At last an AC1 Number.

[Larry H.]

After much prodding I have now the results of an AC1 test. Not exactly sure how it relates to my numbers I had been seeing with the meter, but the nurse felt it was within reason. It was a 5.8. That included a pretty good stretch where I was probably getting higher after meal numbers than I was during the summer period, so I would expect it could have been somewhat lower had I had one done then.
Anyway for all those that have prodded me those were the results.

[Evermont]

Here's a chart that shows the relationship between A1c and your glucometer tests.

A1c chart (http://www.healthyinfo.com/clinical/endo/dm/hga1c.test.shtml)

[princesslinda]

Here's the conversion chart I like to use, as it breaks down the numbers more. I have a copy on my bulletin board, and I highlight my A1C results on it.

For some reason, this link won't post.... but I go under yahoo and type in printable A1C conversion chart and go under the geocities one.

Larry, 5.8 is a good A1C, esp. for someone NOT on meds. My doc encourages patients to begin meds if the A1C stays 6 or over.

[moorejames]

Here's the link:

geocities.com/diabeteschart/bloodsugarchart.html

And here's a few more:

elviradarknight.com/diabetes/a1cnumbers.html

diabetestoolbox.com/HbA1c-convert.asp

[weird, the board doesn't seem to want to post the links - I'll try them without the www. at the beginning]

[Evermont]

I can do it.

http://geocities.com/diabeteschart/bloodsugarchart.html

Just un-check the "Automatically retrieve titles from external links" option. Perhaps Tony could change the default.

[Ronin]

Hi Larry!

As the "Chief Prodder" I am glad you had the test done. Knowledge is a wonderful thing. Now, what does that number actually mean?

Depending on which chart you use (why they are all different still baffles me) it tells you what your average BG levels have been for the past 90 days (actually, it is a weighted average with emphasis on the past 4 to 6 weeks).

An HbA1c of 5.8 is acceptable and not indicative of diabetes according to the various people, organizations, and agencies who make the dignosis criteria. That being said, you are getting close to the upper limit. That explains why the ADA says your numbers are in the Pre-Diabetc range.

What do you do with this bit of information? First of all, take a deep breath and recognize that you are not diabetic right now. Next you have to make a decision about how you are going to live the rest of your life. Most of us know that you can bring down this number by further modifications of your diet and exercise patterns. I brought mine down to my current levels (see bottom of my signature block). Yeah, I do this test monthly because I find this to be more significant than the daily testing which I only do once or twice a day at maximum (FBG with the occasional post-breakfast check).

December increased my HbA1c numbers a bit (one tenth) largely due to reduced exercise levels influnced by family issues and lousy weather as well as too many parties where I'll admit I strayed from the narrow path. Since I'm over 60 I'm not in a panic and I am in control. Will I become a diabetic? Yeah, it may happen, my father was an undiagnosed diabetic for years (also a functioning alcoholic and heavy smoker). On the other hand, when my father was my age he was dead for over seven years. The thing that I do know, based on the fasting C-Peptide test, is that my pancreas is not producing a lot of insulin as I'm on the low end of normal. Therefore, it takes my body longer to use glucose, therefore I must make sure that I don't put too much in at any given time.

You are doing okay Larry. If you like what your results were, then keep on with the program. If you don't like the results -- modify your program and test again (FWIW: I use the Biosafe home test kit which is available from Amazon for about $20/test if you buy a bunch of them as save shipping costs)

[Larry H.]

All your post are rather timely. I just got the printed version from the lab of my results today. As one Ronin Just mentioned they do indeed seem to vary.
I looked at it and see they show a "Mean Blood Glucose" of 117.8. According to one of the above charts that comes in at 5.4. However the doctors office called and told me it was a 5.8 reading? I think another member mentioned it was an average in the mid 130's. That was too high for comfort for me.
What surprises me is the notes on the test that say;

"Hemoglobin AC1 5.8
Arbitrary guideline:
Near Normal 6.5 to 7.0
Good Control 7.0 to 9.0
Fair 9.0 to 10.0
Poor 10.0

These appear to be higher than most I read on this site or other charts?


I will most definitely normally be watching what I have eaten. Thats the worst part, I have done better than nearly anyone around here I have met with the way I eat. Most just eat what they want and take a pill. What the outcome of that may end up being I am not sure? I usually keep the carbs down best I can. I too though fall short once in a while. Yesterday we had lunch out and I had a spinach salad with a oil dressing. Then I had a very slim slice of chocolate cheese cake.. After a pretty low carb meal last night I tested and at two hours was at 178. A pretty high number for me. Towards bedtime it had dropped to 138. This morning I slept a bit later, which sometimes can be worse or better depending on who knows what.. But I got a 98, so that didn't seem too bad.

I am sure I am on my way to type two maybe even if I watch fairly well. But I can't afford to think its ok to go on as before, I tried a modified amount of that after the doctor gave me the "your ok" kind of talk, and my numbers reflected it..

[ladytaz]

Well, 5.8 is a good number, Larry! Just remember, Diabetes is a progressive disease. You may be able to stave it off for a time, but eventually, you will "cross that line". Know that it is nothing you did to cause that crossing, that's just the way it is! And know that you DID do all you could to stave it off, as long as possible! You deserve MUCH credit for that! When the time comes, and you can no longer keep it at bay, with diet and exercise. Don't hesitate to start on the meds! They're there to help! Just do as you said, keep a good watch on it, and press on with the doc, if neccessary, when that time for meds comes. If he doesn't see things your way, then find yourself a new doc, who is as concerned with your health, as you are!

[Real4]

What surprises me is the notes on the test that say;

"Hemoglobin AC1 5.8
Arbitrary guideline:
Near Normal 6.5 to 7.0
Good Control 7.0 to 9.0
Fair 9.0 to 10.0
Poor 10.0

These appear to be higher than most I read on this site or other charts?


Those "notes" are for the garbage can. Normal, non-diabetic A1C is under 5.0. 5.8 is decent control for a DIABETIC, it is not normal and it is not even "good control".
There is one major study where they divided the results into over and under 7.0, SURPRISE under 7.0% had much better long term outlook. So since then 7.0 has been a mantra for certain people including some doctors.
The numbers shown have to go back a long way to a time with only primitive insulins and insulin regimes and before oral meds for type 2. They reflect a treatment program centered around keeping a patient alive in the short term, not long-term freedom from complications.

[Larry H.]

Must be a Southern Illinois thing.. My old doctor still thinks 200 after meals is fine.. I thought you all would find those numbers as faulty. The doctors office who quoted these numbers the health department puts out is in yet another small town near. He treated my dad when he was basically dying of pulmonary heart failure and never figured it out.. Funny part is he is a pulmonary specialist.. I am afraid there must be a lot of mis-information out here. It may be why so many just keep eating way too many things they shouldn't and take there little pill.

And yes I will most likely face that too. In the year and 4 months I have been around here I can see where my numbers are not as easy kept down as they were after my first weight loss and exercise routines began. No doubt though if my fastings were higher and my after meals were higher when I got here that may have been going on for quite some time and didn't realize it. So getting them down to where they are, even if not the best control, is probably at least a slow down in the progression. Doing pretty good, just not perfect.

[ladytaz]

Nobody's perfect! ;) You can only do, the best you can do! And that you are! :)

I just posted on another thread about the Medical Community's general lack of knowledge. It is something that irks me to no end, and I find NO excuse for it! Those doctors and such, that you just described, are doing nothing more than guaranteeing thier diabetic patients early deaths ... for no more reason than they refuse to educate themselves. People in general, tend to do as thier docs say. Take their docs word, as if it's the last and final word. Instead of going out and educating themselves. I, personally, never take a docs word as final. I MUST educate myself on things! Which is what lead me to this fine place! :0)

[wiseguy]

An HbA1c of 5.8 is acceptable and not indicative of diabetes according to the various people, organizations, and agencies who make the dignosis criteria. That being said, you are getting close to the upper limit. That explains why the ADA says your numbers are in the Pre-Diabetc range.

What do you do with this bit of information? First of all, take a deep breath and recognize that you are not diabetic right now.
My recent A1c was 5.7. Does that mean I am not diabetic right now?

[dar917]

Here's a chart that shows the relationship between A1c and your glucometer tests.

A1c chart (http://www.healthyinfo.com/clinical/endo/dm/hga1c.test.shtml)

Holy cow! I finally have an appointment on Wednesday; I'm going to guess mine is going to be between 7 and 8....but then my dad often goes into 300s and 400s and his last one was 7.6 so maybe it won't be quite that bad....

[BlueSky]

..... An HbA1c of 5.8 is acceptable and not indicative of diabetes according to the various people, organizations, and agencies who make the dignosis criteria. .....
Mmmm ..... HBA1c is not usually used to diagnose diabetes. But an HBA1c of 5.8% corresponds to average blood glucose of 129 mg/dl. This is higher than the fasting diagnostic benchmark of 125 mg/dl. And blood glucose is usually lower in the morning than it is during the rest of the day, unless of course if you are a diabetic with a strong DP. I know doctors consider an HBA1c of over 6% as diabetic, but I think it would be a mistake to say that an HBA1c of 5.8% doesn't indicate diabetes.

[Larry H.]

Mmmm ..... HBA1c is not usually used to diagnose diabetes. But an HBA1c of 5.8% corresponds to average blood glucose of 129 mg/dl. This is higher than the fasting diagnostic benchmark of 125 mg/dl. And blood glucose is usually lower in the morning than it is during the rest of the day, unless of course if you are a diabetic with a strong DP. I know doctors consider an HBA1c of over 6% as diabetic, but I think it would be a mistake to say that an HBA1c of 5.8% doesn't indicate diabetes.

I am getting more confused by the moment. What does the Mean Blood Glucose mean on my Test? It says 117.8. They listed the AC1 as you say at 5.8. A chart I down loaded says that 117 range is 5.4. I am totally confused by the numbers, but I agree that it is a Diabetic reading and prone to get worse.

[wiseguy]

Larry,

The 5.8 A1c is very good and most diabetics would be very happy with it. It does not mean that you are not diabetic. I know that you are diligent about your diet, carb watching, and daily exercise and these things are the reasons for the good A1c results.

[Ronin]

Larry, et al.,

I want to chime-in here on one side of the Diabetic/Pre-Diabetic debate -- there is the issue of age. If you visit Larry's profile you will find that he is over 65.

Since the inception of the Pre-Diabetic diagnosis (which was intended to capture the young people before they became Type-2 Diabetics) the vast majority of people being diagnosed as Pre-D's are over-50.

That being said, there are those (Dr. Bernstein, et al.) who hold that the bodily response to glucose must be exactly the same regardless of your age -- if you are 9 or 99 the criteria is exactly the same -- never over 120 and always-always-always rapidly returning to the low 70's after eating any amount of carbs.

The problem I have is that our bodies wear-out over time. The pancreas slows or diminishes in the ability to produce insulin. An inactive body also cannot use the amount of glucose that our society makes available to all people.

What I have noted in this thread is that when Larry works on his diet and exercise he manages to keep his BG levels in check albeit not in the perfect range of 70 - 120 at all times. I, like some others contributing to this thread, am concerned for Larry that his highs are quite high. However, as long as he can maintain an HbA1c of 5.8 without medications that is great!

I have no idea about Larry's potential life span, but it would seem to me that he is doing okay. Personally, I don't want to see Larry sacrificing quality of life in pursuit of what Bernstein, et al have set as the "perfect profile." Seeking perfection can, and usually does, lead to burnout.

Larry, you are doing great! Keep up the good work and don't worry about being perfect. A lot of what you are finding may simply be your age. If you can manage to keep your HbA1c levels where they are, or perhaps a bit lower, you will do fine. Remeber that "the enemy of better is 'BEST!'"

[Larry H.]

Ronin,

Well thanks for the encouragement.. That is the essence of the support group for me. I think many of us come at this with slightly different ways of interpreting things. There are probably as many also on the net. My original feeling that seeing the results of my Glucose Meter was a fairly good reflection of what was going on was probably correct. Others come at it a little different. I will continue to have the AC1 test and see what is going on.
I also agree that if all I could ever eat was no carbs at all I probably wouldn't make it.. Moderation and eating things in quantities that allows the sugars to remain reasonable are my goals. When I see that something is amiss I try to reverse it to the best of my ability. Should I get to the point where I can no longer see readings that are tolerable I will most likely seek out medical help for that. I wish to avoid it as long as possible..

[wiseguy]

I find the term "pre-diabetes" to be totally absurd. It's like saying you are a little bit diabetic. The treatment is exactly the same as it would be for the early stage of type 2 which is exactly what pre-diabetes is.

[Ronin]

Wiseguy, et al.,

The diagnosis of Pre-Diabetic is a poor choice. However, it is not an automatic "Early stage Type-2." It all goes to the underlying theory of how diabetes happens. We have the environmental theory that says what you eat can cause the onset of Type-2 diabetes. On the other side are the Genetic thinking people who beleive that your propensity towards diabetes in built into your geneitc structure and all you can do is delay the onset. Both sides have cogent arguments that make sense.

As I wrote earlier, the intended purpose of the Pre-Diabetic diagnosis (which is supported by the environmental argument) was to capture young people and stem the tide of childhood Type-2. The law of unintended consequences kicked in and thousands of people over 50 are being swept into this diagnosis. The result is a general panic in the over-50 crowd and some MD's handing out pills without really knowing how to treat diabetes and others telling their clients not to worry. The result has been more heat than light.

I can only use myself and a close friend as an example of the result of this diagnosis. The presumption of Type-2 has led MD's to assume that the individual, despite their diet and exercise regimines, are "Insulin Resistant" and that was done without a C-Peptide test. Both my friend and I have very low C-Peptide readings. Whoops, the drugs used to treat Type-2 are to increase insulin sensitivity and don't work on Type-1.5's and only cause problems on those of us with a low-functioning pancreas.

Larry has had an HbA1c at our prodding and has found his average BG levels to be "acceptable" in the perspective of controling BG levels for a diabetic. The next question (and the next test for you Larry) is what is your fasting C-Peptide level. If it is high then you are trending towards Type-2, if it is low you are trending towards Type-1.5. This is not a guessing game, it is a test that shows the direction you are headed and therefore tells you what you need to do to slow/prevent the onset.

I accept that my diagnosis as Pre-Diabetic is slippery, and I also accept that I am now a member of the diabetic community and as such have to live a life different from my fellow humans who are not diabetic (yet).

[jvetter18]

Larry,
The A1C is good, not great, but still good, especially w/out meds. I think that maybe a few small tweeks to your excercixse regimen might do the trick. Working out after your biggest carb meal, (like starting 1-1/5 hours after your meal) might help.

the other thing is that your docs lack of knowledge is a little startling. thank goodness you have the sense to advocate for yourself. 200 is not fine, at anytime. He must be "old school". A pulmonary spec. not being to diagnose a heart issue?

if it were me, like we recommended before, i'd start looking for another doc - not just for the diabetes aspect, but just in case something else might pop up. Your doc seems like the take an aspirin and call me in the morning type.

are you too far from chicago or another metro area w/ good hospitals/docs?

[Larry H.]

I am about two hours from any reasonably large metropolitan area. St. Louis being the closest.
So far no one has responded to the Mean Glucose I refereed to on my test results. From what I googled it appears to be a reference point that shows about 15% lower than your AC1 and is the average a person might see on their glucose meter.
Its surprising how many different times are suggested as the length after eating to test. That site said 90 minutes after eating?
Some times I just don't seem to get any relationship between what I eat and what I get on the meter? Last night we had a couple cups of onion soup, a little chicken and turnips an a few pieces of carrot. Low Carb ice cream and I walked and exercised for half and hour.. It came in at 138. Not bad but 20 or more points higher than I got for a sandwich and chips for lunch. It would seem that exercise in general can tend to raise your over all readings?
One benefit of using the Health rider more and for longer periods is that I actually saw a muscle when I flexed my arm while dressing this morning.. that looked good for an old guy!
On the Pre diabetic debate, I don't know what exactly to make of it. We aren't quite yet meeting the type II diagnosis as far as readings go. But yes the numbers come in higher than normal people for sure. When you read the literature, and Wise guy I know you do, then it would appear to say that a percentage of pre-diabetics go onto type II depending on diet and exercise. So does that mean that some won't? I admit mine seems to be creeping higher. I did also see a study last night that related to increased numbers in winter due to the increase in food and less ability to exercise as in summer.

[Harold]

I am getting more confused by the moment. What does the Mean Blood Glucose mean on my Test? It says 117.8. They listed the AC1 as you say at 5.8. A chart I down loaded says that 117 range is 5.4. I am totally confused by the numbers, but I agree that it is a Diabetic reading and prone to get worse.A Mean Blood Glucose means it should relate to a Mean Average of your Meter readings. Say you take all of you meter readings for the last 90 or 120 days and add them up and divide by the number of readings, and the result is a Mean Average of your Meter readings. The Charts you are looking at are a conversion of your A1c, a Weighted Average, to your Meter Average, a Mean Average. I use this to see if my meter checks are really giving me a true ballpark idea of what my blood glucose is doing. Sometimes it does not which means I am not enough of the highs or lows depending on the direction of the difference. In other words I may be going high or low while sleeping and not catching them with my meter.

You mentioned a difference between charts. It sounds like what you are looking at is a chart for Whole Blood Glucose and a chart for Plasma Glucose levels. Labs measure Plasma and Meters measure Whole Blood. Now the reason it gets confusing is Newer Meters are compensated to display equivalent Plasma readings. Check the booklet that comes with your meter to find out if it displays Plasma or Whole Blood. Then use the appropriate chart to compare your A1c to your meters Mean Average.

[wiseguy]

To me if it looks like a duck, walks like a duck, and quacks like a duck... it's a duck. So called pre-diabetes requires exactly the same treatment (diet, exercise, and weight control) as early stage type 2 and it is for life like type 2. If you are diagnosed with pre-diabetes then you will have pre-diabetes your entire life? This is just ridiculous. I have yet to find a study (I don't think one exists) that would provide an estimate on the percentage of those diagnosed with pre-diabetes that are at some later time diagnosed as type 2. I'm willing to bet that the percentage would be very high.

[Larry H.]

This is just one of many sites that discuss this issue. I just found this one for the sake of showing what it says. I personally don't know if its true or not. I just know I have often read similar sites. This one is taken from the MedicineNet.com site.


(The good news for people with pre-diabetes is that they can prevent or delay the development of diabetes with lifestyle modifications. Modest weight loss through diet and moderate exercise (such as walking 30 minutes per day, five times a week) can slow the development of diabetes and can even return blood glucose levels to normal in some people with pre-diabetes. Overweight people who have pre-diabetes need not achieve their ideal body weight to improve their condition; studies show that a weight reduction of just five to ten per cent of body weight can improve blood glucose levels. Since you can take measures to reverse the condition, recognition of pre-diabetes is an important step in disease prevention.)

It does say "Prevent" or delay so it would seem to mean that?

I think I saw wording something like it in the ADA site also.

[wiseguy]

This is just one of many sites that discuss this issue. I just found this one for the sake of showing what it says. I personally don't know if its true or not. I just know I have often read similar sites. This one is taken from the MedicineNet.com site.


(The good news for people with pre-diabetes is that they can prevent or delay the development of diabetes with lifestyle modifications. Modest weight loss through diet and moderate exercise (such as walking 30 minutes per day, five times a week) can slow the development of diabetes and can even return blood glucose levels to normal in some people with pre-diabetes. Overweight people who have pre-diabetes need not achieve their ideal body weight to improve their condition; studies show that a weight reduction of just five to ten per cent of body weight can improve blood glucose levels. Since you can take measures to reverse the condition, recognition of pre-diabetes is an important step in disease prevention.)

It does say "Prevent" or delay so it would seem to mean that?

I think I saw wording something like it in the ADA site also.
Again, what they are saying you need to do is exactly what you would do in the early stage of type 2. You must adopt these lifestyle changes for life in hopes of slowing the progression which, in this context, is the progression from pre-diabetes to type 2. The only difference between what has been labeled as pre-diabetes and type 2 diabetes is a small difference in above normal BG numbers.

Once you are diagnosed with pre-diabetes the word "prevent" does not come into play. You are already a diabetic and always will be (unless there's a cure).

[Ronin]

Wiseguy, et al.,

This discussion has drifted a bit away from Larry's initial questions about the meaning of his HbA1c results into the definition of what is/isn't "Pre-Diabetes." Unfortunately, we are stuck with the term unless/until the powers behind the Diabetic Community change their mind.

Is Pre-D really nothing more than "early stage Type-2?" Perhaps, but what about those of us who are headed towards Type-1.5 (i.e., our Pancreatic function is diminishing and will cease sometime in the future). In the end, Wiseguy's point is well taken.

Those of us with the Pre-D diagnosis may, or may not develop full-blown diabetes (Type yet to be determined). However, the critical issue is that once so diagnosed we cannot return to the typical diet and exercise pattern we had, or that of our society, because that will hasten the onset of the Full-Blown form of the condition.

As I have noted many times previously, the original intent was not achieved in ushering in this diagnosis -- only the law of unintended consequences. Rather than catching young people who are developing Type-2 at an alarming rate, the category is sweeping in loads of the over-50 population.

Perhaps this is because children are tested less often and usually not until there is a "problem" that calls for blood work whereas the over-50 population gets more regular blood work. The other side is that childhood Type-2 is a sudden onset rather than gradual.

What we do know is that modifications to diet and exercise patterns has a good effect on people with "Insulin-Resistance" as well as those with declining pancreatic function. Actually a bit better on the IR folks -- declining insulin production is pretty much a done-deal -- you've eitehr got it or you don't.

The final question to the over-50 population is: What is the necessary response to seeing your BG levels get into the Pre-D defined areas? Personally, some testing, including HbA1c's and C-Peptide readings are required in order to make good decisions as to the direction you need to go. (i.e., For me adding exercise is not as important as watching to see what happens to BG levels because I am not IR, but my pancreas is slowing down and when my BG starts to spike I need to start supplamental insulin.)

As with all things: Knowledge is Power!

[seekerjohn]

Hi Larry--

I am an SIU alum. You might look into the med school there to see what is being done to prevent onset of the disease. Sometimes people get Metformin (glucophage) or even insulin shots, or doses of other things to improve insulin sensitivity. I do know that diet, exercise and control of blood lipids is a concern. Abdominal weight is an areas to watch, I believe.

seekerjohn

from NH

[Ronin]

Hi Seekerjohn!

Your post makes my final point about Knowlege being Power. You wrote: "Sometimes people get Metformin (glucophage) or even insulin shots, or doses of other things to improve insulin sensitivity." The presumption that adult onset Diabetes is always Type-2 is a problem with a lot of MD's who don't have sufficient knowledge to order the right tests. Injected insulin to an Insulin Resistant person might be of some short term assitance, but it does little to nothing to overcoming the underlying IR condition. In the same idea handing Metformin to a person who has reduced pancreatic function doesn't help becaue the person isn't IR -- s/he doesn't produce sufficent insuln and needs insulin shots!

It takes more than one test to determine the full diagnosis of the condition. No single test can be used to make the diagnosis and more testing is required to determine the correct course of treatment.

My personal gripe is with the MD's who, on the basis of one high FBG test, hand out prescriptions for Metforim or tell the person "not to worry" without really finding out what is going on. (Note: A close personal friend was "diagnosed" this way and spent years before another MD ordered a C-Peptide and discovered that the reason the treatment was not working was because his pancreas had all but shut-down and put him on insulin -- instant fix to the "Real" problem.) Pardon my rant.

[wiseguy]

I guess my real problem with a pre-diabetes diagnosis, with terms like "prevent" and "reverse" in the description, is that too many people (even one is too many) will get the idea that if they watch their diet and exercise for awhile the condition will just go away and they can return to life as it was before. I think people should just be told that they are in the very early stage of type 2 diabetes, and with the proper lifestyle changes, they may drastically slow, or even halt, the progression of the disease.

[Larry H.]

No matter what we call it the hopeful goal is to slow the progress of the problem, I think we can all agree on that no matter what you call your present situation. I think the word Pre-diabetes is a red flag here. The medical community needs a way to definitively test for a problem..So the glucose level of 125 was selected to be the fasting level at which type II would be diagnosed after several readings. If there were no marker to go by then everyone could be said to have diabetes because perhaps some day they would reach those numbers. Well we know that isn't true, but it is a analogy of what is going on here. Its already been said that by good control some can reduce the onset or slow the progression of type II. My feeling is that the diagnosis of Pre is simply a way to get the attention of those that are teetering on crossing that definitive line which the medical community has set as the official number.
From what I have read there appears to be a period in which the body retains some ability to still work partially as it
should. That seems to be in that Pre period. With some intensive changes those persons may, some of them, be able to stave off the complete shut down that causes the complicated numbers seen in full blown Type II's. For a while there may actually be a pre existing condition that if dealt with properly could ward off at least for some time farther deterioration.
Perhaps all hope full thinking. I know my numbers are becoming less related to what I eat and more to some changing body functions. I couldn't possibly lose any "tummy" I already have long since lost that. I am eating less carbs and being more active and seeing a very slow creep in some numbers.
All week I saw a few points raise in my morning readings. Like 98-101-104 107- 111- then oddly this morning I got a 99 even after having a reading of 145 when I went to bed due to going out last night and eating a bit too many carbs. But I wondered if maybe my morning readings were actually rasing due to not eating quite enough?

[Ronin]

Larry, et al.,

I can see that you are calming down as you have more information. I am happy for that. You can live with the condition and now you know that. Perhaps, in time, living with the condition will require some additional medication but you are not there yet.

As to the random readings in the AM - FBG levels are perplexing to all of us. Part of that is the infamous Dawn Phenomenon/Effect wich is nothing more than your liver dumping glucose into your blood stream when you awake (or shortly before you awake -- we're not sure on that one either) to provide your body with the energy required to get going. Of course glucose, being glucose, in order to be used insulin has to be secreted to make open-up the cell membranes and allow the cells to use the glucose. Hence the medical term of "Impaired Glucose Response."

I'm going to push you (Larry) for one more test when you can get it -- a fasting C-Peptide. That test will tell you if your body is Insulin Resistant (i.e., High C-Peptice tells you that your pancreas is producing lots of insulin but the cells cannot use it) or if your pancreas shutting down and does not produce sufficient insulin to transport the dump of glucose.

This is an imporant test that many MD's fail to do when dealing with adult onset of diabetes. They assume, like many on these forums, that adult onset automatically means Insulin Resistance (IR). The problem is that the path to dealing with IR is different from the path to dealing with low insulin production.

One final note from me -- you will note that I do not call diabetes a "Disease." Why? A disease implies a cure and today there are means to deal with the problem but there is no cure. Therefore, to me at least, Diabetes is a "Condition" and that implies that we have to learn to live with it until somebody can devise a "cure."

[Larry H.]

Points taken and well made.

[Tropo]

Again, what they are saying you need to do is exactly what you would do in the early stage of type 2. You must adopt these lifestyle changes for life in hopes of slowing the progression which, in this context, is the progression from pre-diabetes to type 2. The only difference between what has been labeled as pre-diabetes and type 2 diabetes is a small difference in above normal BG numbers.

Once you are diagnosed with pre-diabetes the word "prevent" does not come into play. You are already a diabetic and always will be (unless there's a cure).

In a way your logic is flawed. There has to be some high end of normal that is normal enough not to progress to diabetes. You can't just find a number that is normal, and then when that number is exceeded by 1 label that person as type 2.

IMO labelling people as pre-diabetic is a sound practice that has merit.

[wiseguy]

In a way your logic is flawed. There has to be some high end of normal that is normal enough not to progress to diabetes. You can't just find a number that is normal, and then when that number is exceeded by 1 label that person as type 2.

IMO labelling people as pre-diabetic is a sound practice that has merit.
Like it or not that "some high end of normal that is normal enough not to progress to diabetes" is going to be a number, and one number either way is going to be the difference in the diagnosis. And pre-diabetes is not diagnosed when BG levels are in the high end of normal range. They will be above the normal range. A pre-diabetes diagnosis just gives people more fuel for denial of the fact that they are now, and always will be, a diabetic.

There is no cure for pre-diabetes.

[Real4]

A chart I down loaded says that 117 range is 5.4. I am totally confused by the numbers, but I agree that it is a Diabetic reading and prone to get worse.

One must understand that much that you get in medicine (and science in general) is WAG: Wild Eyed Guess. Since the people involved, are educated and are, by and large, intelligent and honest, the guesses are generally good guesses; in the ball park. But, much of what's presented as fact, just isn't any more than a reasonable guess.

(Computer modeling of issues is somewhat different. There you've basically thrown honesty and intelligence out the window in exchange for computerized "exactness". Most often, exactly wrong. This is becoming clearer to many people as they see the results of computer modeling in financial markets.)

[Tropo]

Like it or not that "some high end of normal that is normal enough not to progress to diabetes" is going to be a number, and one number either way is going to be the difference in the diagnosis. And pre-diabetes is not diagnosed when BG levels are in the high end of normal range. They will be above the normal range. A pre-diabetes diagnosis just gives people more fuel for denial of the fact that they are now, and always will be, a diabetic.

There is no cure for pre-diabetes.

You didn't understand my comment, so I'll try again.

The pre-diabetes numbers are quite a wide range. Do you think that every number in that range is an indication of diabetes?

So you think that someone with FBS = 99 is healthy, and a person with FBS = 100 has an incurable disease?

There's always a grey area in any clinical test results. It's quite possible that a person with FBS = 110 will always be 110 and never progress just as it's possible that a person with FBS = 95 may be on a fast track to bigger numbers. Another person with FBS = 95 may remain healthy for the rest of his life and never require medication.

A grey area is always evident in clinical test results and that is exactly what pre-diabetes is. There's no guarantee either way but it can go either way.

"There's no cure for pre-diabetes" is an oversimplification because maybe it doesn't require a cure in many cases.

There's also a body of research pointing to 2 different types of pre-diabetes:

1. Impaired FBS with normal glucose tolerance.

2. Impaired Glucose tolerance with normal FBS.

I've noticed people on this forum with both types

There is some evidence that one type (#2) is more likely to progress than the other.

[wiseguy]

The pre-diabetes numbers are quite a wide range. Do you think that every number in that range is an indication of diabetes?

So you think that someone with FBS = 99 is healthy, and a person with FBS = 100 has an incurable disease?

There's always a grey area in any clinical test results. It's quite possible that a person with FBS = 110 will always be 110 and never progress just as it's possible that a person with FBS = 95 may be on a fast track to bigger numbers. Another person with FBS = 95 may remain healthy for the rest of his life and never require medication.

A grey area is always evident in clinical test results and that is exactly what pre-diabetes is. There's no guarantee either way but it can go either way.
If you get tested properly there is no grey area. If you consistently have fasting BG levels between 100 ans 125 and the glucose tolerance test comes back between 140 and 200 you will be diagnosed as pre-diabetic in most cases (depends on the doctor).

"There's no cure for pre-diabetes" is an oversimplification because maybe it doesn't require a cure in many cases.
Make no mistake about it, pre-diabetes does require treatment even if the treatment is simply a modified diet, increased exercise, and possibly weight loss. And this treatment is for life. You cannot at some time in the future go back to doing things the way you were before diagnosis.

[Tropo]

If you get tested properly there is no grey area. If you consistently have fasting BG levels between 100 ans 125 and the glucose tolerance test comes back between 140 and 200 you will be diagnosed as pre-diabetic in most cases (depends on the doctor).

Make no mistake about it, pre-diabetes does require treatment even if the treatment is simply a modified diet, increased exercise, and possibly weight loss. And this treatment is for life. You cannot at some time in the future go back to doing things the way you were before diagnosis.

Once again it's obvious you don't understand what I'm trying to say.

Your attitude "make no mistake" and "like it or not" is very unscientific. You've got this idea that pre-diabetes doesn't exist and no one can change your mind.

There's nothing cut and dry. There's a tremendous amount of grey that will take a lot of research to clear up.



Here's a question for you. If a pre-diabetic person doesn't modify his diet and exercise will his condition worsen as a result?

For example, if 2 people with exactly the same readings took 2 separate paths for say a year. One ate badly and didn't exercise while the other ate a good controlling diet and exercised.

After the year the bad eater changed to exactly the same diet as the other one. Would they then be equal?...or would the good eater have better FBS levels? How would they compare if the good eater changed to the bad eater's lifestyle?

[Ronin]

Gentelmen, Gentlemen,...

I think you are both missing the critical point -- there is not a single test that should be used to diagnose any condition or disease, including diabetes.

High FBG's may, or may not, indicate the coming of diabetes. The high may well be due to simple Dawn Phenomenon/Effect. Even the HbA1c numbers may be in the "normal" range. Then there is the OGTT, and C-Peptide readings. Now, all of these tests seen together can properly diagnose the condition of the person being tested.

The problem I have is not with the use of the Pre-D diagnosis, but the MD's who see a single FBG>100 and hand the person a prescription for oral medication without any further testing or the MD who sees that same test and tells the person not to worry and everything is okay.

FBG testing, even done by a laboratory, is not sufficiently conclusive to make an accurate diagnosis.

If the addition of Pre-D to the catalogue of diabetic conditions gets people to take better care of themselves (as it did with me) and those people get to know more-and-more about themselves, what is the problem?

In using the Pre-D diagnosis, the environmental theorists will hope that the onset of diabetes can be prevented, the genetic theorists will hope that the onset of diabetes can be delayed. In either case, the person changes the way they live for the better.

What we all want is to prevent the secondary effects of diabetes (numbness, blindness, et cetera) to be prevented. The label matters less than the action taken.

[wiseguy]

Here's a question for you. If a pre-diabetic person doesn't modify his diet and exercise will his condition worsen as a result?

For example, if 2 people with exactly the same readings took 2 separate paths for say a year. One ate badly and didn't exercise while the other ate a good controlling diet and exercised.

After the year the bad eater changed to exactly the same diet as the other one. Would they then be equal?...or would the good eater have better FBS levels? How would they compare if the good eater changed to the bad eater's lifestyle?
How much the condition will worsen depends on the rate of progression of the individual. This is not the same for everyone. However, the person with good control will almost certainly experience more normal BG levels.

After only a year there may be little or no difference in the severity of the condition between the "bad eater" and "good eater". Again this has everything to do with the rate of progression of the individual.

If the pre-diabetes diagnosis is such a grey area then why label it like this? Why not just call it "slightly elevated BG levels"? The reason is because most people diagnosed with this eventually progress to full blown type 2. And why is this? Because pre-diabetes is early stage type 2.

Have you made any lifestyle changes because of your pre-diabetes diagnosis? If so, why? If it's such a grey area then why go through all the trouble when there's just as much chance that your condition will not worsen no matter what you do?

[Ronin]

Wiseguy, et al.,

"If the pre-diabetes diagnosis is such a grey area then why label it like this? Why not just call it "slightly elevated BG levels"? The reason is because most people diagnosed with this eventually progress to full blown type 2. And why is this? Because pre-diabetes is early stage type 2."

Perhaps this requires a Shakespearian response: "A Rose by any other name,..."

We can debate the moniker used by the ADA and the medical community and there will never be full agreement.

My personal opinion is that the ADA was hoping to get the attention of young people before the condition got really serious but also offer the hope of prevention through better diet and exercise. Unfortunately, the vast majority of Pre-D's are over 50.

I stand firm on my objection to the methodology of diagnosis used by lots of MD's that rely on a single FBG over the magical 100 mg/dL.

[wiseguy]

"Perhaps this requires a Shakespearian response: "A Rose by any other name,..."

We can debate the moniker used by the ADA and the medical community and there will never be full agreement."

Agreed, it is just term created by the ADA but I just think they should come up with a more descriptive one.

"I stand firm on my objection to the methodology of diagnosis used by lots of MD's that rely on a single FBG over the magical 100 mg/dL."

I too believe that several types of test should be done before a definite diagnosis is given but the fact is that way too many health care professionals diagnose pre-diabetes, and even type 2, based on the results of a FBG reading. On the other hand, if a person consistently has FBG readings of over 100 and also has several OGTT readings of over 140, the odds are very good that this person is in the early stages of type 2 diabetes.

I read the scientific studies, and then I read another one that debunks the one I just read. I have come to rely solely on my own experiences and what I witness with my own eyes and ears. This is why I believe that diabetes is purely a genetic disease. I refuse to believe that it is caused by poor diet, lack of exercise, or obesity. I have witnessed to much evidence to the contrary.

This is why I believe that when a person is diagnosed with "pre-diabetes" they are actually in the early stage of type 2.

[Tropo]

Have you made any lifestyle changes because of your pre-diabetes diagnosis? If so, why? If it's such a grey area then why go through all the trouble when there's just as much chance that your condition will not worsen no matter what you do?

A good question.

No, I've not made any changes because I've ALWAYS exercised regularly and ALWAYS been concerned about my health and I've never been fat or out of shape. My entire life I've always strived to eat a healthy diet.

This is my dilemma. There's not much I can change to the better.

The only option for me is to reduce the carbohydrate load in my diet....which I haven't yet done.

All I'm doing right now is monitoring my levels to see if there is any progression. I've not seen a deterioration over the last 2 years, unfortunately I don't have a reference to my BG levels before mid-2005.

[wiseguy]

A good question.

No, I've not made any changes because I've ALWAYS exercised regularly and ALWAYS been concerned about my health and I've never been fat or out of shape. My entire life I've always strived to eat a healthy diet.

This is my dilemma. There's not much I can change to the better.

The only option for me is to reduce the carbohydrate load in my diet....which I haven't yet done.

All I'm doing right now is monitoring my levels to see if there is any progression. I've not seen a deterioration over the last 2 years, unfortunately I don't have a reference to my BG levels before mid-2005.
Since you have made no lifestyle changes, and your condition has not worsened in the past two years, and your A1c is in a range that many consider normal, what is your doctor basing your pre-diabetes diagnosis on?

Have you considered that you may have been completely misdiagnosed?

[Tropo]

Since you have made no lifestyle changes, and your condition has not worsened in the past two years, and your A1c is in a range that many consider normal, what is your doctor basing your pre-diabetes diagnosis on?

Have you considered that you may have been completely misdiagnosed?

I've considered it, but my FBS's are usually between 110 - 120. I sometimes post 1 hr PP's in the 160's. My numbers are worse than Ronin's and he's adamant he's pre-diabetic.

When I was ill (cholestasis) back in mid-2005 I was posting FBS's in the mid 200's...and they were tested in a lab.

I do consider myself pre-diabetic, however I don't lose any sleep over it and just keep a watch for now.

I don't have a physician working on this. The one I did use in the Philippines back in 2005 was useless. He was type 2 himself and I saw him down at the local supermarket once with a trolley full of chocolates! I now live in Thailand where I don't relate well to doctors.

[Larry H.]

Here is a line from a long discussion on the progression of PD to possible type II. I couldn't get it to take the whole paragraph, this is from a finnish study, just part of a lot of information on this topic. Wiseguy, I know you at one time realized this was a possibility! You were an advocate of keeping your numbers down, but perhaps your situation was previously such that your goals were not possible.. Maybe for some they still are..

From Consulatantlive.com

(When patients reached all 5 goals (more than 30 minutes per day of exercise, fat intake less than 30% of calories, saturated fat intake less than 10% of calories, fiber intake more than 15 g/d, and a weight loss of 5% or more),the rate of progression to diabetes was almost zero)

You may be misreading the intent of many here. It isn't that anyone thinks they can just go on and do as they please, I think that there are those for whom a good warning of as you say, possible progression to type II, are able at least for a reasonable time to prolong the onset, and some say prevent it. There are endless sites that agree with that. I doubt that anyone who bothers to come here wouldn't be interested in doing what they can to reduce the chances of progression, even though many, and perhaps most will go on to type II.

In the type II discussion group there was recently a good article linked that told of how the progression of the problem worked.. Something paraphrased like at a certain level of blood sugars your body begins to not be able to handle the carbs as it used to.. That might be the intolerance theory, but that after enough high levels of sugars the system eventually trips and no longer can deal at all with the carbs and that is when the high, difficult to control numbers come in to play. From what I recall it says something to the effect that if blood levels remain at over 140 for periods of time the breakdown begins and eventually the ability for the cells to work stops.. type II...

From that report I feel that the idea some have here of keeping a watch on the situation and keeping active and eating well can slow or maybe stop that damage that would lead to type II.

Sorry for the layman reporting, but you get the idea.

[wiseguy]

I've considered it, but my FBS's are usually between 110 - 120. I sometimes post 1 hr PP's in the 160's. My numbers are worse than Ronin's and he's adamant he's pre-diabetic.

When I was ill (cholestasis) back in mid-2005 I was posting FBS's in the mid 200's...and they were tested in a lab.

I do consider myself pre-diabetic, however I don't lose any sleep over it and just keep a watch for now.

I don't have a physician working on this. The one I did use in the Philippines back in 2005 was useless. He was type 2 himself and I saw him down at the local supermarket once with a trolley full of chocolates! I now live in Thailand where I don't relate well to doctors.
The way you explain your present lifestyle pretty much mimics the prescribed lifestyle that a type 2 diabetic would need to follow in order to control the disease without medication. If it weren't for this I would imagine that your BG levels would be much higher. Hopefully you will be able to keep control this way for years to come.