September 11, 2008
Other, Type 2
Question from Yreka, California, USA:
I’m a 38-year old woman with no family history of diabetes or gestational diabetes (all my glucose tests were completely normal for all three pregnancies and my youngest was born only 20 months ago). My BMI is in the normal range. So, it was a surprise to get a positive urine glucose test during a routine physical. My doctor sent me for follow-up tests. Here are the results: GTT: 99 mg/dl [5.5 mmol/L] fasting; 232 mg/dl [12.9 mmol/L] at the two hour mark. I had a 75 gram glucose drink after three days of high carbohydrate intake. My A1c was 5.4. My LDL was 98, HDL 72.
Since only one of the results was abnormal, my doctor gave me a glucose meter and said to re-do the tests in six months. Over the past two months, I’ve found that my fasting blood sugars are between 90 mg/dl [5.0 mmol/L] to 110 mg/dl [6.1 mmol/L], but I’m often over 200 mg/dl [11.1 mmol/L] two hours after eating. The highest I’ve seen is about 250 mg/dl [13.9 mmol/L], but my blood sugars come down on their own in three or four hours.
I want to be better prepared when I go back to the doctor in four months. Are there are other tests I should request? Do I need a treatment plan beyond the recommended “cutting back on refined carbohydrates” for this level of hyperglycemia?
The oral glucose tolerance test has demonstrated that you have diabetes. At this point, the issue is what to do about it. At a minimum, you need to have a healthy lifestyle. It sounds like you were already doing this. If the level of A1c remains stable, this would suggest that the level of glucose is not going up over time and would make you most likely a person with type 2 diabetes. Recently, the American Diabetes Association and the European Association for the Study of Diabetes entered into a joint position statement indicating that they favor the addition of the medication metformin to lifestyle. This is a change from previous recommendations and was supported by the demonstration that most patients with diabetes have some degree of advancement in their level of hyperglycemia and this may be benefited by starting the metformin earlier. I do not think you need additional testing. There are people such as yourself who have normal fasting glucose values but have high post-meal glucose levels.