October 1, 2005
Diagnosis and Symptoms
Question from Honolulu, Hawaii, USA:
I am 30 years old and am very active in triathlons, competing in two or three triathlons per year. During my training seasons, I will train three or four times per week which includes cycling, running, swimming and weight lifting. I weight 175 pounds at 5 feet, 7 inches.
For the past year, I have been having dizziness, nausea, and headaches. I have never vomited, but I feel like I want to. Finally, after a year, I decided to go to the doctor and have myself checked out for the dizziness and headaches.
I told the doctor my symptoms and he decided to draw some blood. I went back to the doctor after a week and he told me that he did a hemoglobin A1c test and the result was 6.6, although I told my doctor that I had been carbohydrate loading for two races before the blood test. He still then proceeded to tell me that I have diabetes.
My triglycerides were 129, total cholesterol 166, LDL 99, HDL 39 and my glucose was 100mg/dl [5.6 mmol/L]. These results were about two hours after eating lunch, which consisted of rice, beef, potatoes, a peach, and two pieces of chocolate. He said that I should lose weight and that my diabetes can be controlled by diet and exercise.
After hearing this diagnosis, I wanted to get a second opinion because I feel that I am not diabetic or pre-diabetic. Do my test results confirm that I have diabetes? Also, for the four months before the A1c test, I was very involved in training so I consumed lots of carbohydrates and Gatorade, and lots of orange juice. Can this affect my test results or does this not matter? During the past six months, I was sick three times due to a cold and flu. Can all these things I did before affect my results to make me pre-diabetic or diabetic? Can there be different ranges for endurance athletes such as me?
Answer:
You have a point, because at this time, the criteria for making the diagnosis does not include a result for a hemoglobin A1c test. The guidelines for making the diagnosis are the following: two fasting glucose levels (at different times) greater than 126 mg/dl [7.0 mmol/L]; two random glucose levels (at different times) greater than 200 mg/dl [11.1 mmol/L]; or an abnormal glucose tolerance test.
Although A1c testing is helpful in the management of diabetes, it is not used for diagnosis. That being said, a value of 6.6% is not without some concern. I would suggest you go back to this physician with the criteria for diagnosis and point out that fasting glucose testing or oral glucose tolerance testing should be used. If they do not listen, you can find another physician. If the testing is abnormal, you will be better prepared to make life changes.
Most assays for A1cs are normal up to around 6.0%. An increase of 6.6% suggests an abnormal blood sugar over the last three months, which is a large piece of time. Your physician may still be correct that you have to make some changes in your diet if the laboratory tests come back abnormal. Even fasting glucose levels over 100 mg/dl [5.6 mmol/L] are abnormal and values between 100 and 125 mg/dl [5.6 and 7.0 mmol/L] are consistent with pre-diabetes.
JTL
