June 29, 2005
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Spokane, Washington, USA:
I am 4 feet, 10 inches and weigh 117 pounds. I was diagnosed with pre-diabetes in September 2004,when I weighed 108 pounds. I had bad hypoglycemia while on a “diabetic diet” and discontinued it. On the normal diet, I had swings, and then it rose significantly, only to plummet to constant lows for six weeks after a bad bout of the flu. Now, my sugars are rising again and I don’t understand why. I am swinging from fairly normal or low to the upper 180s.mg/dl [10.4 mmol/L]. I have been as low as 41 mg/dl [2.3 mmol/L] and as high as 240 mg/dl [13.3 mmol/L]. I can’t find a pattern to these numbers or anyway to control them. I chart them and it still makes no sense.
Recently, I had thrush in my mouth and I am having more and more symptoms of hyperglycemia. I am so tired and urinating hurts. But, I am still having lows that make me a rotten person to be around and make my physically demanding work very hard. I had a thyroid test done and my TSH and T4 were just barely in the normal ranges (quite low) and I’m wondering if that has anything to do with this. Meanwhile, I feel lousy most of the time and desperately want to do something about this since I have been diagnosed with a mysterious eye condition that the doctor said he would blame on blood sugars, except I don’t have documented diabetes.
What do I need to say or do for the doctors to help me? At twenty, I don’t want this sort of thing going on any longer than it absolutely must, and I fear that the August appointment that I was able to get with one of our town’s few endocrinologists is perhaps not soon enough to ward off troubles.
Answer:
You really need to have different documentation of blood sugars. For instance, to determine if you really have diabetes, as opposed to pre-diabetes, you need fasting glucose values, two hour glucose values, a hemoglobin A1c, and maybe even a two hour glucose tolerance test. For these tests, there are agreed-upon normal ranges. Because you are measuring glucose values in the 40s mg/dl [2.2 to 2.7 mmol/L] with a glucose meter does not make them accurate. The numbers should be verified with plasma glucose values performed in a clinical laboratory like you would find at a hospital, clinic, or your physician’s office. Your sugars may be higher than you know and could put you at the level of having diabetes. The lows could be explained by dysregulated insulin secretion seen with the destruction of beta cells or with insulin resistance.
I suggest you see the endocrinologist. Until then, I would suggest you speak with your primary physician about interventions that might be most helpful. For instance, small meals throughout the day will keep you from going too high or too low. Stay active and don’t gain large amounts of weight. With normal thyroid function studies, it does not sound like this is the cause of your problems.
JTL
