Do I have diabetes?

[retailgeek]

Hi,

I'm a 40 year man who is severely overweight. 310 lbs at 5' 9" (approx 40% body fat per my electrostatic scale). I have high cholesterol (as high as 270 gm/dL) with a family history of heart disease (father died of a heart attack at 40).

I have no family history of diabetes. I'm on 40mg Lipitor for the cholesterol which has it at 196 (188 trig, 46 HDL, 112 LDL) and no other meds (besides 81mg aspirin).

I have my lipids run once at year, and that usually includes a fasting glucose test. My fasting glucose has never been high (84 in 2003 and 91 in 2006).

This year at my physical, my non-fasting glucose was 197. My doctor wrote me a letter that basically said "you now have type 2 diabetes, lose some weight". My blood pressure also has creped up (it's always been a pretty steady 120/80 but my dystolic has creped up to 90).

I wrote him back and pointed at that it wasn't a fasting test and that while 197 was alarmingly high a single high non-fasting test didn't seem conclusive. I asked him to order a A1C and glucose tolerance test. He ordered the tolerance test but not the A1C. At the tolerance test I was 138 fasting, 272 (1 hour after 75g of carb), and 261 after 2 hours.

My doc sent the results with a note saying "start diet and exercise and see me in a few months".

Well, the test results scared me (a good thing) and that day I started trying to eat more healthy (complex carbs and vegi's instead of processed foods), eat more reasonable portions (I started a food journal), and exercise (40 mins at day with heartrate over 130 bps on an elliptical trainer). I also bought a glucose meter and have been testing every morning. Lastly I started looking for a new primary care internist that is more hands on, and with diabetes experience. I have a new appt scheduled.

It's been 21 days. I've done the cardio everyday. I've been averaging 1664 cals a day, 35% (68g) fat, 43% (194g) carbs, 22% (91g) protein. My weight has dropped from 306lbs to 289lbs. After about the first two days, my morning glucose has consistently been in the 80-90 range.

I'll for sure go over all this with my new doc when I see him. In the mean time, should I be testing in more detail/frequency? What's a good protocol? Do I likely have type 2 diabetes? Pre-diabetes? Can glucose really be controlled so quickly with moderate exercise?

Thanks for any advice!

Jason

[The_QUIET_one]

Hmm I dont know, do you have any symptoms other then your physical? Seems like a good thing to me though either way, it seems to have gotten you to convert ot a healthier lifestyle in general. you seem to have good levels too perhaps you were stressed that dya or you had a big meal or a sugar spike but either way keep it up. dont stop with your good healthy lifestyle even if it turns out you dont have diabetes. and you have a very good responce. I wish you the best and sorry I couldnt give any answers

[bkburns]

Jason,
First, welcome to the forums. I think you'l find them a wonderful source of information.

Congrats on your accomplishments so far! I am not far behind you. I was diagnosed at the end of March./ 34 years old, 5' 8", and 326 lbs. Scared the crapola out of me. I followed all the sames steps as you and have lost 40 lbs now to 286. (Only 100 more to go :) )I bike 10 miles every night, and strength train at a gym every other day.

I am afraid with those numbers, you do have diabetes. The fact that he did not order an A1C to finish the diagnosis and give you a starting number is just wrong. Did he talk to you about any medicines, like metformin? Statistically, you are likely Type 2 but I am no expert. I know very little about Type 1. Your morning numbers are probably good right partially because your pancreas is taking a rest because of the exercise and diet changes. Exercise also not only helps you with the weight, but it improves your insulin sensitivity helping your body use the insulin better.

I concur with finding a more agressive doctor.

A good morning number is not always indicitave of how the rest of the day will be. I would test when you wake up, test at at least one meal (dinner or lunch), and two hours after your first bite. and at bedtime. Your insurance should cover the supplies - your doctor will write a scrip for the strips. Even the underachieving old one should do that for you!

I also recommend a GREAT book I learned about from other forum members: "The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed " by Gretchen Becker. Its meant to be a year long book, but you can absorb it pretty quickly. It is spot on with good information.

Sorry you are in the club, but welcome to a great pot for information!

[fgummett]

Hey Jason, Welcome to DF! Glad you found us.
At the tolerance test I was 138 fasting, 272 (1 hour after 75g of carb), and 261 after 2 hoursI would say that is pretty conclusive for a diagnosis of Diabetes. Most likely Type 2. I'm disappointed at your doctor's "wait and see" attitude even with the exercise and new eating plan. Really should be treating this more aggressively right up front but the old school likes to take it's time. You have made big improvements but so far as I know, D does not go away... however you can buy yourself time. Keep up the good work. Visit here often... tell us how you are doing and ask questions. Keep a log of what you eat and when, what activities/exercise you take part in, your daily fasting Blood Sugar and your BS 2 hours after your first bite of each meal, before bed and optionally test before meals as well and at random times to see how food and exercise affect your D :)

Arm yourself with knowledge: The book advised above is great, as are sites by David Mendosa... (http://www.mendosa.com/advice.htm) and Dr Ian Blumer... (http://www.ianblumer.com/)

[kstreeter513]

This year at my physical, my non-fasting glucose was 197. My doctor wrote me a letter that basically said "you now have type 2 diabetes, lose some weight".

I wrote him back and pointed at that it wasn't a fasting test and that while 197 was alarmingly high a single high non-fasting test didn't seem conclusive. At the tolerance test I was 138 fasting, 272 (1 hour after 75g of carb), and 261 after 2 hours.

I started trying to eat more healthy (complex carbs and vegi's instead of processed foods), eat more reasonable portions (I started a food journal), and exercise (40 mins at day with heartrate over 130 bps on an elliptical trainer). I also bought a glucose meter and have been testing every morning. Lastly I started looking for a new primary care internist that is more hands on, and with diabetes experience. I have a new appt scheduled.

It's been 21 days. I've done the cardio everyday. I've been averaging 1664 cals a day, 35% (68g) fat, 43% (194g) carbs, 22% (91g) protein. My weight has dropped from 306lbs to 289lbs. After about the first two days, my morning glucose has consistently been in the 80-90 range.

Can glucose really be controlled so quickly with moderate exercise?

Thanks for any advice!

Jason

Dude, seriously, congrats on your new lifestyle. Keep it up, and don't stop now that you are seeing results. This is a healthy lifestyle anyone would benefit to maintain. You sound like you have adopted a very reasonable diet too(ie. not too restrictive in any one food group).

Yes, a GTT with a BG reading as high as yours sound very indicative of type two diabetes to me.

I can definitely believe results like that in 21 days. I had to take time off from running for two weeks due to an injury and my insulin requirements shot up considerably in just a few days, and after only a couple days of running again, I was able to reduce my total daily dose from about 35 units/day to 26 units/day. I'm type 1, but insulin resistance in insulin resistance.

[Keezheekoni]

I would say that yes, you have T2 diabetes. Your fasting for the OGTT was 138 and you were *down* to 261 after 2 hours.

Changing your diet and exercise habits has helped, obviously, so keep that up!

You should be testing your bg first thing after you wake up, before meals, two hours after your first bite of food, before and after exercise, and before bed. I would do this for a few weeks until you see the effects of food and exercise on your bg. After that, maybe just after waking, after meals, and before bed. It depends on what your doctor says...some are proponents of testing maybe twice a week, some twice a day, some never...which really just boggles my mind.

Good luck to you!

[xMenace]

I concur with finding a more agressive doctor. <--Yup, for all of us!

Great stuff. Just keep in mind that you can't rest easy. You have a history of poor self-maintenance and a family health history. The diabetes will likely be put to bed the way you are going, but it's only sleeping. It could wake up unexpectedly sometime down the road.

Keep it up! :thumbsup:

[Ronin]

Hi Jason!

I'll add my "welcome to the club you never wanted to join."

Your actions to date, following your wake-up-call, are comendable. You have to keep it going and do so for the rest of your life.

To answer your question, yes, the body does respond quite rapidly to life-style changes. Feel good about what you have done to date and keep on doing what you are doing. You can stall the onset of the compllications of Type-2 diabetes although you may need medications (that is between you and your MD).

We are all here to help.

[mortis505]

Welcome to DF Jason. I also would have to concur that you do have D. However, you seem to be on the right track to getting this beast under control. Good on you.

All I have to really add is to watch the carb intake on your foods, and to test, test, test. you will need to know how those foods are effecting you.

[BrianSCohen]

Jason,

Welcome to the forum. Wow, you have just gotten a wake-up call. Talk about a slap upside the head. I have to congratulate you with your response, you are really on the right track. You have elevated test results indicating type II diabetes. Your tolerance test clear shows an impaired resistance, and an elevated fasting shows an inability to get your fast levels down to normal. That certainly is bad news, but keep everything in perspective. You, like millions of others have diabetes, except you learned early and can do something about it. Diet, exercise and medications can enable you live a long and normal life.

However, you still have some serious challenges ahead. You have noticed some dramatic normalization of your blood sugar, however that is likely a result of your starving, not your weight loss. But take heart, you probably can control your diabetes through diet and exercise alone for many years, but you have a ways to go before you get there. Consider a low carb diet, you will find that you can lose weight and contorl your blood sugar at the same time without dramatic calorie restriction. There are many others here who are going through the same journey. Best of luck.

[Tropo]

Hi,

I'm a 40 year man who is severely overweight. 310 lbs at 5' 9" (approx 40% body fat per my electrostatic scale). I have high cholesterol (as high as 270 gm/dL) with a family history of heart disease (father died of a heart attack at 40).



I would say you're way over 40% bodyfat. At 5'9" that would put you at 186 lbs lean body mass which is quite high for a 5'9" guy. You'd have to be pumping weights intensively to develop that much lean body mass. My guess is that your bodyfat is well over 50%.

I would suggest you cut your dietary fat significanly.

[Lizzie G]

Jason,

Whatever the official diagnosis, WELL DONE on the positive lifestyle choices you are making. My partner is around the same level of overweight as you, and I see on a daily basis how difficult it is to stay motivated to lose weight when there is so much to lose. BUT, what you do have is the added incentive which you are seeing already of improved numbers. To be honest your numbers are what would, in the UK, be considered to be diabetic, but if it is type 2, and has been picked up early, then you probably have really good chances of keeping it under control with diet and exercise at least for the foreseeable future (i really dont know a great deal about this but that seems to be the case for my partner's diabetic mother). And as you lose weight, the exercise will become easier, you will feel better and better about yourself and your new lifestyle will become self-perpetuating. i know this because i did it myself....im 5 feet 4 inches and used to weigh around 175, now i weigh 130. i used to be a competitive swimmer when i was younger, didnt do it for years, and on february 3rd 2007 i went swimming, and never looked back! i stopped smoking, and started swimming around 5 or 6 times a week, and i LOVE it! its great for the diabetes control and allows me to eat more, and generally makes me a happier person. i guess the key is, do sports that you enjoy, enjoy your food, your drink, everything, keep everything in balance, and look forward to a long happy and healthy life, whether you are labelled diabetic or not! Well good luck and give yourself a big pat on the back and say well done for what you have done so far, thats absolutely brilliant!!!

[UpNorth]

Welcome to the forums :)

And congrats on those great results in such a short time! Keep it up :) And like others said, yep, you're very likely to be T2 with those readings you've had, but seems like your body is responding very well to your new lifestyle.

[retailgeek]

Thanks for all the good advice and feedback. As everyone here knows, it's pretty disorienting to learn you have a disease like diabetes.

So I did find a more aggressive doctor. We started monitoring 4 times a day (fasting and after meals), and I continued the fitness and nutrition program that I started the day I got my tolerance test results.

The monitoring showed that exercise and diet were doing a great job controlling my T2 (probably caught it very early). I'm usually in the low 80's fasting, and never spike above 100 two hours after meals. So he didn't feel the need to start any meds, and wanted to see how I could maintain my fitness program.

Fast forward 2 months. I have sustained the exercise and eating habits. I've dropped from 310 to 260 lbs. I just did my first labs since my diagnosis. My labs showed great progress:

Total Cholesterol 196->131
LDL 112 -> 74
HDL 46 -> 42
Tri 188 -> 76
Fasting Glucose 138 -> 86
HA1c 5.8%

Overall I'm thrilled with the progress. I'd like to figure out how to raise my HDL a bit, but other than that the lipids seem great.

I was a bit surprised to see 5.8% given the typical results of my home testing. I know 5.8% isn't bad, but given that I've kept my BG between 80-100 all day for 60 straight days, I expected to be in the 4's. I know the test can see 3 months back and I've only been controlling my BG for 2 months, but I also understand that the test if much more skewed to the recent months.

Anyway, the irony of all this is that the T2 diagnosis has potentially added years to my life (and improved the quality) given that it scared me into making some healthy lifestyle changes. I know I need to maintain the lifestyle for life, and I'm very motivated at the moment, but I also have a healthy fear of falling into old habits.

[ElleMarieR]

Wow impressive numbers!!!!!!!!!!!

Great work so far. Are you still having nearly 200 carbs a day?? That would be my only concern but then again with numbers like that who can argue!! Keep up the good work. You are worth it.

[patricia52]

Jason, Welcome to the Forum. I concur with the others. I just want to add that not all doctors agressively treat T2. You are the main player here. You have to deal with D every day and you are the one who will have to deal with the consequences if you do not treat it agressively. Keep up the good work, continue to educate yourself, and find yourself a doctor who will help you treat D agressively. Good luck

[retailgeek]

I'm eating 176g of carbs, of which 19g is fiber a day.

I'm trying to get as much of that from fruit and vegi's as I can. And then from whole grains. I'm really trying to minimize bread, processed carbs, etc...