Early 1.5??

[ddown]

Hi folks,

I recently posted my situation in the pre-diabetes forum but thought I'd get your opinion as well.

I am a slender 31 yo male with the following lab test results:

March '07 A1c 5.3%
May '08 FBG 103
May '09 FBG 109
June '09 FBG 104 A1c 5.2%

My home readings have been between 92-103 for fasting

Post-meal home readings:
spaghetti 1hr 151 2hr 121
oatmeal + 2 slices of wheat toast 1 hr 145
all bran cereal + 2 slices of wheat toast 1 hr 140
quinoa with salad 1 hr 119

All my other lab results (i.e. cholesterol) were normal. Any thoughts on whether I may be very early 1.5 or am I worried over nothing?

[foxl]

Howdy!

You have some nice numbers there!

Hope you learn as much as I have.

I am currently reading papers from PubMed on Insulin Resistance and LADA. I go back and forth on it, but currently suspect I have a fair amount of insulin resistance.

[foxl]

Oh, and thoughts ... have you had GAD-65 and C-peptide run?

[ddown]

I'm just trying to get to the bottom of my mildly elevated fasting BG numbers as Ive always considered myself a pretty healthy person. My primary care doc thinks Im worried about nothing.....

Do those after meals numbers look OK? I suspect if I ate something "bad" like pancakes or a hamburger and fries my 1 hr peak would be higher than the 140 peak limit for normal I always read about.

[foxl]

I am inclined to dislike anything > 140.

I am eating very low carb to keep my numbers there. But ... it depends on who you listen to, what is okay. Some people say anything less than 180 is fine.

How come you are getting A1c's? What is your MD's opinion?

[ddown]

The March '07 A1c was part of some life insurance blood work. I had the most recent A1c done because of the mildly elevated fasting glucose. Im going to try and cut out all refined carbs either way, but would like to know if I'm just on the higher end of normal or if there is something wrong.

[foxl]

The March '07 A1c was part of some life insurance blood work. I had the most recent A1c done because of the mildly elevated fasting glucose. Im going to try and cut out all refined carbs either way, but would like to know if I'm just on the higher end of normal or if there is something wrong.

It cannot hurt!

By the way, you will find there is such a thing as a young, slender type 2 here! Crazy disease. Absolutely nuts.

[ddown]

Does anyone else have any thoughts are experiences similar to mine? Can LADA or DM 1.5 start out as mildly elevated fasting glucose numbers and stay that way for a over a year?

[SoCal]

I think you should concentrate on a healthy diet and excercise - as should every human on the planet - and get an A1C every twelve months for peace of mind. I tend to think you are more concerned than you need to be. You can't live your life indoors on the off chance it might rain.

[mortis505]

Its been my experience that testing at a 1 hour mark may be unhelpful due to the body still processing food. BGs can continue to rise on the average of 75 minutes after the first bite. Your 2 hour numbers look ok, but on the elevated side of ok.

As has been stated, get a C-Peptide test and if that comes back low/nil, then ask for a GAD-65 and/or an ICA test.

[foxl]

Its been my experience that testing at a 1 hour mark may be unhelpful due to the body still processing food. BGs can continue to rise on the average of 75 minutes after the first bite. Your 2 hour numbers look ok, but on the elevated side of ok.

As has been stated, get a C-Peptide test and if that comes back low/nil, then ask for a GAD-65 and/or an ICA test.

Heck, Mortis, I asked for both at once -- and my C-pep was low-normal, but GAD > 30! So it paid off to get the GAD right away ....

[Joder]

Agree with the others, and I would say everyone's physiology is different.

Your HbA1c looks pretty normal to me but your post prandials (carb heavy meals admittedly) are a bit high (<7-8 or 98-112)

In other words you probably have some degree of impaired glucose tolerance (this might be driven by insulin resistance or reduced insulin production - or just the way your body is of course)

have you had a glucose tolerance test? (std dose of lucozade + a timed test from fasting)

and also how are your lipids and blood pressure?

If it were me (IMHO) would get the C peptide and GAD tests done and:

If they are normal I would conclude that it was a (slight) insulin resistance problem, which you can probably reduce by losing any excess fat (not sure if that's an issue for you, you said 'lean') - get BMI to <25 and exercise. If you have no excess fat it may be a fatty liver (genetic factors/excessive alcohol/unhealthy diet etc...) in which case that's the area to address (if you can)

Having done all that - (if none of the above apply ;o))) I would say you have more or less established it's not pre-diabetes - but you should definitely book in regular appointments to track your HbA1c every 4/6 months and then forget about it - maybe avoid massive carbohydrate meals as a precaution) - and if you feel you must keep an eye on it - you could get some Diastix and do a urine test in the morning and after big meals for interest's sake. (I'm not sure I'd get into Blood Glucose Monitoring yet)

If the tests are not normal then it may point to LADA/1.5 in which case there are as many opnions as to what/when to do next as you can usefully model... generally people suggest you should get onto insulin early to protect the remaining beta cells - but I doubt very much this is you :o))

My guess is your MD is probably right (but I would get the Cpep and GAD done and book in for the HbA1cs going forward)

it's a bit early to let it rule your life - but I would get to the bottom of it all the same first and boilerplate it with an ongoing testing regime every six months..

hope that helps

Best

[ddown]

Thank you,

One more question....can not eating many carbs for most the day and then eating several for dinner cause the glucose numbers to be higher?

I had a burrito and a half with refried beans and a whole wheat tortilla and my 1hr was 160 and the 2 hr was 147. At 3.5 hrs I was back down to 100. Could the lack of carbs earlier in the day caused the higher peak and slower lowering?

[Joder]

well we're all different - but I have got into reading the food labels big time.. :o

tortillas and wraps are all too much for me - so I now make my own with spelt flour (an old type of grain)

I found to start with that if I denied myself too much in the day I felt bad by the evening. My best solution has been to eat plenty (nice things) but not too may carbs...

so Avocado, smked salmon, shrimp as treats, cottage cheese, grilled chicken steak - more expensive stuff I know - also nuts, vegetables, eggs, cheese. any sort of big bun or bread doesn't work for me and within a coupe of weeks they don't even taste nice to me..

it is a discovery and I bet many of the guys on here are still discovering after many years..