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June 13, 2005

Diagnosis and Symptoms, Type 2

Question from Nenana, Alaska, USA:

I am 36 years old and have been diagnosed as pre-diabetic. Here's a brief history. In 2002, I had a normal pregnancy and delivery with no elevated blood sugar or glucose in my urine. My baby weighed 7 pounds, 2 ounces. In November 2003, I had a marginally high random glucose test so my doctor did a two-hour glucose tolerance test. My fasting glucose was 92 mg/dl [5.1 mmol/L] and my two-hour glucose was 156 mg/dl [8.7 mmol/L]. My A1c was 4.8. I'm 5'4" tall and weighed 136 pounds at that time. I followed my doctor's suggestions and changed to a low-glycemic diet and cut out simple sugars (sugar, flour, potatoes and bananas). I also started a regular exercise program. I repeated the tests in May 2005. My fasting glucose was 120 mg/dl [6.7 mmol/L] and my two-hour glucose was 188 mg/dl [10.4 mmol/L]. My a1c was 5.9. My doctor wants me to repeat the tests in six months. I've been following the diet and exercise suggestions faithfully. I now weigh 128 pounds and run 25 miles a week. I'm frustrated that my "lifestyle changes" did nothing to improve or even maintain my blood sugars in the last 18 months and I'm scared about what the next tests will show. Is there anything I can do now to keep from deteriorating into full-blown diabetes?

Answer:

I can empathize with your frustration. I would also like to point out that if you had not done those things, what might your blood sugars have done? They could be much worse. It is not like you did not do anything. You did implement healthy lifestyle habits. They may not be enough to outweigh your genetic risk.

The Diabetes Prevention Program was an NIH-funded study that tested interventions for the prevention of type 2 diabetes in family members with pre-diabetes. The treatment groups included those who received no additional treatment (control group), intensive diet and exercise intervention, metformin, and troglitazone. This trial is the trial where troglitazone therapy was associated with liver toxicity and ultimately removed from the market, leaving a control group and two intervention strategies. Intensive lifestyle intervention was the most potent. However, you may be considered for metformin therapy realizing that no study has measured the effect of multiple interventions in the same person.

Keep up the good work. In the big picture, you are making a difference in your health.

JTL