Should I be concerned?

[royalicingflowr]

I went to my doctor today (saw the PA). I told her that I've been getting 2 hour post pran readings from 186-223. My fasting readings are fine, so when they do the fasting test, it comes back ok. My A1c runs 5.9 usually. My mother was diabetic, her sister & father are both diabetic. I try to get tested once a year or so, but the doc says that I shouldn't worry about it at all....I'm within the normal range. From what I remember my mom's doc telling her, her post pran readings should be around 140 as a diabetic. My doc is telling me that as a non diabetic, my readings are ok. Something doesn't sound right.

I'm 38, overweight, history of uncontrolled blood pressure for several years, now under control for the past 9 months. Had (have?) PCOS, but had total hysterectomy (including ovaries) 2 years ago.

[shockme]

yes- i'd be very concerned-especially with your family history.....get a 2nd opinion! take care,trish

[princesslinda]

If my 2 hr post-prandial readings were that high i'd be concerned, and i'm a full-blown T2 diabetic. I was told the 2 hr reading should be 140 or less, I generally shoot for less.

Since your A1C is in the upper limits of normal and you're having high postprandials, I'd suggest you have a glucose tolerance test and see what that shows. I'd also suggest that you start watching your carbs and getting regular exercise. Even if you aren't diabetic at this point, with your family history, you stand a good chance of it, esp. being overweight and having PCOS. If you take control of things now, you might put off a diagnosis of diabetes. If not, you'll be doing what you need to do to help with control.

I've read recently that the post-prandial readings are the first indicators of diabetes, and many diabetics go undiagnosed as usually doctors just run a fasting level. The fasting levels are the last to elevate, as generally your pancreas can function well enough to keep those fasting levels stable for quite awhile. I had normal fastings a year before I was diagnosed, yet looking back I realize I probably had diabetes at that time and just didn't know it.

[JediSurfer]

They are rather high numbers.
I always test my brother when I see him just to make sure he is ok. His numbers never go above a 6 ish or 108.
My father was type 1 like me from the age of three. so there is always a concern but i think my bro got the good genes as he is now 27 years old.

I am Type 1 and would be concerned with those numbers.

Get a second opinion and maybe see a specialist. Infact see a specialist immediately. could be something, could be nothing but best to seek the correct advice to to make sure and prevent any damage that may or may not occur.

Rich

[BlueSky]

... The fasting levels are the last to elevate, ....
That makes sense. The beta cells have the whole night to make enough insulin to bring blood glucose down into the normal range. So it is a poor measure of the body's ability to deal with glucose. It begs the question , why is fasting BG relied on to diagnose diabetes? A glucose tolerance test is a much better indicator.

[JediSurfer]

Fasting rate is the fastest dump of glucose into the system from the liver to get the vital organs up and running. But unless these tests are down within 40 mins they are inaccurate. Thats my own personal experience anyway.

[Tropo]

That makes sense. The beta cells have the whole night to make enough insulin to bring blood glucose down into the normal range. So it is a poor measure of the body's ability to deal with glucose. It begs the question , why is fasting BG relied on to diagnose diabetes? A glucose tolerance test is a much better indicator.

I find this perplexing.

I'm trying to figure out why my fasting levels are always above 110 yet my PP readings are always under 140 at 1 hour and under 120 at 2 hours.

Quite often (more than 50% of the time) my 2 hour PP reading is UNDER my fasting level.

Today was a good example:

My fasting BG = 117 (higher than average for me)
1 hour PP = 125
2 hour PP = 100

My breakfast was high in carbohydrates but did contain a lot of protein too.

Does anyone else experience this?

I'm starting to wonder if it may indicate a problem with my liver.

[JediSurfer]

Beta cells make insulin as and when needed. the cells don't make insulin overnight to deal with the morning. the cells do it as and when required.
My BG can often jump from 6 to 10 within an hour of waking purely due to my liver and brain, yes these two organs are connected, giving my body the carbohydrates it needs.

Don't try to compare your fasting rate with post meal or post prandial or whatever its called. you will just give yourself a headache. Tropo your number look fine to me and you have no need to worry. You must also remember that blood glucose testers are highly inaccurate.

[BlueSky]

... my fasting levels are always above 110 yet my PP readings are always under 140 at 1 hour and under 120 at 2 hours ... I'm starting to wonder if it may indicate a problem with my liver.
It sounds to me like the DP effect is particularly strong. DP is the combined effect of two forces. One is the increase in glucose produced by the liver. The other is increased insulin resistance, caused by raised levels of growth hormone. If the problem was with your liver, one would expect to see evidence of it at other times of the day too. So my guess is that your high FBGs are caused by particularly strong insulin resistance in the early morning.

[JediSurfer]

These number Tropo has mentioned are quite normal for a non diabetic and nowhere near being diabetic.

Tropo, whom exactly told you you are pre-diabetic? because from my lifetimes experience you are not diabetic, prediabetic or have any indication of any other condition from the number you have given us.

By the way. What is "DP effect"? all these shortening of words and names really confuses me.

[BlueSky]

... What is "DP effect"? .....
DP = Dawn Phenomenon - the simultaneous increase in glucose supplied by the liver and a temporary increase in insulin resistance during the early morning hours.

A fasting blood glucose of 110 - 125mg/dl is pre-diabetic in terms of the current diagnostic benchmarks.

[JediSurfer]

At which point after waking are these numbers based on and are they taken under labortary conditions?

From my own testing of over 50 non-diabetics everyone is diabetic or pre-diabetic according to these numbers. And its highly unlikely in Thailand.

[Tropo]

At which point after waking are these numbers based on and are they taken under labortary conditions?

From my own testing of over 50 non-diabetics everyone is diabetic or pre-diabetic according to these numbers. And its highly unlikely in Thailand.

I just came back from the gym (90 minutes of intensive weight training) and posted 104.

JediSurfer, these results are from using my own glucometer...a Horizen "One-touch" meter.

It was interesting that you observe a big jump in the first hour after waking. My testing is never done immediately upon waking, and probably between 30 minutes and an hour after.

Nobody specifically told me that I'm diabetic. I discovered very high BG levels 2 years ago when suffering from a liver ailment (I documented this in some detail on the thread: My Nortorous and Evil Liver). I used medication for a while, then stopped. All testing I've done since then puts me in the pre-diabetic category in terms of waking BG.

Living in Asia, I don't feel compelled to discuss my condition with a doctor.

[Ronin]

Hi Royalicingflowr! (Interesting alias for a diabetic forum)

Should you be concerned? In a word -- Yes! Not because of what one MD says but because of what you say about yourself. It is time to change your ways, and you only need some kind of confirmation to get going. Consider your position confrimed.

As to the whole Pre-Diabetic question: I've been through the roller-coaster on this issue. I figure that if your FBG's are continually in the >100 mg/dL range your body is sending you a message. Is it the potential onset of Diabetes? Not sure, but if it is combined with other risk factors such as obesity, inactivity, high triglycerides, high LDL Cholesterol, low HDL Cholesterol, high blood pressure, et cetera you are potentially a disaster in progress.

In the final analysis, the person you see in the mirror every morning is the person responsible for your health. Tropo may have self-diagnosed while others got the "official" diagnosis from the same criteria. The fact is that getting information and taking action is what it is all about.

I'm still digesting the C-Peptide results I got earlier this week that is discussed in a nearby thread. Am I going to become a Type-1.5? I don't know, but I do know that I am going to be watchful to the symptoms.

Summing it all up, Royalicingflowr - be concerned and do something positive. Tropo, get over the fear, it seems you are managing good control. However, get an HbA1c and perhaps a C-Peptide as well that may answer a whole bunch of questions.

[Tropo]

However, get an HbA1c and perhaps a C-Peptide as well that may answer a whole bunch of questions.

I'm pretty sure I can get these tests done in my area. I've read that fasting is not required for the A1c test. What about the C-Peptide test? Is fasting required for that?

[BlueSky]

.... What about the C-Peptide test? Is fasting required for that?
Yes, to be meaningful, the C-peptide test needs to be done after fasting. C-peptide increases after meals because your pancreas produces lots more insulin.

[JediSurfer]

Tropo, do you have any other symptoms related to diabetes?

[JediSurfer]

Tropo ,

just read your other post about higher numbers. I can see your point mate.

Most important of all is how you feel. so how do you feel at the moment?

An infection of the nervous system could cause these high numbers or general unbalance as I have experienced myself in recent month.

[Tropo]

Tropo, do you have any other symptoms related to diabetes?

None that I'm aware of. My peripheral circulation seems fine.

During my liver related illness 2 years ago when I discovered I had very high BG levels (200 - 250 FBG) I can remember a definite worsening of my eyesight. Although I've always had poor eyesight, at that time I started to wear glasses to watch TV which I never did before.

Since then my eyesight has been reasonably steady (at the new worsened level) and declining at a rate I would consider normal for my age. I do spend a lot of time in front of the computer which doesn't help.

[JediSurfer]

just keep an eye on those number and look for any serious peaks of around 20% or more in your overall numbers.

Good to hear from someone from the sub-continent.

Rich

[Tropo]

Yes, thanks, I will keep a close eye on the numbers.

I'm going to get an A1c soon and maybe a peptide if the test is available.

I wish I had the benefit of a knowledgeable doctor to discuss these things with, but until I can, this forum will be the next best thing.

[Tropo]

An infection of the nervous system could cause these high numbers or general unbalance as I have experienced myself in recent month.

Sorry, I just noticed this post now.

I've never heard that. When I was sick I was looking for any other possible explanation for my high BG levels other than being diabetic.

Do you have any references to how a nervous system infection can cause high numbers?

[BlueSky]

An infection of the nervous system could cause these high numbers or general unbalance as I have experienced myself in recent month.
Do you have any references to how a nervous system infection can cause high numbers?
Be careful you don't get caught up in a fallacy of composition here. An infection will cause the blood glucose to go up in a T1 or T2 diabetic. Infections cause a temporary increase in insulin resistance and and increase in in the supply of hepatic glucose. But a non-diabetic's pancreas produces enough insulin to deal with this, so their BG doesn't increase. If you aren't a diabetic, an infection won't cause high numbers.

[princesslinda]

I find this perplexing.

I'm trying to figure out why my fasting levels are always above 110 yet my PP readings are always under 140 at 1 hour and under 120 at 2 hours.

Quite often (more than 50% of the time) my 2 hour PP reading is UNDER my fasting level.

Today was a good example:

My fasting BG = 117 (higher than average for me)
1 hour PP = 125
2 hour PP = 100

My breakfast was high in carbohydrates but did contain a lot of protein too.

Does anyone else experience this?

I'm starting to wonder if it may indicate a problem with my liver.


I have difficulty with this myself. My fastings are usually 112-116, though I do have lower readings on the weekends, often in the low 90's (which I attribute to eating earlier in the evenings and getting more exercise and less stress).

[royalicingflowr]

Thanks everyone. And Ronin, I do cakes...lots of them. I guess it's a good thing I can't stand to eat them or the icing any more. Too much sweet stuff around all the time.

[Ronin]

Hi Royalicingflowr!

As the son of a semi-professional baker I know exactly what Royal Icing is, how it's made, and that it is loaded with sugar!

[Tropo]

I have difficulty with this myself. My fastings are usually 112-116, though I do have lower readings on the weekends, often in the low 90's (which I attribute to eating earlier in the evenings and getting more exercise and less stress).

You and I differ somewhat in that I've never had a reading under 106, although I don't test everyday so it is possible that lower numbers do occur that I'm not aware of. Another difference is that it doesn't matter how early or late I eat. Even if I don't eat for 12 hours or more, my fasting levels are still well over 100...and I exercise almost every day...intensely.

I found an interesting article that explains that there are 2 distinct phenotypes among pre-diabetics.

1. People who have impared glucose tolerance.
2. People who have impaired fasting glucose.

In the first category are people who have abnormal 2 hour postprandial readings.

In the second category are people like us who have high fasting glucose levels but not necessarity abnormal 2 hour PP readings.

Other points I found interesting. These are direct quotes (in blue) from the article:

1. "The observation that I[mpaired] F[asting] G[lucose] is more prevalent in men and I[mpaired] G[lucose] T[olerance] more prevalent in women..."

2. "They started with a group of 815 men and women 60% of whom started out as normal, and 40% of whom had IGT and administered blood tests to them every two years for at least ten years. Over this period 42% of the normal subjects who developed abnormal Fasting Plasma Glucose did not develop abnormal Glucose Tolerance. This led them to conclude that those who displayed abnormal blood sugars on the fasting test alone were suffering from a different disorder than those with abnormal 2 hour Glucose Tolerance Test results. Not only that, but in the population they studied, "the more common pathway appeared to be the development of abnormal 2hPG levels [on Glucose Tolerance Testing] with normal F[asting] P[lasma] G[lucose] levels."

Here is the link to the article:

Misdiagnosis By Design - The Story Behind the ADA Diagnostic Criteria (http://www.phlaunt.com/diabetes/14046782.php)

To find the section I've quoted from, scroll down about 2/3 rd of the page to the paragraph heading:

"A Large Body of Research Determines that Impaired Fasting Glucose is not the Same as Impaired Glucose Tolerance"