February 2, 2010
Diagnosis and Symptoms, Type 2
Question from Crosswicks, New Jersey, USA:
I was told several years ago that I have pre-diabetes. Now 53, my fasting blood sugar was 104 mg/dl [5.8 mmol/L], but has been creeping up to 112 mg/dl [6.2 mmol/L] over the past six years. When I was in my 30s and 40s, my fasting was always 95 to 99 mg/dl [5.3 to 5.5 mmol/L]. I am not now, nor have I ever been, overweight. My GTT (glucose tolerance test) has been normal. My most recent GTT was done last month with the following results: Fasting 112 mg/dl [6.2 mmol/L];one-half hour – 194 mg/dl [10.8 mmol/L]; one hour – 164 mg/dl [9.1 mmol/L]; two hours – 95 mg/l [5.3 mmol/L]; three hours – 57 mg/dl [3.2 mmol/L]. My A1c was 6.2 last month (it was once as high as 6.4).
Family history: My 21-year-old son has had type 1 for four years. My 89-year-old dad has had type 2 for 35 years. He also was NEVER overweight. He is on oral medications, never needed insulin and retired at age 85. He needed some cardiac stents starting at age 83; otherwise, no complications. My HDL was 70 to 92, triglycerides 95, total cholesterol 210, and LDL 121. My endocrinologist put me on Zocor (10 mg) so now my total cholesterol is under 200 and my LDL is under 95. I see an endocrinologist due to a prior history of Graves’ Disease and now I’m hypothyroid. My endocrinologist just did an NMR panel and concluded (with all the test results and the fact that I have BP 100/70) that I definitely don’t have insulin resistance. I have large LDL particles, among other things, that made him rule out insulin resistance. He said I must have my father’s genes and will eventually develop diabetes and will probably follow a course similar to my father. He also said there is nothing to do to prevent diabetes in my case. I walk for an hour every day and have been doing so for the past 16 years. I eat a lot of carbohydrates. The endocrinologist said cutting carbohydrates won’t help in my case.
With all the information out there about preventing type 2, why can’t something be done? I asked him if I should go on metformin (since it helped prevent diabetes in the DCCT study). He told me that metformin won’t help in my case since I’m not overweight. Should I get another opinion? Could my father have type 1.5 and this is where I’m headed?
Answer:
It sounds like you are doing all the right things. The question is whether you can do anything else to change the natural history of worsening glucose tolerance over time. You indicated that there have been studies done to try and determine whether type 2 diabetes can be prevented. That is true. The largest study was the Diabetes Prevention Program done here in the U.S. That study took people with a first degree relative who had type 2 diabetes and who also had impaired glucose tolerance on an OGTT. The study showed that the most potent intervention was lifestyle change with 150 minutes a week of exercise and a gradual weight loss regimen. Metformin was used, as well. However, metformin was not as potent in its ability to prevent type 2 diabetes. It had its most beneficial response in younger people who were obese. That being said, you sound like you are already doing the lifestyle intervention. Without being overweight, I am not sure there are additional interventions that will be better. Studies like these that have tried to prevent diabetes have only looked at one intervention, not several together at one time. I am not sure you would benefit from the metformin. If you do develop diabetes, it sounds like it might be mild and could be treated. I do not think your endocrinologist is giving you bad advice.
JTL
