My doc. thinks I'm crazy

[homeschoolmom]

Hi,
I've been reading your postings for awhile and thought I would post a question about whether I'm prediabetic.
I think my doctor thinks I'm crazy. I had a fasting bs of 102 taken 4 months ago, so my dr. ran an ha1c. It came back at 5.3. He told me I was normal and to forget about it. The problem was that I kept having this tingling/numbness in my legs. I found that when i cut back on the carbs, the tingling went away. My dr. thinks it is impossible for me to have nerve damage with a 5.3. He also thinks it is impossible for someone with my body type to have type 2. I currently weigh 112 pounds, 5'5", very active, no history of diabetes in my family - so you wouldn't think I would have this problem. -The only reason I might have this problem is because of my love for carbs (growing up I would have a baked potato AND french fries for lunch, 4 pieces of garlic bread for a snack after school, etc.) BUT, since he said I was normal, I went out to eat with my husband and had a huge meal (carbs included potatoes and cheesecake). Sure enough, in the next hour and a half, I urinated 4 times and had a very dry mouth. I bought a meter to prove to myself it was all in my head. Fastings run anywhere from 59 - 91 averaging at 76. Post meal highest # was 188 after spaghetti taken at 1 hour. I exercised and took it again at 2 hrs and it was below 100. Dr. ordered a glucose tolerance test that came back normal with 111 reading at 2 hours. Again, I thought I was normal, so I ate slightly more carbs than usual and had tingling in my legs again!!! My family thinks I'm crazy, but I know it isn't in my head!! What should I do?

[morrisma]

Welcome to the forum.

If nothing else, the numbness will cause you to eat healthier foods by reducing carbs. Not a terrible outcome. Your numbers sound 99% normal while you do exhibit a few common symptoms. Not sure what to make of that. Ever had an allergy test done to figure out if you have any food allergies?

Maybe another forum user will have had this too and jump in.
Mike

[BlueSky]

.... I went out to eat with my husband and had a huge meal (carbs included potatoes and cheesecake). Sure enough, in the next hour and a half, I urinated 4 times and had a very dry mouth. .... What should I do?
It sounds like carbs don't agree with you. So keep away from them, especially the high GI carbs (potatoes, bread, sugar, sweetened drinks, sweets, deserts etc). It should make you feel better. And it may reduce your risk of becoming a T2 diabetic in the future. ;)

[Funnygrl]

I agree it's darn near impossible to have nerve damage, at least from diabetes, with an a1c of 5.2. I doubt you have diabetes, or anything that resembles it, but if it helps, there's no harm in cutting back on carbs.

[Larry H.]

I have a similar numbness in the toes and after walking for exercise I have a tingly feeling in the feet. My numbers are a lot higher than yours but not awful compared to many. So I don't know if something I was doing for a long time before I knew about this or maybe its poor circulation as my hands and feet are very cold in cold weather.
I can relate to the heavy carb usage, but I don't know if its a factor or not. All my relatives ate about the same as me but none of them are diabetic either? But I sure liked my coffee cakes and other high carb items.
As others have said, cutting down can't be all bad, although I also have lost considerable weight and you don't sound as though you can much afford to loose much.

[wiseguy]

First you should look into finding a good doctor. Thinking it's impossible for someone with your body type to have type 2 shows that he doesn't know what he's talking about. I assure you that there are plenty of thin and fit people with type 2.

From what you have said I think you can rule out diabetes as a cause of the tingling/numbness in your legs.

[homeschoolmom]

Thank you for your responses. I thought the tingling wasn't related to bs also, and I researched everything I could think of that might be causing it. I kept coming across articles that linked prediabetes and neuropathy. If you google the two, you will find that these researchers have found neuropathy can be the first sign of impaired glucose tolerance. So it seems that this can happen early on - before diabetes - not necessarily after years of living with diabetes. There does seem to be a direct correlation between the bs and tingling. When my bs is high, my feet feel like there are bugs crawling on them. When my bs is low, I'm fine. It wasn't until the tingling feet/legs progressed to actual numbness in the lower part of my right leg that I realized I must be experiencing nerve damage.

[BlueSky]

I have also seen reports of neuropathy by people with near normal blood sugar. The problem is that it doesn't fit the mould. It has always been thought that high blood sugar is a requirement for peripheral neuropathy. This is not always the case. This abstract may interest you :

Impaired glucose tolerance and neuropathy.
Smith AG, Singleton JR.

Department of Neurology, University of Utah, Salt Lake City, Utah 84132, USA. gordon.smith@hsc.utah.edu

BACKGROUND: Peripheral neuropathy is common. Diabetes is the most common cause, accounting for approximately half of cases, but up to 1/3rd of neuropathy patients have no identifiable etiology. Among this population, impaired glucose tolerance (IGT or "prediabetes") is observed in approximately 40%. The exact nature of the relationship between IGT and neuropathy is debated. REVIEW SUMMARY: A variety of evidence suggests IGT causes neuropathy. Neuropathy may occur early in diabetes. The neuropathy associated with IGT is clinically similar to early diabetic neuropathy, with preferential injury to small nerve fibers resulting in pain and autonomic dysfunction. IGT and diabetic neuropathy patients share abnormal microvascular endothelial dysfunction. Treatment of IGT subjects with diet and exercise reduces risk of progression to diabetes, and those with neuropathy experience a short-term improvement in small fiber function with sustained benefit for pain. An evolving literature links other aspects of the metabolic syndrome to peripheral neuropathy. CONCLUSIONS: IGT is common in peripheral neuropathy patients. The extent to which IGT directly causes nerve injury as opposed to being a covariant with other equally or more important features (eg, obesity, metabolic syndrome) remains to be determined. Preliminary data suggest diet and exercise counseling may be a useful treatment strategy.
Impaired glucose tolerance and neuropathy. [Neurologist. 2008] - PubMed Result (http://www.ncbi.nlm.nih.gov/pubmed/18195653?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA)
The bit that I bolded essentially says that lots of people with neuropathy of unknown cause, have pre-diabetes. It looks like you fall into this category.

Normal blood sugar is 70-90 (average of about 85mg/dl), and your HBA1c of 5.3 corresponds to an average blood sugar of 111ml/dl. And a fasting level of 103 is pre-diabetic. Reducing carbs in the diet looks like the way to go to me. ;)

[xMenace]

I'm almost ready to vote crazy. If there was apoll, I probably would. But one thing diabetes teaches us is that these are incredibly complex bodies we inhabit. When it tells us something is wrong, it usually is correct. Maybe start looking at foods as foods instead of as carbs. Follow the new food credo: Eat foods. Not too much. Mostly plants. Then you may Live Long and Prosper! http://www.adiumxtras.com/images/thumbs/spock_adiumy_1_10193_3811_thumb.png

[BlueSky]

I... Maybe start looking at foods as foods instead of as carbs. Follow the new food credo: Eat foods. Not too much. Mostly plants. Then you may Live Long and Prosper!
Mmmm .... I am not sure what you are trying to say there. But if you followed Michael Pollan's very sensible advice, as explained in his book In Defence of Food, you would stop eating processed food. That includes everything that contains sugar, HFCS and flour, or about 60%+ of the carbs people eat. ;)

[Ronin]

Hi Homeschoolmom!

You aren't crazy, you are experiencing some symptoms and do not know the cause, but you are concerned about becoming diabetic.

The results of your home testing along with the lab tests would tend to confirm what your MD is saying -- you do not currently meet the criteria for a diagnosis of either Diabetes or Pre-Diabetes. (Just curious, did your MD order C-Peptide levels during the OGTT -- that can be very important if/when you discover a problem.)

I fully understand the frustration with the frequent urination, dry mouth, and tingling sensations. Your body is sending you a message to slow down on the carbs. So, you should start listening to your body.

However, you need not go "Cold-Turkey" and eliminate carbs from your diet as it seems your body can manage a fairly good carbo-load (as noted by the OGTT). What you need to do is make carb portions much smaller and spread them out. So, when you have pasta, go to half or a quater of what you consider normal and do not have bread or other high Glycemic Index (GI) carbs in the same meal. That gives you a choice, either carbs in the meal or dessert.

Also try to position your carb intake just prior to aerobic exercise periods as the exercise uses the carbs rapidly. After exercise you can have a small amount of carbs but meals not followed by exercise should be primarilly protien.

Of course shifting your carbs from the simple/refined forms and to the natural and more complex forms will help by slowing the processing, but even here you must exercise caution that you do not overload your system.

That's my $0.02 on the question.

[homeschoolmom]

My dr. did test c-peptide levels which came back low normal at .8. He also tested my blood for antibodies which would show potential for developing type 1 - negative. All of this coincides with several other health issues that were discovered in a matter of days (premature menopause at 37, osteopenia, mutation of the Mthfr gene (blood clotting disorder), mildly positive ana test for lupus - later tests showed negative - so I'm wondering if stress played a role in this? Anyway, I can honestly say that I've never eaten healthier in my life since all of this happened! - My husband and 4 kids are eating much healthier also! :) Sometimes thin people can be deceived into thinking they are healthy -when really they just have a high metabolism. This was how it was with me. Thanks for all your great advice!

[Ronin]

Hi Homeschoolmom!

Thanks for that update. Your C-Peptide is lower than mine, and that is part of the reason I'm classified as Pre-D. Therefore, your problem is that your body isn't producing sufficient insulin to meet all of the needs that a high carbo-load can drive. Hence, you A1c is "okay" but not terrific -- that is to say good for a diabetic but not good for a non-diabetic.

That is the bad news, the good news is that insulin will help you and you are not Insulin Resistant. Of course diet modification and exercise will help and make your bodily insulin production more in line with what you can handle. There is even some thought that if you are suffering from "Beta Cell Burnout" that reductions in your carbohydrate intake can slow or stop the process as long as you don't have the auto-immune problem.

You may not like the idea of potentially going on insulin. However, there is a lot of knowledge on how to use insulin and the side effects are nothing compared to the other drugs used for Type-2 people.

As to the family issues, it is true that whenever any one person in the house starts to deal with a dieatry issue, suddenly everybody starts eating better as a result.

[homeschoolmom]

Hi Ronin,
I'm really confused. Do you think I need insulin? My. dr. doesn't think there is anything wrong with me, so he will really think I'm nuts if I tell him I think I need to be on insulin! My c-peptide was low, but normal - so that means I don't produce enough insulin since I'm having these high blood sugar reactions? Also, I thought beta cell burn out was from insulin resistance - it's from low insulin production? Why didn't my dr. seem concerned about my c peptide? Sorry so many questions, I just need you to explain a little more what you're talking about. Thanks.

[BlueSky]

... I'm really confused. Do you think I need insulin? ...
The test results are confusing, but that is often the case ;) . The elevated blood sugars suggests insulin resistence, but the low-normal c-peptide is not consistent with this. And the negative antibody test result suggests that there is no autoimmune attack. But it doesn't preclude it. Apparently 20% of T1s don't test positive for the GAD antibodies, so this is still a possibility. You will know if this is the case soon enough - your blood sugars will rise. But there is no point in going on insulin unless and until this happens. For all we know, something else could be causing the slight elevation in your blood sugar.

[owlyn]

Present a problem to an engineer, and he will give you an engineering solution. Present the same problem to a marketing person, and you will get a marketing solution. You have presented your symptoms to a diabetes froum, so the answers all surround diabetes. Your problem may have nothing to do with diabetes at all. You may have something else wrong, nothing at all, hypochondraia, or are just crazy :) Your best bet is to tell your dotor what your symptoms are, and not try to steer him towards your diagnosis of your problem.

[lilituc]

I had very similar things and lab results, and I "passed" my first glucose tolerance test and was classified pre-diabetic. In the end, I turned out to have LADA (which is a form of Type 1), but it wasn't clear because I had caught it so early. So is it possible you could have LADA? Yes, especially with that c-peptide.

However, most doctors (that even know what LADA is) would say it's too early to start treatment. I didn't start treatment until almost a year after my initial diagnosis, and it wasn't until six months after that that it was much more clearly LADA and that's when I went on insulin. So even if you got a very pro-active doctor, they would most likely tell you to just monitor it. That doesn't mean that you shouldn't seek out an endocrinologist if you have access to one, though. If you do have LADA, your progression will be individual; there's no way to predict how just quickly or how slow it will be.

Another possibility you might want to look at is MODY. Often people with MODY have a normal or near-normal fasting, but abnormal insulin response to meals. MODY - It's Not Type 1 and Not Type 2, but Something New (http://www.phlaunt.com/diabetes/14047009.php)

[Ronin]

Hi Homeschoolmom!

Take a deep breath, calm down, relax and know that all of us have been where you are right now. Confusion and frustration are the first steps.

Regarding insulin. My comment was that, given your low C-Peptide reading, the treatment for you BG levels will most likely be insulin. At present most diabetics would be quite happy with your HbA1c and OGTT results -- and you aren't taking any medications!

Personally I'm a strong advocate of getting the C-Peptide readings because they determine the best treatment path. Many MD's assume that all adult onset diabetics (including some who include us Pre-D's) is to start trying drugs aimed at increasing insulin sensitivity with the assumption that we are all Type-2's and Insulin Resitant (IR). Your C-Peptide (as well as mine) say: sorry, not IR in this case, low insulin production. That will save a whole lot of trying this medication, then that medication, and putting up with the side effects while the real problem isn't being addressed.

Right now we Pre-D's are in what some call "The Honeymoon" where diet and exercise manage to keep our BG levels in check and we are not in serious danger for diabetic complications. I prefer to borrow a term from the Prostate folks and say we are in a period of "Watchful Waiting." We test, not as frequently as Type-1's or 2's, but keeping an eye on our FBG's with occasional looks at our two-hour post-prandial responses to foods. What we are looking for is the day (that hopefully never comes) when the BG levels start to rise and diet and exercise no longer constrain the rise. Then, as far as I'm concerned I'm ready to start using Insulin because I know that people have already developed the formula for dosage and the side-effects are minimal as compared to the drugs used when an MD is fishing around for the "right" drug to work on a person who is producing Insulin like crazy but it just doesn't work for them.

Don't feel crazy. Just ask the folks here on DF about my first six-months of posting where I was going bonkers. Time allowed me to gain knowledge and perspective. With that I am facing my future currently not using meds, but prepared to start when that will be necesary.

[parrotletzoo]

a c-pep level of .8 is normal. your ogtt was normal and your fasting blood sugar were normal. I'd say diabetes isn't in your picture.

tingling in the legs can be caused by many things. nerve impingement or injury in the back, gleuts, hip. leg. Other thing effect nerve health like b vitamins, calcium levels, omega 3 fatty acids, not to mention tingling can be muscular as well. Kidney disease, liver disease, electrolyte imbalances, parathyroid disorder, adrenal disorders all can cause tingling sensations.

I'm not trying to cause problems by saying all this, I"m just trying to point out that diabetes isnt the only thing to cause that symptom and if it continues to bother you, ask your doctor to send you to a neurologist or specialist that might be better able to look at your medical history to determine what the underlying cause is.

meanwhile, if you seem to have increased symtoms after eating certain foods and it is bothersome, don't eat said foods. Make sure you tell your doctor about that symptom also so they have all of the information they need.

[birdyland]

Have you had your thyroid checked? Hypo/Hyper thyroid can both cause tingling... AND MAJOR CARB CRAVINGS!