February 18, 2004
Diagnosis and Symptoms
Question from Houston, Texas, USA:
I have had glucose intolerance for several years, with randoms in the 200s that usually don’t stay high. In the past month, I have had several episodes of high readings that have lasted and even caused my meter to flash the check for ketones signal. I did check, and had moderate ketones one time and small another. I had eaten a lot of carbohydrates both of these times. Also, for the first time, my fasting blood sugar was in the diabetic range, greater than 130 mg/d/ [7.2 mmol/L]. I went to my doctor and my A1c was still normal, but I had sugar in my urine and my blood sugar was 187 mg/dl [10.4 mmol/L]. (It was 204 mg/dl [11.3 mmol/L] on their office meter.) He said that my pancreas might be starting to poop out and that he would like to do another A1C in three months. He also told me to stay on my diet. I have high blood pressure and he thinks that I am type 2. I am 45 years old, five feet tall and weigh 100 pounds. Many of my relatives are diabetic, both type 1 and type 2. My questions are:
Why can I eat an enormous meal sometimes containing a lot of carbohydrates and have normal to low blood sugar an hour or two later? When I stay on my diet I sometimes have high readings! They really go high if I eat my normal meal and then “cheat” with a piece of cake! Is it normal to have intermittent highs and normal readings in the beginning?
Is it unusual to be thin and have type 2?
Do people with type 2 have ketones?
Answer:
It is possible to have intermittent high sugars before the values become elevated persistently. I would urge you to go ahead and check fasting blood sugars through the laboratory to determine if you have type 2 diabetes or not. The HgbA1C is not the appropriate test to make the diagnosis. I would have to know more about your diet to know if there is cause for your sugars to rise on some occasions and not on others.
It is not usual to be thin and have type 2 diabetes. There are some forms of type 1 diabetes they initially look like type 2 diabetes but are really a protracted form of late-onset type 1 diabetes. Either way, it would be important to establish the diagnosis.
You can develop ketones a number of ways. You can fast overnight and have ketones in your urine the next morning. You can have an illness and have ketones. You can also have poorly controlled diabetes and have ketones.
Your physician can also order tests that determine whether you have adequate insulin secretion or antibodies consistent with type 1 diabetes. I would suggest you get these, in addition to having formal fasting glucose levels through your local clinical lab.
JTL
