Am I prediabetic?
December 2, 2013 7:34 PM   Subscribe

Should I be concerned about my recent lab results?

I recently had blood labs run at the doctor's and got my results. My doctor emailed me and only mentioned high calcium levels, but when I got a copy of the printout I noticed that my A1c is 5.7, which puts me in the 'prediabetic' range. I also had my fasting glucose level measured, which came out normal - 79. I'm wondering if I should take any steps to lower this number, or worry about it at all? Or is it likely that since my doctor didn't mention it, it's no big deal?

For the record, I am around 5'2" and weigh about 112 lbs - so I have no weight to lose really. I already exercise a couple times a week and I think I eat pretty healthy - I almost never drink soda, I don't like junk food, and I cook for myself almost all the time. I do eat a lot of carbs (potatoes, rice, bread and pasta) and my mom is diabetic. Should I cut down on those? I would ask my doctor but I have no easy way of reaching him, so I am turning here first!

posted by queens86 to Health & Fitness (13 answers total) 5 users marked this as a favorite
Really, its your doctor that should be interpreting your blood tests, not us.
posted by motorcycles are jets at 7:43 PM on December 2, 2013 [12 favorites]

Your fasting blood glucose level is normal and you have few lifestyle changes to make to improve your blood sugar. Your A1C is right on the border. Don't worry about it.

If you insist on worrying about it, let that worry manifest as continuing to exercise or adding some more exercise, eating more fiber and veggies, and getting re-checked in a year. You are at higher risk than the general population because of your mom, so it's worth continuing to follow up, but at this time you are fine.
posted by latkes at 7:47 PM on December 2, 2013

To elaborate, the specific numbers that determine prediabetes and diabetes are somewhat arbitrary. Some people have symptoms of diabetes at one number, some at another.

A few years ago, the American Diabetes Association sat down and assigned certain cut off numbers for diabetes. 6.5 or greater would henceforth be labeled "diabetes" because when you look at a large population of people, a significant portion become symptomatic of diabetes at that level (and the higher the A1C, the more people tend to be symptomatic).

The whole concept of "prediabetes" is a fairly new one. It is useful in that it is fairly predictive of who may develop diabetes farther down the line, and labeling someone "prediabetic" may be useful if it helps them make changes in their lifestyle that could delay or prevent that happening. But prediabetes is not a disease in itself.

Since you have a family history, and you're already inclined to exercise, by all means, take care of your health! But that doesn't mean you should go on a low-carb diet or panic about your lab results.
posted by latkes at 7:55 PM on December 2, 2013 [2 favorites]

Ask your Dr., but you're right on the line of what some guidelines identify as metabolic disorder (pre-diabetes). Just keep exercising and staying away from junk food and cut down on some of those simple carb foods (potato, rice, bread, pasta, sugar) in favor of whole-grain options and veggies. Get retested in 6 months.

Hemoglobin A1c is an indicator of average blood glucose levels. So, if you're eating a diet high in refined/simple carbs and your A1c is on the border of normal/metabolic disorder, you can assume that your average blood sugar is a little on the higher side of normal. It's easy enough to lower that with diet intervention and regular exercise. No need to panic at all, just make some adjustments and retest in 6-12 months.
posted by quince at 7:56 PM on December 2, 2013 [1 favorite]

One thing people often forget about lab tests is that they have a margin of error.

You can follow the link to see more information, but basically, the margin of error for hemoglobin A1c is plus or minus 0.5% - this means that your actual A1c value could be as low as 5.2%, well within the range of normal. It also means that the actual value could be higher, but given the other information you've provided, that seems a lot less likely.
posted by treehorn+bunny at 8:06 PM on December 2, 2013 [2 favorites]

Home blood glucose monitors are fairly cheap - you could get one and follow your response to meals for a few days. It might be illuminating, but, that said, ask your doc!
posted by abecedarium radiolarium at 2:49 AM on December 3, 2013

For the record, I am around 5'2" and weigh about 112 lbs - so I have no weight to lose really. I already exercise a couple times a week and I think I eat pretty healthy - I almost never drink soda, I don't like junk food, and I cook for myself almost all the time. I do eat a lot of carbs (potatoes, rice, bread and pasta) and my mom is diabetic. Should I cut down on those? I would ask my doctor but I have no easy way of reaching him, so I am turning here first!

This sounds like me--like EXACTLY--before I was diagnosed as prediabetic! They also told me that I have Impaired Glucose Tolerance, so like you my fasting levels are fine, but my levels after consuming glucose were not great. Definitely talk to a doctor to see if you should make changes to your diet. I have felt much healthier and happier since I went low-carb (I have more energy and I am no longer hungry 24/7, don't know if this is an issue for you), but you need to know for sure if that's what your doctor wants for you.
posted by chaiminda at 4:50 AM on December 3, 2013

Slightly hypocritical advice mode on....

I suspect that the best way for someone who fears becoming diabetic in the future to live is to act like they are diabetic today. In other words, the things that a diabetic should not eat.....are the very things that will get you to prediabetic someday (if you have that predisposition). The things that a diabetic SHOULD eat are the things we all should probably be eating anyway. Rather than worrying that you are borderline prediabetic, maybe take a look at your diet and exercise and see if there are things you can improve (without going extreme) that will be good things. Carbohydrates should be in the form of whole grains and vegetables rather than white grains or sugar. This doesn't mean missing out on birthday cake, just being aware of that sugar in the coffee, the white rice at dinner...that sort of thing. Exercise should be an important part of your weekly (daily?) routine with some variety of activities that both build strength and get your heart pounding. These are things that diabetics are recommended to do to reduce their symptoms....and we all should be doing them anyway even without symptoms!

Lots of people who are prediabetic have a really obvious symptom of weight gain due to insulin resistance that leads to poor sugar and fat metabolism. Unfortunately, there are plenty of people who show the signs of a lifetime of Western refined-sugar and refined-grains living that leads to diabetes without the added weight. If you live like you are fighting diabetes, you will be less likely to ever have diabetes (IMHO).

Oh, I forgot to add....if you have or plan on having children, gestational diabetes is easily treated but also a good indicator of a person's chances of getting diabetes in the future. Be watchful for that!
posted by BearClaw6 at 5:45 AM on December 3, 2013 [2 favorites]

I would make an appointment with your doctor to discuss your recent lab results. Explain that you are concerned about your high A1c levels, especially since you have a family history of diabetes.

Your doctor might send you for a glucose tolerance test to determine if you're prediabetic, or have you repeat the fasting glucose and A1c test in a few months. Or your doctor might explain to you that you have nothing to worry about.
posted by inertia at 7:18 AM on December 3, 2013

IANYD, but on my first visit to a new GP, my fasting blood test results had a glucose reading in the very low end of the "prediabetic" range, and my doctor flipped out about it and told me I had to do diabetic education and change my lifestyle by eating better (He didn't ask, but I already ate a very healthy diet.) and exercising (He didn't ask, but I was running 15-20 miles a week.).

I declined to do the diabetic education, kept eating and exercising as before, switched to a different GP, and never had another high reading.

By all means, though, if you're concerned, call your doctor's office and ask if you can discuss this over the phone, or in an office visit, if you'd really prefer that.
posted by BrashTech at 7:38 AM on December 3, 2013

As someone who has been dealing frequently with doctors and blood testing recently, I have to echo the sentiment of some of the previous posts.

I hate to generalize, but most doctors today aren't as smart or infallible as you may have once believed them to be. They shoot for normal instead of optimal. They are quick to write you a script for Lipitor or any other drug without doing enough testing or "digging" to really get to the bottom of what is going on.

My advice would be to get a second opinion if you really wanted to put your mind at ease, but to continue to eat healthier and make REASONABLE lifestyle changes and get retested and reevaluate your options and approach at that point. Be prepared though to encounter possible contradiction. Of the doctors that I have seen, not only do they not agree, but one will completely contradict the previous.

I would look into possibly seeing a functional medicine doctor and maybe reading Sherry Rogers book on Diabetes.

Good Luck
posted by kbbbo at 9:15 AM on December 3, 2013

a1c measures transient blood sugar levels over time. Higher a1c (unless you are a metabolic outlier) means somewhere in your lifestyle, your blood sugar is going too high. It is a good test because it isn't a snapshot like blood glucose is.

Diabetes and belly fat run in my family, so I've been on the lookout for pre-diabetes. I too can come up with a fasting glucose that is perfectly normal, but if I overeat, my blood sugar will spike delightfully high. Then, 12 hours later, it's back down to normal. When I followed the advice from above, which is to eat as if I do have pre-diabetes, I lost 30+ pounds in practically no time.

Not implying that you need to lose weight, but that adjusting my diet made a huge difference in my overall health. The only problem is that I HATE eating small meals. i am ravenous for 10-15 minutes after a meal. But then I'm fine, and end up feeling not-hungry for much longer than with my previous diet.

The other upside is that many IBS type symptoms went away and I don't have to worry about indulging in the occasional giant meal, because my regular everyday diet is sufficient to maintain my weight. (Instead of being constantly on the calorie watch, and not getting results.)

Short answer: eat half as much per meal. You'll probably find that you don't end up eating twice as often.
posted by gjc at 7:40 PM on December 3, 2013

I'm pre-diabetic. It's forced me to eat properly and to take care of myself. If you're concerned about it, you should start eating low GI foods. Quinoa is great. It satisfies my grain cravings and it's packed with protein. Quinoa won't cause a spike in blood sugar either. When you are eating the starchy foods you enjoy, make sure you pair them with low GI foods during the same meals. Try to avoid eating large portions of simple carbs, there's really no one who can get away with that without overworking their pancreas anyway. Being pre-diabetic can be a blessing in disguise. It's forced me to take my health seriously and I'm actually thankful for it. If it's a concern, just eat like you already are and you'll have nothing to worry about. Problem solved. It runs in your family so you're right to stay on top of it.
posted by OneHermit at 12:42 AM on December 5, 2013

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