A strange diagnosis


#1

Hello,

I’m Dragan from Croatia. I had a strange diagnosis recently so I thought I should ask community about advice.

I’m 39, slim (70kg/184cm) but not very active, mostly sitting and working at my computer but doing cardio about 2 times a week (sometimes every day when i have time). I eat normally and I usually have very plentiful late dinners, right before bedtime (sometimes at 11-12 PM). When I exercise, I do it on empty stomach in the morning.

As I was checking my blood about once a year for the past few years, I’ve noticed that my blood sugar number is getting higher and higher each year.

My fasting blood glucose results from previous years are:
2014: 5.31 mmol/l
2015: 5.68 mmol/l
2016: 5.62 mmol/l
march 2017: 6.05 mmol/l (this is when they told me I should see an endocrinologist)

There is somewhat of a general upwards trend but I thought it’s not something to worry about too much.

But I went to see an endocrinologist in December 2017. He ordered some blood tests and here are the results (bloodwork done after fasting for 12 hours):

HbA1C: 5.4% (Normal: 4.0 - 6.2 %)

OGTT, 2 hours, 75g of glucose:

Time____________Glucose (mmol/l)_________________Insulin (μIU/ml)
0’___________________6.01 ___________________________ 5.39
30’_________________10.90 ___________________________47.97
60’_________________11.25 ___________________________87.95
90’__________________7.06 ___________________________46.27
120’_________________5.91 ___________________________24.41

Please let me know if I should convert these to other units. In Croatia, we use these units.

I’ve made the charts for easier reading (As a new member, I can only include one image per post so here’s glucose):

snip_20180303152304!
snip_20180303152318

So, after seeing the results, my doctor ordered the anti GAD test which came out negative.

He told me that the results are not quite normal, but not diabetes either. That I’m right at the very edge (of prediabetes?).
He diagnosed me with something that would be “increased fasting glycemia” when I translate it to English as a layman.
he prescribed Glucophage (Metformin), told me to eat healthy, not to eat after 7pm and exercise more. I should get back to him with HbA1C and OGTT for control in one year.

Now, I didn’t start with metformin right away, I wanted to inform myself and read about the condition to see if something could be done without tablets. But I’m only getting more and more confused because I’m very slim and all the advice is mostly for people who can afford to lose weight. Does the doctor suggest that I’m on my way of becoming a Type2? Do my OGTT insulin measurments and a negative anti-GAD definitely suggest that I’m not developing Type1?

Please share your thoughts. Should I buy a glucose meter and measure my levels throughout the day. If so, do you know of a guide as to when should I take measurements and how to interpret them? That is, what should my goal be?

Thank you very much for reading and helping out!


#2

I believe there are actually six different auto-antibody tests that would help rule out type 1 diabetes. GAD is only one of those six and you may still test positive for some of the others. One of our members, @Melitta, is the resident expert on securing a correct diabetes diagnosis. Here’s her list of auto-antibody tests that may help clarify your diagnosis:

Get the full suite of autoantibody testing (Glutamic Acid Decarboxylase Autoantibodies (GADA), Islet Cell Cytoplasmic Autoantibodies (ICA), Insulinoma-Associated-2 Autoantibodies (IA-2A), zinc transporter (ZnT8), and Insulin Autoantibodies (IAA, Footnote 2).

Here’s the link for the full post. Melitta has written many comments and posts here about diabetes misdiagnosis, often based merely on age and body type. She knows what she’s talking about. Do a TuD search for her comments – use the magnifying glass icon in the upper right corner of your screen.


#3

To add to @Terry4’s post, these are classic signs of pre-diabetes. Such results can be controlled with dietary changes and exercise - even in a diagnosed T2 diabetic.

The information you provided is good, but you do not talk about your typical diet. Reducing carbohydrates, processed foods, and alcohol and replacing them with fresh vegetables, proteins, and fruits (limited) helps. Also do a small amount of exercise every day (30 minutes) and you will likely find your results will go back to “normal.”


#4

I can’t help with diagnosis, but what I have learned from diabetes is the more data you have the better. I would buy a glucose meter and take measurements first thing in the morning, before going to bed, before any food intake, after food intake at 30 min intervals for 2-3 hours, before exercises and after, before any phisical activity (even something like grocery shopping) and after. Write everything down (time, event, corresponding glucose level). Do it for one week. What you will get by the end is a comprehensive set of data of your body’s glucose response to day to day life. This information will help to understand exactly what is good for you, what is not so good, to decide about lifestyle and diet changes, and to set specific targets (in terms of glucose levels) for these adjustments.


#6

Thank you all for taking time to look at my post and reply. My account was on hold because of uploading two images so I couldn’t have responded yesterday.

@Terry4 Thank you for the link, that was very informative. I’ve looked at the tests available at my local lab and they only have (ICA) and (IAA). I’ll look for others elsewhere.

@kmichel My typical diet is already not very high on carbohydrates. I mostly eat meat, fish and vegetables. I never liked sweets and candies even as a kid. I don’t like bread and rice. I like potato and pasta though. I also don’t eat fruit much. Basically, I have a strong dislike for anything that tastes sweet, I can’t even use ketchup bought at a supermarket because I find it too sweet. I just get pressed tomatoes and make my own ketchup. Is this sweetness-aversion a sign that my body can’t process sugar as well as it should? But it’s been like that for as long as I remember. By the way, the doctor has also tested my cholesterol levels which are ok.

I understand this could be prediabetes but what’s confusing me is that my diet isn’t rich in sugars and carbohydrates and that I’m underweight. I immediately looked at alternatives to metformin after diagnosis but I’ve mostly found the lose-weight advice. Some people also told me that metformin will make me lose weight and I’m already too thin and always have been. This led me to believe I might be misdiagnosed.

@Dmitry2 Thank you for the advice. I’ll definitely do that. After I make those measurements, I should aim for keeping my glucose levels below 10mmol/l (180 mg/ml)?

Also, one more thing, I’ve noticed in the last few years that I urinate more often but only at night. I have to get up to urinate at least two times during the night. So maybe I should also test glucose at those night times? It’s strange because I’ve listened to my doctors advice and don’t eat after 7PM anymore and I still have those urges during the night.

If there’s someone who had similar issues and test results, please share what you’ve learned.

I was hoping that someone here could tell if this looks more like Type 1 by looking at my insulin OGTT levels. As far as I understand, in Type1, I should have a lack of insulin and it doesn’t seem to be so. I couldn’t find a resource for interpreting my insulin OGTT curve that I could understand.

Thank you all again. I know that this is not a big deal comparing to real diabetes but it might be the beginning, and it’s all new to me :confused:


#7

There are people on a couple of forums I frequent that have been diagnosed with T1 diabetes, but their bodies currently still produce some insulin- just not enough.

You may have read online that people diagnosed with T1 diabetes may have lost weight recently and be quite thin upon diagnosis. This weight-loss can be attributed to persistently high blood sugars and lack of insulin resulting in the body not processing food properly. People with sudden onset T1 diabetes may have fasting blood sugar levels well above 500 mg/dl (~28 mmol/l) when they’re diagnosed. My blood sugar was in the 800s, but I hadn’t yet begun to lose weight because my parents caught my diabetes so quickly.

Other T1s may lose their insulin-producing cells more slowly though. I would not consider your weight to be the determining factor when considering which form of diabetes you have unless your fasting blood sugar level is over 140 mg/dl (7.77 mmol/l).

The primary factors (though not sole factors) that determine if someone has T1 or T2 diabetes are:

  1. Do they have antibodies that indicate their immune system attacked the beta cells in their pancreas (Type 1)?
  2. Is their body using insulin properly? Do they have insulin resistance (Type 2)?

I’m looking for studies that state what the normal insulin levels (μIU/ml) should be following an OGTT. High levels of insulin would indicate insulin resistance (pre T2 diabetes perhaps). I’m not familiar enough with the test to say. From what I’ve seen so far, 5.39 μIU/ml fasting is normal. However, 24.41 appears high at the 2 hour mark. I’m still looking though. I accidentally posted this early.


#8

Thank you @katers87 I’m also looking and have found this study: http://care.diabetesjournals.org/content/36/5/1229

Looking at their graph, I’d fall into Pattern 3

Which by their study, means that I have a greater chance of developing Type2 than Patterns 1 and 2 but lesser than 4 and 5.

I’ve also found some insulin graphs in pmol/L units but when I use online converters to convert from μIU/ml, I get some insane values so I guess there’s something wrong with the unit conversion.


#9

Your pattern looks similar to pattern 3, but your levels are a bit lower, so it’s difficult to tell if your levels are normal or not? The pattern may be perfectly normal at lower levels. I’m not sure.

I’ll look a little more today to see if I can find something more definitive.

Here’s a study that shows the glucose profiles of people without diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769652/
image

I think it’d be worth testing your blood sugar a few times a day to see if your profile fits within the normal range. You could also test at night when you get up to urinate. Some people just need to urinate more often, so you may or may not have higher blood sugar levels when you get up.

It’s clear that you’re concerned about the results and want to be healthy. Given that, I think it might be worth compiling some data to see if you’re staying in the desired range.

Exercising can help tremendously with insulin sensitivity. My doctor says that I don’t have insulin resistance, but I still noticed that I’m more sensitive to insulin when I’m exercising regularly- especially more sensitive at meal times. It might be worth adding daily exercise (or every other day) to your schedule.


#10

An A1C of 5.4 approximates an average blood sugar so your blood sugar could be going quite high after meals. While some diabetics feel that 180 as their upper range is okay if my blood sugar is 180 I feel thirsty and if it goes any higher I start feeling tired and moody. If you are becoming a diabetic then the best thing you can do for your long term health is keep your blood sugars as close to normal as possible (80 to 120 or so). It is known that blood sugars that are above 140 for an extended period of time are damaging.

Your low weight could be caused by high blood sugars so if you can get your post meal spikes under control you might start gaining weight. I would start taking the metformin if diet and exercise won’t get your blood sugars to a non-diabetic range and see if it helps.

Also, it is a big deal no matter what point you are at in this disease. Being worried and not knowing what to do is normal with this condition because there is so little public legitimate knowledge on diabetes. You sound like you are on the right track and being proactive is the best way to preserve your health for years to come.


#11

@Dragon_J
In terms of units, the units you will most often see used on this site are:
mg/dl
mmol/L
The conversion factor of these is 18.

There are lots of websites and charts all over to help you convert. Here is one that has a nice visual:
http://www.type2diabetesguide.com/conversion-chart-for-blood-sugar-levels.shtml

Typically, you would simply post your numbers in the units you are familiar and comfortable with. ie - You do not have to (necessarily) convert your numbers for the reader. Some people do - most people do not.

[cut and paste the image from the link to here for ease of use]


#12

In general, it is considered that healthy people would have their glucose level in the range of 75-120 all the time with below 100 at fasting and this is the target of some of us. I have seen very few imperical data from healthy people and it is hard to say if this is exactly how it is, may be occasional larger spikes are a part of a norm too. A rule of thumb is the flatter the line the better.


#13

I would respectfully disagree unless the statement was not including post meal BG - which perhaps I misread the intent of the post.

I am a parent of a T1 and am non-D myself. I can easily spike to 180 with particularly chosen foods and speed of eating. A handful of Swedish Fish consumed in five minutes is only one easy example.

I usually don’t get into it as the obvious response from some would simply be that proves that I am pre-diabetic.

To each their own opinions.


#14

@katers87 Thank you for that graph. I’ll compare my results with it. I’ll buy a measuring kit this week.

@Tim35 It was very confusing to read that you have spikes after eating fish. For a moment, I thought I’ll have to give up my favourite food. But then, since it seemed fishy, I googled Swedish Fish and everything was clear :smiley:

So it seems everyone agrees that it’s OK that I think I shouldn’t just start taking metformin right away but first gather some data and try with diet and exercise first.

And I should rule out Type1 with some additional lab tests.

Thanks!


#15

I recently blogged about suggestions that the BG level at 1 hour is more predictive than the usual 2-hour level:

Your 2-hour level is below the cutoff for diabetes, but according to the authors of the paper I link to, a 1-hour reading of >155 mg/dL (8.6 mmol\L) is highly predictive that you’re heading for diabetes unless you change your lifestyle.

Some type 2s aren’t overweight (read about Michael Snyder, link in my blogpost), and there are also other varieties of diabetes.


#16

Hmm… interesting. I’m going to start some one hour checks. The “2 hour” seems cast in concrete… It’s everywhere in D literature. :sunglasses:


#17

You can test at both 1 and 2 hours after a meal.


#18

Thank you @gretchen, that was very informative.


#20

Hey Dragon_J:

Your Dr. sounds more enlightened than many we have to endure here in the US. He was smart to check for antibodies. The results suggest you’re probably not T1, and likely headed in the direction of T2. There’s a common misperception that you have to be overweight to have T2. T2 is the result of insulin resistance, which can happen to any body type. In fact, the latest research suggests that this insulin resistance is what causes weight gain, not the other way around. Further, I don’t like the term pre-diabetes very much at all. It’s like saying you’re half-pregnant. You either have the ability to normalize your blood sugar or you don’t. In your case, it looks like it’s impaired. I would recommend considering a Freestyle Libre to map out exactly what’s happening with your glucose levels. Regardless, Glucophage is one of the safest and most proven first-line diabetes drugs to specifically address insulin resistance. In fact, they’ve discovered secondary benefits that help reduce the chances of certain types of cancer. Some complain about GI issues as a side effect. The extended release version will usually address that. Your diet and lifestyle sound pretty healthy. Your Dr.'s advice seems pretty sound. Keep doing what you’re doing and keep a regular eye on your glucose trends. You’ve identified it early and have an excellent chance of keeping it under excellent control.

Christopher