I need help interpreting the results of my tests for diabetes. I think my doctor is wrong!!!

I have the general symptoms of diabetes, so I asked my doctor to test me for diabetes. I have had chronic pancreatitis for the past 12 years, and have had 1/2 of my pancreas removed. When I started having those symptoms, I realized that I was probably now showing signs of diabetes, as my past doctors had warned me about because of pancreatitis. Seems reasonable. My Endo tested my blood sugar in his office, it was 179, so he wanted me to have fasting blood sugar tested. First time it was only 97, but the second time it was tested it was 125. So he sent me home with a glucose monitoring kit, and told me to get some blood sugar values 2 hours after eating, and also requested a blood test for AC1. I tested my blood sugar, which varied from 80 to 180, 5 out of 15 were higher than 170 to 180. I called my doctor and gave the results to his nurse. The nurse called me back and said I needed no treatment because my AC1 was great at 5.7. I mentioned my blood sugar values to her and she said she wasn't aware I was testing my blood sugar, but still the doctor said I didn't need treatment. I am confused. Aren't my blood sugar readings high? Are they supposed to be consistently high? Sometimes my 2hr readings are within normal range. And sometimes I can eat the exact same thing, and my blood sugar will me normal one time, and 180 the next. Anyway, I think my doctor is wrong, so I am plan to make an appointment with another physician, who will pay attention and help me. Personally, I think I have diabetes. If I don't, then I must be very sick with something else. Can anyone help me interpret these results?

Your Hba1c is a test that gives them your average sugar over a period of usually 3 months. They want you to be a 7 or lower so your score was good. However blood sugars do fluctuate 2 hours after eating. Everyone goes to 170 180 etc.. but its the diabetics that do not come back down. A fasting of 125 or less is desirable and since you had that your doctor is satisfied that at this time you are not diabetic. You are right to worry since having the pancreatis. I am no doctor but your levels do look good for now. Some people think you have over 125 means diabetes but that is not always true. Some people get glucose intolerant before they have "diabetes" Some have it in the form of hypoglycemia some have normal readings then higher little later on with no explanation. The most important thing is that your sugar does regulate itself by going back down. Your pancreas (even though only half) is doing a very good job. That second opinion will probably help you alot at least make you feel better. I know it would make me feel better to hear another opinion.

Chaos

Strange.. I have been reading the other diabetes posts, and found that a reading as high as 180 is not normal, when tested two hours after a meal. All of my readings were taken 2 hours after eating. And I have also read that some diabetics do have a normal ACI, because they have high readings and low readings that "cancel" each other out which results in a normal ACI. And I have noticed that people have posted that a fasting glucose of 125mg/dl is considered diabetic. During an office visit with my doctor to interpret my fasting glucose results, he wanted to start treatment, because of my history with pancreatitis. And when he gave me the glucose monitoring kit to take home, he told me that a reading of 180 or higher would be something to watch for, again, because of my pancreatitis and partial whipple. So now I am even more confused because of varying comments/posts. I think I will try to find another physician. I appreciate your help!

Readings of 180 are not normal. Nondiabetics may spike at 140 after a large meal, but not 180. If I were you, I would get a 2nd opinion from another doctor. The Hb1ac test does not tell the whole story. You may be having extreme lows that are skewing the results. Damage can occur at 160. 180 is too high.
Jody

Thank you so much Jody! You are absolutely right. Luckily my Endo had a cancellation at the last minute, so he was able to see me today. He said that the nurse did not give him my blood glucose results, so he had no idea. This was a failure of his office, which can be as detrimental as a careless physician, so I may still decide to get another doctor.

He said I am diabetic and prescribed Avandia to see if my blood sugar goes down. If not, he will try something else. At least it is being addressed.

Again, thank you Jody for writing back with good advice. Your support gave me confidence to question his initial diagnosis.

Update for Chaos, you have replied to gonumb, combining my post and gonumb's post resulting in a comment that doesn't seem to accurately address my post or gonumbs. I posted a question on the same day. Just wanted to clear up some confusion.

Today my physician said that a 2 hour blood glucose result of 180 is too high for anyone. Both of my fasting blood glucose results were taken when I had fasted for 12 hours, with only water, no food, nothing else. He said fasting glucose results can vary, so different results of 97 and 125 can occur. But also pancreatitis will shut down the pancreas, causing high fasting and high 2 hour blood glucose levels. He said that a fasting blood glucose of 125 is too high, combined with high blood sugar results, indicates I am diabetic. Thanks for your posts.

I admit I did get confused with the two posts. http://www.healthboards.com/ubb/smile.gif
However, I know of two people, my sister and the other my best friend that started off on diet and excericise first. There levels were much like yours. One had a fasting of 127 and a 2 hour of 189 the other had a fasting of 116 and a 2 hr test of 170ish (cant remember exact). They lumped them in the glucose intolerance category which they called a prequel to diabetes. Some people are able to turn it around at this point. Others it is enivitable due to other health issues (as yourself) or genetics, obseity or a combination of all 3. Also every where I have read says that damaging levels start at 200. Of course they want you closer to the 70-120 range as possible 160-180 is not good that is correct they do not want you there either but the damage control is when your sugar is consistently 200 and over not an occasional 170 180 reading etc. Consistent high sugar is our enemy that is where the danger lies. Your overall condition may benefit you to start you on a very low dose of diabetes meds. You will have to be very careful of lows since you do have fasting levels in normal levels, meds will bring you down even faster. A dietician is very beneficial at this stage also. Every doctor and endo has a different take. Mine do not agree with yours and some other folks while he does have the same views as other doctors advice I see posted. Lab ranges vary as well as doctors opinions of when to treat. It depends on the individual patient. So I have also read that 140 after 2 hour fasting is also a sign of glucose intolerance. My first doc I saw was going to put me on insulin right off the bat. Luckily, the insurance would not approve of the hospital that he was putting me in so I went to another and that doctor put me on oral meds and diet and excercise along with a dietician. 6 months later I had a Hba1c of 127 which in my case was great. (my first one was in the 300's). So sometimes you do need two opinions. I really would worry about becoming hypoglycemic with meds in your case. Also Jody had mentioned that too many lows would skew with the A1c when actually if you are hyperglycemic without medication you would not have any lows. Low sugars occur for a few reasons. One if you are on insulin and have taken your meds and not ate at all or enough. Same with oral meds. And secondly if you have hypoglycemia which is not diabetes but a form of your pancreas misusing insulin, in this case over stimulated when you eat and putting out too much insulin. So if you are diabetic then if anything your test scores would be right when you are first diagnosed. Now after meds for awhile I DO believe the A1c can be skewed and not a true reflection of your balance. But if you are having undiagnosed, untreated high sugar levels then it would be hard for you to get low without some other factor. I only began lows when on medication since my levels were so high that I could never get low. I had answered some of this in the other post. Sorry it was an afterthought http://www.healthboards.com/ubb/confused.gif

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QsusieQ thought you would find this interesting. This is what I was talking about earlier when I said that some doctors would treat you with diet and excercise at this point. It is considered glucose intolerance and not diabetes yet. You fit into this category with your 125 fasting and your 180 2 hr glucose testing. That is the exact levels they use in this example. Here it is.


Impaired glucose homeostasis
This is a new terminology that was developed by the Expert Committee. There are two categories of impaired glucose homeostasis. One of these is impaired glucose tolerance or IGT, known to everyone who is a participant in DEFEND. This condition is diagnosed by a plasma glucose level from 140 to 199 mg/dl at two hours of the oral glucose tolerance test. The second category is impaired fasting glucose when fasting plasma glucose is from 110 to 125 mg/dl. Persons with impaired glucose homeostasis are at high risk for developing diabetes

Anyone that has chronic pancreatitis should be screened for diabetes. My physician wants to be very cautious with me, because I only have 1/2 of my pancreas because of multiple surgeries, and have severe pancreatitis, so my pancreas is slowing destroying itself. This was from a birth defect. There is no doubt that my diabetes will become more severe as I slowly lose my pancreas. My physician is treating the first signs of diabetes immediately, before it progresses and becomes very severe, which it will as my pancreas becomes more damaged. As far as diet and exercise, I am very active, and love sports. I already follow a diabetic diet, because my pancreas makes very little digestive enzyme anymore because of pancreatitis, and I have difficulty digesting fats and carbohydrates. Since I am doing all these things already, my physician is very concerned for high blood sugar levels, because high blood sugar will cause a strain on my pancreas, making my chronic pancreatitis more severe, therefore making diabetes more severe. Because of my severe pancreatitis and many surgeries, my physicians have told me that I will definitely become diabetic, that it is a matter of time, and to watch for it.

My physician told me that there is debate about lowering the 2hour blood glucose level for diabetes from 200 to 180. I have also read this on MANY diabetes websites. Here is what I have been reading on the internet,
" A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dl. This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications."

Chaos: I just wanted to let you know that you might want to edit your comment to gonumb on 6/23 at 8pm, you state "On your health issue, you seem to of been caught very early which is really good especially having half of your pancreas. I would give the doctor a second chance even though his office seems to of made a mistake and that is not good, especially in their profession. People do make mistakes just as I did." You are commenting on my post again, not gonumb. I have only 1/2 my pancreas and had problems with my doctor because of an office mistake. Just thought you might want to know. Also, You made the comment that horsejody gave me advice about having high and low blood glucose levels could yield a normal AC1. She didn't. I did.

I am not sure why you state that my 180 mg/ml is an occasional reading. I get this high reading 33% (5 out of 15) of the time, so some days it high and some days it is normal. Many diabetics do have varying blood sugar levels, I have read on this message board that some diabetics have very high blood sugar readings, and then they experience very low blood sugar readings. My blood glucose levels seem to vary also. I am sorry you have diabetes, and based on your test results, it is obviously more severe than mine. Although 200 mg/ml is the set limit for diabetes (or 180 as some people are proposing), it does not mean that a blood glucose level of 150 to 200 is not something to be concerned about. It is something to be aware of, since it may or may not be a initial warning sign of diabetes. I know you have good intentions, but I will not visit this message board again.

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I WAS speaking to you on Gonumb's post. I was not making a mistake again. At the top of the post I wrote "Q" since I couldnt remember your user name except for that. That was to let you know I was speaking to you. Also reading it over I was correct. It was Jody that spoke of the lows skewing the A1c that I was referring to..Scroll up and you will see it. Also did you not read my last post here? It completely went with what you quoted from a website you read. It did not contradict what I had said. It said glucose intolerance from 140-199. Go back and reread. I did not make any mistakes. It was simple. You addressed me there so I answered you back there. So there is no need to edit. I was very clear on your situation after the first mistake and was trying to be helpful. My intentions were indeed good. http://www.healthboards.com/ubb/smile.gif I know that doctors treat at all different levels and I said something to the effect that in your case it might be a good idea to start low meds but to watch out for lows. Just wanted to clear up the confusion. http://www.healthboards.com/ubb/wave.gif

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I was told at the lab where I go that "fasting" means "nothing by mouth" - that includes water. So I guess a person should not even drink before fasting blood tests.