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August 9, 2001

Daily Care

Question from Cozad, Nebraska, USA:

I am a 44 year old female who is overweight, I am on medication for high blood pressure and cholesterol, my triglycerides are elevated, and I my father had type 2 diabetes (severe). Four years ago, I had a glucose tolerance test and was told that my blood sugar tripled and stated high until four hours when it dropped to normal. Two years ago, my fasting blood sugar was abnormal (they never gave numbers), but they said the HgbA1c was within normal limits, and. recently I had a fasting blood sugar of 157 mg/dl [8.7 mmol/L] with an HgbA1c of 6.2%. My doctor said that I just needed to come back in a year or so for a recheck. I am wondering if I need to follow up with another doctor. I am trying to work on the weight, and do aerobic exercises. Am I worrying needlessly about the fasting glucose number? Were the HgbA1c's are okay? Is there anything else I should be doing? Do I have diabetes?

Answer:

It sounds like you have diabetes. The criterion is more than one fasting glucose greater than 126 mg/dl [7 mmol/L] The hemoglobin A1c is not sensitive enough to diagnose diabetes with mildly elevated glucose levels.

I would suggest that you discuss this with your physician. You may need to learn home glucose monitoring, receive lifestyle counseling with a diabetes education team, and consider therapy. In addition, you need to be monitored for eye changes, lipids, blood pressure, and urine microalbumin.

It is common to have diabetes and not be symptomatic. Remember that type�2 diabetes can follow a plot line such that the sugars don’t have to start high. However, they can get worse over time if you don’t take care of yourself.

JTL