January 20, 2011

Many Think of Pre-diabetes as Non-Diabetes

Diabetes forums can be an excellent learning place. Diabetes forum dlife had a good discussion about a visit to a doctors office and a subsequent call by the nurse in the office, that basically said the patient had an elevated blood glucose level and he was to watch his diet. His blood glucose test had been 126mg/dl which by current guidelines is diabetes.

This is two sided and not as black and white as many want it to be. Here is where I fault the doctors for not weighing in and explaining what pre-diabetes or diabetes actually means. Many just say, “watch your diet as your blood glucose is a little elevated”. Why is this so easy for doctors? Two answers and both equally in error.

First, they do not know what to do because they have heard that between 100 and 125 on the blood glucose scale is pre-diabetes, but they have their doubts since they have not kept up with the latest reasoning or guidelines. And second, they don't want to get their patients alarmed. Therefore they pass on the opportunity to educate a patient and help the patient get an early start on possible prevention for many years. This is where I say the doctors are doing harm.

What many doctors fail to understand that studies are finding that damage to the pancreas occurs earlier than many realize and this is the reason for the American Diabetes Association changing the diagnosis standards. Prediabetes is at least better defined for the diagnosis and treatment for women who are pregnant. Still doctors are not following the ADA.

At least the patient was asking questions and was sincere in wanting answers to understand what was going on and what to do next on the forum. This is a common occurrence as doctors are not doing their job.

What everyone needs to realize is that a fasting blood glucose reading of 125mg/dl and 126mg/dl are just numbers. They both indicate that the pancreas is in trouble and already has damage. Both are serious.

When fasting blood glucose is consistently above 99 mg/dl (5.5 mmol/L), this is considered prediabetes by the ADA in their latest Care Standards published in December 2010. This means that the pancreas is not functioning properly and the condition needs attention. Most doctor dismiss this as being something needing attention, and just tell the patient to watch their diet as blood glucose in elevated. If you get this reading, insist on getting the blood glucose reading so that at least you know how to treat it. And then, find an endocrinologist that will help.

How is the patient going to take this seriously when the medical community does not. Patients often just dismiss this as well and then in the next one to five years when the diagnosis comes back of diabetes, they are shocked and think they had done enough in reducing some sugars and doing some exercising. What they don't understand is that what they did was not a plan and the carbohydrate consumption was not controlled and the exercise may have been when they thought of it.

Both doctors and patients need to take fasting blood glucose readings of 100mg/dl to 125mg/dl (5.6 mmol/L to 6.9 mmol/L) seriously and develop and plan for treating this to prevent them from getting above the upper number. This takes planning and setting goals which must be followed seriously. The doctor needs to see the patient on a regular basis and use the HbA1c to see how good, or poorly, the patient is doing. Both should be prepared to review the plan and make adjustments.

Even if the fasting blood glucose level is 126mg/dl (7.0 mmol/L) and above, many people are still capable of controlling diabetes with nutrition and exercise. This does take commitment to this goal. Some are able to do this for years and some for a few decades. So this should be a goal. For some it will not happen because of other health problems and medical reasons that prohibit exercise. Even then, proper nutrition can be of benefit in keeping off medications.

1 comment:

Gretchen said...

Good points, Bob. I think one important thing is to see if your BG levels are increasing every year. Even if they're considered normal, if they're going up steadily, the patient should take notice. So should the doctor.