[Ronin]

Hi Felinefan!

First of all you are not alone, most of the other Pre-D's on the forum have gone through the same process you are going through now. Anger and frustration come with the turf largely because the Pre-D diagnosis is new and not well understood in the medical community.

First some background I have dug up when I was researching my own diagnosis. The Pre-Diabetic diagnosis was intended to catch young people who were developing Type-2 diabetes in their teens and 20's. Under the law of unintended consequences, more older adults were diagnosed as Pre-D's than the target group.

Behind this is a debate as to the source of diabetes in the first place. Is it genetic or is it environmental? If it is genetic then anyone with the genome is going to develop diabetes and the diet and exercise will delay the onset but not prevent it. If the cause is environmental then diet and exercise will prevent diabetes from happening. Is either source definitive? No.

Generally, I, and most of my fellow Pre-D's agree that one FBG reading above 100 does not relegate anyone to the world of Pre-D. A good diagnosis requires HbA1c testing (which you have already had) and potentially a test of your fasting C-Peptide levels and/or combined with and Oral Glucose Tolerance Test (OGTT) to determine the insulin output of your pancreas.

It is important to understand that most MD's who do not specialize in diabetes get these alerts from the medical community and when you get a FBG reading above 100 it sets off alarm bells (not to mention a fear of being sued if they do not diagnose and treat you properly and fast). So, you have the blood work and you get the diagnosis. Unfortunately, that leaves you both confused and angry.

Now a bit of reality. There have been tests on people with no signs of diabetes. Generally, their BG levels are well below 100 and tend to be in the 70's to low 80's even a few hours after eating a meal. Also, their A1c results tend to be below 5.0%. (Imortant note: HbA1c values are a weighted average that favors the pervious four to six weeks so they don't represent a realistic 90 day average. However, they are the best test to determine your abilty to control your BG levels over time and take out the spikes and valleys.)

So, just what is Pre-Diabetes and why do some of us accept that diagnosis while others do not? I can only answer for myself. I've had a lot of testing done, as well as doing a lot of testing on myself along with a lot of research. For me the Pre-D diagnosis is little more than fair warning. It is the time to take stock, make life-style changes, and to a large degree enter a phase of watchful-waiting for the condition to stabilize or get worse. In the mean time live your life.

On a personal level I already know that my pancreas produces insulin on the low end of normal and that my body response to glucose load is slower than a person with a fully functional pancreas. Eventually I will probably become a Type-1.5 and will need supplamental insulin to manage my BG levels. But not today.

I watch my diet, and when it comes to carbohydrates, I manage portion sizes. I also exercise a lot more than the average person -- being retired allows that to be easier than for a person with a job. But, having a job is not an excuse for not using the body whenever possible as opposed to using other means to get around.

I wish, as do most Pre-D's, that this was a clear cut case and a diagnosis actually means that you have a condition that can be treated or managed. Sorry, that just isn't what this is all about.

You wil have emotional ups and downs on this journey. We've all been here and we are willing to help to the extent that we can. Please be patient with us, and with yourself. The Pre-D diagnosis is not a death sentence, it is, at best, a warning sign on the pathway of life. It is your choice to take action or to ignore the facts.

[felinefan67]

One quick thing; I've read on other websites that the A1C isn't a tool to diagnose Diabetes (so how can it confirm pre-diabetes then?) It is more of tool to see how well a diagnosed Diabetic is managing their blood sugar. Some have said to not rely too heavily on the A1C for a diagnosis (I'm guessing that means for PRE-D people as well?)

If I'm pre-d then why are my after meal readings so "normal"? I haven't done many (just a few really) but they've all come out SOLIDLY normal.

Also, if I don't have a family history (except for my dad who may have got his due to binging on sugar and carbs for YEARS) then is it still considered genetic based on ONE case in several generations on both sides of the family?? My mother's Grandmother (I think) or great Aunt) had it, but that was it as far as we know.

I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.

Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

[xMenace]

Originally Posted by felinefan67

One quick thing; I've read on other websites that the A1C isn't a tool to diagnose Diabetes (so how can it confirm pre-diabetes then?) It is more of tool to see how well a diagnosed Diabetic is managing their blood sugar. Some have said to not rely too heavily on the A1C for a diagnosis (I'm guessing that means for PRE-D people as well?)

I don't follow diagnosis issues very closely. I would not discount an A1C. I think it is much more telling than a few high spot tests.

If I'm pre-d then why are my after meal readings so "normal"? I haven't done many (just a few really) but they've all come out SOLIDLY normal.

I am no expert, but here's my theory. There are two sources of sugar: food and liver. Food intake triggers insulin release. You seem to respond well to food. You don't seem to respond as well to your dawn phenomenons. I think often fasting numbers show rises before post-prandials.

Also, if I don't have a family history (except for my dad who may have got his due to binging on sugar and carbs for YEARS) then is it still considered genetic based on ONE case in several generations on both sides of the family?? My mother's Grandmother (I think) or great Aunt) had it, but that was it as far as we know.

Two cases is enough for me. Keep in mind that many cases have never been properly diagnosed. Some may have lived out their lives with it and never knew. Others may have succumbed to other causes before it hit. Also, it's something that many do not like to talk about. There is a bit of guilt often associated with it.

I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.

Stress and injury are definately causes. D does not usually come on linearly though. There are usually ebbs and flows.

Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

Whether you are D or not, these are excellent decisions. Rock on!

Michael Pollan on The Hour with George Stroumboulopoulos on CBC

[REDLAN]

I think often fasting numbers show rises before post-prandials

From the research and articles I have read, it is the other way around. It is the insulin response to meals which goes first. OGTT (oral glucose tolerance tests) are a much more sensitive test, and these show abnormalities (high results) before the fasting levels start to rise.

Insulin resistance is not insulin resistance per se. what actually happens is that people with type 2 lose flexibility of response. After food the insulin resistance drops, allowing all that glucose to be taken up by the muscles. With type 2 it stays high, causing high insulin levels. As the disease progresses, the pancreas becomes affected and is unable to produce enough insulin and so blood glucose levels rise.

My (non-medical) opinion is that currently you have a high normal blood sugar. You have relatives with type 2. Both these increase your risk - but do not necessarily mean that you will develop type 2.

I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

totally concur with xMenace - ROCK ON!

adopting these lifestyle changes will not hurt, and should help protect you against developing type 2.

[princesslinda]

I've read recently that the post-prandial readings are the first to show elevation. For me, I had annual physical exams with fasting blood work that always showed "normal" blood sugars, one about 8 months before diagnosis....yet my A1C at diagnosis was 9.6 and looking back, I can now relate symptoms that make me think I had it a couple of years before diagnosis.

[homeschoolmom]

Hi,

I have some similar blood sugar readings - only 1 fasting level of 102. Other lab fasting levels have been 85 and 99. When I test at home, I've had some readings as low as 50s fasting (average fasting is 76). My levels after eating have been fairly normal with a couple of high readings after big meals with lots of carbs. My GTT came back normal. My a1c was 5.3. I've wondered a lot of the same things as you. One thing I have noticed is that most prediabetics have fasting numbers above 100 consistently. When I asked my endo about my 99 number, he said, "perfectly normal". Did you know that up until a few years ago, anything below 110 was normal? I consider myself to be "pre-prediabetic" I'm thankful I got a "heads up" call before it was too late. There is a very informative website that you can find if you google blood sugar 101 that answered a lot of my questions. I've recently quit obsessing about it, but I also exercise every day and eat protein with every carb. I stay away from sugar and white flour, drink plenty of water and try to do something moderately active after I eat (wash dishes, clean, etc.). Good luck!

[felinefan67]

Not sure what to make of our conversation, but the bottom line is she is unconcerned and REFUSES to recognize "pre-diabetes" as a medical term. Her exact words were: "The medical community doesn't use the term "pre-diabetes anymore, it's outdated" Everytime I tried to explain my concerns, she kept saying "But you're NORMAL" (regarding my 5.8 a1c reading). She said "People are either diabetic or they're not" so stop worrying." "You are doing just fine with fastings of 99,99,99,(lab 99), 102, 101, 102, and latest of 74.
When I tried to explain about my fasting going up to 102 and a FBG of over 99 is considered pre-diabetes, she said, "Well now you are being a purist" How do you like that?

She also told me (and my mother too) to "stay off the internet". It isn't the "medical profession or something to that effect.


I don't know who's in bigger denial, me or my doctor!! Well I consider this a big huge warning and possible huge risk down the line so regardless of my doc's blah-zea (sp) I'm still going low carb and almost no sweets (I guess I can have a beer or two ocassionally though, right?)

[Tropo]

Originally Posted by homeschoolmom

Hi,
When I asked my endo about my 99 number, he said, "perfectly normal". Did you know that up until a few years ago, anything below 110 was normal?

The bottom line is that doctors don't have time to concern themselves with pre-pre-diabetics (almost pre-diabetic) and usually only treat people when levels may require medication.

It goes something like this: You go to your doctor today and get a FBS reading of 99. The doctor says you're perfectly normal - come back next year and if you're over 100 we'll start your medication.

People really have to treat themselves if they desire to be healthy. Most people on this forum say the politically correct "consult your doctor" whenever people query their readings. This type of advice and thinking won't get you very far with most doctors. People need to study and learn about the condition and possibly look for wholistic doctors that can help arrest the deterioration before it requires medication.

[Tropo]

Originally Posted by felinefan67

I guess I'm trying to figure out if stress and injury could have caused a temporary high that had gone back to normal numbers now. Can that happen? I was under a great deal of daily pain for over three months with my femoral nerve in my right leg. Every day was excruciating (pain-wise) for about the time that was tested under the three month A1C average.

Now my leg is far less painful and I'm getting much more active plus I cut out most of the refined carbs I used to binge on. I'm hoping that the numbers will stay normal from now on.

It happened with me.

Three years ago I had a 3 month battle with cholestasis of the liver. I had severe jaundice amongst other symptoms. Upon doing some blood tests I found out my FBS's were in the mid-200's. I even went on diabetic medication for a few months.

Now, with a fairly high carbohydrate load in my diet I read "quite normal" averaging from 100 - 110 FBS with no medication and regular exercise. My post-prandials are also in the normal range and my HbA1C is 5.7%.

You could say that I went from type 2 diabetes when I was sick to almost normal now.

[Ronin]

Felinefan, et al.,

Your story, as well as your frustration and anger, are quite familiar here on DF. The diagnosis and treatment of the diabetic condition is part science and part art. There are a few specialists and they have well defined predjudices. It sounds as though your MD has the feeling that anyone without an MD behind their name is not qualified to speak about any medical topic. Yeah-Right!

There is one bottom-line take away for you: it is you who is responsible for your health. If you decide to take action on what you percieve to be a Pre-D Condition that is your decision and not the decision of your MD. Don't expect her to support your diagnosis because she thinks that all diagnosis belongs to her. However, you are the person who decides what goes into your mouth, if you test your BG levels and how often you test, how much you exercise or don't. The frustration isn't finished, because if you improve your condition she will want the credit.

In the end adopting a better life-style with more exercise and better diet is good for you regardless of a diagnosis from somebody with an MD behind their name.