Very basic pre-diabetes question

I asked this question on a Sleep Apnea forum ( but thought I'd ask the experts here as well:

"A year or two ago i found out i had an elevated fasting blood glucose level -- which means pre-diabetes -- probably on account of having untreated OSA for so many years. Now I want to monitor things and make sure I don't become diabetic. What's the best test to do to monitor this situation? Is it the fasting blood glucose test? I've heard something about an H1ac or 1ac test. Is that better? What's the difference? "

I just ran across the best resource I’ve ever seen for the questions you are asking earlier today and clipped it for my future reference. So here it is for your reference:

In a nutshell, monitor your post-prandial blood glucose and keep it under 140 mg/dl.

Some people have normal fasting, but go high after meals. An A1c measures average glucose over 90 days, so that will give a broader picture. You can buy a glucose meter (also lots of free offers on-line) to test your BG yourself.

Fasting BG is the worst test may stay normal for years after your after meal have gone to hell.

Some People claim that there is no pre-Diabetes. Either you have it or you don’t. If you are diagnosed with true pre-Diabetes(meaning the test wasn’t a fluke or the high blood sugar wasn’t caused by other means such as meds.) then you can delay the inevitable disease for some time with lifestyle changes such as various “diets”, regular exercise, monitoring blood sugars, keeping appointments with your Diabetes Care Dr, reading up on Diabetes and asking questions etc.

Gerri said that the “A1c measures average glucose over 90 days” – but you say here that i can buy the test at a drug store and do it twice and be done with it. I’m confused – is the A1c test more like a snapshot or a moving picture?

There is a home A1C kit made by Bayer, and it for the most part has been accurate for me. It is a do at home kit about $30, and requires a finger blood sample. The kit has everything you need to do the test at home and is over the counter. The A1c is a snapshot of the average of your average glucose for the past 30 days - the life of your red blood cell - it has to do with the amount of glycated hemoglobin, or in simpler terms how much glucose is attached to your red blood cell. Your physician or practitioner can also order the test through a laboratory.

so when i do the test, i get the result right away and don’t have to do the test again?

For a person who is at the “Pre-Diabetic” phase of Diabetes, the best way to monitor how you are doing is by doing these simple things:

  1. Obtain a glucose tolerance test: An A1C is great for people who are already exploding with high blood sugars, but not so great for many reasons, for persons who have so called Pre-Diabetes. The best way to know if your body is properly handling carbohydrates is by doing a Glucose Tolerance Test.

  2. Rotate your testing: Don’t just test your fasting numbers in the morning. Pick different things to test every day so that you know what’s going on, and preferably test twice a day. Good combos to test are:

  • Before going to bed, and first thing in the morning.
  • Before eating any meal or snack, and 1 - 2 hours afterwards.
  • Before and after exercise.
  • When you are feeling sick, or stressed out.

3. Exercise! Exercise, including resistance training and weight lifting, are wonderful at helping your muscles increase their sensitivity to insulin. Particularly, going for walks first thing in the morning, or right before bed, has helped many take control of their high morning numbers.

4. Cut back on your carbohydrates. Yes, there is no such thing as "the average person." No one should eat an average of 225 grams of carbohydrates b/c it's just what they are told, and it's what an "average" person WITHOUT Diabetes eats. The way this disease progresses and how it strains the pancreas is different for all people... So because this damage is going to be different for all people, a person with Diabetes or Pre-Diabetes should use their glucose meters to test just how much they can get away with eating, and not exceed their blood glucose goals. If when you test, you exceed your goals... then cut back on your portion of carbohydrates, or even cut a certain exchange entirely if it's not doable or worth it for you.

5. Finally, is your OSA under medical treatment right now, and supervision? Whatever other ailments you may have, it is very important to keep on top of them... Especially if they can lead to Diabetes. Are you taking any steroid medications, any statins, any medicines for Depression or Bi-Polar Disorder, or even excess amounts of Vitamin A or C, or Niacin? All these things can also lead to Type 2 Diabetes. Control what you can... and consult your doctor about alternative medications if you are on any of these...

6. Take some time to relax. In this day and age, Diabetes does not have to be a death sentence. There are many modern treatments and methods to help us take care of ourselves, and we know a lot more about diet and exercise than we ever did 20 years ago. You can still have some sugar, so long as you watch your total amount of carbohydrates. Indulge in activities that bring out the true you, and make you relaxed and happy. :) It's not the end of the world. You will survive this.

so what’s the “magic” number that i’m looking for when testing blood glucose and should it be the same goal even at different times of the day?

I would get a meter and test pre meal and 1 and 2 hours after. Record the type of foods you ate and the resulting blood sugars. Personally I think your goal should be to never go over 140, as this is where damage and thus deterioration occur. After amassing some data you can make choices about how to modify your diet, exercise etc. and cut back on the testing.

The operative concept is that we are all affected differently by this disease. I would also second the comment that there is no such thing as pre diabetes. It is a continuum from early stages to later stages. Early intervention means you will be able to use less drastic diet and/or drug measures.

Personally, I always strive to have as close to a normal person’s blood sugars as possible. To get there, my goals are to stay at below 100 mg/dL fasting (70-100), below 140 mg/dL 1 hour after eating, and below 120 mg/dL 2 hours after eating.

The American for Clinical Endocrinologists recommends that patients stay at 70-110 for a morning fasting, and at below 140 mg/dL 2 hours after eating.

These two are by far THE best goals to have in order to avoid complications and developing full blown Diabetes.

which test is the one i should buy at the drug store – what’s the brand and name of it? or are they all pretty much the same?

Walmart has one by ReliOn, which is cheaper, but you have to mail it in to their labs. Otherwise, BayerA1CNow is the brand of the little machine one (similar to a glucose meter), and it costs on average $30 retail, though I general get it on eBay, or Amazon, using a google shopping search, and often find it for much, much cheaper, and sometimes with free shipping. Just watch the expiration dates.

Those are A1Cs… but at the doctor’s office, you should ask for a Glucose Tolerance Test.

oh, so the Glucose Tolerance Test that you’re suggesting i use to take my blood sugar level at different intervals throughout the day is by prescription only? not available Over the Counter at the drug store/ Target? what about these blood glucose meters – aren’t they what i want to buy and aren’t they available over the counter? — sorry i have so many questions. just really trying to get to the bottom on this.

The GTT is a test to help diagnosed pre-diabetes and diabetes, done only at the lab. It is not available at pharmacies. It’s a test that determines how your pancreas handles 75 grams of straight glucose, and they measure your responses.

The BayerA1CNow is a an A1C test which can either be done at the doctor’s office, the lab, or via this little gadget… and it lets you know how your blood sugars have been for the last 2-3 months on average.

A Glucose meter is simply a gadget to help measure your current blood glucose levels, whatever they may be, throughout the day.

so do you think i should make use of all 3 at this time?

When they were referring to “doing it twice” for the Home A1C kit, what they mean is the $30 kit includes two tests; you can take one now and one in six months if you want to see your average over a period of 2-3 months.

My doc told me the ac1 is a look at about three monthss worth of gluclose readings in a whole. This would likely be the most accurate. I know the doctors use the test to get an isea of how well were managing our diabetes as a id say this is the test you would want to get an accurate idea of your levels. In the past few months.