August 23, 2005
Hyperglycemia and DKA, Type 2
Question from Sunnyside, Washington, USA:
I would like your opinion on my condition. I was diagnosed with type 2 diabetes four years ago, in August 2001. I am a 46 year old female. My fasting blood sugar was slightly elevated, 113 mg/dl [6.3 mmol/L], so the doctor performed an OGTT (Oral Glucose Tolerance Test) on me. The results were: fasting – 97 mg/dl [5.4 mmol/L]; 30 minutes – 220 mg/dl [12.2 mmol/L]; one hour – 218 mg/dl [12.1 mmol/L]; two hours – 219 mg/dl [12.2 mmol/L]; three hours – 115 mg/dl [6.4 mmol/L].
Because of those results, my doctor said I was a diabetic and wanted to put me on Glucophage right away. But, I decided to see what my levels were first. So, I am still under no medications for the diabetes. I have lost around 30 pounds since diagnosis and eat a lot better than I used to. My A1c has been 5.3 for the past year now. I will be going in for another round of blood work next week.
A short summary of how my blood sugar levels have been. For the first year, my fastings were around 85 mg/dl [4.7 mmol/L]; two hours after meals – 150 mg/dl [8.3 mmol/L] or less most of the time. During the second year, my fastings were around the same, about 92 mg/dl [5.1 mmol/L]; two hours after meals – 169 mg/dl [9.4 mmol/L] or normal. I was put on 2 mg Mavik for blood pressure, along with a baby aspirin. During the third year, my fasting blood sugars averaged 93 mg/dl [5.2 mmol/L]; two hours after meals, my blood sugars were between 169 mg/dl [9.4 mmol/L] and 200 mg/dl [11.1 mmol/L], but sometimes they were normal. I was put on 40 mg Zocor this year for cholesterol.
More recently, I saw a reading of 221 mg/dl [12.3 mmol/L] when I had a little bout with the flu and two hours after a meal in January 2005. I have seen a few 203s mg/dl [11.3 mmol/L] otherwise, many levels of 170 mg/dl [9.4 mmol/L] or 190 mg/dl [10.6 mmol/L] or under normal levels. Just the other day, I was hungry for cereal for breakfast, so I ate a rather big bowlful and one hour later, my heart was pounding away. So, I checked my blood sugar and it was 206 mg/dl [11.4 mmol/L]! Just yesterday, 45 minutes after lunch, the same thing happened (heart pounding), so I checked, and it was 236 mg/dl [13.1 mmol/L]. Two hours later, it was down to 125 mg/dl [6.9 mmol/L]. But, four hours after lunch, I went down to 67 mg/dl [3.7 mmol/L], which made me feel tired, shaky and a little sick. After I ate half a banana with peanut butter, it went back up to 124 mg/dl [6.9 mmol/L] and I felt much better.
Today, my blood sugars have been “normal.” My fasting blood sugar was 90 mg/dl [5.0 mmol/L]. When I checked one hour after lunch and supper, it was 146 mg/dl [8.1 mmol/L] and 138 mg/dl [7.7 mmol/L].
What made my levels do this? Is it a sign things are beginning to worsen? You don’t hear/read much on people who have normal fasting levels, but abnormal postprandial levels and how it usually progresses? Please help me understand how this may go!
Answer:
You have nicely demonstrated that over time, your post-meal blood sugars have risen. I would anticipate this would raise your A1c to some degree when you have it performed in the near future. It is true that many patients have elevated fasting blood sugars when diabetes is diagnosed. However, as seen with the glucose tolerance test, your post-meal blood sugars have always been more at risk for elevated values than your fasting glucose values. This is not rare. As to why they increase, it is important to know that diabetes has a changing or evolving picture. Like the story line in a book, it changes over time. In other words, this is the natural history of type 2 diabetes. Your physician can use this information to prescribe therapy to help you keep your sugars in good control. Clearly, if your A1c has risen to elevated levels, there would be an indication for medical therapy. If it is still in the normal range, there may be room for additional increased intervention with exercise and nutrition.
JTL
