I suspect that a family member is in denial about his diabetes. He has been ill this week, unfocused and apparently “too sick to eat.” In the middle of this someone said that his blood sugars had been in the 200mg/dl range, but that it was a “normal” level for him.
Is there any way to interpret this other than that he has been living with significantly high blood sugar levels?
No, fasting blood sugars of 200 mean diabetes. Loss of appetite and confusion should be evaluated promptly to rule out ketoacidosis, which can be life-threatening. Please urge him, and family members closest to him, to go to a doctor ASAP.
Full disclosure: IAAD, but not your doctor or your relative’s doctor. This is not an evaluation or diagnosis. Only a medical practitioner can determine what treatment, if any, is needed.
In one sense normal ranges for medical tests are established arbitrarily–a given population of people has a parameter measured a standardized way–and the “normal” is set to be within a certain amount of deviation from the mean.
For diabetes, there are several types of measurements to consider. A totally random blood glucose level may actually bounce around quite a bit, although in general a random glucose over 200 is considered to be worthy of further testing for diabetes. http://www.mayoclinic.com/health/blood-sugar/SA00102 There are standardized ways to test blood sugar (blood glucose, specifically) such as fasting levels, or levels after a glucose load, or even tests that show what the average blood glucose has been for a period of time (Hemoglobin A1c/glycosylated/glycated hemoglobin) A1C test: MedlinePlus Medical Encyclopedia .
“Diabetes” is not a sharply demarcated condition. Think of it like obesity. There is a whole gradual range between the guy who weighs 150 pounds and the guy who weighs 750 pounds. There isn’t some exact point at which he is “fat” even though for management and diagnostic categorization there may well be a formal definition for morbid obesity. Diabetes is like that; it’s a metabolic problem manifested by elevated blood glucose, but you can’t look at any one test and make too much of an inference. Of course if that one isolated test is way out of range, you probably have diabetes in the same way that a 400 pound guy is pretty certain to be fat.
Now the other mistake we don’t like to make as doctors is to assume that, because someone isn’t feeling well and their blood sugar is high, their main problem–their primary diagnosis–is diabetes. Even in a person with no diabetes–someone who handles their sugar just fine–stresses such as illness can elevate the blood sugar. If someone has some level of diabetes, any illness can exacerbate their blood sugar, even to dangerous levels. So as an example, it would not be unusual for a person with unrecognized diabetes to get sick from some other cause and present with blood sugars so high they are confused, dehydrated (you pee off the excess blood sugar, and it drags out free water with it) and sometimes at death’s door. Hyperosmolar hyperglycemic state - Wikipedia We always look for an underlying cause. Sometimes when that cause is fixed (an infection, say), their diabetes itself turns out not to be very severe at all.
It’s impossible to speculate accurately on your family member’s problem and it wouldn’t be safe to do so in any case. In general a blood sugar level of 200 will not, by itself, cause much of any symptoms at all. If it is persistently at that level, a patient might have other related conditions such as dehydration (not too likely for a person whose thirst mechanism is intact), electrolyte abnormalities or even associated morbidities such as infections (which increase with poor sugar control). However a blood glucose of 200 is unlikely to be the primary cause of mental status changes. If his sugars are being measured, perhaps it’s the case that he’s under medical care. I certainly hope so. It is true that many folks get nervous about a diagnosis of “diabetes.” I’m not sure why. In most patients it is a very manageable problem.
Thanks.
This is my brother. I admire how he manages stress in his life. Unfortunately, he can keep so cool at times that he ignores his own personal problems. He’s a contractor running a large-ish small business, and he developed diabetes mainly because he was too busy to care for his body. I think I know where he’s coming from; most of the guys in my family tend to take on this “tis but a flesh wound” attitude.
Basically, I want to get my facts in order before I say anything (I also want to be able to gracefully confront the question, but I think that’s something that I need to work out myself.) I’m pretty sure that he is both confident that he can handle this problem. I also suspect that once it is out of sight, it will be out of mind.
Forgive me if this constitutes a threadjack, but the question here interests me.
In December, 1995, I was diagnosed with DM type 2 after about a year where my primary symptoms were polyuria (excessive urination), polydipsia (excessive thirst) and polyphagia (increased appetite; I was in denial about the first two), increased fatigue, and significant weight loss even though I was eating constantly (and eating crap that should have packed on the poundage at an alarming rate). My physician prescribed some meds (which we’ve changed over the years) and dietary changes, and we managed to get my BG under reasonable control, with one exception…
IIRC, target BGs for me were basically < 120 mg/dL fasting and 2 hour postprandial (after meals). I had no great problems reaching the 2 hour postprandial targets, but for many years my fasting BGs were always in the 150-170 range (if not a tad higher, spiking at 200-220 more often than I liked). Since my HbA1c readings were within the target my doctor had set. (< 7.0, IIRC), after a while he he just shrugged his shoulders and decided it wasn’t worth worrying about as long as the A1c readings weren’t significantly elevated.
FWIW, about two years ago I decided to experiment with caloric restriction in the form of the “every-other-day” fasting (which The Master mentioned in last week’s column), and that appears to have brought my fasting BGs down to “normal” levels (around 100 mg/dL), and lowered my HbA1c readings a bit (from high 6’s down to low-to-middle 6’s).
My point (to bring this back to the topic of the OP) is that it seemed to me that my “normal” fasting BGs were always pretty high (150+) and just “meant” to be that way (at least until I started the intermittent fasting). Is that a plausible interpretation, or am I just kidding myself? 
The bottom line for me now is that things appear to be well controlled; my doctor is happy and therefore I’m happy, and as long as things are working (and my HbA1c tests stay in the low-to-middle 6’s), I’m not going to worry myself over it.
Cheers,
bcg
I’ve never read anything that suggests that there’s such a thing as a “high normal” number, fasting or otherwise. Though I am not a doctor, my latest hobby has been reading everything I can get my hands on, diabetes-related, so at the very least, I’m well-read on the subject.
Fasting number is an important number, in that it gives you a hint of what your body has been doing all night. In general, you want it in the normal range, as it indicates that you may have been normal for a significant portion of the day. Of course, tons of people experience the “dawn phenomenon” where your body dumps a bunch of glucose into your system in the wee morning hours, so fasting isn’t always a great indicator of what’s gone on all night, but it’s the best we have, at least until continuous glucose monitoring gets a whole lot cheaper.
Anyway, if you’re controlling it with diet and you’re fine with that, great. If it wasn’t until control and you were still waking with numbers from 150-200, I’d personally wouldn’t be happy with that, and would be talking to the doc to get it fixed. A little basal insulin before bed does wonders for many Type 2s, or there’s other drugs. But hell, if you can do it with diet, that’s even better.
My inclination is to pay more attention to the HbA1c than spot glucoses of any kind, except where one is adjusting a regimen (diet, pills or insulin), or the patient is symptomatic.
As to your personal physiology–it’s yours, as you point out. All sorts of things, including your own personal metabolism, exercise, diurnal variations and so on affect your own sugar curves.
cornflakes, why is he testing his blood sugar any way? It seems like there is some thing more to his story.
In any case 200 as a baseline is not “normal”.
As to the question of “high normal” in general - well that might be what gets called “prediabetes”
Good question! I’ve been asking it myself this weekend!
Seriously, he was diagnosed with type 2 diabetes a decade ago; I should have made that more clear in the OP. I had the impression that he was managing it, and it is possible that this week was just a bad week for him.
Ah.
Well then. Sorry for my confusion.
Running 200 as baseline is not generally considered good control and is unlikely to be associated with good HgbA1c levels.
OTOH he may be just running high recently while ill as a stress reaction. And just saying its a flesh wound that he always has.
In any case unable to focus and too sick to eat in a diabetic patient? I’d encourage him to contact his doc no matter what he claims his sugars are (if he is even really checking) … not that my brother would ever listen to me.
Thanks, but my fault. Thanks for the info on prediabetes. That may apply for me.