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May 31, 2003

Diagnosis and Symptoms

Question from Independence, Missouri, USA:

I am 44 years old, overweight, and I have PCOS. Four months ago, my fasting blood glucose was within normal range, my insulin level was 45, my A1c was 6.2%, and my C-peptide was normal. I was told I have type 2 diabetes, put on metformin twice per day and told to cut back on carbohydrates. Do I really have diabetes? If so, this does not seem like a good treatment plan to me. Should I be checking my own blood at home?

Answer:

At the present time, the diagnosis of diabetes is not defined on the basis of a hemoglobin A1c. It is determined by the result of blood sugar determinations as they are performed in the laboratory (and not on finger stick blood sugars). Previous studies have shown that the A1c is not a sensitive enough to diagnose diabetes early.

With that being said, we know that Polycystic Ovary Syndrome is associated with insulin resistance, and many who have it are at risk for

type 2 diabetes later on. Therefore, it is not surprising that you may have diabetes.

It has become popular to use metformin in these patients, and it does have a beneficial effect to lower blood sugars. However, this should be done in concert with changes in lifestyle, such as diet and exercise modification. I am a big advocate that if you have diabetes, you should be checking your blood sugars at home.

JTL

[Editor’s comment: See Classification and Diagnosis of Diabetes.

SS]