La Quinta, California, USA:

I am 46 year old man diagnosed with hypothyroidism two years ago which is being treated, and last month I started checking my blood glucose level. I find it is usually 120-150 mg/dl [6.7-8.3 mmol/L], but, for the last couple days I have been around 200 mg/dl [11.1 mmol/L] after meals, and three to four hours later, I’m 90 mg/dl [5 mmol/L]. Then I get hungry so I eat, and, 30 minutes later, my blood sugar is 185 mg/dl [mmol/L]. I go to sleep, and, when I check my blood glucose first ting in the morning, I find it to be 100-120 mg/dl [5.6-6.6 mmol/L]. Do I have type 2 diabetes? My father got this disease at the age of 46, and he is still alive at the age of 82 (having three times daily shots of insulin).

The diagnosis of diabetes must be made by your physician following either a fasting venous blood glucose level of greater than 126 mg/dl [7 mmol/L] or an oral glucose tolerance test, A “casual” blood sugar at any time of day (after meals or snacks) that is above 200 mg/dl [11.1 mmol/L] and accompanied by symptoms of diabetes — frequent thirst, frequent urination, and unexplained weight loss, is also diagnostic for diabetes.

However, there is a category that is now being defined as prediabetes which is more suggestive of the blood glucose numbers you are describing.”Pre-diabetes”, also known as impaired glucose tolerance or impaired fasting glucose, must also be diagnosed by your physician with the same tests described above. A fasting blood sugar of greater than 110 mg/dl [6.1 mmol/L] on lab draw, or a post meal glucose greater than 140 mg/dl [7.8 mmol/L] falls into this “pre-diabetes” or early diabetes state. In early type 2 diabetes, there is a loss of something called “first phase insulin response”, resulting in the quick rise in blood sugar after a meal which you seem to be noticing.

With the blood sugars that you are reporting, and with your family history of diabetes, you are wise to be pursuing this diagnosis and early treatment, including exercise and nutritional management. Please discuss with your physician. Also, congratulations to your father for living a long and healthy life despite diabetes. You have a inspirational role model in him!

DMW