March 28, 2008
Diagnosis and Symptoms, Type 2
Question from Marengo, Illinois, USA:
My doctor diagnosed me with type 2 diabetes. My fasting blood sugar was 124 mg/dl [6.9 mmol/L], checked while I was at the doctor for a sore throat. My A1c level was 7.2, but I don’t have any of the symptoms yet. I have a lot of energy, but I am about 60 pounds overweight. My mother was recently diagnosed. Wouldn’t I be considered pre-diabetic? I thought the fasting blood sugar had to be over 126 mg/dl [7.0 mmol/L]. I don’t want to be labeled a diabetic for future insurance reasons. I am following an exercise and diet plan to bring all of my levels down anyway, but I don’t want to be a type 2 unless I officially am. Are there any rules to follow in a diagnosis? My doctor seemed to think that my diagnosis wasn’t a big deal. I would like a second opinion.
Answer:
I understand your concern. The diagnosis of diabetes is made on the fasting glucose values, not the A1c. There are other reasons why you can have a false positive A1c. There can be certain hemoglobin types that can be measured in the A1c assay. If that is a question, I would have your doctor measure a hemoglobin electrophoresis. You are correct that the diagnosis of diabetes is made by having more than one fasting glucose greater than or equal to 126 mg/dl. Without that, there is not a diagnosis of diabetes. An alternative would be to have a formal 75 gram oral glucose tolerance test. This could be carried out in one day and also provide the answer.
JTL
