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A strange diagnosis

D

Dragon_J

Member
Messages
6
Type of diabetes
Other
Treatment type
Other
Hello,

I'm Dragan from Croatia. I'm slim (70kg/184cm) but not very active, mostly sitting and working at my computer but doing cardio about 2 times a week (sometimes every day when i have time). I eat normally and I usually have very plentiful late dinners, right before bedtime (sometimes at 11-12 PM). When I exercise, I do it on empty stomach in the morning.

As I was checking my blood about once a year for the past few years, I've noticed that my blood sugar number is getting higher and higher each year. Then it was measured 6 mmol/l last year so I went to see an endocrinologist in December 2017. He ordered some blood tests and here are the results (bloodwork done after fasting for 12 hours):

HbA1C: 5.4% (Normal: 4.0 - 6.2 %)

Lipids:
Cholesterol: 4.61 mmol/l (Preferable: 0-5)
HDL: 1.73 mmol/l (Preferable: > 1,5)
LDL: 2.67 mmol/l (Preferable: 0 - 2.5)
Triglycerides: 0.47 mmol/l (Preferable: <1.7)
Atherosclerosis index: 1.54 (Normal value: <3.0)
Risk factor: 2.66 (Normal value: <5.0)

Thyroid hormones:
FT4: 19.36 pmol/l (Normal: 12 - 22)
TSH: 1.55 μIU/ml (Normal: 0.4 - 4)


OGTT, 2 hours, 75g of glucose:

Time____________Glucose (mmol/l)________________Insulin (μIU/ml)
0'__________________ 6.01 ___________________________ 5.39
30'_________________10.90 ___________________________47.97
60'_________________11.25 ___________________________87.95
90'__________________7.06 ___________________________46.27
120'_________________5.91 ___________________________24.41

Please let me know if I should convert these to other units. In Croatia, we use these units.

I've made the charts for easier reading:

snip_20180303152304.png

snip_20180303152318.png


So, after seeing the results, my doctor ordered the anti GAD test which came out negative.

He told me that the results are not quite normal, but not diabetes either. That I'm right at the very edge (of prediabetes?).
He diagnosed me with something that would be "increased fasting glycemia" when I translate it to English as a layman.
he prescribed Glucophage (Metformin), told me to eat healthy, not to eat after 7pm and exercise more. I should get back to him with HbA1C and OGTT for control in one year.

Now, I didn't start with metformin right away, I wanted to inform myself and read about the condition to see if something could be done without tablets. But I'm only getting more and more confused because I'm very slim and all the advice is mostly for people who can afford to lose weight. Does the doctor suggest that I'm on my way of becoming a Type2? Do my OGTT insulin measurments and a negative anti-GAD definitely suggest that I'm not developing Type1?

Please share your thoughts. Should I buy a glucose meter and measure my levels throughout the day. If so, do you know of a guide as to when should I take measurements and how to interpret them? That is, what should my goal be?

Thank you very much for reading and helping out!
 
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Hello and welcome,

You can relax - your units are the same as here in the UK.

All I can say is you seem to be a very healthy man. :)

Your HbA1c is perfect
Your lipids are perfect
Your OGTT was perfect
The initial fasting test before you had the glucose drink was 6.1. Anything up to 5.9 is perfect. You were very slightly above this but in my opinion (and I am not a doctor) it is nothing to worry about. It could have been affected by eating very late the previous night, or rushing about between getting up and having the test, a bit of stress because you were about to have a test, or anything else along these lines.

What reasons did your doctor give for thinking you aren't normal and for giving you Metformin? His advice to eat healthily and not after 7pm is good advice.

The insulin test is not something we have routinely in the UK so most of us are unfamiliar with what the readings mean, but I do believe that a fasting insulin of 6 or under is good, and yours was 5.39. Others may come along to explain more.

I know nothing about thyroid tests.

https://www.diabetes.co.uk/oral-glucose-tolerance-test.html
https://www.diabetes.co.uk/what-is-hba1c.html
 
@Dragon_J all your results are within normal ranges though I am not a doctor. However, it is not understandable why you have been prescribed Metformin. Maybe, someone here on the forum can tell us about it.
 
Last edited:
You're not diabetic. Your hba1c is normal, your OGTT is normal. Your not slightly, eleven a little bit diabetic. I've got no idea why you'd be given metformin or a gad test when you clearly aren't diabetic. Are you paying privately to see this endocrinologist in Croatia? It sounds like he's unnecessarily medicalising completely normal results.
 
Thank you very much everyone for taking time to read and reply!

@Bluetit1802 Regarding reasons, he said that I'm on a very very edge of what's normal. I believe he meant the edge between normal and prediabetic? He also mentioned that my insulin levels should have gone to a lower value after 2 hours.

@catapillar Yes, I'm paying him privately but he told me to come for control after one year. So, I thought if he'd want to get more money from me, he'd tell me to come sooner and more often.

One thing I didn't mention are my fasting blood glucose results from previous years which are:
2014: 5.31
2015: 5.68
2016: 5.62
march 2017: 6.05 (this is when they told me I should see an endocrinologist)
dec 2017: 6.01 (the test from my first post)

There is somewhat of a general upwards trend but I thought it's not something to worry about too much.

I also didn't say my age which is 39.

@Bluetit1802 , you mentioned stress. The test didn't start well, the nurse didn't put the cannula in my vein correctly, so there was some strange reaction where the vein had a spasm and didn't let the needle in. I was in cold sweat and some strange feeling of fury overwhelmed me, narrowing my field of vision. I've never experienced anything like it. We waited a bit for me to calm down and tried the other arm after a few minutes which went just fine. Could that stress have raised my blood sugar so fast, that is, in a few minutes? If so, that initial glucose measurement of 6.01 could be wrong.

I understand you're not doctors, but your comments confirmed that I'm right to have doubts about taking the therapy. Thank you very much. I should ask for an opinion of another endocrinologist I guess.
 
Dragon_J said:
I understand you're not doctors, but your comments confirmed that I'm right to have doubts about taking the therapy. Thank you very much. I should ask for an opinion of another endocrinologist I guess.
Click to expand...

Your very best bet is to reduce your carbohydrate and fruit consumption and buy yourself a home glucose meter to guide you to find good food choices. This will help a hundred times more than Metformin, and will reduce any high insulin and glucose levels. Testing before and 2 hours after eating, and keeping any rise as low as possible, is a good plan. By low, I mean less than 2mmol/l increase, preferably a lot less, but any more than 2mmol/l and there are too many carbs in the meal.
 
Thanks @Bluetit1802 , yes I was thinking about that. But I didn't know what to aim for and when to test so I thought if there's a guide. Okay, so I should find food that doesn't rise my blood glucose more than 2mmol/l after 2 hours.

Is there any advice on when is the best time to exercise? Is it ok that I exercise on an empty stomach first thing in the morning as it delays breakfast? I thought that might be raising my glucose in the morning because maybe my body is expecting the exercise so it gets prepared by raising glucose for energy? I'm not sure if that works that way :)

Or is it best to exercise after the largest meal?

Sorry, I'm swamping you with questions. If you know of a good online guide please let me know. That's what I was looking for all over, but all I've found is "lose weight" advice. And I'm already very slim, always have been, and I actually always struggle to gain weight. I've managed to gain about 5kg in the last 2 years and was really happy about it and now it seems I have to lose it :( I'll look like a strawman.
 
I think your doctor has done a thorough job and you don't have diabetes or prediabetes by most standards.

Looks like your fasting readings are rising but this alone may not lead to diabetes in the future. Especially as your post meal readings are normal at two hours.

You can use a lower carb diet to gain weight or maintain your weight if you want. It is not just a weight loss diet. Exercise when it suits you. It is normal to see a small rise as your body gets you ready for the day's hunting.

Have you changed the time of your last meal? I think this maybe really helpful.

This article is maybe helpful to compare your results against.
http://www.phlaunt.com/diabetes/16422495.php
 
@Alison Campbell Thank you for taking time to help out. If you don't mind me asking, what is your FBG now, 6 years after diagnosis?

Yes, I've stopped eating after 7PM, but now I'm only eating two times a day. I'll try to reorder my breakfast and lunch times as well so as to have 3 meals.

And thank you for the link. Now, in the link it says: A truly normal A1c is between 4.6% and 5.4% and my result is exactly 5.4%. So it seems that's another value that's right at the upper limit.

I've also researched a bit, looking at OGTT curves online and I think I found out what my doctor found suspicious. Turns out that glucose shouldn't go above 10mmol/l during OGTT, which is something called renal threshold. I've only researched this for past two hours so I'm not sure. Anyways, my OGTT shows values above 10mmol/l at 30 and 60 minutes.

I've decided to buy a glucose meter and a treadmill :)

As for the low carb diet, I never really was a fan of carbs. I never liked sweets, even as a kid. I don't like bread or rice. I even can't eat ketchup and various sauces from a supermarket because I find them too sweet. I just buy pressed tomato and make my own ketchup :) So avoiding carbs should be fairly easy, just limiting potato, pasta and fruit I guess.

I just hope I'm not being misdiagnosed and actually developing Type1. I've learned that there are more autoimmune tests that should be done for Type1, not only anti GAD. Like Islet Cell Cytoplasmic Autoantibodies (ICA), and Insulin Autoantibodies (IAA).
 
Hi there @Dragon_J - About the only thing there I see to be a bit on the edge would by your OGTT+1 reading. Yourr stating reading of 6.01 is 0.1 above the line, but I would be surprised if that's a red flag meassure. Usually for non-diabetes folks he +1 hour reads below 10.5-11 (depending on your country's criteria), and yours is marginally above that, but then snaps back promptly.

If that is what your doctor is referring to, he may consider you have a slow first phase insulin response, but we're all speculating here.

Wikipaedia covers things a bit: https://en.wikipedia.org/wiki/Glucose_tolerance_test
 
Dragon_J said:
Thank you very much everyone for taking time to read and reply!

@Bluetit1802 Regarding reasons, he said that I'm on a very very edge of what's normal. I believe he meant the edge between normal and prediabetic? He also mentioned that my insulin levels should have gone to a lower value after 2 hours.

@catapillar Yes, I'm paying him privately but he told me to come for control after one year. So, I thought if he'd want to get more money from me, he'd tell me to come sooner and more often.

One thing I didn't mention are my fasting blood glucose results from previous years which are:
2014: 5.31
2015: 5.68
2016: 5.62
march 2017: 6.05 (this is when they told me I should see an endocrinologist)
dec 2017: 6.01 (the test from my first post)

There is somewhat of a general upwards trend but I thought it's not something to worry about too much.

I also didn't say my age which is 39.

@Bluetit1802 , you mentioned stress. The test didn't start well, the nurse didn't put the cannula in my vein correctly, so there was some strange reaction where the vein had a spasm and didn't let the needle in. I was in cold sweat and some strange feeling of fury overwhelmed me, narrowing my field of vision. I've never experienced anything like it. We waited a bit for me to calm down and tried the other arm after a few minutes which went just fine. Could that stress have raised my blood sugar so fast, that is, in a few minutes? If so, that initial glucose measurement of 6.01 could be wrong.

I understand you're not doctors, but your comments confirmed that I'm right to have doubts about taking the therapy. Thank you very much. I should ask for an opinion of another endocrinologist I guess.
Click to expand...


these fasting levels are completely fine. for comparison, my fasting blood test result was 47mmol/l when I was diagnosed. so I think you’re pretty much okay.
I do not follow the low carb diet but I know a lot of people on here do, might be worth a look into that instead of jumping straight to metformin? Up to you obviously

Kind regards,
jade
 
@DCUKMod Thank you for info. I've googled "first phase insulin response" and found a bunch of new information.

@jadeashton24 Thank you for being reassuring. I hope you're right and that this is not the beginning of something. I so hope scientists will find a cure for diabetes soon and make it a thing of the past. I feel a bit embarrassed that I've come here freaked out by my doctor and test results which are nothing compared to what people with diabetes have to go through.
 
Please don't feel embarrassed. There is no reason to be. You are a young man being proactive about your health, which is excellent, and along the way you are learning all about a disease that has become epidemic. You are also learning how to keep it at bay for as long as possible. :)
 
I don't normally test fasting levels but did this morning and it was 6.4 which is ok for me considering my diet and sleep patterns of late.
If you do get a meter remember that stress, lack of sleep and other illness even a cold can all affect your results.

After reading what you wrote about your diet, it sounds like 75g of glucose would be quite a shock to your system. Sometimes instructions for a OGTT suggest you eat at least 150g of carbs for a few days before the test to avoid false positive results.
 
Thank you @Bluetit1802 and @Alison Campbell . Alison, so your FBG remained almost the same as it was in 2011. Seems like you've stopped the progression.

@kokhongw That's what I've also found today by using google image search :) My graphs are similar to the Pattern 3 graph in that paper. I mostly differ from that pattern in that my levels come back down more after 2 hours. They say that Pattern 3 patients had a higher chance of developing diabetes than patterns 1 and 2, but patterns 4 and 5 are at the most risk.

I'll definitely buy a measuring kit and take frequent measurements for a week to see what more data will show.
 
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