[wiseguy]

Larry,

The 5.8 A1c is very good and most diabetics would be very happy with it. It does not mean that you are not diabetic. I know that you are diligent about your diet, carb watching, and daily exercise and these things are the reasons for the good A1c results.

[Ronin]

Larry, et al.,

I want to chime-in here on one side of the Diabetic/Pre-Diabetic debate -- there is the issue of age. If you visit Larry's profile you will find that he is over 65.

Since the inception of the Pre-Diabetic diagnosis (which was intended to capture the young people before they became Type-2 Diabetics) the vast majority of people being diagnosed as Pre-D's are over-50.

That being said, there are those (Dr. Bernstein, et al.) who hold that the bodily response to glucose must be exactly the same regardless of your age -- if you are 9 or 99 the criteria is exactly the same -- never over 120 and always-always-always rapidly returning to the low 70's after eating any amount of carbs.

The problem I have is that our bodies wear-out over time. The pancreas slows or diminishes in the ability to produce insulin. An inactive body also cannot use the amount of glucose that our society makes available to all people.

What I have noted in this thread is that when Larry works on his diet and exercise he manages to keep his BG levels in check albeit not in the perfect range of 70 - 120 at all times. I, like some others contributing to this thread, am concerned for Larry that his highs are quite high. However, as long as he can maintain an HbA1c of 5.8 without medications that is great!

I have no idea about Larry's potential life span, but it would seem to me that he is doing okay. Personally, I don't want to see Larry sacrificing quality of life in pursuit of what Bernstein, et al have set as the "perfect profile." Seeking perfection can, and usually does, lead to burnout.

Larry, you are doing great! Keep up the good work and don't worry about being perfect. A lot of what you are finding may simply be your age. If you can manage to keep your HbA1c levels where they are, or perhaps a bit lower, you will do fine. Remeber that "the enemy of better is 'BEST!'"

[Larry H.]

Ronin,

Well thanks for the encouragement.. That is the essence of the support group for me. I think many of us come at this with slightly different ways of interpreting things. There are probably as many also on the net. My original feeling that seeing the results of my Glucose Meter was a fairly good reflection of what was going on was probably correct. Others come at it a little different. I will continue to have the AC1 test and see what is going on.
I also agree that if all I could ever eat was no carbs at all I probably wouldn't make it.. Moderation and eating things in quantities that allows the sugars to remain reasonable are my goals. When I see that something is amiss I try to reverse it to the best of my ability. Should I get to the point where I can no longer see readings that are tolerable I will most likely seek out medical help for that. I wish to avoid it as long as possible..

[wiseguy]

I find the term "pre-diabetes" to be totally absurd. It's like saying you are a little bit diabetic. The treatment is exactly the same as it would be for the early stage of type 2 which is exactly what pre-diabetes is.

[Ronin]

Wiseguy, et al.,

The diagnosis of Pre-Diabetic is a poor choice. However, it is not an automatic "Early stage Type-2." It all goes to the underlying theory of how diabetes happens. We have the environmental theory that says what you eat can cause the onset of Type-2 diabetes. On the other side are the Genetic thinking people who beleive that your propensity towards diabetes in built into your geneitc structure and all you can do is delay the onset. Both sides have cogent arguments that make sense.

As I wrote earlier, the intended purpose of the Pre-Diabetic diagnosis (which is supported by the environmental argument) was to capture young people and stem the tide of childhood Type-2. The law of unintended consequences kicked in and thousands of people over 50 are being swept into this diagnosis. The result is a general panic in the over-50 crowd and some MD's handing out pills without really knowing how to treat diabetes and others telling their clients not to worry. The result has been more heat than light.

I can only use myself and a close friend as an example of the result of this diagnosis. The presumption of Type-2 has led MD's to assume that the individual, despite their diet and exercise regimines, are "Insulin Resistant" and that was done without a C-Peptide test. Both my friend and I have very low C-Peptide readings. Whoops, the drugs used to treat Type-2 are to increase insulin sensitivity and don't work on Type-1.5's and only cause problems on those of us with a low-functioning pancreas.

Larry has had an HbA1c at our prodding and has found his average BG levels to be "acceptable" in the perspective of controling BG levels for a diabetic. The next question (and the next test for you Larry) is what is your fasting C-Peptide level. If it is high then you are trending towards Type-2, if it is low you are trending towards Type-1.5. This is not a guessing game, it is a test that shows the direction you are headed and therefore tells you what you need to do to slow/prevent the onset.

I accept that my diagnosis as Pre-Diabetic is slippery, and I also accept that I am now a member of the diabetic community and as such have to live a life different from my fellow humans who are not diabetic (yet).

[jvetter18]

Larry,
The A1C is good, not great, but still good, especially w/out meds. I think that maybe a few small tweeks to your excercixse regimen might do the trick. Working out after your biggest carb meal, (like starting 1-1/5 hours after your meal) might help.

the other thing is that your docs lack of knowledge is a little startling. thank goodness you have the sense to advocate for yourself. 200 is not fine, at anytime. He must be "old school". A pulmonary spec. not being to diagnose a heart issue?

if it were me, like we recommended before, i'd start looking for another doc - not just for the diabetes aspect, but just in case something else might pop up. Your doc seems like the take an aspirin and call me in the morning type.

are you too far from chicago or another metro area w/ good hospitals/docs?

[Larry H.]

I am about two hours from any reasonably large metropolitan area. St. Louis being the closest.
So far no one has responded to the Mean Glucose I refereed to on my test results. From what I googled it appears to be a reference point that shows about 15% lower than your AC1 and is the average a person might see on their glucose meter.
Its surprising how many different times are suggested as the length after eating to test. That site said 90 minutes after eating?
Some times I just don't seem to get any relationship between what I eat and what I get on the meter? Last night we had a couple cups of onion soup, a little chicken and turnips an a few pieces of carrot. Low Carb ice cream and I walked and exercised for half and hour.. It came in at 138. Not bad but 20 or more points higher than I got for a sandwich and chips for lunch. It would seem that exercise in general can tend to raise your over all readings?
One benefit of using the Health rider more and for longer periods is that I actually saw a muscle when I flexed my arm while dressing this morning.. that looked good for an old guy!
On the Pre diabetic debate, I don't know what exactly to make of it. We aren't quite yet meeting the type II diagnosis as far as readings go. But yes the numbers come in higher than normal people for sure. When you read the literature, and Wise guy I know you do, then it would appear to say that a percentage of pre-diabetics go onto type II depending on diet and exercise. So does that mean that some won't? I admit mine seems to be creeping higher. I did also see a study last night that related to increased numbers in winter due to the increase in food and less ability to exercise as in summer.

[Harold]

Originally Posted by Larry H.

I am getting more confused by the moment. What does the Mean Blood Glucose mean on my Test? It says 117.8. They listed the AC1 as you say at 5.8. A chart I down loaded says that 117 range is 5.4. I am totally confused by the numbers, but I agree that it is a Diabetic reading and prone to get worse.

A Mean Blood Glucose means it should relate to a Mean Average of your Meter readings. Say you take all of you meter readings for the last 90 or 120 days and add them up and divide by the number of readings, and the result is a Mean Average of your Meter readings. The Charts you are looking at are a conversion of your A1c, a Weighted Average, to your Meter Average, a Mean Average. I use this to see if my meter checks are really giving me a true ballpark idea of what my blood glucose is doing. Sometimes it does not which means I am not enough of the highs or lows depending on the direction of the difference. In other words I may be going high or low while sleeping and not catching them with my meter.

You mentioned a difference between charts. It sounds like what you are looking at is a chart for Whole Blood Glucose and a chart for Plasma Glucose levels. Labs measure Plasma and Meters measure Whole Blood. Now the reason it gets confusing is Newer Meters are compensated to display equivalent Plasma readings. Check the booklet that comes with your meter to find out if it displays Plasma or Whole Blood. Then use the appropriate chart to compare your A1c to your meters Mean Average.

[wiseguy]

To me if it looks like a duck, walks like a duck, and quacks like a duck... it's a duck. So called pre-diabetes requires exactly the same treatment (diet, exercise, and weight control) as early stage type 2 and it is for life like type 2. If you are diagnosed with pre-diabetes then you will have pre-diabetes your entire life? This is just ridiculous. I have yet to find a study (I don't think one exists) that would provide an estimate on the percentage of those diagnosed with pre-diabetes that are at some later time diagnosed as type 2. I'm willing to bet that the percentage would be very high.

[Larry H.]

This is just one of many sites that discuss this issue. I just found this one for the sake of showing what it says. I personally don't know if its true or not. I just know I have often read similar sites. This one is taken from the MedicineNet.com site.


(The good news for people with pre-diabetes is that they can prevent or delay the development of diabetes with lifestyle modifications. Modest weight loss through diet and moderate exercise (such as walking 30 minutes per day, five times a week) can slow the development of diabetes and can even return blood glucose levels to normal in some people with pre-diabetes. Overweight people who have pre-diabetes need not achieve their ideal body weight to improve their condition; studies show that a weight reduction of just five to ten per cent of body weight can improve blood glucose levels. Since you can take measures to reverse the condition, recognition of pre-diabetes is an important step in disease prevention.)

It does say "Prevent" or delay so it would seem to mean that?

I think I saw wording something like it in the ADA site also.

[wiseguy]

Originally Posted by Larry H.

This is just one of many sites that discuss this issue. I just found this one for the sake of showing what it says. I personally don't know if its true or not. I just know I have often read similar sites. This one is taken from the MedicineNet.com site.


(The good news for people with pre-diabetes is that they can prevent or delay the development of diabetes with lifestyle modifications. Modest weight loss through diet and moderate exercise (such as walking 30 minutes per day, five times a week) can slow the development of diabetes and can even return blood glucose levels to normal in some people with pre-diabetes. Overweight people who have pre-diabetes need not achieve their ideal body weight to improve their condition; studies show that a weight reduction of just five to ten per cent of body weight can improve blood glucose levels. Since you can take measures to reverse the condition, recognition of pre-diabetes is an important step in disease prevention.)

It does say "Prevent" or delay so it would seem to mean that?

I think I saw wording something like it in the ADA site also.

Again, what they are saying you need to do is exactly what you would do in the early stage of type 2. You must adopt these lifestyle changes for life in hopes of slowing the progression which, in this context, is the progression from pre-diabetes to type 2. The only difference between what has been labeled as pre-diabetes and type 2 diabetes is a small difference in above normal BG numbers.

Once you are diagnosed with pre-diabetes the word "prevent" does not come into play. You are already a diabetic and always will be (unless there's a cure).

[Ronin]

Wiseguy, et al.,

This discussion has drifted a bit away from Larry's initial questions about the meaning of his HbA1c results into the definition of what is/isn't "Pre-Diabetes." Unfortunately, we are stuck with the term unless/until the powers behind the Diabetic Community change their mind.

Is Pre-D really nothing more than "early stage Type-2?" Perhaps, but what about those of us who are headed towards Type-1.5 (i.e., our Pancreatic function is diminishing and will cease sometime in the future). In the end, Wiseguy's point is well taken.

Those of us with the Pre-D diagnosis may, or may not develop full-blown diabetes (Type yet to be determined). However, the critical issue is that once so diagnosed we cannot return to the typical diet and exercise pattern we had, or that of our society, because that will hasten the onset of the Full-Blown form of the condition.

As I have noted many times previously, the original intent was not achieved in ushering in this diagnosis -- only the law of unintended consequences. Rather than catching young people who are developing Type-2 at an alarming rate, the category is sweeping in loads of the over-50 population.

Perhaps this is because children are tested less often and usually not until there is a "problem" that calls for blood work whereas the over-50 population gets more regular blood work. The other side is that childhood Type-2 is a sudden onset rather than gradual.

What we do know is that modifications to diet and exercise patterns has a good effect on people with "Insulin-Resistance" as well as those with declining pancreatic function. Actually a bit better on the IR folks -- declining insulin production is pretty much a done-deal -- you've eitehr got it or you don't.

The final question to the over-50 population is: What is the necessary response to seeing your BG levels get into the Pre-D defined areas? Personally, some testing, including HbA1c's and C-Peptide readings are required in order to make good decisions as to the direction you need to go. (i.e., For me adding exercise is not as important as watching to see what happens to BG levels because I am not IR, but my pancreas is slowing down and when my BG starts to spike I need to start supplamental insulin.)

As with all things: Knowledge is Power!

[seekerjohn]

Hi Larry--

I am an SIU alum. You might look into the med school there to see what is being done to prevent onset of the disease. Sometimes people get Metformin (glucophage) or even insulin shots, or doses of other things to improve insulin sensitivity. I do know that diet, exercise and control of blood lipids is a concern. Abdominal weight is an areas to watch, I believe.

seekerjohn

from NH

[Ronin]

Hi Seekerjohn!

Your post makes my final point about Knowlege being Power. You wrote: "Sometimes people get Metformin (glucophage) or even insulin shots, or doses of other things to improve insulin sensitivity." The presumption that adult onset Diabetes is always Type-2 is a problem with a lot of MD's who don't have sufficient knowledge to order the right tests. Injected insulin to an Insulin Resistant person might be of some short term assitance, but it does little to nothing to overcoming the underlying IR condition. In the same idea handing Metformin to a person who has reduced pancreatic function doesn't help becaue the person isn't IR -- s/he doesn't produce sufficent insuln and needs insulin shots!

It takes more than one test to determine the full diagnosis of the condition. No single test can be used to make the diagnosis and more testing is required to determine the correct course of treatment.

My personal gripe is with the MD's who, on the basis of one high FBG test, hand out prescriptions for Metforim or tell the person "not to worry" without really finding out what is going on. (Note: A close personal friend was "diagnosed" this way and spent years before another MD ordered a C-Peptide and discovered that the reason the treatment was not working was because his pancreas had all but shut-down and put him on insulin -- instant fix to the "Real" problem.) Pardon my rant.

[wiseguy]

I guess my real problem with a pre-diabetes diagnosis, with terms like "prevent" and "reverse" in the description, is that too many people (even one is too many) will get the idea that if they watch their diet and exercise for awhile the condition will just go away and they can return to life as it was before. I think people should just be told that they are in the very early stage of type 2 diabetes, and with the proper lifestyle changes, they may drastically slow, or even halt, the progression of the disease.