pre-diabetic

[sandmcd]

Just what is the definition of a pre-diabetic? I see it used in a variety of ways by people including myself.

[Larry H.]

Somewhere here I had copied something off the net which says this;

Glucose Levels;

Pre diabetic; 100 to 125 fasting.

2 hours after eating 70 to 145

random 70 to 125

I think I saw another site though where they said that up to 200 after a meal might be pre diabetic and over it would indicate type II? No expert here, just something I have on a card file.

My take is that the word Pre is designed to get your attention before things really get worse and attempt to stave off any much higher numbers for as long as possible, thus reducing the risk of complications. Many think it means your going to eventually end up type II if your current numbers indicate a problem approaching. Some sites again however say that some people who make changes can possibly avoid becoming type II though diet and exercise and some with meds. Everything I read says the diet and exercise is the most beneficial but at some point if it does keep increasing you may need the medical help.

[Ronin]

Hi Sandmdc!

The diagnosis of Pre-Diabetic is, at best, controversial. The intent of adding this category to the growing realization that Diabetes is not a single condition, was to attempt to catch people before full blown diabetes manifests itself. The basic argument is largely from the Environmental Theory of Diabetes formation -- i.e., it is our lack of exercise, poor diet, et cetera that causes the onset of Diabetes.

Most of the advocates of the Pre-D Diagnosis thought this would sweep in a lot of young people before they began to display the syptoms of full blown diabetes. What actually happened is that a whole lot of people over 50 have been handed the diagnosis, and depending on their health care provider have either been told to change their diet, exercise more, and, in some cases, start taking medications.

To say that the diagnosis is controversial is to put the question mildly. Many Type-1 and Type-2 Diabetics have strong objections to the diagnosis calling it nothing more than "early-stage" diabetes. Perhaps that is true, however the environmentlaists beleive that, caught early, the onset of diabetes can be stopped. The Genetic Theory says that you may stall or delay, but never prevent the onset of the condition if it is in you genetic code.

All of this is why I am a strong advocate of testing more than just FBG levels. I think that the higher than 100 mg/dL reading must be confirmed with an HbA1c test. If the A1c says that you are in the diabetic mode or trending towards the upper end of the scale and are over 50, you should also have your C-Peptide tested to see if you are Insulin Resistant or if you have low insulin output because the regimine and treatment for Type-2 diabetes (the common presumption for adult onset high BG levels) is not the same as for people who have a pancreas that is shutting down or unable to produce sufficient insulin. Type-2 requires drugs to increase the sensitivity of cells to insulin while Type-1 or 1.5 requires supplamental insulin.

All of this verbiage has been summed up by one DF member's signature block which says "We don't have a stinkin' clue." To be sure, improving your diet and exercise will not harm you. However, treating the wrong condition can have serious consequences. Your body isn't managing glucose the way it should, but the question that must be answered is "why?"

[mho357]

I agree with Ronin but I take it one step further. I believe that the diagnosis is reckless at best. The year before my Dx, the nurse at my doctor's office told me that I was what they called pre-diabetic and to "watch my sugar". The way she said it made me think that there was nothing to worry about. Had I known what it really meant was that I was in the early stages of type 2, I might have reacted differently. I did not change a thing until the following year I had an a1c of 7.0 and a type 2 diagnosis. Could I have reversed it before I got to that point? Probably not but I could have delayed things a bit.

Mark

[Ronin]

Mark, et al.,

Yeah, it is that old law of Unintended Consequences taking effect. What irks me is that there are so many MD's out there who don't do the appropriate follow-up testing.

I'm assuming that your current Type-2 diagnosis is correct, the unfortunate part is that you did not get the correct information (based on test results) earlier.

Personally, I am one of the more fatalistic people and subscribe more to the genetic theory of diabetes formation than of environmental. That means if you have the predisposition in your genetics it is going to happen and the only thing you can do is delay the onset.

To me the environmental issues are secondary factors that exacerbate the underlying condition. Too much food, too little exercise and the condition kicks in earlier. To some extent the condition can be stalled by lowering caloric intake and increasing exercise. But that is good advice for anyone -- Diabetic or not.

[sandmcd]

Well, I am not overweight, exercise, eat well, no history of diabetes, excellent trig., cholesterol, and controlled BP. But.....6.8 A1c and blood work fasting 13 hrs glucose random was 136. Soooo .... now I'm on metformin (started Thurs.) Can't eat much because of stomach issues...nausea, etc. Only hope all further testing in 2 months shows improvement.

[princesslinda]

Sandmcd, with the metformin, many have gastric "issues." For me, these alleviated quickly, though I always had a little difficulty if I ate something that was "greasy." If your nausea doesn't abate soon, call your doctor and see if you can be switched to the "extended release" metformin, as many tolerate it better as it releases more slowly throughout the day than does regular metformin. Also, make sure you don't take it on an empty stomach.

[sandmcd]

I always take it with food and actually if I eat ALL DAY LONG, I can be fine. " Feed a cold , starve a fever"....well "feed the nausea, and it goes away!" Of course, I may weigh 20lbs. more before it abates!!!!!!!! My prescription was by mail 180 tablets...don't want to buy more unless I absolutely have to.

[Ronin]

Hi Sandmdc!

Okay, what is your fasting C-Peptide level? Your FBG and HbA1c results say clearly that you have a problem with your body managing glucose levels. But if you do not know the rate of insulin production of your body you do not know the cause.

I have a strong suspicion that you, like a lot of other fit and not overweight people diagnosed as Pre-D, have a low producing pancreas or a pancreas that is failing. If that is, in fact, the problem, met will not make things better becuause you are not Insulin Resistant -- you may well be Insulin Insufficient. The treatment for Insulin Insufficiency is "Insulin."

To be sure, much of medicine is trial and error, but there is a test to determine the insulin production of your pancreas and that is the C-Peptide test.

Unless you have had the C-Peptide check your MD is making the presumption that all adult onset diabetics are Type-2 and therefore IR -- sorry that is not the case. I know because I know six other people that have gone through the mill only to, in some cases years later, find out that all they needed was insulin. So much for trial-and-error.

Apologies for the rant, but this is an issue that makes my blood boil -- MD's simply handing out prescriptions without really knowing what is causing a problem. The process is called "Anchoring" where the "professional" makes a diagnosis and hangs on until there is clear evidence that he is wrong and even then many will not admit that they were wrong.

[Ronin]

Hi Sandmdc!

A bit of background for my rant. Check out the following Metformin - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Metformin). You might try printing it out after you read it and highlight the portions referring to the fact that this drug is aimed at, and most useful for, Type-2 diabetics who are both overweight and Insulin Resistant.

From your self-description you are not overweight and it is yet to be proven that you are Insulin Resistant.

Ask your MD if S/He (I have the feeling that it's a "he" but I'm not sure) knows about Type-1.5 diabetes or adult onset Type-1? Does s/he know if you are simply slowing down in the pancreas department, or is s/he simply writing a prescription based on insufficient knowledge just to do a trial?

Please get more information on your condition.