August 29, 2002
Diagnosis and Symptoms
Question from Florence, South Dakota, USA:
I’m 34 years old, and 10 years ago I had diet controlled gestational diabetes with my son, who was diagnosed with type 1 diabetes about four months ago.Since my pregnancy, I have had annual blood glucose test done at the doctor’s office, and about two months ago, I was feeling “low” and unable to drive home, so I went to my family practitioner who ran a fasting blood test which was 135 mg/dl [7.5 mmol/L].
Since I weighed 205 pounds, my doctor told me that I needed to lose weight and prescribed Phentermine (an appetite suppressant). A month later, my fasting blood glucose number was 127 mg/dl [7.1 mmol/L], but I still haven’t been classified as having diabetes. I am still taking the Phentermine, have lost 17 pounds months in two and a half months, and my doctor doesn’t want to see me for a couple of months now. I have been checking my blood sugars with my son’s meter (normally in the morning), they range from 119-140 mg/dl [6.6-7.8mmol/L], and, when I feel really “high” it was in the 170s mg/dl [9.4 mmol/L].
I asked my son’s doctor (a pediatric diabetes doctor) about my numbers, and he said I should have been diagnosed with type 2 diabetes. There isn’t any diabetes in my family, that I am aware of.
Should I consider myself to have type 2 diabetes? Is it heathy to be on this Phentermine and not have the appetite that you need to eat properly?
Answer:
Fasting blood sugar tests for the diagnosis of diabetes should be carried out in a clinical laboratory. Values from a glucose meter are only guidelines. To have two fasting blood sugars in excess of 126 mg/dl (7.0 mmol) is considered diagnostic of diabetes. It is quite appropriate however to prescribe Phentermine initially to see if by reducing the degree of insulin resistance that being overweight induces will lead to more normal glucose tolerance. In your case, the loss of weight would seem to have brought you nearer to what is called impaired glucose tolerance.
Phentermine seems to be a safe drug, but you need to keep in touch with your doctor to decide at what point you should look on yourself as having established type 2 diabetes and be considering additional treatment with a drug like [metformin].
DOB
Additional comments from Dr. Stuart Brink:
You really should locate a diabetes educator and start learning [ask your physician for a referral, or call 1-800-TEAM UP 4]. You should also visit the American Diabetes Association website since there are many books you can order to get better educated about your own condition, what you can do for yourself, etc.
SB
