Hello, I am new to the forum, but have been reading for awhile. Since both my parents are diabetic and my mother's grandma passed on early from Diabetes, I have been monitoring my blood sugar since about 2008. Both suffer from complications: my father is blind in one eye and my mother suffers from neuropathy to the point that she can barely walk. About a month ago I went to see my family doctor and showed him my meter readings which were consistently between 100-116 and a few that were 121. I also had post meal readings over 140 to about 180 if I eat more than 60 grams of carbs. He diagnosed me with Impaired fasting glucose which I understand is also known as prediabetes and sent me for blood-work. My fasting was 102 and the A1C was 5.6 which he said was normal. I am trying to prevent the full onset and I'm not sure I can since my blood sugar seems to be worsening, even though slowly. I eat very healthy and count my carbs. I am normal weight (111 and barely 5 ft tall). I thought about contacting the TRIALNET study (my Great Grandmother was a type 1 who passed away young and my mom's diabetes is uncontrolled on 2 different meds and she has been on and off insulin), but I am 50 years old, which I think is over the age limit. Is there something I am missing or am I being overly concerned, because I doubt my doctor will do any more testing other than seeing me again in 6 months until my blood sugar readings reach diabetic level?
I really can't tell you advice on this other than you're not too old for type 1 if it is what is impairing your glucose tolerance. It has no age limit and is actually quite common in adults. The onset for adults is slow , where I'd honestly suggest maybe seeing about if you have the autoantibodies for type 1. Even if you're not diagnosed as type 1 yet, you might have them, and that could clue you in on it.
Thank You for your fast reply! I was thinking of being tested for antibodies,but my doctor likely won't order them until my readings are higher. I saw an endocrinologist back in 2008 for a few years because at the time I was having low blood sugar symptoms three hours after eating, which made me feel pretty bad. Since I have been watching my carbs I don't have that problem anymore. The endo wasn't very helpful and she basically told me there wasn't anything I could do because it was genetic and I was already thin. She made it seem inevitable to me and I don't like that. I also don't want to be overreacting so was wondering if I really should be concerned at this stage.
What type of diabetes do your parents have, Type 1 or Type 2? I know your grandma had T1. As Sensorium says, you can be diagnosed with Type 1 at any age, into your 90s and beyond, so you most definitely are not too old. If you really want to know, Type 1 TrialNet may be your best bet. You can get autoantibody testing and understand your risk. And smart of you to limit carbs. Best of luck, keep us posted!
I am totally with you on the doctor shrugging and saying "it's a matter of when not if". I just had the 4th doctor tell me that. I am not a patient person and the idea of just sitting around waiting for my numbers to go to diabetic levels before I do anything makes me crazy! This most recent doctor has prescribed metformin and I'm trying to work up to the full dosage. I am also thin, active, eat low carb and have rising numbers (my last a1c was 5.9). I had gestational diabetes 3 times despite not gaining too much weight. Hence, 2 OBs and now 2 GPs look at me and shrug their shoulders. My bad luck to get these genes, I guess. I find it all the more infuriating because no one else in my family has diabetes! All the more bad luck that I get stuck with a mutation (latest doctor's explanation).
Anyways, I didn't stop that from trying to do something. First I increased my exercise (up to 7 days a week for 30 minutes to an hour each day). When that stopped working I reduced my carb intake. When that seemed to have no effect, I decreased my carbs more dramatically. When that still gives me elevated numbers, I got the metformin. I think you are justified in trying to do something (at least, that's what I convince myself).
I'm sad to say that you will have an inordinately difficult time finding a doctor to assist you in this, but IMO you should start on fast-acting bolus insulin right away. Humalog/Novolog/Apidra pens. Easy and convenient.
This will preserve your beta cells as much as possible, hopefully for the rest of your life being able to handle your basal insulin needs.
The biggest worry doctors are going to have with this approach is the risk of hypos. It is a valid concern. However, it is also quite manageable and avoidable.
DO NOT accept any of the newest, trendy injectables like Byetta, Victoza, and other pancreatic stimulants. They work (in this case by supercharging the phase 1 response from the pancreas after eating), but will buy you a bit of time with less hassle for inevitably many more years under much greater burden.
If you're not T1, then you're at the point for a T2 where preservation strategies for beta cell function are justified.
I think you are diligent and aware of the situation you may be facing because of your family history.
That being said, it sounds like you're doctor's diagnosis is based on your hard work and meter numbers. You absolutely need additional tests starting with an Oral Glucose Tolerance Test for an official diagnosis of Impaired Glucose Tolerance. Your doctor may well be right and you may well be on the diabetic spectrum, but I'd be pushing for more definitive tests before starting down the road of diabetic care. That's a long road and I'd do everything I can to get oriented correctly first.
I did have an OGTT 2 times when I was seeing an endo- one in 2008 and the other in 2009 and passed both. She was actually looking for hypoglycemia then. My fasting numbers were only occasionally above 100 and the 1 hour readings back then were high but not the two hour. Since then I've kept records off and on but noticed the morning readings getting worse in September of this year so I started tracking them more consistently and lowered my carb intake per meal. Now it seems to be getting harder to stay below 140 post meal and my morning readings have not been under 100 since December. My daughter is a newly graduated nurse practitioner and she has been on my back a bit and stated that the fasting numbers are the last to go higher. At this point I am suppose to wait 6 months and see how things progress with diet and exercise according to my family doctor. I'm not sure what other recourse I have at this point, but it's seems more like a wait and treat philosophy rather than preventive.
My great grandmother was a type 1 who passed away at age 58. My mother and father were diagnosed around the age of 60 so both were told they are type 2. My mom has never really had good numbers unless she was on insulin even though she takes two different oral meds. I've always suspected her as having type 1.5, but it was never confirmed.My mom has also just told me recently that her mom is type 2 (diagnosed in her 80's), but is well controlled on meds.
You are very lucky that you have a doctor that will prescribe meds at this early stage. I'm wondering if it's possible to stay at the pre-diabetic state. I considered contacting the Trialnet to see if I could be screened, but I saw the age cutoff was 45 and didn't pursue it. Have you looked into that?
I only test at 2 hrs post now and in the am fasting. I probably should check at 1 hr just to see, but with numbers ranging from 145-180 at 2 hrs,they probably aren't good. I definitely have a delayed first insulin response. The second phase used to over correct years ago and I would feel really shaky and weak, but that doesn't happen anymore because my blood sugars are higher at the 2 hr. mark.
I looked into that, but I don't qualify because I don't have any relatives with diabetes. My great grandmother had diabetes and was on insulin, but no one knows what type (I think she was diagnosed as an adult). My great-aunt had diabetes and was on insulin, but my father doesn't know what type (she was diagnosed as an adult). I believe she was on insulin, but the family consensus is that she didn't take care of herself.
I also had reactive hypoglycemia for years (actually caught it with a 5 hour GTT). It used to hit me at the 3 hour mark. Since my numbers have been elevated (ever since I had gestational diabetes), I haven't had a problem with lows.
By the way, I just got my c-peptide results back and they are low (along with an A1C of 5.8 despite an VERY low carb diet). Because my c-peptide was low (and she was, therefore, impressed with my A1C), my doctor agreed it was reasonable for me to get the antibody testing.
So keep on it - I've learned I know my body better than anyone else, even a medical professional.
At this point, I'd renew your association with your endo. It sounds like you have plenty of reason to think that you're numbers are no longer reasonably normal. Like others have said, you're either diabetic or you're not. It might be a hard pill to swallow, but it just might be time to let go of some notion of "preventing" diabetes and move on to the notion of managing it.
If you've already changed your diet and started monitoring your BG fastidiously, you've already started down that road anyway. If it's to the point where your GP can no longer help you do that, it's time to move on and find somebody who will get you a proper diagnosis, including antibody testing, etc, so you can have more effective management strategies.
I understand what you are saying and I do agree with you. The problem is that every endo I called said I need a referral from my family doctor and I don’t want to go back to the same one I had before. She was not very helpful and didn’t seem like she would treat until my numbers were much higher anyway. Yesterday, I had a meal with 50 carbs and took my blood sugar at 1 hr. to see. The reading was 163 so I thought it would be below 140 at the 2 hr. mark and it turned out to be higher—180. I was a little confused by that. The only thing I can think of to do is wait the 6 months to see if my ALC and fasting are higher to get a referral. Yes I am very frustrated.
That is very frustrating and something I just don't understand at all.
I hope you can get your care sorted out because getting a proper diagnosis and management plan in place shouldn't have to wait if you already have reason to believe your BGs are not running normal.
My c-peptide was 0.61 ng/ml (normal range was 0.80-3.41 ng/ml). I typically eat around 10-15g of carbs per meal or snack. The results are very unpredictable with sometimes giving me good numbers (under 110 at 1 hour) and other times close to 130 at 1 hour. If I eat this level my highest number is at 1 hour. If I go up to 20 to 40g per meal my peak is often at 2 hours. This is something very new - I used to consistently have a peak at 1 hour and be close to normal by 2 and definitely fine by 3 hours. Now, even on the low carb meals I can hover about 115 or 120 for several hours. I suspect this is why my a1c is higher than it should be eating this way.
With my great fasting (87 mg/dl) and a good a1c (5.8%), my doctor says I'm doing really well and it was only when I wanted to know why I have to work so hard to get these good numbers that she agreed to the c-peptide. She also suggested the metformin since there is nothing else I can do and my a1c is still prediabetic. I think she was pretty surprised by the c-peptide results (to be honest, so was I).
