prediabetes or not

[Snow Bunny]

Blood work showed a fasting level of 96. However, whenever I consume a fairly high amount of carbs, particular with sugar, maybe 75 to 100 grams per sitting, my level will scoot up. Today I had about 85 grams of carbs for lunch and my one-hour postprandial level was 169. I asked the doctor if I was prediabetic and he said I wasn't BECAUSE my triglycerides were excellent (75) and my A1C was 5.9%. I said to him that I was told if you had no inclination toward diabetes (pre- or otherwise) then you "would never crack 120 no matter what you ate," and he said that was total bunk. He said even people with normal blood sugars will spike if they consume a high level of carbs.

I really trust this doctor but I'm totally confused because of other things that I've read which say that your 1-hour PP should be under 140 and your 2-hour PP should be under 120.

So ... who should I listen to?

[foxl]

There is an order to when insulin deficiency shows up -- first-phase response, second phase response (the big blip after a meal) and finally, fasting.

169 seems pretty high -- as if you did not have the insulin to handle the carbs (which is a lot of carbs). Can you check with an Endo or maybe get an Oral Glucose Tolerance Test, clinically?

[princesslinda]

Your post meal #s are the first to indicate a problem. That's why many of us aren't diagnosed early, often they use a fasting blood test, which shows up normal.

A normal, non-diabetic A1C according to the lab my blood goes to is between 4 and 6. So by their criteria, 5.9 is considered high-normal.

If I were you, i'd consider this a wake up call, realizing that if you don't take some preventative measures, you may at some point develop T2 diabetes. Keep yourself at a healthy weight and have an annual physical with blood work to include an
A1C. You could even buy a meter once a month take a day's readings to include pre and post meal readings.

Gretchen Becker has a book: Prediabetes: What you need to know to keep diabetes away." I haven't read this particular book, but her T2, The First Year, was an excellent resource to me.

[plattb1]

The key may be the rebound factor. That is, how long it takes you to recover from a spike back to a normal level.

However, the below data is from http://www.phlaunt.com/diabetes/16422495.php:

"A normal fasting blood sugar (which is also the blood sugar a normal person will see right before a meal) is 83 mg/dl (4.6 mmol/L) or less.

Many normal people have fasting blood sugars in the mid and high 70 mg/dl (3.9 mmol/L) range.

Though most doctors will tell you any fasting blood sugar under 100 mg/dl (5.6 mmol/L) is "normal", there are several studies that suggest that testing with a fasting blood sugar in the mid 90 mg/dl (5 mmol/L) range often predicts diabetes that is diagnosed a decade later.

Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugar of a truly normal person is:

Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.

Most normal people are under 100 mg/dl (5.5 mmol/L) two hours after eating.

A1c
A truly normal A1c is between 4.6% and 5.4% "

[jps]

I would take it as a wake up call to modify your lifestyle in some ways.

I have a co-worker who has an A1c of 6.1. The doc tells him he's not diabetic and he's not prediabetic. His fasting is 119.

I've told him flat out, starting watching what you eat and exercise unless you want to swallow pills or puncture your stomach with a needle every day, not to mention making minced meat out of your fingers.

As far as I'm concerned, a fasting over 100 should prompt people to do something.

[Snow Bunny]

[QUOTE=foxl;519147]There is an order to when insulin deficiency shows up -- first-phase response, second phase response (the big blip after a meal) and finally, fasting.


I can tell you this ... I did check my level at the two-hour mark and it was down to 128. So, my guess is that my second-phase response is going okay. Am I correct?

[CarrieOakey]

if you had no inclination toward diabetes (pre- or otherwise) then you "would never crack 120 no matter what you ate

I wish I could go back to my pre-diabetes years knowing all I know now... :(

Non diabetic people CAN and WILL go high if they eat lots of carbs. I'm thinking Christmas and my best friend (non diabetic) who was 12 mmol (216) 1 hour after a meal :eek: But non diabetic people have a pancreas that actually works you see. They should go down to good levels after 2 hours. And she did. She was down to 4.2 mmol (75) 2 hours after an orgy of food...

It's always best to look after yourself and do your best for your health.

[Moonglo]

My only question is, what was your bg like at two hours? Two hours is the mark used in the glucose tolerance test to determine how your bg is doing after carbs. The next time you have a high carb meal, I would test at two hours and see how you do.

Granted, your a1c is on the cusp of being high, it sounds like you may be at a point where you can delay, or possibly even prevent, full blown diabetes if you make some changes now.

[fgummett]

I wish I could go back to my pre-diabetes years knowing all I know now... :(

Non diabetic people CAN and WILL go high if they eat lots of carbs. I'm thinking Christmas and my best friend (non diabetic) who was 12 mmol (216) 1 hour after a meal :eek: But non diabetic people have a pancreas that actually works you see. They should go down to good levels after 2 hours. And she did. She was down to 4.2 mmol (75) 2 hours after an orgy of food...

It's always best to look after yourself and do your best for your health.This [bolded] point is frequently up for discussion here on DF. My take on it is simply an extension of the Pre-Diabetes notion... the BG management system starts to fail over many years (possibly as many as 20) and reportedly there are more and more people being diagnosed with Type 2 Diabetes. This suggests to me that there are more and more people out there already in a "Pre-Pre-D" stage... their BG management system may be starting to get compromised but is not yet at a level where it is diagnostic. Heck, Pre-D has only been recognised by the ADA in recent years. My belief (although not based on blind faith) is that a truly healthy non-D's BG range is about 4-7mmol/l (70-125mg/dl) no matter what they eat.

I'd be advising your friend to take care of what she eats now... small changes such as avoiding refined/concentrated carbohydrates and eating more real whole foods may be all she needs to do. Perhaps a little more activity such as a daily walk, parking further away and/or taking the stairs.

Here is a quote from our resident "Mad Doctor"At a diabetes technology meeting a few years ago I saw a presentation from some guys who were testing a continuous glucose monitor. It sampled interstitial fluid every 10 or 15 minutes for 3 or 5 days, I don't remember which. When definitely non-diabetic adult subjects (BMI less than 25, FBS less than 100, and a1c less than 6) wore the machine, eating one day in the clinic and one day at home as they wished, 80% of their readings were under 100. That is 20 hours out of 24. So for an hour to an hour and a half after each meal they might be over 100, but by two hours or just a few minutes later they were back under 100. And they were not only under 100, they were under 90 and even under 80.

[CarrieOakey]

This suggests to me that there are more and more people out there already in a "Pre-Pre-D" stage...

It's simply awful that PREVENTION isn't on doctors' agenda.

I am sure there is a pre-pre-D state. I am convinced even! I just hate that disease with a passion. I wish we'd get less and less members...

It's always a good thing to be careful what we eat, no matter what. After all, health is the most precious gift.

[fgummett]

It's simply awful that PREVENTION isn't on doctors' agenda.

I am sure there is a pre-pre-D state. I am convinced even! I just hate that disease with a passion. I wish we'd get less and less members...

It's always a good thing to be careful what we eat, no matter what. After all, health is the most precious gift.I agree... some Doctors do consider prevention of course, but it seems all too prevalent that unless someone meets the diagnostic criteria for D (or Pre-D) the attitude is simply "you're OK... just carry on as before".

Then to add insult to injury, when the diagnostic criteria are finally met (strange how that inevitably happens) too many Doctors seems to see the day of diagnosis as Day 1 of the condition and even then adopt a "wait and see" attitude -- let's wait and see how bad it can get before we actually take some action..!

I'm passionate and frustrated by all this, as it is so clear that in the case of Type 2 D: an ounce of prevention really is worth a pound of cure...

I'd suggest that it is the cost of treating the complications of chronic disease, such as Type 2 D, that are bankrupting our health care systems. Prevention has to be the better option for everyone.

[Ronin]

Hi Snow Bunny!

Are you Pre-D or not? That is an iffy question and there are guidelines but not all MD's are in full agreement.

That being said, the real issue behind the Pre-D diagnosis is that it is a warning more than a diagnosis.

Reading your post I have to say that your meal is pushing your system to the max. While you can "get away with that" from time-to-time it isn't a healthy way to manage your eating and it is inviting troubles.

The assertion that no healthy person goes above 120 mg/dL is one made famous by Dr. Bernstein who is more than a bit of an absolutist when it comes to managing blood glucose levels. He can get you to excellent results but his recommendations are usually not sustainable for long periods of time. (FWIW: This assertion is based on a single study of a handful of 20-something Scandanavians who were quite fit and active athletes. Something to strive for but not altogether valid for everyone.)

Try lowering your carb load and/or spreading it out over longer periods of time. Also, exercise is essential to managing BG levels.

You mentioned that your Triglycerides are fine and your HbA1c is in the okay range, what about your Cholesterol levels, blood pressure and weight? Are these also in the good range?

[Snow Bunny]

My BP has always been excellent. I was in the 110/60 to 110/70 range for many years.

With the A1c, I've been tested three times. The first time was about 1-1/2 years ago and my level was 5.8%. I checked it again several months later and it was down to 5.6%. The newest one is 5.9%.

On my 10/21/09 blood work, I had the following values:
Triglycerides - 80 (normal is under 150)
HDL Cholesterol - 87 (normal is over 40)
LDL Cholesterol - 147 (normal is under 130)
Cholesterol - 250 (normal is under 200)

I did mention the LDL and regular cholesterol to my doctor and he explained in very intensive medical terminology that I'm okay, BECAUSE my triglycerides and HDL are so good plus my BMI is under 35). I would like to inject that my coronary risk ratio is 2.87 (average coronary risk ratio for females is 4.44) and my C-reactive protein is 1.45 (under 3.0 is normal). The MD told me to keep taking the stuff I'm taking (i.e. omega-3 fish oil, multivitamins, vitamin D, and so forth) and come back in 6 months for more fasting blood work. Like I said, I trust the guy.

As far as my weight goes, I would have to lose about 40 lb to be at the upper end of the best weight for my height). IOW, if the best range for my height, bone frame, and age is, say, 175 to 215 pounds, then I would need to lose 40 lb to reach 215. No, that's not my parameter, it's just an example.

From what I've read here so far, I don't think I'm pre-diabetic yet, but that's not to say that I can't eventually get to that point, and then there would be probably several years before I became type 2. There is type 1 diabetes in the family (paternal grandmother and one first cousin that I know of), plus I had problems "positive results" with a six-hour glucose intolerance when I was 19. I don't remember the exact numbers but I think the fasting was around 75, by the second hour I crept up to around 110, by the third hour I dropped down to the low 50s (had nasty symptoms with that), and then I slowly returned to the normal range.

Hope that explains everything.

[savvysearch]

5.9 is really skirting at the edge of pre-diabetes. I'd say you are not pre-diabetic but getting pretty close. The 95 is high normal as well. The 169 one hour is nothing to be worried about. It's really the 2 hour that's most important. Your two hour is normal.

But the A1C and slightly high fasting should raise caution. It means you need a healthy lifestyle change despite not having diabetes.