[jaynetc]

I have a long family history of diabetes, and am the same age my father and his father were when they developed type 2 diabetes.

I have been feeling ridiculously bad these past few weeks and went to the doctor thinking I had the flu. Just to be safe, I requested a fasting glucose test. After not eating/drinking for 12 hours, my fasting glucose was 133.

I returned yesterday for my second fasting glucose, which was 127. The nurse told me neither of these readings were high, but ordered a Hemoglobin a1C regardless.

I talked to my primary care physician (I am away for college) and my diabetic father, both of whom are worried that I may have developed diabetes or prediabetes.

As pre-diabetics, would you consider these readings either-or? What would you suggest I do to find out?

[fgummett]

The A1C is a great start as it should provide an average of your Blood Glucose (BG) over the last 3 months.

I'd also ask a about an Oral Glucose Tolerance Test (OGTT) which would show how effectively your body deals with a sudden influx of sugar.

I would say that a truly normal fasting BG is under 100mg/dl

As for a home BG tester and set about testing yourself to find out about your D.

As to whether this is Pre-D or D I think is really academic... as in either case it should be a call to action. Type 2 D is a progressive condition that can get worse over time if untreated BUT it can be stopped in its tracks, possibly reversed or at least slowed down if you are willing to make changes. Being progressive means that the sooner you catch on to it the better your chances of getting it under control.

As to why the nurse told you that "neither of these readings were high"... you might search up a site called "Blood Sugar 101" for a full discussion of why the America Diabetes Association (ADA) and others set the level of what constitutes "normal" BG way too high.

[BigDogz]

I'm mystified as to why that nurse would tell you that your fasting levels "aren't high". Even going by the old standard norms (70-110) instead of the new version (70-100), your fasting sugars would still be high. I hope your physician is better educated about DM than his/her nurse is. If not, find someone, like an endocrinologist, who is. There are way too many detrimental effects from long-term elevated sugars to go playing around, especially when knowledgable treatment can slow or even prevent many of them.

I also agree with the other folks...insist on a HgbA1C and an OGTT (oral glucose tolerance test). They can add a whole new dimension of information to your arsenal.

Good luck and let us know how things are going for you!

[Subby]

Yep, the nurses comments makes even less sense, seeing that even by ADA standards you are borderline type 2.

How to Tell if You Have Pre-Diabetes - American Diabetes Association

Either way, I agree with Frank that it's a bit academic whether to consider oneself pre or type 2 at these kinds of levels: the official line is hardly a universal truth between one state or another, it's a matter of degrees. What is more, as Frank says, your actions over some months could improve your situation from where it is now. I wouldn't see a verdict of type 2 as set in stone at all, at this stage, I do feel that absolute threat hanging over your head. Especially, if you happen to have areas you can vastly improve, such as diet or weight, it could be very much uphill from here as far as having a healthy life.

[jaynetc]

This is strange.

Two hours after eating lunch (corn dogs. I know, not good.) and an Orange Crush later (also, not good) I waited two hours and decided to check my blood sugar.

Surprisingly, it was only 95.

How could my fasting blood sugars be so much higher than this?

Should I still be worried?

The Ha1C results should be back in a week, but at the suggestion of my father, I have been using his extra BG monitor to keep track myself.

[princesslinda]

I'd wait for the results of the A1C and in the mean time try and watch the amount of carbs you are eating. If your A1C returns within normal limits and you're still concerned, request that the doctor do an oral glucose tolerance test.

[BigDogz]

Originally Posted by jaynetc

This is strange.

Two hours after eating lunch (corn dogs. I know, not good.) and an Orange Crush later (also, not good) I waited two hours and decided to check my blood sugar.

Surprisingly, it was only 95.

How could my fasting blood sugars be so much higher than this?

I've encountered the same thing...at times. It confounds me, too, that I can sometimes eat the most atrocious and carb-laden meal and test in the 90's. Then days when I'm being really, really good about eating right and I test in the 180's.

My own personal theory, and I could be as wrong about this as all get out, but my theory is that early in diabetes our pancreas is still trying hard to compensate and it ends up being "lazy" sometimes and launching into "overdrive" at other times.

Through frequent and diligent testing, I've found that my body pretty much follows the same pattern each month. For about 1/2 the month my sugars are averaging in the 90's, even after big meals. For roughly the 2 weeks prior to my period, my sugars jump dramatically and don't come down much between meals. It's also during this time that I have my highest FBG's.

Since I have such a long timeframe of normal sugars, I was kind of surprised to hear that my A1C was 5.8. I just assumed it would be lower with 2 weeks of sugars in the 90's every month. Anyway, my doc tells me, since the A1C is an average of your sugars over a 3 month period, that the highs I experience during the pre-menstrual stage, especially since they're extended, are responsible for driving the A1C higher than I expected.

[cherokee_psh]

I think the Oral Glucose Tolerance Test will give a better picture. In prediabetes you have some lows that help mask the times you are higher thus resulting in a misleading A1C.

[BigDogz]

The biggest problem I have with the benefits of the OGTT is that my sugars are usually higher in the afternoon and evenings and pretty darn good after 7A or 8A - the time OGTT's are normally run. If a doctor is looking simply at the OGTT info from a daytime test, it's conceivable my diagnosis could have been delayed.

For giggles I ran a "home" OGTT using my meter and 75 gms of glucose tablets. It didn't come out all that bad. On the other hand, the "home" OGTT I ran with the 75 gms of glucose tablets in the evening (my "danger" hours) was well into the category of diabetes.

Frankly, at this point in time, I really don't think there's a truly good testing process for diabetes. So much of it is guesswork and conjecture while trying to stuff each patient into the same small diagnotic box that hasn't been revised since the early 20th century.

I'm finding that diabetics are like snowflakes...no two are alike. It seems each person has different experiences on their journey into the world of DM but we trudge through a medical system that struggles, at best, to think outside the box.

[jaynetc]

Wow. You all have been so incredibly helpful. If the diagnosis goes through, I know where to turn to for support.

Can you tell me exactly how a OGTT works? I know you're given a very sugary substance, but what kind of reaction are they looking for?

Since the test, I have been actually paying attention to how my body reacts to what I eat. After eating terribly all day, and then not eating for about three or four hours, I was too fuzzy and weak to even stand.

I didn't want to test my glucose because the massive bruise I left on my finger has me a little spooked. Inexperience. Haha.

[BigDogz]

My lab wants you to fast for 10-12 hours before the test. Once you get to the lab, they draw the baseline FBG (fasting blood glucose) and then give you a 75 gm glucose drink. Mine was orange flavored (ick, I hate orange soda) and, you're right, it is very sugary in taste. Although, you don't really get an opportunity to "savor" it as they want you chuggalugging it as quickly as you can.

Then you sit for 30 minutes before they draw the next blood glucose. More are drawn at the 1 and 2 hour times and, sometimes, the 3 hour marker. You'd be advised to take a good book with you so that you're not absolutely bored to tears sitting around.

They're looking to see how well your body can metabolize the glucose load from the drink. By most standards, any sugar over 200 will give you a diabetes diagnosis, over 140 at 2 hours is often called 'impaired glucose tolerance'.

Normally, fasting glucose levels over 126 will cause a physician to give a diabetes diagnosis. That's why I'm still blown away that your medical provider wasn't at all concerned about your fasting results of 133 & 127.

[Subby]

Originally Posted by jaynetc

I didn't want to test my glucose because the massive bruise I left on my finger has me a little spooked. Inexperience. Haha.

From a normal BG tester? That's very strange to get such bruising. What type of tester is it, and does the lancet device have a name?

[jaynetc]

I used the OneTouch Ultra Mini with the lancets that came with it.

I had it set on the shallowest setting and did it in the exact same place the nurse did.

I must've just done something wrong.

[jaynetc]

Originally Posted by BigDogz

My lab wants you to fast for 10-12 hours before the test. Once you get to the lab, they draw the baseline FBG (fasting blood glucose) and then give you a 75 gm glucose drink. Mine was orange flavored (ick, I hate orange soda) and, you're right, it is very sugary in taste. Although, you don't really get an opportunity to "savor" it as they want you chuggalugging it as quickly as you can.

Then you sit for 30 minutes before they draw the next blood glucose. More are drawn at the 1 and 2 hour times and, sometimes, the 3 hour marker. You'd be advised to take a good book with you so that you're not absolutely bored to tears sitting around.

They're looking to see how well your body can metabolize the glucose load from the drink. By most standards, any sugar over 200 will give you a diabetes diagnosis, over 140 at 2 hours is often called 'impaired glucose tolerance'.

Normally, fasting glucose levels over 126 will cause a physician to give a diabetes diagnosis. That's why I'm still blown away that your medical provider wasn't at all concerned about your fasting results of 133 & 127.

Thanks. That doesn't sound too terribly bad, except for all the testing.

Well, I don't feel like this doctor was the best one I could have gone to. I didn't do the research before I went to her, as I am in a college town and there aren't too many physicians. I won't go into the details, but I am getting my lab results when they come back and running my little legs home to my PCP as soon as I can.

Also, I got the call today that I am MASSIVELY hyperthyroid again. Could that have had something to do with the readings?

[Ronin]

Hi Jaynetc!

I've been here long enough to know that there is a lot of debate about what differentiates Pre-D from full blown Diabetes. I can go on-and-on about how the diagnosis came to be and the intended use as well as the unintended consequences.

I'll make my response much shorter. In my mind (and only in my mind) a Pre-D is a person who is beginning to show the potential onset of Diabetes but, with diet control and exercise can maintain their BG levels in high-normal levels. A full-blow diabetic, on the other hand can improve but not achieve the level of control with diet and exercise only - medication is required.

Testing is essential to see what regemen is working.