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July 27, 2009

Diagnosis and Symptoms, Type 2

Question from Egypt:

I'm a 27-year-old male doctor and I am overweight. For two weeks, I felt polyuria and polydipsia so I checked my random blood glucose. It was 600 mg/dl [33.3 mmol/L]. My fasting blood sugar was 244 mg/dl [13.6 mmol/L]. After ingesting 75 mg of glucose, my blood sugar was 456 mg/dl [25.3 mmol/L]. My glycosylated hemoglobin was 8.6. I sought medical advice and my doctor recommended Glucovance 500/5, diet, and exercise. I was having great control for about a week when, one day, I forgot to take my medication. Even without the medication, my blood sugars were in range. It's now been four days since I took the Glucovance and my postprandial blood sugars have been between 130 and 140 mg/dl [7.3 and 7.8 mmol/L]. My fasting blood sugars are 80 to 90 mg/dl [4.5 to 5.0 mmol/L]. I'm so confused about that and I don't know if I have type 2 diabetes or not. I plan to keep on dieting and exercising to reduce my weight, but can you help clarify my diagnosis?

Answer:

From what you have told me, you clearly have type 2 diabetes. It is not a surprise that your blood sugars might remain normal for a while, even though you have stopped your medication. After successful treatment of high blood sugars, no matter how they are decreased (insulin, pills, diet, etc.), the insulin-producing cells in the pancreas recover from the high glucose conditions. What I think you will find, if you remain off the medication, is that your blood sugars will gradually rise again. You might want to talk your physician about using metformin as a single drug. I think the recommendations by the European Association for the Study of Diabetes and the American Diabetes Association recommend this as a first-line drug. There is net weight loss with the medication and no hypoglycemia. With Glucovance, there is a mixture of metformin and glyburide (a sulfonylurea). The glyburide is associated with weight gain and hypoglycemia.

JTL