A1C 5.3% and 107mg/dl fasting blood sugar.
Dr. says this is prediabetes. Everything else I’ve read says otherwise. Should i get a different doctor?
I am 30 years old, 5’10, 180LBS now, pretty trim and with a lot of muscle… how the hell could this happen? I watch what I eat!
:mad:
Life gives everyone a different deck I suppose.
Mother had gestational diabetes whilst pregnant with me, could that be a reason?
Any thoughts?
According to Kaiser Permanente, and pretty much everyone else, you’re considered prediabetic if your A1C goes over 5.6–but for the age you’re at, I’d really expect it to be lower. I’m pushing sixty and I’m at 5.5, brought it down from 5.7 via a low carb diet. Maybe your doctor is taking your age into account–that’s what I’d do.
Definition of prediabetes currently by the American Diabetes Association is either hgbA1c of 5.7 to 6.4% or FBG of 100 to 125. What it means when the two conflict is not so clear. Neither is perfect.
So by definition you hit it. BUT. A one time FBG could be a fluke. Stress reaction to fasting too long or who knows what.
So healthy diet and regular exercise, likely such as you’ve been doing, and maybe get a home glucose meter (they are pretty cheap) and recheck your fasting glucose a few times.
Even better than only doing a fasting blood glucose is to do a trend–take a day, do a stick every couple hours and graph that, see if you’re seeing big spikes and drops. My cat is diabetic and I have to do random BG checks on him but doing the trendline is what’ll give the info to help determine if he’s gone into remission. Animal glucose testers are more spendy than people ones, but mine cost under fifty bucks, totally worth it.
If I were you I’d make the decision right now that a carb restricted diet is how you’re going to live from now on. Diabetes is no joke and if you did inherit a tendency it’s sure as hell not going to just go away or get all better on its own. If you commit to a good diet and regular exercise now you’ll go a long way towards keeping yourself off medication.
Current standard is that if you’re over 100, there may be a problem. Did your doctor retest you?
Exposure To Gestational Diabetes Makes Kids 6 Times More Likely To Have Diabetes
I see many patients who have a single slightly elevated fasting reading along with a normal A1c. Best thing to do is recheck the fasting glucose, with an actual venous blood draw, NOT a fingerstick. The fingersticks are notoriously less accurate in that blood sugar range, especially for diagnostic purposes. When precision is needed (as it is for accurate diagnosis of diabetes), get the blood drawn, not the finger poked.
Then depending on the result of the 2nd blood test, along with knowledge of the family history, patient’s BMI and diet/exercise habits, I may recommend rechecking both fasting glucose and A1c every 3 to 6 months until things become clearer one way or the other.
Most of these folks turn out to be non-diabetic. At least in the short run (over the next 3 years or so). IME, anyway. A lot of the literature supports that too.
I take warfarin and have been experiencing empirically the difference between a venous stick and a finger stick. I recently came to Kaiser after a shift in health insurance and their meticulous tracking after five years of laissez faire monthly finger sticks is a big change and a little tough to get used to. I’m lucky, though, my venous and finger sticks tend to be pretty close so I only have to get a blood draw if my numbers spike hard enough to make the monitor freak out.
INR monitoring for adjustment of warfarin dose is very different from glucose monitoring, and really can’t be compared, as they’re looking at two very different things. I believe the capillary blood results for INR (which is what a fingerstick is measuring, capillary blood, not venous) are not much different from the venous INR results.
But with diabetics, the capillary results can range quite a bit from what’s a ‘true’ result when glucose is being measured. Statistically speaking, a fingerstick glucose result of 107 stands about a 30% chance of actually being between 90 and 100. So an “abnormal” result really often represents a normal result. Whereas a venous reading of 107 is more likely to actually be 107 (but there is still margin for error there too, just not as great).
There are flukes, and also lab errors.
I was hypoglycemic before I became pregnant, so imagine my shock when my gestational diabetes screening came back 173. I tested my blood sugar with a glucometer that morning, and it was something like 80 (typical for me, but a little high considering I was fasting-- I’ve had fasting blood sugars of 40).
Anyway, I had to go back to the OB for a 4 hour test, where they drew my blood six times, and also did an A1C. Everything came back a little low, just what you’d expect for me.
I don’t know how everything was communicated, if it all was electronic, or if there was the possibility of a scribal error somewhere, and my blood sugar was really 73 the first time, not 173. I’ve never had that high a number in my life, other than that one time. I’ve never had a number over 115, that I know of, and that was under testing conditions.
So, errors do happen.
The OB did suggest that I could have been dehydrated, and asked if I’d been drinking. Some people misunderstand the instructions to fast, and don’t drink water, which can’t elevate your blood sugar a little. I drank a LOT of water before the second test, believe me.
You can ask the doctor for a repeat of the test if you think there could have been an error.
That’s not too far off the variation I get on a Protime–finger stick comes in at, say, 3.2 (too high, should be between 2 and 3 for me) then venous will be within +/- 0.2 of that. It’s funny, they worry more if it drops under 2 fearing a blood clot, whereas I worry more about it spiking (more likely because a low carb diet means lots and lots of vitamin K stuffed dark leafy greens) over 3 fearing getting into a fenderbender, having the airbag go off and dying of a subdural hematoma before anyone figures out there’s a problem. I really should wear a medic alert bracelet.
I wouldn’t worry about it yet. Get the level repeated in a few months. The standards for diagnosis change periodically, but I wouldn’t consider it prediabetes yet. I understand diagnosing diabetes earlier helps prevent problems, but this doesn’t mean one or a few medium sugar levels or blood pressures should be cause for more than monitoring it over time.
I’m not a doctor, but isn’t one of the earliest signs of diabetes a high fasting insulin reading?
That seems to be my case. My blood glucose is creeping up and is borderline pre-diabetic, but my fasting insulin levels are high. High fasting insulin is a sign of insulin resistance.
There is an outpatient lab that will test my levels for $30 or so w/o an Rx.
I also had an FBS test of 107 and I’m a skinny guy too.
Don’t put too much stock in the A1C. As I understand it, people with high blood sugar can have red blood cells that die sooner than normal, thus creating the impression of a falsely low A1C.
It might just be genetic. Some people are just programmed to have problems this way. Eat some bitter melon (a Chinese vegetable) if you can find it at Asian supermarkets or drink bitter-melon tea; it’s reported to do powerful things for reducing blood sugar.
My first fasting glucose test was 102. After I lost 27LBS of weight it went up to 107.
The first time I had fasted for 8 hours, result was 102, the second time I fasted for 14 hours and it was higher? and I weighed less? I don’t understand.
Even before fasting and then bed I would eat about 10 minutes before going to sleep. Typically pretty heavy (like a turkey sandwich and a lean cuisine TV dinner, then maybe a bowl of cereal) The second time I had eaten much lighter (only a lean cuisine and waited 2 hours before bed. Fasted a total of 14 hours the second time and the result was 107?
Is it something with right when I wake up?
Thanks
Thanks to this advice I ordered one. I guess I will have to treat it like diabetes to prevent from getting it.
Can’t be a fluke since first was 102 (8hours fasting, heavy meal before fast) and second was 107 @ 27 pounds lighter, 14 hour fast/lighter meal and 2 hours no food before sleep. Although I really really hope it is. I am on track to lose more weight although I will look grotesque (in my opinion) to see if it helps but I dunno.
I will mention this to my Dr. Since something does not feel right about it.
I’m not certain but I don’t believe the OP is anywhere near that old.
mmm
Sorry for delay in reply, everyone. Been anxiety ridden.
To make clear my FBG tests were at an office. 102 and 107 (second one is after dropping 14LBS)… I usually go most of the day without eating or just have small snacks (olives, almonds, pickles, turkey deli meat) and pretty much binge eat at night/eat the most (probably about 80-100G worth of carbs). I did this the nights before the tests too (time slept + 1-1/2 hours waiting before bed/reading in bed). During the past 3 months (well not the last month) I ate a lot of sugary stuff, I mean ridiculous amounts of it, ice cream, chocolate, graham crackers, peanut butter and jelly sandwiches multiple times per day).
My sleep schedule is currently 4AM-12PM most days as well. I had my tests done in the afternoon around 2-3PM.
Nobody in my immediate family has diabetes and my mother had gestational with me. I am very trim in comparison to many around me, though by definition still a little overweight.
Could any of that have something to do with it? I failed to mention all of that to my physician. I am going to seek out another doctor, hopefully getting another test done shortly with absolutely no eating the evening before the test (including fasting). Got a meter on the way to check it out as well…
Any other thoughts? Anxiety is killing me here.
Thanks again everyone. I really, truly appreciate it.
Speaking as someone with no medical training, but who’s been living with type 2 diabetes for 13 years…
I wouldn’t get too worked up over even two fasting blood sugar numbers that are just over 100. Your A1C isn’t elevated, and I’m pretty sure that the endocrinologist who’s been treating my diabetes wouldn’t be tremendously alarmed by those numbers (though he would, indeed, likely recommend that you keep an eye on things).
That said, your eating habits might well be playing a role in those fasting numbers. Going for long stretches of your day without eating much, and then having a large meal just before bedtime, could well be playing havoc with your short-term blood sugar numbers. One of the strategies which is often recommended to diabetics, in order to help bring their blood glucose under control, is to eat smaller meals, spread out through the day, rather than one or two big meals with very little else eaten during the day. Big meals require more insulin for your body to process, and big spikes in your blood sugar (and insulin levels) are seen as something to be avoided.
Also, regarding fasting before your bloodwork: you noted that you fasted for eight hours before your first blood test (it’s hard for me to parse out exactly how long you fasted before the second test). i have bloodwork done before every visit with my endocrinologist, and they have always stressed that it’s important to fast for no less than 12 hours before the blood draw. So, if you go in for another test, I’d suggest making sure that you truly fast – nothing but water for the full 12 hours before the draw.
My other thoughts are that the worst case here is not so bad. Worst case is you pay more attention to the quality of your nutrition, to regular exercise, and maybe at some point end up taking metformin anyway. Which is cheap, fairly well tolerated by most, and associated with all sorts of good outcomes.