December 31, 2005
Diagnosis and Symptoms
Question from Albany, New York, USA:
I am a 28 year old female. I have Graves Disease and had surgery to remove gland. My latest TSH was 4.69, within range. During my last pregnancy, I had gestational diabetes which was regulated with insulin injections. I had ultrasounds done because of other "problems" in which they said it looks like I have PCOS. I asked my gynecologist and she said they weren't really worried and that I could get my sugars tested. They just did a fasting glucose, which at the time (over the summer) was 98 mg/dl [5.4 mmol/L]. The nurse said I may want to ask my endocrinologist about it since its a little above average, but I didn't. Since I have a glucose meter here, along with a small package of test strips, I have tested randomly, mostly in the morning before eating since that's when most of my problems occurred with gestational diabetes. Typically, they ran from 97 to 117 mg/dl [5.4 to 6.5 mmol/L], rarely below. I tested after meals and was typically around 120 mg/dl [6.7 mmol/L] or so. I have not tested in a while. I have gained 15 pounds since August and sorting out my thyroid medications. I can't say I have the typical symptoms of anything. I am hungry a lot, I have a lot of saliva (don't know why) and I urinate about every two hours. I wake up once or twice to use the toilet and always have to go immediately upon waking. Anyway, I don't know if that's relevant. I tested my sugar last night after eating it was 103 mg/dl [5.7 mmol/L]. This morning, when I woke up, I tested my fasting sugar (no food for about eight hours) and it came was 131 mg/dl [7.3 mmol/L]. I then tested my blood sugar after lunch and it was 120 mg/dl [6.7 mmol/L]. I know that is fine so I am a bit confused. Do you have any clue what could be going on? Should I push the PCOS diagnosis whether or not I have it? They aren't concerned with PCOS since I am not trying to conceive. Or, is this just pre-diabetes?
I am concerned your values are consistent with pre-diabetes. However, the designations for blood sugars are not geared toward values obtained with fingerstick blood sugar testing. They are geared toward the results obtained with a blood test from the clinical laboratory where they draw your blood from a vein into a tube. Since PCOS is associated with insulin resistance and is also associated with increased cardiovascular risk, I think it would be important to have your blood sugars tested by your physician in the clinical laboratory and then address some type of strategy. The weight gain did not help with your blood sugars. If you have more than one fasting over 126 mg/dl [7.0 mmol/L], that is diabetes. The other way to make the diagnosis would be with an oral glucose tolerance test. It is more timely, but it does allow you to make the diagnosis in a single day.