Real life experience:
Fasting BG 138 and 3 months later, 131. Diagnosable as diabetes? Yes, currently, but then, no.
A1c 2 months later, 4.8. Diagnosable as diabetes? NO!
If the doctor had relied on the A1c to treat me, I would not have received appropriate treatment. My doctor was satisfied with fasting BGs in the 150-180 range and did not consider postprandial rises, because they came down in time for the next meal. And my A1c was ALWAYS in the 5's and 6's, even as my BG readings crept up and up.
We tried sulfonylureas, which didn't work, so I asked to be put on insulin. After a lot of trial and error, including 70/30, which resulted in 2 hypos per day unless I was constantly snacking, mixing NPH and R, then NPH and Humalog, and finally, I asked for a pump. He refused the first time I asked, but acquiesced a year later.
I have been very happy on the pump.
A year ago, my BGs started to rise and wouldn't come down even with large doses. 3 months ago, I had an A1c of 10.1 and a month later, 10.7. I ended up in a coma a week after I saw my doctor with the 10.7 -- he never twigged to the fact that it was a life-threateningly high A1c for me. If not for friends missing me at a picnic and coming to check up on me, I would have died.
I know other people have had A1cs higher than that with no serious immediate consequences, and I know what the figures are for A1cs and BG equivalents. But the problem is that I'm a low glycator, and my A1cs indicate my fasting BGs, not average BGs.
It doesn't matter what the statistics say or what expert committees believe, in the treatment of diabetes, sometimes the hoofbeats you hear ARE zebras!
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Hi Natalie,
You may want to have a more conclusive test. There are many questions I have from your post. It sounds as though you were diagnosed type2, but perhaps you are type 1!? A glucose tolerance test or a test for GAD antibody is what correctly diagnosis diabetes. Here are some blogs on the topic of diabetes diagnosis:
http://www.healthcentral.com/diabetes/c/651280/103283/diagnosis
http://www.healthcentral.com/diabetes/c/110/62324/andhalf-diabetes
http://www.healthcentral.com/diabetes/c/17/59130/normal-a1c-level
Hi, Ann,
Thanks for your thoughtful response.
I need to fill you in on some details. I've always called myself "Type Weird" because I don't fit the stereotypical Type 1 OR Type 2 profile.
For many years, I managed on daily insulin doses in the 20's and 30's of units. Not particularly insulin resistant. BUT although I am not obese, I do have the apple shape and hypertension and hypercholesterol.
Neither one of my parents had diabetes: my father was thin, but he had high cholesterol (but no hypertension) and early heart disease and died at age 69. My mother was chubby, but never developed any of the signs of the metabolic syndrome and lived to be 80. Neither my brother nor my sister, nor any of my cousins has it, either.
I had Hashimoto's thyroiditis, confirmed by antibody test, so I do have some autoimmune tendencies.I've since had my thyroid removed because it was getting too big.
I showed some ketones when they tested me when I was in the coma, but they said it wasn't enough to call it DKA. My BG was 600, which is not as high as some Type 2's who are walking and talking.
My daily insulin dose now is in the 30's and 40's -- still not unreasonably high. I respond readily to small corrections (I'm on a pump). But if I try going off insulin or not bolusing, my BG goes high very fast.
I don't think I'm LADA, because I clearly have SOME insulin production (after 19 years), or I would have had DKA. I just think there is more than one type of Type 2 -- and I think they just haven't described what I have.
So as long as I get appropriate treatment (doc suggested Metformin, but I don't see any reason to go on it and don't want to deal with the side effects), then I am content with my Type Weird, and read with interest blogs from both Type 1 and Type 2.
Natalie ._c-