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Confused about second opinion

T

tom36_

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During a health checkup the fasting blood glucose of 102 came up. The doctor recommended me to be more active and eat less carbs. I'm 37 years old, male and my BMI is 24. Afterwards they also measured the A1C, which was 4.8%

To be honest, I was kinda surprised about the fasting blood glucose. I'm working out 2 or 3 times a week, am not overweight and eat between 100g and 200g of carbs. My parents and brother have a fasting blood glucose of 80 to 90.

I would like to react to potentially problems early, therefor I got myself a glucometer.

Fasting:
96, 101, 95, 96, 99, 92, 106, 107, 94
(The values of over 100 were measured after eating a lot of carbs the night before. The other ones during eating low carb.. around 100g of carbs per day)

Post meal glocuse was mostly okay. When eating around 40-50g carbs, the glucose was mostly around 120g one hour afterwards and around 95g after two hours.

Two more extreme tests looked like this:

150g Chocolate cookies (90g carbs, 37g fat, 9g protein)
before: 91
1 hour: 131
1 hour 30 mins: 90
2 hours: 122
2 hours 30 min: 123
3 hours: 123
3 hours 30 mins: 90

75g Glucose Drink from the pharmacy
nüchtern/davor: 94
30 min: 175
1 hour: 178
1 hour 30 mins: 147
2 hours: 123
2 hours 30 mins: 107
3 hours: 64

I now went to another doctor to get second opinion. He also lists diabetes under his specialities.

His opinion was that the fasting blood glucose of 102 was normal, because it was measured around 10am and after 12 hours of fasting. Cortisol and other hormones simply raised the glucose. He also said that the other fasting values in the mid-90s and the home-made OGTT are also okay. The extreme spike during the OGTT is normal and that the value after two hours matters.

To be honest, I was a bit surprised that he was so relaxed about it. I've read that starting with a fasting blood glucose of 90s there can be potential negative consequences and that a lot of people make the mistake of assuming that 99 is perfectly fine and with 100 you you all of the sudden have prediabetes.

Regarding the OGTT, I've read that the value after 2 hours is relevant for diagnosis, but that extremes spikes before that are also not normal.

What's your opinion on this? Is this really normal or should I seek a 3rd opinion?
 
I don't work in what I assume to be mg/dl but it seems that works out at 5.7 mmol, which is almost perfect....

if my assumptions are correct and those numbers are in mg/dl, I cant see why diabetes has even been mentioned...
 
Yes, sorry.. Values are in mg/dl, it's 5.7mmol. Perfect? I know it's not diabetic, but it's past the threshold for prediabetic.
 
To conver mg/dl to mmol/l divide by 18 or use this calculator- http://www.diabetes.co.uk/blood-sugar-converter.html

The numbers you have put are all normal and, (even your 9.9 60min post diy gtt) on context the numbers are at the top end of normal, but still normal and not diabetic or pre diabetic.

I don't think a third opinion would tell you anything different. Even if it did, what would you hope to achieve then? Do you actively want to be medicated? If you are concerned about sitting at the higher end of normal (even tho it's still normal normal) you could think about having more 100 days than 200 days, or having lower gi carbs.

Not sure what threshold you are working on, but 5.7 is not diagnostic of pre diabetes - http://www.diabetes.co.uk/pre-diabetes.html
 
Thanks! I guess there are different criteria for the diagnosis of prediabetic. The first doctor didn't explicitly say prediabetic, he was pretty casual anyways, as it was just a general checkup. But the paper with the blood result, showed a FBG of up to 5.5 as normal.

It seems like there different opinions on the threshold: https://en.wikipedia.org/wiki/Prediabetes#Impaired_fasting_glycaemia
Some use 5.6 some 6.1.

But I guess you are right.. The recommendations for improving the situation are pretty much the same for top-end normal and prediabetic. Was mostly just curious if this requires other investigation to rule out non-obvious causes and how frequently I should have this checked.
 
I assume you are joking ;) I know the a1c looks good, but I've also read plenty about how the A1C shouldn't be used for diagnosis as there are several things that can falsely lower or raise it.. that it should only be used to measure if the persons average blood sugar is improving or getting worse.
 
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