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February 3, 2009

Diagnosis and Symptoms

Question from Alabama, USA:

I am a 30-year-old with no risk factors for any type of diabetes and no diabetes in my family history. About six months ago, I got a virus. I was following up with my PCP (primary care physician) when I mentioned my craving for water. They did some blood work that I thought was related to my illness. About two days later, I got a call that my random fasting blood sugar was 242 mg/dl [13.4 mmol/L] and my A1c was 6. I wasn't really sure what that meant, except that they referred me to an endocrinologist who did an oral glucose tolerance test about three months later. My fasting was 117 mg/dl [6.5 mmol/L], one hour was 262 [14.6 mmol/L], and two hour was 182 mg/dl [10.1 mmol/L]. My C-Peptide was low-normal. The doctor later informed me I was pre-diabetic. He said that I might develop diabetes tomorrow or in five years, but wants me to follow up with him every three months. So, here is my question. I know I'm not diabetic, but I've done a fair amount of research on pre-diabetes and I am concerned. I read that you can get CVD, micro and macrovascular complications even during pre-diabetes' blood sugar elevations, especially if you have IFG (impaired fasting glycemia) and IGT (impaired glucose tolerance). I was given no recommendations to halt my progression. I am already athletic and a little underweight. I have very low blood pressure and great cholesterol. Everything I've read targets someone who doesn't resemble me. My fear is that if I stay in pre-diabetic limbo, with no option of treatment for years, and I develop complications, like retinopathy, anyway. Could that happen? Is there anything I can do beside watching my refined sugar and carbohydrate intake? I feel so helpless. I almost wish I didn't know this. It's like I'm waiting on a bomb to strike. I almost don't want to follow up with the doctor because he'll just repeat that I'm pre-diabetic and tell me to come back in three months.

Answer:

As best I can tell, the information you have received (based on what you have written) appears to be accurate. The lack of a diagnosis in a previous family member is not completely foolproof. Family members may have developed diabetes and not known it. The American Diabetes Association has developed guidelines for treating pre-diabetes. In the highest-risk group, medication with a drug like metformin has been recommended. In the Diabetes Prevention Trial, this had some benefit. However, the greatest effect in preventing the onset of type 2 diabetes is the use of lifestyle change with diet and exercise. This was much more potent than drug intervention. It is also true that repeat OGTT in the future could result in a reversion back to normal glucose tolerance and then you would have some reassurance.

You may also want to ask your physician to have a blood test that looks for an autoimmune indicator of type 1 diabetes, called an anti-GAD antibody. When this is elevated, it is an indicator for type 1 diabetes. If this were positive, you would be dealing with an autoimmune process where there is no standard treatment. Finally, surveillance is always better than ignoring the problem. I hope you follow-up with your physician.

JTL