/2007/08/20/health/20diabetes.html?ref=health).

Perhaps the real answer to the question I posed as the title of this thread "Pre-D: Fact or Fiction" is "Neither, only a fair warning."

It would seem that some of us are pre-disposed to our Metabolic Systems acting up and our bodies not being able to effectively manage the carbohydrates we injest to survive. Medical science has provided us some insights and medications to help but, in the end, the control lies within each of us.

Proper diet along with exercise can slow, delay, and perhaps postpone an aboslute Diabetic condition. However, it is up to us to not only watch our daily BG levels, but A1c levels, Blood Pressure, Cholesterol/Lipids (LDL, HDL, and Triglycerides), Microalbumin, and with the assitance of an eye doctor the condition of our retinas. Yes, it is a lot to do.

Being diagnosed with Pre-Diabetes is the best that the medical profession can do today to give us that "Fair Warning" until some other tests (perhaps genetic screening) can clearly identify who is and who is not at risk of having their blood glucose, cholesterol/lipids, blood pressure, microalbumin get out of control.

The reality is that some of us diagnosed as Pre-D are going to get an easy ride with great control with minimal effort, others are going to either become Type-2 or Type-1.5 diabetics and all we can do is slow the progress of the condition.

I don't think of this as a negative statement, it is simply the way things are today. Perhaps, somewhere in some laboratory, a scientist is already working on something that will prevent the progression or even reverse the progression. Until then, our job is to control our diet, exercise and live a healthy life.

[didi1]

Hi Ronin!

Thanks for starting the information wave for all of us newbies to the diagnosis. I sure will be asking a lot of more questions when I visit him in about a month. I sure do hope everything will turn out okay. I did ask him for a complete lipo blood work including the small ldl and the fibrogen I think. He called it the lipo science one instead of the regular ck for Col, Tri, Hdl etc . I will post those and the new ones when I get them. Again thanks so much. This network helps more than any doctor to inform one self for the better. Keep in touch. I just hae been busy with the beginning of the new school year in services. I will be reading. Thanks to all!

[MJB]

When I was diagnosed in Feb 2007 all I was told was that I had diabetes. I had a few of the symptoms, abnormal thirst and more than normal urination, usually two or three times during the evening while sleeping. I actually had the physical because I thought the Prostate might be the reason for the frequent urination. Also my father passed away from prostate cancer and my sister was bugging me to get a complete phy7sical, something I had not done in more than 20 years. Diabetes was not even considered. It was quite a` shock when my doctor told me I had diabetes and told me he was prescribing Metformin and Avandia. At that point I should have began asking questions but I was speachless.

Once the shock wore off I started doing some research purchased a few books. The first one I bought and read was Gretchen Becker's The First Year: Type 2 Diabetes. It was after reading this book and seeing my nutritionist that I made the decision to "change my ways". I also bought software to download my meter readings to my laptop. I also purchased a program called Fitday and began logging in everything I ate. This program allows you to see all the nutritional values of the food you eat. You can also record your daily activitity to monitor the calories that one burns daily.

One question that I have it if because of my 9.6% A1C and 231 FGL I must have been type 2. Am I still type 2? I am no longer on medication. My last A1c on 6/92007 was 6.2. My FGL is now regularly in the 80s and my GL two hours after meals is between 110and 130.

I would like to do a monthly A1C test. What home tests do you reccomend?

Louie

Once you're T2 you're T2. It does not go away.

[Larry H.]

"There is a lot of built-in redundancy in the design of the pancreas. With T1s, blood glucose only starts rising after 80% of the beta cells have been destroyed. There is no way of knowing when beta cell loss starts with T2. But it is thought to be quite early in its development. And the only way to stop it is to reduce pressure on the beta cells to produce excessive insulin. Hence the emphasis on diet and exercise". :D[/QUOTE]

Just got on and started reading this thread.. Interesting.. I had my doctor to suggest that he thought I was type II from a glucose reading of 128 fasting.. That was the one time in checking at least that I got that on a lab blood test.. Who knows what others might have been.. I got on line an started reading as others have, I joined this group and cut way back on carbs and started serious walking and manual lawn mowing, ect.. After about 9 months at it I had a 85 fasting this morning and many of them are falling in that range. An over 100 morning reading I haven't seen in months. When I eat I now get readings closer to 120 or less rather than the 150 to 60 I was getting and higher at first. Lost 33 pounds, feel and look a whole lot better. As others I can eat more carbs and things that at first I would have gotten really rotton readings from and now get reasonable ones.. Something is different.. That brings me to wonder as others, does this if caught in time perhaps level out and either reverse some, or slow a great deal?

In doing some research on the net about "catching the glucose levels early" or something of that nature, I came across a study that said that beta cells (I think) they are, when caught early in there downward spiral of glucose intolarance or what ever, that in backing off the sugar and carb levels they actually showed renewed ability to handle the sugar more normally. I am really pharaphrasing here.. But hopefully you get the idea. I know that a lot think there is no return once your headed the wrong way, but it just might be that caught early it can be somewhat reversed or greatly slowed.

I personally take no prescriptions for the diabeties.. I do take the Salacia Oblonga discussed here now and then.. It does seem to lower my levels by some compared to not taking it.. I also had all the Cholestrol and related issues.. My cholestrol and good and bad levels were the best ever the last time I had blood work done. I don't know what it all means, but I think we do need to take a hard look at how various people seem to react, and they don't seem to be exactly the same. For my self I wouldn't want to see those 150 readings after meals back.. My medium carb cereal breakfast this morning came in at 95 with a bit of walking added. Hope to keep it that way..

[Ronin]

Hi Larry!

Thanks for you observations. Your observations are similar to mine. In many ways I appreciate getting the diagnosis, even though my first reaction was panic.

I have found that exercise is a key ingredient in the formula. The past few days have been miserable for bicycling and, while I can usually get away with a single "rest-day," more than one usually results in BG numbers creeping up as it did the day before yesterday. Even though I did adjust my carb intake (perhaps not enough) to compensate for the lack of aerobic exercise.

Like you, I don't take any diabetes medications. I do take both Zocor and Niacin for cholesterol management.

There may well be a genetic factor in all of this and it may be made worse by too many carbs in the diet. As one signature block (I forget who it belongs to) says: "We don't have a stinking clue" Perhaps that sums it all up.

[Jenny]

I also was dx'd as a pre-d about 4 or 5 years ago.....the strange thing is that about 1.5 years after that they discovered I am hypothyroid. Once they put me on synthroid my bg's started leveling out more....on days when i eat within the 1 hour after taking my synthroid or miss it is when my bg's get wacky. Now, one doc told me that the thyroid has a lot to do with bg's and other told me that it wouldn't cause the bg's to do that...all I know is what happens when I miss or take my meds wrong my bg's get screwy anywhere from 50-180;s.

[sweetblood]

can a pre-d have microalbumin level of 171...that was my level a few months ago...

dr wasnt concerned...thats kinda odd...

i have had a few episodes of mild elevated bp...140s/90s...drs arent concerned abt that either...

as fer as bg...i get a very rapid spike...st 200s folloed by a rapid drop...into lo 100s...w in hr...

and i get 1 to two lows a wk...50s to 70s or very rapid drops...

last nite was 170 and w in 30-45 min had dropped to 70...isnt this common in pre-ds

last a1c was good at 5.0...

but hdl was only 27...eeeek... that the lowest ive EVER seen it...

total chol. was 173...been creepin up...maybe bc getting older...tho im only 32...

btw got dx thru ogtt

[Ronin]

Hi Sweetblood!

From the data you presented I highly recommend that you read Know Your Numbers, Outlive Your Diabetes by Jackson & Tenderich. Those numbers, per the authors, suggest that you may be in the midst of the Metabloic Syndrome and the elevated Microalbumin is directly related to your BP. As far as the wild swings in BG levels, that can be related to the regulatory mechanism of your body are not working properly.