I was diagnosed as pre-diabetic back in May 2015. Recently I gave birth to my son, and I was ordered by my endo to retake the 2 hour glucose tolerance test.
Well, I failed. But the numbers are a bit odd to me and I was told to retake the test in six weeks.
The first time I did the glucose test back in May 2015, all of my numbers (a1c, fasting and 2hr test) were in the pre-diabetes range. This time my fasting was 67 mg/dL, 2hr result was 252! A1c came back at 6.3%. I haven’t spoken to my endo yet and I’m trying to make sense of what these numbers mean.
I had gestational diabetes during pregnancy which was controlled well (a1c around 5.5%) with fast acting insulin. After I had my son, raising a newborn proved to be more difficult than I imagined and I ended up eating more carb. I also haven’t been exercising much. Moving forward I will exercise (walk after a meal, Pilates) and eat less carb but what I’m wondering is do I need to take any medicine? Am I pre-diabetic or diabetic (not that the distinction will make any difference in what I need to do)?
It looks like your natural basal insulin is working OK, but your insulin response to a meal is impaired. Your A1c of 6.3% is high compared to the gluco-normal population but is a good range for someone with diabetes.
If it were me, I would get a blood glucose meter and start to check upon waking as well as before and after each meal. Keep a record and this will help you to understand about your glucose metabolism impairment. It will also help you start to understand how different kinds of food drive your post-meal numbers. You may need to start on some fast acting meal insulin again like you did during your pregnancy.
I would insist that the doctor order auto-antibody blood tests. There are about five or six of those. Just ordering one is not enough. These anti-body tests will help determine whether you are T1D or T2D.
This is not a trivial matter and not all doctors think it’s important. It is important because many people with T1D get misdiagnosed and their effective treatment gets delayed, sometimes for years while they get exposed to needless hyperglycemia.
You’ll also likely need a c-peptide test to measure how much natural insulin your body currently produces.
I am similar. I was diagnosed with GD and after having my daughter my fasting was fine, but I was spiking into the 200s and my A1C went into the pre-diabetic range. My Endo treats me as diabetic, which was particularly helpful in monitoring my blood sugar and getting early treatment during my current pregnancy. Normally I am diet controlled, since my fasting is ok as long as I eat a low carb diet my blood sugar is good. I don’t know if you are planning another pregnancy in the future, but I found that my blood sugar rose faster and I needed fast-acting insulin sooner this time.
There is a standard formula in medicine that the more endocrinologists the medical schools generate the lower the thresholds for diagnosing diabetes are made. Not to say that is what is going on in your case, but it is useful to keep in mind.
Thanks for your comment. I have a glucose meter but I haven’t been religiously keeping track of my BG level since I gave birth. I did it occasionally here and there, and did see an improvement in response to carbohydrates from when I was pregnant. Because of this, I had assumed that I was back to pre-diabetes.
As you’ve suggested, I started checking my fasting as well as post-meal BG levels. And carb counting. For the post meal though, what is the target? 140 mg/dL after 2 hours?
I have had antibody tests performed before, in early pregnancy. I was tested for GAD, ICA and insulin autoantibody and all came back as negative. I’m quite skinny (BMI below 18) but I’m Asian and my mother is also pre-diabetic (and has rheumatoid arthritis) and probably those are the risk factors for me. My endocrinologist has told me that it’s likely due to genetics that I have this.
With this pregnancy, I needed to be on insulin starting 8 weeks, when I went to see my endocrinologist. I was told before getting pregnant that I’d likely need to be on insulin after getting pregnant as I was already pre-diabetic prior to getting pregnant. And it turned out to be true. Throughout the pregnancy, my fasting BG remained excellent except for a couple of days where it was in the low 100’s. It was post-meal numbers that was not very good. I started with 3 units of insulin with each meal (30-45 g carbs) and I was up to 7 units by the end of my pregnancy. For the next pregnancy, I was told to make an appointment as soon as I was ready to try for another one, even before becoming pregnant. I’m afraid management of GD will be tricker with the next one.
Thanks for your comment. I have a feeling that statement is true for any discipline
Even if diagnosis of diabetes is made even if I’m only pre-diabetic, I don’t think it’s a bad thing as either way, I’m not processing carbohydrates like a normal person. I can no longer drink soda or eat a bowl of ramen without spiking my blood sugar into 200’s and I know that I need to manage with diet, exercise, and possibly medication. I was just wondering what the numbers mean and has diabetes progressed more since the initial diagnosis back in 2015.
I think staying below 140 mg/dL post-meal is a reasonable standard to keep in mind. Crossing that line with an occasional meal should not be too much of a concern. I understand that even gluco-normals can go a little higher without becoming diabetic.
Your meter is your friend and knowledge is power. Good luck!
