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October 31, 2007

Diagnosis and Symptoms, Type 2

Question from Australia:

I saw my general practitioner (GP) because I'd been thirsty and going to the toilet a lot some days. My GP told me I have pre-diabetes and I need to exercise and diet. My fasting numbers are between 4 mmol/L [72 mg/dl] and 5 mmol/L [90 mg/dl]. Two hours after a meal, I am between 9 mmol/L [162 mg/dl] and 10 mmol/L [180 mg/dl]. Four hours after meals, I am between 5 mmol/L [90 mg/dl] and 8 mmol/L [144 mg/dl]. These numbers were from five weeks ago. Before being told I have pre-diabetes, I was already eating healthy, tomatoes on toast for breakfast, a salad sandwich for lunch (either tomato and lettuce or grated carrot), tomato and lettuce and for dinner usually chicken or fish with vegetables like cabbage, broccoli, carrots, capsicum or small potato (80 grams). I snack on celery, capsicum sticks or peanuts. The bread I buy has 25.3 grams of carbohydrates and I never have butter on my toast or sandwiches. I had been exercising also, usually a 20 minute walk five times a week. I'm not overweight. I'm 157 cm (5 feet, 2 inches) and weigh 41.5 kg (91 pounds). I have lost 2 kg in 10 days. There is history of type 2 in my family, three uncles and all my grandparents, and they are either overweight and/or have a lot of difficulties losing weight. All were diagnosed over the age of 40. I'm 20. There is also type 1, but there were my mum's uncles. Is it inevitable that I'll end up with type 2 because of family history? Or, could it just be the these numbers are normal for me and I don't have pre-diabetes?

Answer:

First, your blood sugars are not consistent with diabetes. I would not qualify you as having pre-diabetes based on those numbers. Fasting glucose levels were not over 5 mmol/L [90 mg/dl]. The only other way to diagnose pre-diabetes would be with a formal oral glucose tolerance test. At this point, your healthy lifestyle is still important.

You are at high risk for developing type 2 diabetes. Previous studies have been shown that even healthy first-degree relatives of people with type 2 diabetes have some abnormalities without frank diabetes. You are correct thinking that type 2 diabetes, although familial, occurs in those who are overweight or frankly obese and in older individuals. Without high glucose levels, I can’t see how the sugars explain the symptoms. Have hope and keep up the good work. I would insist that you have an oral glucose tolerance test for a more formal diagnosis.

JTL