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Old 03-09-2006, 10:11 PM   #1
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Misdiagnosis? What do the numbers mean?

Misdiagnosis??

Is diabetes or pre-diabetes misdiagnosis common? Here’s a recap about what happened to my boyfriend in the past few weeks: My boyfriend is 40 years old, exercises every day, and his weight is normal (5’11’ 190 lbs). He went to his family doctor for routine physical including blood tests since he hadn’t had this done in over 10 years. No one informed him to fast and prior to his morning appointment, he ate late the night before which included candy and had pop-tarts and coffee for breakfast. They drew blood and no one asked him when he last ate. The next week, the doctor asked him to come back to take more blood to re-do one of the tests but didn’t say which one. Again, he wasn’t told to fast and he ate breakfast and had a Frozen Caramel Frappuccino from Starbucks – no sugar in those!

My boyfriend called for the results of the 2nd blood test and the nurse informed him he was Type II diabetic – just like that! They told him his blood glucose level was 121 and his A1C was 5.7. I was surprised they diagnosed him over the phone just like that...no explanation or anything. Having little knowledge of diabetes I searched the Web for hours and realized that the test they performed was actually the random plasma glucose test since he didn’t fast, right? Most sources state a random glucose test has a level of 200 or higher for diagnosing diabetes, and his level was 121.

The nurse told him to come in ASAP to discuss his condition. I went with him to his appointment 5 days later. The doctor sat down with us and told him he wasn’t diabetic, but pre-diabetic and that he will become diabetic in 10-15 years. Then the doctor stated that since it ran in his family, he will get it. I questioned this, and my boyfriend reminded me that his grandmother was diabetic. However, she wasn’t diagnosed until her 80’s, and she lived until she was 90! I’m not too sure but I don’t think that’s as important as, for example, a parent or sibling being diabetic and diagnosed at a much earlier age than 80??? It seemed like the Dr. was basing this diagnosis on “family history” and a non-fasting glucose level of 121 as well as an A1C of 5.7. When I questioned the Dr. regarding how fasting can affect the results and informed him that my boyfriend didn’t fast for either test he said it didn’t matter, and that “a glucose level of 121 is high regardless of when you last ate.” Then he said an A1C of 5.7 was elevated and a normal number was 4.2. I realize that fasting does not affect the A1C.

We insisted on another blood test since many sources state that a fasting glucose test is recommended for diagnosis, and the doctor said it wouldn’t matter and that he didn’t need one based on the A1C being 5.7. Again, is it possible that he's pre-diabetic based on a random glucose level of 121?? We still insisted, so he finally agreed and said he’d also do an insulin test because that is a better test for diagnosis and he took blood right then (my boyfriend didn’t have a crumb of food for over 12 hours).

He just got the results back from the 3rd test today and his results are:

Fasting plasma glucose – 80!
Fasting insulin – 4
C-peptide – 1.3

Thankfully the FPG number is now in the normal range (he fasted!), so when the Dr. stated that eating “doesn’t matter” when testing glucose was he totally off base? The number went from 121 to 80. What is the significance of his non-fasting glucose level being 121? I couldn’t find any information about that. Also, does anyone know what in insulin level of 4 means? The range on the print out said <17. What is the C-peptide test? And could it be possible that my boyfriend is pre-diabetic based on his A1C since eating doesn’t affect the number?

Thank you for any input!

Last edited by Marie_85; 03-10-2006 at 10:18 AM.

 
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Old 03-10-2006, 12:18 AM   #2
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medair73 HB User
Re: Misdiagnosis? What do the numbers mean?

His doctor is an idiot. Anyone's sugar will appear higher if they eat anything starchy or high in sugar before being tested. It doesn't mean he's diabetic at all. First hint that the doctor is an idiot is that they didn't tell him to fast before the blood work. He just needs to change doctors first of all and then do a complete 24-hour fasting CBC, which will tell him for sure what his counts are. He will most likely show up with normal glucose counts. CHANGE DOCTORS!!

 
Old 03-10-2006, 07:25 AM   #3
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fishdude HB User
Re: Misdiagnosis? What do the numbers mean?

I agree that your Doctor is a complete Moron!!! However, a non-diabetic who exercies and is not obese should be able to produce enough insulin to handle that high carb breakfast of coffee with sugar and pop tarts. The C-peptide test tells you how much insulin your beta cells can still produce, so that test is extremely beneficial to you, but I don't know what your result means. Your new Doctor should be able to advise. The bs number is elevated, but not alarmingly so. You have sufficient reason to CHANGE DOCTORS and have the tests run again, fasting this time. Cut off food no later than midnight the night before, and ensure your test is scheduled at least 10 hours after fasting begins (midnight would require a 10 A.M. test). You should be able to have black coffee and/or water in the morning, but no food. It is possible that he is, indeed, on the road to becoming a diabetic and finding out now that he may be insulin resistent could very well save him a life time of Diabetic complications, so this mistake could actually help him by raising awareness significantly. CHANGE DOCTORS!!!

 
Old 03-10-2006, 09:03 AM   #4
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Marie_85 HB User
Re: Misdiagnosis? What do the numbers mean?

Thank you for your replies! We will for sure be going to a different Dr. in the future!

We did get a 3rd blood test after we insisted and my boyfriend sat there sticking his arm out saying "please draw my blood again". I made sure he fasted for 12 hours before we went to the appointment. The Dr. reluctantly agreed and said "it doesn't matter" whether he ate or not. He also ran an insulin test.

The results from the 3rd blood draw are:

Fasting plasma glucose – 80
Fasting insulin – 4
C-peptide – 1.3

What is the significance of his non-fasting glucose level being 121? Is that elevated?

Does anyone know what in insulin level of 4 means? The range on the print out said <17.

Is it possible that my boyfriend is pre-diabetic based on his A1C (5.7) since eating doesn’t affect the number?

The results just came in yesterday and I'm sure the Dr. won't call my boyfriend back until next week and we aren't sure what these new results mean -- the insulin and C-peptide levels. Thank you so much!

 
Old 03-10-2006, 01:27 PM   #5
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Dog House HB User
Re: Misdiagnosis? What do the numbers mean?

For most non-diabetics, their blood sugar will be below 130 mg/dl 2 hours after a meal, although it can go as high as 140 2 hours after a meal.

I believe that the random glucose test is a good screening tool to indicate if further tests are needed, such as a fasting blood glucose (which he got). 80 is pretty much right down the middle for normal (70-100 is usually considered normal). Fasting BG of 101-125 is usually considered pre-diabetes.

As far as family history, I was told that if one parent has diabetes, a child has a 30% chance of getting it, 2 parents - 60% chance. If his family on the other side from his grandmother do not have a history of diabetes, simple arithmatic says his chances are 15%.

You should be able to search the internet to find out what normal c-peptide is.

 
Old 03-10-2006, 08:01 PM   #6
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Mark Munday HB User
Re: Misdiagnosis? What do the numbers mean?

Quote:
Originally Posted by Marie_85

The results from the 3rd blood draw are:

Fasting plasma glucose – 80
Fasting insulin – 4
C-peptide – 1.3

What is the significance of his non-fasting glucose level being 121? Is that elevated?

Does anyone know what in insulin level of 4 means? The range on the print out said <17.

Is it possible that my boyfriend is pre-diabetic based on his A1C (5.7) since eating doesn’t affect the number?
An HBA1c of 5.7% converts to an average glucose of 126 mg/dl. Which is a bit on the high side. An HBA1c in a normal healthy young person could be expected to be about 4.5% (average blood glucose of 83 mg/dl). So I can see why the doctor was concerned. Having said that, the results for the third blood draw were pretty normal. The insulin test result of 4 shows that there is no insulin resistance. Apparently it is not unusual for people with insulin resistance to have insulin levels of 90+.

The elevated HBA1c suggests that there is something going on. The pancreas doesn't seem to be producing enough insulin to deal with glucose loads. Blood sugars don't seem to be high enough for it to be Type 1, unless if it is at a very early stage. An antibody test would confirm this. Or something else could be compromising insulin production. It certainly isn't serious at this stage. But it would be as well to keep an eye on it.

Cheers,

Mark

 
Old 03-10-2006, 08:23 PM   #7
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Marie_85 HB User
Re: Misdiagnosis? What do the numbers mean?

Thank you for the information, Mark!

I can see how an A1C of 5.7 is elevated. What does that number, since it's elevated, mean by itself since his other numbers seem normal? ( I believe his C-peptide is normal.)

Should we be concerned since is seems his BS does rise after he eats based on what you said and his non-fasting level was 121?

Does this put him at risk for developing Type II diabetes in the future? Is there anything he can do that would help lower his A1C?? Would changing his diet help? Even at 40, he still kind of thinks he's invincible and eats whatever he wants including lots of sugar!

Thanks again for your response.

Last edited by Marie_85; 03-10-2006 at 08:24 PM.

 
Old 03-11-2006, 04:21 AM   #8
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Mark Munday HB User
Re: Misdiagnosis? What do the numbers mean?

The insulin test shows that there is no insulin resistance. So the prospects of developing Type 2 diabetes are remote at this stage. And we can only speculate on why the pancreas appears to be producing insufficient insulin.

Having an antibody test done would hopefully rule out T1 diabetes. There could be some type of infection or inflamation. Or it could be a thyroid problem. But to get a professional opinion, you should really take him to an endocrinologist, who will do a full examination and order relevant tests.

Cheers,

Mark

 
Old 03-11-2006, 07:14 AM   #9
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Dog House HB User
Re: Misdiagnosis? What do the numbers mean?

Quote:
Originally Posted by Mark Munday
An HBA1c of 5.7% converts to an average glucose of 126 mg/dl. Which is a bit on the high side.
I've got to shake my head...not at you Mark, at the medical profession.

I went to 3 different web sites and got 3 different values for 5.7 - 104, 111, & 125.

My last A1c was 4.6, which the lab said was within the normal range (true) and converted to a mean blood glucose level of 67 (which they said was below normal). NFW that my average is 67 (T2, no meds)!

 
Old 03-11-2006, 01:51 PM   #10
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Mark Munday HB User
Re: Misdiagnosis? What do the numbers mean?

Quote:
Originally Posted by Dog House
I've got to shake my head...not at you Mark, at the medical profession.

I went to 3 different web sites and got 3 different values for 5.7 - 104, 111, & 125.

My last A1c was 4.6, which the lab said was within the normal range (true) and converted to a mean blood glucose level of 67 (which they said was below normal). NFW that my average is 67 (T2, no meds)!
Mmmmm ..... I wonder if this is because of distinction between whole blood and plasma readings. Here is some info on that:

Quote:
Whole Blood Glucose vs. Plasma Glucose
Glucose levels in plasma (one of the components of blood) are generally 10-15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. There are many meters on the market now that give results as "plasma equivalent". This allows patients to easily compare their glucose measurements in a lab test and at home. Remember, this is just the way that the measurement is presented to you. All portable blood glucose meters measure the amount of glucose in whole blood. The meters that give "plasma equivalent" readings have a built in algorithm that translates the whole blood measurement to make it seem like the result that would be obtained on a plasma sample. It is important for you and your healthcare provider to know whether your meter gives its results as "whole blood equivalent" or "plasma equivalent."
This is the formula that was used in the conversion I gave : Plasma Blood Glucose = (HbA1c * 35.6) - 77.3 . A blood glucose of 67 seems way to low for an HBA1c of 4.6%.

Cheers,

Mark

Last edited by Mark Munday; 03-11-2006 at 02:30 PM.

 
Old 03-11-2006, 01:52 PM   #11
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Re: Misdiagnosis? What do the numbers mean?

Consider this a wake-up call! With diabetes in his family, plus his BS elevation, it is an indication he is headed down the road toward diabetes in the future. It is possible to avoid diabetes by making a "lifestyle change for life" now. That is, lose weight if overweight, exercise, reduce amount of starches, sweets, and carbohydrates in general, eat less, choose more non-starch foods, low fat foods, etc. Making better food choices will help protect pancreas from overworking.

 
Old 03-11-2006, 04:03 PM   #12
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Betty325062000 HB User
Re: Misdiagnosis? What do the numbers mean?

C-Peptide test is one that many doctors use but fail to take into consideration one important aspect of it. It tells you how much insulin you have used. So if you eat a high carb diet, your c-peptide result will be a much higher figure than if you are on a low carb diet. Carbs require insulin to handle those and that determines the c-peptide. C-peptide has its uses but consider the diet along with the lab result.
Betty

 
Old 03-19-2006, 11:56 AM   #13
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singer1 HB User
Re: Misdiagnosis? What do the numbers mean?

His doctor is more than an idot, he's an ***! I would definately go for another opinion outside that practice! They should have told him not to eat anything after 8PM and he could only have water. This is why I do not trust doctors at all. I have looked into some things about a friend of ours who was diagnosed with a 170 count which I am told isn't THAT high and to put him on the meds that his doctor did made me so furious that I took the medicine and flushed it down the toilet!! When someone is pre or borderline diabetic you can control it usually with diet and excercise. Type ll is mostly diagnosed to people who are overweight...not all but usually which our friend is. However, why in the world would they put him on meds without trying to control it first naturally? The body is designed to heal itself and if you're not in a danger zone of any kind, why not try the natural thing? When anyone takes medication, there are always side effects. The med may help one thing, but could cause 5 other things and frankly, I am just not one of those people who like to take that gamble unless I REALLY have to. Right now, our friend has a choice on treatment as it sounds like your boyfriend does. Get a second opinion. My Father has borderline Diabetes and controls it with diet and is just fine. Get a third opinion even because you want to be absolutely sure you are doing the right thing for his situation. Good Luck!!!!

 
Old 03-19-2006, 04:07 PM   #14
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Betty325062000 HB User
Re: Misdiagnosis? What do the numbers mean?

[QUOTE=Marie_85]Misdiagnosis??


Fasting plasma glucose – 80!
Fasting insulin – 4
C-peptide – 1.3

I agree that doctor is not one to continue with. However the numbers I have quoted above as well as the numbers in the rest of you post do not add up to diabetes. Most doctors tend to be to lenient but this guy has gone the other way. An A1C of 4.something perhaps is normal for some people but not even all non-diabetics. less than 6 is generally accepted. Looking at information on fasting insulin, something I have not seen before, I don't know what the number should be but for sure do not see any reason for it to be entered into this mix. This is new to me, but I don't believe it is part of a diagnostic procedure for diabetes.
BVan (Betty)

 
Old 03-20-2006, 04:22 PM   #15
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singer1 HB User
Re: Misdiagnosis? What do the numbers mean?

I'm just curious, we have a friend who was recently diagnosed with diabetes and his stats are: LDL-145, HDL-47, Total-236
Tryglycerides-220
A1C-7.3
Fasting bl. sugar- (12 hours)-162

Is this terribly high? Can it be controlled by excercise and diet? He is on Vytorin for his Cholesterol every day.

 
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