a1c 8.9 ...

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a1c 8.9 ...


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Old 06-23-2019, 14:31   #1
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Default a1c 8.9 ...

A friend of mine (52 y.o. male, overweight but not obese) recently had his a1c level checked at it was 8.9. This was after several weeks of using a glucose meter to track disturbing blood glucose values. He then went on a rather severe low carb diet, lost several pounds, and his a1c is now 5.7. Of course I am happy his a1c is now at a safe level. But I have some basic questions about his situation

1) Should he go through more extensive testing to determine his insulin output? Is this done only through an endocrinologist? I believe my friend has only been working with a PCP.

2) An a1c of 8.9 suggests to me that he has been unknowingly been dealing with elevated blood glucose for a long time (years). If it was a sudden onset then presumably there is some autoimmune mischief going on. Would checking for antibodies (to distinguish type 1.5 diabetes from type 2 diabetes) be standard procedure?

My friend has dealt with rather awful health issues in his life, including cancer, and has the right fighting attitude to maintain his health. Fortunately for him I think he can sustain the diet he is on even though he hates it!


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Old 06-23-2019, 15:51   #2
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I went to a couple of general practitioners that only told me that I was borderline diabetic for a few years before I went to an endo who told me that I was a type 2 "lean". The GPs never told me I was prediabetic or diabetic. The Endo's office told me to come in non-fasting because he liked to see what was going on. I was told that the 166 mg/dL 2 hours after breakfast they tested didn't mean I was diabetic. I asked him what did my A1c of 8.8% a couple of months prior to seeing him mean. Type 2 lean, it was going to be hard on me because I wasn't obese and didn't have a lot of weight to lose. I wanted to go to an Endo to get to the nitty gritty of what was going on in my body. Instead I got general presumtions.

My unqualified opinion in response to your questions:
1) Your friend's PCP should be able to determine fasting insulin levels and should be able to run an OGTT (oral glucose tolerance test) to measure blood glucose and insulin levels. If not then maybe go see an Endo. I am sure they are not all like the one I went to.

2) Your presumption is correct and yes it should be standard practice to test for antibodies. Although not all type 1.5s may not present positive results for antibodies initially, many misdiagnosed type 1.5s could start proper treatment with insulin and not type 2 meds if they did. Retesting for antibodies should be standard for those whose BG control continues to get worse after beginning treatment for type 2.

"Severe low carb diet", what does that mean? I eat 20-30 grams per day and I have never hated it, in fact, I am eating a more diverse choice of foods now than I was prior to going LCHF. Is your friend, by chance, having stronger cravings for the foods that he/she gave up than having a dislike of the foods that he/she is now eating.

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Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.4 (10/2018)
TC 206 LDL 102 HDL 85 TG 96 (10/2018)
Supplemental vitamins and electrolytes
64 YY Love the LCHF diet. The cheese goes well with my whine

updated 10/31/19
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Old 06-23-2019, 18:23   #3
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Quote:
Originally Posted by mbuster View Post
I went to a couple of general practitioners that only told me that I was borderline diabetic for a few years before I went to an endo who told me that I was a type 2 "lean". The GPs never told me I was prediabetic or diabetic. The Endo's office told me to come in non-fasting because he liked to see what was going on. I was told that the 166 mg/dL 2 hours after breakfast they tested didn't mean I was diabetic. I asked him what did my A1c of 8.8% a couple of months prior to seeing him mean. Type 2 lean, it was going to be hard on me because I wasn't obese and didn't have a lot of weight to lose. I wanted to go to an Endo to get to the nitty gritty of what was going on in my body. Instead I got general presumtions.

My unqualified opinion in response to your questions:
1) Your friend's PCP should be able to determine fasting insulin levels and should be able to run an OGTT (oral glucose tolerance test) to measure blood glucose and insulin levels. If not then maybe go see an Endo. I am sure they are not all like the one I went to.

2) Your presumption is correct and yes it should be standard practice to test for antibodies. Although not all type 1.5s may not present positive results for antibodies initially, many misdiagnosed type 1.5s could start proper treatment with insulin and not type 2 meds if they did. Retesting for antibodies should be standard for those whose BG control continues to get worse after beginning treatment for type 2.

"Severe low carb diet", what does that mean? I eat 20-30 grams per day and I have never hated it, in fact, I am eating a more diverse choice of foods now than I was prior to going LCHF. Is your friend, by chance, having stronger cravings for the foods that he/she gave up than having a dislike of the foods that he/she is now eating.
Thanks!

I realize I wasn't quite correct in my post. It was his long term PCP who had him use a glucose meter and referred him to an endocrinologist. The endocrinologist had him do the a1c test and then, according to my friend, was insistent he take metformin and refused to discuss diet since he (my friend) "wouldn't stick to it anyway". So my friend "fired" his endocrinologist and sought out a functional medicine practitioner. It was this doctor who got him on the right dietary path. However from what you are saying my friend will need to find a new endocrinologist for more advanced testing. I suspect he would only do so if/when his a1c creeps up or experiences blood glucose dysregulation (eg, low blood glucose).

As for "severe low carb diet", I wasn't meaning to sound critical. Few people can curtail their carb intake by 90% and stick to it indefinitely. The psychological and physical adjustments during the early days/weeks would scare most people from even attempting such a diet I suspect this is why my friend's endocrinologist simply didn't want to talk about it. I greatly admire people who can do it!! A few years back I reduced my carb intake to 50-75 grams daily. I really leaned out. However my libido tanked; my testosterone level dropped to 400. But I suspect there were other factors in play since upon doubling my carb intake, and gaining weight, my libido/testosterone only improved moderately. It took at least two years to fully recover (my testosterone level is now 570). Of course this makes me skittish of going the low carb route but I may do so because it is such a healthy way to live. If I do I will do so very slowly and redouble my efforts in ensuring I am consuming sufficient nutrients.


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Old 06-25-2019, 00:08   #4
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I was at 9.0 at diagnosis 10 years ago. I also had a "C-Peptide" test that determines insulin output. Mine came out "Normal." I asked the doctor, "so...why am I diabetic?" He said, "I don't know."

Yes, I've heard that most Type 2's product sufficient insulin, but it doesn't work properly - for unknown reasons.

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