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Diabetes

Give Me Your Opinion Please

02/01/2008

Question:

Hi! , I`d like to know your opinion of where you think I am at in my "diabetes journey." I understand type two diabetes is progressive, but I am confused. I am a 48 year old female who was diagnosed 6 1/2 years ago via the O.G.T.T. (I was not pregnant at the time). I had a fasting level of 113 at a routine physical, so my doctor ordered the O.G.T.T. to be done. The results of that test follows: fasting 97; 1/2 hour 220; 1 hour 218; 2 hours 219; and at 3 hours, I was down to 115. Because of those levels, my doctor said I was diabetic. I`ve been doing diet and exercise only so far. I`ve lost about 30 pounds and eat a lot healthier than I used to since my diagnosis. The medications I am on are: lisinopril, 20 mg for high blood pressure (which I had a year before dx), and zocor, 40 mg for cholesterol and a baby aspirin daily. The highest my A1C was was 6.08% in Dec. of 2006. Then this past June (2007), it went down to 5.42%, and this past Dec. (2007), it went down to 5.24%. As far as I know, I really haven`t done anything different for it to go down and I haven`t re-gained any of my weight loss. Of course, I`m glad it`s gone down, but it makes it easy to go into denial. My latest fasting levels have been from 92-99 (with a couple 100`s, & one 103)---my fastings have never been higher than the 103 (except at diagnosis), and my 2 hour post-prandials lately have been around 135. Lately/latest means for the past 2-3 months. The highest post-prandial glucose level I`ve seen was 255 about an hour after lunch when I had a bout with the flu bug in Feb. 2007 (last year), but an hour later, it came down to 123. Phew! I do know that there have been times where I can check my glucose an hour after a meal and it may be around 204 even 220, but it can come down under 140 at the two-hour mark. This hasn`t happened since my last A1C was performed (Dec. 2007). Over the past few months, my 2-hr post-prandial readings have been around 135. My question is this: am I really diabetic, or am I pre-diabetic, or normal? I`ve had some diabetics tell me I wasn`t diabetic based on my levels. What would you recommend someone like me to do and how does the average person dxed like I was usually progress?

Thank You For Answering My questions, Debbie P.S. Some Family History: My mother`s sister (my aunt) was diabetic, on insulin, died at the age of 65 of a heart attack My mother`s mother(my grandmother) was also diabetic and on insulin My mother`s mother`s two sisters(my great aunts) were also diabetic (when I was little, I heard about one of the great aunts dying after having her leg amputated) My mother`s mother`s brother (my great uncle) was diabetic, but not on insulin My father`s father (my grandfather) became diabetic late in life.....he just recently died at the age of 94 & had been on medication (pills) for the past 5 years

Answer:

The criteria for the diagnosis of diabetes are based on blood sugars in the morning after an overnight fast (not eating for at least 8 hours) and 2 hours after a standard glucose challenge, an oral glucose tolerance test (OGTT).  The blood sugars between the baseline and the 2 hour time point are no longer included in the criteria for diagnosis.  My own view is that having had the abnormal OGTT, you should take on the mindset that you have diabetes and its for keeps but that you can have (and have had) times when you achieve much better blood sugar control.  As far as we know, those improvements in blood sugar control reduce the risk of microvascular complications of diabetes (eye and kidney disease and nerve damage); we don't know yet about whether it reduces the risk of large vessel disease, like heart attacks and strokes.  Your family history and your own time course are consistent with this being type 2 diabetes. 

So what does this mean?  It means you should live your life trying to maintain optimum lifestyle in terms of diet and exercise regardless of whether your blood sugars are abnormal at the time.  You may go through periods when you need diabetes drugs to obtain optimum diabetes control.

For more information:

Go to the Diabetes health topic, where you can:

Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati