Do you Have Pre-Diabetes or Diabetes?

On an initial consult I ask my clients to bring a copy of their most recent blood work. As I glance at the numbers I may ask "when did you get diagnosed with diabetes?" I usually get a look of astonishment with the client saying, "my doctor told me my sugar was a little high and that I am pre-diabetic but not diabetic."

How do you know if you have diabetes? The American Diabetes Association (ADA) has clear-cut guidelines. However, I find these guidelines are not known or acknowledged by many health care professionals.

There is a blood test called the glycosylated hemoglobin A1C. Basically, this is a fancy word showing what your blood sugar has been averaging over the previous 3 months.

Laboratories across the United States have differing normal values, but the average normal for A1C is 4.0-6.0. Once you go above 6 you are technically diabetic, not pre-diabetic. It is like you are pregnant or not, not just pre-pregnant or a little pregnant.

Another way to diagnose whether you are diabetic is to look at your blood sugars 2 hours after eating a meal. If your values register over 126 on more than 2 occasions the ADA guidelines state you are diabetic.

I look at my patient’s fasting blood sugar levels as well. A fasting blood sugar in the 100-115 range could indicate diabetes or that one is on the verge of diabetes. Because these values fall into normal range your physician may not alert you to your level.

Obtain a copy of your blood results and look at your values over time so you have control over your health and knowledge of what is happening in your body.

A diagnosis of diabetes is not a death sentence. If your A1C goes over 6, altering your diet and exercise program can quickly put you back into the normal range. However, your lifestyle will need to be maintained. Diabetes requires daily management.

Knowing your values and the definitions gives you awareness of your health. Hopefully if you hear your health-care professional state "you have diabetes" it will not come as a surprise.

Can you Have Diabetes without Knowing It?

Diabetes can be a slow silent killer and closer than you realize.  With one in three Americans insulin resistant and in the pre-diabetes range soon these people could be diabetic.

Double the amount of people in the US getting cancer and swine flu combined have diabetes, yet many are not even aware of the risk or take it seriously.  Diabetes is a serious disease with multiple complications, yet can so easily be prevented and or controlled with simple lifestyle management.

So where do we begin?  I am going to take a few blogs to answer questions and invite those reading to ask questions they may have regarding nutritional diabetes management.

If you have a parent with diabetes you have the gene and are at a much higher risk that those without a family history and/or have a poor lifestyle.  In general it is a good idea to have your doctor monitor your fasting blood glucose level (sugar taken prior to your am meal).  This number should be less than 95.  If you find your fasting blood sugars rising over several years you are slowly becoming diabetic.  Fasting numbers in the 100-115 range are considered pre-diabetic.  What are other measures to check if you suspect you are diabetic?

Glycosylated hemoglobin A1C – a fancy name for what your blood sugar averaged over the last 3 months - can be easily measured with a regular blood test. That number should be less than 6.0.  Many times patients will come to me stating they have pre-diabetes or a few higher blood sugars when indeed they are diabetic.  Once this number is over 6.0 you are technically diabetic.  Another way to diagnosis diabetes is to test your blood sugars 2 hours after a meal.  If that number is over 126 on more than 2 occasions then you are diabetic, according to the American Diabetes Association guidelines.

If you want to get more technical then have 2 other tests done- a fasting insulin level and c-peptide.  Both these measures can become elevated before the A1C rises and measure how hard your pancreas is working to achieve a normal blood sugar level.  The fasting insulin should be less than 10 and the c-peptide should be less than 4.0.  Normal ranges for some laboratories may slightly differ from these numbers.

Have these laboratory tests measured annually with a physical exam to keep track to prevent a possible surprise diagnosis.  Taking control of your health may mean you need to monitor these levels yourself since they may be in range, and passed over by your physician who may be looking for flagged numbers.  Because a lab does not differentiate whether a “normal” glucose is fasting or non-fasting it is very possible to be diabetic and not be aware of it.  So yes, you can have diabetes and not know it sometimes for many years.

Tomorrow – Preventing Diabetes