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February 18, 2005

Diagnosis and Symptoms, Type 2

Question from India:

A man, age 45, weight 100 kg (220 pounds), 5 feet, 7 inches tall, had an insulin level 19.2 before a Glucose Tolerance Test (GTT), which was normal. After the GTT, it was 88, which is very high. His blood glucose was 280 mg/dl [15.6 mmol/L] due to the non-utilization of glucose at the time, one hour after GTT. The diabetologist says that this is an obesity oriented situation which is surely reversible after permanent normal weight maintenance. Is this true? What is your expert opinion? Why would there be such a non-utilization of insulin? We think that beta cell function is normal and very good.

Answer:

It depends on when the glucose of 280 was drawn. If this is at two hours, you have type 2 diabetes as any value greater than 200 mg/dl [11.1 mmol/L] at two hours is considered diabetes. Our model for the development of type 2 diabetes is a combination of both insulin resistance and inappropriate insulin secretion. Individuals can have insulin resistance, but, if they also have elevated glucose, they most surely have an inappropriate insulin secretion as well. My recommendation is that if you have type 2 diabetes, do not wait to induce weight loss before being treated, as the value of 280 mg/dl is very high.

JTL