Is there a distinct line between type-2 diabetic and non-diabetic or is there a fuzzy zone where you can go either way?
My wife in not overweight, 22.7 BMI. She had a FBS of 6.1(110) at the Lab and passed the OGTT because she had a reactive hypoglycemic reaction. She got an A1c of 5.6%. However, give her a glass of orange juice and she hits 200+ real fast.
Our Doctor has not marked her as diabetic, but has written an Rx for test-strips which I consider is very thoughtful of him. His words were "Just watch it!". One diabetic per house is enough. I have convinced her to cut the carbs and she does test quite a bit. She is on a half-ass version of Dr Bernstein because I am leaning on her to go in that direction. She is getting a lot of BGs under 6.0(108). Her mother was a T2 and I think my wife has got the message without freaking out.
I hate to see true T2 diabetics not diagnosed early enough to prevent damage. Also I'm not impressed with the "See your Doctor, take your meds" over simplification of treatment.
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My wife went and had her A1c tested about two years ago. She blew a 5.8%. I informed her that she had diabetes. I wasn't very tactful and boy was she pissed. She basically called me a liar and questioned why I thought I knew so much more than the dr. I was perhaps not as tactful as Alan. But in her heart, she knew what I was saying was true. By the time you reach the point of getting diagnosed with overt diabetes you have lost 80% of your beta cell function. This is straight from the mouth of Ralph DeFronzo, in his 2008 ADA Banting Award lecture.
In my view, as soon as you start to display blood sugar abnormalitities, you have diabetes. The healthy non-diabetic has plenty of reserve insulin capacity to keep their blood sugar rock steady at normal levels. Once your blood sugars start to waiver, something is terribly wrong.
My wife has since adopted a low carb diet, eating only the foods I prepare. And in the process lost a fair bit of weight. Her A1c is back in the normal range. She is successfully treating her condition with diet alone. As to whether she truly understands that she now has diabetes and will likely always have to treat it, I cannot say. At least for now she seems permanently committed to low carb.
"blew a 5.8" LOL.
You laugh now, but in phase II of the Diabetes Prevention Program, they will be setting up roadblocks and making drivers submit to an A1c. Those that have an A1c > 6.5% are pulled over, given a 60g carb meal of grains and then forced to exercise until they get better.
They are looking to reduce medical expenses by reducing the population of people with diabetes the old-fashioned, Malthusian way.
Soylent green is people!!!!!
I am in the school of thought that it is like pregnancy. You are or you are not. I think many of us type 2's will report we had years of hypoglycemia before becoming officially type 2. Since the HbA1c is an average if you are spending lots of time in that hypo range it may negate thos post meal highs. My feeling is if your endocrine system is working the way it should you would never get those 200+ bgs. I guess the medical community and the media have us convinced only overweight people get diabetes because of poor food choices. We all know that is not true. My BMI is around 20 and I am a full blown Type 2. I consider type 2 an allery to eating carbs. The lower carb I go the more stable my bgs go. I never go much below 90, but never go above mid 120's either. Doctors need to make this connection between hypoglcemia and full blown D.
OK, once the discussion on A1c got started, my hot button got pushed. The current probably soon to be definitively adopted guidelines on diagnosis by A1c is 6.5. So, bsc, if your wife was told by her doc that she had a 5.8, he would have laughed you out of the office if you had suggested that she had diabetes. So far, they are REFUSING to understand that A1c varies by individual and that MY 10.7, which is what I had when I went comatose, is more likely equivalent to someone else's 16 or 17 or even 20. I've said it before, but when I had BGs that were diagnosable by current standards (138 and 3 mo. later 131), my A1c was 4.8. In a way, I was lucky that my diabetes progressed fairly rapidly compared to T2's, because 2 years later, my FBG was in the 160-180 range, and PPs were around 250, and I still only had a 7.1, but it was enough to be diagnosed, and when diet and exercise and sulfs didn't work, in MY opinion (i.e. weren't bringing my BGs down at all, even though they weren't emergency high), at least I had a doc cooperative enough to put me on insulin.
Your wives are lucky that they have someone knowledgeable looking out for them, because the VAST majority of people who don't hit the accepted cutoffs MAY be told they're pre-diabetic, but they don't get any help, any kind of treatment or and directions on where to go to educate themselves. CDE education is CERTAINLY not available to them, so self-education is the only way to go. Internet savvy people have a chance, but think about how many people out there, especially the disadvantaged, non-native English speakers and poorly educated, don't have the access nor the skills to use the internet. I sit and listen to medical professionals and govt. critters moan and groan about the diabetes epidemic, but I DON'T see much in the way of genuine help, other than telling people not to consume added sugar. Well, a giant hamburger bun and french fries have no added sugar, but they're just as bad, and MOST people don't know that. Aaarghhh! I told you it was a hot button!
Hi Alan. This is borrowed from a blog I wrote: "One day for the fun of it, I talked my husband into testing his blood glucose. Oops! It was high! He tested again before and after meals; post pandrialy his results were always high. However, his fasting BGs were normal. My husband has always been thin and active and has no autoimmune conditions or insulin resistance. We decided he has a condition that we are calling "Type Geriatric". We went off to his doctor, who gave C-Peptide and other appropriate tests, and agreed that he has "Type Geriatric". My knowledge from the DOC, and especially TuDiabetes, has been a lifeline for both of us, and in the interest of full disclosure, he's a biological scientist and comes into the situation with some knowledge of his own!"
His doctor is fully aware of my husband's problem, and knowing that we both have some insight into the problem, we are all working together to treat the problem of this "pre-diabetes". I guess I'm just pointing out that pre-diabetes is not necessarily the manifestation of just Type 2, or even LADA.
Type G:) Great to have a good doctor who ran tests.
My fasting BG was always normal from annual labs. I can only guess what postprandial was because I crashed & almost died from DKA.
This "Pre-diabetes" condition is a murky area. It's scary to think of how many people have a problem without even knowing it. With respect to Type Geriatric, I believe that doctors should routinely check for it, which appears to be simply the beta cells dying out from age; but what age does it usually start? For the patient, it can be so easily confused with just growing older.
Hi Gerri. Yes, we are so lucky with our medical team, which we share to some extent. Just the thought of DKA is so scary, sorry you had such a close call.
I LOVE the term "Type Geriatric"!!!! I DO believe it exists, and is just one of several types that simply haven't been recognized. I have a friend, age 86, who is emaciatedly thin, but was told she had Type 2 diabetes, and to limit her carbs and carefully measure out her other foods. A TYPICAL T2 weight-loss oriented diet! And weight loss is the LAST thing she needs! I honestly don't think, at her age, potential complications in the future are the main worry -- what matters is keeping her in the best possible health RIGHT NOW. A couple extra pounds might get her through an illness when she couldn't eat, whereas as it stands now, she has exactly NO energy surplus to spare. Of course, she listens to her doctors -- she's of the generation that trusted them implicitly, so she won't listen to me, but I really think the special needs of the elderly, at least those over the age of 75 or 80 should be taken into account!