How should I monitor myself for potential Type II diabetes?
October 18, 2007 12:27 PM   Subscribe

I have a family history of Type II Diabetes and would like to be proactive about monitoring my own health. Questions & concerns inside.

My mom has it, her mom has it, and I had gestational diabetes. It's [statistically] likely that I will eventually be diagnosed with Type II.

3 months after delivering my son, I had an Oral Glucose Tolerance (OGT) test and passed. My OB was constantly surprised at my fasting numbers (very low) during pregnancy, but that my postprandial numbers were very hard to control even when eating only 30 grams carbs at a meal. Additionally, a few 2 hour postprandial readings I took with my meter (a few weeks after pregnancy but before my OGT) were quite high - near 200. I was frankly very surprised that I passed the OGT.

She told me that I should probably have the 75 gram OGT yearly. She said that usually after a gestational diabetic patient passes the first OGT after pregnancy, they should have a simple fasting test yearly after that, but she highly recommended that I have the OGT yearly instead.

I finally chose and saw a primary care doctor (I won't see my OB again unless I'm pregnant) and had a long get-to-know-you appointment where I scheduled a lot of routine lab tests. I told her all of the above, and she seemed bemused by my OB's suggestion of an OGT. New Doc said that's not the way she does it, and she suggested an A1c test. I'm familiar with the test since my mom gets them, and thought it was a great idea at first, but after Googling it, it doesn't sound like test is ever used to diagnose diabetes.

Would the A1c be useful for a non-diabetic at all?

Should I just request or demand the OGT?

Is there any standard of care for patients like me who are not officially diabetic or even pre-diabetic, but have a high likelihood of getting Type II and want to avoid it? (I'm already doing the "duh" things: I exercise 6 days a week, don't drink pop, eat reasonably, maintain a healthy weight - but hey, I did all that before and still had hard-to-control GD.)

I do know that one option is always to buy my own monitor and test strips, but as that wouldn't be covered by insurance it would be exceedingly expensive for me.
posted by peep to Health & Fitness (11 answers total) 8 users marked this as a favorite
Best answer: Type II here. I was diagnosed by a fasting blood test (hello 399!).

I am not a doctor or your doctor, so you should ask YOUR doctor to clarify why she wants to do an A1C, as there might reasons the general lay person doesn't know. My guess is that since the A1C measures blood glucose over time, she may want to establish a baseline and continued history to see how you're progressing.

What you're doing diet and exercise wise seems perfect.

Look around your city and see if there's a diabetes program that offers free meters and/or cheap strips. The hospitals are usually good for this.
posted by Brandon Blatcher at 12:50 PM on October 18, 2007

Maintain a normal BMI. This is crucial. I can't even emphasize how crucial.

Keep exercising.

A diagnoses of DM II is made after two abnormal fasting blood sugars. The regular fasting blood glucose, nothing fancy.

Hb A1C in your case cannot hurt. You have had elevated blood glucose in the past.

Eat and behave like you have diabetes right now and for the rest of your life. This is not an especially difficult way to live. The exchanges and all that stuff is old school. It's about calorie control and refined carb control. You can still have a piece of cake now and then. You probably are aware of this since you had gestational diabetes. Visit if you haven't already.

Don't be so sure that you will eventually develop diabetes. Yes, gestational diabetes can increase the likelihood, but fight on and keep yourself healthy.

posted by LoriFLA at 12:56 PM on October 18, 2007 [1 favorite]

I also meant to add: trust your physician on the A1C. She probably isn't doing it for ha-ha's.

Researching medical information can make us all question and wonder, which can be good. It also can raise anxieties and give us incorrect or bad information.

Good luck.
posted by LoriFLA at 1:03 PM on October 18, 2007

The A1C is basically a 90 day average of your blood sugar. It's used by diabetics to monitor their long term control. So yes, if the A1C is outside of accepted normal ranges, it certainly can indicate a problem.

However, most people feel it when their blood sugar is too high or too low. Given that your not actually diabetic, I would think you don't need to worry about checking your exact blood sugar levels daily and just be aware. If you blood sugar is swinging low or high you will feel it and that will be the trigger to get back to the doc.

Just my opinion, I am not a doctor and I don't play one on the internet.
posted by COD at 1:06 PM on October 18, 2007

Best answer: However, most people feel it when their blood sugar is too high or too low.

No, this is wrong. Diabetes is a silent killer. Most people have no idea that their moderate diabetes is damaging their retinas, kidneys, heart, nerves, and blood vessels until severe, irreversible damage is done.

You don't just take a person off the street and order up an HgbA1C to find out if they have diabetes, peep, that's true. But if a person has had pretty significantly elevated blood sugar levels, they're not the random guy off the street any more; they're in a diagnostic grey area. An OGTT and fasting fingerstick capture a snapshot of a person's glucose level at one moment in time - a highly artificial snapshot that doesn't reflect the way that person lives every day.

Just as COD says: HgbA1C is a compound created when high glucose levels in the bloodstream cause the hemoglobin in blood cells to become glycosylated - in other words the extra glucose sticks to the hemoglobin. It's important because red cells stick around for 120 days or so and so instead of getting a snapshot of one moment in time you're getting a moving average of blood sugar levels over a couple of months. If this number is low or in a middling range, it won't be useful. But if it's very high it can be an indication that the other tests aren't fully capturing the range of your blood sugars and that you may have diabetes that's flying "under the radar" of the screening test. Remember that screening tests are never 100% sensitive in terms of diagnosing the disease in question, but when it's your own health on the line you'd like to be close to 100% sure.

Over time we're learning that it's much better for overall health to treat diabetes before it ever generates symptoms and in general I applaud docs who use all the diagnostic firepower they have when things are in the grey areas.
posted by ikkyu2 at 1:18 PM on October 18, 2007

Correction noted. People generally feel lows, not so much highs, especially mild ones. And it's the highs doing the damage. Not sure what I was thinking when I typed that.
posted by COD at 5:04 PM on October 18, 2007

"I do know that one option is always to buy my own monitor and test strips, but as that wouldn't be covered by insurance it would be exceedingly expensive for me."

They really aren't, here is one with test strips for $35.

I bought this one about a year ago just to play with. What I learned was that my ability to gauge my own blood sugar level by how I felt was actually a little worse than chance.

Please note that a glucometer like this cannot be used to diagnose diabetes. It's just too inaccurate and outside of a doctor supervised test it really isn't going give you more than a ballpark idea of where your blood glucose ilevel is.
posted by 517 at 6:31 PM on October 18, 2007

Here it is.
posted by 517 at 6:33 PM on October 18, 2007

This page has some specific info on what appears to be a good preventative diet. I'm lazy today and didn't check the sources, so you may want to keep that in mind.

The article concludes: "Available evidence indicates that diets abundant in grains, vegetables, and fruit; restricted in highly processed foods; moderate in fat and restricted in saturated and trans fat; and moderate in protein are associated with a wide range of health benefits. This same basic dietary pattern is linked with weight control and sustainable weight loss; with regulation of serum insulin levels; and with the prevention and amelioration of diabetes mellitus. "
posted by moira at 2:07 PM on October 19, 2007


Another try at the link.
posted by moira at 2:08 PM on October 19, 2007

Response by poster: All answers were good, thank you! My doc didn't order any other test besides the A1c, so I'll get that one done and go from there.
posted by peep at 10:01 AM on October 22, 2007

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