October 9, 2005
Diagnosis and Symptoms
Question from Cheney, Washington, USA:
I have had something wrong with me for nearly a year and half now, with no definite answers as to what it might be. Now, I have even more test results and I hope they will be helpful to you in helping me decide what to do.
In May of 2005, I had a glucose tolerance test that told me that my two hour reading was around 160 mg/dl [8.9 mmol/L]. At that time, I had fewer symptoms than I do now. I requested, and finally got to see, an endocrinologist and they ordered a glucose tolerance test for comparison, so I was told. This newest test showed a two hour reading of around 190 mg/dl [10.6 mmol/L], which I was told was unconcerning for diabetes.
Very well, but I find it suspect that it would change like that since the last two have both had my two hour at about 150 to 160 mg/dl [8.3 to 189. mmol/L]. I have problems that cannot be explained like chronic UTIs and yeast infections that are ridiculously hard to get rid of. If I eat a 1200 calorie diet, a lot of my symptoms go away and my postprandials and fasting glucoses stay normal. If I eat a normal diet of about 2000 calories, my numbers swing wildly, 41 to 248 mg/dl [2.3 to 13.8 mmol/L] and I feel terrible. I also constantly have ketones in my urine. I’m 4 feet, 10 inches and weight about 108 pounds. I’m 21 years old. Oddly enough, my A1c has stayed very normal, always about 5.5.
From everything I’ve read, I believe something needs to happen now, but I don’t know what. I feel awful a lot and it disrupts my normal life. I think that there must be better care out there than what I have received; how do I go about getting it? Surely there is a doctor in my area that would review my chart and realize that it is strange for someone to go from being hypoglycemic for over a decade to this. If it means anything, my TSH levels are all over the normal range, too.
Answer:
First, your results from the oral glucose tolerance test are not normal. Values at two hours between 140 and 199 mg/dl [7.8 and 11.1 mmol/L] are considered to be impaired glucose tolerance. The term pre-diabetes has also been used for this condition. You can see that you have had two results that fit into this category. Pre-diabetes is anticipated to become type 2 diabetes if nothing is done to address your risk. This means avoiding becoming overweight or obesity, exercising, and potentially using medications (such as metformin). The question is whether the symptoms you have with widely fluctuating blood sugars might respond to more aggressive therapy with glucose lowering. The exercise/lifestyle and metformin intervention were studied as a means to prevent type 2 diabetes in relatives of people with type 2 diabetes in a study called the Diabetes Prevention Trial. This is general knowledge. There have also been prevention studies performed with other medications, as well. Finally, there is also the issue of whether this is latent type 1 diabetes. Often, people are tested with antibodies to determine whether there are markers present that may allow suspicion for autoimmune destruction of the insulin-producing cells in the pancreas. As far as receiving care, I think you will have to do some homework to find someone you can talk to and work with. I understand it is not always easy to do.
JTL
