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Type 2 Strange question

rickydoo

rickydoo

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how would a doctor be able to tell if a diabetic person, that has their blood sugar in check and in a “normal” range, has diabetes?
 
If you have your numbers in non diabetic range, you are not at risk of complications from high blood sugar so I guess it wouldn’t matter?
 
rickydoo said:
how would a doctor be able to tell if a diabetic person, that has their blood sugar in check and in a “normal” range, has diabetes?
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That’s an interesting question, hopefully others with more medical knowledge will chime in as I’m interested in knowing too, but for my thoughts:

So, given that the measures used are just a reference point, if your levels don’t reach those via the usual tests such as hba1c then there wouldn’t be a flag for diabetes unless you historically had it would be my thoughts. Similar to me where I will remain flagged as such but my diagnostic measurements wouldn’t indicate

however, eating higher carbs and similar will cause a spike that is greater than others, so potentially there is a way that some tests (OGTT for example) would highlight. Although for me sugar in this way (chocolate) doesn’t seem to actually cause longer term spike. But potatoes and similar will, so I can see the indicator from what I eat

another indicator could be longer term impacts from previous levels, so historic nerve damage or retinopathy etc. This can take a lot longer to reverse (if at all) so may indicate a marker for it
 
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rickydoo said:
how would a doctor be able to tell if a diabetic person, that has their blood sugar in check and in a “normal” range, has diabetes?
Click to expand...

There are a number of tests that can be used to look at endogenous insulin production.
HbA1c is the most used
Oral Glucose Tolerance Test OGTT) is another that looks at the body's response to a measured "hit" of glucose.
There is also an Insulin resistance test HOMA IR which looks at how much insulin resistance you have using a fasting insulin and fasting blood glucose figure.

Most UK doctors know about the first.
More experienced will know about the second
Few if any will know about the third (and so far as I know it's rarely if ever available through the NHS).
 
If, as I do, I controlled my diabetes with diet sufficiently well then I would probably pass the random test and also have an acceptable Hba1c. I would not pass an OGTT since they feed you a lot of glucose and see how you coped with it two hours later.
 
My personal point of view is that the problem with the OGTT (as a diagnostic tool for diabetes) is that many low carbers would fail (due to not habitually injesting carbs) -- regardless of whether they were ever diabetic.

Maybe an OGTT is just a reflection of a carb-centric environment where it is assumed that the pancreas is prepared for an onslaught of carbs?

So, for me personally taking an OGTT would not make sense (after close to six years of keto) unless I carbed up for a week or more before (and why would I do this just to please someone else)?
 
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rickydoo said:
how would a doctor be able to tell if a diabetic person, that has their blood sugar in check and in a “normal” range, has diabetes?
Click to expand...
If you mean having your HbA1c tested when the doctor didn't have your history then he wouldn't know you had diabetes. You might fail a OGTT, I am sure I would, but they don't do those routinely.
My GP used the QRisk calculator and said he was supposed to prescribe statins. I pointed out that he had ticked the box for diabetic and he wouldn't think I was diabetic apart from my notes. He said fair enough, ran the calculator again and didn't mention statins again.
 
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