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October 13, 2004

Diagnosis and Symptoms, Type 2

Question from Two Rivers, Alaska, USA:

I am 36 year old, normal weight woman. My husband has type 1 diabetes. Over the past 10 years, he has occasionally checked my blood sugar with his meter to make sure it is working correctly. Until recently, my blood sugar has always been below 100 mg/dl [5.6 mmol/L]. A couple of months ago, he checked and we were both very surprised to see a result of 192 mg/dl [10.7 mmol/L] an hour or so after dinner. I followed up with my doctor who did an A1c and a glucose tolerance test. My A1c was 5.3. My fasting blood sugar was 99 mg/dl [5.6 mmol/L] and my two hour reading was 172 mg/dl [9.6 mmol/L]. A pancreatic antibody panel was negative. My doctor told me that I was pre-diabetic, type 2, and to cut back on simple carbohydrates. Can type 2 come on so rapidly? Besides the recent normal home glucose tests, my blood sugar was never elevated during my pregnancy and my son, who's now three, was seven pounds at term. I have no diabetes on either side of my family. Also, would you suggest any further testing or other follow-up (stricter diet, more home monitoring)? I'm supposed to do a repeat A1c in six months.

Answer:

Although the onset seems rapid to you, you have probably been developing insulin resistance for years. Now, your pancreas is beginning to give out from the extra workload of compensating for the insulin resistance by producing extra insulin Have you gained weight in the past few years? This frequently puts people over the edge.

The best treatment we have for pre-diabetes is sensible meal planning (restricting carbohydrate intake and total calories in general), regular physical activity and weight loss, if that is an issue for you. You are very fortunate to have been diagnosed with pre-diabetes, giving you an opportunity to follow these lifestyle changes and hopefully prevent or delay the onset of type 2 diabetes. Some people are not as fortunate as you and their first diagnosis is type 2 with complications.

JS