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Question:

From North Carolina, USA:

I have been diagnosed with pre-diabetes via a two hour OGTT and blood sugars running from normal to 254 mg/dl [14.1 mmol/L] two hours postprandial. I have an upcoming appointment with an endocrinologist but, during this six week wait time, my blood sugars have returned to normal (just over the past week and a half), even after eating carbohydrates. Could this be the honeymoon of LADA? I'm 31, thin, have no family history of diabetes but had gestational diabetes. I thought the honeymoon only ensued after insulin treatment has begun. Could there be other reasons for the high blood sugars? Could they return? I am just wondering if I got misdiagnosed somehow. I am not sure what would cause blood sugars close to 200 mg/dl [11.1 mmol/L] and higher, other than diabetes. I haven't been sick, haven't had surgery, etc.

Answer:

With your history of gestational diabetes, you are at risk for type 2 diabetes. The number you quoted of 254 mg/dl [14.1 mmol/L] was not on an OGTT, was it? If it were, this would be diagnostic of diabetes. The official line is that a two-hour post-load glucose after a 75g glucose load over 200 mg/dl [11.1 mmol/L] is diagnostic of diabetes. However, to be clear, it sounds like you might have been monitoring your blood sugars after meals with a glucose meter. Make sure the meter has been calibrated with control solution. If you had put it away after your pregnancy and started using it again, there is an expiration date associated with the strips.

The honeymoon period is usually associated with type 1 diabetes. This refers to the time when sugars have been brought down with insulin and there is a progressive decrease or even stopping of the insulin dose and correlates with improvement of the function of the surviving insulin-producing cells. LADA is usually more gradual, in terms of the glucose elevations. These patients often look like type 2 diabetes, but the condition is associated with antibody markers, such as anti-GAD antibodies.

JTL

DTQ-20081103114358
Original posting 11 Nov 2008
Posted to Diagnosis and Symptoms and LADA and MODY

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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