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Pre-Diabetic and confused
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bradse posted:
I have just been diagnosed as Pre-Diabetic with fpg levels over past 5 years moving from 88 to 115(last week). Just had Ha1c test yesterday and level is at 7. I am 47 and male. My Total Cholesterol is 119. I am a triathlete so my bmi is low, low body fat, and outside of being slghtly anemic all other blood levels, liver function, thyroid etc. normal. Very slightly elevated blood pressure 125 over 85. I have a clean diet. Nothing to do with my diagnosis. Just my regular regiment High fiber complex carbs, tofu, lots of beans, non-starchy veggies, fish, moderate fruit intake very limited dairy. No sugared drinks, no fruit juice or smoothies, no caffeine etc. Desserts about twice a week max. Moderate alchohol consumption - mostly red wine. 14 - 20 drinks per week. Not sure what to do next. Is there a possibility of pancreas problems where i am not producing enough insulin versus insulin resistance? Really confused. Do I meet with an Endicronologist? SHould i start tsting total insulin? Any expert opinions greatly appreciated. Thanks in advance.
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flutetooter responded:
I'm no expert, just a prediabetic with a runner/biker husband, so I understand your activity level and your athlete's diet. In my opinion, with your build and activity, I would definitely contact an endocrinologist for management ideas that may be quite a bit different from a non-athlete's. Your A1c is too high for just being a prediabetic.

I suggest buying at your local drugstore or Walmart, etc. a blood testing meter and some testing strips and keeping your own log to see what sends your numbers up. Dessert and red wine have a lot of sugar that you probably aren't using up right away. I take a walk after every meal. You may need less starchy carbs when you are not running. Otherwise you iet looks fantastic.

Don't mess with insulin on your own. It can drop your blood sugar very fast and very far and be deadly in a short time without being covered by an exact number of carbs. It really needs to be managed by an expert endocrinologist who specializes in athletes.
If at first you don't succeed, try, try again!
 
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bradse replied to flutetooter's response:
Many, many thanks for your reply. Some very good suggestions indeed. Especially looking for an Endo who will understand my special needs. Again, thanks for taking the time to reply. Much appreciated. Have a great day and weekend.
 
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betaquartz responded:
Your situation may be able to be tweeked with your carb intake, and or some oral medications. As flutetooter says, an endocrinologist will help with these decisions. Best never to mess with insulin unless under care of a Dr.
 
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bradse replied to betaquartz's response:
Thank you for the reply. This is what I am hoping. In further reading I think I may have to retake my hac1 test. I have tested positive for anemia which might be giving me a higher hac1 level than reality. What I am reading is that I need to fix the anemia issue and re-test.
 
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betaquartz replied to bradse's response:
Sounds like a plan, keep us(board members) informed.
 
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Laurie Anderson, MSN, RNP, CDOE responded:
Hi,
Some thoughts:

You are correct about anemia increasing the A1C; it must be corrected before judging A1c results. Here is the summary of one study with otherwise healthy subjects with iron deficiency anemia (IDA): Before iron treatment, the mean HbA1c (7.4 /- 0.8%) level in patients with IDA was higher than in a healthy group (5.9% /- 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% /- 0.8 to 6.2% /- 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c. More info here:
http://www.ncbi.nlm.nih.gov/pubmed/15345893

Testing your blood glucose 1 hour after meals will give you the info you need to know about your glucose control; when your A1c is below 8 then the biggest influence comes from what we call the post-prandial (after eating) numbers. A post meal blood glucose should be less than 180 mg/dl on your meter; if it's not then you know that your body is not managing carbohydrates well. Medications can be used to target post meal blood glucose elevations; exercise can also lower them.

Talking to an endo about medication options is a great idea; he or she can also advise you on the how the degree of your anemia is influencing your A1c.

Kind regards, Laurie
 
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Laurie Anderson, MSN, RNP, CDOE replied to Laurie Anderson, MSN, RNP, CDOE's response:
PS: an A1c > 6.4% is used to diagnose diabetes: http://diabetes.webmd.com/news/20091228/a1c-blood-test-ok-for-diabetes-diagnosis
 
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flutetooter replied to Laurie Anderson, MSN, RNP, CDOE's response:
"..when your A1c is below 8 then the biggest influence comes from what we call the post-prandial (after eating) numbers." Thank you for that information, Laurie. I've always wonder why diabetics tend to discount those high after dinner numbers and wait until 2 hours pp to test. It seems that they are not realizing that the after dinner numbers such as the 200 range and higher are also counted into the A1c, even though they may be below 140 at the 2 hour mark.

In fact, that is where my doctor first was alerted to my diabetes -- from random blood sugar numbers in the 185-225 range, not from my glucose tolerance test, which ended up at 90 after two hours, and not from my fasting numbers. The A1c, which showed the average of ALL of my blood sugars did come back higher than normal, which prompted me to start asap working on reducing my blood sugars.
If at first you don't succeed, try, try again!
 
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DavidHueben replied to flutetooter's response:
I believe most people self-test their two hour post-prandial glucose levels because that is the customarily accepted time to test.

Also, Flute, I am a little confused. You said you were "alerted to your diabetes" after some tests. One week ago, you described yourself a a "pre-diabetic". Which are you? Have you ever been formally diagnosed with diabetes? If you have been diagnosed in the past, you are not "pre-diabetic". You are a well-controlled diabetic.

DMH
"We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm." - Winston S. Churchill
 
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flutetooter replied to DavidHueben's response:
David, I know that most diabetics test only after 2 hrs. pp because that is what their doctors told them to do. My point was agreeing with Laurie's information that the biggest influence on A1c's under 8 was post prandial high sugars. I was thinking that people might realize how high their blood sugars actually go if they wanted to test occasionally a bit sooner than 2 hours.

As to your "confusion" about what kind of a "diabetic" I actually am, what difference does it make to you whether I am a real bonafide diabetic, a prediabetic, insulin resistant, glucose intolerant, suffering from syndrome X or metabolic syndrome, high normal non-diabetic, or "the most deligent patient my doctor has ever had"? My body has trouble handling carbs and in various years, various tests (including fasting blood sugar in lab tests, random glucose tests in labs, glucose tolerance tests, and lab A1c's) and in the views of different doctors, I have been diagnosed as all of the above. So take your pick!
If at first you don't succeed, try, try again!
 
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DavidHueben replied to flutetooter's response:
It makes no difference to me what stage of the disease you have. But, based upon standard diagnostic criteria, you have either been diagnosed as diabetic or pre-diabetic.

If you have ever had two fasting glucose tests that were greater than 126, then you are a diagnosed diabetic. Doesn't matter where you are today.

My last A1C was 5.1%, but that doesn't qualify me as a pre-diabetic. Just well controlled.

DMH
"We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm." - Winston S. Churchill
 
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flutetooter replied to DavidHueben's response:
David, I know what kind of "diabetic or not" I am and it was not pertinent to the point I was making - which was agreeing with Laurie's information.

It was only you who were "confused" and were pushing the issue just to be argumentative IMO. Over and out, here.
If at first you don't succeed, try, try again!
 
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DavidHueben replied to flutetooter's response:
There is a difference between being argumentative and asking direct questions. I guess you do not wish to answer direct questions. So, I will drop it. Feel free to label yourself in any manner you wish.

By the way, I do not agree with Laurie Anderson's assertion that a one hour post-prandial glucose test is of much value.

DMH
"We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm." - Winston S. Churchill
 
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flutetooter replied to DavidHueben's response:
David, I am NOT labeling MYSELF. I have official hospital printouts containing lab fasting blood reports, doctors' office notes, glucose tolerance tests, yearly physical reports and A1c reports with all of the "labels" I mentioned two posts ago. Again, that was NOT the subject of my original post about Laurie's information. If you disagree with her information about post prandial readings, please reply to her post of 17 hours before this one.
If at first you don't succeed, try, try again!


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