I am very active and fit 45 year old woman. In the course of my physical for professional scientific SCUBA diving (year-round in Alaska), my fasting glucose level was measured at 121 mg/dL [6.7 mmol/L]. I’m cleared to dive, but told the cutoff would be 125 mg/dL [6.9 mmol/L]. Three years ago, I had a distal pancreatectomy (and splenectomy) due to a serous pancreatic cystadenoma and had about two-thirds of my pancreas removed. My primary care physician and internist think that the high glucose level may be due to that. I am not fat (5 feet, 4 inches, 130 pounds). My cholesterol levels are good (total 152, triglycerides 53, HDL 49, VLDL 11, LDL 92), and I exercise regularly (long-distance biking, running, hiking and scuba diving) so, I don’t fit the profile of someone likely to develop type 2 diabetes. The only recommendation I received was to re-check in one year. Is this level harmful? Can or should I be doing something (more exercise, diet changes) NOW to lower this glucose level? I can’t find any information on high fasting glucose levels that does not suggest that diet, exercise and weight are responsible and should be controlled.

Your fasting glucose level is abnormal and would be categorized as impaired fasting glucose. I agree with you that if you had two-thirds of your pancreas removed, the removal of these insulin-producing cells is the likely reason for the problem. If the glucose levels stay this way and do not progress to full diabetes, diagnosed with fasting glucose of greater than 125 mg/dl [6.9 mmol/L] on two occasions, you probably still have some increased cardiovascular risk. Patients with impaired glucose tolerance by an oral glucose tolerance test have been found to have higher cardiovascular risk than those without impaired glucose tolerance. What can you do to ward off the increased risk of diabetes and cardiovascular disease? Lead a healthy lifestyle with exercise, smart eating, avoidance of obesity, and other preventive strategies. These might include a baby aspirin each day, the monitoring of lipids, and regular stress testing. Therapies that have been used as preventive have been tried in patients with impaired glucose tolerance and have included diet and exercise, metformin, and drugs like the thiozolidinediones. However, you may not fit the usual pattern because you have probably lost roughly 75% of your insulin producing cells in the pancreas. Anything that makes your body more sensitive to insulin you make may help. I would talk with your physician about these preventive strategies and make sure you have regular testing to go along with your healthy lifestyle.

JTL