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Question:

From Lincoln, Nebraska, USA:

I have been having skin issues for a couple of years and my general practitioner prescribed a steroid cream. It helped but never enough to heal, although it did help with itching. He thought it was a hair follicle fungus. After a particularly bad itchy weekend where I drew blood accidentally from scratching for the umpteenth time, I called a dermatologist. I was finally diagnosed with granular annulare after a biopsy.

To make a long story short, I am 35, quit smoking 10 months ago and gained 45 pounds. I currently weigh 207 pounds have always had 110/70 to 120/80 blood pressure and have never given birth. The brochure suggests it could be diabetes related.

I was given a prescription for prednisone, but had to make sure I wasn't diabetic first. I got my results yesterday. I had a fasting blood sugar of 106 mg/dl [5.9 mmol/L]. The nurse I talked to who told me said 99 mg/dl [5.5 mmol/L] is the high normal but it was only recently changed from 120 mg/dl [6.7 mmol/L] being the high threshold and to take the prednisone. I am worried and wonder if I should be taking steps. Should I retest again and, if so, when? What diet should I be following, low Glycemic Index or low carbohydrate or what? Please direct me to the correct next few things I should do. Do you see a regular doctor or a specialist or an internal medicine doctor?

I am scared and am regretting quitting smoking if it helped me to be pre-diabetic or type 2. By the way, which type am I?

Answer:

These are proactive questions and good to discuss. The one blood sugar of 106 mg/dl [5.9 mmol/L] is in the range of blood sugars termed impaired fasting glucose and is a form of pre-diabetes. This is according to definitions used by the American Diabetes Association. Pre-diabetes does not mean diabetes. If you are ever asked whether you have diabetes, the answer is no, you do not have diabetes. Pre-diabetes was thought to be a helpful designation because it might allow patients and their healthcare providers to address lifestyle issues that may make it less likely to progress to diabetes. If you have pre-diabetes prior to prednisone therapy, it makes sense to have the blood sugar checked if you have to be on the prednisone therapy for any length of time (more than a week or two). In addition, you should have periodic checks of your blood sugar with your doctor as a certain percentage of patients convert to diabetes.

However, it is not a one-way street. I think it is prudent to address exercise and diet as the most likely interventions that help to decrease your risk. As you have asked, it is not enough just to be on a diet. If you have not had any experience, you should check with a dietitian. There is a whole process of evaluating your usual diet, comparing to a theoretical diet, looking at the balance of foods you eat (protein, fats, carbohydrates, fiber, cholesterol, etc.) and bringing it all together. Since this will be of importance to you over a lifetime, I think you should do it correctly the first time and receive additional information that will empower you and make you a better patient. In addition, any time exercise is recommended. You should receive from your doctor, an exercise prescription that takes into account what your current activity and limitations might be. Remember that if you are risk for heart disease, it is also reasonable to have a stress test before exercising vigorously.

I do disagree with you about smoking. Of all the things you do, smoking is one of the most destructive. It increases the risk of diabetes, even if you carry less weight. Therefore, don't entertain going back and starting to smoke again. It is so hard to quit. You may have increased appetite on prednisone, depending on dose and duration of therapy. Please discuss this with your physician.

JTL

DTQ-20061206102617
Original posting 10 Dec 2006
Posted to Diagnosis and Symptoms and Meal Planning, Food and Diet

  
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Last Updated: Tuesday April 06, 2010 15:10:10
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