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June 26, 2005

Diagnosis and Symptoms

Question from Mississauga, Ontario, Canada:

From my last blood test, I had a fasting glucose of 4.3 mmol/L [77 mg/dl] (range 3.3 to 6.0 mmol/L [59 to 108 mg/dl]) and tested negative for glucose in the urinalysis. Does this completely rule me out for type 1 diabetes? Sometimes, two to three hours after a meal, I feel real tired and cannot concentrate. Throughout the day, it is also hard to focus. I eat six meals a day with the first four of them including about 40 grams of carbohydrates and I feel tired the most around my second and third meal. I weight train three times a week with three days of cardio/yoga. Anyway, my doctor has been trying to get me an appointment with an endocrinologist, but we have to wait because they are not taking appointments. It's already been two months so I want to try testing this for myself until I get that appointment. Would you suggest buying a glucometer and finding out exactly what my values are throughout the day? If so, how, and what should I be looking for?

Answer:

The normal fasting glucose suggests you do not have diabetes at this time. The symptoms may be related to a marked fall in your blood sugars after meal. It sounds like you may have gone to small, frequent feedings to get rid of the symptoms following meals. However, this dietary intervention sounds it has not improved things all that much. Without having seen you and not having all the information, it sounds like you need to be evaluated for reactive hypoglycemia. This condition is associated with an exaggerated fall in blood sugar in response to the post-meal insulin rise after meals. A glucose meter may be helpful in correlating low glucose levels with symptoms. It would be unlikely to diagnose diabetes.

In Canada, you may not be able to get a meter paid for by insurance if your physician does not prescribe it. If they do, you can work with your physician to define your pre- and post-meal sugars and find out if any lows are associated with symptoms. This would be helpful as your physician evaluates your condition. There are a number of good glucose meters on the market. You can talk with pharmacists or representatives from medical supply companies to discuss cost and performance features.

JTL