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August 5, 2009

Diagnosis and Symptoms

Question from United States:

I am 30 years old (as of last November) and went in for a physical in April 2009. I had a blood test in which my fasting blood sugar was 102 mg/dl [5.67 mmol/L] and my HDL was a little low (I think it was like 27 and the normal minimum is 35). My blood pressure and absolutely everything else came back fine and well within the norms. I am not overweight (currently 5 feet, 11 inches and 145 pounds) at all nor have I ever been. I admit that I love eating fast foods and seemingly have never had any issues due to a high metabolism. The doctor told me that I was totally fine and should be happy to be young and in shape, and that even though blood sugar normally should be below 100 mg/dl [5.6 mmol/L], for the most part, I was fine and that I should eat more fish and whatnot for the omega-3 fatty acids to increase my HDL cholesterol. At the time, I felt that maybe my sugar might of been high since, in days prior, I had binged on some sugary cookie snacks and I hadn't exercised in awhile, so I figured no big deal if the doctor said it was all basically fine. I started to exercise more regularly until I injured my left calf in late May, which forced me to take about three weeks off. Fast forward to mid-June. I got sick from a stomach virus which required that I visit the Emergency Room (ER) as I had bad stomach cramps, diarrhea, vomiting, slight fever (99.7 degrees), chills, etc. I was told by the nurse, before she took some blood for a blood test, that I was really dehydrated (since I hadn't eaten anything or drank anything for over 12 hours at that point) and that was probably why my stomach cramps were so bad and I was very, very thirsty. She advised me NOT to drink though since it could make me vomit and dehydrate myself even more. Later that night, when I finally got in to see the doctor, and given an I.V., he showed me the results of the blood test the nurse had taken a few hours prior. He told me that everything seemed fine except that my white blood cells were high, which would indicate that I probably had a bug (maybe some sort of salmonella from something I ate) and why I had the slight fever, chills and whatnot. BUT, he also said that my blood sugar level was at 121 mg/dl [6.7 mmol/L] and that even though that seemed consistent because of the dehydration I had and the fact I hadn't eaten or drank anything for over 12 hours, that it could still mean pre-diabetes and that I should have it checked out. In any case, I have started to eat better than ever now (sworn off fast foods and sugary snacks) and exercise regularly again since my calf is healed, but should I be overly concerned that this is perhaps really pre-diabetes? No one in my family has had diabetes, not my father, mother, or brother. Is this something I should run to the doctor to check out or should I just eat better and exercise more? I am not saying that I am overly worried...but I kind of am since I am only 30 years old and have RARELY ever gotten sick (the stomach problem in June was the first time something got to me in almost two years) so I am really wondering what's going on here with these blood sugar results.


First, everything you report says you do not have diabetes. Therefore, the real issue is whether you can make any predictions about whether you are at increased risk for diabetes in the future. You can’t use your fasting glucose of 102 mg/dl [5.7 mmol/L] to predict. It is so close to normal of less than 100 mg/dl [5.6 mmol/l] that it would be a poor predictor. Your blood sugar when you were sick is not helpful because you cannot make the diagnosis of diabetes or even pre-diabetes when you are sick. Stress hormones that peak when you are sick can artificially raise blood sugars and cannot be used to diagnose diabetes. You were also hemoconcentrated and I would also raise the question as to whether you had intravenous glucose infusing when the blood sample for the glucose was measured. I agree that you should continue to concentrate on a healthy lifestyle and continue to see your physician for yearly wellness exams.

As for your HDL-cholesterol, there are several things that can lower HDL-cholesterol. If you smoke, have a lipid metabolism defect (such as elevated triglycerides), poor physical activity (not you), or your parents had low HDL-cholesterol. The latter is the most potent determinate of low HDL-cholesterol. You can do things to raise it some, such as fish oil, exercise, etc. Make sure you discuss this with your physician.