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November 14, 2005

Diagnosis and Symptoms, Type 2

Question from San Francisco, California, USA:

I recently visited my primary care physician for a routine physical and she tested my fasting glucose level. The results came in at 105 mg/dl [5.8 mmol/L], which is now considered "pre-diabetic." I was shocked! I exercise four to six times a week and watch my diet for carbohydrates, fat, and sugar. My weight only fluctuates three to four pounds and I've attributed my higher weight to more muscle mass due to the intensity and frequency of my exercise. At age 27, I am 5 feet 4 inches, 138 pounds. My physician has asked me to lose 10 pounds to control this pre-diabetic phase and prevent the onset of diabetes. I'm overwhelmed! Honestly, I don't know how much I can alter my existing diet to lose weight. My mother is adamant about seeking a second opinion and fears that a goal weight of 128 pounds is too low for my body and physical activity level. For someone who already eats healthy and exercises all the time, how do I go about losing weight and lowering my fasting glucose levels? How big of an influence is stress?

Answer:

Pre-diabetes is a marker. It indicates you are at increased risk for developing diabetes later on. You did not indicate your family history. In some people, even a healthy lifestyle is not enough to overcome genetics. I would suggest you look into this topic more closely and understand its ramifications. If you feel the dietary recommendations are too general, I would recommend seeing a dietician. One is available at most hospitals or through most physicians. You can receive more complete counseling about your recommended weight and get feedback about your eating habits.

In addition, there are some conditions that can antagonize your blood sugars. Have you had an intercurrent illness? Did you fast overnight prior to the blood sugar test? Was the test done on blood drawn from a vein in your arm? Fasting blood sugars should not be screened with a fingerstick blood sugar test for the general population. If your impaired fasting glucose persists, consider talking to your physician about the latest information in the prevention of diabetes. Specifically, several pharmacologic agents have been tested to prevent or delay the onset of diabetes. My recommendation is to get over the shock and get more information. With more information, you will have a better understanding of what is known and you will be less shocked.

JTL