Am I or Am I NOT Diabetic?

I had to wait a couple of hours before I wrote this post. Yesterday, I contacted my PCP to request a prescription for test strips for my meter (I had used up my stash I had from my previous endo). While on the phone with the receptionist, she asked why did I need test strips. Once I realized she wasn’t joking I explained I was a diabetic (controlling my diabetes via diet) testing 2x/day. She said she would have the doctor call me back. My PCP called me back and told me that I was NOT a diabetic. I gently told yes, I was when I came to her 2.5 years ago. The PCP said that yes I take prednisone for my RA but I’m not a diabetic. (?) O.k.? and she wanted me to come in fasting for labs.

I agreed to do. I went in at 9 am with a BG of 106. Note: I have been running around 110 to 125 in the mornings, during the day around 150. Very thirsty, drinking a gallon of water daily, but not having an appetite.

I told her this information yesterday on the phone and today in person. She still says I’m not a diabetic, that the prednisone is the culprit. I’ve had a previous PCP, 3 endos, a rheumatologist, and a cardiologist all say I’m a diabetic, but this PCP says I am not a diabetic. She is doing a full blood panel and confident that I am not a diabetic.

When I was diagnosed in August 2013 my A1C was 7.5. When my previous endo left the area in 2017 my A1C was 6.2 and she wanted better. The previous endo wanted my morning fasting to range between 90-100, before lunch/dinner to be less than 120, and after meals less than 150.

I told the current PCP I’ve been running 120-130 in the mornings, and around 140-155 lunch/dinner with blurred vision. She says that the numbers are not bad and does not indicate diabetes.

I can’t go to an endo without a referral from her. I am unable to change doctors because doctors in the area are not accepting new patients (this was before COVID-19). She’s always been a little off (rude). But now she’s really got me worried.

My rheumy has been counseling to remain in tight control with the keto diet which is what I am doing which is why I am concerned about my numbers. I do stretching throughout the day.

One thing is different is that I at work my BGs were better but I was always in pain from my RA, now with the quarantine, I’m working from home, and my RA pain is minimal, but my BGs are climbing but I’m staying on my diet even better.

I’ve lost about 5 lbs in 2 weeks.

All advice is greatly appreciated.

What tests are included in the full blood panel?

She said she would be doing an A1C, CBC, full blood panel for my liver, kidney, etc. She did the blood drawn in her office. She also did a urine sample and said she saw no sugar spilling into my urine.

Kate - with respect, I’d seek out another PCP. Yours sounds like mine - unqualified to make diagnoses in fields beyond her basic training.

As far as the strips go, your only option is to self-fund until you find a different doc who’ll write the appropriate prescriptions

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Yeah, that’s what my gut is telling me too Jim…alarms ring in my head every time I go in for a visit, this time it was sirens…that was too weird… I even told her the diabetic medications I had taken in the past, and it didn’t matter.

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Also talk to your pharmacist to see if he has any suggestions if you cannot change your doctor. Just an idea. So sorry you are having this situation. Nancy50

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It appears that your diet choices can keep you in the non-diabetic range, and guessing you eat a “lower” carb diet to achieve those numbers.

One test I didn’t see on your list is glucose tolerance test. They give you a high carb drink, and then test bg at intervals. Maybe you can request that, and it would support your need for bg testing RX.

Here are guidelines from ADA, which unfortunately lead doctors to think one size fits all.
https://emedicine.medscape.com/article/2172154-overview#a1

You may also find cheaper bg tests, equivalent to your insurance covered strips, that won’t even require RX. I have used ReliOn, and it is comparable to my Contour Next.

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Thanks MM1. No she said come in at 9 am fasting. I did and she didn’t have the orders written. Then she came in the room again and said I wasn’t diabetic even though I know I am. I thought she would the glucose tolerance testing or additional testing to confirm but no, she’s just adamant that I’m not—that the prednisone “elevates” my BG.

She’s very strong willed so I’m just going to try to ride it out until I can find another doctor. Thanks for the tip on the test strips.

The one endo that wanted to place me on insulin May '15 when I saw him (1 visit only) was right…he told me—your pancreas is working now, but you need insulin for meals…treatment by diet will last only so long. At the time I wasn’t ready to make the commitment to insulin.

He was a good doctor but he was in a group (you may or may not see him for your appointment) and he was downtown so I’d have to take a day off from work.

It’s possible that without the prednisone you would “only” fall in the prediabetes range. I ran near that 125 number for several years and then had a long course of pred due to Ulcerative Colitis. With the pred, I needed to take insulin even with a fairly low carb diet. But when I weaned off, my numbers came back down. (Wish the same was true after I improperly got Decadron with my first few chemo infusions a decade ago. BG went up to high 300s and never dropped to previous levels.)

I really can’t say since I’ve been taking the prednisone since I was diagnosed with RA in 1995. I’ve been weaned down to the lowest maintenance dose of 4 mg/daily, and 40 mg via IV every other month when I receive my Remicade monthly. But my rheumy is unable to wean me completely off the prednisone or my RA will go into a raging flare. As is, my RA is not under control…my SED and CPR are high (reason for monthly Remicade). I also take Plaquenil.

I was diagnosed with Graves disease as a teenage at 13 in 1983. I was given radioactive iodine (2 doses) resulting in me becoming hypothyroid, the doctors had never given the RI to anyone so young so it was a shot in the dark.

The PCP is saying it is the prednisone and I’m not diabetic. Previous doctors say I was going to be diabetic anyway the prednisone just helped the process move it along. What I’m trying to tell my doctor is I’m doing everything I can on my end, are we moving the line that the previous doctor had me working from?

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@Kate25 See if your rheumatologist will run more labs to help make the determination. When I see my rheumy and ask about something, they will order/run the lab for me.

There are antibody tests which can help determine if what type it is.

You could start with a non-fasting blood sugar and c-peptided test.

These posts (made in the same conversation) may be of interest to you:

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As any type one who’s had an orthopedic cortisone shot knows, corticosteroids definitely have a sustained elevating effect on BG (took me weeks to get back to normal the last time I had one). So your numbers may count as “normal” for someone on prednisone therapy. But because that therapy isn’t going away for you, in practical terms it’s almost academic whether you label it “type 2 diabetes” or “side effect of my medication.” You still need to work at keeping it in check, and for that you need the gear to do it, test strips included.

Plus there’s this:

One of the side effects of oral corticosteroids is that they can increase blood glucose levels and increase insulin resistance, which can lead to type 2 diabetes.

Typically, blood glucose levels will return to normal after you finish taking the steroids but in some cases, particularly if you have pre-existing risk factors for type 2 diabetes, you may be diagnosed with this form of diabetes.

Being on steroids for a longer period of time, over 3 months, may also increase your risk of type 2 diabetes.

TREATING DIABETES WHEN ON STEROIDS
If you have diabetes prior to starting on oral corticosteroids, you need to be aware that your blood glucose levels may rise whilst you are taking steroids. This is more likely to be the case if you are taking steroids orally.

If you do not currently monitor your blood glucose levels at home, you may wish to ask your doctor if a prescription for home blood glucose testing will be appropriate.

If your blood glucose levels rise significantly, you may need to increase or change your diabetes medication.

https://www.diabetes.co.uk/diabetes-medication/costicosteroids-and-diabetes.html

This isn’t exactly the most obscure bit of lore in the medical universe, even for non-specialist PCPs. The above, adjusted for the fact that you are on prednisone essentially permanently for a chronic condition, means that your doctor is off the rails in this case.

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I’m all for not giving business to sub-par professionals. Until you manage a new physician, though, maybe you just need to inform the current that there is a diagnosis/billing code for drug-induced diabetes! You shouldn’t let then deny you monitoring tools because they want to ■■■■ over semantics.

E09.9 Drug or chemical induced diabetes mellitus without complications

There are other codes covering drug-induced diabetes WITH complications.

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Kate25, my husband takes prednisone for a form of arthritis. His A1c has risen but still is below 6. We are really keeping an eye on it and will tell the doctor that my husband needs diabetic meds if it goes any higher. We would consider him to be a type 2 diabetic.

He now eats the way I do which is plant based and low fat, so the his A1c stays around 5.6. It had risen to 5.9, so he dropped all bread and alcohol.

I sure hope that you can get a new doctor.

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Yes, that’s what the last endo and my rheumy had me doing…no pasta, rice, or bread. Those are my weakness and I’ve been doing well, that is the reason for the concern I could see the creep of my BGs.

Yes that’s what the downtown endo called it “drug induced (prednisone) diabetes”. My last endo (before she moved) as well as the downtown endo said that the diet would hold for a while but eventually I would need meds/insulin. Their mark was 150…if I saw my BGs creep to/above 150 let them know.

Yes you are correct Dr.BB, usually after my monthly infusion there’s a window of 3 days that my BGs are elevated which are considered “given” but we (the doctor and I) expect them to return to normal. If they don’t then that’s a red flag. Likewise, if there’s an abnormal creep, like I’m experiencing now, I was supposed to alert the doctor as well.

I’ve always been told, since back in the antediluvian era when I was dx’d, that sustained levels above 160 are where the damage starts to occur, so yeah that makes sense. For perspective, by T1 standards you’re actually doing really well, but that’s no reason not to be concerned.

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Update - just got my test results from my doctor. A1C is 6.2 and she says that is fine. Nothing should be done because it is due to the prednisone. She is happy with it. I just left the pharmacy…they charged.me $45 for 50 strips 1 box (2x/day). I don’t know how my previous endo wrote my script but I would get 4 boxes. SMH.

I’d look into a Libre. Not sure if you can get one without a prescription but it might be less expensive (and more illuminating) than finger sticks over time. If your PCP won’t help you, see if one of your specialists will.

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