New here with some questions and observations..

[felinefan67]

Hi. (this is going to be long)

I haven't been "officially" diagnosed with pre-diabetes however my father was diagnosed with Type 2 last year (He's 70).

I am 40 and haven't had the greatest eating habits over the years and wasn't a very active person (especially in the winter).

I started testing my fasting blood glucose last fall with my dad's meter. I tested 99 in Sept, (Lab work at the dr.'s office also came back 99 fasting in Oct of 07. I remained 99 in Nov/Dec.

Over the winter I injured my femoral nerve in my right leg and my pelvic bone. I was pretty much laid up for much of the winter although I did get up and go to work every day.

I tested myself again this March on Easter Sunday and my FBG was 102. A week later it was 101, then a few weeks later it was 102. I asked my DR. for a A1C test which came in at 5.5 (I've seen some sites say that 5.6 starts pre-diabetes). During this time I started to exercise and diet (Eat Right 4 Your Type, blood type diet) The Nurse at my DR's office made light of my A1C reading and said 5.5 is normal and if I had any more concerns to consult with my DR. at my next physical (Oct of 08).

Just this morning I tested my FBG and it came out at 74!! I tested again an hour and 45 minutes minutes after breakfast (Oatmeal and fruit) it was only 85.


I am a bit confused and have some questions:

If FBG numbers can flucuate, how on earth can a Dr. make a diagnosis of "PRE-diabetes" from fasting numbers at a physical? What if I just went on a day where the numbers just happened to fall in the normal range or the abnormal range??

AND if the numbers can reverse down that low from 102 down to 74, does that mean I am pre-diabetic with a normal reading for a change, OR was I a normal, non-diabetic that happened to have a couple of abnormal (pre-diabetic) numbers due to stress (from my injury and subsequent inactivity??)

I also ate an abnormally high amount (way more than usual) sugars and carbs over the winter due to being "bored" and housebound from my injuries.

I had ONE doctor call me an out and out diabetic (Some of you here may agree) and another doctor say "102 was your fasting?" "Don't worry about it". "If you are pre-diabetic, then we all are."


I might add that my dad has the same blood type as me and is following this blood type diet RELIGIOUSLY and STRICTLY and his numbers are near normal most of the time. He was diagnosed when his numbers were in the 400's but very quickly on this "diet" his numbers came and stayed down. His doctor is skeptical but amazed at the same time.

Should I worry about my A1C number and the three FBG in the early Spring??

I'm beginning to think if the numbers can fluctuate between normal and abnormal then how can the medical profession truly nail down a diagnosis of pre-diabetes??

My Doctor didn't feel it neccessary to perform an OGTT test just yet.

[felinefan67]

I thought this would be helpful forum?? 65 views and not one reply??? Can anyone suggest a different forum maybe?

[xMenace]

If FBG numbers can flucuate, how on earth can a Dr. make a diagnosis of "PRE-diabetes" from fasting numbers at a physical? What if I just went on a day where the numbers just happened to fall in the normal range or the abnormal range??

I'm beginning to think if the numbers can fluctuate between normal and abnormal then how can the medical profession truly nail down a diagnosis of pre-diabetes??

It's like a speeding car. Do you really know it's speeding if it's going 60 in a 55?

Diabetes is like going 75+. I was doing 220 at diagnosis. It was pretty ****ing clear.

I thought this would be helpful forum?? 65 views and not one reply??? Can anyone suggest a different forum maybe?

At 12:15am you only have the west coasters, who we all know are high on designer drugs at that time, and the Aussies, who are shutting down for the winter because they no longeer sweat all day.

Really, do you think anyone is going to pay much attention to a normal person on a forum like this? Puhleeeeease!

The bottom line is a human body is a wondeful and complex thing. Testing procedures are not exact and neither is diagnosis. Wait until you get into treatment...perhaps you are glimpsing our whacky lives just a little bit ;)

[Penny]

You are very welcome here. Some of us might read your post and not know how to help you. I often just greet people because I have little else to say. I don't understand what you need now....for someone to tell you that you are Diabetic? Your doctor needs to be tthe one to do that. This is a really good forum, just give them time, someone will respond with the information you need.

[davef]

Felinfan,

The area of pre-diabetes is not something I am at all familiar with, partly becuase in Ireland there is no official classification of pre-diabetes (I believe this is largely a political decision) and also because there was no doubt when I was diagnosed, my A1c was 11.6 and FBG was 378.

I would suggest that if you are seriously concerned about being diagnosed as T2 that you should consult your Doctor. He will not base diagnosis on one FBG, to my knowledge doctors look for 3 "abnormal" FBG AND look at your A1c's before making a diagnosis.

If you feel you are likely to be diagnosed and have a strong family history, then perhaps it would be wise for you to consider your diet, can you make any changes to make it a healthier diet, could you cut down slightly on your carbs or the sweet things?

You didn't get a reply from me earlier, because I haven't been online, like Penny I generally respond when I have something to offer. I don't think it is necessarily fair to complain about 65 views and no answers, it is no harm to have 100 views and only one valuable answers rather than 100 answers that won't help you.

You are very welcome here, please try to give your a little break and don't stress out to much, most of us here would love your BG readings. I would urge you, if you are concerned to speak to your doctor.

[fgummett]

Welcome... I agree with above comments. Your tests seem great to me. Bearing in mind that blood glucose meters are not that accurate... they can differ by 15, 20% or more, so you really can't compare a fasting 99 with 101, 102 or even 74 for that matter.
If you are concerned, by all means check with your Doctor but also use this opportunity to live a healthier life... the diet and exercise changes are really what everyone should be doing anyway.

[princesslinda]

Welcome Felinefan....sorry you've not gotten the number of replies you've hoped for....you came on past my bedtime;) .

With your dad's diagnosis, you now have a family history of diabetes, so there is a chance at some point in the future you may develop it as well. Maintaining a healthy weight, getting regular exercise and eating will hopefully keep you diabetes free for a long while. Sounds like you are doing well for now.

I'd consider your dad's diagnosis a wake-up call for your entire family to be healthier.

One thing to consider....all of us Type 2's were pre-D at one point, whether we knew about it or not. If you think you may be pre-D (and only your doc can diagnosis this) be extra-diligent about your health and have regular checkups so that if you progress to T2, you'll know early and be able to control it easier.

[Coppernob]

Hey there Felinefan - please feel welcome as this is a wonderful and supportive group of people who always try to help - well that has been my experience anyway.

I did look at your thread last night but it was late and I was really tired. The other thing is I never encountered the term pre-diabetic until I joined this forum last month. Consequently I didn't feel I could help.

I know your physical is not until October '08 but could you not either ask for a phone consultation with your Dr or make an appointment - then make a list of all the things you want to discuss. Let your Dr know how concerned you are - that might help. Sorry not to have more concrete input. Apart from that, I agree with the comments and advice of the others here.

[notme]

Welcome to Diabetes Forums felinefan. Many times there are people who come to this site to just read. They are not members and they will view a thread without the ability to post. We have great members who do their very best to help anyone who may have a diabetes question. We have parents of children with diabetes and girlfriends who have questions about a boyfriend with diabetes.

In your specific case, I would suggest you not worry much yet. Meters have a 20% error rate and your tests suggest you are not pre-diabetic or diabetic. If you take an average of your readings, you are well within the normal range. I would be more concerned if you were symptomatic.

Stay in contact with your doctor. Let him run lab tests during your check-ups if you are concerned. If you develep symptoms of diabetes, by all means make an urgent appointment.

Good luck to you and Welcome to Diabetes Forums.

[patricia52]

So sorry I did not see your post earlier. I know how frustrating it is to be uncertain about your #'s and symptoms. I was there just a few months ago.
It sounds like the diet and exercise accomplished for you what I was not able to accomplish. Keep up the good work and keep a watch on those #'s from time to time. If they start to creep upward again talk with your doctor again.
Check back here any time you have questions. There are some really good people here that know a lot more than I know.

[Tropo]

I tested myself again this March on Easter Sunday and my FBG was 102. A week later it was 101, then a few weeks later it was 102. I asked my DR. for a A1C test which came in at 5.5 (I've seen some sites say that 5.6 starts pre-diabetes). During this time I started to exercise and diet (Eat Right 4 Your Type, blood type diet) The Nurse at my DR's office made light of my A1C reading and said 5.5 is normal and if I had any more concerns to consult with my DR. at my next physical (Oct of 08).



I'll put it to you straight and tell you what you probably don't want to hear.

I've had 2 recent HbA1C's at 5.7 and I consider myself to be pre-diabetic. You're getting close to those numbers and you have a sedentary lifestyle with bad eating habits and you're 8 years my junior.

Your HbA1C of 5.5% translates to an average BG level of 119. Mine translates to 126. A truly normal level is under 100 average which translates to an HbA1C of under 5.0%.

You should be concerned.

Did you know that some people can have good FBS readings but still have impaired glucose tolerance?

Some people can have impaired fasting glucose with normal glucose tolerance.

Your doctor sees quite low numbers so he considers you to be normal and probably didn't see the need to check your glucose tolerance with an OGTT (oral glucose tolerance test).

Get a test done and check for yourself exactly where you are.

Right now you may be a pre-pre-diabetic, but you're near the border and with your lifestyle things can only get worse.

[REDLAN]

nice post with some interesting numbers...

to answer the question - am I pre-diabetic?

I don't know, and nor does your doctor....

yet

let's first off clear up some of those uncertainties

first off Hba1c's and those average BG's - they were calculated from the DCCT - Diabetes Control and Complications Trial, which looked at type 1's. They're still relevant to type 2's, however there is something that you need to understand about HbA1c's.

there is large variations between individuals. Similar average BG's can lead to HbA1c's to vary by as much as 1.0%. Your 5.5% could be someone else's 4.5%, and you could both have the same average BG. Treat HbA1c as your own personal average BG, and you won't go far wrong. Oh and differences of 0.1 to 0.3% from one reading to the next are of no consequence - effectively they need to be treated as though they are the same. It's down to the accuracy of the machine that measures them.

Now for the fasting glucose test results...

WHO guidelines say that IFG (impaired fasting glucose) are values between 6.0 and 7.0 mmol (108 to 126). So....

technically you do not have impaired fasting glucose, but what is described as a high normal fasting glucose. However your family history means that your high normal is more significant, and may mean that you are at much greater risk of developing diabetes.

so why do they choose 108 as the cut off for IFG? It's all to do with false positives. They chose this value because it excluded a sufficient number of those high normals, to make it an effective cut off point.

A diagnosis is never made on the basis of just one blood sugar test. So could your high fasting glucose be down to your recent sedentary habits and an injury?

It's possible. If your fasting BG stays around it's current level you probably do not have anything to worry about. But don't take my word for it - see your Endo.

another cause for the variation in your fasting glucose. Over winter the body slows down and attempts to store fat. It does this by increasing insulin resistance (specifically your muscles find it harder to absorb glucose, forcing your liver to convert more glucose into fat). In your case it elevates your BG. Now that spring is here the reverse happens - insulin resistance drops and your body starts mobilising those fat stores.

onto glucose tolerance tests.

this is a much more sensitive test i.e. it will catch more people with pre-diabetes, however it will also catch a load more of those high-normals. They may well have borderline OGTT, but never go on to develop diabetes.

[jakesfnm]

Like you, I've got a dad with diabetes and like you, I was ill for quite some time during the late fall/winter. I was drinking lots of beverages with much higher carb content than usual because I couldn't eat much. I had a 6.1 a1c. Since then I've gone back to eating healthy and have cut down on carbs considerably. I've also had some "low" BG counts (65-80s) - but also a couple of 140s after higher carb meals. My suggestion to you is to relax. Test just enough to know how you react to certain foods/quantities. But most of all, take this as an opportunity to get healthy - exercise and eat a delicious "diabetic diet" as much as possible. My blood pressure's gone down and I'm fitting into smaller sizes for the first time in many years! I'm splurging on some of my favorite good-for-me foods (salmon, roasted veggies). I've switched now to just regular a1c tests. I'm awaiting the results right now! Good luck.

[felinefan67]

Well, things are worse then I was told over the phone. My lab results say 5.8 on the paperwork, NOT 5.5 like the nurse (or whoever) said. I am fairly certain I'm pre-diabetic. I just didn't think it could happen so fast (from last fall (FBG of 99) until March/April of this year. I still have seen some sites say that 6.0 -7.0 is considered pre-diabetes (A1C). My doctor is calling me back tomorrow to discuss my concerns.

So far my blood sugars are all within normal range after meals. It's the high fasting (those few times) and the high HBA1C that has me freaked.

The U.S.A cut-off for Fasting Blood Glucose is 99 for normals and 125 for pre-diabetics. After that, you are diagnosed Type 2.

[Coppernob]

Felinefan, I am sorry that you had a shock over the A1C but I am glad that the Dr is calling you tomorrow to discuss everything with you. Whenever I speak to the Dr by phone, I make a list so that we cover all the things I am concerned or have questions about. Good luck and think positive. :)

[Ronin]

Hi Felinefan!

First of all you are not alone, most of the other Pre-D's on the forum have gone through the same process you are going through now. Anger and frustration come with the turf largely because the Pre-D diagnosis is new and not well understood in the medical community.

First some background I have dug up when I was researching my own diagnosis. The Pre-Diabetic diagnosis was intended to catch young people who were developing Type-2 diabetes in their teens and 20's. Under the law of unintended consequences, more older adults were diagnosed as Pre-D's than the target group.

Behind this is a debate as to the source of diabetes in the first place. Is it genetic or is it environmental? If it is genetic then anyone with the genome is going to develop diabetes and the diet and exercise will delay the onset but not prevent it. If the cause is environmental then diet and exercise will prevent diabetes from happening. Is either source definitive? No.

Generally, I, and most of my fellow Pre-D's agree that one FBG reading above 100 does not relegate anyone to the world of Pre-D. A good diagnosis requires HbA1c testing (which you have already had) and potentially a test of your fasting C-Peptide levels and/or combined with and Oral Glucose Tolerance Test (OGTT) to determine the insulin output of your pancreas.

It is important to understand that most MD's who do not specialize in diabetes get these alerts from the medical community and when you get a FBG reading above 100 it sets off alarm bells (not to mention a fear of being sued if they do not diagnose and treat you properly and fast). So, you have the blood work and you get the diagnosis. Unfortunately, that leaves you both confused and angry.

Now a bit of reality. There have been tests on people with no signs of diabetes. Generally, their BG levels are well below 100 and tend to be in the 70's to low 80's even a few hours after eating a meal. Also, their A1c results tend to be below 5.0%. (Imortant note: HbA1c values are a weighted average that favors the pervious four to six weeks so they don't represent a realistic 90 day average. However, they are the best test to determine your abilty to control your BG levels over time and take out the spikes and valleys.)

So, just what is Pre-Diabetes and why do some of us accept that diagnosis while others do not? I can only answer for myself. I've had a lot of testing done, as well as doing a lot of testing on myself along with a lot of research. For me the Pre-D diagnosis is little more than fair warning. It is the time to take stock, make life-style changes, and to a large degree enter a phase of watchful-waiting for the condition to stabilize or get worse. In the mean time live your life.

On a personal level I already know that my pancreas produces insulin on the low end of normal and that my body response to glucose load is slower than a person with a fully functional pancreas. Eventually I will probably become a Type-1.5 and will need supplamental insulin to manage my BG levels. But not today.

I watch my diet, and when it comes to carbohydrates, I manage portion sizes. I also exercise a lot more than the average person -- being retired allows that to be easier than for a person with a job. But, having a job is not an excuse for not using the body whenever possible as opposed to using other means to get around.

I wish, as do most Pre-D's, that this was a clear cut case and a diagnosis actually means that you have a condition that can be treated or managed. Sorry, that just isn't what this is all about.

You wil have emotional ups and downs on this journey. We've all been here and we are willing to help to the extent that we can. Please be patient with us, and with yourself. The Pre-D diagnosis is not a death sentence, it is, at best, a warning sign on the pathway of life. It is your choice to take action or to ignore the facts.

[felinefan67]

One quick thing; I've read on other websites that the A1C isn't a tool to diagnose Diabetes (so how can it confirm pre-diabetes then?) It is more of tool to see how well a diagnosed Diabetic is managing their blood sugar. Some have said to not rely too heavily on the A1C for a diagnosis (I'm guessing that means for PRE-D people as well?)

If I'm pre-d then why are my after meal readings so "normal"? I haven't done many (just a few really) but they've all come out SOLIDLY normal.

Also, if I don't have a family history (except for my dad who may have got his due to binging on sugar and carbs for YEARS) then is it still considered genetic based on ONE case in several generations on both sides of the family?? My mother's Grandmother (I think) or great Aunt) had it, but that was it as far as we know.

I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.

Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

[xMenace]

One quick thing; I've read on other websites that the A1C isn't a tool to diagnose Diabetes (so how can it confirm pre-diabetes then?) It is more of tool to see how well a diagnosed Diabetic is managing their blood sugar. Some have said to not rely too heavily on the A1C for a diagnosis (I'm guessing that means for PRE-D people as well?)


I don't follow diagnosis issues very closely. I would not discount an A1C. I think it is much more telling than a few high spot tests.


If I'm pre-d then why are my after meal readings so "normal"? I haven't done many (just a few really) but they've all come out SOLIDLY normal.


I am no expert, but here's my theory. There are two sources of sugar: food and liver. Food intake triggers insulin release. You seem to respond well to food. You don't seem to respond as well to your dawn phenomenons. I think often fasting numbers show rises before post-prandials.


Also, if I don't have a family history (except for my dad who may have got his due to binging on sugar and carbs for YEARS) then is it still considered genetic based on ONE case in several generations on both sides of the family?? My mother's Grandmother (I think) or great Aunt) had it, but that was it as far as we know.


Two cases is enough for me. Keep in mind that many cases have never been properly diagnosed. Some may have lived out their lives with it and never knew. Others may have succumbed to other causes before it hit. Also, it's something that many do not like to talk about. There is a bit of guilt often associated with it.



I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.


Stress and injury are definately causes. D does not usually come on linearly though. There are usually ebbs and flows.


Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

Whether you are D or not, these are excellent decisions. Rock on! :thrasher:

Michael Pollan on The Hour with George Stroumboulopoulos on CBC (http://www.cbc.ca/thehour/video.php?id=1992)

[REDLAN]

I think often fasting numbers show rises before post-prandials

From the research and articles I have read, it is the other way around. It is the insulin response to meals which goes first. OGTT (oral glucose tolerance tests) are a much more sensitive test, and these show abnormalities (high results) before the fasting levels start to rise.

Insulin resistance is not insulin resistance per se. what actually happens is that people with type 2 lose flexibility of response. After food the insulin resistance drops, allowing all that glucose to be taken up by the muscles. With type 2 it stays high, causing high insulin levels. As the disease progresses, the pancreas becomes affected and is unable to produce enough insulin and so blood glucose levels rise.

My (non-medical) opinion is that currently you have a high normal blood sugar. You have relatives with type 2. Both these increase your risk - but do not necessarily mean that you will develop type 2.

I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

totally concur with xMenace - ROCK ON! :cool:

adopting these lifestyle changes will not hurt, and should help protect you against developing type 2.

[princesslinda]

I've read recently that the post-prandial readings are the first to show elevation. For me, I had annual physical exams with fasting blood work that always showed "normal" blood sugars, one about 8 months before diagnosis....yet my A1C at diagnosis was 9.6 and looking back, I can now relate symptoms that make me think I had it a couple of years before diagnosis.

[homeschoolmom]

Hi,

I have some similar blood sugar readings - only 1 fasting level of 102. Other lab fasting levels have been 85 and 99. When I test at home, I've had some readings as low as 50s fasting (average fasting is 76). My levels after eating have been fairly normal with a couple of high readings after big meals with lots of carbs. My GTT came back normal. My a1c was 5.3. I've wondered a lot of the same things as you. One thing I have noticed is that most prediabetics have fasting numbers above 100 consistently. When I asked my endo about my 99 number, he said, "perfectly normal". Did you know that up until a few years ago, anything below 110 was normal? I consider myself to be "pre-prediabetic" :) I'm thankful I got a "heads up" call before it was too late. There is a very informative website that you can find if you google blood sugar 101 that answered a lot of my questions. I've recently quit obsessing about it, but I also exercise every day and eat protein with every carb. I stay away from sugar and white flour, drink plenty of water and try to do something moderately active after I eat (wash dishes, clean, etc.). Good luck!

[felinefan67]

:confused: Not sure what to make of our conversation, but the bottom line is she is unconcerned and REFUSES to recognize "pre-diabetes" as a medical term. Her exact words were: "The medical community doesn't use the term "pre-diabetes anymore, it's outdated" Everytime I tried to explain my concerns, she kept saying "But you're NORMAL" (regarding my 5.8 a1c reading). She said "People are either diabetic or they're not" so stop worrying." "You are doing just fine with fastings of 99,99,99,(lab 99), 102, 101, 102, and latest of 74.
When I tried to explain about my fasting going up to 102 and a FBG of over 99 is considered pre-diabetes, she said, "Well now you are being a purist" How do you like that?

She also told me (and my mother too) to "stay off the internet". It isn't the "medical profession or something to that effect.


I don't know who's in bigger denial, me or my doctor!! Well I consider this a big huge warning and possible huge risk down the line so regardless of my doc's blah-zea (sp) I'm still going low carb and almost no sweets (I guess I can have a beer or two ocassionally though, right?)

[Tropo]

Hi,
When I asked my endo about my 99 number, he said, "perfectly normal". Did you know that up until a few years ago, anything below 110 was normal?

The bottom line is that doctors don't have time to concern themselves with pre-pre-diabetics (almost pre-diabetic) and usually only treat people when levels may require medication.

It goes something like this: You go to your doctor today and get a FBS reading of 99. The doctor says you're perfectly normal - come back next year and if you're over 100 we'll start your medication.

People really have to treat themselves if they desire to be healthy. Most people on this forum say the politically correct "consult your doctor" whenever people query their readings. This type of advice and thinking won't get you very far with most doctors. People need to study and learn about the condition and possibly look for wholistic doctors that can help arrest the deterioration before it requires medication.

[Tropo]

I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.

Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

It happened with me.

Three years ago I had a 3 month battle with cholestasis of the liver. I had severe jaundice amongst other symptoms. Upon doing some blood tests I found out my FBS's were in the mid-200's. I even went on diabetic medication for a few months.

Now, with a fairly high carbohydrate load in my diet I read "quite normal" averaging from 100 - 110 FBS with no medication and regular exercise. My post-prandials are also in the normal range and my HbA1C is 5.7%.

You could say that I went from type 2 diabetes when I was sick to almost normal now.

[Ronin]

Felinefan, et al.,

Your story, as well as your frustration and anger, are quite familiar here on DF. The diagnosis and treatment of the diabetic condition is part science and part art. There are a few specialists and they have well defined predjudices. It sounds as though your MD has the feeling that anyone without an MD behind their name is not qualified to speak about any medical topic. Yeah-Right!

There is one bottom-line take away for you: it is you who is responsible for your health. If you decide to take action on what you percieve to be a Pre-D Condition that is your decision and not the decision of your MD. Don't expect her to support your diagnosis because she thinks that all diagnosis belongs to her. However, you are the person who decides what goes into your mouth, if you test your BG levels and how often you test, how much you exercise or don't. The frustration isn't finished, because if you improve your condition she will want the credit.

In the end adopting a better life-style with more exercise and better diet is good for you regardless of a diagnosis from somebody with an MD behind their name.