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March 17, 2010

Diagnosis and Symptoms

Question from Virginia, USA:

I am 35 years old, slim and experienced a sudden onset of extreme dry mouth, thirst, urination and nausea. My fasting blood sugar, checked at the doctor's office, was 169 mg/dl [9.4 mmol/L]. On another day, I had a fasting blood sugar of 124 mg/dl [6.9 mmol/L]. At my third visit, I had a post-prandial blood sugar of 239 mg/dl [12.3 mmol/L]. My A1c was said to be normal so they advised me to go back in a month for another fasting blood sugar check. I don't have consistently high blood sugars so I guess they are not sure what to make of it. I feel very spacey and tired and, at times, feel like my blood sugar goes too low because I get hungry and shaky. Why would my blood sugars be so up and down? I am trying to avoid refined sugar, but I still feel horrible.

Answer:

Based on the information you have provided, you have not met the criteria for the diagnosis of diabetes. You have to a fasting glucose greater than 126 mg/dl [7.0 mmol/L] on more than one occasion. You do not have that. Finger stick blood sugars are not used to make the diagnosis of diabetes, although they could suggest it and are also used to follow treatment of diabetes. The fingerstick glucose above 200 mg/dl [11.1 mmol/L] is also suggestive, but, again, has to be done in the laboratory.

Recently, the American Diabetes Association adopted the broader definition of diabetes based on HbA1c. Your HbA1c was normal. You continue to be symptomatic. The only other recommendation I can provide you would be to have a 75 gram oral glucose tolerance test. This will allow the diagnosis of diabetes if your two-hour glucose load blood sugar is 200 mg/dl [11.1 mmol/L] or greater. The only other recommendation would be to have your blood sugar checked in the fasting state more often so that there might possibly be an abnormal result that would move you along towards therapy faster. I am very concerned you do have diabetes and that it may cause your symptoms.

JTL