[Ronin]

Fellow Pre-D's:

I've been living with the diagnosis for a while and have noted that there seem to be more than a few schools of thought on the Pre-Diabetic Diagnosis. Therefore, I think it is time for those of us living with the Diagnosis to talk about the implications of the diagnosis. To kick things off, I'll start with my opinion, and I'm sure your opinion will be different. But, perhaps we'll be able to come up with some common insights.

About me: I'm a pretty active guy being a very avid tandem bicyclist riding over 100 miles/week and doing a full upper body Bowflex routing 3-times per week as well. Looking back at my medical records (I keep copies of my stuff going back a long time) I have found that my FBG levels have been over 100 for the past 15 years. Only two-years ago, when the Pre-D diagnosis was introduced, was I given the diagnosis. Until then I was considered "High-Normal." I did have a cholesterol and triglyceride problem that has been resolved by a low-fat diet and lots of exercise.

Now, about this diagnosis: From what I have been able to dig-up this was a decsion by various leaders in the health field to attack the "epidemic" of early onset Type-2 Diabetes by getting peoples attention before they develop full-blown Type-2. The thought was that they would capture a lot of teenagers in the at risk category. What actually happened was that a lot of 50-plus folks have been swept into the Pre-D universe -- so many that a fourm like DF now has a separate category for us. I think that ignoring the age factor is a real problem because there seems to be at least one group that thinks that your BG levels have to never go above 120 and always-always-always rapidly return to between 70 and 80 mg/dl within two hours of eating or you are headed for diabetic ****. Sorry, I cannot acccept that because, at 60, I realize that all of my body functions have slowed -- including glucose metabolism.

There is another theory which is being called "The Metabolic Disorder" which uses more than just BG levels to diagnose your condition and a sliding scale for each measurement. The key factors considered are:

• HbA1c below 6.5%
• Blood Pressure below 120
• LDL Cholesterol below 80
• HDL Cholesterol above 55
• Triglycerides below 80
• Microalbumin below 30
• Annual retinal exams showing no evidence or retinopathy

(Source: Know Your Numbers, Outlive Your Diabetes by Jackson and Tendrich_

By this set of criteria I am not at risk of the Metabolic Disorder even though my FBG levels are usually above 100. Albeit my 2-hour post prandial readings are below 130 unless I have a large amount of carbohydrates in that particular meal.

A question is: will every person diagnosed as a Pre-Diabetic become a Type-2? I don't think so, because a good friend was similarly diagnosed and he was a latent Type-1.5 and his pancreas quit about two years ago and is now well controlled on insulin.

Did this diagnosis help or hurt me? Overall it scared the $#!^ our of me at first. I dropped an additional 20 pounds but nothing much else has changed. I eat fewer carbs, a bit more protien (a lot more salads to keep the protien moving), and all my Metabolic disorder critera are in the good end of the range.

Personal Summary: I'm testing four times per day FBG, and 2 hour Prandial and the results are boringly normal. I also use a good home testing HbA1c kit monthly. Knowledge helps but I also realize that I can be fairly normal in my eating and have the occasional high-carb splurge without any significant effect. So, for me it was an awakening but perhaps over blown.

What is your experience -- perhaps somebody who is in the research end of things is reading this stuff and might learn something from those of us who have the diagnosis.

[rzrbks]

I think this is what's known as preventative medicine, which to my way of thinking, even tho I'm an old Phart too, is what medicine should be about.

1. Cheaper for all concerned if caught before actual onset of disease.

2. "An ounce of prevention is worth a pound of cure."

3. Has this been a "Bad Thing" for you?

4. Good for you for taking positive steps, too many, even if given the same info you got, will continue down path of stupidity----if the smart ones take care of themselves then the stupid ones will be fewer in number and less of a pain for everyone else.

[baskar20]

Hi Ronin,

I am very happy to see the wordings as "boringly normal". I want everybody's results to be like that.

This shows that you ar working very hard and also taking care of your diet very well. Congratulations!

I am also Pre-diabetic like you. My Doctor prescribed Avandamet. But I am not taking that.

The problem with me is that my FBG will always be normal. My 2 hr OGTT showed the glucose level be 174 and the insulin levels to be 298 iU. Hence, the Doctor told me that I am diabetic. Fasting BG was 83 and fasting insulin was 10 iU.

In one way, it helped me to start taking care of the diet soon. May be a three or four years before the full blown diabetes.

Even now, if I eat white rice or pizza, my blood glucose level goes to 250 to 300 mg/dl. If I eat low carbs, I am okay.

Yours may be a similar case. Did your Doctor do a OGTT for you?

Baskar

[Ronin]

Baskar, et al.,

Actually, I did a home grown OGTT with my trusty BG meter and three GU-Packs (25 grams of carbs per pack - sicky sweet - these are a cycling staple for long duration riders). The results were: at 30 minutes BG went from 106 up to 140, at 1-hour up to 170, at 1:30 down to 160, at 2:00 down to 125, at 2:30 back down to 110. Can't say that I liked the "sugar rush." An MD might have diagnosed an "Imparied Insulin Response" but all-things-considered when I went over the results with my primary care, she was impressed although she maintains the Pre-D Diagnosis.

I've eaten all kinds of stuff and done testing including rice, pasta, even chocolate cake -- the highest I've ever hit was 180 and it didn't stay there for more than about 15 minutes. I can say that I've never seen 200 mg/dl. I do find that portion size matters a lot. What most people consider a portion for one is usually a portion for one small family or one very large person.

[princesslinda]

I've read that the post-meal #'s are the first to show any abnormal blood sugar elevation. Apparently for some time, your body has enough time to do what it needs to do overnight and the fastings can still be normal. A few months before my diagnosis, I had fasting blood work drawn that came back with a normal fasting level. At diagnosis, my A1C came back 9.6! so the doctor said i'd probably had diabetes a few years before diagnosis. I can relate symptoms of diabetes retrospectively about a year and a half before definitive diagnosis.

Interstingly enough, I can now control my post-meal levels easier than my fasting ones.

[baskar20]

Princess Linda,

I was thinking that the FBG will creep up gradually and also the A1C along with that. I think the main problem is that the Doctors are not catching it early enough. When FBG goes higher, only then they test A1C etc., and it is too late..

Ronin,

I think you are doing better than me with respect to the OGTT.However, I still feel that you should continue with the low carb and exercise regimen.

I guess the insurance companies / pharmaceutical wanted more people to be diagnosed as diabetics / pre diabetics so that they can generate more revenue for themselves. Hence they lowered the limits for diagnosis.

Baskar

[princesslinda]

Baskar I agree. I'm thinking that not all pre-diabetics will eventually become diabetics, but all T2s have been pre-diabetic, whether we knew it or not. Unfortunately so many of us don't go to the doctor for an annual checkup until we're older, so this isn't usually caught for many of us until we reach full-blow T2. I know i've had annual gynecologic exams for years, but basically all they do is a urinalysis, which usually doesn't show anything until urine spills at blood sugars around 170 or so. Had I had a regular physical, with my family history, they would have probably did the appropriate blood tests and caught me in the pre-D stage....of course, I "helped" things along eating as if there were no tomorrow and being lazy. No point in wondering what "might have been," but I do hope all the pre-D's here will keep close watch and be able to avoid T2.

[baskar20]

Ronin,

I also noticed that you are taking Niaspan. I have been taking 2000 mg Niaspan since 2000. My HDl increased from 28 to 40 md/dl.

However, I now understand that Niaspan could cause the early onset of diabetes and currently I stopped that. I have not yet done my cholesterol testing yet.

But I find a good difference in the blood glucose readings. When I was on Niaspan the same food used to spike my BG a lot more than now.

Not sure about the effect on HDL though. Will I go back to 28 mg/dl? I have to wait till my next lipid profile test.

Baskar

[cherokee_psh]

Much like Ronin, I too was caught by the OGTT. My fasting number were fine and remain fine. Breakfast was my biggest problem. Two hours after I was averaging 180 on a regular basis. The other meals numbers were fine. Also the A1C was climbing, 5.1 at diagnosis (5/2004) to 6.3 this past May. I went on metformin (only) and my reading are much more normal. I did make some changes and dropped some weight didn't change much for me. Seeing how I have/had diabetic parents genetics may be part of the equation for me.

[Ronin]

Hi Everyone:

I appreciate the insights that are coming out. I tend to agree that all Type-2's have, at one time, been diagnoseable as Pre-Diabetic. However, I have to say that I am becoming more-and-more an advocate of the Metabolic Disorder hypothesis. That means that the indicators are multiple and not limited to BG levels, other factors are included and indicate an overall and much larger problem. This would tend to explain why it takes dietary changes and serious exercise to alleviate the onset of not only Diabetes but other serious consequences like related cardiovascular problems. It would seem that the health consequencs take more than one single trigger.

A few clarifications:

I take Niacin not Niaspan (which is a prescription medical dose of Niacin that costs a lot more than the stuff you get at your local suplament store). Yes, I get Niacin-Flush and it doesn't bother me and no I don't take asprin to counteract the flush -- I tried that and almost destroied my stomach. As far as my lipids go my last test resluts were: Cholesterol = 161, HDL = 80, LDL = 63, and Triglycerides = 91.

I was diagnosed as a Pre-D based on FBG levels -- the OGTT was a home based "experiment" as was the one time I managed to shoot my BG levels up to 180 which was the result of a large slice of Lemon merangue Pie along with a large glass of sweetened Ice Tea (apx 150 g. of glucose in one sitting) I have to admit it tasted better than the GU that I used for my OGTT.

I have no plans to change my current regimine of lowered carbohydrate consumption and maintaining my daily exercise routine. However, I'm not concerned about furhter dramatic lowering of my glucose levels and won't be "doing a Bernstein" any time soon.

I'm quite satisfied and my daily testing is to make sure that nothing is going wrong. Yes, I'm a bit obsessive/compulsive on health topics as I was when I was first diagnosed with high cholesterol almost 30 years ago when my father died of diabetic heart complications. FWIW when my father was my current age he was already dead for seven years! (53 was a really weird year for me!)

I have a question for Rzrbks: What was your experience as your pancreas began to fail to produce sufficient insulin? That might give some insight to other Pre-D's who may be slipping towards Type 1.5.

Now, I know there are more Pre-D's lurking out there, I do want to hear your story as do a lot of others so please chime in on this thread.

[ladytaz]

Though I'm not a Pre-D (dx'ed T2 - possible 1.5 - still need tests to determin that) ... once, years ago (1993) I was, though it was called "Borderline Diabetic" back then ... my OGTT at that time was 140 (by TODAY's standards, I was already "full blown" Diabetic) ...

I personally think it has NOTHING to do with ANTHING one does ... either you're predisposed to it or you aren't. Period. If you're gonna get it, you're gonna get it. Nothing you can do to "stop" it. Maintaining it, well, that's a different story. No matter, either you're gonna get or you aren't.

Ronin, you are a good example. You've been very healthy, at least since your "Pre-D" diagnosis, and you maintain that health. Though, you do what you do, you're STILL "Pre-D". No matter what you've done to "improve" your health.

****

What one does or doesn't do, has nothing to do with a T1.5 diagnosis ... it runs along the lines of T1. It's gonna happen NO matter what one does.

T2 ... Honestly, I feel the same way. One may be able to "put it off", but essentially, they're still T2. Just give'em an OGTT!

My sis is an example. She's been dx'ed T2. She does SO very well with so many foods! Her BG is pretty much always VERY good (5.8 A1c). But, with certain foods (rare, they are), her BG raises considerably.

With an OGTT, it was way too high (I don't remember the exact number now, but it was TOO high - in the 200's somewhere). She has, on more than one occasion, said to me, I don't think I'm Diabetic! I tell her, YES you are! Just by how your body reacted to that OGTT, and how your body reacts to those certain foods! Those that DO NOT have Diabetes, if they eat "this or that", their BG does NOT go, and stay, for a long period of time, above 150! I think it's finally "sunk" in with her.

[plluna51]

When I was diagnosed in Feb 2007 all I was told was that I had diabetes. I had a few of the symptoms, abnormal thirst and more than normal urination, usually two or three times during the evening while sleeping. I actually had the physical because I thought the Prostate might be the reason for the frequent urination. Also my father passed away from prostate cancer and my sister was bugging me to get a complete phy7sical, something I had not done in more than 20 years. Diabetes was not even considered. It was quite a` shock when my doctor told me I had diabetes and told me he was prescribing Metformin and Avandia. At that point I should have began asking questions but I was speachless.

Once the shock wore off I started doing some research purchased a few books. The first one I bought and read was Gretchen Becker's The First Year: Type 2 Diabetes. It was after reading this book and seeing my nutritionist that I made the decision to "change my ways". I also bought software to download my meter readings to my laptop. I also purchased a program called Fitday and began logging in everything I ate. This program allows you to see all the nutritional values of the food you eat. You can also record your daily activitity to monitor the calories that one burns daily.

One question that I have it if because of my 9.6% A1C and 231 FGL I must have been type 2. Am I still type 2? I am no longer on medication. My last A1c on 6/92007 was 6.2. My FGL is now regularly in the 80s and my GL two hours after meals is between 110and 130.

I would like to do a monthly A1C test. What home tests do you reccomend?

Louie

[volleyball]

While there is no one size fits all or even most, I think the prediabetic term is more for doctor pigeon holing. A prediabetic can get by without medicine and a diabetic needs medicine. Though some that say they are pre are on meds while some type 2 take nothing and have similar results.
I look at it as I am type 2. Plain and simple. If I don't watch it, my BG will go way higher than a non diabetic.
In a small way, I look at it like a recovering alcoholic, may never get drunk but the propensity is there.

[Dan Gato]

Ronin, good thread.


It's OK that some people are pre-D & control their bg's with diet & exercise.
It's also OK to be ocassionally over 150, or 170.
But what you should do is read here on the Forums & also read other research papers, if people are with sustained elevated BG's they'll have really bad complications. & these complications don't start overnight, it takes a while & the persons aren't aware of the harm being done to them.

Ronin, If you at 60 don't have any complications, that is great.

I went to see the eye doc, he told me that he has seen serious eye damage, & that it happens to people that have too much bg's fluctuations, & that the damage to the eye nerves start at bg's over 150.
I've read that damage to the other organs start at 140 ( regardless of any D diagnosis) & reversal of damages could be done with "normal" bg's.
I've read that non-diabetics have A1C's of: 4.2 to 4.5. I'm far away from that.

I low carb & take meds to control my D. I'm T2.
If I eat a high carb meal my bg's would get very high, even taking by meds, I'm a low dosage for now.

The more carbs a person eats, they're causing beta cells burn out, which is the main cause for D.
I need to preserve my beta cells.

Ronin, et al, have you had a c-peptide test?
do you have any minor complications?

[didi1]

Hi there.
I had a physical and a ogtt was ordered too. The blood work did include a c-peptide test. Afterwards, I too was in shock about the dx. 142 at 2 hr and a high c-peptide (I think it was 12.1 at some point. ) I just remember being speechless too and did not ask any questions either. Went home crying. I Do remember the doc saying "insulin resistant" or something. After the shock, did some research but any help here is greatly appreciated.
ogtt 1 hr 169
ogtt 2 hr 142
c-peptide 2 hr 12.1
A1c test 5.3 at General Doc
A1c test two weeks later 4.9 at Endo's Office
fasting BG 82-86
post pranials 2 hr 88-95 most times (occasional 105 after more carbs)
Doing low carb diet, exercise, no meds.
I did read about pancreas burn out "Bernstein's book" and I wonder how far am I along? Should I be on medication too?
thanks