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July 26, 2007

Diagnosis and Symptoms, Type 2

Question from Placerville, California, USA:

Last Monday, I had my annual blood work. My doctor called me in the next day and said the I have type 2 diabetes. My triglycerides were 1046 mg/dl and my glucose was 271 mg/dl [15.1 mmol/L]. It was a fasting test. Here is were I have my doubts... I was luckily to see the diabetes nurse one day later. She hooked me up with a monitor and showed me how to use it. My first test, three hours after breakfast, was 128 mg/dl [7.1 mmol/L]. She had a puzzled look and rechecked. She told me to test before meals until my blood sugar was stable then start checking after meals. I have had checked several times over the course of the week and all were with-in the range the nurse suggested. She told me it would take several months to get my numbers down. So, how could I go from a 271 [15.1 mmol/L] fasting to a 144 mg/dl [8.0 mmol/L] in six days? I know I need to improve my diet and lose some weight, but can my laboratory work been wrong?

Answer:

Your doctor should have also done a test called a hemoglobin A1c test. This test looks at your average blood sugar over the previous three months. With blood sugars in the high 200s mg/dl [14.4 to 16.6 mmol/L] fasting, you should have had high levels for some time and the A1c test should reflect this. A fasting glucose of 271 mg/dl [15.1 mmol/L] is high and is usually associated with symptoms of diabetes. These include frequent urination, thirst, urination at night with loss of sleep, blurring of vision, and generalized weakness and fatigue. I did not notice whether you were placed on medication. Six days, in the face of medication, may be enough time to lower the glucose.

The triglycerides are also very high. Values over 1000 mg/dl fasting can be associated with pancreatitis. In addition, values for triglycerides over 400 mg/dl are usually associated with an inherited lipid abnormality. These high triglycerides necessitate action. Medication is usually used. In addition, you need to avoid fatty, fried foods, alcohol, and work hard on weight loss. Pancreatitis, if it occurs, can be life-threatening. You do not want to mess around with this.

JTL