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May 4, 2001

Community Resources, Diagnosis and Symptoms

Question from Glendale, Arizona, USA:

I'm a 40 year old female, am not overweight and have a history of gestational diabetes and recurring urinary tract infections, and have been gradually been getting more fatigued over the last two and a half years. Thinking that I need to get more physically active, I took up a brisk one-hour walk five times a week which did not make me feel much better. I kept it up for six months, but stopped when I started to get really dizzy about 30 minutes into the routine. Recently, thinking I' needed to take a different proactive route, I got a glucose monitor, and four of my readings so far range between 160 and 203 mg/dl [8.9 and 11.3 mmol/L] two hours after a meal. I had a non-pregnancy one-hour glucose test (after a 75 gram load) which was 144 mg/dl [8 mmol/L], and I am scheduled for a two hour oral glucose tolerance test. I don't think that I will be classified with diabetes, but feel I have impaired glucose tolerance (IGT).Would seeing some physicians/dietitians that specialize in diabetes or IGT might be better educational option for me instead of being handed a sheet of paper with suggested menus? Should a patient ask for a referral to a dietitian and an endocrinologist if the attending physician doesn't make that recommendation?

Answer:

The diagnosis of impaired glucose tolerance carries with it some medical risk. For instance, individuals with IGT are at increased risk of heart disease. There is also the risk of progressing to frank diabetes. Your history of previous gestational diabetes is also a risk for developing diabetes.

Your best approach is to address lifestyle issues, including moderate weight loss through diet and exercise. If you need help with weight loss, a dietitian is a great place to start. Although it is popular to project that oral medication for improving insulin sensitivity might help in the prevention of type 2 diabetes, this has not yet been proven in clinical trials (but stay tuned). I agree it is a good strategy to use a proactive approach when you have impaired glucose tolerance.

JTL