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February 13, 2003

Diagnosis and Symptoms

Question from Colorado Springs, Colorado, USA:

I have type 2 diabetes on both sides of my family, and I have been having symptoms for several months now (frequent trips to the bathroom, excessive thirst, and also feel hyperglycemic frequently). My doctor sent me for a lipid profile and a fasting blood glucose, which showed a triglyceride level of 300 mg/dl with a fasting blood glucose of 107 mg/dl [5.9 mmol/L]. Two weeks later, I had another fasting blood glucose of 125 mg/dl [6.9 mmol/L] so she then had me purchase a glucose meter and start checking my blood in the mornings and when I feel the my blood sugar is high. For the most part, the readings I get are 140-180 mg/dl [7.8-10 mmol/L], but I have caught it as being over 200 mg/dl [11.2 mmol/L] on several occasions. My morning readings have been 120-133 mg/dl [6.7-7.4 mmol/L] for the last two weeks. Could I have or be developing type 2 diabetes?

Answer:

All the blood sugar levels you report, whether performed trough a lab or a portable meter (which is in fact not accurate enough due to its variability for diagnosing diabetes) are greater than 110 mg/dl [6.1 mmol/L] and are not normal. In addition, the triglyceride level is above normal which might be secondary to impending diabetes. Readings readings greater of 200 mg/dl [11.1 mmol/L] are already diagnostic of diabetes indeed.

I’d ask your doctor for another lab determination of a fasting blood sugar with an urinalysis and hemoglobin A1c to rule out definitively the diagnosis of a very likely abnormality in glucose metabolism.

JTL

[Editor’s comment: Testing for diabetes should include blood sugar levels performed by a medical laboratory. The timing of the sample (fasting, random, or postprandial) would influence how high a level is considered abnormal. See Classification and Diagnosis of Diabetes Guidelines. for further information.

Occasionally, lab blood sugar testing might be normal in an early case of diabetes, repeat blood sugar testing at the same or a different time, or performing a glucose tolerance test, might be appropriate if there is a high suspicion of diabetes despite normal initial testing. Another test, the glycosylated hemoglobin, might be used to help confirm a suspected diagnosis of diabetes, but the GHB (also called HbA1c or A1c) is not usually considered as appropriate to make an initial diagnosis. Antibody testing is occasionally done as a screening test in high-risk situations, or as confirmatory of type type 1A (autoimmune) diabetes, but is not part of routine testing.

Urine sugar tests or home glucose testing, if done, might be positive, which would make the situation more urgent to get lab testing done to confirm the abnormal results. However, urine or home glucose testing, if negative, would not exclude diabetes.

SS]