March 15, 2002
Diagnosis and Symptoms
Question from California, USA:
I’m a 37 year old male diagnosed with type�2 diabetes about eight months ago when I was in treatment for a kidney stone, and the urologist found glucose in my urine during a routine urine dipstick test. After forwarding the results to my primary care physician, two fasting glucose tests were done which were 121-144 mg/dl [6.7-8 mmol/L], and my A1c was 6.9%. My doctor diagnosed “borderline” diabetes and instructed me to eliminate sweets.
Wanting to follow the doctor’s instructions word for word, I had intentions of changing my diet immediately. However, when I sat down and really thought about what I ate, I didn’t change anything since I normally don’t eat those things anyway. I tried to be more active, but after years of having kidney stones, I knew I really couldn’t resume my normal activity levels until I passed the stone. After the stone finally passed, I was finally able resume my normal activity level, and I started taking my glucose readings, with the goal of keeping fasting levels at “around 100 mg/dl [5.6mmol/L]” per doctor’s instructions.
Three months later, during a scheduled office appointment, I told my doctor that I was getting daily readings of 70-85 mg/dl [3.8-4.7 mmol/L], but he told me that my glucose levels were taking longer to return to normal after eating. How he knew this without a glucose tolerance test, I’ll never know. I was getting pretty frustrated at not being able to duplicate the glucose levels found during diagnosis (even with the 12% adjustment for lab serum readings) so now and then, I’d purposely eat enough lunch for two, intentionally heavy in carbohydrates and take my glucose level two hours later and would get readings of 57-126 mg/dl [2-7 mmol/L].
I decided to go to another primary care physician for a second opinion. I told him my previous lab results, and he ordered another fasting glucose test along with a two hour glucose tolerance test. The results (from the same lab that did my initial blood tests) are as follows:
Fasting glucose — 89 mg/dl [4.9 mmol/L]
Two-hour post 75 Grams of glucose — 126 mg/dl [7 mmol/L]
Estimated mean blood glucose — 87 mg/dl [4.8 mmol/L]
Hemoglobin A1c — 5.2%
The new doctor told me I do not have diabetes.
The lab results print the diagnostic criteria for diabetes which are exactly the same as those that I’ve read on the American Diabetes Association and Joslin Diabetes Center websites. It may be splitting hairs but I don’t think the initial numbers constitute diabetes since the criteria specifically states greater than or equal to 126 mg/dl [7 mmol/L] fasting and confirmed same on a subsequent day.
I am completely confused by the initial diagnosis. I’ve read that infections increase blood glucose levels, and I’ve been told I have urinary infections when passing kidney stones since I was 12. When I was 17, I had to take the urine test to enter the military four times because of what they called “urinary tract infection producing protein in the urine”. Since then, whenever I have a medical exam that includes a urine test, the doctors always tell me I have a urinary tract infection but dismiss it when I tell them I passed a kidney stone recently. Can this be the cause of the initial readings? Can the year of bloody urine and fevers during this past kidney stone passage have caused abnormal glucose levels? Do I have diabetes?
I have an FAA medical exam coming up soon, and I am required by law to tell the truth. Have I been officially diagnosed with diabetes? Do I have to go through the nightmare that will surely follow if I have to apply for a waiver of some sort because of a diabetes diagnosis? Is my first doctor right or is the second one correct?
I can empathize with your position. I think I would challenge the diagnosis of diabetes too. You did not have two fasting sugars greater than 126 mg/dl [7 mmol/L] on subsequent days, and a hemoglobin A1c cannot be used for diagnosis. It could also be the case that those blood sugars you had during your episode with kidney stones may also have antagonized your sugars. If your first physician has diagnosed you with diabetes (by the way, there is no diagnosis of borderline diabetes), I would appeal to your insurance company so that you are not charged additional premiums.
My understanding about FAA physicals is that these exams have to be performed by a licensed physician who regularly gives these. They would know the difference between impaired glucose tolerance and frank diabetes. It may be a point they will agree with you on. However, I would check with other sources before the FAA exam to know how they might rule on this issue.