Confused

[JTBNC]

Hi. I am new to this group and I look forward to learning from all of you.

I was diagnosed three weeks ago with Type II. I am an overweight, self-employed, and I the primary care-giver for my ailing mother. My life is typically fullsteam ahead and tension is a big part of my day. This diagnosis has not helped.

My dr. diagnosed me solely from a finger prick. He told me that anyone with a singular reading of over 200 was automatically diagnosed. He also did an A1C and the reading was 6.1. My BG level was 224...after of morning of primarily sugar to eat. My highest BG level ever was this past summer while I was in the hospital being treated for a blood clot and it was 264 (132 8 hours later). He put me on Glucophage and Xenical for my weight. I take the Glucophage befoe bedtime. The diagnosis was made without any BG fasting tests. In the last three weeks, I have dropped significant weight and my blood levels are running between 109 at the lowest and 166 at the highest...typically in the 125- 135 range.

I have received conflicting information since receiving the diagnosis. I have spoken with the 800 number for the ADA and there numbers do not support my doctor's. They said my A1C was below the concern level. I am simply seeking answers. I am not arguing with my diagnosis but I want to be accurate in what my situation is. I would appreciate learning from any of you who might have some perspective to offer.

[DeusXM]

Whilst I am not a medical practioner....

Sort your doctor out. Now. A reading of 224 is pretty much what any person, diabetic or not, would have just after eating. If your doctor was doing his job properly he would have asked you to not eat anything and drink only water in the 12 hours before doing a fingerprick test.

As for your A1C...I think most of us would kill to get that kind of reading.

However, before I go out making even more outlandish statements, I've got a question for anyone out there with Type 2 - is there a 'honeymoon' period like there is with Type 1? If there is, that could explain your currently very good levels.

JTBNC, if you could tell me more about the circumstances behind your diagnosis I might be able to help you more. As I've said, your A1C is what a 'normal' person would have, which suggests to me that you don't have diabetes, or, worst case, you have only very recently developed the condition, which I find rather hard to believe since the majority of people diagnosed with Type 2 have the disease for about 2 years before it gets diagnosed properly.

Your weight loss can be attributed to the fact that you would modified your diet since being put on Xenical, and as for you BG levels, they're so static it's almost unbelievable.

I don't want to build your hopes up too much since there's still a possibility you have diabetes, but I recommend that at the very least you go back to your doctor and ask him to carry out a finger prick test properly this time, which he should have done before.

A one-off reading of just over 200 is, quite frankly, terrible grounds to automatically diagnose diabetes. Whilst you're back insisting on another blood test and another A1C, I'd also suggest you ask for a urine test too to check for ketones, which are a far more reliable marker of whether you have diabetes or not.

Make no mistake, I'm not saying that you don't have diabetes.

I'm just saying you should get a second opinion from a qualified healthcare professional.

[Jon]

If your blood glucose is over 120, they automatically diagnose you with diabetes. If everything is working right, it will not get that high. To be sure though, they should have given you more tests before putting you on medication. Ask your doctor to refer you to an Endocronologist. They specialize in diabetes and they are more familiar with testing and how to treat it.

[snakeye]

If fasting blood sugar is above 130 its have diabetes.
If fasting is always normal but if it rises over 130 2hrs. after your meal. Then you have what's called (I don't know the quite exact term) "hidden" diabetes. It's like you'r body doesn't respond to insulin enough to dynamically cover the "peak" state of the blood sugar rise after a meal...
Especially for type 2 diabetes they test after loading sugar to see if everythings "really" fine at "peak" times...

SO

70-110 is the range for fasting
110-130 is the range after a meal

I have heard a lot that even in a healthy person blood sugar could go up to 160 even 180 sometimes but these are rare situations.

A1C range is 4.6 - 6.2 You've gotto be in between..

However for a diabetic person the successfull considered range
could be more than 6.2 in the upper end... like 7.0 could be considered a successfull control.

Opinions:
According to your A1C leves it's either because you have been aware of your diabetes very early (which is good news) OR your BS only rises in "certain" conditions where it doesn't really reflect on your overall (A1C's. ) Which still mean that u join the party.

If there is anything else, that means that I'm not a doctor!

SNAKE

[snakeye]

Meanwhile I've never hear that typeII's go into a ketoacidosis coma. That's also why they're more prone to be diagnosed late.
However it could be; when their natural insulin does have no effect. (which is when they start to use insulin insted of triggering their own with the oral antidiabetic agents)

[DeusXM]

I've tested friends who don't have diabetes and 60% of the time they've had readings over 120.

I've also been told (by Diabetes UK) that A1C for 'normal' people should be 7.0 or less, and that actually it's usually very dangerous for people with diabetes to have an AIC less than 6.4 because it means that they will almost always be having a lot of medium to severe hypos.

Maybe it's different for me because I have Type 1, but I've been told by every doctor who's ever worked with me that anything between 72 and 144 is fantastic, and that 180 is the maximum that should be encountered just after a meal.

Snakeye, I'm not saying you're wrong, but I'm rather frightened by the disparity between the figures both you and I have been given.

One question for the Americans here - do your doctors recieve any kind of financial incentive for placing people on medication? I only ask because, given the sheer strictness of the diagnosis routine, I'd argue that a lot of people who don't have any geniune health problems could be diagnosed with diabetes because there's an incentive. It sounds to me (from what I've heard elsewhere on the forums) like your doctors are far more zealous in handing out anti-depressants and diabetes medication like they're sweets or something.

[rzrbks]

DeusXM, you're numbers are more like what I heard while going through Diabetes schools, total of 14 hours of training.

Yes, Drs. over here are given an incendive to diagnose everybody with everything. The more patients you have, the more money you make. It's called Free Trade:D which is why it costs more over here than there:whistling

[snakeye]

I can't see a huge difference.

Yes, the numbers I wrote were for healthy people without diabetes or otherwise indicated. As the discussion was like a diabetic/non-diabetic issue I had gave it.

144 mgdl reading could be considered normal for a diabetic as you say..Not for a healthy person.

Renal excretion of sugar starts from 160 and changes by person. 180 is definately a number for renal excretion so it's not good for the kidneys.

Never been over 5.5 with the a1c's and that's the way "I" feel good. Hyop's are something that's dangerous for a starter so I would of course go with your numbers if someone would tell me you'd die with this...So it's gotto be expressed in an efficient way...maybe like: "Don't go under 90mgdl"

I remember occasions that I didn't take sugar even with 60 because I knew that it would rise a few minutes later....It's all about being aware of what ure doing. But if you're too busy...course u can't take it you have to raise a bit...

[DeusXM]

'The more patients you have, the more money you make. It's called Free Trade which is why it costs more over here than there'

Hardly good for human health though...

Apologies to Snakeye, I did a bit of research after my post. All the figures I've been told are ones for people WITH diabetes (guess my care team didn't feel the need to overdo the pressure on me!), and I checked the WHO guidelines, and yeah, basically your fasting level should be 113 or less.

One point in my defence though - why wasn't JTNBC tested for the presence of sugar in the urine? That's a completely infallible way of diagnosis since there should never be sugar present in a normal person's urine.

[Mick]

"A reading of 224 is pretty much what any person, diabetic or not, would have just after eating."--DeusXM, that is just not accurate. Either are many of the other "factual" statements you have made, and I feel that there has been much confusion over these numbers and what they mean.

"A1C for 'normal' people should be 7.0 or less"--Absolutely not the case. The ADA used to say the target a1c FOR A DIABETIC should be under 7. Now they have recently lowered that to under 6.5, and "normal" levels, depending on the "Lab Normal" of the lab doing the test, is anywhere between 4.2 and 6.2. OVER 7 is considered "requiring medical intervention".

"It's usually very dangerous for people with diabetes to have an AIC less than 6.4 because it means that they will almost always be having a lot of medium to severe hypos." False--I've been type 1 for 38 years, and although I nearly always keep my a1c right around 6.4, I have been as low as 6.2, with absolutely no lows or significant hypoglycemic events. It's not easy, but with VERY careful and strict control and utmost discipline, such levels are safely possible.

"Maybe it's different for me because I have Type 1, but I've been told by every doctor who's ever worked with me that anything between 72 and 144 is fantastic, and that 180 is the maximum that should be encountered just after a meal." Mostly accurate. "Normal range" is generally set by American doctors at 80-120, which, as a Type 1 since 1965, I recognize as an impossibly narrow range to realistically maintain. My personal goal is 65-165, and 85% of my tests fall within that range. Yes, 65 IS a tad low, and 165 a tad high, but both within a fairly safe zone for me, and a range of 100 is way more possible than a range of 40!

Hope that clears some things up,
Michael

[DeusXM]

With the numbers (sorry to harp on about this!), are we talking about whole blood or just plasma?

[snakeye]

Originally posted by DeusXM
'
One point in my defence though - why wasn't JTNBC tested for the presence of sugar in the urine? That's a completely infallible way of diagnosis since there should never be sugar present in a normal person's urine.


Apologies? Nehhhh!
This has really been a good discussion so far.

Maybe the BS numbers were enough for them to decide? Meanwhile in that case we've gotto know if a person does release sugar or not if their BS raises over "their" ranal excretion rate for a short period.

Like...I don't know if I pee sugar if I go over 180 only for 1or2 hrs...:rolleyes:

[DeusXM]

As far as I'm aware, you only get sugar in your urine when you're really high, I mean like over 300. If you have untreated diabetes, you WILL have sugar in your urine, I mean, that's why it's called Diabetes Mellitus (Sugary Fountain).

JTNBC's numbers ARE elevated, so I suppose you can argue that diabetes is present, but I still think that a urine test, as well as the blood tests, should be performed. Ketones and urinary glucose are still the best determinant of diabetes because they'll only be there if something is genuinely wrong with you.

[Mick]

Everyone has what's called their "renal threshold" for glucose in the urine. Thats the level of glucose in the blood at which glucose "spills" into the urine. It's also called "kidney threshold", "spilling point", and "leak point." Although the average renal threshold for glucose is approximately 160-180mg/dL, the threshold varies greatly among individuals, and I've seen studies which put the renal threshold for many people as low as 150. Strangely enough, back when our only tests WERE urine tests, we had NO notion of any of this, no knowlegde of what the "one plus" "two plus" "three plus" "four plus" results of our urine tests meant. We had NO concept, for example, that a "negative" urine test could mean a blood glucose level of 150-180! The blue color was good, orange was really bad--that's all we kiddies knew back in the old days... Today, no doctors I know of use urine tests to diagnose diabetes, because without knowing the patient's renal threshold, you'd have no idea if the spilling of sugar meant only a borderline 150 or a much more dangerous 180+.

Michael

[Alaska]

****, did you have to mention the urine testing strips??
Years and years and YEARS have past and I had forgotten those rotten things......Now the horrid memories flood back......lol

[snakeye]

without knowing the patient's renal threshold, you'd have no idea if the spilling of sugar meant only a borderline 150 or a much more dangerous 180+.

That's much in-depth of what I was onto :cool:

[Jon]

My son was diagnosed with a urine sample 6 years ago.

At one time, a diabetes test consisted of somebody tasting the urine. If it was sweet, there was sugar in the urine. If it was salty, the patient was not diabetic.

High blood glucose can also cause a sweet fruity smell on your breath.

[DeusXM]

To the best of my knowledge, no doctor diagnoses purely on the result of a urine test. However, a combination of both urine and blood testing is frequently used. The presence of sugar in urine is an absolute guarantee that something is wrong. The blood test verifies that with more accuracy.

The thing is that anyone can have elevated BG levels occasionally, but few people, unless they have diabetes will have sugar in their urine.

For the record EVERYONE here should still check their urine when they're ill, not for glucose, but for ketones. I know it's distasteful and a lot of you would like to consign urine testing to the dark ages but unfortunately it just doesn't work like that, and no matter how much you try to sanitise testing, there will still be a place for urinalysis.

I'm assuming that when people here go to their clinics they're supposed to provide a blood sample and an early-morning urine sample, so quite obviously, urine testing is still essential.

[dpav]

From Jon "High blood glucose can also cause a sweet fruity smell on your breath"

This smell is a sign of ketones in your system. This means you need insulin immediately. You can smell this fruity smell no matter how bad a person’s breath is. It smells exactly like the “Certs Fruit Flavored Breath Mints”. If you have this it needs to be fixed immediately. The next step from here is Diabetic Keto Acidosis, then Coma, then Death. I have been there 6 times when I was very young