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Old 10-18-2012, 02:08 PM   #1
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Diagnoses

I got some new outlook on my medical condition yesterday. My doctor is himself an adult onset type 1 diabetic. My former Docs looked at my age, my FBGs, and my A1C, and said I had prediabetes or metabolic syndrome. This new doctor looked at the same things, plus an insulin resistance score based on lipid patterns from Liposcience, my always very low triglycerides, and my always very high HDL. Then he asked if I had ever been fat (no). Then did I gain or lose weight easily (lose)- if I decide I am getting a little ugly I can shed 5 pounds in a couple weeks, merely by dropping lower on carbs. He asked if I craved sweets or other carbs (no).

Then he said that very likely I have genetically marginal insulin output, but that my blood sugar control is good because I eat almost no carbohydrate, beyond greens, onion and garlic, et cetera. He said if I ever did become diabetic, it will be much more similar to Type 1 than type 2, and as such actually easier to control. He also said that if I relaxed my dietary control and exercise I would likely need insulin fairly quickly. But I have no plans to do that, giving up carbs to me is a lot like giving up nothing. My liking for potatoes and such was mainly cultural, and therefore vulnerable to conscious rational attack. ( Would you rather eat like your grandfather and get sick, or eat like you actually do and feel and look good?)

I find medicine and medical diagnoses and interactions interesting from a social or anthropological POV. And this makes it less personal, and thus somewhat less threatening.

Ha
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Old 10-18-2012, 04:06 PM   #2
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I think medicine is a lot like physics. There is far more we don't know than what we know (or think we know). Still, most in both fields seem to try their best.
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Old 10-18-2012, 04:20 PM   #3
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This is your brand new doctor? So he has only seen your A1C and other blood values once?

I'd switch doctors, personally. I could be wrong, and probably am, but this one sounds a little flaky to me. One high blood sugar reading just isn't enough upon which to diagnose pre-diabetes, at least for my doctor and F's (different) doctor.
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Old 10-18-2012, 04:26 PM   #4
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Very interesting. It sounds like you are doing all the right things regardless of the differing opinions on diagnosis between your new and old docs.
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Old 10-18-2012, 04:47 PM   #5
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Also diagnosed metabolic syndrome... and also love carbs...

Gave in to DR. and take metformin to drop glucose to under 100 (from 115).
Biggest problem is BMI, which is over 30... but after 20 years with same weight, don't have plans to change... Have taken stuff for triglycerides and cholesterol and they work.... now close to normal from really bad.... Now BP averages 120...

Didn't usta care, but now I do...

25% of adult males in U.S. have metabolic syndrome...

Would like another 8 to 10 years... renegotiable at that time.
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Old 10-18-2012, 05:03 PM   #6
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I think medicine is a lot like physics. There is far more we don't know than what we know (or think we know). Still, most in both fields seem to try their best.
Yes but the problem I've run into is Physicists will gladly admit that they "don't know". Doctors on the other hand will always insist they are right, will never even consider you might know re about how you feel than they do, and are all full of "You have to believe me. I'm a doctor". I've never been nearly killed by a physicist's unfortunate sequelae. For a while I was almost convinced my doctors had a pool going.
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Old 10-18-2012, 06:11 PM   #7
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This is your brand new doctor? So he has only seen your A1C and other blood values once?

I'd switch doctors, personally. I could be wrong, and probably am, but this one sounds a little flaky to me. One high blood sugar reading just isn't enough upon which to diagnose pre-diabetes, at least for my doctor and F's (different) doctor.
Well, he didn't actually diagnose pre-diabetes, I had that put on me by a previous doc, and then it kind of followed me around. I may not have been very clear in my post. I don't know the exact criteria, perhaps prediabetes may not really be a diagnosis, just a catagory when you are not fully normal but don't really meet the criteria for a diagnosis of diabetes.

This doctor has seen my results going back years. If I go to new doctor I take a packet. He says that by diagnostic criteria including A1C, I have nothing, no diabetes, no prediabetes, no metabolic syndrome. Yet I have no doubt that my sugar processing is not fully normal, and neither does he when I describe how I eat and what happens if I don't eat that way. I have a meter. Some people can eat a hot fudge sundae and an hour or two later have a blood sugar of 80. That would not be me, although I do not test that hypothesis.

I think all he said, and I actually agree with him from the observations I have made over the years, is that to whatever extent my carbohydrate processing is less than optimal (and it is), it very likely comes not from insulin resistance, but from a relative lack of insulin production. These are fundamentally different conditions. My sister has been diagnosed with this- adult onset Type 1 diabetes. A fundamental difference between her and me other than she has had 4 babies, and I am male, is that she does not believe in the value of lifestyle adjustments when confronted by physiological malfunctions.

I admit I am proactive about this kind of thing, but to me the biochemistry and pathophysiology is more important than what the medical consensus decides at any certain date is the threshold for a named diagnosis- although I know that is very important from an insurance POV. I just ask myself, what is important, what might I be able to have some control over, and what does it cost monetarily or behaviorly. As I tried to point out in my OP, food reward from carbs is not a biggie for me while avoiding certain outcomes is.

Everyone has differing discount functions about decisions like this for sure.

Ha
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Old 10-18-2012, 07:04 PM   #8
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My doctor tells me I am fine. I tested with my meter yesterday after two hours and I was at 230. I checked one hour later and 230. I exercised heavy for 15 minutes and it was 140. My fasting is always under 90 so no doctor around here will tell me I am diabetic. I know better. I ordered one of those A1C kits online a few years ago and it was 5.6. I know for a fact it is not that good now. I have not watched myself very good for a while now but you bet I will from now on. I am 5ft 10 and weigh 180 but nobody believes I am that heavy. I do not want to lose a lot of weight like I did 8 years ago so which route do I go? I have known about this problem for over 8 years. I am age 65 and since I retired I have got a little lazy but after that number yesterday I am back on the program again. oldtrig
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Old 10-18-2012, 08:28 PM   #9
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I think medicine is a lot like physics. There is far more we don't know than what we know (or think we know). Still, most in both fields seem to try their best.
I think you are maligning physics.
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Old 10-19-2012, 12:06 AM   #10
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I read a book called Diabetes Solution by Richard Bernstein long time ago (maybe 10 years ago). It was written by a man who was diagnosed with Type 1 diabetes when he was a teen. He, I believe, was the first person who treated his Type 1 diabetes with diet while monitoring his blood sugar levels. (He was an engineer and found all this by researching and experimenting himself with his theories and he even tried to publish some findings, but nobody took him seriously, so he decided to get a medical degree.)

Anyway, he looked like the proof that even Type 1 diabetes can be treated with diet (although I believe he still had to take a small amount of insulin) - I cannot remember much of what he ate, but I think he just limited carbs.. and ate tons of fat (I remember recipes with one of those fibrous scandinavian crackers (sorry to be so vague, I cannot remember the name) - that seemed like the only carb he allowed himself.)

So Ha, I believe whether Type 1 or Type 2 or pre-diabetic you have, what you are eating (and not eating) is definitely doing you a lot of good (Probably your pancreas is thanking you for not overloading it with crap.)

I am just amazed as to how well you can adhere to the low carb way of life. My hats off to you.

BTW, oldtrig, I did those over the counter A1C tests (Bayer, I think - wasn't cheap) myself. I don't trust it. My result from the clinic lab was way off campared to the numbers I was getting from the A1C kit.
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Old 10-19-2012, 11:41 AM   #11
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I see the "genetically" marginal insulin production and wonder if you have any autoimmune symptoms? Is your hsCRP reasonable?
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Old 10-19-2012, 11:54 AM   #12
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I am curious - what "symptoms" would lead a person to believe he/she may be diabetic, or pre-diabetic or anything diabetes-related, if fasting blood sugar levels are always normal?

Just trying to give myself yet another thing to worry about. Siblings are Type 2 and Pre-D, and keep telling me it's in my genes. Meanwhile, I am a dedicated carbohydrate consumer, who loathes fatty foods.

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Old 10-19-2012, 01:03 PM   #13
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As far as diabetes symptoms go, if you have metabolic syndrome you are a baby step away. Just google it and see how much of the description applies to you.
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Old 10-19-2012, 01:43 PM   #14
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Thanks - but all my "numbers," as far as tests go, are in the normal range, and I am not overweight. Somehow, I got the distinct impression that some posters also have "normal" test results, but just don't "feel" quite right, which makes them suspect a diabetic situation. I just wondered what the "not feeling right" part could be.

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As far as diabetes symptoms go, if you have metabolic syndrome you are a baby step away. Just google it and see how much of the description applies to you.
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Old 10-19-2012, 04:29 PM   #15
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... I just wondered what the "not feeling right" part could be.

Amethyst
Oh, OK. As far as that goes, I doubt there is a reliable feeling which predicts diabetes. The best thing to do is get a meter and do some post meal testing. Meters are inexpensive and will give you a much better idea of what is happening compared to annual fasting glucose measurements.
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Old 10-19-2012, 09:54 PM   #16
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I agree with rgarling.

Amethyst,

Get a meter and test it every 15 minutes after you eat. What is expensive is the test strips. I use truetest strips and the meter. Cheapest on the market , I think. On ebay, you can get 100 test strips for like 25-30 dollars.
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