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November 15, 2000

Diagnosis and Symptoms

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?

Answer:

You probably have type 2 diabetes, if you have diabetes. Your physician needs to discuss with you whether you meet the criteria for diabetes. When glucose levels rise with steroids, it usually occurs because you have a predisposition (or family history) for developing diabetes. The higher the steroid dose, the more the effect on your blood sugars. You need to be tested with more formal testing to definitively answer the question of whether you have diabetes. If you do have type 2 diabetes, I anticipate you wouldn’t need insulin, rather, you could be treated with a pill to lower your sugars. A hemoglobin A1c is a test which is used to determine your average daily blood sugar over the previous three months. However, it is not usually used as a screening tool for diagnosing diabetes.

JTL