February 20, 2005
Diagnosis and Symptoms, Type 2
Question from Stewart Manor, New York, USA:
After a recent miscarriage, my OB/GYN did various blood tests. Because in previous pregnancies I had failed the one hour glucose tests (but passed the three hour follow ups), he tested my A1c level. It was 6.0. Since then, I’ve been home glucose monitoring four times a day as per his advice, until I get my appointment with the endocrinologist, which is in three months.
My morning levels had been ranging from 90 to 106 mg/dl [5.0 to 5.9 mmol/L] for three weeks until this morning when it was 125 mg/dl [6.9 mmol/L]. My post prandial levels are in the same range, sometimes going as high as 117 mg/dl [6.5 mmol/L], but generally around 90 to 108 mg/dl [5.0 to 6.0 mmol/L]. I am restricting my carbohydrates to whole wheat and grains and I exercise daily on the treadmill for 30 to 45 minutes. I am about 10 pounds overweight, but am losing as I write. I am 5 feet, 8 inches tall, 167 pounds. I began to diet and exercise immediately after the miscarriage and have lost 10 pounds so far.
I am 35 years old and petrified after this morning’s number. I do have a very sore throat that started last night and I am on day 13 of my menstrual cycle. I’m wondering if these may affect my fasting blood sugar. Additionally, I don’t know what else I can do to get the fasting numbers below 100 mg/dl [5.6 mmol/L] daily. I’d hate to start medication, as the post meal numbers seem to be right on, even when I cheat, as when I had one slice of pizza in a weak moment (my post meal number was still 101mg/dl [5.6 mmol/L]).
My endocrinologist appointment isn’t for another month and a half. I am consumed by these morning numbers and they set my mood for the day. Should I be doing more? Can someone still be healthy and have a one time spike in fasting glucose? Does the fact that I’m a nervous wreck every morning before I do the test affect the outcome?
First, you should know if you have type 2 diabetes. So far, you have not provided me with information that makes the diagnosis. The A1c is not sensitive enough to make the diagnosis. The blood sugars you are monitoring at home are good in that they help you maximize your present situation, in terms of making good lifestyle choices. However, I would suggest you speak to your physician about doing a 75 g oral glucose tolerance test. With one test, you can determine whether you have diabetes. If you do, you are not that far off, in terms of treatment goals. Your fasting glucose levels are the highest. Weight loss is a good start. I would also add that you need to exercise. This, in addition to weight loss, decreases the insulin resistance you have. Your menses and infections can also cause temporary elevations in sugars. However, the A1c suggests you have at least high normal sugars for the last three months. In general, I would suggest you get this taken care of and remove any of the guess work and you will feel better.