Pre-diabetes in my early 20s?

Type 2
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Hello, I’m new here! My name is Veronica, and I’m from Montreal. I’m 23 years old, and a university student

Last month I went to my GP because a cousin of mine came to visit me, and she was recently diagnosed with type 1 diabetes, and was really into testing everybody’s blood sugar when she had to check hers. My two hours after lunch number was 13.3 mmol/L and my aunt felt that was too high and said that I should bring it up with my GP. Having a long family history of diabetes (my dad and grandpa have type 2, and my maternal grandmother, my mom’s sister and her four children all have type 1), I decided this was a good idea. I hadn’t had any symptoms, but better to get it checked out and have it be nothing, than to do nothing and have it be something. I made an appointment with my GP for later that week. My dad (a type 2 - I still live with my parents while in university) decided to take a few more numbers with his meter on the Sunday prior to my appointment. My fasting number was 7.2, my 2 hours after breakfast was 15.9, before lunch it was 7.7, and two hours after it was 13.1, before dinner it was 6.8 and two hours after it was 9.9. Before bed it had come down to 9.1.

I told my GP this, and she sent me for blood work. My fasting blood sugar according to the lab was 6.8 mmol/L (which they flagged as too high) and my hemoglobin A1C was 6.3%. My GP said that my A1C was totally fine but that my fasting blood sugar was a bit too high, was pre-diabetes, and that I should try and lose 5lbs to correct this (I’m 5’6 and weigh 160lbs). I can’t even figure out how to lose 5lbs. I already take 25 000 steps a day and swim an hour every day. She said she didn’t want to prescribe any medications or do any further testing (I asked if she should check me from type 1 antibodies and she said no, if I had type 1 it would have come on very severely), and that I absolutely should not test my blood sugar at home anymore because that could backfire. She also said she didn’t want to diagnose me with diabetes because that label would follow me forever and I wouldn’t be able to get health insurance.

Is that really the standard way of treating pre-diabetes? Telling the patient that they have it, to lose 5lbs, and seeing them on their way??? My dad felt that wasn’t right, and he has been testing me twice a day on the weekends, a fasting and a 2 hours after breakfast readings. In the three weeks since, the lowest fasting blood sugar I’ve had was 5.5 (only one time, all of the others have been in the 6-7 range) and my two hours after breakfast have all been in the 12-17 range, with one reading of 22.8. I just feel totally helpless and like the doctor totally brushed me off. And like I am WAY too young to be at risk of type 2 diabetes…

Any input would be most appreciated. Thank you :slight_smile:

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Welcome @VeronicaB!!! First, I’d like to assure you that you are going to be ok. I know that you are probably a bit scared and confused right now. But in the grand scheme of things you have gotten some really important information early. So please close you eyes, take a deep breath and repeat the following words to yourself three times. “I am going to be fine.” “I am going to be fine.” “I am going to be fine.”

So, as you probably know, you have diabetes. The kind of diabetes, that you will need a doctor to properly diagnose you. While it might be Type 2, chances are that you have type 1. And any suggestion that you have “pre-diabetes” is an indication that your GP is not competent to diagnose you and probably not able to treat you properly.

Your A1c is only 6.3% it measures an average over three months and your blood sugar readings indicate abnormal blood sugars that alone suggest diabetes. First, you can be diagnosed with diabetes with a fasting blood sugar of 7 mmol/L. You have diabetes. You can be diagnosed with diabetes if your blood sugar 2 hours after a meal is more than 11.1 mmol/L. You have diabetes.

And unless you are really overweight, losing weight in unlikely to help with either type 1 or type 2. So don’t even bother with the weight loss thing. And to tell you the truth, the circumstances in your story suggest to me that you likely have type 1. Type 1 can strike at any age, I have a good friend who got it in her 60s. And when you get Type 1 as an adult it can be slow onset. There is even a name for that LADA (for Latent Autoimmune Diabetes in Adults). Your story seems to fit many other stories of LADA. And unfortunately it fits many stories of misdiagnosis and mistreatment. I’m sure others in our community will share their personal stories.

Ok, so another deep breath. What you need to do is get rid of you current GP. You kind of have three options. Demand a referral to a specialist (an endocrinologist). Visit another GP. Or visit the emergency room next time you have blood sugar of 20 mmol/L. If you must fight with your current GP then prepare yourself to question his competency. The current Canadian guidelines for diagnosing diabetes is here. If your GP refuses to follow published guidelines you have every right to file a grievance against him and seek a competent doctor. If you do have type 1 and suddenly lose control of your blood sugars you can end up in the emergency room and potentially be harmed by a misdiagnosis. Not having a competent doctor at this time is like driving a car without a seatbelt and your eyes closed.

Finally, let me tell you that you are not helpless. Just by coming here you display wisdom and bravery in the face of a difficult situation. You have a “right” to fair access to competent medical care. I would urge you to push back on the system to get the care that you deserve. Bring you Dad along if needed. Don’t take no for an answer. If you are type 1 you should be closely monitored and as you probably already know insulin is a very effective treatment.

ps. And don’t let diabetes lead you to believe you cannot be insured. That is just not true. My understanding is that Canada has a nationalized health system. There are many members here with type 1 who live in Canada.

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Well, sorry to hear that your fasting BG is out of whack, and with your family history I’d be concerned too. Your advice from your doctor is normal, but pretty bad nonetheless. Many doctors think the issue with Pre-D and Type 2 is weight, and the cure-all is losing weight. This isn’t and has never been the actual case, but doctors don’t get much training on it. That’s not to say losing weight can’t help bring BG into control.

I can’t tell you what your numbers mean for you, but if I were in your shoes I’d be asking for a consult with another doctor (preferably an internist or endocrinologist). As for weight loss, I don’t know if you should lose weight, but exercise isn’t going to be the ticket for that (on its own) if that is your goal for any reason. In order to lose weight you have to eat less calories than you burn during a day or week. It is very difficult to add exercise in sufficient quantities for most people to lose weight, and it is much easier to cut back on how much one is eating. But it has to be done consistently for a period of time.

If you are Pre-diabetic (which is early stage Type 2 diabetes in most cases, occasionally early stage Type 1), then changing diet is going to be helpful in the long run regardless of anything else. Eating less carbohydrate per meal is the gold-standard for tackling blood glucose issues when you don’t have “full-blown” diabetes. Reducing the amount of carbs eaten per day also has the added benefit (for most people) of reducing hunger, since fat and protein are more satiating. It might be worth looking up some info on low-carb diets.

And for the record, a 6.3% A1c is not totally fine. That would be considered fine by most doctors for a Type 1 or advanced Type 2 on insulin therapy, but a “normal” range is in the 4.5% - 5.7% for someone who doesn’t have diabetes. 5.8% and above are out of range and indicate a problem. With high fasting BG and a higher than “normal” A1c, I’d ask for that consult or find a new doctor. Diabetes Canada lists an A1c range of 6.0-6.4% as “Pre-diabetic” officially. Incidentally, a fasting blood glucose over 7.0 mmol is also diagnostic for diabetes in Canada. Definitely warrants a follow-up and more than “lose 5 pounds and call me in the morning,” in my opinion. From the same page:

The combination of an FPG of 6.1 to 6.9 mmol/L and an A1C of 6.0% to 6.4% is predictive of 100% progression to type 2 diabetes over a 5-year period (27).

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Welcome to our coimmunity! I am glad you found us. You came to the right place. I agree strongly with everything Brian said, and I’d like to add [quote=“VeronicaB, post:1, topic:60702”]
She said she didn’t want to prescribe any medications or do any further testing (I asked if she should check me from type 1 antibodies and she said no, if I had type 1 it would have come on very severely)
[/quote]

that this is simply not true. Many with LADA have it come on slowly. here are some more facts on LADA

and yes, take a few deep breaths, and you’re going to be ok. but you need a new doctor.

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You raise a lot of issues. I’ll try to give you my personal take on them in order.

First, let’s get this out of the way: you have diabetes, as others have said above. Those A1c and BG readings, and most particularly those postprandial numbers, make it clear. Non diabetic people don’t have numbers like that, hours after eating, time after time.

And the advice about losing weight is . . . well, let me be polite and just call it “antiquated”. In the first place, 5 lbs isn’t going to fix those high numbers. In the second place, the traditional belief that being overweight causes diabetes is becoming more questionable with each passing day. There is a growing suspicion that diabetes and weight gain, rather than being having a cause-effect relationship, are in fact both results of an underlying cause. If that turns out to be the case, and the science is tilting more and more that way, losing the weight might make you slimmer but it won’t touch the diabetes.

Echoing what others have said, you absolutely should get tested for T1. For one thing, both types run in your family. For another, having a correct diagnosis will probably affect your insurance coverage (it’s usually better with T1; not a reason to wish for it, but certainly a reason to find out for certain). For yet another, your doctor is just simply wrong about the presentation. LADA, as mentioned above, can often present very much like T2 in its early stages.

Finally I must second the advice about finding a new doctor. Telling someone with an obvious BG problem not to test at all leaves me speechless. It’s like telling someone with a fever not to bother checking their temperature. And I have absolutely no clue how it could “backfire”. It seems clear that your GP is not knowledgeable about diabetes and that what ideas she does have are outmoded or simply inapplicable.

Finally, you’ll find this community to be a bottomless well of knowledge and support. You’ve come to the right place. We’re glad you found us! Welcome to the family :smiley:

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I wouldn’t worry about insurance, not only are you in Canada but you live in Quebec and have a provincial drug insurance plan far as I’m aware.

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Also, what everyone has said is correct. Type 1 runs in my family too. While I had all the classic symptoms - losing weight, excessive thirst and peeing, blurry vision, extreme fatigue and a blood sugar above 33 upon admission, my brother was diagnosed type 1 a few laters later and presented symptoms and blood sugars similar to you. Get to an endo or a hospital ASAP.

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My Canadian experience has been that diabetes makes it pretty much impossible to get life insurance (beyond normal 1x annual salary group insurance at an employer), but not health insurance.

Good luck with finding a doctor who can help. As the others have said don’t wait to long as it is not normal to be 12-17 after a meal.

If you are at McGill - a suggestion might be to drop by or call the diabetes clinic at the hospital and let them know you are a student who is having high blood sugars when you test and ask them for advice on who to talk to. I know they probably want a referral but they may be willing to help point you in a better direction than your GP seems to be doing.

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Thanks to you all for your words of support and encouragement.

Yes, in Canada we all have health insurance through the government, but when my boyfriend and I move back to his home province (Alberta) after my degree is finished next month, there is no governemwnt funded extended benefits (prescription drug, vision, dental) plan as far as I am aware, unless you are low income.

Thanks for the suggestion @AE13 , though I am at Université Laval. I might wait and find a new doctor in Alberta after the move in June. I begged the GP for a referral to an endocrinologist, but she said it was pointless for pre diabetes and that even if she did concede and refer me, it would be unlikely that I would see anyone before I leave Montréal.

I went to pharmaprix and bought my own meter and strips today so that I could check things more regularly, fasting, and before and after each meal, and I have been writing those numbers down with food diary so that I’ll have a nice record for the next doctor I see.

Thanks for the encouragement @Brian_BSC . I had kinda figured out that it was more diabetes than prediabetes when I saw that 22.8 reading. My type 2 dad and grandfather have never had a number that high, so if I were only pre diabetics I shouldn’t either. Since I had no luck begging for the endocrinologist appointment, I decided to take your advice and go to the ER the next time I had a number above 20. That happened to be today after lunch - 90 minutes after eating, because I had class at the 2 hour mark and didn’t want to have to test there, and the number came back at 24.1 (probably stress from the exam I wrote that morning???) so I went to the ER, told the triage nurse this, and my history, and showed her my meter. Being “not an emergency” I ended up waiting for 4 hours, and after 4 hours of no food and only water to drink, the number had come down to 10.7 and I was discharged pretty much as soon as I got to go back and see the doctor, with the advice that I diet and exercise to treat my prediabetes, and probably not have anymore Starbucks (OK, so I know that that frappuncino had a lot of carbs, but I had a salad with no dressing, but only spinach,lettuce, avocado, celery, egg and chicken on it to eat). Frustrating! On the upside, that means my pancreas does still make insulin, so maybe it really is type 2 and I’ll be able to reverse it?

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Veronica,

Sorry that you are having a problem with getting taken seriously and properly treated.
You do have diabetes. Probably it is type 1 rather than type 2, given your age, your size, and your family history.
Please know that this can get very serious very quickly.

A reading of 10.7 after more than 4 hours of not eating is certainly not normal. How on earth can they consider that prediabetes. Any reading above 10, already should get you a diagnosis of overt diabetes and warranting treatment.

For now I would suggest:-

  1. Low carb eating to minimize your insulin requirements.
    (Look up Dr Richard Berstein; his book is Diabetes Solutions, he has 200+ lectures under “Bernstein Diabetes University” on u-tube. These would be a good place to start. Make sure you eat adequate protein and fats. Particularly fats, as you don’t want to be ‘starving’ yourself.

  2. Keep using your meter. Daily. Record your fasting levels and your 2 hour post eating levels. This should at least guide you on which foods raise you less than others. It will also give you ammunition and information to present to your next doctor.

  3. Look up the symptoms of diabetic ketoacidosis. Become familiar with them. If you in any way suspect you are developing this go straight to the nearest emergency room. Do not hesitate; far better safe than sorry in this scenario which can rapidly be life threatening.

  4. Try finding a different doctor. Please request a repeat Hba1c. If your current high numbers are developing quickly, then your hba1c will also be on the rise. A rising Hba1c will be very concerning. Please request C-peptide and antibody testing.

  5. Do not give up. You deserve to be healthy and well. And you can be, even with diabetes, so long as you have the tools and support and knowledge to treat it.

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@VeronicaB, my heart goes out to you. It sounds like the emergency room was a bust. I bet if you have just eaten a couple of candy bars while waiting you would have had a different experience and outcome. Don’t let this stop you. You can do this. You just need to persist. So I’m going to give you some additional things to try.

First, most good emergency rooms place a follow up call to patients to see how they are doing. You can preempt that and call back to the ER and tell them you need to speak to a diabetes educator. This is an entirely appropriate request. Chances are that the hospital network you visited actually has a diabetes center. If they do you can either call them or just go there. Ask for their help and be insistent. They should know all about diabetes and all the doctors and specialists in the area.

Contact JDRF Canada in Quebec City, ask for their assistance. 581.983.7789 (french) or 1.877.634.2238 or email rboily@jdrf.ca. Tell them your story, you are 23 and have suddenly found you have highly elevated blood sugars > 20 mmol/L and you believe you have type 1. Tell them you are a student, all alone and ask for a referral and their direct and personal assistance getting competent medical care to get properly diagnosed and treated.

Call Diabetes Canada 1-800-BANTING. Tell them you have just come down with type 1 diabetes, your blood sugar is surging over 20 mmol/L and you need their help immediately to get a competent diagnosis and treatment. Ask for them to refer you personally and to directly provide the clinical practice guidelines to the provider.

Contact Diabetes Quebec at 514 259-3422 ext. 233, 1 800 361-3504 ext. 233 and do exactly the same thing as with Diabetes Canada. You can also email them at infodiabete@diabete.qc.ca.

Your University has a research school and a large faculty focused on diabetes and obesity. You can find out all their names, telephone numbers and emails using this link. Find some that specialize in diabetes and contact them directly with a plea for help.

I’m sorry, I wish I could just snap my fingers and get you the care you deserve. But unfortunately I think you are going to have to fight this one out. I just don’t want you to do this alone. Get as much help from others as you can.

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@VeronicaB, I have nothing to add to the excellent comprehensive advice you’ve received above. You need to persist to get the care you need. It’s unfortunate in any health care system that strong advocacy is an essential requirement to gain access to care.

Your doctor likely suffers from too little exposure to slow onset type I diabetes. Only about 10% of all diabetics are T1D and only a slice of this demographic is of the slow onset type, also known as Latent Autoimmune Diabetes in Adults or LADA. The small incidence of this type of diabetes means your doctor may have never seen someone with your symptoms who was not type II.

Good luck! You will get through this phase and will have every opportunity to live a full and meaningful life.

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Just to say I totally agree with JustLookin re Dr Bernstein. He has two books - Diabetes Solutions, and The Diabetes Diet. Both books are ‘must reads’ for anyone who is diabetic or re-diabetic. The Diabetes Diet goes into some depth about diets and how to loose weight, and more importantly, the science behind weight loss and how insulin, carbohydrates and protein play their part. His monthly web seminars are great. I would get his books and spend the time reading them asap. He has a lot to say about people just becoming diabetics and what they can do to preserve some insulin production. The big problem is that it based around a virtually zero carb diet which is very difficult to achieve. I personally try my best, but it is HARD! If you can get you parents to read the books, too, and get them on board, you might find it easier. I live in a household where a low carb diet is unacceptable which means there are a lot of delicious carbs around at all time and I have to prep my own meals :frowning:

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“most good emergency rooms place a follow up call” ??? Certainly not my experience. Before CGM I was ‘kidnapped’ to ER 4 or 5 times due to hypo. The only things I received were a sandwich and a huge bill. I do not recall any followup calls.
I say kidnapped because once in ambulance your demand for release is not honored and have since learned that upon arrival at ER I could verbally refuse any and all care.

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Hi Veronica,

I hope you have started searching for another Doc from the sources listed. You’re prolly type 1. Eat low carb until you get diagnosed. Protein, fat and small carbs from mostly veggies and berries. You could end up in DKA which is life threatening. Once your body shuts down insulin supply it can happen rapidly. If you go over 250 with nausea and or vomiting, trouble breathing and visual disturbances go to the ed immediately. Leading up to this you will start drinking everything in sight, especially sweet things & craving sugar and you’ll be peeing a lot etc. as well as losing weight even though you’re eating everything in site and more. No matter how much you eat or drink you’ll still feel hungry and thirsty. Other signs are severe yeast infections, dry irritated eyes, intense itching, dehydration, sores in your mouth etc.

I hope you find an endo who can diagnose you. I’m not sure about the insurance but if it’s true Alberta doesn’t cover those things maybe you can change your plans.

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