Question from Newtown Square, Pennsylvania, USA:

I have had a kidney disease since I was six (minimal change disease). I have been on and off of prednisone for many years. I’m 37 now and just had another relapse. I went up to 40 mg of prednisone until I stopped spilling protein. Now I’m on 25 mg. every other day and tapering down to 7.5 mg. Recently, I have recently been spilling glucose (it never happened to me before) in my urine. This got me scared so I bought a glucose meter to check my blood. My fasting glucose seems to be between 76 and 88 mg/dl [4.2 and 4.9 mmol/L]. I’m really stressed out right now. I went to the doctor to get what I guess is called a A1c test. If I don’t watch what I eat my glucose goes up to about 209 mg/dl [11.6 mmol/L], then in two hours or so it is around 109 to 114 mg/dl [6.1 to 6.3 mmol/L] and, in three hours it’s about 90 mg/dl [5 mmol/L}, and I will spill glucose and ketones in my urine. When I’m on my off day of steroids I may only have ketones in my urine. One other thing the glucose and ketones are about a trace or a little more and disappear in about 4 hours or so. When I watch what I eat my blood glucose will go to about 145 mg/dl {8.1 mmol/L] after eating then drop to about 90 mg/dl [5 mmol/L] if I don’t eat anything else after that. I do urinate frequently when I’m on the prednisone day. I only get up one time at night to urinate, but I do get a little sleepy when I eat.

Could this be type 1 or type 2? How can you tell which one you have? Is type 1 worse than type 2? I really don’t want to take insulin shots. What is a normal A1c?