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Question:

From Houston, Texas, USA:

I am a 44 year old female, who 5 feet tall and weighs 100 pounds. When I was in my twenties, I was about 25 pounds overweight and diagnosed with borderline diabetes, but I lost weight, felt better, and pretty much ignored it until two years ago when I started feeling the symptoms again. I took my blood sugar on a home meter and found that it was elevated.

I went to an endocrinologist and took records of what I had eaten and what my readings were. He said that I was not the "body type" for diabetes, even though I have a strong genetic predisposition, and some of my readings were over 200 mg/dl [11.1 mmol/L]. My family practice doctor does an hemoglobin A1c every six months, and although it has always been normal, I have been on a modified diet for the past two years trying to keep myself from becoming developing diabetes. I also am very active physically.

For the most part, I keep my fasting levels well under 120 mg/dl [6.7 mmol/L], but still struggle some with postprandial readings.If gain any weight my fasting sugars start to rise. Recently, I had a one-hour postprandial of 214 mg/dl [11.9 mmol/L] and today, about an hour after a snack, my blood sugar was 182 mg/dl [10.1 mmol/L]. For dinner I had a grilled chicken salad with no starches, and an hour later my blood sugar was only 92 mg/dl [5.1 mmol/L]! It seems like two to three carb units causes me to be somewhat high. For the past few days, I have been extremely tired, my skin seems very dry, and I have been getting up to use the bathroom in the middle of the night.

Ever since I went to that endocrinologist I have felt like I was making a big deal out of nothing. Does all of this sound silly to you? What should my blood sugar goal be? Could I possibly have Late-onset Autoimmune Diabetes of Adulthood (LADA)? I was going to talk to my doctor about all this, but I wondered if I was being an alarmist.

Answer:

No, I do not think this is a lot about nothing. I would recommend you get a 75 gram oral glucose tolerance test to determine whether you have diabetes. That is the first step and will categorize you as having diabetes, prediabetes, or nothing. Some of the post-meal sugars you have are clearly abnormal and lead me to think you have a good chance of testing positive for diabetes or pre-diabetes. This will be the test that sets the record straight and allows you to get on with the treatment you need.

Recent data have suggested that even treatment of the pre-diabetic state may be important in preventing or delaying the onset of diabetes. In essence, this is what you are trying to do anyway. It will give you additional consideration for using medication, such as metformin, if the test results are abnormal.

JTL

[Editor's comment: See Diabetes Prevention Program (DPP) for some other thoughts. SS]

DTQ-20030508002216
Original posting 4 Jun 2003
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:46
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