Diabetes without hyperglycemia??

[theresadls]

Hi, I am really confused by what my docs are telling me.....I have normal sugar levels - though rather flat OGTT. BUT my C-peptide level is low and my insulin levels during the OGTT are low until after 1.5 hours, then go up to normal range. I am active, fit, not overweight, have low blood pressure and good lipid numbers. I do have Hashimoto's disease, but had my thyroid removed three years ago do to Huerthle cell nodules.

How can my endo and my cardiologist say I am prediabetic? Basically, the cardio guy said the only reason my sugar numbers are normal is that I eat so well and exercise so much. Can this be true? It sure doesn't feel right. Can someone point me to a place I can read more to understand this?

Thanks for your help!

[Ronin]

Hi Theresadls!

Yes, it can be confusing. Low C-Peptide levels would indicate that your pancreas is not producing sufficient insulin. Having a healthy, low carb, diet allows you to manage and even slip from time-to-time. However, it also indicates that you are headed towards becoming Type-1.5 (LADA). Hence, you do not now have a full-blow diabetic condition, but you are probably in the camp that is called "Pre-Diabetic."

Now, take a deep breath, relax and remember that Diabetes is not a death sentance. You are already proof that you can live without complications by virtue of diet and exercise. However, you may need to start thinking about supplamental insulin in the future. You should also have a BG meter and start some tracking of how your body reacts to your life-style.

In a way you are lucky that your MD had good reason to give you an OGTT with C-Peptide readings and knowledgable enought to recognize the situation -- just read through the posts of the people here who have been diagnosed as Type-2's only to find that they are really Type-1.5's only after having been through the tortures of the wrong meds and the inabilty to control their BG levels.

As I often say: Welcome to the club you never wanted to join.

FWIW: go to your public profile and fill in some of the data, it helps us to know a bit about you and it also defaluts to "Male" and I have a feeling that you aren't.

[BlueSky]

......I have normal sugar levels - though rather flat OGTT. BUT my C-peptide level is low and my insulin levels during the OGTT are low until after 1.5 hours, then go up to normal range. ...
This doesn't add up. The OGTT involves a 75 gram glucose load. And if your insulin levels had been low, your blood glucose would have been very high, and not "flat".

If your blood glucose numbers are normal, your insulin levels (as reflected in the c-peptide number) are as high as they need to be. If they were any higher, your blood glucose would drop below normal. The fitter you are, the more isulin sensitive you become, and the lower the insulin level needs to be.

"Pre-diabetic" is an interim stage in the progression to type 2 diabetes. There is sufficient insulin resistance to raise blood glucose slightly, but not high enough for for the the type 2 diagnostic benchmark to be reached. Insulin levels can be 10 times higher than normal while blood glucose is still normal, as the beta cells pump out insulin to overcome the insulin resistance. So without insulin resistance, there can be no "pre-diabetes".

If you were pre-diabetic, your c-peptide level would be high, and your insulin levels would have been very high during the OGTT. Your insulin levels are low, so you can't be pre-diabetic. Maybe your doctor was talking about something else. But it can't be T1/T1.5 diabetes either. If you were in the early stages of type 1 or type 1.5 diabetes, the low insulin levels would have been acompanied by high blood glucose, especially during an OGTT.

From the info you have given, it doesn't sound like there is anything wrong with you. The exercise is obviously keeping you in good shape. And welcome to the forums. ;)

[theresadls]

Thanks Blue Sky.

You are saying EXACTLY what I have been thinking. It doesn't add up to me either.

The cardio guy ordered another OGTT with fifteen minute glucose/insulin/c-peptide levels now, apparently to see what my insulin is doing.....but, again, it doesn't really make sense to me.

The whole reason I had the glucose tolerance test was that my blood sugar was plummetting a half hour to an hour after my endurance training jogs. None of my running friends had had this problem, so I went in to see if I should be worried about it - (it was very unpleasant but I recovered from them in an hour or two.)

I found a single study that said well trained athletes have lower insulin levels (hence, lower c-peptide levels), but at almost 40, while I'm fit, I can't say I qualify as a well trained athlete! But maybe you don't have to be - maybe a high level of fitness is enough.

Has anyone else had the type of OGTT test that I now have to have done?

Thanks,
Theresa

[drsanjaynayak]

theresa
welcome to teh club and i know it sounds cofusing especially with the docs saying that you have a diabetic problem
all i want to know from our colleagues is WHAT IS PREDIABETES ?? what are the cut off values of blood sugar for fasting and post lunch which determines prediabetes?? my problem is i test at around 100 fasting without exercis and if i take a one hour brisk walk its around 85 . One hour after lunch its around 160 and two hours after ward its 124 or 125 . what am i really?/ i have no medication whatsoever.
please help ...you may reach me also at sujirnayak@gmail.comif u want to send me a personal reply

[fgummett]

Hi Theresa and Welcome to DF... sure is confusing. I would be interested in the OGTT with additional blood tests.

Dr Sanjay... Welcome also! I think the significant number in your list is the 160 mg/dl 1 hour PP. Your fasting and post exercise BS are good but someone without D should not go above 140 mg/dl no matter how much or what they ate. The fact that it is back down to 125 mg/dl at 2 hours is good and probably why you are not yet on medication. With that said, I have been reading recently that a more aggressive approach to early treatment is beneficial... as opposed to the more traditional step up approach which waits for things to get worse first.

[BrianSCohen]

theresadls,

Welcome. I know it is confusing and kinda scary being told that you might be getting diabetes. There are many people here who are well informed and can talk you through things. If you are pre-diabetic you should take every opportunity to keep your condition at bay. Many people are able to go years with proper diet and exercise.

Diabetes manifests itself in a number of ways. Most people who are type 2, have insulin resistance and end up being less and less able to use the insulin they produce effectively. This leads to the elevated insulin that Bluesky mentions. In your case, you may just be different. The dropping blood sugar you mention (reactive hypoglycemia) can be a symptom of emerging diabetic problems, although usually it indicates too much insulin. You mention Hashimoto's, and it is quite possible that this is all tied together with your thyroid problems. Hashimoto's correlates with diabetes, and other conditions such as PCOS do as well. Before you leap to a separate unrelated diagnosis of diabetes, you should really make sure that you have a good endo that you can trust to work through everything.

I see you are an endurance runner so it is unlikely that you are a prime candidate for insulin resistance. Your OGTT seems to implay an insulin production issue, but you don't give any glucose numbers. Given this, you do have some risk of high blood sugars, even though you have not displayed them yet. I would suggest you keep on top of this, learn more about diabetes. It would be good to monitor your blood sugars to see if you go high. Do not go on endurange runs while high, but by all means, keep up with your exercise. You can also start to learn about your second defense against diabetes, namely diet. Many find that a low carb diet works best for diabetes.

Keep in touch, people here do try to be helpful.

[drsanjaynayak]

whatis the cut off figure for diabetes?? what is the cut off figure for pre diabetes?? my fastingregularly is 104 without exercise and about 85 to 90 after a 6 kms brisk walk ...i also feel hypoglycemic in the afternoon and when i checked recently before lunch it was 76 ( and i had a good breakfast that day) i am not on any medication ..
post lunch it was 160 afterone hour and then 124 after 2 hours ...my doc told me that after one hour its ok as food is needed for insulin stimulation and utilisation .i am confused