[Noturningback]

Hello again!

This is a continuation from a thread I posted this morning:

Question aboutmy A1c Results

I emailed my GP about an A1c test result of 6.5 that I received last week. I have some history which you can read about at the above link. My blood sugar has always been normal but, I suspect that I have been IR for some time now.

For the record these results were mailed to me last week with a note to retest in three months.

Here is my email to my GP:
-------------------------------------
Hello Dr. X:

I'm concerned about the A1c results. Does this confirm Insulin Resistance, Diabetes, that I ate a lot of junk on my vacation or does it prove nothing? My OB/GYN has thought I am Insulin Resistant for some time because I have PCOS and acanthosis nigricans. Lately, I've had problems with my PCOS and have been trying to get my OB/GYN to return a phone call so I can clear that up. I've also read that there may be a link to high white blood cell count and diabetes. I'm not sure how true that is though.

Thank you,
~Danielle

His response:
---------------------------------
Hi:

The HbA1c level is a measure of your average blood glucose over the last four months. Anything over 6 is in the range of diabetes. Binge eating probably didn’t affect it much.

Type II diabetes is due to insulin resistance. The resistance results from substances put out by fat cells. If you decrease the mass of fat cells (lose weight), the diabetes, at least for the next few years, will clear and won’t return.

Your pancreas is actually putting out more insulin that a normal person. Over the long run, the pancreas will fail and then the diabetes will be remain even if you lose weight. Right now, though, you could completely get rid of it.

Inflammation (reflected by the high white blood count) raises blood glucose levels, but doesn’t cause diabetes.

The reality is that your weight is setting you up for trouble in the future. You would be a much happier camper over the long run if you slimmed way down. Easy to say, right? --------------------------------------

I don't know what to make of it. I feel like he waltzed around the question and didn't provide an answer. I'm not looking for a disease but, I want to know if I'm up the creek without a paddle. Basically, I wanted to know if I'm prediabetic, diabetic or something else? I'm trying to figure out if I can lose weight without medication because I have had little success in the past - and I've tried everything - as I'm sure many of you may, unfortunately, experienced.

Any advice is greatly appreciated.

~Danielle
PS - He isn't being sarcastic. He has a great bed side manner and struggles with weight himself. I'm just not sure he is helping me either.

[princesslinda]

I don't get the feeling that he's waltzing around the issue. I don't think he wants to give you a diagnosis of T2 based on one result....and he's very encouraging that if you manage to lose weight, your insulin resistance may improve and you'll have less chance of becoming full-blown Type II, if you don't have it already. You might also want to consider having a glucose tolerance test if you don't consider your A1c to be diagnostic of T2 diabetes.

Normal A1C from the lab I use is between 4 and 6. I'd want to be closer to 4 than 6. There's obviously something going on with the PCOS symptoms and a high or high-normal A1C.

I think i'd ask to try metformin as it will help with the insulin resistance (and some lose weight on it, as insulin resistance causes that insatiable hunger) and then work really hard to get your weight down. I understand that its difficult, i'm a big girl myself, but I can tell a tremendous difference in my stamina since losing 70 lbs....though if you saw me you'd still consider me overweight...and I have a ways to go.

I still think you may benefit from seeing an endocrinologist. The nigracans should improve as your insulin resistance decreases.

If you are a T2, its not going to go away, but it can be controlled w/o meds, with lifestyle modfications. Once diagnosed you're always diabetic.

[BrianSCohen]

Noturningback,

Welcome to the forums. You will find many knowledgeable and sympathetic people here. While your doctor and OB/GYN may be trying to be helpful, you have not been particularly well served. From everything you say, you have had metabolism problems all your life. The acanthosis nigricans comes from high levels of insulin. Do you know what else high levels of insulin causes? Yes that is right, it causes our bodies to lay down body fat.

I am dissapointed at your doctors explanation. [insulin] resistance results from substances put out by fat cells. This is just not true. Fat cells don't put out some substance. Certainly fat contributes to insulin resistance, since fat absorb some of your generated insulin, but that is it. I doubt you were this heavy when you were young, but you still had these metabolism problems. Your weight is most likely a result of metabolism problems, not a cause.

Unfortunately, you have the markers indicating diabetes, and in any case I would bet you are very insulin resistant. You could ask for a glucose tolerance test, but I don't think you need much more conclusive evidence. Your OB/GYN is ill-informed, you may very well benefit from Metformin. Metformin improves insulin sensitivity and is routinely prescribed both for Type 2 diabetics and for PCOS. Metformin could be very helpful in trying to lose weight. Of course you should also consider a low carb diet and exercise.

If your OB/GYN are not helpful you may just need to get other advice. In fact, you would be well served by additional advice, perhaps from an endo.

[davef]

Danielle,

No matter what his advice to lose weight is good, this comes from somebody who FULLY appreciates how easy it is to say that and how hard it can be to actually do. I have been overweight for about 30 years, I have had some great success at times and then put it back on, so I don't say it lightly.

Yes, if you lose weight it will bring reduce you BG levels by lowering your insulin resistance, largely due to weight loss but also because you will be eating better and exercising more, both of which contiribute to lowering BG levels.

I'm not totally onboard with his "the diabetes, at least for the next few years, will clear and won’t return" and in fact there is a contradiction built into his sentence. On one hand he is saying it will clear and won't return (I don't agree with the "won't return" but he is also saying "for the next few years it will clear". Essentially, if you have diabetes, then you have diabetes, if you lose weight and eat properly, then you will keep it in it's box under control (what he calls clearing), but this is like it being in remission, BG levels will remain in normal range, prossibly without meds. If you slip into old habits and put the weight back on then it will raise its head, with higher BG levels etc.

So, my advice, listen to you Doctor, lose weight, exercise more, eat healthy but do monitor you BG. If you have diabetes then you need to make you are in control. Can I ask, aside from the elevated A1c, do you have any other symptoms?

In relation to your A1c, to my knowledge, this reflects your average BG level over the past 90-120 days (closer to 90 in most people) and tends to be weighted (about 50%) to the last 30 days.

[Noturningback]

Originally Posted by davef

........ Can I ask, aside from the elevated A1c, do you have any other symptoms?

.........

high triglycerides, borderline high cholesterol, hypertension (taking micardis HCT) and PCOS

I was sent to this GP by my eye doctor, several years ago, who thought I may be diabetic. My GP tested me with a fasting blood sugar test and I tested 75. I've tested 75 every year until last week when he ran the A1c - 6.5

I have a question about diet. I know this is a debatable issue but, I'm wondering what people are doing to lose weight. I believe in restricting carbs but, how much? I would prefer to do a 40/30/30 plan but, if that is not low enough, I'll do what I have to do.

Thank you again for the responses. it's been a life saver - literally!

~Danielle

[xMenace]

A coworker of mine started running when he was diagnosed. Within two years he had lost nearly 100lbs and has now done a few m,arathons.

You can lose the weight.

[Scrabblechick]

Hey not, I totally sympathize with the weight thing. It isn't easy. However, I really think you should get a second opinion, maybe with an endocrinologist. If you haven't fallen off the cliff yet into full-blown diabetes, you're standing on the very edge with one foot in the air. I've lost about 50 pounds since January. I love to eat and hate to exercise, but I did it. I've been overweight my whole life, so I know just exactly how difficult it can be.

You want to get your numbers under control NOW. Getting it done now means so much less trouble down the line. With your metabolic history and PCOS, you've got to be proactive. Eating a lower-carb diet now certainly won't hurt you, and it could really help. Also, get some comfortable shoes and start walking 10 minutes a day. Add five minutes every week or 10 days.

Welcome to the forums, incidentally! And as I always say, let us know how you're getting along. We do care!

[BlueSky]

Originally Posted by Noturningback

.... I was sent to this GP by my eye doctor, several years ago, who thought I may be diabetic. My GP tested me with a fasting blood sugar test and I tested 75. I've tested 75 every year until last week when he ran the A1c - 6.5 ...

The fasting glucose is normally used to diagnose diabetes, but it is usually the last to rise. You have a fasting of 75mg/dl, which is low/normal. But your HBA1c of 6.5% equates to an average blood glucose of 154mg/dl. This is a diabetic level. I find it strange that the doctor doesn't see a 6.5% HBA1c as warranting more active treatment.

[Noturningback]

Thank you all for the responses.

I'm feeling a bit better about my prognosis.

I went out this morning and purchased the book suggested in a previous thread. The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed

I also looked at glucose meters today and good grief the test strips are highway robbery! It's a sin to charge diabetics these prices. Maybe my insurance will cover the device? I was thinking- no -since I don't have an official diagnosis but, maybe it's smarter to bite the bullet and make the purchase.

I've been reading on the forum about diets and grams of carbs per day. I figured it was a hot issue. I will try doing a 40/30/30 diet (low GI) and stay away from the processed sugar/flour. I guess the only way to know if it's working is by testing my blood sugar and potential weight loss.

I've watched so many people in my family literally die from this disease. They didn't take care of themselves - at all. However, even with that knowledge, I have to admit I'm scared.

You all have been wonderful.

Alrighty - enough negativity from me. I know that isn't helping my situation. It's time for me to get a grip and pick myself up from my bootstraps.

~Danielle

[Noturningback]

Originally Posted by BlueSky

The fasting glucose is normally used to diagnose diabetes, but it is usually the last to rise. You have a fasting of 75mg/dl, which is low/normal. But your HBA1c of 6.5% equates to an average blood glucose of 154mg/dl. This is a diabetic level. I find it strange that the doctor doesn't see a 6.5% HBA1c as warranting more active treatment.

Agreed - it's time to find an endocrinologist!

~Danielle

[fgummett]

The insurance question is yet another reason to push for a diagnosis.
I'd go with your Doctor's first paragraph, "The HbA1c level is a measure of your average blood glucose over the last four months. Anything over 6 is in the range of diabetes. Binge eating probably didn’t affect it much." To me that is as good as saying that you do have Diabetes. Yes, exercise and weight loss (MUCH, much, much easier said than done ) might delay your need for medication, but as Linda said above... once you have D you have it for life I think a more aggressive approach to treatment is required; which needs action by you, but also by your health care team

I'm not sure that running at 200+ lbs (?) is a good idea but at least 1/2 hour of walking every day, 1/2 hour of weight training once a week, maybe a jazzercise class in the swimming pool...

As for glucose meters: the usual deal (unless you can get one free from your Doctor... or get your insurance to cover the cost) is that when you buy the strips you often get a free meter. I also understand that Walmart has a relatively inexpensive and reliable meter & strips for not too many dinero

[lilituc]

If your fasting bg is still normal, then it IS your after meal spikes that are causing the elevated A1c. So I don't understand the doctor's explanation.

You're right, though - the way to tell what diet is working is to test after meals and make sure you're staying in range. Then you can learn which foods are the problem. I find that one portion of certain foods is okay, but more than one will cause a big spike, for example.

[BrianSCohen]

Danielle,

As Bluesky noted, while you have a normal fasting blood sugar test, your HbA1c indicates a dramatically elevated average blood sugar level. This really points to major insulin resistance, and what is likely happening is that after you eat a meal contain carbs, your blood sugar rises dramatically. It may go as high as 300-500 mg/dl. Your body valiantly pours out insulin, which is not effective because of your insulin resistance. A GTT will display your problems to even the most dimwitted resident. High blood pressure and high cholesterol and elevated triglycerides are a likely a side effect of your condition.

You need to get a doctor your recognize your condition. When a doctor diagnoses you as diabetic, your insurance will cover a range of things (presuming you have insurance). My insurance covers diabetic education classes and all my diabetic supplies. I get a three month supply of strips for $25.

[Noturningback]

Even more replies Thanks

Just to make it clear. My fasting glucose has been 75 every year up to this year. I'm not sure what it is this year because he only tested the A1c. Can one get a good fasting blood sugar reading but, a "bad" A1c reading at the same time?

I was always told by my GP that I wasn't in the prediabetic stage. My OB/GYN suspected IR but never tested me because my GP did - and my FBS was 75. I was under the impression that IR and prediabetes are the same.

I don't have a glucose meter so, I've been eating 20g of carb at breakfast and lunch (low glycemic/high fiber/whole grain) and at dinner eating veggies only plus flax/fish oil with lean protein at each meal. I have a snack in the afternoon with a 40/30/30 ratio (no grains). I figure that is better than sitting around and doing nothing for myself.

Unfortunately, my knee gave out on me a week ago. Getting an MRI today. It doen't seem to be anything horrible but my gait is off which makes walking laborious. I have a treadmill so I'm lucky to have a no incline platform to walk on. As soon as the Ortho clears me - I'll start walking in short increments. Meanwhile, I'm doing leg exercises - minus weights - to strengthen my muscles. My LMP license has finally come in handy -

~Danielle

[Eddy]

Originally Posted by Noturningback

Just to make it clear. My fasting glucose has been 75 every year up to this year. I'm not sure what it is this year because he only tested the A1c. Can one get a good fasting blood sugar reading but, a "bad" A1c reading at the same time?

Yes. That's absolutely possible. That happens when meals spike your blood sugar, which remains elevated during the day... then finally drops overnight.

Originally Posted by Noturningback

I was always told by my GP that I wasn't in the prediabetic stage. My OB/GYN suspected IR but never tested me because my GP did and my FBS was 75. I was under the impression that IR and prediabetes are the same.

I'm less than keen on the term "prediabetes". Exactly what does that mean, anyhow?

One can be "prediabetic" with or without IR. One can have IR and be well beyond "prediabetic".

As I start to think... pre-blind? pre-deaf? pre-insane? pre-ED? Let's have a contest for the most-humorous "pre" condition!

Originally Posted by Noturningback

I don't have a glucose meter so, I've been eating 20g of carb at breakfast/lunch (low glycemic/high fiber/whole grain) and dinner veggies only plus flax/fish oil and lean protein at each meal. I have a snack in the afternoon of with a 40/30/30 ratio no grains. I figure that is better than sitting around and doing nothing for myself.

It is a start. However, monitoring will help you track your progress, and to profile what works well or not.

Originally Posted by Noturningback

Unfortunately, my knee gave out on me a week ago. Getting an MRI today. It doen't seem to be anything horrible but my gait is off which makes walking laborious. I have a treadmill so I'm lucky to have a no incline platform to walk on. As soon as the Ortho clears me - I'll start walking in short increments. Meanwhile, I'm doing leg exercises - minus weights - to strengthen my muscles. My LMP license has finally come in handy -

Ouch!

How are you with swimming? I need to get back in the water, but I always loved to swim... great exercise, and nowhere near as tough on the joints.