For most of my adult life (I am 38), I have experienced blood sugar “crashes”, and have attributed this to hypoglycemia. Despite two fasting blood sugar tests, I am told that I do nor have diabetes, yet the ups and downs continue. Recently, a friend told me that there were key indicators in sub-tests of the fasting test that most doctors do not look for that are indicative of a pre-diabetic condition. Are there any publications that I can turn to for information on these tests? (She was telling me this in reference to a discussion about Glucophage as a preventive) I am overweight (have been all my life), both parents suffered from hypoglycemic crashes, paternal grandmother was diabetic, as is my brother. I have had two children over the birth weight of 9 pounds. Whenever I take the “you may have diabetes” tests, they practically scream at me – YES!, yet the fasting tests say No. I would really like to get a handle on this; any direction you can point me in would be helpful!

First of all, I think that you need to find out exactly what your fasting blood sugars were. In recent years, both the American Diabetes Association and the WHO (World Health Organisation) have specified criteria for the diagnosis of diabetes. There have been a number of studies to compare the effectiveness of the two standards On balance, it seems most cost effective to use fasting blood sugar levels only and to accept the ADA criteria which are that blood sugars up to 110 mg/dl [6.1mmol]/L] are normal, between 110 mg/dl and 125 mg/dl [6.9 mmol/L] indicates impaired glucose tolerance, and over 125 mg/dl [6.9 mmol/L] is diagnostic of diabetes.

If you should turn out to have the middle category, then with your weight problem and family history would be indications to try again with diet and exercise, but it would be unwise to start metformin, until you were formally diagnosed. LADA or Late-onset Autoimmune Diabetes in Adults can occur at your age, and, very rarely, can present with hypoglycemia. However, with your weight problem, this is extremely unlikely.

The second issue is to try to define exactly what you mean be a “hypoglycemic crash”. Hypoglycemia is very rare in type�2 or in insulin resistance due to obesity, so you need to be quite sure that these episodes really are associated with a low blood sugar. If indeed they are, the diagnosis may be something quite different from diabetes, and something for which you will need your doctor’s help in diagnosis. You might even consider getting one of the new blood glucose meters to develop a profile of your blood sugar over 24 hours. Then, you might find that is quite normal, and you will have to consider alternative reasons for the crashes.

DOB