Does pre-diabetes really exist?

Is there a distinct line between type-2 diabetic and non-diabetic or is there a fuzzy zone where you can go either way?

My wife in not overweight, 22.7 BMI. She had a FBS of 6.1(110) at the Lab and passed the OGTT because she had a reactive hypoglycemic reaction. She got an A1c of 5.6%. However, give her a glass of orange juice and she hits 200+ real fast.

Our Doctor has not marked her as diabetic, but has written an Rx for test-strips which I consider is very thoughtful of him. His words were "Just watch it!". One diabetic per house is enough. I have convinced her to cut the carbs and she does test quite a bit. She is on a half-■■■ version of Dr Bernstein because I am leaning on her to go in that direction. She is getting a lot of BGs under 6.0(108). Her mother was a T2 and I think my wife has got the message without freaking out.

I hate to see true T2 diabetics not diagnosed early enough to prevent damage. Also I'm not impressed with the "See your Doctor, take your meds" over simplification of treatment.

Your wife is fortunate to have you to guide her. Tragic how many T2's coast along believing T2 is nothing (not the "bad" kind) & their doctors don't offer help or education. Not to mention the additional issue that the standards for diagnosing are too lax.

Good doctor to have prescribed strips. Heartbreaking for those who are told to test a couple of times a week, or less because that's all their doc or insurance will allow. A friend's T2 husband, with excellent insurance, was advised to test several times a month. His A1c isn't good, but he's not aware of this because his doc said he's fine. He dutifully takes Metformin & sadly believes that's all that is needed.

See your doctor, take your meds. Eye rolling at that as people's health declines.

T2 is a complicated disease. Nothing simple about trying to stay ahead of the eight ball.

I agree with this. I've had several friends "on the cusp" who seem to be told "you're ok" but actually are running numbers out of normal ranges but not enough to trigger a response from the medical industry.

We found out that my wife had a problem soon after my diagnosis when she tried out my meter one morning to see how it worked and out popped a 119 fasting. She has lost some weight and is very disciplined about daily exercise but isn't as disciplined as she might be about carbs. That's the downside of having a T1 husband who isn't a low carber.

Her "diagnosis" is pre-diabetes although she is growing convinced that she really has a well controlled case of T2 diabetes. Her primary did prescribe strips and sent her to a session with a very good CDE and a helpful nutritionist so I'm not complaining about her care. But if we weren't on top of it she would have been much further down the road before her primary took action.


This topic has given me an idea. How about a Light Blue Day where we test partners, kids, friends?

The 2012 test strip feud has begun so I don't have any spare strips and am not sharing, unless it's somebody "on the team" who's in distress...

A "Light Blue Day" is a great idea, Gerri! I went so far as to get free meters with strips for my mother, sister and daughter, after my diagnosis. My daughter had some problematic numbers and has cut back on the carbs.

There actually is NO distinct cutoff between normal, prediabetes and frank T2. The line is wherever the medical establishment decides to put it. A couple of decades ago, the diagnostic cutoff was 140, because a given percent of the population fell below that number (don't remember what the percent was).

Then some studies emerged, primarily on the Pima Indians of Arizona, but also on other populations, which showed that the incidence of diabetic complications, primarily retinopathy rose sharply at FBG somewhere around 120 - 130, so the powers that be decided to lower the diagnostic threshhold for diabetes to 126. They were cautious about not making it too low because they didn't want to treat people who really didn't need it.

Now, they're looking at A1c as a gold standard for diagnosis, based on studies of complications as well. Heart disease is a major issue for T2s and some of the decision will be based on CVD statistics. The number that they're going for is 6.5, which to me seems pretty high, all things considered, but they're not taking individual variation into account -- just looking at overall populations.

The concept of pre-diabetes is a fairly new one, and establishing the low end of the spectrum at 100 is pretty arbitrary, but at least people who have good doctors will know they're at risk, and have the chance to do something. Avoiding an actual diagnosis through good control habits is essentially the same thing as saying you've prevented or delayed it, and can have benefits, such as when you apply for insurance.

In my own case, if current guidelines had been applied, I would have been diagnosed 2 years earlier, sparing me a lot of agonizing over whether I did or didn't have diabetes. (The previous year, I definitely didn't) But in the end, the best advice was given me by my dearest friend: don't worry about whether you have diabetes or not -- live as if you did, because that means striving for a healthy diet and sufficient exercise and healthy living -- it can't hurt you and it CAN help!

I gave a friend a meter. He's T2 with his head in the sand. Really worried about him. His doctor said he's hypoglycemic (not hardly from the tests I did showing him how to use the meter), so he's swilling Coke when he feels off. He's probably got reactive hypoglycemia.

Well, I think she's a candidate for both dietary control (no more fruit juice, carb counting/control and avoidance of "fast" or "simple" carbs), a serious exercise program (resistance and aerobic) and that she may benefit very soon from a very low dose of Metformin, if she can tolerate it.

I also had reactive hypoglycemia -- for decades -- before I was officially diagnosed with T2 -- an early red-flag warning of genetic difficulty with carbohydrate metabolism. I still get angry when I recall the snide way my (former!) doctor told me that I was "fine" when my 12-hour fasting BG went from 90 to 105 to 115 over a two-year period. I wasn't fine. I was sliding up into T2 and I should have been testing regularly at home, moderating carbs, etc. as soon as the creep started. Who knows what I was running after meals? No one was testing it so I have no idea. I do know that my first A1C -- taken after I finally passed the Magic Diabetic Threshold with a fasting above 126 -- was in the double digits!!! And I'd been complaining of blurry vision and trouble with my night vision for a couple of years before diagnosis. Gah.

At that time (in the four years leading up to diagnosis) I was very active in the local swing-dancing scene and was dancing (East Coast swing, Lindy Hop, Balboa and Salsa) upwards of 15 hours per week, plus lots of commuting on my bicycle. After my melanoma surgery on my foot, I couldn't walk for six months, much less dance. I gained a lot of weight, stopped exercising and -- tada -- was diagnosed with T2 one year after the melanoma surgery. If my doctors had actually cared about me, they would have suggested physical therapy and a substitute exercise program after my crippling foot surgery and they would have kept on top of my creeping blood glucose after I lost my ability to exercise vigorously.

Oh, well. Hind-sight is 20-20 and HMO's suck. We have to be pro-active these days because the new medical paradigm results in drive-by pseudo-medicine. No one is really watching out for us but ourselves and our families. Your wife is blessed to have you.

My wife went and had her A1c tested about two years ago. She blew a 5.8%. I informed her that she had diabetes. I wasn't very tactful and boy was she pissed. She basically called me a liar and questioned why I thought I knew so much more than the dr. I was perhaps not as tactful as Alan. But in her heart, she knew what I was saying was true. By the time you reach the point of getting diagnosed with overt diabetes you have lost 80% of your beta cell function. This is straight from the mouth of Ralph DeFronzo, in his 2008 ADA Banting Award lecture.

In my view, as soon as you start to display blood sugar abnormalitities, you have diabetes. The healthy non-diabetic has plenty of reserve insulin capacity to keep their blood sugar rock steady at normal levels. Once your blood sugars start to waiver, something is terribly wrong.

My wife has since adopted a low carb diet, eating only the foods I prepare. And in the process lost a fair bit of weight. Her A1c is back in the normal range. She is successfully treating her condition with diet alone. As to whether she truly understands that she now has diabetes and will likely always have to treat it, I cannot say. At least for now she seems permanently committed to low carb.

"blew a 5.8" LOL.

You laugh now, but in phase II of the Diabetes Prevention Program, they will be setting up roadblocks and making drivers submit to an A1c. Those that have an A1c > 6.5% are pulled over, given a 60g carb meal of grains and then forced to exercise until they get better.

I Agree 100% Gerri,

3 years ago after a routine blood test and a1c of 7.2 I was told to "cut down on rice and potatoes" and sent my way. No explanation, not medication, no test strips, no advice etc etc... I found this site and believe I've learned much more than my GP would ever know.


They are looking to reduce medical expenses by reducing the population of people with diabetes the old-fashioned, Malthusian way.

I am in the school of thought that it is like pregnancy. You are or you are not. I think many of us type 2's will report we had years of hypoglycemia before becoming officially type 2. Since the HbA1c is an average if you are spending lots of time in that hypo range it may negate thos post meal highs. My feeling is if your endocrine system is working the way it should you would never get those 200+ bgs. I guess the medical community and the media have us convinced only overweight people get diabetes because of poor food choices. We all know that is not true. My BMI is around 20 and I am a full blown Type 2. I consider type 2 an allery to eating carbs. The lower carb I go the more stable my bgs go. I never go much below 90, but never go above mid 120's either. Doctors need to make this connection between hypoglcemia and full blown D.


It's criminal! Maleficence that should be malpractice. Wish patients would sue these doctors to get the attention of the medical community. Makes me militant.

OK, once the discussion on A1c got started, my hot button got pushed. The current probably soon to be definitively adopted guidelines on diagnosis by A1c is 6.5. So, bsc, if your wife was told by her doc that she had a 5.8, he would have laughed you out of the office if you had suggested that she had diabetes. So far, they are REFUSING to understand that A1c varies by individual and that MY 10.7, which is what I had when I went comatose, is more likely equivalent to someone else's 16 or 17 or even 20. I've said it before, but when I had BGs that were diagnosable by current standards (138 and 3 mo. later 131), my A1c was 4.8. In a way, I was lucky that my diabetes progressed fairly rapidly compared to T2's, because 2 years later, my FBG was in the 160-180 range, and PPs were around 250, and I still only had a 7.1, but it was enough to be diagnosed, and when diet and exercise and sulfs didn't work, in MY opinion (i.e. weren't bringing my BGs down at all, even though they weren't emergency high), at least I had a doc cooperative enough to put me on insulin.

Your wives are lucky that they have someone knowledgeable looking out for them, because the VAST majority of people who don't hit the accepted cutoffs MAY be told they're pre-diabetic, but they don't get any help, any kind of treatment or and directions on where to go to educate themselves. CDE education is CERTAINLY not available to them, so self-education is the only way to go. Internet savvy people have a chance, but think about how many people out there, especially the disadvantaged, non-native English speakers and poorly educated, don't have the access nor the skills to use the internet. I sit and listen to medical professionals and govt. critters moan and groan about the diabetes epidemic, but I DON'T see much in the way of genuine help, other than telling people not to consume added sugar. Well, a giant hamburger bun and french fries have no added sugar, but they're just as bad, and MOST people don't know that. Aaarghhh! I told you it was a hot button!

Soylent green is people!!!!!

Hi Alan. This is borrowed from a blog I wrote: "One day for the fun of it, I talked my husband into testing his blood glucose. Oops! It was high! He tested again before and after meals; post pandrialy his results were always high. However, his fasting BGs were normal. My husband has always been thin and active and has no autoimmune conditions or insulin resistance. We decided he has a condition that we are calling "Type Geriatric". We went off to his doctor, who gave C-Peptide and other appropriate tests, and agreed that he has "Type Geriatric". My knowledge from the DOC, and especially TuDiabetes, has been a lifeline for both of us, and in the interest of full disclosure, he's a biological scientist and comes into the situation with some knowledge of his own!"

His doctor is fully aware of my husband's problem, and knowing that we both have some insight into the problem, we are all working together to treat the problem of this "pre-diabetes". I guess I'm just pointing out that pre-diabetes is not necessarily the manifestation of just Type 2, or even LADA.