Foundation for Prevention
There are many diagnostic tests that your doctor can use to evaluate you for prediabetes or type 2 diabetes. If you have to choose the most meaningful, it is the A1c. This test, for most people, provides a window into how high their blood sugar has been over the past three months. This section discusses a number of items that your doctor may use in evaluating you.
What tests should my doctor do?
- A1c. Also known as hemoglobin A1c or glycosolated hemoglobin. This test measures a percentage of your red blood cells that have been modified by your sugar level. Since your blood cells last several months, this provides a picture of your average blood sugar over a period of the past two to three months. In the past, 6% was considered it a the cutoff figure to differentiate between normal and diabetes. However, newer recommendations are more confusing! There is a very slight increase in risk above 5.7% so these are sometimes considered abnormal. However, those risks go up considerably and at a much faster rate once 6% is past. Despite the increased risk of disease from high blood sugar, there are now recommendations that diabetics should not go below 7%. That caution only pertains to diabetics receiving medication, since it has been shown that diabetic medication, when used aggressively to bring A1C back to normal, increases the rate of death by stroke! When using dietary control without aggressive medication, A1c should be brought down all the way to normal ranges.
There are few times that this test may falsely give a lower reading. Some people of Mediterranean descent may have a type of anemia that has a different form of hemoglobin, making this test inaccurate. People who have had a recent blood loss will have newer red blood cells, also making this the test give a falsely low reading. In these special cases, a test called Fructosamine can be substituted. Because the A1c is commonly used to monitor people who are already diabetic, insurance companies occasionally may block its use in other people, despite it being the best available test. If this is the case, pay for it out of pocket if you can. It is well worth it.
- C-reactive protein. This test does not measure your sugar, but instead it is a marker for inflammation. This inflammation can be present in the metabolic syndrome and is associated with the harm done by excessive insulin levels and insulin resistance. It should be considered the second most important blood test for prediabetes.
- Glucose tolerance test. This test comes in a variety of lengths, typically two to five hours. It requires you to stay in the laboratory, while they give you a measured amount of sugar to drink and repeatedly draw blood at specific intervals. Needless to say, neither the patient nor the laboratory love it. It does provide valuable information, demonstrating how your body reacts to high sugar levels, whether it brings them down to normal, and can demonstrate abnormal reactions found in people with hypoglycemia, which also can be a precursor to type 2 diabetes.
- Fasting glucose. This is the most common tests given, usually as part of an annual chemistry panel. It only shows what your blood sugar is after you have been fasting overnight. In the early stages of type 2 diabetes, or a prediabetes, your body is still capable of bringing high sugar levels down in that extended time period. Therefore, it can completely miss the diagnosis while your body is being actively harmed. Although is useful to know and does provide a diagnosis when it is high, a normal reading does not signify that all is well.
- Fructosamine. As described above, this test is a useful alternative when the A1c may not be accurate. It too reflects average blood sugar, but over a shorter period of two to three weeks.
- Fasting insulin level. Most people believe that diabetes means that you have an insufficient supply of insulin. That is totally true for type 1 diabetics, who comprise only 5% of diabetics in the U.S.. Today, most diabetics are type 2 diabetics. This is more complex. Type 2 diabetes is characterized by insulin resistance. Your body reacts to it excessive carbohydrate intake by telling your pancreas to produce more insulin. The cells that received the insulin signal gradually become more resistant to this insulin excess. As this insulin resistance increases you have to produce even greater amounts of insulin to cope. It is only in the very late stages of type 2 diabetes that your pancreas can not produce sufficient insulin. A high insulin level can be a marker for insulin resistance in the early stages of prediabetes and type 2 diabetes. . This can be a very useful test for young women suffering from polycystic ovary disorder.
- Home glucose monitoring. You would not expect someone who has not been diagnosed with diabetes to use home monitoring, but it is common when another family member is diabetic. People sometimes borrow their relative's glucose meter to check their own blood sugar. If you have done this, don't waste at this valuable information. Record it and share it with your physician. The three best times to record this are first thing in morning before eating, two hours after eating, and if you experience a hypoglycemic episode, such as feeling lightheaded, dizzy, or anxious.
- Your waist measurement. In American men and women waist circumference greater than 40 inches for men and 35 inches for women usually signifies the metabolic syndrome. This is because some the conditions that bring type 2 diabetes about also bring about abdominal obesity. This obesity is not just subcutaneous fat deposited under your skin, but also includes omental fat covering your internal organs. These numbers are slightly lower if you have Asian or Latin American ancestry. The ratio between your waist circumference and your hip circumference can also provide valuable information.
- Your weight. Although it is not a guarantee, overweight increases the risk of developing diabetes. However, you need to know that some diabetics are considered with in the normal weight range. Also, your ethnic heritage and muscular development may influence what is considered it your normal healthy weight range. Although BMI or body mass index is often used in government studies, it is a poor measurement for individual decisions. When time and equipment allow, estimating your percentage of body fat can lead to better decisions regarding healthy weight goals.
- Your physical examination. Your doctor may notice physical problems associated with diabetes. One example is diminished feeling or loss of sensation to vibration in your feet and legs, which could be due to early stages of a peripheral neuropathy.
- Your family history. Diabetes in close relatives in your family of origin can point to both genetic and cultural factors that increase your risk.
- What you have to say. You may tell your doctor about problems you are experiencing that may help with your diagnosis. The single most important skill in any doctor should learn is to listen to their patient before coming to any conclusions.
READ DIABETES RECOVERY:
Reversing Diabetes using the New Hippocratic Diet®
Disclaimer and Cautions
This information is provided by Irving A. Cohen, MD, MPH. Dr. Cohen is the author of Diabetes Recovery: Reversing Diabetes with the New Hippocratic Diet®. He is a Fellow of the American College of Preventive Medicine. He obtained his training in Preventive Medicine at Johns Hopkins University where he served as Chief Resident of Preventive Medicine. All information presented here is the opinion of Dr. Cohen and represents general information. If is not intended to offer individual medical advice. Individual medical advice should be obtained from the reader's personal physician.
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