I actually haven’t been diagnosed yet but wanted to introduce myself. My husband and I had labs done for our life insurance applications, and when my A1c came back at 5.5% with a fructosamine of 1.75 (on normal scale of 1.2-1.6), as a registered dietitian, I knew something was up with my blood sugars. I purchased a meter last weekend and have been tracking my levels. Premeals are 60s-70s and
1 1/2 -hour postprandials are 150s-160s, followed by a drop down to 100 within an hour, then back down to 60s-70s within 3 hours. I’m 44 years old and fairly active, thin, and I eat a very high-fiber balanced diet that is moderate in carbs, fat, and protein.
I was going to wait until I had a diagnosis (prediabetes, Type 2, LADA, or something) until I started posting, but I just found out my doctor is out of town until early April, and I didn’t want to wait that long to get started here. Also, it seems that for many people, getting a definitive diagnosis as to type of DM is pretty difficult, especially in the early stages.
Has anyone on the site had a presentation similar to mine, or do you know of someone who has? At this point I am going to try to eat smaller meals with fewer carbs to try to prevent glucose excursions, but I wonder if any of you have any insight based on my limited information.
I think this site is fantastic, by the way. Such an incredible, supportive community.
Hi, welcome to the site. I guess with those levels doctors usually just have you watch what you eat and you probably wont be put on meds just yet. The one thing that seems a little bit above is the post numbers. How many times have you tested to get post numbers. A lot of times you want to see an average over time. So my suggestion keep an eye on things and see how they move in time. I was not one that was diagnosed with smaller numbers but a trip to ER with a glucose of to dont know what really the protocol is for early diagnosis and what do doctors watch out for.
I was going to say - wow - awesome readings - since it shows your pancreas is doing what it’s supposed to do (mine doesn’t due to going on a holiday without telling me when I was only 7 - poo on that pancreas!!). I’d say your blood sugar after the meal might be a wee bit high - so like you’re doing - keep a check on it - but other then that - range before hand and after you’ve dropped down are perfect - but I’m no medical practitioner here - so don’t take my word for it. My nonD hubby has been a guinea pig for me a few times - and he’s between 7-8 mmol or 126-144 after 2 hours of eating a meal - and is within the “norms” for fasting, etc. like you are.
Here’s a website that might help you abit. Though I think as a dietician - you already know enough about diabetes - but it’s nice to talk to others that maybe have been thru’ similar experience. Hopefully they’ll see your post real soon and come to your aid - we’re one big happy family here in Tuville (my affectionate name for this website).
You may find that you can control your spikes by eliminating or reducing portions of certain foods. Likely candidates are grains(even whole grains can be a problem for some) potatoes and fruit. Everyone is different, by testing and experimenting you can determine your individual reactions to various foods and modify your diet accordingly.
The delay in seeing a doctor may work to your advantage because you can use the time educating yourself so you can ask the right questions and request the right tests. Many meter manufacturers have software that allows you to download. your meter readings to a computer and then print out charts of your readings. This can help you and your doc understand the data better. Sure beats a blood stained logbook:) I have used both the Wavesense and Bayer programs and liked them both.
Another site many of us have found useful is BloodSugar101
Thanks so much for all the responses. Testing is very new to me – I’ve only been doing so for three days since receiving my lab results, but the results are pretty consistent so far. I realize that I’m not even at the stage where diabetes or prediabetes can be diagnosed based on my A1c and fasting labs, but I also know that since an A1c is a 2-3 month average and my premeals are so low (although not technically hypoglycemia for someone without DM), I must be spiking to 150s-160s after most meals. And as a dietitian, I honestly eat the same way I recommend my patients do: a large portion of nonstarchy vegetables with 1 cup whole grains, 3-4 oz lean protein, and 2 Tbsp healthy fat at meals. Theoretically,a mixed meal with low glycemic index foods (about 50 grams carbs) should not cause blood sugar to spike above 140 in someone with normal endocrine function. And it seems that going from 60s-70s to 150s-160s after such a meal in an hour to an hour and a half is a pretty significant spike for someone without diabetes/prediabetes. Again, I think that whatever is going on (definitely seems like lack of first phase insulin response) is in its earliest stages, but it’s still puzzling to me based on everything I know about DM and its progression. Incidentally, the timing of this is somewhat ironic – for the past year I have worked primarily with Type 2 diabetics and am currently studying for the Certified Diabetes Educator exam. I am really enjoying this site and learning about the various experiences you have had. Thanks again for your responses and support
I am really glad you joined us here. I think you are doing a great job asking yourself critically about whether you have a blood sugar problem. Unfortunately, the ADA has done a terrible injustice to the public by pushing the A1c as a screening and diagnostic tool. The A1c and fasting blood sugar are “lagging” indicators of diabetes. By the time your A1c and fasting numbers have gone south, you have diabetes bad and there is little hope of managing your condition with diet and exercise. The researcher Ralph DeFronzo in his 2008 Banting award lecture suggested that newly diagnosed T2 diabetics had probably already lost 80% of their beta cell function.
The best test for most people to catch blood sugar problems (T2) early is the OGTT. You can give yourself an OGTT at home with a simple load of 75 of fast acting carbs, dextrose or glucose is perfect and using your home meter. Since you are already in the midst of studies on these matters, you probably know all the basics. Your peak blood sugar is an indication of how strong your phase 1 response remains and your ability to bring your blood sugar down at 2 hrs tells you how strong your phase 2 response is. Typically, your phase 1 response will decay, you will find your blood sugar at 1hr going over 200 mg/dl and then you will eventually not be able to bring it down at 2 hrs.
Right now, from what you say, your blood sugar seems to be within “normal” ranges. But you really need a more sensitive test as above to tell.
You are fortunate that you are looking at this early. Many of us only learned late that we had diabetes when modest measures to manage our condition were no longer effective. And unfortunately, many of us have felt “let down” by the medical system and turn to communities like this. Diabetes is a chronic condition, we as patients must oversee, manage and make the vast majority of decisions about our own care. We can’t sit in our chairs waiting for someone to come fix it, it just is not going to happen. We can’t take some pill and make it go away. Diabetes affects our lives profoundly. So we band together as a community so that we can take care of ourselves on our own.
I’m certainly not qualified to diagnose but it does seem you are in the early stages of something. Current theory says anything above 140 is damaging, although you are only spending a short time there. I believe a normal response for the meal you describe would be more like topping out at around 125 and quickly going back down.
A friend of mine decided to test after a carby meal a while back. She hit 180. She has cut way back on wheat and potatoes. Her last A1c was 5.1
You could also do a sort of glucose tolerance test on yourself by eating a high carb meal of foods you know will probably spike you and noting your response. The more data you have, the better you will be able to decide on a course of action.
Many of us who waited too long to deal with this have paid the price of needing to modify our diets drastically or having to use drugs, so I’m an advocate of early intervention, as opposed to many Dr.s who will adopt a watch and wait attitude. My friends Dr. said there was something going on but refused to even do an A1c, so she has no baseline. She finally got tested at work at a yearly health screening. Your meter is your best friend.
You may have already seen this thread about reactive hypoglycemia but in case you haven’t check it out.
This is a condition where the pancreas overreacts to a spike because it is having trouble getting it back down. The root cause is insulin resistance and would suggest the early stages of T2. Normal blood sugar after the body has metabolized the glucose from a meal is generally considered to be 83
Wow, thanks again for all of the advice and support. You certainly know how to make a newbie feel welcome
Reactive hypoglycemia sounds a lot like what I’m experiencing. although I’m not having any symptoms of low blood sugar. I talked to the two nurse practitioner diabetes specialists at work today – they’re both Board Certified in Advanced Diabetes Management – and they said I really need to have C-peptide and GAD antibody lab workup done in order to rule out LADA given my apparent lack of first phase insulin response, family history of autoimmune disease (uncle with hyperthyroidism and grandfather with DM on insulin, likely Type 1, although my mom isn’t sure), age, and size. But prediabetes/Type 2 certainly isn’t ruled out by any means. Like everyone has suggested, I am going to try lowering my carb intake at meals and see what happens, and I think I’ll try a home OGTT over the weekend. Thanks, everyone!
I was just about to suggest that you get the antibody work up, and then if you do find out you have the antibodies and show potential for developing T1, you might want to get involved in one of the trials that seeks to dial down the autoimmune response to delay the onset of full blown T1. I’m not sure you’d qualify for TrialNet, which is the research being done to identify relatives of people with T1 at risk for developing it, but it never hurts to ask. You can find more info about it here: http://www.diabetestrialnet.org/
Interesting case. It’s sort of as if the patients are ahead of the doctors and the medical industry in being able to tell something is up and finding the answers themselves. Which is sort of what diabetes of any flavor can be about?
Glad to see you got good advice from co workers about which tests to have. Too often people are misdiagnosed because the proper tests haven’t been run. Here’s a recent thread about misdiagnosis.
Please keep us informed about how you are doing and the results of your diet changes and Dr. appointment.
Thanks, BadMoonT2! I started reading that very interesting thread but will have to finish it over the weekend when I have more time. I’ll let everyone know what happens when I see my doctor in April. Fortunately, she is board certified in endocrinology as well as being a GP, so that is definitely a plus!
Once again, thanks to ALL of you for your advice and support. I will definitely refer my patients, particularly those newly diagnosed to this site
I started at 5.5 A1C, as you are, Franzi, and still at that level today, seven months later. I was at 180-210 mg/dl first week I was diagnosed, which wouldn’t come down at all without shots of insulin. The diet you are following now would spike me over 150 for sure. I wouldn’t dare take 75 grams of glucose, cuz I would get over 200. I’ve never had the fructosamine test.
Once I started meds, I was usually in the 90s before meals. This January I started getting low, 60, 70, so I discontinued the meds and got my doctor’s OK to just take a pill for times I accidently eat too much carb, 50 grams will spike me to over 140. I usually aim to eat less than 40 grams each meal, except dinner needs to be 35 or less.
I worried a lot the first four months what type of diabetes I had. Looks like type 2. I was on meds until just recently, now can do by diet control alone. I agree with other posters that ADA diet isn’t strict enough. A diet healthy for people without diabetes is not also healthy for PWDs.
I saw your post on the Stevia 4 Health group and linked up to this discussion. I’m an RD too and was eventually dx with LADA in 2006 after about 7 years of increasing blood sugar problems, including reactive hypoglycemia (your description of your testing results sounds a lot like what was happening with me back in the beginning). I also came to the conclusion that the symptoms I was having (before starting on insulin) was due to inadequate phase 1 production. I’m glad you are getting on this from the start and hope you get a good response from your doctor. I was continuously told that all my blood work was fine and that there was nothing wrong with me (before my initial misdiagnosis of type 2 in 2004). I had to experiment with my carb intake to see what worked for me too. I also had the best luck reintroducing the lowest glycemic load carbs back into my diet without much difficulty. Good luck and keep us updated.
Quick update: I found a great endocrinologist who did a bunch of lab work and says at this point I have subclinical hypothyroidism (normal TSH and T4 but slightly low T3) and impaired first phase insulin response/impaired glucose tolerance (low-normal fasting but elevated 1-hour postmeals and A1c now 5.6). He is going to retest all labs in 3-6 months, and I will likely start thyroid medication before the end of the year. He’s also waiting to test for antibodies once I’m at least at the prediabetes stage since at this point I can manage with diet and exercise. I’ve read so many posts from people who were diagnosed with both hypothyroidism and LADA, so if that is my ultimate fate, I know I am in good company
Right now your numbers are actually pretty good. The only thing that is high is postprandial but it’s not outrageous by any means. I wouldn’t be surprised if your doctor dubs you to be pre-diabetic and recommends you watch your carbohydrate intake. For LADA (which actually is slow onset Type 1) the tests are GAD65 and 1a-2 – antibody tests. You might want to request they be ordered by your doctor.
