I am not sure if this has been discussed before I just have to wonder how long a person is allowed to float around in the pre diabetes diagnosis.
I have a walking friend who was told she had pre diabetes about 8 years ago. She has never been heavy, exercises everyday, eats well. She is in very good shape. But her A1C is in the 6.1-6.4 with every check. She has been told the same thing over and over about losing weight, exercising and eating better but there is really no room for improvement. My concern for her is that while the blood sugars are not super high, we all know what kind of damage higher than normal blood sugars can do to the many systems in our bodies. I just worry about her eyes, kidneys, heart, nerves etc. I mean don’t many who are finally diagnosed with type 2 end up with complications probably due to how long the blood sugars have been elevated before the diagnosis. She has been hanging in limbo without a diagnosis and I just wonder if it’s just about a number?
Scary thing here is, my sister was just given the pre diabetes diagnosis and again, I have to wonder how long do they let it ride?
What do you think? I keep telling her she needs to at least start asking for the tests that everyone who has diabetes gets all the time. Eyes exam, kidney tests, nerve test etc. Because she really does have diabetes, right?
There are many that consider “pre-diabetes” a deceptive term, myself included. You either have the ability to regulate your glucose to normal levels or you don’t. Pre-diabetes is like saying you’re “half-pregnant.” I think your concern is well founded, and your friend is at risk of secondary complications at the sustained levels you state. I also find it upsetting that there are still so many medical practitioners that refuse to intervene until patients have tipped past the point of no return. These are often the same ones who blame the patient for the progression because of their lack of “self-control.” The more forward thinking endo’s begin with an aggressive treatment regimen of Metformin and basal insulin at the first sign of symptoms. Everyone’s diabetes is different, and your friend’s may or may not progress, and to what degree depends on a multitude of factors. However, her best chance of avoiding any secondary complications is considering treatment options that get her back to a non-diabetic A1c as quickly as possible.
i belive she needs to be tested for lada diabetes
I would tend to agree with Christopher, there really is no such thing as pre-diabetes. Regardless of what we want to call it or what the root cause was the pancreas is not making enough insulin to properly regulate sugar levels. The only difference regardless of root cause is to what degree insulin is being made.
While a “T2” may be making more insulin than a “T1” the biggest struggle for both is meal time sugar spikes. Nearly all T2’s loose their robust meal time insulin release. In the not to distant future Apple will be introducing the new IWatch with the CGM band. It’s currently targeted for release sometime next year. When that happens and people start understanding what “normal” post meal blood sugar should be, things will change as the doctors can no longer hide the sugar numbers from the patients. When the lunch group starts comparing numbers at the table and everyone is under 130 expect for that one guy, that guy and millions like him will start demanding help.
The big thing will be technology like the IWatch will forever change how people view diabetes and how doctors treat these meal time sugar spikes. Along with this people are going to want that spike brought back down to normal asap. With non-diabetics that means in the mid 80’s in under 3 hours. Things like metformin just don’t do that. Only the meal time insulins can and the fastest at bringing down the sugar level and the fastest out of the body to prevent hypos is afrezza. It basically replicates a healthy pancreas with its insulin release.
If your friend can get her post meal sugar down to non-diabetic levels like she was non-diabetic, her A1c will take care of itself. More important her sugar will not be 140+ for hours at a time causing microvascular damage.
The problem right now is few inside the diabetes community understand how important it is to control meal time sugar spikes, let alone those outside the community. Your friend is a victim of this. As Christopher said the more aggressive Endo will treat with metformin and a basal. Neither is suited for dealing with meal time spikes. But soon the technology will open up the numbers to the world and they will start using the correct “tools”.
Do you have any public source or is this from the CNBC “secret project” report from this past April?
Note that unless something has changed, the FDA maintains jurisdiction over all Blood Glucose Monitoring Systems (BGMS) whether invasive or non-invasive.
Apple had their tech conference last month. I don’t think the secret project is any longer very secret. Tim Cook and a couple hundred others have been walking around the Bay Area for awhile testing the thing. I think Tim Cook got his in January and seems to have a thing for diabetes, not sure why.
The last I heard, Cook said he wants no part of the FDA. Its being planned as a “fitness” device not FDA approved but who really cares if its pretty close to correct. The point is it opens up the current world of “hidden numbers” to the entire world. Back in the 1970’s there was this thing being used by a few computer scientists that no one ever heard of. By the 1980’s all the computer geeks were using it but no one else every heard of it. They called it the Internet. I see the same technology revolution coming to medicine with diabetes being one of the first big targets because it can be easily measured and tracked with real time sensors and the cloud.
The IWatch fits perfect into the world of Dexcom and the Libre. Once you see you are 160+ after meals you go on Amazon or ebay and get an FDA approved Libre and use it for a couple of weeks so your doctor can get FDA “approved” numbers. After that its back to the watch. Who wants another thing jammed in their arm like a traditional CGM?
Or maybe your doctor gives you a loaner Dexcom for continuous feeding of the numbers to the cloud. I see zero issue with the FDA and Cook’s plans.
I agree with @shelly4, she should be tested for adult-onset Type 1 diabetes. Also, I have read that people with some forms of monogenic diabetes (aka MODY) can run high but never develop complications. IMO, I would suspect slowly progressive Type 1 diabetes (LADA) or MODY. Autoantibodies can be tested for LADA.
If the FDA decides that this is intended or will be marketed to the diabetic population then this would almost certainly fall into the Class III (high risk) medical device category.
Trying to make the argument that a Blood Glucose Monitoring System (BGMS) is not intended to be used by diabetics and would have absolutely no marketing towards diabetics would seem to be a pretty big challenge.
Apple is big but are they big enough to take on the FDA and win? Potentially we may get to watch this unfold.
I read a few more articles on this and it sounds more that Tim Cook does not want the FDA involved with the Apple Watch itself - not that Apple does not want to get involved with the FDA at all. One possibility is the “smart band” where the watch band has the BGMS and the band DOES go through the FDA process. However this would (potentially) not impose any restriction on the Watch itself which is perhaps what Apple wants (needs) to avoid at all costs. The Watch is obviously hugely profitable for Apple and Apple likes to move on its own timeframe.
When the smart band gets FDA approved then it can be attached onto the Watch.
Based on the limited information available it sounds to be at least plausible.
Exactly, the band is separate from the watch but don’t make the assumption they want to get it FDA approved. I am under the impression they view the FDA as huge speed bump they would like to avoid.
Since it does not pierce the skin and does not touch any blood I think they have a better than fighting chance to side step FDA approval process. Additionally, while it may be close to a meter I would be surprised if is good enough for dosing.
Its a fitness device not much different than the fitbit but IMO its life changing for the diabetes world as it brings sugar monitoring mainstream and brings a whole new awareness to how important staying in non-diabetic range is for overall health.
The FDA has already placed non-invasive BGMS intended for diabetics into the Class III (high risk) category. This would almost certainly be that. Whether it could be dosed from would be a different question. Similar to how the Dexcom was FDA approved for glucose monitoring but only recently had the additional approval to dose from.
Simply calling it a fitness device would not alter the fact that it really is intended for use by diabetics. From what I read, Apple would be going down the FDA path for the band but not the watch. One way to know for sure - wait to see how it turns out.
Some folks are “high glycators”. Their red blood cells live longer than average for a variety of reasons. Their mean blood glucoses might be entirely normal but their A1C numbers are elevated above the usual relation, because of their long red blood cell life.
There are also “low glycators” whose red blood cells live an unusually short time or for other reasons have lower A1C’s than expected.
Some published medical research on the details which can make the usual relationship between A1C and mean blood glucose a little more complicated: Is There a Relationship between Mean Blood Glucose and Glycated Hemoglobin? - PMC and HbA1c: A Review of Analytical and Clinical Aspects - PMC
If your friends A1C’s are always a little elevated but bg’s are always normal then it is possible she is a high glycator.
If a person is a known high glycator or low glycator there are other “average bg indicators” like fructosamine that may be better.
The really old fashioned glucose-in-urine tests may still have some value if you don’t know if you can trust A1C.
Buying a cheap home bg meter and checking throughout a typical day may have some value too.
A glucose tolerance test is really awkward and many don’t like them (my wife did one for each pregnancy and SHE HATED IT) but for many docs they are more likely to accept a lab glucose tolerance test more than a home bg meter result.
Tim - here is another one. While I know you feel strongly the FDA will get in the way others are betting they won’t. Here is a crowd sourcing approach. We will see but lets hope the FDA doesn’t stand in the way of the train and slow things down. It long past the point that pre-diabetics and T2s need to pay proper attention to time in range driven by meal time sugar spikes.
“The biggest push, though, is coming from Qualcomm QCOM, -0.88% , which has offered a $10 million prize to the team who can develop a specific type of multifunction medical device. Without involving a health-care worker or facility, the device must be able to accurately diagnose 13 health conditions, including pneumonia and diabetes.” Opinion: Could your Fitbit data raise the cost of your health insurance? - MarketWatch
would like to be considered pre rather than post . my blood was normal 4 years ago than blood work for surgery
said 6.6 ac1 your friend at 6.4 is close to the dreaded point of no return. I wish I had gotten phyicals ever year
and got a head’s up about diabetes. had no idea about diabetes before dx. but don’t really understand the
line of 6.5 and over past saving. your friend doing all the right things and has a problem with b.g. . I have
known of people who did every thing wrong smoke drink do drugs are overweight and have perfect blood work
life is ridicullosly unfair.
Yes. Yes. A thousand times “yes”.
This is certainly possible but it can’t ever be measured or quantified, since by definition an undiagnosed person can never know how long their blood sugar was elevated before somebody noticed, nor by how much. A day? A month? Two years? Slightly? A lot? No way to tell.
The #1 variable affecting the development of complications is how soon the patient takes aggressive action to establish control. Whatever that action is—pills, exercise, insulin, diet, or whatever—the sooner it begins, the better the probable outcome.
Not rocket science.