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I'm not diabetic, and you're the only diabetic you know well and you don't know yet what your final outcome will be.
OTOH- I treated hundreds of diabetics over the course of 40 yrs, making the original diagnosis in many of them and came to know the eventual development of complications (or not) in all but the last 75 or so under my care when I retired.
The average doc only gets 50% of his pts down to the target HbA1c of 7.0 or better. I got 75%+ of mine down to good control. I think that's because I explained the situation, dispelling their fantasies, and keeping it simple, individualizing the treatment plan, not using one recipe for all.
I also know about complications: they don't correlate very well with control-- plenty of pts with good control still get complications, while plenty of those with bad control don't get them...The problem is, you don't know what group anyone falls into ahead of time.
Many pts test too often. Many don't test often enough. Everybody has individual needs. Do what makes you happy, but don't tell anyone that that's the right way to do it just because it works for you.
Do you have any recommendations if one is experiencing higher BS upon wakening?
Location: Was Midvalley Oregon; Now Eastside Seattle area
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Quote:
Originally Posted by leastprime
^male,70, metformin 500am+500pm. BMI 26.6. BG runs ~140 fasting morning. Trigly +1000 nonmed, 400-800 with meds.
Cholest high normal. Statins/tricor intolerant at any level. Tolerate gemfibrozil. Low protein diet. Moderately low carbo, but I do eat a fresh fruits careful not to go into hot flashes, crashing, and excessive urination. Vascepa, 3rd month. Moderate excercise. Eligard for psa is effective but not helping DBt2.
No response is necessary.
something happened Mar-May 2021 and not sure what happened.
BGL dropped to 100-110 in AM and not so high during waking hours.
Fewer hot flashes related to BGL and when I do get a hot flash, I've had relatively high starch/sugar intake. Still get hot flashes if I am not careful.
Maybe the CoVid vaccinations in March changed my blood or got my pancreas to produce more. I do crash if too much carb.
Triglycerides seem to stabilized around 300-400. Have to fight with the lab to do direct reading of LDL and triglyc, rather than do calculated determination. New cardiologist too. I had to train him to order direct reading for lipid panel. LDL borderline high. Ezetimibe, may be part of answer to reduction of TG.
Clear soups with vegs. Low carbo diet but not strict.
Still peeing a lot with if I consume too much carbs/sugar but the hot flashes are much reduced, thankfully.
A1c is about, 6. I think. The lab screwed up the order.
Luv your screenname-- It's very apropos to the question at hand-- So much fantasy and false expectations about BS control/DM going around.
I practiced Int Med for over 40 yrs. 120 y/a, they said "If you know syphilis, you know medicine." That's because that disease was common then, and it had protean manifestations involving all organ systems. The same could said about DM today.
I think this new fad of diagnosing "pre-diabetes" is just a gimmick, having no meaning in the real world. You're not pre-diabetic anymore than a 16 y/o girl who will eventually raise a family of 3 kids is pre-pregnant...She has the genetic ability to get pregnant, given the right "environmental factors," if you know what I mean. If she avoids those enviro factors, she'll never become pregnant and develop the complications of pregnancy (physical or social).
The analogy holds well for diabetes-- It' a condition requiring the genetic background interacting with environmental factors to show itself. That enviro-factor is diet. People without the genetic make-up can eat all they want. Under no circumstances will they become diabetic. Those with the diabetic genes will show high BS and probably complications if they eat more than a certain, individually determined diet. Like baldness, it doesn't usually appear until a little later in life. (We're talking about Type II)
Non-diabetics will have fasting BS below 120mg%. Their BS may or may not rise after eating, but will return to baseline by 4 hrs after eating (post -prandial BS, or ppBS).
Diabetes, OTOH, is defined as fasting BS over 120, or any BS over 140. We usually take a 2 hr -ppBS for standardization. As a screening test for DM, we've traditionally used the fasting BS, but that's dumb. Many early diabetics show normal fasting levels, but elevated 2hr ppBS. That's what oughta be used for screening.
HbA1c levels give us an idea of "average BS" over a three month period. I compare it to hanging a clean sweater in the middle of the room and coming back in 3 months to see how much lint it has collected. It tells you the total lint that was in the air, but not the time schedule--Maybe the dust level was constant over the 3 months or maybe it was mostly very low but there was one big dust storm to cover the sweater.
It's been shown that non-diabetics have HbA1c levels under 6.0. A level of 7.0 corresponds to an average BS level of 165mg%. It's been shown repeatedly that complication rates go down when HbA1c is lowered to 7.0 but don't go down any farther when HbA1c levels are maintained at less than 7.0. (Hypoglycemia, a much more urgent danger is actually unnecessarily more common when certain drugs are used to achieve the lower levels.)
Always keep in mind that diabetic complications are a result of hi BS over a prolonged period of time measured in decades and years, not days, wks or hrs. Don't worry yourself silly over meaningless, frequent testing.
As to your original question: take fasting levels (more than 4 hrs after last food intake) occasionally-- kinda like a surprise, "pop quiz" just to check up on yourself. People on drugs that directly lower BS (like sulfonylureas) need to check more frequently. Those on insulin need to check a couple times a day, maybe only a few days a week if they have a good history of stability, maybe before every meal if they're on a sliding scale for dosing.
If your HbA1c is running down around 6, we could question your need to stay on meds. Proper diet and exercise may well keep you in control. Primum non nocere.
Just happened on this thread, and what made me wonder about was the stated need to test for blood sugars and take medication for what is being called "prediabetes", or sometimes "insulin resistance" as I've heard it, defined as a fasting blood
glucose level over 100 mg/dL on more than one occasion. I've seen the criteria for a diagnosis of diabetes being fasting levels of 126, hemoglobin A1C levels of 6.0% or over. I checked recently and found it still holds that this be confirmed by an oral glucose tolerance test, unless the glucose is very high ( ex. 300 mg or more) and the person shows the signs and symptoms of diabetes, to call it such. At this point it'd be appropriate to start diabetic meds, check blood sugars daily with a meter, etc.
But for "prediabetes"? Of course watching one's carb and sugar intake, engaging in lifestyle changes to include diet and exercise, losing weight as indicated are needed to control this, and periodic blood sugar, possibly A1C checks to see where one is in this spectrum. I just don't understand the push to start the medication and regular fingerstick checks when one has not been diagnosed as diabetic.
I've had fasting blood sugar levels a bit over 100 mg ( generally in the 104-107 mg range), for years now- generally checked twice a year when I see my PCP. On a couple occasions it's been 116 or so, and I've also had the A1C checked. That has run the gamut from high normal ( 5.4 % upper range of normal) to 5.9%, never has been 6.0 % or higher. These results have been the same for years no matter what I've done dietwise, or exercise- I try to be careful and I exercise regularly. Fortunately my PCP has never suggested any medication or regular glucose checks for it, and I'd dispute the need for those if she did.
In fact, she finally agreed with me that my higher than normal ( but not diabetic) levels of glucose may well be due to some of my medications. These include chlorthalidone, and metoprolol ( fairly high level of metoprolol).
Do you have any recommendations if one is experiencing higher BS upon wakening?
Thank you!
What do you mean by "higher?" and are you being treated with any meds that lower your BS?
"Normal" is defined for any metric by taking a random population, running the test and graphing the results out. They usually fall into the "bell shaped curve." ...The middle 97% that straddle the mean (average) are defined as normal....Being 7ft tall is, by definiton, "abnormal." That doesn't necessarily mean it's some sort of disease.
If your AM fasting BS is on the high side, it may just be your "normal." If it's above the 12omg% level, you may be diabetic, confirmed if you get 2hr-pp BS >140mg%.
If you are a diabetic on drugs like insulin or sulfonylureas that can make your BS go too low, then a high AM fasting BS may represent less than optimal treatment-- OR-- maybe you get hypoglycemic while you're sleeping so your body reacts by generatiing more sugar. ..It's a common mistake to think a pt on insulin who has hi AM BS needs more insulin..Exactly the wrong thing to do in many cases.
Quote:
Originally Posted by Travelassie
... I checked recently and found it still holds that this be confirmed by an oral glucose tolerance test, ....
Docotrs wh know what they're doing don't trephine skulls to let out evil spirits anymore, nor do they use leeches to bleed out bad humors, nor do they do gluocose tolerance test-- potential for dangerous hypoglycemia and provide no info a simple FBS and 2hr-ppBS can't provide.
What do you mean by "higher?" and are you being treated with any meds that lower your BS?
"Normal" is defined for any metric by taking a random population, running the test and graphing the results out. They usually fall into the "bell shaped curve." ...The middle 97% that straddle the mean (average) are defined as normal....Being 7ft tall is, by definiton, "abnormal." That doesn't necessarily mean it's some sort of disease.
If your AM fasting BS is on the high side, it may just be your "normal." If it's above the 12omg% level, you may be diabetic, confirmed if you get 2hr-pp BS >140mg%.
If you are a diabetic on drugs like insulin or sulfonylureas that can make your BS go too low, then a high AM fasting BS may represent less than optimal treatment-- OR-- maybe you get hypoglycemic while you're sleeping so your body reacts by generatiing more sugar. ..It's a common mistake to think a pt on insulin who has hi AM BS needs more insulin..Exactly the wrong thing to do in many cases.
Docotrs wh know what they're doing don't trephine skulls to let out evil spirits anymore, nor do they use leeches to bleed out bad humors, nor do they do gluocose tolerance test-- potential for dangerous hypoglycemia and provide no info a simple FBS and 2hr-ppBS can't provide.
Funny, I still see 2 hr glucose tolerance tests listed as diagnostic tests for diabetes on both Webmd and the American Diabetic Association sites I just checked. ( 2020 updates). Perhaps you should inform them that this test is outdated and dangerous and should be relegated to the Museum of Medieval Medicine along with the trephining tools and leeches. .
Now, it has been stated in those references, and in the others I read, that a patient showing a significantly elevated glucose, either fasting, random, post perandial, whatever, and has signs/-symptoms of diabetes can be diagnosed with diabetes by virtue of those findings. But apparently the 2 hr GTTT still has its place in the diagnosis of diabetes under some conditions.
Last edited by Travelassie; 11-17-2021 at 05:07 PM..
Funny, I still see 2 hr glucose tolerance tests listed as diagnostic tests for diabetes on both Webmd and the American Diabetic Association sites I just checked. ( 2020 updates). Perhaps you should inform them that this test is outdated and dangerous and should be relegated to the Museum of Medieval Medicine along with the trephining tools and leeches. .
Now, it has been stated in those references, and in the others I read, that a patient showing a significantly elevated glucose, either fasting, random, post perandial, whatever, and has signs/-symptoms of diabetes can be diagnosed with diabetes by virtue of those findings. But apparently the 2 hr GTTT still has its place in the diagnosis of diabetes under some conditions.
Good example of why the layman has to be careful of what Dr. Google tells them. You can an article on how to ride a bike but it will be meaningless once you actually get on one for the first time. Experience is the best teacher.
Funny, I still see 2 hr glucose tolerance tests listed as diagnostic tests for diabetes on both Webmd and the American Diabetic Association sites I just checked.
The current standard for diagnosing diabetes is the A1C. It's not perfect but it's the best they got. Too many variables otherwise. Short term factors like medications, illnesses and other conditions can affect blood sugar temporarily. The A1C spreads it out a bit. It's 90 day average, weighted higher for the most recent 30.
If you are concerned, you can even get a home A1C test. They sell them at Walmart. If you have a walk in cash lab in you area, get blood work done there. It would be more accurate. You don't need a doctor's order for it either. It costs me $20 for a complete diabetes test which includes glucose, A1C and insulin among others.
Fact is, a large percentage of the population is insulin resistant. IR would also affect any kind of test like the glucose tolerance. IR goes hand in hand with obesity. Somewhat of an epidemic in this country it seems. You can blame the SAD in large part for this problem. Americans eat crappy food and too much of it.
Good example of why the layman has to be careful of what Dr. Google tells them. You can an article on how to ride a bike but it will be meaningless once you actually get on one for the first time. Experience is the best teacher.
About as good an example as assumptions made about anonymous posters one has never met, and knows nothing about except what they post on a public forum.
As well as the assumption that one's own repository of "knowledge" constitutes the universe of that knowledge.
Last edited by Travelassie; 11-18-2021 at 08:26 AM..
The current standard for diagnosing diabetes is the A1C. It's not perfect but it's the best they got. Too many variables otherwise. Short term factors like medications, illnesses and other conditions can affect blood sugar temporarily. The A1C spreads it out a bit. It's 90 day average, weighted higher for the most recent 30.
If you are concerned, you can even get a home A1C test. They sell them at Walmart. If you have a walk in cash lab in you area, get blood work done there. It would be more accurate. You don't need a doctor's order for it either. It costs me $20 for a complete diabetes test which includes glucose, A1C and insulin among others.
Fact is, a large percentage of the population is insulin resistant. IR would also affect any kind of test like the glucose tolerance. IR goes hand in hand with obesity. Somewhat of an epidemic in this country it seems. You can blame the SAD in large part for this problem. Americans eat crappy food and too much of it.
There's also a lot of undiagnosed thyroid disease in this country, which predisposes people to diabetes. Primary care doctors and even endocrinologists are unaware of the link, and they seem to be trained to deny patients have thyroid issues is the first place. It's not only overweight people who get pre-diabetes and diabetes; people who are slim, generally healthy, and active develop insulin resistance too, but tend to get the brush-off from doctors when raising their concerns, because they don't fit the typical profile. Medical education needs to improve in this country, and the insurance industry needs to stop interfering with how doctors practice.
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