Re: Diet, testing, and DA
- From: Jenny <lottadatacarbs@xxxxxxxxxxx>
- Date: Sun, 07 Aug 2005 10:54:00 -0400
Chris J. wrote:
I just read it... I disagree with parts of it, such as the line
"Diabetes is only easy to diagnose after many years of elevated blood
sugars have caused blindness or kidney failure."
Chris,
I had 2 diabetic pregnancies, lost most of the weight I'd gained
and was told I was normal for many years, based on the fasting glucose test, while I fought a continual series of bacterial and fungal infections. My kids used to joke, "Don't let mom have an ice cream sundae if she's driving" because I would darn near pass out if I did. Turns out at least 50% of people with gestational diabetes do go on to develop Type 2. But I was told that because I had no weight problem and hit the gym regularly, I had nothing to worry about. WRONGO!
However, if your mom has had GTT tests, and they are normal, she should be okay.
When I was spilling sugar in my urine and getting readings over 200 mg/dl any time I ate a bagel, Kaiser refused to diagnose me as diabetic because my fasting blood sugar was still normal and my A1c was "only" 6.2%. As a result they would not pay for any testing supplies or medication. I paid for my own testing supplies for two years and controlled my blood sugar with a low carb diet, as that was all that was available to me. The infections abated, thank goodness.
Eventually I found a doctor who recognized that many repeatable readings over 200 mg/dl is also diagnostic of diabetes (as per the complete ADA guidelines, though they do not mention this in the summary information they release.)
My own situation set me out on a quest to find out why the diagnostic standard was the way it is and if perhaps it was missing something. I was quite surprised to discover that it wasn't missing people like me because we had some weird diabetes variant, but because it had been intentionally set high.
But to make things clearer: When I write "diabetes is only easy to diagnose"-- the emphasis is on the "easy". Obviously, my diabetes was not easy to diagnose because it won't show up on a fasting test and it took me years to get a diagnosis. For that matter, my fasting blood sugar still won't test in the official diabetes range after 7 years. I have controlled my blood sugar rigorously in the intervening years, so I don't know how bad it really is, but I have seen the occasional reading over 250 mg/dl when I've gotten sloppy so my original "diagnosis" appears to be accurate. My endocrinologist says all my various test results are compatible with full-blown type 2 diabetes (especially the sky high fasting C-peptide matched to that normal fasting glucose).
But the fact remains if doctors are unwilling to perform an oral glucose tolerance test and Insurers won't pay for it because the ADA criteria label it expensive and unnecessary diabetes is going to be tough to diagnose for people like me. Tor me the GTT is the ONLY test which would clearly show that I had diabetes.
BTW, I am not alone in having this kind of experience. I have a friend whose doctor told her she was normal when her fasting blood sugar was 120 mg/dl. (The diagnostic cutoff at the time was 125). She didn't get diagnosed until her post-meal numbers were way over 300 mg/dl! That is a level compatible with retinal and kidney damage.
In my family, because we are thin, the first "symptom" of diabetes has occasionally been a sudden fatal heart attack in the early sixties. I have been reading up and it seems that one possible early diabetic complication can be autonomic neuropathy--which adversely affects the nerves that regulate blood pressure, heartbeat, etc. An interesting study of heart attack survivors shows that quite a few of them turn out to have previously undetected elevated blood sugars. Undetected because the only test they were ever given is the fasting glucose test.
BTW, it is worth remarking that there are also people whose blood sugar works the exact opposite way. High fasting bg, with near-normal post-challenge spikes. However, studies (esp one published by the Baltimore Longitudinal Aging study group) show this is a much less common pattern.
Anyway, I hope this explanation clarifies the statement in my page that troubled you. Your thoughtful well-reasoned response made me want to get this cleared up!
.
- References:
- Diet, testing, and DA
- From: Alan S
- Re: Diet, testing, and DA
- From: Quentin Grady
- Re: Diet, testing, and DA
- From: Jenny
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