I just had my annual physical and my doctor said I may be pre-diabetic, that my sugar was high. I am 53 years old. No one in my family has ever been diabetic. I am not overweight. I swim four times a week, exercise with cables and dumbbells twice a week, and I don’t have high blood pressure. So, I am confused as to why I may be pre-diabetic. My cholesterol was high, but my HDL was 90 which is off the charts, while my LDL was 141, total 245. My glucose post fasting test was 118 mg/dl [6.6 mmol/L].

My doctor had me get some more tests. The A1c was 5.1%, which is considerably lower than the pre-diabetic range. All other tests – urine, liver, thyroid, etc., were within normal limits. Regarding the cholesterol results, the HDL is so high, it outweighs the LDL; the ratio is 2.7 which is well under 3.3 to 4.4 low risk. Does the A1c result of 5.1% outweigh the glucose post fasting test result of 118 mg/dl [6.6 mmol/L]? Basically, taking all the test results into consideration, am I pre-diabetic? My doctor wants me to repeat the tests in six months.

Your doctor is correct to indicate that a fasting glucose level of 118 mg/dl [6.6 mmol/L] is abnormal. If this is repeated and found to be similar (similar being over 100 mg/dl [5.6 mmol/L], but less than 126 mg/dl [7.0 mmol/L]), the correct designation is impaired fasting glucose. This is considered a pre-diabetes value. Normal human results do not usually test that high.

The A1c is used to follow patients with diabetes and is not considered a test that defines the presence of diabetes.

Just because you do not know of a family member with diabetes does not mean you can’t have a problem. The good news is that you can do something about it. You can get treated for your elevated LDL-cholesterol. You can watch your glucose levels carefully. You can maintain your exercise and follow your diet. In some cases, physicians may recommend medication to prevent the onset of diabetes. However, published literature suggest that the strongest prevention for people at risk for diabetes is intensive exercise and diet. These are issues to discuss with your physician. I believe they are giving you the correct information.

JTL

Editor’s Note: In 2008, an expert panel agreed that the results of an HbA1c screening could be used to diagnose diabetes. For more, see The Pros and Cons of Diagnosing Diabetes With A1C.